Day Eight, 1 June

So, we leave for our second day of the Clinic (however, the director,

Dr. Guido, doesn't want to be called "director," but rather "líder" (leader), and doesn't want us to call it "clinic," but rather "Centro de Salud," (Center of Health) because of the associated connotations ...

Begin work and see a blur of patients -- women my age (early sixties) who look eighty...weathered, wizened, exhausted -- muscle aches which they claim are their "huesos" ( bones) protesting.. no small wonder -- their daily task which is to feed the family has them laboring in the field, harvesting, carrying firewood in -- and everything is transported in the bulging, vibrantly-colored striped mantels slung on their backs.

Sweet, nice-looking woman of 39 years old, today, has never had a Pap smear. Not afraid to do it, though, she says ... just never came up ...she agrees she should have one and then we tell

her to make sure her daughter gets one when she is 18. She agrees.

Funny thing is -- they are all like this -- compliant and patient as they wait for a couple of hours to be seen. They all seem eager to have proper meds and modern medical help ... and yes, eyeglasses.

The ones who speak Quechua are clearly the poorest. They come dusty and dirty with broken shoes and ripped clothing. Yesterday, one of the doctors I was helping asked what the stripes of dark discoloration were on the young girl's chest and stomach, thinking it was a skin condition or signs of another disorder. Mamita started laughing --the "condition/disorder" is a set of deeply etched stripes of dark dirt.

"Mami Walli"

So, we're ready to leave for the day and everybody's gathering up materials and

heading out for the bus ... I happen to ask one of the Clinic staff what is beyond the dusty wall

outside the back door, and which we all passed by, as we walked to the building where

our lunch had been set up. It had the words "Mami Walli" written on it.

We're talking about two steps out the back door and another eight steps to where we ate.

Word-freak that I am, I had been curious all day as to what the Mami Walli sign, hand written, but

with happy strokes and color, meant. The fellow I ask is the generous Quechua speaker/IT fellow

who helped us yesterday and came back just to help again. He absolutely insists I hear about and

go out to see it "... pero se me pierde el autobus!," I try to leave. " No, no, profesora, tiene que verlo," he insists

and prevails.

He explains ... the Mami Walli sign on the worn, used wood wall designates "Mommy's Home",

a little compound for new mothers about to give birth and those who have given birth. It is

part of the Clini ... whoops, Centro de Salud. So, unlike the US where women go in and drop their

babies and leave the next day (in Europe they still stay in the hospital for a several days, up to

a week after childbirth). Well, the Quechuan women come, give birth and then go to these

little temporary shelters which all face each other into a common courtyard. So, to make it

comfortable and what they are accustomed to, they can elect for a shelter with gas for cooking or wood

stove (of course there is no electricity or running water in the individual huts. Pedro opens

the wooden door, the courtyard is simply dry dirt and dusty clay ...

there is a communal sink in the middle ... there is a little dusty, really dirty small child who is peering

out and comes to his "doorway" ... I peek in ... equivalent digs to what I have seen at the Reed Peoples'

huts -- manteles thrown on top of platforms of some sort to serve as a bed ... nothing more ...

The women stay for six to seven weeks if all is normal ... then they can go back

to the "comunidades" (out-lying remote villages). By that time they will have healed and

the infants are more likely to survive. As they stay here, they can socialize and help one another,

and the Centro is literally right out the door, should they need anything. I find it fascinating and

heartening.

By the way, in Quechua, women are called "Mami" or "Mamay" in direct address ... it is

said with great affection and respect ... (the first time I heard it, I was surprised on my flight

from Lima to have an older man address me this way... ) So, there is respect for motherhood, it seems.

Day Seven, 31 May, Tuesday

PRIMER IMPACTO

Wake up -- don't read my watch correctly without my glasses on and think I have ten minutes to dress, collect all my supplies, and get on bus (to say nothing of a possible shower or

breakfast) ... I panic --know I need to bring everything for the entire day (small wad of toilet paper -- very small supply in my hotel room, water, my own meds ... sunblock and hat for walks into and from town (from bus), "soles," glasses and Quechua dictionary, Spanish/English dictionary, various Applied Medical Spanish Books, note pad, pens, etc.

Bus is slow in coming, and I actually have 40 mins ... we take off and then have to

stop along the way for people from town who are partnering with us ... we arrive and are walking to Clinic -- word is out that we are here -- a few people see us dressed in scrubs and come up asking if we can help them.

Everybody from town is dressed the same -- everybody being women (few men come to the Clinic -- and then it's usually for our free prescription glasses).

Dress: even though it's 65-70 degrees F., knit leggings ( Alpaca or wool), several layers of wide skirts, layers of shirts and wool sweater and the famous bombín (Bowler hats).

Babies are carried in "manteles" slung over the mothers' backs and shoulders papoose-style.

We see lots of patients with worms -- one very old woman (who was actually 63 yrs.

old-- chronologically they all look older) says she hears worms "scream at night" in her stomach.

We see a lot who have bad vision (the climate is very dry and severe, so no small wonder)... we dispense eyedrops and give eye exams and give donated prescription glasses.

My first in-take patient is a small baby boy, nearly delirious in his mother's arms. We get him to our (really sharp-- amazing) Chilean-born pediatrician who sends him immediately to a hospital in the 'nearby' town of Cusco.

There are complaints of ringing in the ears and dizziness -- irrigations of ears reveal incredible, impacted wax and dusty debris ..

Some come with back pain from the heavy lifting and weight they carry in their manteles. They say they have pain in their "riñones" (kidneys), but I think it's the location of

the pain in their back they are describing ... they speak in terms of organs because they

butcher their own dinners ...so they know the body "parts" ...

There are several women who won't reveal to our male doctors that they are victims of

domestic violence but it's obvious ... I talk to a few privately and then to a female doctor at the Clinic who will follow up with them (there is a social agency in Cusco). The cycle is: they come with complaints of vaginal pain, STDs and UTIs caused by their husbands' wanderings --so they come,

are treated today, and then will come back with the same symptoms -- with no end in sight (the men refuse to use condoms, I'm told by the women). The women cry ...

One woman is 76 years old and has walked alone well over an hour on bumpy, dusty

roads to the Clinic -- she has to take the same route back over streets covered with stones, potholes, and the strong smell of urine. She waits for hours; I bring her water.

As a contrast, our hotel manager/owner brings us a hot lunch (little veggie "frittatas," rice, fried

yucca -- complete with real plates, water !!!, bread, and he ceremoniously serves us donning a

white toque. He's incredibly supportive of us as we are helping his people. He attends to us

as if we were family members.

Scenario for rest of afternoon: same routine -- we see patients, translate like crazy, and give out

prescriptions filled at the pharmacy we set up by our own pharmacist.

All the students get incredible hands-on practice and training. They also connect to the natives using

their Spanish skills.

One young man is seen for eye strain he says is caused by the glare of his computer (!)

screen and receives his eye drops and sees we are having enormous trouble understanding an

Andean woman speaking Quechua. He patiently stays and offers to translate as he is bilingual

(Castellano (which is Spanish)/Quechua). Turns out he works as an intern at times in this Clinic, and

is studying IT which explains the computer comment.

So, the translating goes like this: the old woman who has chest pain and eye problems speaks to him (in

Quechua). He then speaks to me and one of our students in Spanish. We then speak Spanish

back to him and he to her in Quechua. Ultimately, I speak English to the doc who tells me what

to say. I speak Spanish, explaining the doc's recommendations, to the Quechua/Castellano

translator who tells the patient in Quechua what the doc has determined. However, it bounces

around sometimes back and forth and not always in one direction of the "circle" we create.

We come back to our EcoHotel, have a meeting and dinner and I dance with Jorge (the owner)

at our dinner to the great surprise ands amusement of our team. If I hear music, I gotta dance.

As I do each night, I brush my teeth with bottled water, get into heavy sweatpants and a fleece

jacket (it's really cold) and get into bed with all these layers on. Can't take a shower ... too tired.

I pray for Marisa .. one of our patients I made a promise to ... she's separated from

her husband, came in for gyne problem and I attended her pelvic exam and she cried when we were

in private as she told me her story of her husband's abandonment of herself and her two children.

She told me of his new "woman" and child. I pray.

Day Six, Monday, 30 May

Go to Clinic -- unpack and organize our supplies from the U.S. and set up "Consultorios"

(Dr.'s Offices) for tomorrow. Discover there's no toilet paper (anywhere) in the Clinic. We

pee in a toilet and share small pieces of paper from one another.

We spend all day setting up, head home to Urubamba Eco Hotel and have dinner, then another group meeting -- suggestions from all and "assignments" -- who will work with which

doctor and we also discuss the meds we brought.

I'm to do in-take and be on tap to be pulled wherever necessary. Since I'm not an MD but rather a translator, I'll do, of course, whatever is useful. I'm nervous -- will I be of help? Will what I see move me too deeply? ... after all, they are all trained as doctors and accustomed to seeing this type of hardship ...

Tonight, I have one of my academic anxiety dreams -- you know, I'm at the front of the class and supposed to be teaching Physics, only I haven't ever studied Physics.

With the meds for nasal and eye dryness which our pharmacist gives me, I at least

can sleep through the night ... first time in days!

Day Five, Sunday, 29 May (Day Four is Actually Included in Day Three)

Leave Puno and drive -- Latino music -- Spanish chatter--majestic Andes-- snow-capped/glacier peaks ...

Stop to see condors (Pepe has promised me --didn't mention they were part of a very, very humble animal hospice and so they are within a reserve. But, still, they are impressive as they

swoop down for the carrion provided by their caretaker). We give small donations as we leave.

Everything, mind you, is always dry and dusty and the dry dust/dirt kicks up into the air

as you walk (I think I'm sucking up the DNA of pre-Incan bones...). It's getting increasingly hard to breathe through my nose and my throat feels dry as the desert (weird to think it's a desert climate, since it's not hot and there's no sand -- I keep reminding myself to stay hydrated).

Drive several hours more and arrive Pisac market -- incredible open-air/partially covered

market of artisan wares. It's just closing due to the time and the downpour--frankly, not to my dismay, don't feel like "shopping"-- I manage, however, to buy a cool, gorgeous high quality sterling silver pillbox with designs of the Nazca Lines on it (Kathy buys a gorgeous bracelet with insets of Lapiz). These are both from an enterprise that (of course) Pepe has connections with ...

We wander deeper still within the market and find several textile stalls still open but the

vendors are disheartened by the rain and lack of business ... I also buy a long hand-woven

runner for my dining room table -- and another "tapete" (cloth)/runner for the top of my kitchen table at home .... (I cook for friends "en casa)"

Onward finally to our destination -- the next EcoHotel which will be our home base for

the Medical Mission. The entire group who had come from Cleveland Clinic and Case Western

Reserve Schools of Medicine are out on the street in the dark cheering and greeting us.

Pepe sounds his loud, long siren horn of the minivan and you would think we were celebrities.

Enormous welling up of love and strong embraces. I had actually been counting minutes

to seeing them all, but especially my two students, Pedro (class name) and Bill. I hug and kiss

them and go into the EcoHotel while they go out to dinner (they've been up since yesterday morning).

They return and we all discuss details -- our student leader (this is a student initiative and the students are given the reins) has a well-organized agenda. We discuss and set up a system of triage (in-take interviews, coding system for rooms and patients, etc.).

Tomorrow we'll go to the clinic to set up meds (we brought a dozens of suitcases filled with supplies, and a Pharmacist) and "stations" or consulting rooms. The clinic is in Lamay (small village in Urubamba about an hour from our EcoHotel).

Day Three, 28 May

Awake and leave 8 am to see Lake (Titicaca) and visit the reed people -- "los Huros" are sweet and seem to love us.

We dress up and dance while they sing their Quechuan songs. What a riot.

Back to hotel to rest (I'm hitting the wall with fatigue, and the altitude sickness has me taking Diomox 2x/day ) and then back in car again to view perimeter of lake at night --

view is gorgeous with lights dotting the Andes ...

Return to hotel for the night -- we finagle our hotel charges and very complicated personal debts with one another and what we'll owe our driver in the morning so that tomorrow might be less complicated.

We also have to take into account dollars vs. "soles." (three soles/American dollar). Nerves

are short from trips down and tourista stops ... we settle finances. We crash.

The Reed People

So, these are the Huros (Indians) who live

on the highest navegable lake in the Western

Hemisphere (Lake Titicaca). Yes, the people

actually live ON these floating reed platforms

and live in theses huts made out of reeds; and,

as you can see by the little girl, peel back the

outer part and chew on the white fiber and eat it

(kind of like what you would do with sugar cane...).

They speak their own Indian language, Aymará.

Day Two, Thursday, 27 May

Arrive Cusco -- our pick-up, Pepe (little Joe), arranged by me through Jorge (hotel owner of three Eco(logical) hotels we end up staying in/ social activist/helper) is not here.

Oh, no. Lucky for the rental phone the young woman pushed on me at the Lima airport

last night -- could have sold me anything at that point, of course ... our resistance was way down as fatigue set in ...

We call the driver -- no luck. try. try. try. nada ...

Then we think to call Jorge himself -- yes! the protector of our endeavor scold/calls one of his guys -- within minutes we're greeted by not only his guy but Jorge himself who wants to see with his own eyes that we have transportation and are secure.

Cusco Hotel -- upscale digs, ( we've just come from our Lima stay). Seems weird, in a way, lots of hot coca tea, (yes it's legal and which we need for the altitude sickness we now know we are fighting --shortness of breath, hard to breathe, kind of dizzy, really, really tired). We take a walk to the Plaza -- it's dark -- we end up buying Alpacan Indian hats and gloves and scarves from some street market stalls . My bartering skills, not practiced in the Latin style

for a while, aren't at all bad ...

Back to the hotel -- dinner, laughs, and we decide "What happens in Peru stays in Peru" ...

for some reason we really laugh, it's not that funny, but we are in hysterics.

Then, at 9:30 pm we decide to take them up on 1/2 hour massages for $20 American money. I'm in Wonderland, I also tack on a manicure for around $9 American money ...

my hands are a mess -- nails torn and jagged due to the trip prep and travel ..the delay, though

pleasant, has exhausted me. We sleep, arise and leave the hotel at 8 am to go to Puno --port of Lake Titicaca where the reed people live. Arrive in the dark -- stop along the way to

see some small, pretty unexciting 'ruins' -- some shored up by old boards -- but a good place for

drivers to stop with tourists so locals can sell wares --. So, o.k., we do buy. Little tchatkes

like Andean wood flute (quena) for my music-major son. My companions deliberate on

some textiles and ceramics and end up with little ceramic birds that whistle with one tone when you blow into them and then a different tone when filled with water. ¡Preciosos!

Back in the car, the ride with Pepe is a blast -- great conversations in Spanish .. great Incan

music on his CD player and finally Louis Armstrong (he wants to surprise his American friends) with "What a Wonderful World."

Arrive Lake Titicaca (Puno) in the dark ... check into another Eco Hotel. Crash.