First Weekend Adventures

Last weekend was very busy. I thought I would have time to sit down and write an entry or two, but we were always going.

Friday night we were all exhausted from meeting so many new people and from our first day at the hospital. (I will write a separate entry about the hospital after this one, because there is a lot to say.) We had planned to go to the gym after dinner, when it wouldn't be so busy but we were all too tired and went to bed really early.

Saturday morning we did get up and go work out. It was fun to watch all of the surfers as I ran. We also went to yoga class. If I had to describe a Peruvian yoga master it would be this man exactly - petite, very fit, long dark curly hair, and way more flexible than any person should be. The yoga class was very relaxing. All of our mats faced out a giant glass window, which looked over the ocean. Only about 30 of the 90 minutes were hard. At the end of the class the instructor gave each of  us a short neck massage. I felt bad for him, because I was so sweaty... he's probably used to it....

For lunch we went to a place on our block that serves chicharrones (pork sandwiches). You are supposed to eat them for breakfast but we didn't know that. Obviously I didn't eat any - but Sarah and Chrissie told me that if I were to ever eat meat again this is what I should eat. The pork is served on a bun with yams and onions. I just had a side of yams... still very delicious.

After lunch we joined Andrea and a bunch of her friends for their Pisco tour. Pisco is a brandy made from grapes that originated in Peru. The standard drink it is served in is a Pisco Sour - 60% Pisco (84 proof) and the other 40% sugar and lemon, and topped with egg white. You can also serve Pisco with fruit juices, ginger ale, etc. All of them are very potent, because the alcohol is masked by the sugar. I only had one small drink and could definitely feel it.

After the first stop on their Pisco tour we left to meet one of our colleagues from DIGESA, Dr. Osorio. She had told us that we were going to see water falls, but really she meant water fountains. She met us at the front of Parque de la Reserve. The park is filled with water fountains that light up at night and some are synchronized with music. There were also some fountains that you could run around in - maybe without getting too wet if you were smart about it. We didn't want to get wet, but there were lots of little kids who kept getting sprayed. A couple of interesting facts: The park was redone in 2007 as a gift from the mayor costing 13 million american dollars. It holds the record for the largest water fountain complex in the world and the tallest water fountain (80m) in the Americas. Below is a picture of me, Sarah, and Dr. Osorio in front of the large fountain.

After the water fountain park we rejoined the Pisco tour. Before they got another drink we all stopped at Bembos. Bembos is the main Peruvian fast food place - like McDonalds but much more expensive and I think much better quality. They have lots of different interesting burgers. Sarah got a burger that had guacamole and doritos. It reminded me of "walking Tacos".

The next stop was a bar called Munich - a german piano bar. The pianist knew many, many songs by heart. Our group was very loud and sang to a lot of songs by the Beatles. Then the pianist started to play a lot of Peruvian traditional and pop songs. It was still fun to see them all singing along, especially since they were all on their third drink and I only had one 5 hours before. Below are Andrea, Sarah, Chrissie, and Francesca (another medical student at Cayetano and Andrea's cousin) with their beer mugs. I tried a sip of the beer. It was very creamy - not that I know much about beer or even like it that much. I don't know how they drank such large steins... and these were only the smallest of 3 sizes....

On Sunday our faculty mentor from the U of M, Dr. Valdivieso, met us for lunch. Dr. Val and his wife, Astrid, took us out for Chifa. Chifa is Chinese-Peruvian fusion and extremely delicious. I was worried that they wouldn't have much vegetarian food, but because Peruvians love fish there were a lot of appetizers with shrimp and fish. For our main course they brought us 5 or 6 huge platters of food. Specially for me I got a mushroom and tofu dish and vegetarian fried rice. We have so many leftovers in our fridge that it takes up almost all of the space. Now we have meals for almost the whole week.

Later that evening we were invited to Dr. Valverde, one of the directors of DIGESA, for "tea". One of his friends, Norma, picked us up in a Taxi. When we first arrived it was just Dr. Valverde and his family, Norma and us. His family was very nice. His son is in his 3rd year of medical school (kind of our 3rd year of undergrad) and his daughter is trying to help set up a better recycling program for Lima. She authored two manuals about how to help build a recycling system and how to protect workers and give their job more prestige. Building a recycling program is very difficult. Even hospitals just dispose of hazardous chemicals in normal waste and they know the health risks.

About an hour after we arrived Jonathon Woods, the business man that visited the treatment plant with us, and his business partner from Uruguay arrived. After they arrived the night started to get a little rough. She loved to talk and would speak in rapid spanish telling 20 minute stories that no one would stop and translate for us. After 20 or 30 minutes of her talking she would finally pause and someone would sum up the entire conversation in one sentence. Then finally after an hour and a half we sat down for dinner - a HUGE dinner. They had made risotto because they knew I was vegetarian and they had been vegetarians before as well. They served humongous portions and none of us were hungry for any food after such a large, late lunch. I tried to eat as much as a could. Dr. Valverde (who doesn't speak English) started asking me in Spanish why I wasn't eating and if I didn't like the food. I felt so awkward. I tried to explain that it was good, but I wasn't hungry. Sarah had eaten the same amount as me and knows Spanish but never got called out. I was very flustered. For dessert there was ice cream, a cake, apple pie and lemon cake. I can't believe how much food there was. Finally, after over 5 hours we got to take a taxi home with Norma. It was very nice for them to invite us over, but we were all frustrated that we were there for so long and with the conversation being dominated by the woman from Uruguay. By the time we got home we all collapsed in bed.

This morning we met Dr. Valdivieso at DIGESA to talk about starting the project this week. They need to apply for papers to take water samples from the water treatment plant, Sedepal. They wanted to start next Monday, but we are anxious to start so we are going to take samples from some of the 8 different districts in Lima that we are testing on Wednesday (we don't need papers to take water samples there). While at DIGESA we also looked at our practice culture plates that we prepared last Monday from water taken directly from DIGESA. On one of the plates there were red colonies growing. According to our protocol they looked like H. pylori colonies. These colonies will be prepared and sent back to Michigan for analysis. Hopefully, it worked (and on our first try)! It would send a very powerful message if even the water at the department in charge of monitoring water quality had water containing H. pylori.

We had the afternoon off to relax. It was nice after not getting any time to ourselves last night. This evening we met Mrs. Montesinos, the woman who had us over and to the club the first Sunday we arrived. She just got back from Arequipa, because she is arranging all of the social event for the PAMS (Peruvian American Medical Society) conference that we are attending next week. She reminds me of my Grandma Jaffe, because she is very active in rotary club. Her late husband was a pediatric cardiologist (and I think a surgeon). Together they created a congenital heart clinic for lower socioeconomic patients that is completely sustainable, among participating in many other service projects. The clinic even has the best catheter lab in Peru. I am excited to attend Mrs. Montesino's rotary club meeting on Thursday morning with Dr. Valdivieso. Mrs. Montesino is such an interesting person and extremely generous. I can't wait to get to know her better.

We are going back to the hospital tomorrow to shadow one of the medical students that we met there, so I will catch up on all of the hospital news/info after we go back tomorrow!

Miercoles y Jueves

Wednesday morning we attended a conference during which some experts in environmental and occupational health were trying to revise their policies for the use of asbestos. Unfortunately, everything was in Spanish and when they arrived they separated me, Christina, and Sarah to 3 different tables. At my table it was helpful that they were editing on a large projector, because then I could at least make out some of the words... well at least the words that were similar to English. Even though it was interesting to see how each group worked together to edit a couple sections of the policy and then at the end how all of the groups came together and shared, it was still a long four hours.

There was no work for us to do in the evening, because our water samples need to incubate until next Monday so we were given the afternoon off. With our free time we decided to take the Metropolitano (the expressway bus system that I mentioned before) to the cities historical center, Plaza San Martin y Plaza Mayor. There was a nice pedestrian mall connecting the two plazas. About 80% of the shops were for shoes...and not just different shoe stores, but the same stores repeated on every block (and even 2 on the same block). If they didn't have your size in one store you could just walk a couple feet down to the next store or the clerks would even run to the next store to see if they had the correct size. After a couple of tries (or many) Sarah finally found a pair of shoes in a size 9 1/2. I think I will be completely out of luck here, because I wear a 10 - good thing I remembered to pack mine!

Wednesday night we met a friend of an M4. Her friend, also Christina, moved back from the United States to Lima at the end of junior high. Christina and her friend, Andrea, met us for dinner and a drink at Larcomar (the mall on the ocean). Christina works as a child psychologist and Andrea is home on summer break from Norway to work on her Master's thesis in "the public perception of hydrocarbons as an alternative energy source"... I'm still not quite sure I understand what that means... They are both very fun and open (and speak excellent English). Andrea invited us to a Pisco tour with her friends this afternoon. Pisco is a type of liquor made in Pisco, Peru. They are very proud of it here, even though the Chileans are trying to claim it as their own. The Pisco tour is kind of like a bar crawl, where the group travels to different bars and restaurants and at each stop you have a different drink made with Pisco. It should be fun to meet more people. Later we are meeting Dr. Osorio, director of DIGESA, to see the largest water fountain in South America (I think?). Then this evening, Christina's boyfriend plays rugby and they are having an initiation for the younger members of the team and invited us to go watch. Should be a busy/fun afternoon!

We have also joined a beautiful gym and yesterday we started work at Hospital Cayetano Heredia. Both deserve their own entries so more posts to come in the very near future.... but now it is definitely time for lunch!

Yo hablo, tu hablas, usted habla....

So a little background on my project...

I came to Peru to study Helicobacter Pylori, an acid producing bacteria that was only discovered in the early 1980s. H pylori is responsible for causing stomach ulcers, which can sometimes lead to other diseases such as gastric cancer. It is believed that up to 50% of the world is infected with H. pylori and of these people 30% are symptomatic. A huge amount of the infection burden is in developing countries, and even within developing countries most of the disease burden resides within lower socioeconomic districts.

In Lima H. pylori is endemic in both adults and children. In addition, Lima has an extremely high rate of gastric cancer, but the distribution of gastric cancer differs between socioeconomic areas with the 3 districts with the highest rates of gastric cancer being in some of the lowest socioeconomic districts and the 2 districts with the lowest rates being 2 of the higher socioeconomic districts. Because H. pylori and gastric cancer are correlated it is possible that there is a community-acquired source of H. pylori in these lower socioeconomic districts that may lead to the gastric cancer (and stomach ulcers). We hypothesize that people are acquiring H. pylori through a community water source.

So on to what I will actually be doing here... While we are here we will be splitting our time between Hospital Cayetano Heredia and DIGESA (where I visited yesterday). At the hospital we will screen for patients infected with H. pylori using a questionnaire that asks about stomach ulcer symptoms. A second questionnaire will also be administered that assesses risk factors, such as where the patient gets his or her water from, living conditions, etc. Once a patient is identified an endoscopy will be performed to take a sample to test for specific strains of H. pylori. Then, we will hopefully be able to go to the patient's water source, and with the help of DIGESA, take 2 liters of water and a biofilm sample to test for H. pylori. Some of the lab work will be done at DIGESA (this is what we learned to do yesterday) and some of the sample will be shipped back to a lab at the School of Public Health at U of M for DNA strain analysis. Culturing the water samples will be the hard part of the experiment. It is believed that H. pylori exists in a different form in humans and in the environment. There are standard protocols to culture H. pylori from stomach mucosa, but it has been very hard to culture H. pylori from water samples - even water samples that have had H. pylori added directly to them. We will definitely have our work cut out for us!

Today we were given a tour of the water treatment system for Lima. With us was a man from England. Thank goodness he was there, because he could translate everything that was said and ask questions. We also went to lunch with him and a director from DIGESA. He is trying to sell a new water purifying system to Latin America (also used in pools and trying to be approved for necrotic infections with diabetes). Quite the salesman...but very nice...

The water treatment plant is a huge complex with beautiful green gardens, a new modern headquarters that was all blue (how fitting for the water theme), labs to test different chemical and microbiologic aspects of water quality, and even some soccer fields. As of now this is the only water treatment plant for all of Lima - 8 million people! 82% have access to some "purified" water (no one at the plant said they would drink it) and only 20% have water uninterrupted 24 hours a day. Even our water turned off this morning just as we finished our showers. This is supposedly uncommon since we live in one of the nicest districts in Lima. It was amazing to see the river running in one side and come out almost completely dry on the other. I was also surprised that they talk about such a water shortage, but on the grounds of the water plant I saw 5 or 6 large sprinklers watering their grounds... I wonder how often they use the sprinklers...

Pollution of the water is also a major problem here. People illegally dump everything from dead horses to chemicals from unregistered and registered factories. I asked what the penalty is for illegal dumping. If chemicals from factories are found, then they take a water sample every hour to check for water. Other people will be fined and will hire companies to remove the waste they have dumped, but often these hired companies will just double back and re-dump the waste in the river!

Seeing the whole system reminded me of one of my favorite Magic School Bus books as a kid. In the book Ms. Frizzle took the kids to a water treatment plant and they moved through the whole system as raindrops being purified. The book didn't leave out anything ... even flocculation. In the book the water ended up so much cleaner! Here at the flocculation step there was still a lot of junk floating at the top of the water because the plant is putting through 20% more water than it is built for. Luckily, there is a second water treatment plant that is scheduled to open. This plant is supposed to supply the remaining 20% of people with water collected from higher up in the mountains.

We tried to go to a conference at the ministry of health about environmental health. After waiting for 2 hours it was cancelled, because the minister of health was stuck in a meeting and there was really bad traffic. Lets be honest... I wouldn't have understood anything anyway... and at least Sarah and Christina helped me practice conjugating verbs and we played some Angry Birds on Sarah's iphone.

No hablo Espanol (but I am trying....)

Cassie and friends have inspired me to start a blog while I am in Peru for the next 7 weeks. So here goes my first entry, which may be kind of lengthy because so much has happened in the last few days....

We arrived in Lima 2 nights ago (Saturday). After leaving my apartment a little before 4am and 20+ hours of traveling we finally reached our apartment in the Miraflores district of Lima. Upon arrival a whole family was waiting in our apartment to give us our keys and show us around the apartment. It was strange, because only one of the two daughters spoke English, so they all just stared at us from the living room as we looked around. It didn't help that we were all too exhausted to speak in English or Spanish, and in my case, too tired to just speak English. As soon as they left I completely crashed and left putting all of my things away until the morning.

Sunday morning I felt a little better. We waited for the woman renting our apartment to come give us an extra key and to pay her our rent. She was supposed to come at 11 but didn't show up until half past 12. By this point we were starving, since we didn't have much food to eat for breakfast. After she finally showed up we walked over to Mrs. Montesino's apartment. Mrs. Montesino is a good friend of Dr. Valdivieso, the doctor who is overseeing our project. She served us a delicious breakfast and took us on a tour of an outdoor shopping mall that overlooks the ocean. Then her friend Lily picked us up and drove us (well her driver drove us) to a sports club, the Peruvian equivalent of a country club. It was a huge complex with "any sport you can think of", 3 beaches lined with empty chairs (it is winter here) and multiple restaurants. Lily's grandson also joined us. He 1 and a half years old and adorable. They had a babysitter who took care of him the whole time. It was strange that a babysitter accompanied them everywhere. They didn't speak to her very much, but did buy her dinner.

On the way home from the club we were all very tired again. We stopped at the supermarket and bought a few things for breakfast and dinners. Some foods were very cheap compared to American foods while some were really expensive. For example, some of the fruits and vegetables are very cheap, but a box of cornflakes was $6 or $7 dollars - probably because it was imported. We skipped out on the cereal and ate  toast for breakfast. I may go through cereal withdrawal while I am here.

Today we started our first day of work at DIGESA (La Direccion General de Salud Ambiental), they check water quality throughout many of the districts in Peru. After being introduced to a lot of different people we were shown how to prepare water samples for the lab and to ship back to our lab at Michigan. By the end of the procedure I was falling asleep - we had just watched water filter through a vacuum to collect on a membrane to try and grow H. pylori colonies, and then watched serial dilutions. It was interesting to see how their lab techniques differed from when I worked in a lab. In the US there is so much emphasis on using gloves, but here none of the lab technicians wore gloves. Instead they wore hair nets and face masks. It was very hot breathing my own air for almost 2 hours. There was no other work for us to do today so we went to lunch with the director. Em, I am sorry to say that you may have to eat fish while we are here. At most of the restaurants there are not any other options besides fish and meat with potatoes and rice. They love their yucca and rice here...it comes with almost every dish. So bring lots of granola bars and we can cook at my apartment or you can make a peanut butter and banana sandwich to bring with you everywhere we go.

After getting out of work early we took the bus back (our taxi in the morning was 16 soles or $7...way more expensive then 3 soles both ways on the bus). The bus system that we took was really clean and convenient. They run down the middle of the streets, kind of like the trains that you pass in Chicago. At major intersections there is a bus station and ramp down into the middle of the road where you can take the bus either north or south with the swipe of your bus card. There are stops close to DIGESA and were we are staying in Miraflores. Hopefully, we will be able to take the bus to Hospital Cayetana Heredia as well, because it is much farther than DIGESA and will probably cost a lot if we have to take a hired car.

Before heading back to our apartment we visited Kennedy Park. I thought the sign in front commemorating the park would describe why it was named for JFK, but instead it simply said the walkway around the outside was for selling souvenirs. Kind of amusing. I was surprised by how narrow the park was - much smaller than a "major" park in the US is. It was more peaceful than the rest of the city and there were lots of little kids running around. I miss seeing little kids and all of their energy. I often forget how many of them there are while living on a college campus. We ordered coffee and chatted while enjoying the sun that popped through the clouds for a couple of hours today (more about the weather at another time...). On our way home Sarah bought the cheapest guitar at a music store. The clerk told her jokingly it is for "los ninos"(for kids) because it is so small. She is playing it now and it sounds great to me! Maybe I will learn to play some guitar before I come home, but I should probably work on my Spanish first.

We cooked our first meal together - stir-fry vegetables and rice. So delicious! I didn't bring my camera today, but Sarah did so I will try to steal some of her pictures soon.

I am looking forward to getting a tour of the water treatment system tomorrow morning and doing more work in the lab tomorrow afternoon (hopefully we will actually get to help tomorrow). Time for some hot chocolate and soon I will update on why I actually came to Peru......