After three weeks:

It’s hard to believe we’re almost done with our time here.

After our first week, the patient volume slowed down at the Lamay clinic, and so we have been able to take some time to do outreach to the smaller communities of the Sacred Valley. Midway through our second week (while climbing up to 13,000+ feet in search of a glacier) we met Yanett, a social worker who coordinates services for many of the rural mountain communities in this area. These are communities without any clinic whatsoever and with infrequent medical care. Dr. Fike and I traveled with her to Matinga, an adobe village about 40 minutes from Lamay. This Tuesday, half our group will return and run a health fair in the village school.

We’ve been able to do outreach through the Lamay Clinic itself: on Monday I went with Dr. Greenhouse and two other students (Matt Weiss from Dartmouth and Kuba Tatka from Stonybrook) up to another community. In theory, the children we saw are seen every month by a team from Lamay; however, without insurance their medications are not covered, so our presence was pretty helpful – as we were able to either provide or pay for the medications they needed. Mostly what they need is nutrition: all but two of the 14 children we saw are lagging behind on their weight-for-age and weight-for-height curves. After some discussion, we decided to give them all the antiparasitic albendazole, which covers most of the worms in this part of the world, including ascaris, which many of the kids (and adults) we’ve seen at clinic have had before. It’s possible that none of the kids in this group had ascaris, and that their malnutrition is just a lack of protein and calories, but they’re left alone frequently while their mothers are working, and, like children everywhere, they get into what’s around. (Here, what’s around is ascaris).

On Thursday the entire group went up to Pampallacta to run a clinic for the town’s adults. When I say “up” I mean it: on Monday we went up the mountains in the back of the tiny Lamay ambulance, whose rapid climb up the narrow switchbacks left the four of us in back alternately nauseated and terrified (when you can’t see the road out the window, the drop down looks even farther). On Thursday we climbed up from the roughly 9,500 feet of the Sacred Valley floor to 12,700. Here too we used a school for exam rooms (one for gynecology, two for general medicine, one for meds and supplies), and Rachel, who sat outside and did intake, got a sunburn and froze at the same time. Pampallacta is removed from the relatively more prosperous and modern towns of the valley floor, and it had been years since many of our patients had been to a doctor.

As in Lamay, gastritis and low back pain were the predominant complaints, but we were able to do gynecologic exams and cervical cancer screening (with acetic acid) for about twenty women. We diagnosed a few pregnancies and were able to give out prenatal vitamins. Urine analyses proved tricky, as we had forgotten plastic cups. We used the cimetidine and mobic bottles (conveniently empty due to the above complaints) for specimen containers, and when those ran out we used a plastic bag, which dripped and resulted in a photograph of Satoko and me squatting outside – uphill – while the golden liquid dripped into the dust. It was almost as picturesque as it sounds. She held the bag, I the urine strip. Essentially, this trip has been all about two things: teamwork and flexibility.

Next time: planning for future trips…

-Anna