Huancayo!

Caleb arrived at the Lima Aeropuerto (late) on Monday night and Boy Was I Glad to See Him!

Tuesday morning (early), Dr. Yabar picked us up at the hotel to drive us to the bus station. In tones evocative of Gandalf, Yoda and Barack Obama and in a language stringing from Spinglish to Spanish to English he gave us a message muy claro (very clear). Here is a (loose) translation: "My very good new American Friends. I send you forth to a place high in the mountains called Huancayo and from which the biopsies we receive are crappy. You must go to them and educate them. Caleb must translate the message well. I am putting you on a bus which will take you over a 14,000 foot pass. They will offer you food on this but you must not eat it or it will make you sick. When you arrive in Huancayo you must first acclimate to the altitude, then bring the important message to the doctors there, then eat a food called PACHAMANCA, then return safely to us in Lima."

Well, the bus was small and cramped but the scenery was beautiful (if you don't count the slums of outer Lima). Unfortunately for me, they were playing videos with the first one being the movie (in English!), "My Sister's Keeper." My eyes kept straying from the scenery to the screen and I cried and my sinuses plugged up again. When we arrived in Huancayo i was almost too sick to stand up. Bless Caleb. He had a Z-pack with him. In fact, Dr. Karin Tansek had sent him off with 2 Z-packs. 2 hours after 1 gram of azithromycin I felt better than I had after a week of the Peruvian Levofloxacin (oh no! was it Fake Peruvian Levofloxacin???).

I was able to get up, doll up and get off the the Huancayo Hospital in good shape with Caleb in tow on Wednesday (this) morning. Caleb was the star of the day. NO ONE HERE SPEAKS ENGLISH. YO NO HABLO ESPANOL! Caleb starred as a simultaneous translator in the Hospital Director's office (Director's message as translated by Caleb: "We are doing a great job here in Huancayo and you need to tell the Es Salud people in Lima that and tell them that that they need to pay us more money!"). Caleb then translated for my hospital tour (pretty similar to Rebagliati but smaller, no bone marrow transplant unit). Caleb then translated for my Grand Rounds Lecture (good attendance and great questions after which means that Caleb must have done a really great job). THEN Caleb translated my, "How to do a really good biopsy" lecture and I could tell from the looks on the faces and the questions after that THEY GOT IT!! Me amo Caleb!!

THEN, the really cool doctors took us out for PACHAMANCA! Pachamanca is the Peruvian equivalent of a clam bake but no clams. They dig a pit in the ground, fill it with hot stones then throw in meat, potatoes and (Get This) Fava Beans (no G-6PD deficiency in this town!). The meat includes, chicken, pork, goat and CUY. Don't know what CUY is? It's GUINEA PIG (yum?).

Word of the day? Pachamanca!

PS: Wireless Internet in Huancayo? Perfecto!

Geography Lessons

This was written on April 26 but I couldn't post it because the wireless internet wasn't working in the hotel in Lima! Gracias to my Peruvian Amigos and to my more more geographically inclined Amigos in Estados Unidos who have been so diplomatic in gently informing me that Huancayo is not some jungle back water but a major Peruvian city that happens to be up in a beautiful mountain setting. Thus, wireless internet has found it's way to Huancayo just as it has insinuated itself into many less well established communities (possibly some of which are in Iowa). Thus you may be hearing from Vanessa in Huancayo whether you really want to or not.

Today is Secretary and Personal Assistant Day in Peru. Is it also in the US? The rest of the civilized and uncivilized world? If so, and if Kris and Linda are reading this, you know that if I were in Minneapolis right now I wouldn't be able to survive without you and I am grateful for all that you do for me. At any rate, the pathologists put on a really cute little party where the women pathologists (please don't ask why) served goodies to the transcriptionists, the secretaries and to Dr. Yabar's assistant.

I am off to aeropeurto (airport) to get Caleb. Today's word? Have I learned olvidar (the verb "to forget") yet? I can't remember! (Yo olvidado!)

Mas claro

I visited the Museo Archeologica in Lima today and, although it isn't as breathtakingly incredible as the Museo Larco that I told you about it certainly cleared up a few things for me. Check out the quotes. You read along and you might think that someone got lost in the translation but, believe me, now that I've been here a few weeks I pretty much think that they mean exactly what they are saying. Perujanos no están bromeado (previous word for the day meaning that these Peruvians aren't kidding around). This place has a deep and powerful past and these folks all just seem to be trying to live up to it.

Well, if all goes as supposed to, Caleb should arrive tomorrow night. Después, if all goes per Dr. Quinones' plan, he and I should be bussing our way to Huancayo so he can do his Great Service to the Peruvian people by explaining to their doctors in Spanish whatever it is that Dr. Quinones hopes that I will tell them. If there are no blogs for another week, don't worry. If there is no blog by Wednesday May 5 (yup, Cinco de Mayo), Please Start Worrying Big Time. In fact, if no blogs by Cinco de Mayo please alert Kelley Hendrickson (personal banker), James McCormick (personal trainer), Alberto Varillas (local lawyer) and ask them to send someone smart, nice, multilingual and preferably well armed to look for me.

Word(s) for the day? Esperanza realistica (meaning, of course, realistic expectations).

It's all about knowing who your friends are

Follow up on the money thing: I made sure that I sent a really nice, hand-written thank you note (in careful Minnesotan) to Alberto to thank him for the fabulous dinner at Huaca Pucllana Restaurant. Check out the envelope. I sent it from the Miraflores Post Office to his address in Miraflores six blocks away (You know why; it just looks more cool and formal with a stamp on it). It cost S. 2.40. Yes, that's right, almost a dollar to send a thank you note six blocks. So, smile bigger the next time you see your neighborhood USA mail delivery professional, okay?

Why a hand-written thank you note and not just an e-mail or nada at all? Because I, as I suspect do we all, spend much of my excess cerebral processing capacity trying to figure out who my real friends are and how to let them know it (shout out to any home vandals or their family members that might be reading this -- Not My Friend). So I spent most of Friday afternoon being taken out to lunch by my two new Fabulosa Amigas, Drs. Julia Avila and Adelaida Vargas. Okay, we did stay up late Friday night analyzing their flow cytometric immunophenotyping cases and talking about optimizing antibody panels and FACS-DIVA histogram analysis software but that's besides the point. They picked me up at the hotel on Saturday morning and spent the whole day touring me and Peruvian Gourmet feeding me all over Lima Central (that's pronounced with some rolling of the "r" and the "l"!). They wouldn't let me pay for anything which felt kind of uncomfortable because I know that they probably hope that I am going to tell someone that the Flow Cytometry Lab needs more money but, hey, you all know that I am pretty honest about that kind of stuff and, guess what, the Flow Cytometry Lab here DOES need more money. Technicalities aside, Central Lima is lovely although heavily weighted to the Catholic Church version of Peruvian history and dotted by USA culture and pickpockets (note the photo of me with my bolsa (purse) firmly gripped in front of my pudenda (oh, you know what body part I mean) as instructed to me by my hosts). We even went on a fun bus tour and inspected the original adobe ramparts built by Francisco Pizarro, his soldiers and slaves to defend themselves against the indigenous Peruvians who wanted their land, their gold and their women back.

Speaking of friends, my good friend Dr. Quinones is shipping me off the Huancayo for a few days. Her plan is that Caleb will translate for me there so that I can tell them in a language that they don't want to understand that they need to improve the quality of their laboratory. My good friend Guadalupe who works at the hotel thinks that I am being sent to Huancayo because I am being punished for something. I have thought about this carefully and I actually think that Dr. Quinones' motives are genuine and appropriate: 1. Huancayo looks like a very cool place for me and Caleb to see. 2. The quality of the microscope slide specimens sent from Huancayo is not terribly good. 3. Sometimes it is easier to accept what might be perceived as criticism from your friends as what might sound like good advice from a visitor from another planet (Minnesota). Thus, blogging might decrease as internet might not be available in the interior. Stay tuned.

Saturday's word? Aceita which means oil (like the oil for the microscope objective that I hope Caleb will remember to bring) and which I can't ever pronounce correctly. Today's word? Lluvia which means rain which it does not do in Lima but when I try to pronounce the word it comes out sounding like the Spanish word for Thursday (Jueves) or the Spanish word for eggs (heuvos). So it goes.

Funny Money

Money is funny here in Peru, but, I guess you could probably say the same thing about any place. What's funny here in Lima is that you can use US dollars and Nuevos Soles practically interchangeably almost anywhere. At the supermercado and pharmacias the cash registers show you the total in both $US and in S.Peru and you can pay with either. Cambio (change) is in whatever coins they have in the register. Even without a register the street vendors and cab drivers will gladly tell you the price in either or both $US and S.Peru. Pretty much every block in my neck of Miraflores has a casino (honestly, really nice casinos like smaller versions of Lost Vegas), a Peruvian designer alpaca wool and Peruvian cotton outlet store, a pharmacia, a beauty salon, a cute little restaurant, a street vendor, and one or two men or women who call themselves Cambio. The Cambio wears a bright green vest that says, "Cambio" and has a big roll of $US in one hand and S.Peru in the other hand. They also have cell phones and are up to the minute with the current exchange rate. I am always amazed when I walk out of the supermercado with two huge, ripe paltas (avocados), a veggie wrap, a big bag of bulk trail mix and a two liter bottle of water for $6 US. I am then confused to think that my little hotel room is listed as costing $85 US per night. I was really confused when I thought about the fact that I got a fabulous bargain on a B-day gift for sobrino (nephew) Frank with a little something for his mom but then mailing it at the cheapest rate cost me $30 to send it to Boulder, CO. Fascinating was the process to send a package from Peru to the US. I was warned when I bought the shipping envelope not to seal it before it could be inspected at the post office. I am so glad the I heeded this warning. At the post office they would not accept anything that was even gift wrapped unless they could open it and inspect it. I was then fingerprinted (really, truly, honestly, not kidding) and sent to the copy store around the block to buy (for 5 cents US) a photocopy of either my US driver's license or my passport to tape to the outside of the package (see photo).

Speaking of funny, I actually made two jokes in Spanglish today and everyone laughed (well, I think that they were laughing at the jokes). Laughing was probably a good thing because there was an earthquake drill (I really, really, really am not kidding) during my lecture that made it necessary for us all to exit via the hospital mortuary and chapel. Why and how on earth someone managed to schedule a funeral service during a planned earthquake drill is beyond me. So today's word has to be "bromear" with is the verb "to joke" as in "No estoy bromeado" which means "I am really, really not kidding."

Just making myself feel at home

I was quizzing Dr. Yabar in el carro on the way to work this morning about how health insurance works here. The explanations are starting to seem more consistent and I think that I am actually understanding it now. People with no jobs, no money and no insurance go to charity hospitals (like Santa Rosa; see previous blog). The Peruvian government requires all legal employers to register their company and their employees with the government health insurance plan (which is called Es Salud) and to buy health insurance from Es Salud for all of the employees unless they are buying from and insuring their employees with a private (more expensive) insurance company. Unemployed parents and spouses of employed/insured workers and children 18 years and under of insured workers are covered on the working family member's plan. Employers typically give their employees the option of which insurance they want (Es Salud or more expensive private company) and deduct a percentage from their pay check (this is the 75 soles a month that Peruvians have been telling me about for Es Salud). Small companies try to ignore the law and the government has a difficult time policing this law for all but the largest companies leaving some employed people uninsured and needing to go to charity hospitals. Es Salud operates its own hospitals (Rebagliati is one of them) and only patients on the Es Salud insurance plan can use those facilities. There are numerous "Clinica's" that are much nicer than the Es Salud facilities. These Clinica's provide care for the private insurance companies that they have contracts with and only persons on those private insurance plans can go to these facilities. Those of you reading this who know me well will understand how this conversation somehow led me directly to the topic of abortions in Peru. They are illegal here and it is the person who performs the abortion who is breaking the law, not the woman who has an abortion. This, of course, means that wealthy women can pay (lots of) cash for an abortion at a private clinic if they are on one of that clinic's private plans. Uninsured or Es Salud insured women pretty much do their own abortions leading to high rates of injury, infection and maternal deaths. I explained to Dr. Yabar how pretty much every election in the USA now (even school board elections) can be swayed by a small group of highly vocal abortion opponents. He thought that I was kidding but, then again, he didn't believe me when I told him about the Breck School graduates repeatedly vandalizing my house.

Today's word is "ambos" or "los dos" both of which mean "both." It comes in handy along with "lo mismo" which means "the same"(as in, Estados Unidos es loco lo mismo como Peru.) Today's photo's include my office at Rebagliati which I have discovered smells so uncomfortably like xylene and formaldehyde because the windows in the office are directly above the air vent for the chemicals in the Histology Laboratory. I can't complain (in part because every time I feel like complaining I remember that Dr. Paul Farmer, "Mountains beyond mountains," guy and I feel guilty about complaining), at least my office has a door that locks so my computer can't get boosted.

Some more thoughts on the subject

Thank you and bless you to those who noticed and inquired about yesterday's bloglessness. Yes, I'm still alive and I have decided that if I'm not muerta (dead) then it's still an adventure. For those who have decided to learn Spinglish, I mean Spanish, with me, yesterday's word was "tal vez" which is a sort of cooler way to say "maybe" and actually comes off more like "perhaps..."

I was too tired to write last night because I went out on a date with another hot guy. Well, sort of (quizas); Dr. Juan Navarro took me and Dr. Yabar and Dr. Pilar Quinones (because, like I said, I go where she goes) out to dinner at the Yacht Club. Really. Lima has this very traditional Yacht Club (they've won three world sailing championships) founded in the 1800's. It has grown to be the largest private (yup, means expensive) sports facility in South America. It is pretty fabulous. Dinner was in the Clubhouse Restaurant where they serve, what I was told, was real traditional Peruvian food (I had spicy shrimp with rice and corn). Conversation was along the lines of the evolving theory that Dr. Yabar and I have been developing during our car ride to the hospital each morning that goes something like this: Problems with delivery of consistent, quality health care to anyone who needs it in the USA or Peru comes down to managing the distribution of resources. If a small number of very intelligent, very knowledgeable and, most importantly, very honest people could sit down together and achieve consensus on the most critical reforms and an implementation plan, a more optimal system could be achieved with a reasonable expenditure of money. I sense that Dr. Yabar, like me, is, at heart, an old cynic and that Dr. Navarro is a relentless optimist on this subject...

Oh well, today's word is "Aburrida" which means BORING! Every day I give a lecture which is basically just me reading a chapter from the World Health Organization (WHO) Classification of Tumours of the Haematopoietic and Lymphoid Systems. In other words, they want me to teach them how we diagnose leukemia and lymphoma in the old USA. Every day, over and over again, I tell them that the only way that you can follow the WHO's guidelines is to have very good quality blood smears and/or biopsies that are consistently well prepared for interpretation by an experienced microscopist (not Dr. House from TV) and that the interpretation of what you see through the microscope MUST ALWAYS be put together with the patient history and physical examination and with all of the other laboratory tests. Over and over again I say it but I just don't know how to implement it in Peru........