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........