Making Friends and Influencing People
Today, Cindy and I got up at 6:00, and fortified by some delicious Dunkin Donuts, made our way back out to Callao to meet up with Melecio and Judy (Briana, unfortunately, was feeling a little ill, but after taking a day to rest, is now doing much better). We just have no luck with taxis here – when we got into the cab, the driver asked me if we could get to Callao by driving along the beach. Yes, definitely. With that out of the way, he wanted to know if I´d be able to direct him to our destination once we reached Callao (for the record, this guy had a GPS on him). Unlike loyal readers of this blog, he didn´t know about my abysmal sense of direction, but even so, all I could do was sit there and think,
You wanted to charge us 35 soles for this trip (which we did not pay), and you need the foreigner tourists to give you the directions?
I managed to communicate to him that he should definitely not rely on me for any of his directional needs, and instead put him on the phone with Judy, who managed to get us to the rendezvous station safely, if late as usual. Then, it was back out to Ventanilla with Melecio and Judy!
Today we visited a different health clinic than yesterday, which meant going to a different area of Ventanilla. This area initially felt a bit nicer, but quickly got just as poor as yesterday. Most of the settlement, we found out, was built on the equivalent of an enormous sand dune. Walking through the area was like being at an extremely depressing beach, if the beach somehow happened to be uphill both ways (I don´t know how this happened. Somehow everything was “just at the top of the hill!“).
A hill advertising Jehova.
The Health Clinic Mi Peru.
Anyway,we arrived at the Center Mi Peru, where we met up with our guides for the day: Dr. Anita and her assistants Milagros and Jully. None of these women had ever worked with ASPAT before, so Melecio began explaining the goals of the organization, particularly those specific to this health center. Dr. Christian, the regional head of TB treatment in Lima, has been working with Melecio to implement a system where 2 or 3 recovered patients from each health center take responsibility for the rest of their community, encouraging them to take their meds and providing something of a support group where they can all air their grievances and compare their treatment experiences. (For more on Dr. Christian, see Callao, Here We Come! ) Did Dr. Anita think such a program would be successful in Center Mi Peru?
Dr. Anita and Nurse Jully, both skeptical.
No, as it turns out. Center Mi Peru is famous for its noncompliant patients: 1.5 % of their cases of MDR-TB stop treatment before completing a full course. Those who do successfully complete treatment often just want to resume normal lives and forget about their struggles with TB.
We were all concerned about this high rate of failure. As it happens, the area that Center Mi Peru treats has a very high population of drug addicts, which is generally weakens their immune systems to the point where they catch TB. TB medicine can´t be administered while the patient is simultaneously consuming street drugs for fear of drug interactions, and obviously, most of the addicts are not willing to make use of rehab centers or the like to overcome their problems (indeed, rehab centers don´t appear to exist in this part of Ventanilla).
With that said, I´m going to segue into talking about the patients. Most of the TB patients here also have jobs (they take meds on an irregular basis so that they can still work, which might make them feel better but in terms of increasing drug resistant TB strains, is just about as bad as abandoning treatment completely), so they weren´t at home. There were two patients who made an impact on Cindy and I (and ASPAT, of course), although once again, we were unable to meet them personally. Instead, we spoke to their families. Here are their stories:
Here is a photo of Daniel’s parents.
Age: 25 years old
TB: XDR-TB (Extremely Drug Resistant TB)
Daniel was first diagnosed with normal TB in 2003, and took the treatment for two months before failing to complete. Naturally, the TB returned a year later, and he was resistant to one of the two primary drugs used in TB care, so he was put on another plan for eight months. He quit again after five. Again and again, Daniel tested positive for TB, always resistant to more meds. At this point, he has made himself completely drug resistant, and there is no possible cure for him. We learned from his parents that he has been sent to the Hospital Carrion to be isolated.
Melecio and Judy think that surgery might be possible to save Daniel`s life. They will evaluate him, and if the two of them, Dr. Christian, and Daniel´s doctors all concur, they will send him off to CERI, a Peruvian commission that evaluates extreme patients on a case-by-case basis to see what, if anything, can be done to save their lives. If Daniel`s TB is not too advanced, they will be able to remove the infected part of his lung and send him on his way. Unfortunately, if the TB has spread throughout the lung, he will not be able to have surgery (all this is contingent on the assumption that he is even strong enough to survive surgery). If he cannot receive the surgery, he will die.
Juanito, Jocelyn’s eldest son.
Age: 19 years old
Jocelyn is one of Dr. Anita´s problem patients. Although she has been diagnosed with MDR-TB, she is, to the best of my understanding, a crack addict (crack appears to be the drug of choice in these parts). The health workers are never able to reach her, as she sleeps until 3 or 4 in the afternoon, presumably wandering the town at night in search of her drug source. She has two children: Juanito, a little boy who is 3 years old, and Ivan, a baby of about 1 year. We met both of them, and they are absolutely adorable. Juanito spoke with Cindy and me, and showed us his toys. He seems very bright and eager for attention. The boys and their mother live with Jocelyn´s younger sisters and their mother. The mother works while the two younger girls are at school, leaving Juanito and Ivan at home all day with no one to feed them or take care of them until Jocelyn`s sisters are able to get there (the sisters are maybe 12 and 15). It´s an appalling situation. We spoke with Jocelyn´s mom, who is clearly overwhelmed dealing with her drug-addicted daughter, her younger girls, and her grandsons all on her own.
Melecio and Judy promised to send the mother food support for the next three months for the babies, on the condition that they are kept away from Jocelyn. Both feel that the best outcome of the situation would be for the boys to be taken into the custody of the state, and I believe they intend to begin this process as soon as they possibly can.
More photos of Ventanilla:
What is driving away from us is a “moto,” a motorbike turned taxi that is pretty comfortable – but may flip over if there is too much imbalance of weight. Disclaimer: we haven’t seen firsthand a flipped over moto on the road, but the situation seems possible.
As bleak as the patients´stories have been today, I think Cindy and I truly had a good time. Milagros and Jully, the two assistant who accompanied us, were really engaging, fun people, and told us all about how they think we should both become doctors and then move to Peru to run a clinic and teach everybody English. Milagros actually did speak a little English, and told us she´d learned a bit in school, but had gotten out of practice. We taught her a little English, and she and Melecio taught us a bit of Quechua in return! (Quechua is the local indigenous language. I am assuming that both Melecio and Milagros are indigenous, since it´s not particularly common for non-indigenous Peruvians to learn Quechua, but don´t quote me on that).
So, here are the two words of Quechua that we know:
Ari = Yes.
Si = Ten.
I feel totally prepared to conquer the indigenous markets in Cuzco now. Expect a very interesting blog post about that experience in a week or so!
Lauren and Milagros! There are photos of the whole group, but Cindy’s phone died so the photos are on Judy’s camera. We promise to post all of the updated photos here later.
We also talked with Jully and Milagros about our perceptions of Peru, which they were very interested in hearing, and then about the U.S. (because they´d learned about in school). I explained that Cindy and I attend school in a city called Chicago, but that I actually live in the northeast and Cindy lives in the capital.
Milagros: Oh! NEW YORK! (Very excited)
This would be a perfect segueway into the conversation Cindy and I had with Melecio about the Peruvian education system, but this post is already really long, so I guess it´ll have to be a teaser instead! Expect a bonus blog post about Peruvian education sometime in the next couple of days (by which I mean, by the end of the weekend).
After we walked by everyone´s houses, which took several hours, we dropped Dr. Anita, Milagros, and Jully back off at the center, posed for several photos, and exchanged contact information. I´ve noticed that we´re definitely more of an oddity in Ventanilla than Callao or other parts of Lima (or at least, I am – Cindy apparently looks native from a distance), so people consider it more of a thrill to meet us – especially the kids.
Once we´d said our goodbyes to the trio, we headed back with Melecio and Judy to Callao, and ultimately, to Miraflores.
I have no idea what we´re doing tomorrow, but I know we´re going to be able to sleep later, which is always exciting. Until then, good night!