Tuesday - Wednesday may 18-19

Tuesday and Wednesday May 18-19
Tuesday we got up and got all dressed up in our finest clothes to go to the posta in Santo Tomas, the same village we visited Sunday night. The posta is a health department satellite and they are found in nearly every large neighborhood and village. They provide basic preventive health care for pregnant women and children as well as treatment for Tb and malaria for everyone and for STDs, and chronic illnesses for adults. As always the courtyard and waiting area is full of mostly women and children seeking care. In one room children with RSV (brochiolitis) and presumably asthma are being treated with nebulizer treatments. The lab can test for malaria, dengue fever, glucose, and do urinalysis. It is also an urgent care. Pharmacy had all the Tb meds, usual antibiotics, no HIV meds, salbutamol for asthma. They had no diabetic medications, or meds for other chronic diseases despite their supposed role in helping patients manage chronic illnesses. We hear all the time from patients that they don’t have meds and we are not sure why but this has usually been the case. The students enjoyed photographing the children in the courtyard – my favorite child was a little 3 year old who found a wrought iron gate leaning against a wall and he was crawling back and forth behind it and would sit there looking through the bars. The ground was dirty and his mother was nowhere in sight be he was happy as a clam and as you might expect REALLY dirty. We finished the posta in under an hour and so we walked on the street talking to the vendor. The owners of the store next door were very friendly and not only told us about their store but also gave each of us a green tangerine. Their store carries necessaries like soap, toilet paper, canned goods and a few fresh fruits and vegetables like yucca and onions.
We then went with Princessa, one of the volunteers from Poppy’s house, to the Santo Tomas school where we were given a tour and had a chance to talk to some of the kids. The school was impressive in that each student had a book for each subject that they could use and all of the books were new. I paged through the social studies book for fifth grade. They study the history of South America, china, the pacific, Europe and the United States. They learn things our children either never learn or learn only in high school or college. Children start school when they are three and most graduate by the time they are 16. If students fall behind or drop out they can go to the grade they need to be in regardless of age. Some of the girls at Poppy’s house who are in 5th grade are 14-16 years old. The Santo Tomas school has an exceptional principal who has gotten a lot of resources for it and also holds the faculty accountable. This is not true for every school. In some schools there are no books and teachers basically come when they feel like it. This is very sad as education is enshrined in the Peruvian constitution as the sine qua non for a free society so every child has the right to free and compulsory education. (Susan the schools are a lot like some of the ones in Guam and Micronesia). The primary students go to school in the morning from 730-1200 and the secondary students go from 1:00-6:00 PM. We had a chance to talk with children in the 5th grade classroom and noticed that there was a student created posted about using condoms. The teacher said the poster was created as part of a project by the secondary students. The one thing that struck me is that all the chairs in the school were primary sized and I wondered how the secondary students managed to sit in them for 6 or more hours.
After we left the school we went back to Paul’s for lunch and to prepare for the teaching programs and to go to the hospital. We had a short siesta period when we walked over to the artisan’s market and went shopping.
In the afternoon we went to the Iquitos hospital (not the big regional hospital but the older hospital). The hospital was built 64 years ago and has been added onto somewhat willy nilly since then. We went to the OB ward where Lucia the obstetrician who has been working with us in the clinics has her clinical internship. She met us there and she had been working all night delivering babies. Interns work 12 hour shifts. So she worked 6PM to 6Am then went home to bed and was at the hospital to meet us at 3 PM. The hospital is old and the healthy women who have given birth in the last forty eight hours are in a big ward that is somewhat dark. There are two beds in each cubicle. The beds are small and narrow and are shared by both mother and child. The beds are closer together than they would be in the US and as is true in most developing countries the individuals need to bring their own sheets otherwise they lie on bare mattresses. Nearly all babies are delivered by the “obstetricians” who are similar to a nurse midwife. Only mothers requiring C-sections are attended by physicians. The children’s ward is quite full there is an RSV outbreak as there often is when the seasons change. The ward is large and brightly painted with cartoon characters. The equipment is quite old but is also well used.
We were shown a new room in the hospital which is tiled, air conditioned and contains new modern beds but little else. The supervising nurse who also teaches at the University of the Amazon said that it was an ICU for “people like us” and they were hoping to get donations from foreigners for equipment. I found it disturbing that they were building a nice facility for people who didn’t live in Peru and leaving the old and decrepit to the Peruvians. Watching the old people lying in beds in wards of 6 in the heat without sheets or with only what they could bring from home. Some of the older people looked so ill and their care so minimal. Although the supervising nurse said there were supposed to be 5 patients per nurse, more likely there were 2 nurses for 30 patients. She also said that there were plenty of openings for nurses in the hospital but that the pay was so low that graduates of the university went to Brazil or elsewhere in South America where they could make more money. This is quite different from what we were told two years ago when they said there were no jobs for nurses in government hospitals.
Wednesday
Today was our day to tour the College of Nursing. All of the faculty were gone testing – we think they were proctoring tests and there were very few students in the building. Most of the ones’ we saw were similar to CNAs. We encountered 5 nursing student and their faculty member in the library looking up some topics on Google – they were working on a project perhaps for their senior thesis. All students complete a thesis in their fourth year. We had a chance to peruse some of the theses which can be written by from one to three students. Most appeared to be descriptions of health issues from health department data. One was on the prevention of HIV among hotel and bar workers in Iquitos, another on the incidence of Malaria in Iquitos and a third on dengue fever. We also looked through their books and found Perry and Potter in Spanish as well as Kozier and Erb and several well known Maternity texts. I looked for Ball and Bindler but much to my surprise did not find it. The public health and psych texts were nearly all written originally in Spanish and published either in South America or Spain. There were however several US psych texts but I can’t recall the authors. Although we went on a nice tour I was disappointed that there were few students and no faculty for our students to interact with. I did discover that Perla who was the dean two years ago is now the director whose role is similar to the Associate Dean for Academic programs (Anne’s role at the CON). There is a new dean Dr. Rosetta ?? When we asked the administrative assistant she said all the faculty had doctorates but that has not been the case up to now and I am pretty certain that the people who were here have not obtained Phds in the last two years.
After our return we prepared for a teaching session at the orphanage that was scheduled for 3 PM. We went to La Nina de Loreto, where we went 3 or 4 years ago. The building and grounds are beautiful with trees and gardens a large play yard and lovely Spanish style buildings. This is really more like a boarding home since some of the students have parents in the jungle and live here, others have parents in Iquitos and live here for enrichment, while yet others are without parents like the little girl who spent a lot of time with me. Her father is in Lima and she has not seen him in a long time and has never visited him in Lima, her mother is in Iquitos but she never sees her either. She has an uncle who she visits from time to time but she says he really doesn’t want her with him much. She wishes she had a real family. It must be so hard for girls like her to share space with other girls who have families. The nuns we met, two Peruvians and one Columbian seemed to genuinely care about the girls and treated them with warmth and tenderness. The girls flocked around our students and they played and talked together until a giant tropical rainstorm suddenly dumped huge buckets of water on us and we had to run in to the building. Our students did some really great educational presentations that kept the girls engaged the whole time. The group doing exercise had a small group come to the center and get down on the floor and do some simple yoga by having them pretend to be cats hissing and cows pushing out their bellies and dogs getting up. A second group did a tooth brushing song that was hilarious, then a group did a germ transmission skit using glitter for the germs and showing how it spread around the whole group. The last group did a hilarious skit about antibiotic resistance complete with germenes with glittery antennae. One student pantomimed being ill and taking only part of an antibiotic while the others were the germs only some of whom died before she stopped. Soon she was sick again and went back to the doctor and got another antibiotic and this time she took it all and all the germs died. The girls loved it as did we. The afternoon was really a lot of fun. Tomorrow a clinic in Belen.