Tuesday, December 14, 2010

Out on the river



what does it mean to roll along the Amazon?

No anacondas, piranhas, crocodiles, or snakes..... just butterflies, birds, and sleek gray dolphins surfacing with a puff by your raft.

Frequent swim breaks in the coffee-with-milk colored water.

No sign of the opposite shore and a current that sneaks away from our grasp just as quickly as we can catch it again.

A song from a far-away raft hanging in the still air, until you add your own voices to it.

Dancing late at night with the locals in a river town, taking shots of some strange liquor as I try to translate Persian dancing to cumbia.

Waking up on a mass of lifejackets I placed between me and the growing puddle of rain from the thunderstorm outside.

The dreams. The heat. The slow drift of water beneath you.

Wednesday, December 1, 2010

In the Jungle

There was a very clear moment, as I stood shuffling my feet on the dirt floor in this young man's small thatched-roof home in an impromptu house call, when I debated in my mind whether or not to make up for my lack of a stethoscope and just put my ear directly on his chest. The thought of doing things the old-fashioned way brought a smile to my face. Here I was, not yet a doctor, yet called upon to act as one.

But a memory came as well. A flashback to four years ago, when I was enrolled in Raymond Lifchez's writing class at Berkeley. The minuscule class size (and Professor Lifchez's nudges) was perfect for sharing our writings, experimenting, moving in new direction and backtracking until we found what worked. My writing was really rough back then, bordering on the unintelligibly abstract-- even the most basic elements like narrative and dialogue came slowly, fitfully. Then, one week, I thought I'd write an honest-to-God, plot-and-characters-and-emotion-and-dialogue story. And I'd write about something I was fascinated with: international medicine, the lone doctor who moves into a small village, gets involved with a local, and finds himself shaken and transformed by the reality of the situation. Even though I swear I hadn't read Mountains Beyond Mountains at that point, I named my character Paul (I was thinking more of the New Testament figure spreading the word/medicine).

The piece was rough and tinged by that element of melodrama that crept into so much of my writing early on (Professor Lifchez will attest to this). But the dialogue felt real, the emotions felt real (if overdrawn), but most of all-- Paul felt real. And so did his situation. Because in my mind, much like so many of us that have long dreamed of international medicine, I would become Paul. I would someday take my medicines and my knowledge and my stethoscope out to a place that desperately needed a doctor. And I would live among them, and be the doctor they needed.

It's a fantasy so many of us have had-- I think of so many late night conversations I've had, sitting there spinning the tales of our future lives-- of traveling out in the world, unattached to any one place, bringing our medical skills to the jungles and deserts and slums, earning the respect of those we had helped.

Looking back now, I must sound naive.


The reality of international medicine is something far far different. Perhaps our most naive assumption was that we could fix things with medicine. Not that we would solve everything, but that we would at least be able to eke out some sort of lasting change through providing medical care for a group of people. In truth, such a thing is rarely possible for a doctor alone to achieve--even in the United States. Even the Paul Farmer's of the world can't make it on their own. As I've come to understand, any real change comes from combined efforts.

There's a fantastic quote from one of my attendings at the LA Free Clinic's High Risk Youth Clinic: "For every large complex problem, there is a simple direct solution that is wrong." Large complex problems require large complex solutions. As I'm starting to see, the role of the physician in the international setting is to be just one of the facets of the larger solution. I know it's a blow to our egos, but when you find yourself wrapped up in a project that combines Tuberculosis diagnostics research with microloans with mental health interventions.... things start to make more sense. And you start to realize that you just might actually make a change.




But why am I in the jungle? Because even after everything I've said-- about how it takes these large combined efforts to make a real change--- nothing quite compensates for the emotional immediacy and satisfaction of caring for a patient one-on-one. The unfortunate side effect of working on such a large-scale project is the distance it places between you and those you wish to help, from that human interaction that renews you and refreshes you and keeps you strong. My dear friend Ellen and I have spoken over and over (on many long walks) about somehow working on a global level while maintaining one's link to working with the people themselves, to those individual connections.

And so I found myself in the jungle these few months ago, traveling out on a lark to the butterfly farm with some newfound bird-researchin' hostelfriends. After blue morphos, jaguars, capybaras, I was chatting with the woman who ran the farm. When I mentioned that I was a medical student from Los Angeles, though, her eyes lit up.

"Ah! My employee has been in bed for three days with fever. Come, you must come. None of the doctors know what's going on."
"I could take a look at him."
"Alejandro! Come, come, take this young man to go see Paco."
A lanky boy appeared at the door and beckoned me with his hand. And so I followed. For the patient, of course. But perhaps just as much for myself. To experience, however briefly, what it feels like to be Paul.


More on the experience later.

Friday, September 10, 2010

The Meaning of Life

"Juan, que significa la vida?"
.
.
"......."
.
.

"Que significa la vida para ti, Juan?"
.
"....."
.
"Que significa?"
...

Still, a deep silence hung in the room, except of the scratching sound of the wooden walls grating against each other in the wind, and the flapping sound of the plastic tarp roof. Frank, the psychologist on our staff, and I sat in the stillness with Juan, waiting for his answer. Juan is one of our patients in the Ventanilla program, part of an enormous study on tuberculosis encompassing everything from microloans to novel diagnostic tests to psychological interventions, all in one of Lima's largest shantytowns. He's one of the younger ones, only 16 years old. Juan's bout of tuberculosis occurred not too long ago-- in fact, recently enough that he still gets sideways looks from people when he stops at the market. The thought of relapse crosses his mind whenever he coughs. Recently though, his mother was hospitalized with a stroke, leaving Juan at home to look after his 5 year old brother. Once we got the news of this, Frank decided to pay Juan a visit.

"Que significa la vida?"

The question still remained unanswered, lingering in the room. I was lost in my thoughts, sitting on the wooden bench of their dining table, across from Juan. The question filtered into my mind further with each repetition. Frank was searching for something within Juan-- some reason for Juan to keep a hold on, to give his life meaning even when everything was being pulled away.

And yet I couldn't help but hear this question -- and ask myself the same thing. What does life mean to me now? Why am I down here in Peru, at this point in my life?

On the surface, it's all about the research project. As Fogarty Scholars, we have been sponsored by the National Institute of Health (i.e., American taxpayers) to take part in research within the international setting, especially for developing nations. My project focuses on tuberculosis and depression: there's a mountain of quantitative data just waiting to be analyzed, and I'm hoping to get a qualitative study going as well. Spending time in the field (Ventanilla, that is) is a complete immersion-- not only in Spanish, but also in terms of urban poverty and international health.

The project itself will be interesting to follow all the way through-- yet at the same time, it's passive. So much will come from this data analysis and from the study, yet at the same time it lacks that active interaction with people that I've come to love. Even in the roughest parts of last year's clinical rotations, there was something still refreshing and satisfying about getting to know your patients, hearing their stories, cracking a few jokes, and making a connection as you care for them. So even though I'm working with the health of an entire community right now, a large part of me still craves that individual interaction that's so full of meaning.

Luckily, that's been coming. There's been chances to volunteer at Centro Ann Sullivan, a school for children with disabilities, and somehow I even assisted at a delivery out in the shantytowns. Even in the jungles of Iquitos, I was called upon to follow a small child down a path to a village to see a bedridden patient (more on this story in a later post). And those experiences have so fulfilling, so reminiscent of the same joy I would get from my patients back at home. There's a sense of satisfaction that comes from pouring out your kindness for just one person at a time. There's just so much meaning in it.

That, in truth, is why I am here. It's to work on multiple levels at once-- the qualitative and the quantitative, the shantytown and the city, the community and the individual-- and to strive to do good on all of these levels, to find meaning in all of these experiences. Even between work and play, there is so much meaning to derive-- from great conversations to great weekend trips to new foods to new connections. I'm surrounded by such fantastic people, all here because they want to do good. And I think we're all going to grow in the process. We'll all learn how to do good well.



"Que significa la vida?" I know my answer. And Juan's answer isn't far off. After talking through everything, he finally opened up. Here it is:

"For so long there were so many bad things in my life. There is still bad. But I also have good things now too that I hold on to."




Good night and good luck, all of you.

Friday, September 3, 2010

To the desert and back!






Hey everyone, gotta tell you about an amazing little trip to the desert this past weekend! Mika (another Fogarty Scholar) and I felt like getting out of Lima this past weekend, so we threw out the idea to our posse and scraped together a last minute trip to Ica and Huacachina, two desert towns just a few hours south of Lima.

Such a perfect break from the hustle and bustle of Lima. Though Ica still has some of the features of its noisy and sprawling older sibling, there's still the somehow relaxing presence of enormous sand dunes surrounding the city. Huacachina is a smaller town, a tiny oasis couched between the vast expanse of pure desert. The wineries are excellent, plus Huacachina is home to a number of party hostels (where naturally all of the post-army Israelis flock to).

And then there's the desert-- just dune after dune of nothing but pure fine sand. Literally nothing. The Negev in Israel was an enjoyable experience with camels, etc., but there was so much scrub brush and rocks and variations in the landscape to really feel like the desert you've always dreamed about. Huacachina is like that-- just endless nothingness, and after every sand dune there's more nothing. But that nothing is in itself something-- something actually really exhilarating and inviting and even cleansing about it. I felt immediately swallowed up in it, and even though it was the middle of the day, it was nice to lay down on a comfortable dune and rest. Then dune-buggying and sandboarding sent us flying through the desert, sand sticking to the sweat on our bodies. Follow that with a dip in the ice cold pool and shower at the nearby hostel, and suddenly your skin is like new!


After that, there's even more stories... but they'll come soon. gotta run to work!

Thursday, August 26, 2010

The Best Moments of Lima So Far


In no apparent order!

- "Ah! You are Middle Eastern, not Latin American, right? That's why you look like one of the Taliban." --Health Fair worker, Ventanilla.
- The giant flower from Marieke on my birthday.
- 8 sun salutations in a row at yoga with Karen-- "Perro mirandose abajo!"
- Churro + thick, rich Spanish hot chocolate at Cafe Manolo's on a Sunday morning.
- Stumbling onto the secret staircase to the roof at Bar Ayahuasca (above) with Tripper.
- Salsa Dancing up in the Lima hills with Joao and his awesome family.
- The hot chocolate at Cafe La Maquina (with just a touch of pisco).
- "Aromatic pisco" from Emily, with Matt and Josh and Karen. Tastes like fire, and no amount of lime and sugar can fight it.
- The all-out raucousness of Help! (Thanks, Luis) complete with a big old fashioned Peruvian mosh pit.
- "You guys eat like poor children."-- Franco
- The scarf conversation with our boss, Bob...actually any conversation with Bob.
- One extremely strong maracuya sour with Marieke and Coco at lunch at La Caplina.
- Helping out at a delivery in the shantytown of Puente Piedra. When I knocked on the door to that area, they just said "Come on in! We got a woman who's about to start pushing, so join us!" Sterile field? not so much.
- Maybe the best part is just life in Lima. It's not the greatest place to visit, but it's an extremely comfortable place to live your life.

Friday, August 13, 2010

Bye Bye Bolivia

Writing this right now after a four day jaunt to Santa Cruz, Bolivia, a groovy little town locked between the highlands of La Paz and the jungles of Brazil. Santa Cruz is built in concentric rings, extending outward from the Plaza del 24 Septiembre. The Plaza is filled with people at all hours of the days: old folks playing chess, young couples on the park benches enjoying some PDA, and burned-out backpackers watching people pass by. About a decade ago, sloths used to climb through the trees on the plaza (until nearly all of them got run over on the nearby streets--too slow, apparently).

But this is all beside the point. You may come to Santa Cruz on a leg of your South American backpacking trip, or for your agricultural business trip, or to investigate possible research on Chagas Disease (as I was doing). But what you will find here are the most beautiful women in Bolivia, maybe even in all of South America. Somehow, the Brazilian influence that has crept in here mixed with the indigenous look... and it just leads to gorgeousness.

As wonderful as these women are, and as relaxed as the city of Santa Cruz, it's not quite the right place for me. I'm falling in love HARD with Lima, and I think it's got me under its power.
(Plus I just found a boba place with easily the best boba i've had in a while-- and they do beer with boba in it).

So. Let's see where it goes from here. I'll keep you guys posted!

Sunday, August 8, 2010

Anticuchos, how I love you.





Hey folks-- so in my quest to eat my way through South America (and do a little research on the side), I've come across the first of many food challenges: Anticuchos. These are skewers of beef heart, heavily doused in a savory marinade, and grilled over an open flame.... and they are awesome. Somehow they come out with just the right amount of crisp on the outside and this tender little core, and the flavor extends all the way to the very center. Thinking about it right now already has me drooling again, even though I've had it for the past two nights running (maybe the third too??). For all my med school friends-- yes, you can see the trabeculae and the papillary muscle, and they're like little pockets for the sauce = more flavor.

Friday night we hit up Tio Mario's in Barranco, right on la Puente de los Suspiros (hold your breath as you walk over it for the first time) and a stone's throw away from the cliffs overlooking the ocean. The anticuchos were excellent, the aji spicy as all hell, and the corn GIGANTIC. Huge freakin kernels, people. For Saturday night, a lovely little barbecue with new friends Manuel and Nya, who acted as fantastic hosts while we grilled up anticuchos and chorizo in their patio. Pisco sours, Maracuya sours... I could go on and on but I'm getting hungry again.

The first week here has been a huge rush. Expect another post soon! Plenty of adventures so far.
Signing out--Dan


Thanks to www.thousandflavors.com on Flickr for the photos.