Week Two

Well, where did I leave off? Everything seems to be a blur orienting myself to this place and constantly thinking. It's seriously exhausting, but also just as well; I may not be able to sleep through the noise of Ave. Arequipa without a small dose of exhaustion each night. And earplugs, por supuesto. In an effort to save you another play-by-play, I'll simply recount a few tidbits of the past week... just enough to keep you hooked and wanting more. (Okay, just indulge me.)

The project:

Although folded beneath a classification of "data analysis," my project here has henceforth provided enough variety to keep me constantly scribbling notes and doing the "yo no comprendo" head-tilt that usually belongs to my dog. You know the one. Much of said head-tilting is due to re-learning the language, but I'll get to that in a bit. In a nutshell, I am working with a major study on the use of rapid testing for syphilis among pregnant women in Peru. Obviously based in Lima, the researchers here (16 women, 3 men) have enrolled 19 health workers (9 midwives, 7 nurses, and 3 laboratory technicians) at la Maternidad to do the rapid testing in an urban setting. When I say "urban," think Harlem-urban. When pregnant women come to the hospital for prenatal care visits, deliveries, emergencies (i.e. botched illegal abortions), or hospitalizations, they receive the rapid test for syphilis. Likewise, when women come for prenatal care or delivery to one of the 16 participating health centers in Ventanilla, they receive the test. When I say "Ventanilla," think mazes of shack-like houses made from aluminum, palm fronds, cardboard, and the occasional piece of wood... swirled around dune-like hills as far as the eye can see. Got it? If not, here are a few pictures...

So far, I've visited la Maternidad twice- even learning how to take a sample and conduct the rapid test- and Ventanilla once, helping to collect blood samples stored at the various health centers. I've also observed the biologists conducting the "gold standard" (comparison) tests in the laboratory at the university. I've also played with datasets quite a bit. So, pretty much, first two weeks: getting an idea of the big picture.

(L) Prenatal midwives at la Maternidad; (R) INMP (la Maternidad)

The language:

Re-learning Spanish after 5 years of not conversing regularly is a challenge, to say the least, but I can feel myself understanding (and even speaking, on occasion) better poco a poco. For those of you who didn't grow up with the basics of Spanish in junior high, that means "little by little." I carry around a handy-yet-dorky small notebook on which to write Spanish words that I see/hear and don't remember... or recently, English words that I have trouble saying in conversation... or even more recently, English words that stop my thought process because I can't translate them into Spanish. After two weeks here, I already find myself thinking in the language. Sounds great, right? It's actually quite frustrating with the diction-equivalent of a 3rd grader. Nevertheless, I press on. Poco a poco.

I'm also reading Harry Potter y el calíz del fuego... yes, obsession traverses languages.

The off-time:

I don't have much here, to be honest, but as mentioned before, I've met an amazing group of people who've let me into their network of fellow-foreigners for the time being. So far, I've re-learned a bit of salsa dancing, seen top-notch salsa performers in a benefit raising money for travel costs to the world championships in NY, celebrated an early 22-person Thanksgiving dinner (one contributor even made cranberry sauce by rehydrating and pureeing dried Craisins), tried every type of ceviche dish, and poked around one of the Inca markets in the city.

(L) Salsa dancing; (R) New friends at Thanksgiving

Oh yes, and I endured my first bout of traveler's sickness... á la Montezuma's revenge, except without the Aztec namesake. This certainly wasn't the first time I've endured the revenge, but this time my foremost thought was... "Am I really enduring anything? How fortunate am I to have a bed to rest in, a flush toilet to utilize, and the ability to access safe water?" I miss a day of work, drink un montón de fluids, pop a few pills, and catch up on missed sleep... great, it's a vacation. So many people around the world who contract diarrheal diseases- about 4 million per year, to be precise- do not have these simple provisions. For 2.2 million of them, lack of access to sanitary conditions transforms a simple stomach bug into a rapid death sentence each year. Most victims are children. All infections are treatable or preventable with existing low-cost interventions, but communities like Ventanilla are simply unlikely to see widespread intervention. But there's nothing simple about it. It's a tragedy.

Leaving you with that uplifting thought, I promise that I'll try to write again soon. Tomorrow and Friday my work group is hosting an international workshop on rapid testing, hosting representatives from the ministries of health of 18 countries and the World Health Organization. Should be good!

Chau chau,

Kristen

¡Saludos de Lima!

Hello! Thank you for visiting my updates of fieldwork in Lima, Peru. In this blog, I will give updates of my experiences with the project, people, culture, and travel in Peru. I hope you enjoy it, and please feel free to comment or ask questions!

Brief introduction: My name is Kristen Roehl, I am a Master of Science in Global Health candidate at Duke University, and I am spending 10-12 weeks in Lima to hacer mis prácticas (do my fieldwork) and prepare my master's thesis. I am working with the study group of Dr. Patrícia García at la Universidad Peruana Cayetano Heredia (UCPH), where over half of public health research in Peru is undertaken (or so I've been told), helping to determine the diagnostic quality of rapid tests for syphilis among pregnant women in and around the city. While here, I am living at the "Gringo House"- an apartment for short-term foreign students working with studies at the university- as well as taking Spanish lessons and learning/seeing as much as I can.

For those of you who have been eagerly awaiting my oh-so-exciting posts, sorry to have kept you waiting. My first week in Peru has been somewhat of a blur... but that can't be anything but a good thing. Most of my time has been spent learning one thing or another- details of the study of which I am now a part, names of coworkers and expats, the statistical program, or (the biggie) the language. The first thing I learned in Lima was never to carry a bag on my lap. The second was how abysmal my Spanish abilities have become in the past 4 years of rare use.

Back up a bit. In case you're curious, the bag incident to which I just referred was my cheerful welcome to the greater environs of Lima. On the taxi ride home from the airport at about 1 am, a man broke the window where I was sitting and attempted to steal my carry-on from my lap. Fortunately, my reflexes did not fail me and I bear-hugged the bag, leaving the would-be robber with only my brand-new travel pillow. A slightly jolting start to my time here, I'll admit... but at least it taught me to be as inconspicuous as possible. And never to carry anything valuable in anything that can easily be snatched away.

Now that the perfunctory mention of safety hazards is over, on to my synopsis of the rest of the week...

Wednesday - Introduction to UCPH/Cayetano Heredia/Proyecto Cisne. César, the data management head of the study, picked me up from the "Gringo House" in Miraflores and drove me through the congested streets of Lima to the university. By car, the direct commute is about an hour and a half during a peak time. The traffic here any time, but especially during la hora punta (rush hour), is horrendous - reminiscent of Cairo, but not quite as life-threatening. César was nice enough to give me tidbits of information about sights in the city on our way, though the only tidbit I remember was the one about the statue that mistakenly ended up with a llama on a woman's head due to a mistranslation. I haven't yet seen that statue in person, but it has to be worth seeking out. Otherwise, I spent the day getting acquainted with the study staff and my role in el Proyecto Cisne, details of which will come in a separate post for those interested.

Wednesday night - Introduction to the significant expat network in Lima... just the student side of it. Beth, an MPH student from Columbia who has been working with the study for about 6 months now, took me along to network over pisco sours and maracuya (passion fruit) sours at a local hipster bar/café/coffee shop/performance hall. I also had another first travel experience - a local photographer asking if I would pose for his next calendar, an offer which I politely declined. All in all, a full and interesting first day.

Thursday - First full day at the office. Stumbled through communication in Spanish, as I have since, and successfully negotiated the Metropolitano. El Metro is a recent (2 months new) express bus system that cuts through the city, hence avoiding traffic. I'm fortunate to have arrived when I did... with the Metro, my commute is about 50 minutes and much more reliable. Reviewed my knowledge of STATA and made a good start to my do-file.

Friday - Visited el Instituto Nacional Materno Perinatal (INMP), the largest and most comprehensive of all maternity care centers in all of Peru. Located in a central neighborhood of Lima called La Victoria, where I was told many times not to stray by myself, INMP or la Maternidad handles most complicated pregnancies in the city and its surrounding areas. Some patients come from as far as 8 hours away to give birth at la Maternidad, as it is one of the only hospitals with specialists and equipment equipped to handle pregnancies of the highest risk. I'll wrote more about la Maternidad in another post, as there is much to say... but for now, let's just say that it was an experience. I'm hoping to return on Friday and Monday to shadow one of the midwives involved in the study, so I´ll be able to provide a more comprehensive report.

Friday night - Was taken to Iyahuasca, a bar in the neighborhood of Barranco named for Peruvian traditional medicine. Met a fair number of Peace Corps volunteers and Fogarty Scholars from all over Peru in town for the weekend. Learned that nighttime Lima moves at a faster pace than I am used to (certainly)... but enjoyed the banter oscillating between English and Spanish... and the cocktail. Ingredients: pisco, vodka, pineapple juice, passion fruit juice, lime, and coca leaves. Interesting.

Saturday/Sunday - A bit of down time and a lot of exploration. I took a Lima City Tour to get oriented and learn some of the history, so I was able to explore the city's historical center, see the catacombs from Spanish colonial times, and pinpoint the ruins of ancient civilizations scattered throughout the city. I finally tried ceviche (freshly caught that morning) and ventured over to la parque del amor (the park of love) on the ocean... where tile sayings encapsulate the bonds of specific lovers and an enormous statue of a lovers' embrace boldly declares the location's purpose.

Monday/Tuesday - More STATA and observations of the laboratory tests in the study. Beginning of nighttime private Spanish lessons with an amazing and hard-nosed teacher named Elsa, and coordinations for early Thanksgiving with the expats.

Wednesday - Visited Ventanilla, a "suburb" of Lima comprised of extensive clusters of shanty homes and scattered health centers involved in the study. Writing about Ventanilla will take a while, and I must leave the office in order to make it back to Miraflores by dark. For now, I'll leave you with a few pictures of my first week in this busy, diverse city...

Peruvian artwork

Plaza de San Martín

Plaza de San Martín

Run Lima 2010

Rapid Test for Syphilis poster