¡La Playa!

"Beauty awakens the soul to act." - Dante Alighieri

We got an unexpected surprise last night, when our professora, Shannon, told us we would have today off to go to la playa!  After breakfast we headed to a lovely Peruvian beach resort located about an hour away from la parroquia.  Although it wasn’t too populated because it’s the off-season, we lucked out with beautiful weather – plenty of sunshine and a light breeze coming off the Pacific Ocean.  The day was spent relaxing on the beach and by the pool – swimming, reading, sunbathing, and sipping pisco sours, a popular Peruvian drink made with pisco (Peruvian grape brandy), lime, sugar, and egg whites.  For lunch we ate with a few missionaries & people from the parish, sharing an array of traditional Peruvian dishes.  The ceviche was my favorite!  The day was capped off perfectly, listening to the waves crash along the shore as the sun set over the ocean. Estabamos muy contentas. :)

Making friends at the beach!

Esperanza!

Trying pisco sours!

Almuerzo

Muy hermosa.

A todos mi familia y mis amigos en los Estados Unidos! <3

Loving life,

<3 Lisa

p.s. Tonight I am writing to the sounds of Latin music coming from the fiesta of our neighbors down the street. They shot off fireworks too! (I need to figure out how we can get ourselves invited next time...)

Clínica Pro-Vida

"Never mistake knowledge for wisdom. One helps you make a living the other helps you make a life." - Sandra Carey

We finally had a day with beautiful blue skies!  It is winter in Peru (which is easy to forget because it’s still so hot), thus it has been very cloudy since we’ve been here.  Today I had clinical in the Clínica Pro-Vida – which is completely free to pregnant mothers in the community.  Cecilia, the nurse that runs the clinic here at la parroquia, is absolutely amazing at what she does and I learned so much from her!  She was really great about letting my clinical partner, Ellen, and I be extremely independent.  We had a steady stream of patients all morning, so the time went very quickly.  The women that we took care of ranged between primips, multips, single teens, and married Señoras, all at different stages in their pregnancy.  For each woman, we began by completing an intake, getting to know her by asking a slew of questions about herself and her pregnancy and documenting her answers.  After taking blood pressures and weight, we went on to complete focused assessments.  This included measuring fundal height, to ensure that the baby is growing at the proper rate and using Leopold’s Maneuver to determine the position of the baby.  This allowed us to easily find the baby’s heart, so that we could listen to fetal heart tones using a doppler and assess the anatomy of the baby using an ultrasound machine.  My favorite part was locating the baby’s head, heart, arms, legs, etc. on the screen, and then watching the mothers faces light up!  The babies were excited too because we had a couple kickers – muy fuertes!  We also did a lot of teaching, wrote prescriptions, and made some outside referrals.  The women were extremely grateful for the care that they received, and I feel so fortunate to have been involved in such an important time in their lives and the lives of their unborn children.  One of the women said that she was so grateful that God had sent las enfermeras de Marquette to Piura to help her and the community.  I am really looking forward to returning to the pro-life clinic with Cecilia in the coming weeks! :) 

On another note, I tried ceviche for the first time today at lunch!  If Peru had a national dish, ceviche would be it.  Raw fish is cut into bite-sized pieces and marinated in the juice of an acidic fruit (usually lime), salt, and seasoning.  The texture takes a little getting used to, but the flavor was light, refreshing, and muy delicioso!

Ceviche

In the afternoon we had class with our profesora to solidify the topics of the two projects we will complete over the next three weeks.  For my individual project, I will be teaching the women’s group, Vaso de Leche, about arthritis and physical activity.  I’m very excited to work with this wonderful group of women, who are so eager to participate and learn!  For our aggregate project, my group has chosen Casa Maria – a women’s shelter run by la parroquia for survivors of domestic violence. We will be gathering data on this group of women to formulate nursing diagnoses and interventions, using current research to support our findings.  We will share our final project in the form of a paper and a 30 minute presentation with our teacher and members of the community during our last week in Piura.

We also discussed our impressions on community health nursing and health care in Peru thus far.  Some of the main ideas that we discussed were the differences between hospitals here and in the United States, including differences in the standards of care.   We have concluded that a lot of those differences are due mainly to lack of resources: money, supplies, medical equipment, facilities, knowledgable staff, etc.  However, it is amazing to see what these people can do with so little. Open communication, faith, and strong relationships are vital. For example, the hospice doesn't have any strong pain medication to give the patients, so as nurses it is up to us to be creative in using non-pharmacological pain management techniques.  Next, the Peruvians hold health care providers and nurses, specifically, in very high-esteem with full trust. Everyone is extremely impressed when we are introduced as las enfermeras de Marquette, and we aren't given any less respect because we are students. This status in the community provides us with many opportunities to educate the people and for them to actually listen!  On another note, it seems that the approaches to health care in both countries are similar in that it they are mainly curative.  This is where public health nurses try to make an impact – by providing care and education to aid in health promotion and disease/injury prevention in the community!  Although, public/community health is strongly dependent on the collaborative efforts of countless different people of different professions and talents.  This is extremely evident at Santísimo Sacramento, and I know that working with everyone here will continue to be a valuable experience.

Today we also said goodbye to the first session of Marquette nursing students – I’m hoping that they have all arrived home safely, and I wish them the best of luck with their pediatrics course that starts Monday! 

Hasta mañana,

<3 Lisa

First Day of Clinical!

"A woman whose smile is open and whose expression is glad has a kind of beauty no matter what she wears."  - Anne Roiphe 

We finally got to start clinical today!!!!  We unfortunately were a bit delayed in starting because Veronica, the head nurse here at the parish, wasn’t able to fit both groups of nursing students in at the same time.  On a typical day, we are sent out to different clinical sites in both the morning and afternoon in groups of two.  We will all rotate between the following clinical sites: emergency department at the local public hospital, Pro-Life Clinic, hospice, social services, midwifery clinic, and home-visits.  In addition, during our last week at Santisimo Sacramento a medical mission will be doing free hernia surgeries for people in the community, so we will be helping with pre-op and post-op care, instrument sterilization, and patient teaching.

This morning, my clinical partner Ellen and I were assigned to do home visits in a nearby pueblo, San Jacinto, with a nursing assistant from the parish, Yackie.  As we walked through the poor side of town, I talked with Yackie about some of the most common health problems – hypertension, diabetes, arthritis, and osteoporosis – that we would most likely assess.  We went to three households to visit four different patients, all of whom receive check-ups once or twice a month.  For each patient we recorded vitals, did a quick physical assessment, went over any medications that they were taking, and just talked with them to see if they had any other problems or concerns. We also helped with their personal hygiene - nail care, cutting hair, and washing their hands and feet.  These may seem like simple tasks; however, the assistance was much needed and much appreciated!  Overall, I really enjoyed the home-visits in San Jacinto; there was plenty of time to incorporate creative, individualized health teaching into the visits and to just get to know the patients and their beautiful families.  Most Peruvians live with their extended family – which tend to be muy grande – because of their close relationships and limited resources.  Another advantage to the home visits was that we were able to assess the living environment of the patients – all of the homes had dirt floors, no running water, and various animals running around. 

I really loved getting to know these two women and their family! 

The woman sitting in this chair absolutely lit up when I braided her hair and painted her nails. Unfortunately, she contracted polio as a child before she could finish her regimen of vaccines. Believe it or not she uses this chair to help her walk.

Erin had some fun teaching third graders English today!

This afternoon, we went to a presentation given by a local nurse on Peru’s public health systems.  We were lucky that our dear friend Felipe was able to come and translate for us; however, we didn’t realize that the presentation was going to be a two hour lecture in a small dark room...Felipe became a bit lazy in his translations as time went on, which ended up being extremely hilarious for those of us that can understand some Spanish.  All in all, there were a few interesting things that I took away from the presentation.  The Peruvian government believes that everyone has a right to health care; 98% of Peruvians have public health insurance and 2% have private insurance.  Despite their universal health care system, there are many flaws in the systems and many problems with the health of the country.  These include the following: a high prevalence of communicable diseases, high infant-mortality, low coverage, limited access to medications (these are not covered by the government), financial insufficiencies/inequities, disordered administration, and limited promotion of utilization of health care services to certain aggregates. To sum things up: there are A LOT of problems with Peruvian public health, which is going to be very frustrating over the next month to witness. 

Always learning,

<3 Lisa

p.s. Shout out to my Aunt Iris: Don’t worry, I have been taking a multivitamin every day!

¡Hola, Padre Joe!

“People can only live fully by helping others to live. When you give life to friends you truly live. Cultures can only realize their further richness by honoring other traditions. And only by respecting natural life can humanity continue to exist.”

This morning we toured another public hospital in Piura called Santa Rosa.  As our interpreter Felipe said, “There just isn’t enough medicine.”  The people have to often wait very long to receive care – months, weeks, and days – even in emergencies.  There just isn’t enough funding and supplies to go around, which was very obvious during the tour.  Also, the fact that the standards of cleanliness, safety, and patient privacy/confidentiality are quite different from the U.S. was also pretty evident. For example, when we toured the maternidad (maternity) unit, we went into a room with about 6 different women – some of them had already given birth and then there was another woman in labor, who was seriously about to pop when we walked in.  I’m not sure if they were going to move her to another room to give birth or not.  Meanwhile, the head nurse who was giving us the tour just grabbed a woman’s baby out of her hands (without asking) and gave her to Hope!  During my OB clinical this past semester, we had to do a three minute scrub at the beginning of each shift before we were allowed to touch any of the newborns.  We also noticed that there were no basinetts to be found – all of the babies were sleeping in bed with their mothers (the safety of this is often debated).  Down the hall, we noticed that the isolation room had a window that was open and that oncology units don’t exist in most hospitals because treatment is  simply too expensive.  We were then invited into the OR to view cataract & strabismus corrective surgeries being done by Vision International.  HIPPA certainly does not exist in Peru.

Where people can pick up a number to get in line for care.

The hospital was very open to the elements.

Hope, loving the newborn!

El grupo!

Enjoying chicha morado - a popular Peruvian drink made out of purple corn. Cheers!

In the afternoon we had an interesting presentation on natural medicine.  Our presenter, Luciano, explained to us that we need to purify and detoxify our blood every year after age 20.  “The first healer is God. He puts on earth the plants for us to use. For this we give thanks.”  He showed us all sorts of different plants that are commonly used by Peruvians for both preventive and curative health purposes.  The plants are utilized in a variety of different forms including teas, vapors, and raw.  I wish I could sneak some Uña de Gato (Cat Claw), which is used to prevent all types of illness, back to the U.S. with me!

After our presentation, we finally met the infamous Padre José, since he had been traveling for the last week collecting donations for the parish.  Padre Joe is actually from the United States – his parents and sister graduated from Marquette, and he graduated from Notre Dame University (we decided to forgive him for his unfortunate choice in schools).  However, his love for working with the poor brought him to Santisimo Sacramento, and he has been the priest here for over 19 years.  Padre Joe talked to us about the many social services that Sacramento Santisimo provides for the Piura community.  These services range from various health clinics, legal services, a family-to-family meal program, hospice, women’s groups, a substance & abuse home for men, transitional women’s shelter, and many more.  He also talked about how 90% of the population in Peru is Catholic, and there is no separation between church and state.  This is an important factor to remember when learning about Peruvian culture and interacting with the people.  Faith and religion plays a huge role in the people’s lives.

After mass there was a going away party for the first group of Marquette nurses! Here is a picture of Padre Joe & Cecilia saying a few words to the group.

On a very exciting note, we got got our clinical assignments for tomorrow! My partner, Ellen, and I will be doing home nursing visits in one of the villages tomorrow....more to come!

"Elena" & I

Salud!

<3 Lisa

La Colegia San Ignacio Loyola

We are all travelers in the wilderness of this world, and the best we can find in our travels is an honest friend. ---Robert Louis Stevenson

This morning we were invited for a tour of La Colegia San Ignacio Loyola, a private all-boys school in Piura.  We were told that this school is the second most expensive in Piura; however, the boys receive an education that sets them up to go to school at the University once they graduate.  A few “seniors,” as we would call them in the U.S., also accompanied us on the tour.  I really enjoyed learning about the education system here in Peru from Emanuel – who will graduate from la colegia in December – as I helped him practice his English.  Students go to school from 5 to 16 years old; this includes primary school for 5 years and then secondary school for 6 years.  If a student wants to go to the university, he or she must take an entrance exam, and their score determines what profession or major they can pursue.  Emanuel was an extremely motivated, bright student; he told me that his goal to go to school to be a doctor or an engineer, and he is taking a prep class to prepare him for his entrance exam.  Overall, la colegio was extremely nice, and it seemed as though the boys were very happy there, while getting an excellent education. Unfortunately, the majority of Peruvians are not quite as lucky.  On our way back to the parish, we witnessed the strike that is currently going on with the public teachers in Piura.  As a result, children that are getting a public education are out of school indefinitely.

Emanuel y yo!

Mi cinturón - making sure I didn't fall off the truck & die <3

Teacher's strike

In the afternoon, we went to La Iglesia de Santa Lucia to teach bible school.  We ended up helping the children color bible story pictures, make rosary necklaces, and play games, while another group went outside with the kids’ mothers to play volleyball.  I really enjoyed getting to know María and Alejandro who who chatted with me the whole time, despite my broken Spanish! María told me about 20 times that she would find me at mass tomorrow night, so I’m really hoping I get to see her again soon. :) 

María, Alejandro, y Michael!

After church and dinner this evening, a mariachi band came in honor of two of the girls’ birthdays in the first session of nursing students.  We had an absolute blast dancing and passing around los sombreros!

Beethoven is quite the dancer.

Con cariño,

<3 LIsa

Hospital Universitario

"I think everyone should be told they’re beautiful until they believe it."  - Unknown

I am truly content right now just sitting in our gathering space reflecting on the day and listening to the guitar music and singing coming from the salon de amistad, or fellowship space, at the church.  Santisimo Sacramento is such a welcoming place to live – full of people of all ages praying, socializing, and celebrating life at all hours of the day.  Just as I was sitting up above in our apartments, a few young girls called up to Esperanza (Hope) and I from the courtyard to come and talk with them.  After a few minutes of chatting, they excitedly asked us for a picture and our facebook profiles.

This morning all of us 23 of the Marquette student nurses went to the Hospital Universitario for a tour.  This hospital is associated with the Universidad Nacional de Piura and is publicly funded.  When we first started the tour of the hospital we couldn’t believe it was a public hospital.  How different it was from the other public hospital we toured.  This small hospital was ventilated, clean, air-conditioned, and looked similar to facilities in the U.S..  However, the biggest difference between this hospital and the other  Peruvian public hospital was one thing: there were no patients!  This beautiful hospital was built about 2 years ago; however, it is extremely underfunded and doesn’t have the money to keep it staffed and purchase all of the supplies and equipment that it needs.  We did end up finding a few patients on the second floor, but it is mainly used for outpatient visits from students on campus.

The lab isn't quite complete yet.

Our tour guide, Lys, was actually a UNICEF nurse from Brazil who was sent to Peru to help out the hospital in its beginning stages until the end of the year.  This inspiring, intelligent young woman has traveled all around the world working with UNICEF and had some interesting perspectives on Peruvian culture and healthcare. She said that Peruvian health care is most often "curative" versus "preventive."  She also expressed frustration with the fact that female college students she sees don't like to make decisions on their own; they must first consult with either their mother or their boyfriends for permission. After the tour we exchanged emails, so I hope to stay in touch with her!   

El grupo.

After eating lunch (chicken & rice) at la parroquia and embarking on an interesting trip to the supermercado with Vidal and my fellow classmates to pick up some essentials (mainly peanut butter), we went to meet with the women’s group, Vaso de Leche.  These exuberant women were extremely welcoming and so much fun to work with!  We did a group teaching session with the women about exercise, going on to lead the women in some stretching exercises and dances – the Macarena and the Chicken Dance!  Everyone was smiling and laughing the entire time as we flapped our chicken wings and polka’d around with one another. They kept telling us how beautiful we were, despite how sweaty we were dancing around in our scrubs. At the end of our meeting, we asked the women about topics that they would like to learn about and discuss in the future, so I look forward to working with these women again soon!

Afterwards, we had a tour of the church compound and were introduced to more of the services Santísimo Sacramento (http://www.santisimo.org/) offers to its parishioners and the entire Piura community. There is a full-time staff of 30 people that help with administrative duties, health clinics, nursing home visits, missionaries, sacraments, group meetings, the hospice, school, etc. We even got a tour of the new rooms that were built just a couple years ago to be used by medical missionaries that come to volunteer.  A team that did cataract and strabismus surgeries last week was just cleaning up – they did over 100 surgeries in a week!  The first group of nurses helped them with pre- and post-op care, and my group will be helping a group of medical missionaries do hernia surgeries in July.

At mass this evening, there was a special blessing for all pregnant mothers.  On the 25th day of every month (because it is believed that Jesus was born on the 25th) the mass is dedicated to these women in support of the Pro-Life Clinic.  Some of our Marquette nursing students also handed out colorful baby blankets to the expecting mothers!

The pregnant mothers receiving their blessing!

Christian & Kiara!

p.s. Shout out to Debbie McFarland: I am continually getting compliments on my angelo de enfermería!

Time to Celebrate!

"Celebrate the happiness that friends are always giving, make every day a holiday, and celebrate just living!"

This morning I was awakened not by a rooster, but by a marching band!  We were told that the soldiers at the nearby military base are practicing for Peru’s Independence Day festivities on July 28th (we unfortunately will just miss this).  After breakfast, we all hopped in the vans and trucks and headed to la iglesia de San Jacinto for Sunday mass.  At the end of the service los campesinos (farmers) of the town brought up 6 huge bags of rice as an offering to the church signifying a successful harvest.  We found out after mass that it was National Farmer’s Day, and that we had been invited as guests of la parroquia to a fiesta with the campesinos in a neighboring pueblo (town), La Legua.  One of the missionaries that was also with us told me that we had been invited because Padre Joe, the priest of Santísimo Sacramento, had given the farmers a loan 5 years ago to begin planting rice in the region.  Today, their crop has developed to such a high quality that they are exporting the rice to other countries in South America.

Los niños welcoming us!

La Iglesia de San Jacinto

Completely legal. :) 

 After another short drive through some extremely dusty roads (luckily I was riding inside with mi amigo nuevo - our driver, Vidal), we ended up at a small fenced-in compound, that I believe is usually used to store rice and various equipment.  We were joined in the compound by about 20 farmers, their families, and a very outgoing MC - the “Don Juan of Peru,” as someone coined him.  He invited one of our professors, Darlene, to help give out various awards, including ones for the top winners in the farmer’s fútbol league.  Next, he proceeded to sing a few songs for us and picked about ten of us to stand up in front.  Not knowing what was in store for us, he had 10 campesinos also come up front and had each of them pick a girl to dance with.  We all went along with, and it actually turned out to be a lot of fun! My partner Juan was quit the gentleman, lol. (We found out later that our MC was actually one of the winners of Mexican Idol, and that we might see him again at other fiestas.)  For lunch, we were served carne, arroz (no surprise there), and zupa de novios (lovers soup).  After the fiesta, we were supposed to go to a girl’s school; however, some of the DE’s were feeling sick, so it was decided that we would postpone our visit.  

Darlene handing out the first place trophy!

¡Almuerzo!

He was quite the swooner.

When we got back to la parroquia, we finished the final preparations for La Fiesta de Cumpleaños for Erika, the mother of Marquette’s adopted family! We have been paired with this family for the past couple years through the parroquia's family-to-family program, where it matches a U.S. family with a Peruvian family (often single mothers and their children) that is need of some extra help. For just $25 a month the family receives a large package of food to help them make ends meet; however, the generosity and relationship between these families often extends far beyond the monthly donation to help build homes and send the children through school.  Anyway, the party ended up being a huge success!  We played musical chairs, ate pizza and cake, and gave Erika and her beautiful family regalos in celebration of her 30th birthday. :)

Asientos musicales

Nuestra familia!

Besitos y abrazos,

<3 Lisa

p.s. Shout out to Jessica: thank you so much for the regalitos for las enfermeras y la familia! They send their all love & many thanks!