Our day started early with a 7:00 AM breakfast after which
we took the public bus to our destination.
The sun was breaking out above the tall peaks to the east as we walked
down to the local bus station.
Heading off in the morning
2 The run rising over the peaks
near the hotel
The night had been
very cold but as soon as the sun came out it started warming up. This apparently is the norm and it is best to
dress in layers that you can peel off as the day progresses.
Today we were invited to a local health care clinic in
Pisac. The clinic serves the population
of about 5000 people from the 5 surrounding districts. The clinic offers mainly ambulatory services
and also obstetrics and has 9 beds for inpatient care. Anything serious is transferred to Cusco
which is about 35 minutes away. A number
of patients are from the surrounding mountain villages and speak Quechua.
Part of the visit included a reception hosted by Dr. Morales
and Dr. Edgar and the mayor of Pisca and several women from a neighboring
mountain village were present to thank the team for their contributions. Dr. Edgar gave a great overview of the health
care system in Pisac and Cusco. Some of
the main problems they are facing are:
- Access problems – some of the villages have no access roads and have to be reached via trails that can be navigated by horses or walking.
- The cultural issues – the Quechua people feel uncomfortable going to large centers where the staff may not understand their customs and traditions.
- Financial issues- The clinic gets most of its support from the local municipal administration. They salvaged 2 abandoned vehicles and fitted them with off road tires and uses these to reach remote villages and transport sicker patients to Cusco. They often struggle with supplies e.g. they have a nebulizer but may not have masks.
- They don’t have enough space and need to expand their present facilities and also build similar facilities in other districts.
- Staffing problems – they don’t have sufficient personnel to visit the villages as often as they would like. They train lay people to provide some primary care and health education to the villagers and they communicate via radio to the Pisac facility if someone needs to be transported there.
Dr.
Morales talked about the various beliefs of the Quechua. They often believe that certain health
problems are caused by evil spirits and physicians would be powerless to cure
these. So they don’t even try to seek
care. He presented a case of
neurofibromatosis who was believed to be possessed by evil spirits and no one
would help her.
They believe in certain foods being hot or
cold and these can help cure certain conditions. For example any inflammation would need a
cold food to suppress it. They lose
faith in physicians who do not know this and may not take the medications
provided by this physician.
The
visit ended with a tour of the facilities and a boxed lunch provided by the
hotel.
It
was a very instructional visit and helped put the role of our team in perspective. But it was not all work all day. Pisac had a great marketplace for purchasing
locally made handicrafts. Most of the
team went shopping while a few went to see the Inca ruins near Pisac. At 4.30 PM we took the bus back to
Urubamba. Tomorrow is a big day – the
first day of clinic and everyone is putting finishing touches on packing and
supplies and planning.
Panorama of the Pisac Mercado
-Dr. Neil Mehta, CCF Internal Medicine
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