Day 2

6/5/2012

This morning after a hearty breakfast at our favorite Eco Hotel, we set out for our first day of seeing patients!  We were as prepared as we could be - our group plan was solid, our individual roles defined, our supplies packed...but still there was an air of uncertainty and anticipation.  It was the day to put our preparation to the test, and we were all eager and nervous to see the results! 

We arrived in the small village of Huandar - just outside the larger town of Pisac - just past 11:00 this morning.  Our destination was a schoolhouse a ways up the mountain.  The bus, despite our driver's tenacity, didn't make it all the way up with its passengers, and we walked up the last stretch with suitcases in hand.  It was a good chance to test our acclimatization to the altitude!  After we arrived at the top, our Coordinator of the day directed us to our station locations, and we got to work. 

The school is on the mountainside overlooking Rio Urubamba.  Behind the school, mountains.  Across the river, mountains.  To the right, to the left, mountains again.  In the short time writing this entry before dinner, I'll leave it to a picture to describe our location instead of clumsily searching for the right words.

Over the course of my day, I saw patients who spoke Spanish and who spoke Quechua.  They were aged 2 months to 95 years.  Most of the children were healthy, with simple complaints of nasal congestion, a few days of coughing and sore throat.  There was a lovely 6yo girl with a strange tongue lesion - painful, non-healing erosions that affected the majority of the anterior third of the tongue that had been coming and going over the past 4 months.  I was stumped, no doubt.  We sent the patient and her father to the town pharmacy for a steroid swish'n'spit solution in case there was an inflammatory cause of her problem, and gave her some multivitamins in case vitamin deficiency was playing a role.  It is too bad we won´t have a chance to follow up with this young lady to see if she improves!

The last patient of my day was a 95yo lady with smile lines as deep as the Valle Sagrado.  She spoke purely Quechua and so taking a thorough history was difficult.  She was having a gradual worsening of vision, more on the left than the right. She also had worsening hearing, more on the left than on the right.  She noted dizziness when standing from lying down, headaches, and vomiting in the mornings.  On physical exam she had cataracts, and some decreased strength in her handgrip on the right side.  In the US, I would have recommended she have an MRI and referral to neurology and/or a vestibular (or balance) clinic.  This is simply not possible here, and as such the thoroughness of the care we can provide her is a faint shadow of what it would have been in the States.  We will be able to refer her to a cataract clinic that will be visiting the area this year, and this is at least something. 

Mejores deseos de Urubamba!

Isaac Schwartz, MS4, Case Western Reserve University