Meet our hosts in Pisac!

Pisac, noted for its bustling markets and echoes of pan-flute music along colorful streets, is a village in the Sacred Valley within the province of Cusco, Peru. It also houses the Asociacion Winaypaq Pro Desarrollo Humano, an association to promote health, education and culture within the Sacred Valley headed by Dr. Morales. Dr. Morales has graciously been our main contact in Peru since 2010. His passion for the Sacred Valley has mobilized health care providers in Peru and abroad to meet the health demands of its residents. On our first clinic day in Peru, we journeyed from Urubamba to the Centre de Salud in Pisac to learn more about the local population and the health challenges they generally faced.

At this health orientation, Dr. Morales and host of other physicians welcomed us and echoed our hopes for further cooperation and continued development of the project. Their hospitality shown in the warmth of their greetings, the colorful welcome banners and local variety of refreshments. Our kind hosts debriefed us on their expectations for this year’s patient profiles and clinical exposure. An obstetrician, hospitalist and nutritionist all explained the ongoing issues their patient confront and the ways in which the public health care legislation has attempted to address these concerns. We learned that all pregnant women receive free health care, which includes dental care and nutrition in addition to the general follow-ups with moms. And while trained mid-wives can attend to normal deliveries, they must refer complicated pregnancies outside the Pisac district.

We were informed of the ways in which public health officials are targeting parasitic infections in children and the challenges in treating adult patients who can’t afford to leave work for a doctor’s visit. Compounding problems and critical conditions are often the only reasons adults tend to see physicians and often times these conditions are beyond treatment. Additionally, we were given a brief overview of the cultural myths that have  dominated the region and the ways in which they affect health care. For example, congenital anomalies are often attributed to evil forces (soka or macho). Moreover, Dr. Morales explained that a lot of medications and healing traditions rely on the quality of the food they are supplementing their treatment with. Foods and drinks are inherently “hot” or “cold,” the quality of which is not dependent on the physical temperature of the food. Hence, physicians are advised to tell patients to consume whatever they believe is best for the illness because an incorrect recommendation can debase the physician’s credibility in the eyes of the patient.

After the orientation, the rise in energy level of our group was evident and we were more than excited to start our first day in clinic on Tuesday (6/11) in a beautiful village called Huandar!  Please stay tuned for our series of “Meet the patients of the Sacred Valley and Chincha.”

The date is set! 

Please join us for this year's "A Taste of Peru" Gala on Saturday, April 13th from 5-9 pm at the Cleveland Skating Club. The Charity gala will benefit the medical missions trip, as part of the CCF/Case Western Global Health Initiative, to improve the health of people in the Sacred Valley & Chincha Peru. Join us for great Peruvian food, crafts, ethnic dances and Latin music!

To purchase tickets, please click here!

2013 Applications!

We would like to announce that the application for this year's trip is now open!

We encourage all those interested to apply.  If you missed the informational meeting, please email us at the address below for a brochure.  Important details of the trip are summarized below. 

The general application is due December 14th at 6pm.

You can access the application here:  PHOP 2013 Application

If you have any questions/concerns, please direct them to phopoversightcommittee2013@case.edu

Saludos!
PHOP coordinators 2012

Trip Information:
-          Trip dates:

o   Sacred Valley: Jun 10^th – July 5^th , 2013

o   Chincha: June 24^th – July 5^th , 2013

o   2, 3, or 4 week options for students

-          First meeting dates (times and locations TBA):

o   November: 15^th and 28^th

o   December: 12^th

-          Application information:

o   Deadline for general applications: December 14^th

-          Requirements:

o   Spanish fluency (can be a beginner actively working on improving Spanish!)

o   Attendance at bimonthly meetings

o   Participation on planning committees

-          Approximate cost: 
          o   $1500 for 2 weeks, $2500 for 4 weeks (with potential partial reimbursement for student 
                               participants)

Join us in 2013!

We are now recruiting for the 2013 trip!!  Informational meetings will be held on:

Oct 2nd at the Lerner Research Institute, Room NA5-25, from 6-7:30pm.

- OR - 


Oct 3rd at the Case Western School of Medicine, Room E301, from 1:15-2:45pm.

Please join us!

Trip Recap

For the 4th consecutive year, students from CCLCM and Case SOM traveled to the Sacred Valley area in Peru for a month, to provide medical services to the indigenous population. This was organized through Peruvian Hearts (NGO) in collaboration with the local authorities and medical officers. Support for this elective was provided by CCLCM, Medwish, fundraising events, and private donations. Additionally, for the first time this year, PHOP collaborated with the Peruvian American Medical Society (PAMS), serving an additional 800 patients at the PAMS clinic in Chincha Ica, Peru.

Total # of patients seen: ~3300

Participants : 60, including 20 medical students (CCLCM, CaseSOM),  4 residents, 2 Fellows, 13 volunteer Staff members (Cleveland Clinic, University and Metro Hospitals) including Internal Medicine, Pediatrics, Ophthalmology, Family Medicine and Infectious Diseases, 5 Nurses, 2 Physical therapists and 6 non-medical volunteers.

The group traveled to remote villages, orphanages, schools, and homes for the disabled to provide primary care to the indigenous population.  Additionally, the group was able to distribute basic medications like antibiotics, analgesics, and multivitamins and screen for vision problems, fitting patients with eyeglasses as needed. Health education for patients and health care workers was provided on many topics including back pain, metabolic syndrome, and CPR. A two day educational symposium targeting health care workers was held to disseminate knowledge about common childhood illnesses, emergencies, and nutrition. A physical therapy department was established in Chincha utilizing local carpenters and resources.

In addition to learning about culturally sensitive and sustainable care in resource limited areas, the elective also provided unique networking, administrative and leadership opportunities for the medical students .With each passing year, we continue to humbly learn more about the people in these regions of Peru, allowing us to focus on sustainable interventions.  We are thrilled that our outreach continues to expand, and are looking forward to beginning planning for next year's trip. 

Post-Trip Reflections

June 28, 2012

Back home seeing patients at Cleveland Clinic, I’m reflecting on my Peru trip and comparing differences in treating patients in the developing and developed world. Chronic disease management stands out as a major difference. 

Chronic diseases have become much more prevalent in the developing world compared to decades ago when infectious diseases dominated health problems.  Many of the Peruvian locals had not seen a doctor in ages and developed chronic medical problems. As an internal medicine physician I’m required to manage such chronic conditions, however, managing chronic disease is a challenge when you’re not assured to have adequate follow up. Several patients come in with diabetes, hypertension, hyperthyroidism, etc, but the treating these conditions appropriately requires continuity. Medications often need to be titrated, and side effects need to be monitored.  For example, a patient comes in with a BP slightly high of 154/90 but asymptomatic. I know this likely needs to be treated but my concern is starting someone on a blood pressure medicine without follow up. What if they are equisitely sensitive to the anti-hypertensive causing hypotension and symptoms of light headedness? One lady I saw had epigastric burning suspicious of peptic ulcer disease, but after further questioning it seemed to be associated with exercise and became concerned that this may be an atypical presentation of angina cardiac chest pain. At the very least I would like to start this lady on an aspirin, however, what if the aspirin triggers a life threatening GI bleed from peptic ulcer disease? I’d be causing more harm than good. The bottom line is that people need a primary care doctor, and primary care requires follow up – which outsiders simply cant provide during a short trip. I foresee many opportunities to solve this problem, particularly through technology and as well as by capacity building of the local community through various community driven entrepreneurial structures.

Despite the challenges in chronic disease management, I can say with certainty that the PHOP group helped hundreds of people. Treating acute complaints and infectious diseases, referring emergencies, teaching physical therapy for back exercises, restoring eyesight with glasses, giving out toothbrushes, shoes, sunglasses, and the list goes on.  We appreciated them welcoming us with open arms, and the Peruvian people genuinely appreciated our efforts (except the one child that kicked Travis, our Friends NE rep, in the “private” parts!). Whether it is their expression as you treat them, witnessing a poor village in the Andean Valley going out of their way to cook lamb for us and naming their new health center after us, or a patient making chocolate bean dip for us, they clearly appreciated our help. And it is this appreciation from the Peruvian locals that made the mission especially rewarding. 

Vipan Nikore MD, MBA
PGY-2, Cleveland Clinic Internal Medicine Residency Program

Chincha Recap

Under the auspices of the Peruvian American Medical Society, Chincha, a small city 3hrs from Lima, was the new and additional site for our project this year. Street side rubble and empty lots continue to be grim reminders that this city was near devastated by an earthquake in 2007. Several of our patients lived in ‘homes’ with straw walls and no roof, making respiratory illnesses a common complaint.

Devastation left behind from the earthquake

At this clinic, we had the opportunity to work side by side with several specialists and volunteers from St Louis, Miami and Chicago. Besides seeing adult and pediatric patients, the students also got the unique chance to work with specialists in Cardiology, Gastroenterology, Dermatology, OB and Endocrinology in an underserved setting! It was amazing that our newly diagnosed patient with hypothyroidism could get an Endocrine ‘consult’ right way (although the Endocrinologist did confess she had never seen such severity of symptoms) or a pediatric patient with severe sleep apnea will get his surgery for free next month at the nearly hospital. Our students were amazing; I heard it over and over again from all the specialists they worked with-these docs want to time their visit with our visit next year to work with them some more! Karen Stary, our star therapist established a PT department in the short time she was there and worked with a local carpenter to make splints for patients who otherwise could not have afforded it. We screened for metabolic syndrome, provided dietary counsel, visited orphanages and schools to discuss dental hygiene, safety and domestic violence, taught CPR to more than 100 individuals, distributed hundreds of eyeglasses… a little accomplished, a lot more remaining!

Students enjoying a didactic session

All these little stories are gratifying and humbling at the same time- the mother who on the last day told me that she would be waiting for our return next year, the local nursing students who shyly took pictures with us, the hugs from our patients, the camaraderie built in the short time with other doctors and volunteers with a common purpose... we are rolling up our sleeves and looking forward to returning next year a little accomplished, a lot more remaining!

Sangeeta Krishna, MD

Cleveland Clinic Children’s Hospital

PHOP Director