Letter: Cachin

I’m finally putting the unbelievable experience of working with Project Helping Hands into words. It was unlike anything I have ever done before, and to be honest, I am not sure I’ll be able to convey the essence of what it was really like to be in these beautiful small communities. But I will do my best to capture it with words and photographs. During the mountain portion of the trip I didn’t bring my journal with me. I have been kicking myself ever since. I had my clinic notebook that I could have jotted down my initial impressions, emotional responses, descriptions of the people and landscape, and patients that stood out to me. But I didn’t. I think I was overwhelmed with the logistics of each day. Writing was the last thing on my mind. I regret it so much now. The days were filled with intensity from the moment we woke up until the moment we fell asleep. I will try to recapture the experience in these next posts, identified by the names of the communities. The first is Cachin, sometimes also spelled Ccachin.

Getting there

I woke up at 3:30am the morning of our departure. My pack was filled with just the essentials, since I knew I’d be carrying it for the long trek between towns. This boiled down to four main categories for me: daytime clothing, nighttime essentials (warm clothes, sleeping pad, sleeping bag), personal items, and clinic items (stethoscope, blood pressure cuff, otoscope). It’s amazing of how fast a backpack fills up with just the basics. When I left the house to walk to Llama Pack, it was still dark. Jeff walked the four blocks with me and when we arrived the house was buzzing with activity. The bleary eyed team was loading bags of medical supplies and personal belongings on top of the two vans that had come to pick us up. Jeff went back home to keep sleeping and to get the kids to school before driving our car (and a sick member of the team) up to Cachin later in the day.

The vans went up the valley to Calca, then turned north to start the ascent over the pass. It was dark and cold, then got even colder the higher we went. It is probably a good thing we could not see over the edge. The mountain roads were narrow, snakelike, and just on the edge of a long drop down. Every now and then we’d pass a roadside shrine, commemorating lives lost to accidents.

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Abra de Lares, 14,400 feet.

Sometime right around sunrise we arrived to the Abra de Lares, which is basically the top of the pass. The sun was just starting to peak out from behind the mountains and the air was freezing. Luckily I had thought to grab my down jacket out of my pack before it went on top of the van. Some of the group weren’t so lucky and were shivering in their seats. The elevation was 4,400 meters which is about 14,400 feet. Some of the group did roadside jumping jacks to warm up. Their breath was quickly cut short that high up. IMG_6567We loaded back into the vans for the descent. With the sun up now, we were able to see the steep drops off to our sides, but also stunning views of the mountains and valleys. We saw herds of alpaca and llama grazing on the sides of steep fields, and every now and then we passed a small village made up of a cluster of 5-10 houses. We passed waterfalls, snow capped mountains towering in the distance, and baby sheep bleating at us as we drove by. It was beautiful. Cold and rainy, but beautiful. We descended for a brief stop in Lares (town of about 6,000 people), then took a sharp turn back up to get to Cachin about 45 minutes later. Our early arrival was planned so that we could start seeing patients that morning. As we unloaded the vans and looked around the school to see where we would sleep and attend to patients (same room) we saw that some people had already started waiting in line. We scrambled to unpack and get things situated.

Clinic

To be totally honest, I was a little apprehensive and even disheartened at this point of the trip. It was cold, rainy, and to my somewhat type A personality, pretty disorganized. I was feeling a little useless. I didn’t really feel like part of the team. Remember, they had all gotten delayed in Lima and their bonding had been going on for a while without me. Also, they were all staying together at Llama Pack in Urubamba, while I was going back home each night. The team had gone to the salt mines in Maras, and to Ollantaytambo together. They had gotten to know each other in ways that sharing bathrooms, bunkbeds, and beers will do. I felt a little isolated, and when that happens I usually like to buckle down and do something productive. But getting a clinic set up in an elementary school while people are waiting to be seen is a bit challenging, and not super smooth. So, we put our heads together, stacked backpacks in one room, opened up the pharmacy suitcases, moved desks around, set up a triage station, assigned education roles, paired up with interpreters, and in no time we were up and running.

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The waiting room.
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Foot care clinic.
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Bonus mani-pedi.

 

 

 

 

 

 

 

 

 

 

 

The sun came out for a little while, which was nice after the gloomy beginning of the morning. Jeff arrived mid-day with one of the team members who hadn’t been feeling well. We all cheered when we saw them. The dental clinic was set up in a classroom at the end of the long school. The dentists were amazing–seeing all the kids and any adult who needed their services. I didn’t see much of the dentists the 2 days in Cachin because they were physically far away from the medical clinic, and we didn’t take many breaks together. The medical clinic was set up inside one of the school classrooms. There were 5 or 6 stations, made up of a desk, a provider, an interpreter (sometimes 2 interpreters if the patient only spoke Quechua), and then chairs for the patient and family members. We each had a little pink emesis basin to put commonly used meds in, as well as reading glasses so we could easily reach them without going back to “pharmacy.”

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Jeff in action.

Our pharmacy was made up of 5-6 giant suitcases on the floor behind the stations. The meds were somewhat organized, but there was a lot of digging around looking for what you needed. In this photo the suitcases are up on tables, which we finally figured out would make our lives a little easier. A lot of trial and error, and me wrapping my head around the fact that I needed to let go of my very American affinity for efficiency. Things started to click better for me the second day of clinic. I got into a better rhythm, knew where things were, and took breaks when I needed some fresh air.

Some of the local women came and displayed their woven products while they waited to be seen.

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Ruins

Our first afternoon, once clinic was closed for the day, the team hiked through town to some pre-Inca ruins. It was a misty, cold walk and the altitude was noticeable. We wound our way though people’s backyards, saying hello to some sheep, pigs, and lots of dogs along the way. We saw some of the people we’d seen earlier in the day, and others who we encouraged to come see us the next day. There was a feeling of team togetherness after that first day in the Cachin clinic.

Some people walked and talked together, others stayed to themselves and breathed in the thin crisp mountain air. When we reached the ruins, the clouds and mist were floating beneath us in the valley. We could see the elementary school below (through the door in the photo above), and it gave me a dual sense of accomplishment, knowing we’d seen a lot of patients earlier that day and that I could climb above my comfort zone. I was feeling a little more like part of the team, happy that Jeff and I were doing this together.

Eating & Sleeping

Our team of ~25 needed to be fed. The logistics of the trip were all taken care of by the amazing people of the Llama Pack Project (I highly recommend you check out their website and support them in any way you can). Logistics included all of the drivers, cooks, food, and transportation–be it llamas or sprinter vans. To feed this many people three meals a day for 6 days is quite an undertaking. Especially with weird clinic hours, early morning wakings, and the fact that all food and drink had to go from van to llama in the middle of the trip for transport. IMG_6587That first day in Cachin we noticed that some of the cargo was moving, and making noise. Um, hello. I’d like you to meet our friends: Breakfast, Lunch and Dinner. The bags diminished in number as the trip went on. We had very fresh chicken soup, chicken sandwiches, chicken stir fry and chicken & eggs. It was all prepared by three cooks who spent their days peeling and cutting vegetables, boiling big vats of rice and noodles, cleaning and washing dishes, and I suppose doing a bit of chicken killing. They were fantastic. No small task, considering that the entire kitchen was mobile and had to be set up and taken down sometimes in the same day. I must admit that by the end of the trip we were all a little tired of chicken, but seriously, how could we complain? I should also note that there were several vegetarians and/or gluten free folks on the trip, and every meal they had an alternative plate. Seriously amazing cooks.

Sleeping arrangements could be described as indoor camping. We moved the clinic stations to one side of the room, and spread out our sleeping pads and bags, and set up shop. In Cachin we had two main sleeping rooms. One was later dubbed the “kids room” and all sorts of antics were going on in there. Apparently we missed out on a rowdy game of truth or dare. Those millennials. (Little did I know I’d be part of the kids room in the days to follow–stay tuned). Happy to be in the adult room, we were lights out, ear plugs in, snoozing away and trying to stay warm. It was SO cold that high in the mountains. I have since discovered that my sleeping pad has a hole in it, which might explain my generally frigid nights.

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Education

A big part of Project Helping Hands is education. We had an Education Lead who assigned everyone different topics before we left the states. My topics were First Aid and Hypertension. Others included Hand Washing, Low Back Pain, Foot Care, STDs, Human Trafficking, Nutrition, Family Planning, and more. Our hot topics were definitely Low Back Pain and Foot Care. I referred so many of my patients to the back pain guy. He taught them some basic stretching and physical therapy, in addition to proper lifting techniques and strategies for farm work with reduced back strain. Almost all of our patients, men and women, were potato farm workers. They spend long days in the fields, which are literally on the sides of mountains. They work on angles you wouldn’t believe. Then they carry huge loads to town and to the market on their backs. No wonder their backs hurt.

My second morning in Cachin I got to be a part of the Education team that went to the High School on the other side of town. Unfortunately it was rainy and muddy for our 30 minute walk down the hill. We huddled together and took shelter under various trees when it got really heavy. We once again walked past cows, pigs, sheep, and the occasional alpaca on our way.

Once we got there, we divided into “screeners” and “educators.” I was slotted to be a screener, so in each classroom I met individually with each kid and went through some health screening basics. It seemed like every student in the whole school had headaches and blurry vision. I felt a little helpless asking them questions about their health that I wasn’t going to be able to do much about. This was a low point for me. I couldn’t offer comprehensive vision screening (we only had reading glasses), and I felt useless educating about good nutrition and a balanced diet when I know that many of the kids eat mostly a diet of potatoes. On the other hand, had some really great conversations with the teenaged girls about puberty, menstruation, and reproductive health. Some were super shy, but when I told them I was a doctor and I’d answer any question they had, some of the girls asked great questions and I felt like the private conversations were useful to them. The students who needed more medical care were referred up to the main clinic. This was a little challenging too, since many of the students walk up to 2 hours to come to school, so their parents aren’t around to get permission. While I was educating/screening one by one, the rest of the group was going classroom to classroom and hitting some of the big health topics for the different ages. High school in Peru starts at 7th grade and ends at 11th grade, so the range of topics changed depending on the classroom. In the younger classrooms, they were still such goofy kids. I let them play with the stethoscope and listen to each other’s hearts. They loved it. One of the boys, Alex, was known to the group leader from a previous trip. He helped translate Quechua during a clinic last time, and he helped again with our group. He is the one in the colorful winter hat. You’ll see him again!

After a full morning we hiked back up in time for lunch and then a full afternoon clinic. I definitely got into a better groove in the afternoon, seeing patients and reminding myself to embrace the chaos, uncertainty, and limited amount that I could provide. Again, the sun peaked out here and there, warming the chilled mountain air, and reminding me that it can’t always be sunny and beautiful, but when it is I must sit back and enjoy the warmth on my skin.

One of my last patients of the day leaned over and took an armful of dried corn from her burlap sack. She gave it to me as a token of her appreciation. IMG_6645I was not the only one to receive such a gift. By the end of the day we had a large sack of corn. Not knowing exactly what to do with it, Jeff brought it back to Urubamba where it now sits in a decorative bowl and reminds me of how simply some people live, and how grateful I am to have so much. There is Quechua word, ayni. The way I’ve heard it translated is reciprocity with love. This gift of corn was the beginning of my understanding the true nature of ayni. The days that followed built on that first gift of corn in unimaginable ways.

Departure

Our last night in Cachin we closed clinic late and had dinner all together. We talked about the highs and lows of the day, and planned for our departure the following morning. Unbeknownst to me, there were plans to go to the hot springs in Lares, the town we passed through a few days before. We loaded into the vans and wound our way back down the serpentine road to the most magical place. The hot springs were divided into several different pools. Some were cool, some warm, some hot, and some scalding. We stripped down (literally, since I for one had no bathing suit) to our skivvies and hopped in. It was glorious. It wasn’t even cold getting out. We were warmed to the bone. It was a late night and a cold night (wet hair!), but it sure was lovely while it lasted.

In the morning we packed up and said goodbye to Cachin. We also said goodbye to Jeff, who had to get back to Urubamba for the kids. There was a part of me that wanted to get in the car with him and head home. I was cold and still a little disheartened by my own sense of uselessness at times. But I was also starting to feel more and more like part of the team, and also excited about the prospect of hiking into the mountains to smaller communities. We took a last group shot and waved goodbye to the school, goodbye to Jeff, and goodbye to the people of Cachin.

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