Lessons from the NICU

1.      Be grateful for the simple things.  Seeing NICU babies accomplish even the tiniest milestones such as breathing, drinking, or pooping is cause for celebration.  These are things I take for granted daily, but are yet so fundamental as well – it’s a reminder for me to be thankful and count my blessings.

2.      True love is unconditional and without prejudice.  Some NICU babies may suffer from physical or neurological deficits that will affect their entire lives in a profound manner.  But no matter their condition or the work required to take care of them, their parents love them even more, with all their hearts and souls.  It’s an encouragement for me to treat others in the same way.

3.      See the good and innocence in everyone.  These babies are cute, helpless, and wholly dependent right now, and it’s hard to fault them for anything at all.  But they too will become adults one day and make their own mistakes – some may even get on the wrong side of the law.  But even so, we take care of them all the same.  I am reminded to focus on the good in others, just as I do with these babies.

4.      Slow down and be patient.  I love to rush through things, and oftentimes my impatience shows through all too clearly.  But with these NICU babies, everything we do is in small steps, whether increasing feeds or weaning supplemental oxygen.  It’s truly in “baby steps”, for rushing things will just lead to future problems.  Many times in my life, I need to learn the same, to just take a breath and take it slow and easy.

5.      Life is a miracle, yet fragile at the same time.  Seeing these NICU babies enter the world in such a precarious state and exit the hospital ready to fly is a great joy and encouragement.  But there are always the sobering reminders of the few babies who never made it home.  Life is a God-given privilege that we have, not to waste, but to use wisely.

Catholicism

Since the Spanish conquistadors arrived in South America bearing sword and Scripture, Catholicism has taken root in the culture of Latin America, becoming an integral part of the very fabric of the continent itself. Although not a Catholic, I have many friends in the faith who I respect greatly, some of whom converted as adults and have shared their stories with me in detail. Through the influence of some of them, I have attended daily Mass during Lent, Good Friday services, and visited Vatican City. And it was through one of these friends that we became connected with Lumen Dei, the Catholic order which runs the hospital-clinics where we worked.

As the hospital is Catholic run, the influence of the Church was clearly evident, from the flowing robes of the nun-physicians to the medallions of the hospital’s patron saints and the large murals of Christ and Mary which hung from the walls. Every morning began with prayers in the waiting room for all the patients and each noon was punctuated with midday devotions. In the exam rooms, patient records contained a spirituality section which dictated confirmation and baptism status, and small notes on the desks reminded the doctors to serve the patients with love. Though we did not witness prayers in the exam rooms, on occasion we listened as nuns counseled of the dangers of contraception to unhearing ears.

In the midst of such strongly Catholic imagery and tradition, I felt a sense of order and peace. Every day continued in the same ritual, as it always has been. Though we did not take of the Eucharist, the nuns made us feel at home, patiently encouraging us with prayers. At one of the rural clinics in Oropesa, we happened to be present for an annual celebration. The festivities began with Mass in the hospital chapel, which was connected to the main building through an outside passage. Although I could not understand much of what the priest was saying, the few words I could comprehend resonated: Jesus is the Great Physician. Cast your cares on Him, for He will heal you. I walked out of the chapel into the warm sunlight, encouraged.

That afternoon as we headed back to Cusco via ambulance, the sister in charge of the hospital sat in the back with us and could not find a seatbelt. The ambulance began to charge down the steep, rocky path and all of us were jolted out of our seats. She quickly made the sign of the cross on her chest and laughed – and we all did the same. Pray for us, they pleaded on our last day at the hospital. We certainly will.

Español

Some say one of the best ways to learn a language is to be “immersed” in it fully by traveling to a place where it is spoken exclusively. This was one of my main goals in coming to Peru, to improve my conversational Spanish so that I could better talk to Spanish-speaking patients as a medical resident.

From the outset of my trip, I kept my eyes and ears wide open, trying my best to absorb every Spanish conversation, tidbit, or printed word. I strained my ears to hear each phrase and tried to practice my tongue with every opportunity that presented itself – grabbing doctors, nurses, patients, waiters, taxi drivers, and tourists to talk to – anyone who would give me the light of day.

It was not easy, however. I could start conversations, but often found it hard to continue them. I strained and tripped over words, my tongue halted in mid-pronunciation, arms gesticulating wildly while struggling to convey what my mind was speaking, much to the dismay of the other party.

I’ve never quite felt this way before. In most places I’ve traveled, I could speak the local language or at least resort to English while the other person adapts. This time though, I tried my best to keep the conversation in Spanish, handicapping myself. If felt like I had a disease – a speech impediment – an inability to let out what was desperately trying to come out inside. Listening wasn’t any easier. I could make eye contact, attune my ears to every utterance, and nod appropriately, but alas, comprehension was not so easy. Oh, it was frustrating to not understand, and I could see the same reactions in the speaker when I greeted their extended statements or questions with a blank stare and an apologetic smile. If others were around, such as my much more fluent classmates, I was reminded of when I was a child, listening to my parents talk but not understanding the adults’ conversation.

My month-long lesson in Spanish was not in vain, though. I did improve greatly in my comprehension and eventually could understand the gist, at least, of patient summaries during rounds and found ways to express myself, if in very basic terms. Indeed, despite having studied Spanish for many years in high school, given my Spanish level prior to coming to Peru, it would be very hard not to improve.

I realize my initial goals of achieving fluency in four short weeks were a bit naïve, but I leave Peru with a greater appreciation of the Spanish language and Latin American culture, and hope to continue to build on this foundation as I meet and treat Spanish-speaking patients in the future.

Macchu Picchu

As a member of the Incan ruler Pachacútec’s family in the 15th century, you were lucky to receive an invitation to winter at Macchu Picchu, currently believed to be a resort perched high in the mountains of the Sacred Valley, a week’s journey by foot from Cusco. The lost Incan city was “discovered” by American archaeologist Hiram Bingham in 1911 during a quest to find Vilcabamba, the last jungle stronghold of the Incans. Instead, a local villager pointed him to the ruins of Macchu Picchu, overgrown with ivy on the top of some of the most spectacular peaks in the valley.

Journeying to the ruins today is a lot easier and cushier. We took two local buses a few hours from Cusco to the historical town of Ollantaytambo, where we hopped on our comfortable, glass-ceilinged train to ride along the lush gorges of the Río Urubamba before arriving at the base of the ruins. Early the next morning, we grabbed a shuttle out of the gateway town of Agua Calientes (hot springs) to the top of the peak.

Macchu Picchu was covered by fog and light rain, as if shrouding it in continued mystery. As we were some of the first tourists there, walking through the eerily deserted buildings and pathways added to the intrigue. We didn’t linger, but breezed to the other side of the ruins to start our trek to Huayna Picchu, the mountain peak which towers behind the city. Rain made the grueling stone steps especially slippery, but we safely made it to the peak, though our views were obscured by thick clouds. Thankfully, as often happens during the rainy season, the late morning sun began to burn through the cloud jungle and reveal glimpses of Macchu Picchu – fleetingly at first, but gradually increasing in permanence until the whole city was seen.

We took well advantage of the magnificent views and, after filling our camera memory cards to our desires, started the steep descent back down to the ruins. By now, tour groups had staked ground in various corners of the ruins, and we returned after lunch to more carefully explore the ruins. The city is surrounded by self-sufficient agricultural terraces and traversed by an elaborate drainage system, allowing the foundation to stay intact until today. Some of the views from the individual homes are spectacular, with stone patios giving way to deep gorges and soaring mountain views. This was not a bad vacation resort!

Turning a corner in the city, we saw a couple with the guy proposing on one knee. After giving them a minute, we shouted “¡Felicidades!” before passing by. The excited couple showed off their matching rings with grins from corner to corner. Truly this was a fitting place in history from which to begin their own future.

Isolated

This past weekend, Tom, Brianna, and I traveled by overnight bus to the city of Puno, the Peruvian gateway to what is considered by many to be the highest lake in the world, Lago Titicaca. Surrounded by Incan creation myth and ringed by snow-capped mountains, this incredible body of water hangs like a jewel high in the Andes, and its views are not to be exaggerated.

We hopped on a small motorboat and reached the Isla Taquile after three hours, which would be our home for the weekend. This small, 7-square km island is inhabited by 2,000 Quechua people who live frozen in time while the rest of the world marches forward. We were treated to a local meal of quinoa soup, grilled trout, and coca and mint tea, after which we met our host, Mario. Mario, we found out, is our age and is a born-and-raised Taquile-ian. He mostly farms potatoes and maize for a living, but the recent tourism boom has allowed him and his wife to run a home stay and collect income from the community restaurant as well. This extra revenue has allowed for electric lighting in his house, but otherwise they do not have running water, television, internet, or any connection to the outside world. Dinner with Mario and his wife was surreal -- never have I spoken to people who were so disconnected from the rest of the world, yet so peacefully satisfied in their own simple lives. If not farming, their days consist of weaving and knitting delicate handcrafts to sell to visitors, much like their ancestors have been doing for centuries.

I tried my best to dive right into indigenous life, spending the lazy afternoon reading and writing and tucking in at an early hour. The only tourists that day, we hiked around the entire island by foot as well, admiring Incan ruins now adorned with Catholic crosses and stunning cliffs 4,000 meters high which plunged into the cold waters of the lake, which resembled more of an ocean in its size and scope. We paid a price for the views, however, as multiple applications of sunscreen in the high elevation were no match for the Peruvian sun, and we escaped with pinker than usual noses, ears, and arms.

The trip back also allowed us to stop at the Islas Uros and visit its people who live on a series of floating islands made of reeds and soil anchored to the shallow lake bottom, a most unusual (and at times bobbing and wet) experience. Arriving back on solid land, our first priority was to find someplace in Puno which was showing the Super Bowl in the midst of the drunken and festive feast of La Virgen de Candelaria. It was not easy, but we were successful and although had to leave for Cusco before the game was over, were delighted to find out the score this morning. Go Gigantes!

Quechua

Picture a deeply sun-bronzed woman in a wide-brimmed, straw hat. She is wearing a traditional, quilted vest decorated with red, green, and black woven designs which cover many more layers of wool and alpaca garments beneath. This woman speaks some Spanish, but she will tell you much more fluently in her own language that she is from the native Quechua people who live in the Andes throughout South America.

At the Casa Hogar del Campesino, or Peasant’s Home hospital where we are working, almost all of the patients are Quechua who hail from Cusco and its surrounding rural areas. These patients sometimes travel for many hours on crowded mini-buses to receive the free care provided by the Catholic nun-physicians, nurses, and staff at the hospital. Many of them are impoverished, and the generous medical care, food, and love provided by the nuns are much needed and appreciated.

Life in the rural village is often without modern sanitation, and many of the Quechua suffer from parasitic diseases such as leishmania festering in their feet and legs to amoebas and other unwelcome gastrointestinal guests. Under the seasoned eyes of the nuns, these tropical diseases are quickly diagnosed and appropriately treated. Daily farming and grueling physical activity have prevented many modern problems such as heart disease and diabetes, but are unable to stop others, such as the scourge of mental illness. Every day, patients break down from describing their internal pain through various physical complaints. These diseases are particularly hard to treat, though for the worst cases specialist care is available for consultation on a few days set aside by the nuns.

Despite the significant challenges posed to the staff, they are backed by a large church-based humanitarian arm which is able to provide basic medicines and just enough personnel to meet the needs of the endless supply of patients. Their love and patience are a daily inspiration as they greet each patient with the eyes, mouth, and hands of Señor, no matter how busy the line outside.

Sudamérica - First Impressions

After a grueling 26-hour journey, Brianna, Tom, and I finally arrived in Cusco, Peru this morning. Our 1980s era British Aerospace jetliner sliced through the clouds and negotiated a steep, lush valley before landing smoothly on the tarmac at 11,000 feet. Shortly after stepping out of the airplane, we began to feel a bit light-headed and woozy, causing us all to move a little bit slower and talk a few decibels lower.

As we drove into the city, I was reminded of many similar mountainous villages in Asia and Europe, but what struck me most keenly was the tempo here. Perhaps my altitude sickness was contributing, but it seemed that everyone -- not just us gringos -- was walking, gesturing, and eating with the speed as if a highway patrolman was watching. Talking to the muy amable local people, whether the receptionist or waiter, only confirmed these feelings.

While this pace of life is a shock to me, I am sure I will adjust to it just as my body gets used to the altitude. I only hope that we will keep our eyes open and bring the perspective we gain here back to sea level.

3 Cups of mate de coca (coca tea)-made from the leaves of the coca plant, which is used to make cocaine in large quantities but is a local cure for altitude sickness in these amounts