Organzing with food

I am a bit of rebel. Troublemaker. Organizer.

Sometimes that means blockading a highway, riding in Critical Mass, offering a skill share, attending a vigil, supporting a political prisoner, hosting a community meeting or throwing a party. People often forget what essential, effective organizing tools food and good times are.

There is mixed and wonderful group of volunteers here. Not to mention the amazing, passionate and beautiful community of Ollantinos that graciously opened their arms for us gringos this summer. Those things can be the start of wonderful relationships, just given a spark and moment to connect. Ana Maria, mi mamita peruana, has the perfect house for gatherings with a large comedor, years of experience hosting groups of foreigners and an ideal patio for a bonfire. We hosted a beautiful despidida for 6 volunteers recently and my family threw a fantastic birthday dinner for me that was easily the best birthday I've ever celebrated outside of the states.

Tomorrow another evening bonfire will happen, functioning as a despidida and get together for everyone. These potluck parties, drinking extravaganzas, are magical moments of friendship building, community strengthening and laughter making machines. In those moments and experiences you find and build trust with people and relationships. With that trust people will support you when a change needs to happen or when someone has to stand up to the system. Sometimes I wish the left would do their organizing at dinner parties and potlucks. Imagine the progress we could make while drinking and eating deliciousness.

Visitors

A favorite thing of mine while traveling is having friends and family come visit. Hint, hint everyone. The co-founder of the Centro de Idiomas, in Nicaragua, Dhyana, became a cherished friend of mine during that year. We bonded over our love of food, coffee, conversation, people and a commitment to bettering the world that we were born into. She is one of those people that I think about and am like, damn, she is so awesome. You know how we all have those idols or role models who do the things that really impress us? Or the things we would like to be doing ourselves? Dhyana is one of those people for me.

I emailed her in late May to say hi and see where she was, what she was up to and to fill her in on my adventures. I freaked out with joy when she wrote back to say that she was working in Peru this summer! I must of looked like a deer in the headlights of awesomeness at that moment. She is working for the Peruvian Ministry of Education and had time off towards the end of July. We planned to hang out then.

Dhyana came to Ollanta, which was wonderful because I was able to host and play tour guide, two of my favorite things to do. And sharing Ollanta, my everyday, mi familia aca and everything awesome about this place with her was great. She arrived a bit sick but my host family and I were able to dote on her. Insisting that she eat sopa de trigo and drink te de panti. Not tea made from panties, but from a little purple flower that is great for clearing up coughs and throat concerns.

We wandered around town, drank yummy coffee at El Albergue, made delicious brownies for my host family and the volunteers, and talked for hours and hours about everything. This might be, aside from her insight, intelligence and passion, the thing that I love most about Dhyana is that we can talk for hours upon hours and still have stuff to talk about the next day. Its phenomenal.

Getting updates about the Nicaraguan families I knew, our mutual friends, and Ocotal was great. It fed the fire that has been growing in my belly to visit Nicaragua again soon. My fingers are crossed for within the next year.

I'd like to raise a glass to toast those people in our lives who move us to be better, to work towards our goals and who make us feel genuine in every way.

Swedish tourists need help too.

"Coming home to Ollanta the next day was a relief. Exhausted, dirty, with sore muscles and burnt by both the sun and wind I was ready to lunch and then nap for a few hours. While drifting off to sleep, Abrahm, mi hermanito Peruano, hollered, "Demetrio! Te buscan!" What? Gah. I wrap a towel around my waist and step outside to find two volunteers, Chet and Oren,sitting on the stone wall outside my house. "Hey! Demetrius, someone is dying and theywanted us to come get you." Shit. Um….Ok. I splash water in my face, put on pants, grab myhoodie and head out. Whats going on?, I ask. "I don't know, Annie found some women in her hotel who is really sick." Awesome. Time? 3pm.

Walking to the market I have this realization: Choosing to work in healthcare means giving up a level of privacy in exchange for a skill set and commitment to society, broadly, and your community, specifically.

Amidst dust clouds from tour buses Oren and Chet give me the run down about what is going on. This woman is having heart palpitations, trouble breathing and tingling in her hands and feet. She is waiting outside the market with Annie and Chantelle. In my head, I was expecting a Peruvian woman. Why? No idea, but I was totally surprised to find that the person was Lika, a tall, blond, Swedish rock journalist on holiday.

We are now making a scene outside the market as Lika can barely stand, Chantelle runs and grabs a blood pressure cuff and we commandeer a market stall for some quiet space. I check her vitals. My guess is altitude sickness but I'm not a fucking doctor. A call with Rocio, the doctora I work with here, confirms my guess and we make a plan.

Lika needs oxygen, steroids and to get to a lower altitude. Ollantaytambo doesn't have the facilities that she needs, nor does Urubamba, so we need to get her to Cuzco. Ok, go to Cuzco, find a doctor and you'll be fine Ms. Tourist. Glitch: Lika doesn't speak any Spanish. French, English, Swedish? Yup! But Spanish? Nah. Awesome. A moment of silence passes around the volunteer circle as we all weigh the option of going to Cuzco tonight. I look at Annie, who started this mess, and she looks at me demurely as if to say, no way boy, all you. No one looks excited to take her to Cuzco. So I say, hey, what the hell a trip to Cuzco should be fun. We haggle with a taxista and then get aboard.

Ollanta is the last main train station before Machu Picchu. This blog is mostly written at that train station because the best coffee in town is at El Albergue. Daily about 10 trains passthrough town. When the trains arrive and the tourists disembark a massive traffic jam occurs .Ollanta is small and can hardly cope with the tourism boom and the strains it puts on the infrastructure. Local and national corruption guarantees a slow pace for improvement projects. For example, the main plaza is currently under construction, has been for months and while being worked on one of the roads in and out of town is shut down. The small, Incan sized roads complicate things and with every train arrival the town is plugged up for hours. A train had arrived half an hour before Lika and I tried to leave for Cusco. We waited in the taxi for an hour. Just as we got moving another volunteer, Anne Marie, knocked on our window looking for a ride to Cuzco. Anne did a quantitative analysis of the economic impact that Awamaki has on the weavers of Patacancha. It was great to have another person aboard and to discuss Anne's research.

We make it to Cuzco around 8pm, drop off Anne and book it to the hospital. We queued up forthe doctor. Lika had gone over her symptoms and story with me in the car but we recounted the tale to the doctor here. Checked her vitals again, listened to her heart and were able to check her oxygen absorption rate. Which was unsurprisingly low. The hospital doctor was in agreement with the diagnosis of altitude sickness. So, a shot of steroids was ordered up along with a few minutes on oxygen.

Intra-muscular shots in Peru are most often administered in the butt, specifically the upper right quadrant. Back home it is usually in the arm. Lika braced herself and the nurse administered the shot. Lika gave me a look that I know all too well. The "I am going to faint right now look," wide eyed, pallid and facial features laced with fear. Trying to keep her with me by talking didn't work, she blacked out, I shouted her name to wake her up and she came to. The next look she gave me was one of abject horror and then she clung to me like a limpet. We put her oxygen and I sat with her for about an hour as she recovered.

Scary right? It was scary for me too. I figured that she would be alright, but I didn't know and had to fake it the entire time. That was draining. I wonder if that fear would ever go away? Even with years of training will that nagging doubt of my own abilities linger with me?

Once Lika was recovered, we went to a swank hotel she knew of and crashed out by 11pm. Waking up in a fancy hotel with a hot shower and soft bed was nice treat. The breakfast buffethad real butter! Oh man. That was phenomenal. Lika needed some assistance changing her flight to Lima and then we got her situated for the rest of the day. I geeked a book from the hotel for the volunteer library at Awamaki and after a good hug goodbye, hopped a combi backhome to Ollanta.

Lares

Ollantaytambo is in a valley, the Sacred Valley, populated with ruins and scrubby trees. The climate here is moderate, similar to the bay with cold, foggy mornings, bright, sunny afternoons and crisp, clear nights. Pleasant in its familiarity. Lares is the next valley over and it is hot, damp, burgeoning with life and home to thermal baths. It can take 6 hours on combi and bus through Ollanta to Urubamba to Calca and finally Lares. Or you can hike 8 hours from Patancancha, over the pass and through the valley to the baths. We opted to hike.

Waking up at 5am to the sound of rain was nice yet ominous because at 2800 meters, in Ollantaytambo, rain is simply rain, but at 4600 meters, the pass to Lares, rain is snow. Ana Maria, mi mamita Peruana, forewarned me about snow and I even retreating to my bed for some quality book time but the thermal baths and challenge of the hike won out. Our group of nine left Patacancha under a soft rain and headed up the mountain towards the snow line. We crossed the snow line about an hour after starting and it became painfully apparent that none of us had properly prepared for snow. Everyone was in sneakers and a few were without rain gear. Luckily we had oja de coca, plastic bags to wrap our socks in and plenty of encouragement from to make it through.

Amidst the falling snow and our freezing toes we walked through beautiful scenery. Sighting brown, white, black and red alpacas and llamas on the hillside against the freshly snow covered hillside with their pivoting ears and cute faces was fantastic. It was spectacular. We worked our way up skinny llama trails until the herds of alpaca and llama flanked as we hiked and they ruminated happily amongst the rain and snow. A cluster of houses surrounded by sheep and barking dogs greeted us at 2 hours in. The land around the houses was dotted with mysterious dark circles that looked like a giant polka dot blanket on the mountainside. Perfect for stepping into to avoid a bit of snow, it turned out that these were urine stains from the llama herds. Awesome.

The snow descending heavily as we kept climbing. Happily sucking on coca leaves and rocking out to Lady Gaga to stave off the cold and wet, I took the lead on the hill. Looking back at the human chain behind me, dark little figures trekking in the snow, and then gazing upward at the pass and thinking, this is amazing. Cresting the pass first I celebrated with a little "I made it to the pass first" happy dance. Everyone made it up ok, we took a group photo, drank some water, chewed more oja de coca and started down the mountain.

Going down was treacherous compared with ascending. The transitioning from snow and rocks to mud to wet grass was rough. One of us fell about 20 times, everyone fell at least once and luckily all without any serious injuries. The landscape shifted from snow covered mountains to eucalyptus trees and bushes as we descended into the valley. Passing by houses, giggling children and vicious, territorial dogs we strolled towards Lares in rain soaked and mud stained clothes. Once the hot springs were sighted it seemed that each volunteer spontaneously beamed with joy. Thoroughly soaking our bodies in slightly scalding sulfurous water worked wonders for easing tight muscles after that hike. After a night in Lares with a good meal, hard beds and much laughter in the hotel we boarded a bus the next morning to return home.

No placenta left behind.

Waiting. Waiting. Taking inventory of the emergency pharmacy. Administering medication to sick babies. Nebulizing someone with pneumonia. Waiting. Waiting. Drinking mate. Drinking coffee in the dirty kitchen, three people on a tiny wooden bench. Eating cookies. Gossiping. A kitten mewls. Waiting. Waiting. Fixing insurance forms.

Knock knock knock. Doctora!

The couple is a dude who is freaking out and a woman breathing heavily, wet stains all down her sweat pants. We pile into the birthing room and send the dad to go buy needed supplies at a pharmacy. Deysi, la obstetriz, takes over. She calms the mama down, goes over breathing and what's specifically going happen during the birth. A quick check on the baby's process then a look at the clock. Part of her brain is calculating how much time until the baby must come out and the other is clearly thinking about going to bed.

The mom to be is not into it. She has been pushing for about 30 minutes now and is tiring out. The baby is still in there and mama is fading fast. Rocio, la doctora, tells momma that if she gives up the baby dies cause we can't cut anyone open in Urubamba. This motivates the mom to push enthusiastically and POP! Baby!

Healthy, 3.10 kilos, cute, eyes moving like crazy. All is well in baby world.

Mama is still having issues. The placenta came out quickly but during the birth there was some tearing and now we've got some blood flow to deal with. Deysi starts cleaning and suturing. After the external lesions are sewed up there is still bleeding. Turns out that just inside the vaginal opening is a small lesion. More sewing. We are now an hour into the birthing process and new momma is losing blood still. I've got no context for whats going on, so a part of me begins to worry but Rocio and Deysi are calm, so I do not sweat it. We get a speculum and dilate her to see what is going on inside. More blood comes pouring out and as we are swabbing inside with cotton bandages a 1 inch piece of placenta appears. Well, that is that. The bleeding stops. We are done.

Deysi wipes her brow. That birth took about two hours. She is tired. Im wired, adrenaline pumping hard at all the new information to process. Take away: Never forget to get all the placenta out!

Don't freak out.

You'll never find a bloody cotton ball on the floor of a hospital hallway back home. A midwife would never leave the birthing room filthy with a trail of blood from door to birthing table to trash can and back out the door. The hospital gowns soaked in sweat, urine, excrement, vomit, blood and other bodily fluids that pile up in a big white bucket behind the emergency room are to be washed later. But after a few hours of midday heat those gowns emit a distinct stench that infiltrates your nostrils. As a volunteer, I acknowledge that I cannot change these things. This is the reality of the situation. My role is to support, not criticize, and to work, dutifully, alongside my mentor while learning and observing todo de lo que hay.

Im going to tell you some stories. Don't freak out. During a recent night shift a drunk 55 year old man arrived, bleeding from a nice 3 inch scalp wound received during a bar fight. We cleaned, then stitched him up. As he rose from the ER chair his hair left a bloody paintbrush stroke across its top. We let it be for the night. Our following patients were told to simply avoid the stain.

One midday shift was defined by a 38 year old male victim of a traffic accident with heavy bleeding from a head wound. He was instructed to wash in a sink by an emergency nurse. A common washing technique here is to wet your hair, run your hands through it and then shake it out. Apply blood to this situation and you get a beautiful splatter pattern on the walls which has remained there for the past 25 days.

Just after luncheon last week a 65 year old woman was brought to us, unconscious and convulsing. We took her vitals, got an IV going and tried to arrange for emergency transport to Cusco plus a bed in an intensive care unit. The first bed was available at 8pm. We crossed our fingers and hoped she'd make it. She died in our ER at 6:30pm, just as the ambulance arrived. She first convulsed that morning at 8am. The family let her be because they had to work on the farm that day, had not signed up for the free government subsidized health insurance and did not have the money to bring her to the hospital. When she hadn't woken up by the afternoon and they decided to bring her in, it was too late. Maybe with new technology and more staff we could of saved her. Maybe if we had an intensive care unit in Urubamba, maybe if Cusco's ICU had more beds, maybe if the family had brought her in earlier. Maybe.

These things do not happen because no one cares, people here are dirty or do not understand basic healthcare. These things happen because, just like at home, healthcare workers and the underclasses are overworked, under paid, under valued and disrespected. The staff aft La Posta bust their asses daily take care of the people in the Sacred Valley. The 65 year old unconscious, convulsing woman without the free government insurance? She, nor her husband, had documents on them. The husband did not know his, or her, national identification number. Magali, the coordinator of insurance in our posta, searched for their children, found them and got the woman insured within half an hour to guarantee that emergency care, ambulance ride and ICU care would be free. Rocio, my mentor, called Cusco every 30 minutes to plead with the admitting doctor there to get a bed for our patient. We did everything we could with the time and resources we had. This is a patient I'll never forget.

The gentlemen with head wounds were cleaned and stitched up professionally and promptly. But with lines 5 people deep all day long outside the emergency room, no one had time to clean. There is one dedicated person on the janitorial staff. She lives at the posta, works 16 hour days and does a great job cleaning but is overworked and underpaid. Rocio works an insane schedule, that I mirror, and hasn't been paid in 4 months.

The money indicated for hiring more staff, paying the existing staff, purchasing new equipment or building improvements often vanishes. The posta was severely damaged by the intense rains that bombarded the valley earlier this year. The money given by the government for repairs ended up in officials' pockets and we got shiny new plywood consultorios and no replacement equipment. Empty boxes of gloves, syringes and medications lie around as reminders of what we do not have. If a patient needs an injection, the prescription they receive has gloves and a syringe on it as well.

With what we have people get care, get cured and return smiling and appreciative for the healthcare providers of la posta. I was bear hugged yesterday from a newborn's papa whose birth I assisted with. It was quite surprising, felt amazing and has kept my smile big and bright all day. The care here is genuine and effective. When you consider the challenges faced, it becomes even more impressive.

Healthcare is not sterile, pastel colored rooms, pristine lobbies and shiny new machines. Sometimes it is bloody cotton balls, bright red splatter stains, dirty gowns and messy rooms. That is our backdrop here. Everyday we kick ass, make patients smile, help babies come into this world and get kids with broken legs to laugh as blood runs freely from their wounds.

The ruins of Pisac and us.

Deep breathing. Step after gigantic step. Pausing for a second to survey the Sacred Valley as seen from Pisac. Back to climbing. Steep. Land terraced 2000 years ago for farming to my left and right. Ascending 600 meters just shy of an hour. Cresting the top and realizing there are three more peaks filled with ruins behind this one. I clamber around the remnants of a temple. Plop down on a stone wall as the same sun that spurred growth in Incan crops warms my back.

Grass now grows in perfectly cut stone walls. Wind pushes through stone passage ways and carries seeds in search of little dirt deposits to call home. Whispers of clouds pass over head, teasing us with cool shadows. The wet season brings rain and cooler temperatures. Those seeds take root, grab all the soil they can and push little rootlings between precision cut Incan stones.

I see all this. Giant stones shifting as wind, water, sun and plants take back the space once occupied by the Incans. Those stones will become dust and memories of this place will exist in words and stories. Un dia nos va a tocar a la misma. What will be said about us in stories? What will be remembered?

The Routine

The routine, my everyday.

A funny family of six and their noises. A combi starting, Ana yelling for Abram, the dogs barking, people shuffling in and out of the bathroom, yelps from the cold shower and the occasional restroom tune.

We all start with bread and tea, sometimes chocolatada(cacao milled with oats) for breakfast. There is the occasional cheese and the ever present, super sugary pineapple jam. They brew coffer here using the sock method. Hang a sock through a wire hoop, add coffee and hot water, strain, add sugar, drink.

A groggy walk through town. With my headphones too often in, catching up on podcasts, news, science health and food ideas or slyly rocking out. Watching everyone wake up, or noting that everyone is already way awake, and that I've been sleeping in again. This is an agricultural town. People are up early to get to the chacra and then return home and to go to another job. Ana gets the some farm time in and then opens the store down town.

Porters for the Incan Trail gather in the square around mamitas selling coffee, poncho and pancito. Blowing on their hands to keep warm and shuffling the weight of their packs back and forth.

The Urubamba bound crowds mug the combis, everyone angling for a good seat. As a 6'2" man in a country designed around people a foot shorter than myself I know all the combis and all the good seats to keep these tree-trunk legs from cramping on the 40 minute ride. A ride defined by school kids, all rowdy, stinky, boisterous, giggling and laughing while displaying little flashes of adult behavior. This is my morning lesson in patience and schoolyard slang.

The walk form the bus depot the health center brings me past Starwood resorts, basketball courts, tire repair shops and a fancy, air conditioned gas station with it's imported booze and chocolate just feet from the women hawking chicha de quinoa or roasted fava beans(delicious!).

The health centro is U- shaped, located directly across the street from the main gas station and alongside a huge Wednesday market where you can buy everything from piglets, chickens, leggings, panties, carrots, tomatoes or a dozen different kinds of potatoes. For record's sake, I've only bought carrots and panties.

The centro smells like a fake pine forest in the mornings. Norma loves it and cleans twice daily while no doubt dreaming of evergreen forests. The walls are unpainted, mostly plywood and the ceilings are high. Earlier this year there were devastating rains in Peru and the two ends of the U were ruined by flooding and rendered useless due to a massive mold infestation and weakening of the wooden infrastructure. "Emergency " consultorios - consult rooms - were built out of plywood in what used to be the lobby. Thankfully, the emergency room - topico and salon de partos - birthing room and the hospitalization/inpatients center were undamaged.

Most of our days, Rocio and I, are spent in the consultorio. A simple plywood box over dark, well worn, wood floors, a simple hospital bed, a stained movable curtain, a desk, a computer and four metal lockers define the space. That and three chairs. When I started volunteering with Rocio we had to hunt for an extra chair every morning, a chair that would inevitably disappear by the afternoon. It took two weeks of chair hunting and meeting all the staff, explaining what I was doing, before the chair remained in the consultorio semi-regularly. I've liberated a few chairs in the afternoons here.

We see about 20 patients in the morning and 20 in the afternoon as well as any emergencies that need attending to. For comparison, the doctors in my current practice see about 16 a day. Imagine what is lost in the rush.