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.