I am sitting at my gate at the Lima airport a full hour and a half before my flight. My boarding pass tells me that boarding will begin an hour before the flight (supposedly) and the doors to the plane close 35 minutes before our scheduled departure (supposedly). With a round trip flight from Lima to Pucallpa already under my belt, my experience thus far with domestic air travel on LATAM in Peru is that these times are listed to encourage passengers to arrive to the airport on time, as things seem to run a bit behind schedule for one reason or another. But, I digress. Tonight I will arrive in Cusco and resume my “original” itinerary. I have spent the last 5 days in a Lima AirBnB recovering from a food poisoning incident in the Peruvian desert (more on that later), and am happy to report that I feel healthy, strong, and ready to continue. Although unanticipated, the past few days have been a wonderful chance to pause and reflect. There were many highs, many lows, and many lessons embedded in the first two weeks of my year.
After departing from DCA with carefully-chosen and meticulously-packed backpack and suitcase (which is already COVERED in scratches and scuff marks), I joined a group of medical professionals at the Dallas Fort Worth Airport en route to Lima. For the first ten days of my trip, I worked as a Spanish translator on a surgical mission trip to Pucallpa, Peru. In planning my Watson year, I had been curious to participate in and be adjacent to medical mission work to learn more about cross-cultural care interactions.
There is no denying that legacies of colonialism and white saviorism are woven deeply into the fabric of missionary work. Is there any way to hold space for these legacies while uplifting local communities and creating impactful, sustainable change? I do not have the answer. In his 1986 conference address, To Hell With Good Intentions, Ivan Illich addresses the paternalism inherent to volunteer service endeavors abroad and prompts listeners (or readers) to reflect on their intention versus their impact. This is a piece I first read years ago, but one of the perspectives I carry with me as I try to disentangle the nuanced complexities of what it means to serve and who I am capable of best serving, even in my home communities, as I look towards a career in medicine. Dialogue surrounding colonialism, paternalism, and racism in medicine are hard and uncomfortable, but essential and valuable in pursuit of providing the best possible care in all contexts, and I welcome any chance to engage in conversation with anyone who is interested.
On a related vein, I was curious: what propels individuals to travel far distances and provide medical care in distant communities? How does the positionality and collective identity of the care team enhance or inhibit their ability to provide direct patient care? How do community members perceive the visiting care team? Whose opinion about the work being done, and its relative benevolence or malevolence, matters the most? These are just a fraction of the thoughts and questions that were swirling in my head nearly three years ago as I developed my project proposal.
What I found in Pucallpa, Peru was different from what I had anticipated. I did not realize that I was working with an organization that employs locals nor did I know about their current campaign to raise funds and build a campus to further benefit the local community. Scalpel at the Cross (“Scalpel”) is a Christian medical mission organization that seeks to "be a lighthouse for Christ through a medical ministry in the Peruvian Amazon." Founded in 2004, they serve the orthopedic need of the Pucallpa community. In this time, they have grown quite the local following — amongst patients and medical professionals at the local hospital. In 2017, the organization decided "to divest American staff and invest in Peruvian staff," by hiring a local physical therapist to track patient outcomes and serve as a liaison with the local hospital. They have built an impressive electronic medical record system (a mini-version of Epic, for my medical friends) to track their patients from intake, through surgery, and across various follow-up time points. Currently, the organization is raising money to build an orthotics & prosthetics fabrication site and physical therapy center to better serve the long-term need of patients on a campus that will also house local employees. To read more about the organization, their mission, and their current fundraising campaign, check out their website.
On a very warm day in the Amazonian heat, our team saw 102 patients in clinic for various orthopedic concerns. Across three days in the OR, we preformed approximately 20 surgeries, and many more patients received non-operative injections for pain management. These days were accompanied by a cascade of thoughts, reactions, and emotions to a myriad of beautiful, eye-opening, and sometimes hard moments.
A group photo on the afternoon we spent outside of the hospital. I clearly missed the memo to wear the team shirt.
I left Pucallpa with more refined and nuanced questions than when I arrived, and eager to return and continue to develop some of the relationships I have begun to build in the area. Stay tuned! Back in Lima, I said my goodbyes to a wonderful group (we really worked like clockwork together, and I grew quite fond of them in the week and a half we spent together!) and set off on my own with a hop-on-hop-off bus ticket heading for Cusco.
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My first stop was Paracas, a small fishing town, where I spent most of my time on the balcony of my hotel room, soaking in the warmth of the ocean breeze. Between naps (I was trying to catch up on a lack of sleep from the previous week) I did venture into the national reserve for a beautiful sunset trek. The plan was to stop in smaller towns and cities along the way for two or three nights each, with some overnight rides interspersed. I thought this would be a good way to (A) see more of Peru, (B) decompress a bit from the nonstop pace of the past week and a half, (C) think more broadly about my plans for the year now that I had some sense of what it was like to be out in the world and working on my project. Also, I thought it would be a nice way to celebrate my birthday, which was a few days away.
In Huacachina, I was a bit peeved that I had somehow booked two nights at what is marketed as “South America’s Best Party Hostel,” when what I really wanted was some R&R and to be as far away from a COVID superspreader space as possible. Luckily, the front desk offered ear plugs for guests actually looking to sleep, so I grabbed a pair and left them in my room before heading off for a dune buggy tour of the Ica desert surrounding the oasis. The tour mimicked a desert rollercoaster and the views were incredible.
The next day started off smoothly. I treated myself to a birthday brunch overlooking the oasis and hopped on a bus to tour a local pisco vineyard. Let’s just say, this is where things took a turn for the ugly. Back in Huacachina, I decided it was time for the BRAT diet (bananas, rice, applesauce, toast), and went to the mini-market on my way back to my hostel room, where I purchased 2 bananas, a bag of dinner rolls, and a 3L bottle of water (you can’t drink the tap water here).
The afternoon hours dragged on. I found slight respite when a cocktail of IBGuard, Peptobismol, and Ibuprofen settled my stomach and reduced my fever and chills enough that I could fall asleep despite the blaring party music that was only semi-muffled by my earplugs. I awoke from my nap, no longer feeling like I was on my deathbed, but far from perfect. To add insult to injury, the power in the hostel was on-and-off, and with it, the fan that kept the room a bearable sensation (circulating heat is better than stagnant heat). For dinner, I ate two pieces of bread accompanied by a packet of electrolyte replenisher and was off to bed by 8pm. I awoke in the middle of the night to discover there was no water coming out of the faucet and the toilet would not flush. I went to the front desk the next morning who informed me that their water tank had run empty, but I should have water in an hour. Great.
As I waited to shower, I sat on the sun deck and researched stays in Lima. I had come to the decision that I was in no shape for an overnight bus with no bathroom, and it would be best to return to Lima, rest for a few days, and fly to Cusco. I must have left the faucet open in my slumbering haze and the tiny sink with poor drainage hadn’t been able to keep up with the flow of water that rushed from the faucet as I sat unknowingly outside. The bathroom floor was a step higher than the bedroom. When I returned to my room to see if the water had returned, I encountered a miniature Niagara Falls. Luckily, all floors were tile. In that moment, I praised my self for investing in a hard sided suitcase and a waterproof backpack; the damage to my belongings was minimal.
What felt like eons later, I found myself unlocking the door to my home for the next 5 days. In this “lovely Miraflores apartment” (the title online), I reset my stomach and reflected on the very high highs and very low lows of the first two weeks. One lesson stood out above the rest: always, always, always read reviews before booking a place to stay, especially if it's a hostel.
This blog was originally written on February 15th, 2022. WiFi connection issues and packed days in Cusco led to a delay in posting!