Michael in Peru Archives - Benjamin A. Gilman International Scholarship

Science, Medicine, and Global Health

June 17, 2014

Since before my freshman year of college began, I have desired to obtain the dual degree MD/PhD. The MD signifies training to be a medical doctor, while my PhD training will prepare me to perform scientific investigations. I plan to pursue a PhD in biomedical engineering, where my hope is to assist in the development and clinical implementation of novel devices and techniques. During my time abroad in Peru, these goals have not changed. In fact, this experience abroad has strengthened my resolve to achieve this goal. I now have a better understanding of where I hope my career will take me, as well as the global impact that I hope to make.

In the process of science and engineering, I believe that the most important part of the whole project happens before any experiments have been conducted, or the data has been analyzed, or even before the conclusions are drawn. The key is, first and foremost, to be asking the right questions. What is the current state of my field of discipline? What does the field need now? How will my project advance the field toward that goal? In the health sciences, that goal should always ultimately be the improvement of patient health. For me, in addition to my scientific thought process, my passion is for those that the rest of society has forgotten about. The people who need the most help are often those who are unable to reach it. As I have found through my honors thesis and experience, in Peru those people are the indigenous language speakers. The majority speak Quechua, but Aymara and the indigenous language speakers of the Amazon are also in need of improved healthcare. My life goal is to commit myself to the development and implementation of novel devices that will directly improve the lives of marginalized populations around the world.

This is not a simple task, but requires several vital steps that I have come to understand through my clinical experiences here. First, understanding the culture is key. Without an understanding of the daily life of the population, it is nearly impossible to design a device that will actually result in any kind of benefit. Diving deeper, we must understand what specific problem we are trying to solve. In global health contexts like these, it is often a question of maternal and neonatal health, nutrition, or communication. A cultural understanding will allow an investigator to see the roots of the surface problems, as well as providing guidance to solutions that would actually be socially accepted. Integration of this new technology would require ownership from the community, especially the medical personnel. In this stage of a project, my clinical training will serve me well.

Before my time in Cuzco, I had no more than a basic understanding of all these components to a career in global health. Over the past 3.5 months, both my passion to help the world’s poor as well as the intellectual understanding of how to do so have been amplified. Both of those components will serve me well in my near academic future and throughout the rest of my life.

The Oscillations of Life Abroad

May 28, 2014

While this graph certainly describes many of the joys and struggles of studying abroad, my experiences would look a bit more like the oscillations of an EEG. When I arrived, everything was incredibly exciting and invigorating. I was thrilled that my Spanish was functioning well enough for basic conversation. Every experience, from figuring out what a specific paper was used for in the clinic, to visiting the famous Incan ruins, to buying something at the local grocery store, was an adventure. My being was prickling with anticipation for what was to come in the following 4 months.

Within about 2 weeks, I was beginning to feel the pains and difficulties of living in a foreign culture. I believe the main reason for those struggles to be a lack of people from my home culture and language to interact with. I also had difficulties making friends outside the familiar college context; the clinic was not the easiest place to meet an abundant amount of people, and my Spanish was only functioning on a basic level. There were only a handful of native speakers who were willing to struggle through communication with me.

Eventually a few other Americans arrived in the clinic, and we became friends. At this stage, I was able to reengage with the culture and become excited once more, because I now had a home-base where I could recharge. We explored several regions of the country, and it was beautiful to see the unique nature and culture of the various regions of Peru.

A little over 2 months into the trip, a situation beyond my control caused me to lose contact with my group of friends. It was hard for me to lose the only people who understood the culture I came from. In addition to this, I received bad news on several other fronts, not the least of which was my 3-year-old host sister being diagnosed with a very serious medical condition. Cuzco did not have the required specialists or machinery, so she and both parents traveled to Lima to continue her hospitalization. To me, I have become a part of this family during my 3 months here. Seeing them go through this turmoil and hardship affected me on a deep level.

Most recently, my time has been committed to my senior thesis for my university back home. While I immensely enjoyed learning about the healthcare system in Peru, it sucked away time that I could have been investing in more relationships. My host family has also stayed in Lima, although extended family has come to take care of my host brother and me. Unfortunately, I do not have the relationship with them that I had with the parents of the family. As at the start of my trip, I felt alone.

I now find myself on yet another up with finishing my thesis and other good news from back home. My final few weeks here look very promising in terms of excitement and diverse experiences, so I have no doubt I will be leaving Peru on a good note. I cannot yet speak to what will happen when I return home, but I am flying away to Guatemala for June and July so I suspect I will have some irregularities in that portion of the curve as well.

Lastly, I want to make sure that you understand everything I have learned through the good and the bad times here. This trip has truly been full of some of the best and worst times in my recent past. It would be easy for me to want to magnify the good and simply forget the bad, but such an action would be me throwing away some of the most formative experiences of the trip. I can now say that I know who I am when everything around me is falling apart around me and all my support systems are 4,000 miles away. My passion for including those who feel out-of-place has grown even more; I hope that many people back in the states, especially those from international backgrounds, will benefit from this lesson I have learned. Teachings like these are every bit as important as the tremendously joyous experiences I have been blessed with. If you fear experiences like this in an experience abroad, I beg you to not let that fear stop you from adventuring away from home. Cherish the ups and the downs; if you are able to continue pressing into the culture through it all, I promise you that you will not regret taking a risk and experiencing something new.

Seeing Peru Through Peruvian Eyes

May 20, 2014

For my first few weeks, finding friends was a struggle. I have become accustomed to making friends in the university setting, but that avenue was unavailable to me here. My luck has improved since. I now have two groups of friends here in Peru. The first group consists of other internationals; we naturally bond together when no one else speaks our first language or shares our skin color. However, I also have a group of Peruvian friends whom I enjoy immensely. It is with this group that I learn about the true daily life in Peru instead of the typical flashy tourist attractions. As great as the stunning Incan ruins and colonial architecture have been, the raw Peruvian experiences have proved formational to my understanding of this country.

The first group of friends I will describe for you here are medical students from the clinic. Their names are Andy and Wilson, and they have helped me tremendously with learning Spanish and Peruvian culture along with navigating the clinical setting. I now work in obstetrics and neonatal, so they described both processes to me entirely. They took the time to teach me every component of the physical exam of newborns so that I am not entirely confused throughout the visits to each patient. I can now read patient charts as well, which gives me a deeper understanding of each examination. What before seemed like nothing but chaos and disorder has now been made clear. Yes, this clinic does look and function a lot differently than what I am accustomed to in the US. However, because of these friends, it is becoming obvious to me that the people making up the system are very knowledgeable and there are reasons behind everything I see.

Some other great learning experiences have been with my friend Kevin, who I met through a local church. I expressed interest in Peruvian cuisine, so he invited me to his father’s restaurant to learn some traditional dishes. I have eaten in plenty of restaurants here, but entering one as a friend instead of a client gave me a better grip on what the lives of restaurant owners is like. In the United States my mother owns a restaurant as well, so I was able to compare the two experiences. In Peru many restaurants are family businesses, as was the case for Kevin. His dad and cousin were the only two other employees in this place meaning that it was basically their home. I have put in my fair share of hours in Vibrant Grains, my mom’s award winning restaurant in west Michigan, but I do not play a vital role in the same way as Kevin. My mom’s restaurant requires other cooks, bakers and servers that have no relationship to our family other than business. I am learning more and more every day how Peruvian values manifest themselves in the culture and systems of Peru.

Peru’s Natural Beauty and Conservation

April 3, 2014

Michael exploring the Inca Trail

Peru is blessed with more than its fair share of natural splendor. There are 3 distinct ecological regions of the country: the desert coast, the mountainous highlands, and the Amazon Jungle. My personal experience can only speak to the breathtaking beauty of the first two. In the desert, I first visited Huacachina; it is an oasis straight out of a Hollywood film. The massive dunes surrounding the water and palm trees are used for sand-boarding, an experience unlike any other. My next visit was the Islas Ballestas, which are commonly called the “Poor man’s Galapagos Islands.” Birds filled the sky above the rocky and photogenic crags of the islands. Moving inland, I have experienced the beauty of Puno and Lake Titicaca. Lake Titicaca has an area of 3,200 square miles and is over 12,500 feet above sea level. It is an incredible sight to see such a large freshwater lake surrounded by mountains. Because of the altitude, clouds barely hover over the lake and often touch the peaks of the surrounding mountains. The culminating and most significant of my outdoor experiences was the Inca Trail, the iconic 4 day trek to Machu Picchu. Around every turn and through every pass, my gasps for air were accompanied by gasps of wonder and awe. Paired with nature’s magnificence were intact Incan Ruins that were never found and destroyed by the Spanish. These ruins somehow feel more authentic and pure than those near Cuzco, for there are few people and the preservation is superior. Of course, I must mention the natural and man-made beauty of Machu Picchu, Peru’s own wonder of the world.

Pelicans at Islas Ballestas

Huacachina

The Peruvian government acknowledges the ecological and archaeological riches within its borders, and therefore has taken a great deal of caution to preserve them. However, in Peruvian daily life environmental cautiousness is often not a concern. In the towns surrounding Cuzco, it is common for trash to be strewn throughout the land and the streets. When only organic materials were consumed in these towns there were less problems with this habit, but the commonality of plastic and glass became difficult. Instead of using trash bins like in the US, people in Cuzco leave uncontained trash out by the street. When I was engulfed by the black fumes of a bus while waiting to cross the street, it literally hit me that vehicle pollution is also a significant problem. There are not any enforced regulations about vehicle pollution here. The most commonly practiced environmentally friendly habit I have witnessed in the city is the use of public transport; that is something we could often use more of in the U.S. Even if the vehicles are dirty, there are less of them on the road than there would be if people all drove themselves. The people will need more education about environmental concerns before the populated areas can match cleanliness of the more well-known tourist attractions.

Ruins along the Inca Trail

Keeping a Level Head Throughout Ambiguity

April 3, 2014

Traveling is a brutality. It forces you to trust strangers and to lose sight of all that familiar comfort of home and friends. You are constantly off balance. Nothing is yours except the essential things – air, sleep, dreams, the sea, the sky – all things tending towards the eternal or what we imagine of it.” – Cesare Pavese

This statement certainly sums up much of my experience in Peru. It has been a fantastic month and a half, but “easy” or “comfortable” are certainly not words I would use to describe my experience. I have entrusted all my valuables (camera, computer, etc.) to a family I had never interacted with prior to my arrival. I came here without companions, so everyone I now spend time with was unknown to me when I arrived. Everything here is different; even if I find something disguised as American like a McDonald’s or a mall, I am always surprised by Peruvian cultural differences. The perpetual struggle to understand what is going on around me makes every day more tiring.

While every day is filled with examples of the “brutality” of being in another country, there are a few examples from my trip to Puno that specifically attest to the need to trust strangers while traveling. I followed my family’s suggestion to set up the trip to Puno through a travel agent who is a friend of my host family. In Peru, it is absolutely essential to know people for the best deals. However, I was not entirely confident during the scheduling process. I gave her the money, but even though I asked many times, I never received a receipt. We were told that everything would be taken care of for us; someone would pick us up at the bus station and take us everywhere we needed to go for the trips we had already paid for. After a 7 hour bus ride, we arrived at the bus station at 4:45 AM and looked for someone with a sign that had our name on it. We gave up after 30 minutes and took a taxi to the hotel, that I was told we would be staying in. However, the hotel had no reservation with our name on it. Even though it was 5:30 AM, I called the woman who planned our trip, to no avail. Through a complex series of events we finally got in touch with the travel agent and the people who came to pick us up and we learned that they had transferred us to another hotel because of last-minute pricing changes at the original hotel. Everything worked out perfectly well in the end, but it was a terrifying morning. My only option was to believe that the agent’s word was true even though all aspects of my experience pointed to the contrary. The first lesson I learned through this experience was to trust relationships when I have a deeper connection with them. Without that, I will always be certain to not hand over any money until I have an official confirmation in my hands. Second, I learned a valuable lesson about how to handle stressful and ambiguous situations. The essentials are keeping a level head and reasoning through options until one finally works.

All-in-all, my time in Peru has largely been spent off balance and confused. This high level of discomfort has also contributed to my learning; I am more alert and observant when I experience hardship. Looking back at everything I have experienced, my primary emotion is gratefulness for it all. I have not enjoyed every moment, but I can see the applicable, deep lessons I have learned through each episode.

Guinea Pig and the Peruvian Approach to Food

March 26, 2014

Peru is famous for cuy, which Americans call guinea pig. At the high altitudes in the mountains large animals can be difficult to maintain, so guinea pigs fill diets with protein. The first question any good Peruvian asks a foreigner is “Have you tried cuy?” I didn’t think my trip to Peru would be complete without eating this famous dish, so I communicated to my family that I wanted to try it. One day, I came home from work to find a full guinea pig on my plate. I must say, cuy does not taste like chicken. The flavor is difficult to describe, although perhaps the even more interesting part was prying meat off the bones of a guinea pig; that is not a behavior I was accustomed to. I did enjoy it, although there are other foods whose flavor I prefer. I have also had the privilege of visiting guinea pig farms, which is a stark contrast to the cute cages for our pets in the United States.

Peruvian Guinea Pigs

Overall, the food in Peru has been fantastic. Breakfast consists of eggs, white rice, occasionally vegetables like avocado and tomato, and fresh bread from a local oven. This bread is made in round, individual pieces instead of loaves. The mountainous region of Peru is known for its soups, and almost every lunch begins with one of these delicious dishes. Lunch will also have rice or potatoes and some type of meat. Dinner is often a repeat of lunch, since it tends to be a smaller meal that is warmed up individually. My taste buds have yet to be disappointed by a Peruvian meal.

The largest meal in Peru is lunch. Accordingly, almost all working people go home from 1 to 3 PM every day. Everyone eats lunch together. This is the primary time to meet each other and reminisce about the day. Because of this long lunch break, many Peruvians don’t return home until 8 or 9 at night. In the US, lunch is typically more of an individual affair. Dinner is our primary meal, and working people almost always eat lunch apart from family. We often will eat dinner as a family around 6 or 7 in the evening, when Peruvians would still be working. Our structure is probably a reflection of the mobility of our society. Since we often hold jobs very far from home, it could be both difficult and expensive for us to transport ourselves home and back twice a day. The Peruvian work structure is different, since jobs are almost always geographically close to home. A break in the middle of the day is not a major inconvenience for them, and I know they value time with family between stressful times at work. Overall, the Peruvian system is different, but I am seeing how it is very consistent with the values of Peruvian culture.

Adapting to Life in the Clouds

March 18, 2014

When I signed up to spend four months in Peru, I knew the first few weeks would be a challenge for me. I knew no one in Cuzco, the city which I now inhabit. I had only taken one formal Spanish course in the university, which is far less than most who study abroad in a country that does not speak their native language. I was able to converse on a basic level with Spanish-speaking friends back home, but whenever my vocabulary faltered we could just switch to English. No one speaks English in neither the clinic where I intern nor my host home, so that safety net was left in the U.S. I knew this was exactly what I had signed up for, but I began to realize that all my thoughts couldn’t adequately prepare me for setting foot in another country for the first time. Excitement and nervousness churned together in a maelström that consumed my thoughts for several weeks before departure.

Upon arrival, everything started coming together. Cuzco is a beautiful city, full of rich history and exquisite natural beauty. I have adored mountains, since taking up rock climbing after a visit to Yosemite, CA. At an elevation over 11,000 feet, which is about one-third the cruising altitude of many commercial jets, mountains are inescapable. Awe washed over my exhausted body as I stepped off the plane and looked at the spectacular green peaks around me. When my host family came to pick me up, I was relieved that my Spanish was sufficient to communicate with them. Life would not entirely become a game of charades for the next four months. Female Peruvians greet men and women by touching cheeks and kissing the air. I knew these greetings were coming, but I still had some apprehension about putting them into practice. I quickly learned that going with the flow is the optimal protocol for figuring out cultural differences like that one. Additionally, I was fortunate enough to evade altitude sickness upon my arrival to this city in this clouds. Within a day or two, my previous apprehensions had settled.

Main Street in Cuzco, Peru

Despite the lessening of this initial apprehension, there have been difficult situations to navigate and days that were hard to endure. For example, Peruvian public transport system is very different from the car-dominated area where I live in the states. I need to ride the bus 30 minutes every day to arrive at Clínica Belenpampa, where my internship is held. The bus system here is not organized the same was as in the U.S. Instead of having a list of when each bus route will arrive at my stop, buses come and go as they please. Each bus has a designated advertiser that shouts the stops and tries to convince people to get on. Buses navigating the same route under the same name are not an identical set; my inability to recognize this in homogeneity has caused me to wait for extended periods of time at bus stops on numerous occasions. Additionally, to get off the bus, there is no string to pull to let the driver know that you would like to get off at the next stop. Instead, the advertiser shouts the stop names so that everyone can hear, then listens to hear if anyone requests to get off. When sitting in the back of a packed bus with all seats filled and two rows of people in the aisle, communication with the front is difficult. More than once I have realized I was going to be late to my next destination as the bus flew by my stop.

That said, minor frustrations such as buses or the language barrier cannot stop me from loving this place. What I most appreciate and want to make sure I integrate into my life is the Peruvian approach to relationships. For example, when a Peruvian walks into a room full of family, they greet every person individually. A broad “hello” is not enough, because you are not showing your appreciation for each individual. I was invited to a family reunion with my host family this weekend in a nearby town, and I got to see the Peruvian value of family and relationships first hand. I did not time how long it took my host father to say goodbye to everyone, but I promise that everyone left that gathering knowing they were part of a loving family that cherished them. There are certainly cases of tight families in United States, but Peruvian culture seems to be a system that fosters care and value to all who partake in it.

Overall, my experience suggests that the most critical component of adjusting to a new culture is staying engaged. Getting frustrated should not lead to retracting and pulling away; it should nurture a new understanding that will inform the future. Every day I learn how to better navigate the bus system. Every day I learn a more of the medical Spanish that is rattled off at break-neck speed in the clinic. This ability to learn and grow in a new culture is often dependent on our ability to continue to pursue understanding and friendship even in the midst of miscommunication and frustration.

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