Siete

This is it. The end. Finito.

Hospital Carrion, Lima, Peru, was an amazing experience. The day began with our typical breakfast in the hospital cafeteria. I have actually grown to really like the Peruvian style of coffee.

It starts as a dark espresso type sludge that you then water down. I liked it thick. Yummm.

We started with the patients, just as we did the day before. Nearly all patients donned their prosthesis and began working with our PT duo as Al + I did some touch ups and follow ups.

The patients were amazing. Just as the previous day, they began to move about the PT gym, exploring their new found was to move.

Since it was the last day, there was loads of picture taking, hugs. More pictures and more hugs. "Uno mas" was the phrase for the last couple days, simply meaning, one more. One more picture, one more hug, one more moment with new friends on the other side of world.

Around 1pm the patients, some hospital and rehab staff gathered together for a celebration. The head hospital administrator, Dr. Mary, Mani and Hernando all did their best through a flood of smiles, hugs, handshakes and of course tears, to muster words of praise, thankfulness, joy and hope.

The ceremony was followed by a wonderful spread of pisco sours, cerviche, choclo, inka cola, little cookies, and pastries. And as you can imagine, many many more hugs and photos.

You'd think this was the end... ;-)

The crowd began to disperse. We began to pack up our supplies. Pat was giving amazing shoulder rubs in our work room. You can see from the pic, Andy's body was not quite as malleable as it should be.

Karen was presented and wonderful ;) present of a sort of paper mache rooster....ooo, this was the hot gift.

We traveled back to the hotel to shower and gather our luggage. Made our way to the airport for our Red-eye flight. Just outside the terminal, nearly all of the patients, and Dr. Mary were there to see us of....for uno mas.

By the numbers.

10 - spine surgeries performed by Andy
13 - prosthetic legs fabricated and fit
1 - arm
20 - patients serviced
60 - PT treatments to Non-prosthetic patients in Hospital Carrion. And THEN they came to help us ;)
1000-10000...hugs.
10 - number of minutes from wherever we are, to wherever we were going, according Hernando. Usually more like 30-90
6 - Aliases for Mani, Issue-boy, sir, Indian-Peruvian-Irish John Wayne, Dr. Loco, the Ventillian Cowboy movie start. Dr. Wuss
2 - aliases for Andy...David of Md. + The God Father.
1 - impromptu chorus of "walking on sunshine" in both English and Spanish
We've touched down in Hot-lanta. It's nice to be back on American soil. I miss my family, my friends.

Even more so, I feel privileged to have been on this trip. I have some amazing new friends in Karen, Pat, Mani and Andy, and even more so with Al, not mention the

We'll see you all soon.

Adios.
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Seis

Have you met Dr. Andrew Wakefield? This year marks 7yrs of Andy traveling to Peru as part of the relief efforts of "Dreaming and working together". Andy, is neurosurgeon who operates at Hartford Hosp. In some ways, he is the team member who is least seen. In others, he is the most instrumental....no pun intended. For several years Andy has come to Peru to perform spine surgeries, introducing more advanced surgeries and instrumentation to the Carrion Hospital.

For those that know Andy, they know he is super intelligent, particular and matter of fact man....with smarshsmellow insides. That's right, I said smarshsmellow. ;)

In the 1st pic, is Dr. Wakefield with his interpreter, Estelle. ( I took this pic , by standing on a table and leaning out the window of the room that Al + I work in.) Estelle is a Peruvian PT, who works about 1.5 hrs outside Lima. When finishing her studies last year, she served as an interpreter for Andy....this year, he wanted the best back again. He's a bit particular, you know.

Over drinks last night, Estelle and her fiance asked Andy to be the God Father for their wedding in 2014. It was a touching moment.

At work, it was a fantastic day. Most of our patients were well fit by yesterday. Today was a day for prosthetic training by super PT's Karen and Pat, as well as follow up and minor adjustments/ fine tuning on our part.

In many ways it was a utopian type day for a person to receive a prothesis. Around 10am, Al gave a brief inservice via interpreter/PT student, Cindy, on prosthetic care and wear expectations, followed by a massive "team treat" of all the prosthetic patients, by the head PT of the hospital.

I am sorry, her name escapes me.

Still, look at the picture. She was barking out orders and demonstrating movements that the entire patient population participated in. I have never seen such an event. Patients from 18yrs to 60yrs rolling around. Performing general movement exercises...desensitizing; increasing awareness of body movements and positioning; activating muscle groups that may have not been called upon in many moons. It was wondrous to say the least.

One of the patients, Rosa, brought in fresh corn and homemade cheese for our group. Notice her standing behind the table. This is her 1st prosthesis. There is no crutch by her side. She moved and served her delicious dish as though she had been walking her whole life.

The corn and cheese were delicious. The corn kernels were HUGE. There were homemade sauces for the corn. The red one made my ears red and my head sweat. Mani was in heaven....runny nose included.

At the beginning of today, as Al + I were prepping supplies, Dr. Mary came in with a bottle. Chicha de Jora!!

Yes, Dad, it is a sort of special corn beer. Woooo ;)

Notice the bottle is generic. No true label. The best stuff in the world comes in bottles like this.

I hugged her graciously thanked her as we put the bottle in the cooler that we used for drinks.

At the end of the day, we were just about ready to leave. The whole crew just happened to all be in the work room at the same time. Dr. Mary came in. I said, "Oh, Dr. Mary!?" No other words were needed. She said Yes!!!....and we gathered cups and all toasted with Chicha de jora. Delicioso!!! When I finish the bottle, I will stop thumbing for the night ;)

Tomorrow will be our last day. It should be similar to today. Good follow up care and fabulous prosthetic training. I will probably get on more post out before we board the plane.

If you haven't explored it, at the top right of the blog is a scrolling album. Also, at the bottom is a series of pics. If you click either, you will be brought to the picasa album that holds them. I can't remember what I have posted and what I haven't, so come Sunday, I will upload any remaining pics that I have not posted. Check back if you want to see.

Hasta manana.

Salut

Pablo.
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Cinco

If there was ever a normal day in Peru, this was it. We got in the van to the hospital at 7am. Took a brief inhale of lunch around 2:30pm. And finally got home from the hospital by 9:30pm.

The normal part was that prosthetists got to be prosthetists and therapists got to be therapists.

Over the course of the day, Al and I were able to get all of the new patients up and training with the PTs on their new prostheses. It is a pretty amazing site.

Most of the time Al + I and the team are doing fittings in a fairly small room. But when the patient and the over all fit of the prosthesis seem good, we release them into the PT gym. In the PT gym, all of the patients are sitting, waiting patiently for their turn. Every time a new patient emerges from the fitting room, the remaining patients break out in great applause. It is then that the PT's take over and guide training.

Today was also the day scheduled when patients that had been to this clinic before could come for follow up. These are previous patients of Al and the clinic.

It was impressive to say the least. Al does a wondrous job with the patients. He so darn smooth, as though every move was preplanned. The patients coming in were all doing very well. Some were ready for replacement sockets while others simply needed new liners, and minor repairs.

By the time we were done today, every new patient was in the gym, working with the PT's and learning to remaster the art of walking. It was quite a site. Many were helping each other. Showing how they had mastered a certain aspect. Spying from my fitting room I could see patients practicing better posture in front of the mirrors. Encouraging and helping their fellow learner. Some took to their prosthesis like a baby bird learning to fly. They were scared, unsure. Had developed years of bad posturing and habits. Others were like fish in water. One gentleman, Jorge, was quickly walking around the gym while chatting on his cell phone. He was so easy and natural.
The Peruvians are a warm social bunch. With every greeting and every departing....and even a few inbetween, this is a hearty exchange of hugs. For me, a welcome change from some stuffy Americans. I think I may have given/ received some 52+ hugs today. Too many?.....nay. ;-)

Tomorrow should bring a few fittings of some returning patients. But the bulk of the day should be spent training the patients and putting finishing touches on their prosthesis. Like every day so far, I am really looking forward to it.

Hasta manana

Pablo.
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Cuatro

I thought yesterday was tough to illustrate. Today, was even worse...or perhaps better.

Hernando picked us up at 6am. He and Dr. Mary were taking us out to Ventanilla. This is a village about 20-30min outside Lima. It is located within the town of Callo.

Dr. Mary wanted to show us the village in which she has set up a free clinic.

Please see the 1st few pics, starting with me an Dr. Mary.

Peru is a country that has both the richest of the rich and the poorest of the poor...in fairly close proximity.

The conditions of Callo and Ventanilla reminded me of Haiti. There is not running water. There is limited power.

Dr. Mary, a physiatrist, runs a free clinic here. She comes every Sunday and provides counseling and general medical support for the area. Apart from Sundays, the clinic is closed unless Dr. Mary can find other support staff to run the clinic.

The clinic IS the brown structure that Dr. Mary and I are in, in the picture. The outside of the clinic, is the brown structure where we are having a makeshift breakfast picnic.

If you see Mani Seetherama any day soon, please ask him about any Peruvian Westerns that he has starred in. These women of Ventanilla were quite taken with him.

The people from the "neighborhood" knew we were coming. They had prepared a meager, yet welcoming feast of simple sandwiches. Dr. Mary gave a short speech, and clearly got a little choked up in the process.

Over dinner tonight, and after much inquiring, I learned that a "water truck" comes to Ventanilla every day. You can buy water for 9 soleis per bucket. I estimate this at about 3$/ gal. Just like the US, eh? ;-). This is not potable water. It must be treated to be drank. But it is roughly the amount needed per person, per day...for everything. Wash, cook, bathe and drink.

Try it.

Just so you know the situation, Dr. Mary is a physiatrist. She is a rehabilitation doctor. Near as I can tell, from about 7pm till about 2 pm she works for the Carrion Hospital in Lima, where we are currently working. By 2pm she goes to her "real" job at a private hospital. Here she can earn "real" money. THEN on the weekend she goes to Ventanilla to volunteer her time and energy. She is a modern day Mother Theresa.

Dr. Mary is simply incredible. Over dinner tonight, as I was asking more and more questions, she simply said," I just hope I can do good job.". Funny, because I think she IS the reason we are here and this is working so well.

We arrived back at Carrion Hospital to finally begin work around 11am. Al and I worked with the rest of our rehab staff until about 6:30 pm. Getting our patients fit. I am happy to report that nearly all 13 pts we had pre-fit yesterday were walking and doing fairly well by the time we concluded fittings today.

Of course there were a few hiccups and work arounds, but we are regrouping and refocusing on those things tomorrow.

After work, we were a bit tardy for a meeting. A local meeting of the society of rehabilitation was taking place and. Dr. Mani Seetherama and Pat Black, RPT were slated to speak. Without major preparation these 2 gave oral presents, case situations and medical decision / diagnostic methodology that were impressive to say the least. Pat really shined in her Q+A, when in response to an intricate question about .......

crap, I can't remember. My PT friends will laugh at me. Let's call it the McAllister technique. It sounded like a sophisticated joint mobilization.

Anyhooo, Pat brought the questioning therapist up. Did a brief q+a's and a few baseline assessments.

The inquiring therapist had pain + initial, personal limitations in neck range of motion. A few pokes and prods later and Pat had this lady shaking her head in + out like she was doing the Hokey Pokey. And that's what it's......

Mani + Pat were stars.

The meeting ended around 10pm. Dinner time. We walked to a local restaurant. I was most fortunate to sit at the end of the table near Dr. Mary and a great PT/ Interpreter, Estelle. I was able to ask all sorts of curiosities about the clinics, their works and plans.

Estelle is a Peruvian PT. She works a. Bout 1.5hrs outside Lima, but she speaks very good Engrish. Andy, requested her as a translator, since they had worked together in the past and he, a very particular sort of fella, really like her style.

By the end of the evening, I finally let Dr. Mary know that I really needed to try a local fare of Chicha. She and Estelle promised me that tomorrow evening I would get to try some.

They told me a little about the styles, but I'll wait till I try it before I attempt to wax on the qualities of the local quaff.

Asta manana, mis amigos.

Pablo
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Tres

Hola
Framing this 1st day is going to be a challenge, but here goes.

We met Hernando at 7am in front of our hotel. He took us to the hospital. It was a little unusual this morning for the fact that it was raining. Simultaneously, while waiting for people to emerge from their room, Hernando and I looked at each other, each asking. Did you feel that?

Lima sees less than 1" of rain per year. This was a small, yet notable event.

We also met Dr. Andrew Wakefield. A neurosurgeon from Hartford Hospital, Andy was the 1st person to begin this annual pilgrimage, almost 7 yrs ago. The team continues to grow.

Upon arriving to the hospital, Hernando toured us around the rehab. areas where we'd be working as well as introducing us to the staff.

I don't quite know how to describe Lima and the areas we've seen so far. It seems poor but not desolate. It is crowded but not suffocating.

Breakfast was at the hospital. Hard boiled eggs, light white cheese, olives, juice and light, white rolls with butter or marmalade. Coffee was like an espresso that you dilute with a half water.

Work began

Al + I saw all 13 new patients, today. We did evaluations and test fits of some of the pieces we had pre-made for the trip.

The Peruvian people seem so unique. Dr. Mary had provided us information and some pictures of our new patients. As I saw them stroll in, I recognized them from their file. "Hola, mi jamo Pablo." I would say. Each patient greeted us and left us with a genuine hug. They arrived at 8am and some patiently and enduringly waited till 4pm to be seem for the chance, possibility at a real prosthesis.

Yes, the room we work in is small. The ventilation is poor. The day was hot, but the day flew. It is so easy to get wrapped up in each case. Trying to figure out the best plan of attack...and yet accomplish the most possible for the present. Our time is short with these people. We want to be effective.

My head is starting to nod now, so I need to wrap this up.

Pic1 + 2- molding and fitting a patient. Thanks, Abby for your help with this. One

Pic 3 + 4 - Karen eating a fruit that looks a touch gross and yet is called something like Gonorrhoea.

5 - King Al, as he seems to be known, working his wondrous skills.

6 +7 - Miguel, Dr. Mary, Mani, Al, patient and me. Or Dr. Mary, Mani, Al, me, Karen and Pat.

I'll write more later.
Buenos Noches, Mis amigos.

Pablo.
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Dos

Well, after one of the longest travel days I've had in a while, we have arrived in Lima.

Hernando, our fearless leader was here, smiling wide to greet us.

As my kids can tell you, I have a knack for choosing the wrong line to stand in. I have held true to my rep. Coming through customs took an hour anyway. It didn't help that our dog chewed the corner of my passport, leaving it un scan-able. The Customs lady looked like a grocery clerk with a bar code that wouldn't scan. Had to put it in manually. Ugh..

And Then, after customs you go through a 2nd checkpoint where you are selected at random to get your bag scanned. Ding, ding, ding. I won again.
Lima is warm. Didn't need my socks, that's for sure.

The pics attached are of Hernando, fearless leader. And Pat, recharging herself ;-)

2AM here. We sprung forward and back again. Weeeee.

We start at 7AM, Manana. Time to sleep.

Pablo
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Uno

After much simply sitting around, we're off to the other side of the equator.

There will be more on our players later, but this is Mani, Al, Karen, and Pat
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