Visit to Neuroscience Institute & NAMRU-6

Tuesday, May 28, 2012

Events: Visit to Neuroscience Institute (Dr. Hugo Garcia’s NCC Clinic & Lab, Museum), NAMRU-6

The highlight of today was visiting the Neuroscience Institute and meeting Dr. Hugo Garcia. This happened completely by coincidence, set up by Dr. Tilley, but this experience was very personal for me because I had worked with neurocysticercosis (NCC) last year and we actually collaborated very closely with Dr. Garcia. Although I never met the man, my PIs were conferencing with him every week, visiting him multiple times a year, and working with his reagents and slides for all of our collaborations. Since only a handful of people study this disease, everyone knows each other and the associated work in this small circle. It was really cool stumbling upon and finally meeting “the mystery man” through my GHSP experience. After touring his lab, we visited the associated museum and were able to see many brain collections, neonates with chromosomal abnormalities, and various aspects of the nervous system. Our visit to the NAMRU-6 naval base thereafter was nice and warm as we were greeted and welcomed by the Lima staff.

It may just be me, but all the foreign countries I’ve been to like Honduras, India, and Sierra Leone seem very similar to Peru, embellished by their own cultural nuances. Do similar levels of poverty lead to similar conditions/looks? Perhaps. Based purely on observation, in my mind, there are categories of urban poverty and rural poverty that differ between well-developed and developing countries. Given the environmental conditions, these conditions can look very similar from culture to culture, and from country to country. The GDP of the country as a whole also influences the fate of the poor. For example, clean running water is rarely a problem in the United States. Families of low SES from the United States that may receive government assistance and have access to clean running water may have completely different circumstances when compared to a family from Peru that lives in a floating hut, constantly surrounded by fecal water and trash.

Situational knowledge and awareness is also a factor. Having grown up in these circumstances, families may not perceive such contaminated water and trash as a source of anxiety; in fact, kids bathe in it all the time and swim in it for transport. Many houses in Belen have flat screen televisions, but are still fighting starvation and fecal contamination. What should one do in these circumstances? How does an outsider enable people to recognize the harms of their environment that they (the natives) are so accustomed to?     

People in poverty make the most of their resources. They are creative with objects (using bottles as rolling pins) and conservative in their use (reusing and rewashing). Some lifestyle choices may not be the healthiest, but what is one to do when the healthier options are often more expensive and less available? 

Arrival Monday, May 27

Lima is a bustling metropolis. By the time we left the airport, it was well after 11:30 p.m. Our chauffer, Senor Homberto Negron from Torismo Total, assured us the heavy traffic in the city was nothing out of the ordinary, despite the late hour. Under the shroud of darkness, Lima brandished its neon lights and high rises. As we drove towards Mira Flores, the buildings gradually shrank into neat rows of residences sheltered behind fences and locked gates. Mira Flores’ affluence was apparent. The use of glass in the buildings’ architecture provided an appealing contrast to the palm trees that lined the streets. This was a beautiful and obviously expensive part of town. NAMRU-6 personnel connected us to a reasonably priced hostel at $20 a person per night, La Hostal Eiffel, located in the heart of tourist district in Mira Flores. Despite the modest facilities at our abode, we were mere blocks from the Pacific Ocean, the Marriott, and numerous casinos. Understandably, Lima aims to attract tourists and investors by highlighting the city’s beauty and attractions. The inclination to present to foreigners the best that one’s country has to offer also stems from a sense of national pride. However, it may be more beneficial for visitors to see and experience an accurate rendition of the economic and social aspects of the country. It would allow foreigners to better appreciate the triumphs and struggles of the country, adding to a more enriching vacation. Coming to Peru as a global health scholar, I am in the state of mind to learn as much as I can about the way of life for Peruvians of various socioeconomic classes. However, I wonder how much of the culture can I truly understand and appreciate as an outsider who has limited proficiency in the local languages. How does one achieve substantial immersion in a short time frame?

2013 Introduction

Greetings on behalf of the 2013 GHSP Peru Team. We have already been in Peru for about 2 weeks. We arrived in Lima on Monday, May 27, and traveled to Iquitos on Thursday, May 30. Given that we have not posted any blogs until now, we will catch-up and update with some retroactive posts.

NOTE: This blog is posted on behalf of Sara Tabikh because I got to a place with internet before she did. ~Hannah :)

Hello everyone! Boy has this trip been an amazing experience; being that it is my first time being outside of the US I have truly been humbled by so much we have seen thus far. Last week we had the honor of doing rounds at the “Hospital Regional de Loreto”. The first thing I noticed upon arrival to this hospital was how huge it was; this place was a monster! It was much bigger than the clinic that we have been visiting quite often in Belen; this place had to be at least 25 times larger. The next thing I noticed were the people that inhabited the hospital, so many mothers breastfeeding their children in the waiting rooms; older patients that have been sitting in the waiting rooms for who knows how long, children running around in the hallways, and workers running from one room to the next. We received lots of stares from people because our group included myself, Derek, Hannah, Jenny, Dr. Craft, Dr. Tilley, and Dr. St.Claire (if I were alone I personally probably could have gotten away with the stares as long as I did not talk but having several men over six feet tall with light skin and light hair gives us away quite easily)!

Sara, Melita, Dr. Craft, and Jenny discussing cases at the hospital

We finally stopped in the infectious disease wards and Dr. Craft whispered to me that we were about to see things that we would never be able to see in the US. We were introduced to a Peruvian attending physician who was in the midst of explaining a patient to the ~10 students who were present. The Peruvian doctor continued to proceed with the rounds after our welcoming and we all circled around a hospital bed with a young female that looked like she was in mild discomfort. I felt so bad since the patients were already going through so much the last thing they probably wanted was a crowd of twenty people encircling them! It was an interesting new experience seeing what rounds were like, especially it being in Spanish. The doctor explained that she was 29 years old with multiple hepatic abscesses due to E. histolytica. It was interesting standing in this circle listening to the doctor who explained things in Spanish extremely well (the fact that I can somewhat understand him proves how slow and clear he was with his explanations)! Seeing the native students writing every possible detail in their little notebooks seems like a foreshadowing to what we will be doing next year! When we walked into the next room, I immediately noticed a young male in his 20’s with eyes I have never seen in my life- they were yellow and EXTREMELY bloodshot red. We quickly learned that he had leptospirosis. Dr. Craft told us that was something that he has never seen in person in his life and that there is only one picture of eyes like his that is classically used in the literature!


Cases of leptospirosis in Iquitos and the surrounding areas this year.

Other cases included a malaria case, pnemothorax due to a parasite, and several parasite infections. So what did I appreciate the most during our rounds? The kind patients that let us overwhelmingly encircle them I appreciated so much. The people in the hallways gave us all so much respect and warmth and they welcomed us with open arms. I can never look at a hospital bed in the US the same- these hospital beds were lucky to have sheets and a pillow for a patient, let alone being in an air-conditioned room with flat screen televisions as it is in so many hospitals in the US. These patients were lying in these beds (that had a mini chalkboard on top of each bed that identified each occupant) in a non-air conditioned room in sweltering heat. There was no television or radio in these rooms. How they would pass the time in a hot room all day living with their illness I have no idea. Overall, we all truly enjoyed our experience doing rounds; we will have more details of this incredible trip to come!

Sara, Jenny, Hannah, Derek, Dr. St.Claire, Melita, and Dr. Tilley outside the hospital. Dr. Craft is behind the camera.

Hola todos!


It's a perfectly sunny Sunday in Iquitos, and our group is spending the day relaxing and catching up with some overdue Internet/email correspondence. 


One of our incredible PSCOM faculty members, Dr. David Craft, departed from Iquitos this morning after spending a highly productive week with us. Through Dr. Craft's contacts with the U.S. Navy, we were able to access the NAMRU-6 microbiology and parasitology labs in Punchana, and receive the training necessary for identifying parasites (in particular, various species of roundworms and amoebas) from human stool samples. Additionally, we were able to meet with CITI-certified translators, refine our household survey questions, purchase supplies for water-sample "coliform bacteria" analysis, and begin mapping out a schedule for our group research project that is set to commence tomorrow in Belen! We're all incredibly grateful to Dr. Craft and the NAMRU-6 crew for their unwavering support thus far. And naturally we will keep you all in the loop about the progression of our latest protocol during the coming weeks.


And now an update about last year's protocol, through which our original team members (Kim, Katie, Chloe, and Derek) collected survey data and potable water samples from 50 homes located between Upper and Lower Belen. Two weeks ago, Derek and Dr. William Strosnider (of Saint Francis University) returned to Belen to discover that the neighborhood was (and still is!) flooded to a much greater extent this year than in previous years. They opted to revisit the original cohort of 50 homes. In order to expand upon the information collected via last year's endeavor, the duo enlisted two health workers, Anabela and Roger, from the 6 de Octubre Health Center to assist them in locating each home and to serve as translators when needed. 


While Derek and Dr. Strosnider were unable to revisit all 50 residences -- two had been evacuated during peak flood season and another two had seemingly vanished entirely -- they nevertheless collected useful data on home water use and contamination. In addition, they collected 46 water samples for fecal coliform/E. coli analysis and, thanks to Dr. Strosnider's expertise and equipment cache, conducted turbidity and chlorine tests on each sample. While it will take several weeks to receive the results of the coliform analysis tests from the local microbiology lab, Derek and Dr. Strosnider observed interesting trends in water turbidity and chlorine levels. For instance, it appears that homes located in more distal areas of Lower Belen (aka those experiencing the highest degree of flooding) have drinking water that is significantly MORE turbid and considerably LESS chlorinated than homes in Upper Belen or drier areas of Lower Belen. These preliminary findings suggest that residents of Lower Belen have a greater risk of consuming feces-contaminated water and therefore a greater risk of suffering acute bouts of diarrhea/gastroenteritis. We're greatly anticipating receiving out lab data in order to put the full story together.


Below, for your viewing pleasure, are some photos from Derek and Dr. Strosnider's adventures in Upper and Lower Belen. We hope you enjoy! As always, thanks for your support and hasta pronto!!

 Roger and Dr. Strosnider afloat in Lower Belen

Canoe-boat captain who facilitated the watery 

adventure through Lower Belen 

 Roger and Anabela, certified health workers 

from the Belen Health Center

 Beautiful Lower Belen, mid-morning

Perfect view from the canoe 

Anabela, Roger, and Dr. Strosnider, 

mapping the route through Lower Belen

Hey everyone!

Sorry it took us awhile to post, but we were still getting settled in and trying to figure out where to find the grocery store! Our first week in Iquitos just flew by. After a full week in the heat and humidity of Iquitos, we are gearing up for what will be a frenzied foray, visiting house after shanty in the still-flooded streets of Belen. Although we still do not have permission to do our projects (fingers crossed for June 10), our training begins this week with the arrival of Dr. Craft and visits by several of the U.S. Navy personnel who have been instrumental in assisting us with our projects. We are all very hopeful and anxious to begin the research portion of the trip, conducting surveys and collecting stool and water samples. Derek and Dr. Strosnider spent several consecutive (and exhausting!) days revisiting households in Belen as a continuation of last year’s project. He will post about their adventures in Belen soon. We anticipate perhaps even longer days for the next couple weeks to come. In the meantime, us chicas have been getting to know Iquitos and trying to find ways to make our projects go smoothly once we do start work.

Our very gracious hosts, Claudia and Ítalo (below) have made us very welcome in their home.

They have a lovely house with four floors and a patio to sit on when it gets warm out (all the time!). Here is the view of their street from the patio.

 Their neighborhood is nice and in a good part of town. It can be rather loud due to “motorcycle gangs” (they’re not actually motorcycle gangs, just groups of people driving by) like the one to the left, but that’s part of the fun! J

On Wednesday we visited the Centro de Salud clinic in Belen, and on Saturday we enjoyed some of the most delicious grilled pollo (chicken) at a barbeque fundraiser for the clinic. We also came prepared with our dancing flip flops, which was good because our Peruvian friends had a few moves to teach us. And these people can move! Latin America lives up to its reputation in more ways than one.

During our downtime we have taken advantage of a few of the local spots: swimming at the treehouse pool of La Casa Fitzcarraldo Jane and Tarzan style; enjoying the local fare of ceviche and other fresh fish, plantains, chicken, and cecina (except Sara—no jungle pork for her); and visiting Laguna Quistacocha, a nearby lake, zoo, and fish hatchery with excellent eats. We snapped some good photos of animals and food while we were there, and wanted to share a few with you.

The animals above are a marmoset and an "anta." A marmoset is essentially a cross between a tiny monkey and a gerbil, or maybe just a ball of fluff. They love fruit and are very difficult to photograph because they move their heads around so much—they’re very skittish. An "anta" looks like cross between a pig and an anteater with a miniature trunk (like an elephant’s trunk) that is very flexible for sniffing after food. They were super friendly and loved to try and lick our hands and faces.

Meal Blurbs:

Hannah—For lunch, I had “chaufa con pollo,” which is Chinese fried rice with chicken. It was very tasty, but my favorite part was the “madura,” which are the fried plantains around the edge of the plate. They are just a little sweet, so they were like dessert after lunch.

Jenny—I cannot get over how good the ceviche was at this place. It’s impossible to explain in broken Spanish to the servers that I don’t like fishy fish, so I just ordered the paiche ceviche and hoped for the best. I was NOT disappointed. Holy yum. Fresh. Not at all super fishy. Almost melts in your mouth. Behind the ceviche are these fried plantain medallions (can’t remember the name for sure). Will be returning to Quistacocha for the food!

Sara—I absolutely love the food here, especially the fish! I have had whole grilled fish twice now and I am loving it- it is very VERY delicate, moist, and I don’t mind having to work to get the fish meat off the bones. I don’t know what exactly it is that makes the fish here so incredible- working at a seafood restaurant has made me appreciate the finer taste of fish, and boy would this make the cut! I look forward to eating more and more fish the rest of my trip despite my fellow team lacking the desire to have to deal with the bones of these little guys! Love love love it!

P.S. Apologies everyone, for the quality of the photos. We are uploading this blog post from an internet cafe and things are going very slowly, so we couldn't upload full-sized images and cutting and pasting into paint messed up the area around the photos. We just really wanted you to see them!

T - 9 hours...

Greetings!

Well, we officially start driving to JFK Airport tonight at 11pm. Craziness! We're flying to Lima on Saturday morning, then going out to dinner with Jenny's friends before spending the night in the Lima airport. We leave for Iquitos early on Sunday and will be in the Amazon by 10am (they're an hour behind the Eastern Standard Time, I think) that same day. Kim's friend, Claudia--who has graciously opened her home to us vagabonds--will meet us at the airport.

We did not reach our fundraising goal with Indiegogo but, thanks to our very generous donors, we raised $995 to help cover the costs of supplies for our projects.

Big thanks to:

Mr./Ms. Anonymous
Jeanne Cusimano
Deb Gresh
Roger Barkoff
Kerry Soso
Bill Yates

Muchas gracias! You all are awesome!

~Hannah :)