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Nandini Razdan recently returned to the US after completing an internship with MEDLIFE in Lima, Peru, and is now applying to go to medical school. Read more about her experience with patient follow-up in her Intern Journal entry below.
Over the course of routine patient follow-up appointments, I had the opportunity to meet a very special patient named Eduardo. We met with Eduardo's mother near his house in an extremely dusty and desert-like community on the outskirts of Lima. While walking to their house, Eduardo's mother took the time to stop, pick-up, and drag a large piece of cardboard all the way to the front of her house, where there was already a growing pile of trash. I later found out that selling recyclables was the primary means that Eduardo's mother earned money, as most of her time was spent caring for Eduardo.
We entered the humble dwelling and made our way to the bedroom that Eduardo and his mother shared. Before embarking on our journey to Eduardo's house, I had failed to ask MEDLIFE doctor, Dr. Jose, about the patient's condition and history. My jaw gaped open and my breathing stalled as I entered the bedroom and saw what seemed to be a breathing skeleton.
Eduardo had the misfortune of developing Cerebral palsy (CP) as an infant. Cerebral palsy is a group of non-progressive conditions caused by damage to the motor centers of the brain. CP causes physical disability in human development, primarily concerning bodily movement. Limited movement leads to limited activity, which can be accompanied by lack of sensation, sight-based perceptual problems, communication problems, and sometimes impaired cognition. In the unfortunate case of Eduardo, he choked on a small piece of food as a baby, and for an extended period of time was unable to breathe. The hypoxia caused cerebral damage, and from then on, his life would never be the same. Eduardo is now in a near vegetative state -- unable to talk and minimally able to move. The years of lack of movement have caused his body to become deformed; he is all skin and bones with no muscle or fat to be seen, and his hands are completely bent forward due to lack of usage over the years. He is unable to speak and his inability to control his bowel movements forces him to wear a diaper. Eduardo does have some level of remaining cognitive perception. He smiles when he is happy and whimpers when he is sad. He recognizes his mother and is able to understand basic conversation, even though he is unable to respond.
Eduardo's story really hit home for me in various ways. I had an older sister who for ten years of her life was also in a vegetative state, but due to a genetic disorder, not Cerebral palsy. Living in the US, my family struggled with dealing with my sister's condition, but still had access to some of the best home-care possible for her from the first day of her illness. My sister had a comfortable hospital-style bed, a state-of-the-art wheel chair, access to any medicine she needed, and nurses at her bedside day and night. Eduardo had a simple bed with a quilt and few pillows, and a second-hand wheelchair that looked uncomfortable for his bony body and that caused his feet to drag on the floor.
The purpose of our visit to Eduardo was to give him a nebulizer treatment because he was having trouble breathing. As I held him in my arms during the treatment, I looked above and saw a roof full of dust, which clearly was not helping his breathing. Had we not come to bring the treatment, Eduardo's mother would not have been able to afford paying for the treatment in the hospital. My sister's illness was incurable, but CP has the potential to be prevented from worsening through years of care and therapy with specialists. With the lack of resources living in poverty in Lima, Eduardo's family had little to no chance of accessing the specialists needed to prevent his condition from developing as it had. When MEDLIFE first met Eduardo several months ago, extensive damage had already occurred and follow-up treatments were limited.
Eduardo's mother told me about Eduardo's history, and I was shocked to find out that the small body I held was that of one who was a whole year older than me! I thought Eduardo was no more than 10 years old, and he was actually 23. Two things struck me with this new finding; firstly, how much life and will to live was in this human to have made it to 23 years in such a physical condition? Secondly, I noted how different our lives were despite our similarities in age -- simply due to fate. I am a 22-year-old enjoying my time in Peru and trying to add to my experiences in order to enhance my career. Yet this 23-year-old was simply trying to live another day and breathe a bit better. Furthermore, Eduardo's mother told me that Eduardo's father had passed away from liver disease just two weeks before, making her the primary breadwinner. Eduardo's father had been an alcoholic, and one can imagine that the stresses of poverty and caring for a handicapped child contributed to his drinking problem. Also, she had another daughter who was 16 years old, but who lived with another family because she was unable to take care of both Eduardo and her daughter. Had my own family been in this family's position living in poverty in Peru, I could have easily been that daughter who was forced to live with another family because my own could only take care of my sister.
Dr. Jose has been taking care of Eduardo for two years, visiting him whenever he needs medicine or when he is sick. A few days after my first encounter with Eduardo, I accompanied MEDLIFE nurse Ruth Varona to take Eduardo to the hospital because he potentially had pneumonia. Being seen by a doctor in Peruvian public hospitals can be a very lengthy process. It took approximately six hours for Eduardo to finally be seen by a doctor in the emergency department, yet nurse Ruth stayed and waited with Eduardo and his mother the entire time. Eduardo might not have access to the home care that he deserves, but having his devoted mother by his side at all times and MEDLIFE doctors and nurses ready to help are the only reasons I can think of for the smile on this fighting 23-year old's face.
Last week, three members of the MEDVIDA Ecuador team, Martha Chicaiza, Maria Chavez and Luis Cartagena, came to visit our office in Peru and get a taste of fieldwork in the shantytowns outside Lima. For Maria and Luis, it was their first visit to Lima and the first time they experienced in person the work that MEDLIFE does here. What did they think?
"Before my visit, I thought Lima would be nicer," said Luis. "But I was stunned when I saw the amount of poverty in Pamplona, and people who didn't have basic services, in comparison to the city of Lima. I can't stop thinking about the injustice of what I saw."
Though the MEDLIFE office in Riobamba, a rural region of Ecuador, deals with the same issues of poverty and lack of health care, they manifest themselves in different ways. Luis said the most surprising difference for him was the imbalance in living conditions in different social classes in Lima. He says the rural poor that he sees in Ecuador generally have a better quality of life than those in the city. "And if poverty exists in Lima it is because of the land invasions, because where people come to take possession of the land, it's all rocks where nothing can grow, and so living from agriculture is impossible and they go to work in the city," he said. In Ecuador, emigration to large cities for job opportunities has also become a widespread trend, though the cities do not experience the kind of land invasions seen in Lima.
Because the fieldwork in each location of MEDLIFE is built on listening to the needs of the local community, a lot can be learned from sharing experiences and ideas between them. The Ecuador team agreed that the visit to Lima was an educational and memorable experience. "The visit inspired me to work even harder to improve conditions with MEDLIFE," said Luis. "I'll always remember the times I shared with MEDLIFE colleagues and the things I learned thanks to the tour."
As a student at Florida State University, Mauricio Parra-Ferro founded a MEDLIFE chapter at his school and spent a summer interning in Lima, Peru. Even after graduation, he remains involved with MEDLIFE's work, and came back to Lima for a week this March to help out at a Mobile Clinic. Now back in the States working as a biology teacher for underserved middle and high school students and preparing to go to medical school, he took some time to reflect on his visit with us.
My involvement with the MEDLIFE Florida State University chapter has made it very near and dear to me, and seeing how much the chapter's expanded this past year makes me both amazed and extremely proud. With its 47 students, FSU comprised approximately 80% of the March 11-15th Lima Mobile Clinic. However, it was the combined effort from all of the universities which made the clinics and development project so successful.
Throughout the week, I spoke with several of the students to discuss their opinions on global health, the most memorable experiences, and what they hoped to get out of the trip. I was very pleased upon hearing the responses. Everyone seemed to understand the importance and necessity of real sustainability, and they appreciated how MEDLIFE always aims to create this through improvement of the local infrastructure, and through consistent patient follow-up. Moreover, rather than only focusing on their own experiences, they would often talk about the patients they saw in the various stations, the communities they visited, their admiration and respect for the MEDLIFE staff, and the reoccuring issues they were exposed to.
While several people came prepared, having learned various Spanish phrases and studied the Peruvian culture, I feel confident that everyone managed to leave with an altered perspective on life. The educational and eye-opening experiences which MEDLIFE provides gives participants the opportunity to expand their knowledge and subsequently be better prepared to serve others in the future, especially those who live in areas of extreme poverty.
In conclusion, my time helping run the clinics was everything that I hoped it would be and more. It was extremely refreshing to visit and work with the old MEDLIFE staff, people whom I consider family, and I loved meeting and getting to know the new members of the team. I sincerely appreciate having had the opportunity to be welcomed back to the communities to interact with residents, and help make even the slightest bit of impact on their lives. I have come to realize that throughout all of my volunteer efforts, especially the ones through MEDLIFE, while giving back to those who need it the most is undoubtably a rewarding feeling, it will always leave you feeling like you want to come back and do even more.
Nandini Razdan, a recent graduate of the University of Delaware, joins us in Lima, Peru for an internship this month! Learn more about Nandini and how she got involved with MEDLIFE in the Q&A below:
Tell us a little bit about yourself.
I graduated from the University of Delaware (Go Blue Hens!) in Spring 2012 with a degree in Biology and a minor degree in Spanish. I grew up right outside of Philadelphia in good 'ol Wilmington, Delaware. My passions include going out with friends, watching political and social documentaries, eating pizza every day and all day, and dancing. Dancing was a huge part of my collegiate life, as I danced on two different South Asian/Indian dance teams. I aspire to become a bilingual primary care physician working in underserved areas in the States, as well as hopefully becoming involved in global humanitarian work.
How did you get involved with MEDLIFE?
In Winter 2011, I volunteered in a MEDLIFE mobile clinic in Cusco, Peru. I initially signed up for the clinic because I felt that humanitarian aid was something I wanted to become involved with as a future doctor, so I wanted to get a taste of what it actually required. My experience there was absolutely unforgettable. Being able to actually work hands on with patients in a way that you usually can't in the States was a treat, and being able to help intervene in the health of 751 patients in one week was a true gift.
Why did you decide to become an intern?
I applied to be an intern for MEDLIFE because I felt that as a clinic volunteer, I had only scratched the surface for the amount of impact I personally wanted to make on the poor communities and how much I wanted to learn about global health. What stood out to me the most as a clinic volunteer were the reasons that many of the health problems existed and how preventable they were. In Obstetrics, it was shocking to see case after case of pap smears potentially positive for cervical cancer. The high levels of cervical cancer in Latin America are partially attributed to the lack of women's health education, but also ignorance of consequences of promiscuity in relationships. While assisting the doctors, I saw that common gastrointestinal issues were a result of unclean drinking water. Additionally, many patients' painful headaches were often associated with poor dental hygiene. Preventative health education is currently being highlighted in the United States healthcare system, so I think it is important for pre-health professionals to become exposed to that aspect of healthcare. Two things that stood out to me about MEDLIFE were the health education presentations and materials that were handed out during the clinics, and also patient follow-up when the clinic was over. As an intern, I wanted to be involved in researching some of the relevant health problems and hopefully helping to present these to the communities. Also, I wanted to see what happens behind the scenes once the clinic weeks are over through patient-follow up.
What was your first impression of Lima?
Coming back to Lima was like falling in love with South America all over again after having previously travelled to Chile, and Lima and Cusco in Peru. I landed in Lima around midnight and woke up the next morning at 6 am on a summer day (escaping the winter in the USA) to the sound of chirping exotic birds and a fresh glass of juice, and pleasant weather. I was immediately immersed into helping with the clinic. The bus driver blasted salsa and reggaeton music during the commute to the clinic, which was even more effective than a morning coffee. The best thing about Peru in general is that the people here are extremely friendly. The friends that I had made before welcomed me back with open arms, and the new friends I have made both in MEDLIFE and otherwise have made my stay so far amazing.
Tell us an anecdote about your experience with MEDLIFE so far.
I've only been in Peru for a few days now, but every minute still has given me an opportunity to learn something new and to gain appreciation. The clinics in Lima are set up in the "pueblos jovenes," which are densely populated communities built on the outskirts of the city in the hills. Peruvians from rural areas migrate here to take advantage of the opportunities of the city. The final day of last week's clinic, the community whom MEDLIFE volunteers built a staircase for held a small party for us to show their appreciation. The volunteers played a game of soccer with the community on their hand built field which they had toiled for 5 years carving out of the dusty mountain. The community members were very hospitable, offering us snacks and drinks, even though they themselves had to work very hard to afford these things. This experience reminded me of how hard those within limited means work in order to be able to afford the things that we take for granted, yet they are the people with the most generous of hearts. The people were proud of their dusty mountainside soccer field with boulders for stadium seats and they were happy to offer the American volunteers humble snacks of Inka cola and soda crackers.
What do you look forward to about your internship?
I am looking forward to assisting doctors and nurses during patient follow-up because each medical case fascinates me and I appreciate that MEDLIFE takes the time to make sure that the patients get care outside of the clinic. Also, I am looking forward to being involved in preventative health education. Hopefully my experiences will help shape my medical journey to becoming a public-serving physician and hopefully MEDLIFE's audience will gain more perspective on the worldwide issues and be motivated to become involved.
Dr. Jose Luis Rodriguez joined MEDLIFE in 2010 as a general practitioner. He has always demonstrated a keen aptitude for patient care; just a few months after starting with MEDLIFE he began implementing new medical and educational programs for our Mobile Clinics. Now doctor Jose serves full times as our Medical Director, and is in charge of the supervision of all medical aspects of MEDLIFE´s operations. Learn more about Dr. Jose below:
Where are you from?
I am from Lima. I was born in Lima, but my father is from Trujillo and my mother is from the border between Chile and Peru.
How did you get involved with MEDLIFE?
Three years ago a colleague and friend named Iliana Rodriguez, who used to work here, called and asked me to fill in for an absent doctor on one of MEDLIFE's Mobile Clinics. So I agreed to help. This was in December, about three years ago. I came to the clinic and ended up helping for all ﬁve days and loved the experience; luckily, they invited me to come back for the next clinic. I was working as part of the Mobile Clinics for about two months when i ﬁrst met MEDLIFE Director Nick Ellis, and he asked me if I wanted to work in a more permanent way, as a coordinator. I agreed and have been working here permanently since then. And that is how I got into MEDLIFE.
What do you like about working here?
First of all, as a doctor you have the call or duty to serve the community. Sometimes, our jobs don't allow us to help as much as we would like to, but in the Mobile Clinics you can really see how the patients are so grateful. Those kind of experiences make me feel that what I have learned is really useful, and that is very fulﬁlling.
Talking about good experiences, I also enjoy working with the volunteers. The students have their own personalities and they come full of excitement, wanting to help and to learn at the same time. I like watching them interacting with the patients, and I get the sense that they also appreciate the way that I work. Since the feeling is mutual, we generally make a good team.
What do you like to do in your free time?
I love dancing! That is definitely one of my favorite things to do. I also love soccer, and that's because I'm 100% a sports person.
Could you name some of the patients who made or make an impression on you?
There is one lady who comes from the sierra and lives in the community of Oasis here in Lima. The ﬁrst time she saw me was the ﬁrst time she ever saw a doctor; she hadn't been treated by a doctor in her entire life until that day. At the Mobile Clinic she was measured and weighed by a nurse; she then saw a dentist and general practitioner. She was very moved by the kindness we showed her and said she felt treated more like family than like a patient. She was so moved and grateful that she started crying, and I was thinking to myself, that i never understood how much we were really doing for our patients. That was a very emotional day.