Random notes from my Ica notebook

Some more thoughts about Peru

Chicken farms: as we rode down from Lima to Ica in the bus, we passed many giant chicken farms near the ocean. Have you ever smelled a chicken farm in the United States? It smells just the same along the Pacific Peruvian coast…the salty sea air does nothing to cut the stench. I like chicken, and the Peruvians do, too. But, P.U.!

Nature studies and Chifa: On our one R&R day on this trip, we went to Islas Ballestas, kind of a small version of the Galapagos Islands, and the guano there is pretty stinky, too. We really enjoyed seeing the sea lions jockeying for a spot in the sun, the penguins waddling around and the beautiful indigenous birds. Turns out that the Chinese population of Peru first arrived to shovel guano on these shores and went on to be successful community members. Everyone loves chifa, the Chinese-Peruvian food found in most every town.

Huacachina: A small oasis amongst the dunes, Huacachina is a fun little village. We danced one night at a place called Huaca-$%&@-China and we sandboarded via dune buggy on our R&R day. Apparently a princess fell in love with a commoner, and looked in a mirror and became a mermaid after her father hunted down her lover…or was it that the commoner abducted her? Anyway, she’s a magical mermaid now. Or something like that. Just keep dancing and sandboarding!

More later on our cultural adventures in Ica.
Yours in healing,

Shari Salzhauer Berkowitz, Ph.D.
Assistant Professor
Director, SPARC Lab
Dept of Communication Disorders
Mercy College
Dobbs Ferry, NY

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Friday – nos vemos

On Friday I got a birthday surprise—Luis Montalvan, Cheyrisse Boone, Helen and I were on TV and radio in Ica! Luis had arranged an interview with the “Cara a Cara” show (Face to Face) on Canal 35 “Somos Ica” (We are Ica).

We appeared with the male and female hosts, think Kathy Lee and Michael Strahan…mas o menos. They asked many questions about the mission, our motivations and rewards for going, how many children we had seen in the week, etc. Luis did most of the talking, being a native Peruvian, and translated for Cheyrisse and Helen. I spoke up in Spanish, mostly in response to a question about the causes of clefts. Some Peruvians believe clefts are caused by eclipses, lightning, demons, etc. and I have been trying to assess this via survey and also to dispel these myths, because they follow the child and the parent even after the clefts are repaired. If the little silver scar on your lip tells your neighbor that God has punished your parents, how do you get past that? The fact that the host asked about this without prompting shows me that I must continue this line of research and also produce outreach materials about what does and does not cause cleft. The answer is: part genetics, part environment, and part we have not figured it out quite yet. But parents need to know it is a medical condition and not anything they did.

Luis always says that Peruvians find Americans speaking Spanish to be quite appealing…does he mean humorous? I don’t know, but he also says that when they hear it, it catches the ear. So maybe my message will be heard. Or maybe it will be picked up by a Spanish blooper show, who knows. I have the CD of the show, graciously provided by the channel as a parting gift on Sunday; I will have to figure out how to extract just our clip after our semester simmers down and you can see (and hear) for yourself.

To top off our trip to the radio station, we rode back in an ambulette, and when the traffic at an intersection snarled, our driver flipped on the lights and sirens! My birthday “limo” ride was complete.

The surgical schedule was light on Friday, because the team was so efficient on Monday thru Thursday. The team packed up the medicines and materials to bring back to New York and Texas, prepped a few suitcases to leave with a colleague in Lima for next time, and gave away the last of the toys, scrubs, soccer shirts, trucker hats, stuffed animals, etc. We made sure the nurses on the floor where our patients stayed (and where we had our speech office) received some of the bounty. They were gracious hosts in every way.

Lastly, we had a ceremony in the auditorium, where the giant ad for the mission, with Dr. Ryan Brown’s face two stories tall, loomed over us. The medical students received certificates, and apparently every ceremony here ends in my favorite way: with a little glass of sweet wine and loads of kisses and hugs. The highlight of the ceremony was traditional dancing provided by a boy and girl pair who were highly trained in the art of Peruvian dance and who were mesmerizing with their stage presence, costumes, postures, facial expressions and moves. They were about six years old!

We said our goodbyes and left Hospital Regional de Ica and all our newfound friends and colleagues, but not before taking endless photos, exchanging business cards, phone numbers, etc. The point of these missions is not just to do surgery and leave, but build something longstanding, leading eventually to no more need for missions. We are well on our way here, with our colleagues, medical students, concerned local leaders of industry, media outlets, school teachers…I can’t wait to return to Ica, to work with them all again.

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Wednesday Thursday – more good work

We kept our great location for speech, and we got into a rhythm. In the morning, we saw the post-surgical patients, and advised them in small groups and individually. Then we saw all comers…kids with undiagnosed hearing loss, undiagnosed submucous clefts (the outside skin looks good but the inside muscles sure not connected), developmental disabilities, etc.

We gave two talks to our medical students, about clefts, child development, and many other topics. They also shadowed us during the week as we treated patients. They are so bright eyed and engaged, absorbing all we offer them and always ready for more.

On Thursday night, we all busted loose and went dancing. Our medical students can dance! We had a great time and danced until midnight…which was the start of my birthday! I was serenaded by a room full of colleagues, friends, and strangers. Peruvians take birthdays seriously, stretching them out for up to a week. This is a tradition I’m ready to adopt.

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Shower roulette

At our hotel, we are all playing an extended game of hot water shower roulette. Shower at night and get hot water one day…before dawn another day. One shower starts out cold as ice, warms up and ends up burning hot…another starts out perfectly warm and ends up a trickle of freezing drips. While you are covered with soap and shampoo.

Of course, our patients from the jungle and from the Andes would laugh if we told them to spend their limited fuel budget on heating water for washing. How soft can a person be? It’s always important to be aware of our “first world problems” when we travel outside our comfort zone, both literally and figuratively.

Fingers crossed that I win on shower roulette tonight!

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Tuesday – speech office is open

We found the big activity room on the pediatric floor…the one we had seen in Manoj’s photos back when the team scoped out Ica last year. It was perfect for us: kid sized chairs, adult sized chairs, a white board, and plenty of room. First things first, we saw all the patients who had surgery yesterday. It is standard policy on these trips to do complicated cases first, so that the surgeons are still in town if any complications arise. Thus, the majority of the Monday patients had palate surgery. We worked with the parents on how to best establish oral resonance and airflow using their new palates, and we did therapy with the kids directly. Soon after, the kids were discharged, taking home speech practice materials and, for those who have access to the internet, my business card. Kisses and photos all around, and we bid the first “batch” good bye.

No sooner did we send the post-surgical patients off, than we were swamped with new clients. We were hopping all day! For each child and parent, we did a quick evaluation on the fly, developed a home program, and made sure the parent understood our recommendations. Some of the families had heard about us on the radio, some on TV; some had been told by friends or family members who work at the hospital to bring their kids while we were in town. We saw everyone…it was a very full day.

Late in the afternoon, we closed the speech office and headed to surgery, to see a double z plasty, commonly called a Furlow, after the surgeon who first wrote about it. I’ll let Jessie tell you about that in a separate post.

We are all fine, teaching, learning, sharing and enjoying…enjoying the people of Peru, our beautiful hospital, the welcome we are receiving and the collegiality we are building.

More later.

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Monday – developmental disabilities day

This trip would not be as productive as it is without our volunteers in Peru who get the word out about the mission, arrange for family transport, hotels near the hospital, meals, etc. On this trip, in addition to kids who need lip or palate surgery, our patient finders brought 15 kids with developmental disabilities…kids with Down syndrome, cerebral palsy, and other kids needing help with speech and language. This is a new idea for Healing the Children Northeast, and a great opportunity for the speech team.

The hospital gave us a small auditorium on campus, and the dentist, Dr. Daniel (sorry, I don’t know his last name, but Luis does), made sure to get the families there on time. In the morning, we gave an interactive talk on how to develop speech and language skills in children who are struggling to communicate. Each parent expressed their most pressing concerns, and we addressed these in our demonstrations. In addition to lecture style, we acted out how to help kids move to the next level of communication. Parents were extremely tuned in and listened intently to our advice. We talked about total communication–using signs, gestures, and pictures along with oral speech to expand vocabulary and increase successful transmission of messages from child to parent and back again.

It was a very full morning, with lots of new information for the families to absorb. After a short lunch break, we then saw all the families individually for a mini-evaluation and treatment plan. Each family left for home with a set of recommended activities and goals for the future. They were extremely glad to have had the opportunity to meet with us, despite the sixteen hour trip down from the mountains of Huancavelica.

Joining us on developmental disabilities day was the psychologist from the area where the children live, and two staff members, in lauding SLP Caroll Arpi Quispe, from KusiRostros, an organization providing therapy for kids with clefts in Lima. So, we continue to create new connections for collaboration, between us and our Peruvian colleagues, and also amongst the various Peruvian professionals, working far away from each other geographically, but for the same goals. Another great outcome for our speech team.

We kissed all the kids goodbye and wished them well. Perhaps DDD will be an ongoing event, or perhaps we will find other ways to serve these families. As on all our trips, we roll with the punches and cook up good ideas every day as we go.

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Sunday in Ica…screening day

Our trip down to Ica was a very long one. We started at JFK at 9pm on Friday, meaning some of us left home at 4 or 5. After a good flight, some delays at customs (as usual) and a slow bus ride, we unloaded the bags at the hospital at 530 or so Saturday night. So yeah, close to 24 hours traveling to arrive in Ica Peru. The Texas, San Fransisco and Colorado contingents had an even longer trip. And yet, somehow, the Texans were singing on the bus! They’re a fun gang.

Sunday was screening day, and we had the best, most efficient screening day ever. Medical students from Lima and Ica, shepherded by Jury and Rosa, our long time collaborators, had the patients fill out paperwork as we set up, followed by photographs of each kid, hospital bracelets, surgical, medical, and anesthesia screening, and of course, speech screening! A new wrinkle on this trip…we have about a dozen patients from Huancavelica with developmental delays. Tomorrow will be DDD…developmental disabilities day, more on that as we go.

When the dust cleared, 88 children and teens had been screened, and the surgical schedule is packed for the week. Speech has a full plate for the week, too: DDD, rounding on kids in the rooms (not wards!) post surgery, parent training meetings, and building our connections with colleagues in Peru. We are so happy to be in Ica, where the sand dunes surround us and the pisco is local. Everyone is so happy to work with us, and the hospital is brand spankin’ new and so clean and welcoming.

This is the start of something big.

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