Last week in Lima

After eight fascinating and eventful weeks, our tropical medicine course here in Peru is coming to a close. We traveled to the tropical medicine hospital and classroom for the last time today. Our final exam to determine whether we've earned the Diploma in Tropical Medicine and Hygiene in on Monday and then we fly to Iquitos on Tuesday (in the Amazon region of Peru) for our last week of seeing patients in the jungle. Of course the real exam will be remembering and applying the information in Burundi (and elsewhere around the world for the other course participants) with patients and medical students.

Pictures from the week:

Neurocysticercosis (the black circle with white dot - scolex - in top right of brain pic) - a very common cause of seizures in the developing world, pig tapeworm that ends up in the wrong host

Cute little Peruvian baby quite healthy despite a complicated pregnancy - mom had mucocutaneous leishmaniasis (from a sandfly) affecting her airway. She's also thankfully doing well now after treatment.

Does your hospital advertise conquering dengue fever? :)

Rounds again at Loayza Hospital on a beautiful day

Loayza (who the hospital is named after) was evidently a Spaniard who began a small clinic in Lima in the 1500s

My favorite circle in Lima - all the buildings around this statue look identical and are painted that bright blue color

6 year old who was admitted to the PICU extremely ill after a spider bite. He actually was in kidney failure and required dialysis but now has almost fully recovered. I gave him the sticker and somehow it seems universal that kids automatically put stickers on their foreheads! No translation needed. :)

Well, tropical medicine involves spider and snake bites (although actually we treated both in Alabama as well, much more frequently than in Kenya), so we had a special lab to learn to recognize the various species.

I'd just like to dispel the assumption that just because I live in Africa, I don't mind big bugs - that's just not true! Thankful for teammates willing to kill them for me. :) Although actually, probably because of the altitude, we did not have too many bugs in Kenya, but I did have a bird fly through my house and need help finding the exit. I suspect there are more critters in Burundi, though, unfortunately.

Anaconda (above) and Tarantula (below). Wondering what our jungle experience will be like next week!

The small brown dot on the statue on the left is a cat. Actually we see several cats on this statue as we drive by everyday. And now we know cats spread toxoplasomosis, sporotrichosis, bartonellosis, toxocariasis, and probably some others. I knew there was a reason I didn't like cats!

Lecture by Dr. David Warrell - inspiring British infectious disease doctor who has spent most of his career living and working in the developing world and in the process has become a world expert on snake bites, rabies, malaria, etc. In fact, he wrote many of the textbook chapters on the above topics. Loving his anecdotes and humble manner of presenting knowledge he knows so well and even discovered.

Last lecture before the exam by Dr. Freedman - course director and travel medicine/tropical disease doctor from University of Alabama at Birmingham - where I first heard about the Gorgas course

Last clinical rounds in Lima with Dr. Gotuzzo, the other course director - teaching us about Brucella spondylitis (infection acquired from unpasteurized cheese)

Lytic and blastic lesions with new bone formation in Brucella spondylitis patient (Medical teaching point for those interested - TB spondylitis only causes lytic lesions with no new bone formation.)

 

Heading off to the hospital for rounds

I mentioned earlier the interesting travel stories of my fellow classmates. Well, just for fun, I conducted a survey of the class (34 participants), and determined that we've each been to an average of 21.7 countries (most = 58 countries by a German classmate; least = 6 countries). [The numbers include tourism travel as well as humanitarian work.] And the above map includes all 144 countries (in red) visited by at least one of the 34 of us. Our average age is low 30s, so hopefully in the years to come, we'll visit or even live in some of the unshaded countries - especially those with significant need in Africa & Asia. People seem to be leaving the course inspired to continue serving the underserved around the world. I look forward to seeing how our paths cross in the years ahead. I know these travel experiences and opportunities put us in the minority compared to most of the people of the world. "To whom much is given, much will be required." Luke 12:48

I appreciate your prayers that I will humbly glorify God with the experiences and opportunities and talents He gives me each day. 

Still here in Lima

For those of you wondering, yes, I'm still here in Peru! Two more weeks of the course remain, which means I have lots of studying to do for the final exam. This week we enjoyed lectures on plague, anthrax, vaccine preventable diseases, dengue, & yellow fever, among others. We continue to see interesting patients on rounds - especially on dermatology and pediatric rounds this week. Please pray for perseverance to the end as the studying and the schedule are getting wearying at this point! Looking forward to seeing family and friends back in the States soon, but also want to continue to make the most of this opportunity in this place and with these people.

 A visitor joined us on rounds one day.

 He evidently wasn't very interested in the case, though, as he made a lap of the room and then left. :) 

 One of our course directors, Dr. Gotuzzo (on right), hosted us in his home for a lovely dinner last week. We enjoyed socializing with the faculty and each other outside of class.

 Friends from the course and Dr. Seas pictured in front of a 1500 year old (!) pre-Incan tapestry at Dr. Gotuzzo's house

 Dr. Legua with a leprosy patient

 A patient with her knee almost completely destroyed by multi drug resistant tuberculosis

 Abdominal mass - cancer? Large liver and spleen? Fluid (ascites)? 

The CT scan reveals:

 Hydatid cyst disease - usually only one cyst is present in the lung or liver, caused by a dog tapeworm. In this case, the liver cyst ruptured a couple years ago when the patient was hit during a soccer game, and then spread throughout the abdomen. This condition is very difficult to treat and is relatively common here.

 Same patient with decreased lung volume from the abdominal cysts

 Loayza Hospital - reminds me of pictures of hospitals from 50 years ago. The high ceilings and windows make this ward very well ventilated, though, which is good for infection control even though the patients are all in one place. Hopefully we can design something similar in Burundi as the current wards at the hospital there are very crowded and underventilated.

 Cayetano Hospital - patients always in the hall as there aren't enough beds. Even without extra bed space, though, these hospitals provide impressive care to the patients here, diagnosing and treating conditions definitively that we would only guess at in Kenya or Burundi due to lack of lab and radiology facilities. Just as I saw when I visited both Ethiopia and Burundi from Kenya, there is a wide disparity in degrees of poverty even within the designation of "developing countries." Click here to read Eric's recent blog post about the poorest country in the world designation. 

Neonatal Intensive Care Unit

Hard to study on such a beautiful day!

I will not miss Lima traffic! But you never know what you might see - as the cars started moving, this lady ran beside the bicycle contraption (center lane of three lanes, more or less, on a major highway) steering it while the man rode the bicycle (unmotorized)!

 Fun study break today for birthday celebrations

Even as I continue to learn tropical medicine here in Peru, my thoughts and prayers are with my friends on the front lines in Africa. I'm thankful for email, Facebook, and blogs to keep me up to date. Please pray for continued strength, peace, and joy for those struggling with nurses on strike, abandoned babies, advanced AIDS patients, extreme poverty and malnutrition, refugees, and living far from family. Especially, please pray for my teammate John Cropsey who arrived in Burundi yesterday to continue preparations for our team's move there next summer. Click here to read specific prayer requests for his trip.

Cuzco

Our group traveled to Cuzco to learn high altitude medicine and see the different tropical diseases of the "high jungle". Course we experienced our own altitude sickness as well jumping from sea level to 11,200 feet in just a one hour flight - thankfully we took medication for prophylaxis and mostly did ok. Cuzco is such a beautiful city which evokes a certain mysterious sense of centuries of untold stories beneath its old stones. Enjoy the following pictures and add Cuzco to your bucket list if you get the chance! I'm so thankful for this opportunity!

 View of Cuzco from the airplane

 Hospital rounds

To read the story of this blue little boy, click here

 Lady now much improved after treatment for an amebic liver abscess (original CT scan below)

Amebic liver abscess

 Cuzco

 Quechua family

 Patient with mucocutaneous leishmaniasis - healed lesion on leg and elbow and collapsed nose with nasal perforation and hoarse voice from mucosal disease. Leishmaniasis is a tropical disease caused by a sandfly bite that can produce very debilitating disease. It seems to be quite common in Peru as we've seen many patients with this condition. 

 Qorikancha - Spanish church built on top of an Incan temple

Note the ruins of the Incan temple below the arches of the Spanish church

Impressive symmetry by the Incas

Thankful for a beautiful afternoon in Cuzco despite the rainy season

Saturday, we enjoyed a day off to visit Machu Pichu - traveling by van, bus, train to get there (didn't have time to hike the Inca trail - maybe another time). Took this train picture for my nephew Sam who loves trains, but actually, we rode in luxury inside. :)

View from the "Vistadome" train window 

Following are pictures of Machu Picchu - the "Lost City of the Incas" - built around 1450A.D. and undiscovered by the Spaniards during their conquest of the region. In fact, it wasn't discovered by an outsider until 1911 - long after it was abandoned by the Incas.

 

 

A friendly (and wet) llama

Several of my Gorgas classmates with our tour guide

We experienced a wide variety of weather as you can tell from our clothing in the pictures, but thankfully enjoyed incredible views throughout the day of both the mountains and the ruins. 

 We weren't the only ones enjoying Machu Picchu :)

 "High Jungle" - we left before the bugs started biting. Sometimes you can know too much about potential tropical diseases! :)

Mountains en route back to Lima