Saturday, July 2, 2016

From the Rainforest of Peru to the Mesas of Arizona

 Late entry. Originally written June 12, 2016:

It has been almost 3 years since my last blog post -- one of many things in my life that went on hold during Family Medicine Residency. On reflection, residency does seem like a bit of a black hole that has consumed more time and energy than I ever could imagine I had to give, week after week, year after year. On the other hand, it has also given me so much: knowledge and skills, incredible friends and colleagues, and the opportunity to bear witness to so much joy and sorrow in the range of the human experience.

Now those three years are coming to a close and I’m fortunate enough to be spending my last month of residency on an away elective at a hospital in the Amazon Rainforest of Peru. It is absolutely incredible here; it feels like a combination of medical school in Cuba and working in Santa Ana, Ecuador, which have been two of the most incredibly rewarding and life-changing experiences of my life. I am working in a small town called Santa Clotilde on the Napo River in the Amazon Rainforest of Peru. Santa Clotilde is only accessible by boat, by an approximately 7-hour journey by motorboat from Iquitos, the capital of the region which is in turn only accessible by boat or plane. Remote as Santa Clotilde is, it is home to several thousand people and is the district capital and houses the government and the hospital for a vast region of rainforest. I am working as one of five doctors at the local hospital, which has a 20-bed unit for hospitalized patients, one delivery room for vaginal births, one operating room for cesarean sections and other basic surgeries, and an outpatient clinic area with four exam rooms. There is a lab which can run some basic tests (blood counts, some kidney and liver function tests, as well as checking for malaria and intestinal parasites) and an ultrasound machine, but no x-ray. Many of the staff at the hospital are recent graduates from their areas doing their year of “social service” which is required before being able to move on to further study such as residency for physicians. I am living in the same large house they all stay in, which is part of what reminds me of my time at ELAM (medical school in Cuba) – cooking, washing clothes, eating communally with young medical professionals from all different parts of Peru. The ingredients available to buy are rather limited, but we are always discovering new ways to prepare the basic stables (flour, oil, rice, beans, lentils, yucca, platano) and a few fruits and vegetables (tomatoes, onions, carrots, cabbage, beats, peppers) in new and different ways. Today I taught them how to make flour tortillas from scratch and we made tacos which turned out delicious.

The rainforest here is amazing. Yesterday afternoon after we finished seeing patients, one of the local staff members took us on in a ‘peke-peke’ (homemade boat with a small motor for going short distances in the river) up the Napo River to a neighboring community named Wiririma. We swam in a tributary of the Napo River that has an intense black hue to the water due to some kind of mineral. The river was high due to the recent rains, with the bases of many trees swallowed by the black waters. It happened to be Wririma’s anniversary celebration, so after we swam, we went up into the community center to watch the soccer tournament and taste the local homebrewed fermented yucca alcohol Masato. It is an opaque white liquid that tastes a bit like yogurt or kambucha mixed with some fibrous remnants of yucca. Traditionally women would chew the boiled yucca and the saliva would provide the enzymes necessary to produce the sugars for fermentation to produce alcohol. In this region, people have generally switched over to alternative methods such as adding sugar cane juice to facilitate fermentation. It is fascinating to see the blending of tradition and modernity in Santa Clotilde and the surrounding communities. In general, the influence of modernity seems to predominate more in this area than in Santa Ana, Ecuador, the community in which I previously had worked for years on water treatment. Even though all of these communities here in Peru are accessible only by river and Santa Ana has road access, fewer people speak their native languages here (although some do speak kichwa and I’ve gotten to use a bit of what I remember from Santa Ana), there is less traditional music and dance, and more integration of modern expectations of hygiene and lifestyle. But people still maintain an incredible knowledge and intimacy with the natural environment, from the chakras where they still grow a lot of their own food, to the rivers that provide fish and transportation, and the tributaries where people wash clothes and swim. Although some seem to live more of a "city" lifestyle, there are limits in that there is only electricity here from 6pm-11pm because it is generated here, the paved roads only go so far within the city, and it is impossible to escape the mosquitos and the diseases they carry, especially malaria. Most people around here have had malaria at least one, if not many times in their lives, and we see and treat it every day in the hospital and clinic.

I have been very impressed by the Centro de Salud Santa Clotilde where I work both in the care it provides and the integration in the community. The inpatient area is an open ward meaning all the beds are in the same two rooms except for an isolation room and two rooms for moms and babies. I often seen the patients hanging out with each other within the ward or in the courtyard. Although there are only 5 doctors, there are so many other staff members here: laboratory staff, maintenance staff, nurses, nursing techs, pharmacists, midwives, administrative staff, public health staff, and they do an incredible job with very little resources to care for a large number of patients each day (approximately 30-50 outpatients and 10-20 inpatients). In addition to seeing patients in clinic and taking call every fifth day, I have also brought water testing equipment and am teaching the public health team how to use it to assess water safety and encourage treatment (generally boiling or chlorination) as I have done previously in Ecuador and Uganda.

Working here feels like a merging of many threads in my life – public health and medicine, water and health, living and learning in another language and culture. It has been 10 years now since I first traveled to Santa Ana. I am not sure what it says about me that I still love this work just as much and have the same goals and dreams as I did 10 years ago. Maybe I was a precocious 19 year-old. Or maybe I am stunted in my ability to grow and evolve. Or maybe it is simply that I have come to the end of an 11-year educational process of university, medical school, and residency, and am just now finally be able to start to do the work that I have always intended to do from the beginning.

Sometimes I really do wish I could just move here to Santa Clotilde and work full time after I graduate in a few weeks, but I still have too much debt from medical school to make that a reasonable option. Instead, I have chosen a rather parallel job within the United States for after I graduate: working for the Indian Health Service at the Hopi Health Care Center on the Hopi reservation in Northern Arizona. I start in October and will be working in the outpatient clinic, as well as in the emergency room, on the 4-bed inpatient ward, and the tiny labor and delivery ward for low risk vaginal deliveries (women who are high risk or might need a cesarean section for any reason deliver at Tuba City instead which is 45 minutes away), along with three other physicians and a handful of nurse practitioners and physician's assistants that run the small critical access rural hospital. There is a laboratory and radiology department on site with x-ray, CT scanner, and ultrasound capabilities and an MRI that comes in a trailer twice a month. The Hopi reservation is both incredibly remote and stunningly beautiful albeit in a slightly austere way. It is in the high desert of Northern Arizona with few trees and little water, but incredible mesas with endless trails for hiking and running. The Hopi are a pueblo people and have lived continuously in some of their communities at the top of their mesas for almost 1,000 years. Their traditional culture, including language, religion and farming practices are still very much alive and the Hopi have a reputation for being very open and welcoming to medical staff, often extending invitations to ceremonies and dinners. I am very much looking forward to this opportunity for a cross-cultural experience as well as the opportunity to apply the skills and knowledge I have gained over these last 7 years in a place where they are very much needed.

Sunday, June 30, 2013

container garden!

Just wanted to share some pictures of my awesome container garden that I planted just over 2 weeks ago. It is doing really well despite the fact that it is in a narrow alley and doesn't get very many hours of sun. I guess the fact that it is direct midday sun and that it is so nice and hot here in oakland in the summer is making up for it somehow.

Here I am standing  with my newly planted herb garden

My little carrots that sprouted a few days after planting them

Zucchini, morning glories, tomatoes, and herbs

Beans on top and argula/spinach on the sides

The avacado plant I sprouted in the last weeks with a baby spider plant
Baby arugula coming up!

In the middle - the big brother avacado tree I sprouted many months ago

It is so much fun to come home every day and water my plants and see what is new -- it really does change every day!

Also, I wanted to share that I hired a really awesome woman to help me get the right supplies and plant things the right way. Her name is Asha and she works with another really awesome guy named Spira to run a business called Rhizome Urban Gardens. If you are in the bay area and want some help starting a garden or want to hire gardeners to plant and maintain it for you, I highly recommend them.

Sunday, June 16, 2013

And the run is over!

Photo of today's race on Golden Gate bridge from SF Gate

Well I did my half marathon today, and I have to say it is amazing what training can do. Two years ago I messed up my knees (my IT bands to be precise) while training and could only swim to train. Race day was the first time I had run in months, and while I finished, I couldn't walk for a few days afterwards.

This time, I managed to keep my IT bands happy and trained pretty well, so I was hopeful this would be a much smoother day, and indeed it was. The route was beautiful, starting at the ferry building, running along the Embarcadero, through the (hilly) Presidio, across the Golden Gate bridge and back, and then through (hilly) neighboorhoods down to Golden Gate Park for the finish. And even though today's race was waaaay hillier than the one I ran 2 years ago, I felt much better the whole time and though I'm sore for sure, I'm walking without a limp already!

Wave 7 with the Bay Bridge in the background
I always thought I ran at a 12-minute mile pace, so I signed up for that wave, but somehow I ended up running at a 10-minute mile pace today, so I spent most of the time weaving in and around people to pass them. And there were a LOT of people running, so it was actually kind of a challenge, but kept things interesting I suppose. It is always fun to run with so many people at once, and see people of all different ages and paces and running styles. Quite a few people struck up conversations with me about my crazy 'toe shoes' that I run in, which is always fun.

At the finish line!

I ended up finishing in 2 hours 12 minutes, which is a 10:07 minute mile pace. I feel pretty proud, although I was barely in the top half of runners, haha, and I didn't do a whole marathon. Maybe someday!

And the real success is the over $3,400 we raised for Clinica Martin Baro!!! Thank you so much to everyone who contributed, I really appreciate it. If anyone still wants to donate, its not too late, you can use this webform.

Thursday, June 6, 2013

Half marathon training, or how I ended up running 7 miles in a mini-skirt

Ten days from now I'm doing my half marathon for Clinica. My start time is 5:30 in the morning so if all goes well I'll be done around 8am and I'll have the whole rest of the day ahead of me. Crazy way to start a day! There are four of us doing the half, and a couple others doing the 5K, and between all of us we're hoping to cover Clinica's rent for the year. We're doing pretty well, having raised $2275 between all of us -- we need another $2000 to meet our goal.

If anyone has been meaning to make a donation, there is still time to do so using this webform.

I wanted to write a post about all the fun, exciting, crazy, and sometimes painful adventures this training process has brought. So here they go:

Brady passed out on the floor after one of our runs
#1: Scrubbing my dog Brady down with dishsoap. While home in Stoughton, WI, I went on a few training runs with my mom's dog Brady, who is a great companion but loves swimming too much for his own good. We can never take him off the lease because everytime we have, he chases rabbits, ducks, and geese for miles before we can track him down again. We were running on a floating pedestrian bridge over a little river when Brady up and jumped over the side, happily swimming alongside the bridge on his lease all the way to the other side. "River" might have been a generous term for the swampy water we were crossing, so when we got home I knew Brady needed a serious scrub down before coming in the house. After a bunch of hose water and some dishsoap, he was good to go.

A Google Streetview shot of Broadway Terrace
#2: Leaping off the road into landscape shrubs. Today I thought it would be fun to investigate Robert Sibley Volcanic Regional Park, only 3 miles away from my house as the crow flies, and the nearest point to me of the epic Bay Area Ridge Trail. Unfortunately, as the roads go, the way from my house to Sibley Park involves going through crazy switchbacks up on a road called Broadway Terrace through a very affluent neighborhood. I did my best to always run on the side with the best visibility and move off to the side anytime I heard a car coming, but a couple of times I ended up flinging myself into the landscape shrubbery in front of a house as a car came around a blind corner. I'm never running on that road again.

Grizzly Peak Boulevard (from Google Street View)
#3: Going over instead of under the Berkeley Hills. To avoid running back on Broadway Terrace today, I took Grizzly Peak Boulevard, which is a well-established bike route and much more pleasant to run on. It also took me directly over Hwy 24 as it enters the Caldecott Tunnel, which I will be traveling through twice a day every day to get to work (and not so infrequently waiting in a long line of cars to enter). Only we were so high above it and the day was so foggy, I didn't even realize we had already passed the tunnels until way too late. I'll have to come back another day to get a bird's eye view of these Tunnels that will be such a part of my life for the next 3 years.

My running route from today
#4: Surprise, going 11 miles! As a result of #2 and #3, my little jaunt to check out the park that is 3 miles away form my house turned into an eleven mile run. I walked bits of it due to steep hills, scary blind corners, and a few side stitches, but I ran the vast majority of it and it makes me much more confident that I will indeed be able to do these 13 miles ten days from now.

#5: Running 7 miles in a mini-skirt. On my last day in Madison, I knew I'd have a few hours downtime in the city so I packed my running stuff -- my "toe shoes" that I run in, sports bra, shirt, waterbottle, even a backpack to put all my other stuff in and have my brother watch it for me. I was all prepared -- except I forgot to take my shorts out of the drier. I wasn't about to let those hours go to waste, so I thought desparately about creative solutions - running in my underwear (its just like a swimsuit bottom, right? no one would care in madison), or in my jeans (not the most comfortable and they'd be super sweaty afterwards, but better than not running). In the end I realized I had a second shirt with me, a plain black tank top, so I put it on like a skirt and went on my run. I'm sure I was getting funny looks, but I got my run in!

#6 Running in Zion National Park at Altitude. I only got to do one run while hanging out with my family in Utah (after the first one I came down with cold) but it was pretty spectacular -- running on a dirt trail along the Virgin River through Zion National Park. Here is a picture of the river and trail from someone else's trip there. So beautiful and solitary, mostly I just startled mule deer out of their slumbers.

And a couple last photos to share, that have nothing to do with running, except that doing this painting has made me see the trees and their trunks, branches, leaves, and how the light hits them so much more intensively when I am out running. They are of the mural of a birch grove my mom and I painted during the six days I was home with her in Stoughton.

Saturday, April 6, 2013


Sayidat and I in Uganda in 2010 when I met her
Sayidat is heading into her final semester of nursing school. She is studying hard and doing very well, I am so proud of her! I need to send her $600 for tuition and room/board sometime this month, if anyone wants to contribute, it would be very much appreciated. I am so grateful to all of you who have contributed over the last few years -- what an amazing thing to have enabled her to finish nursing school together!

If you feel like contributing, you can send me money by paypal to or by check to my address (which is in the email version if you are on the update list, if not, write to me by email and I'll give it to you).

New Beginnings

March 15th was match day and across the country medical students opened envelopes at exactly the same time saying where we have been sent for residency. Its an intense process, as all of the other scenarios, possibilities, and opportunities vanish out of the realm of possibility in one instant. Couples and families suddenly contemplate separations or cross-country moves, or experience the relief that all those worst case scenarios that a moment ago were possible, now will not come to pass.
my match letter
I matched at Contra Costa Family Medicine Residency, an amazing program based in a county hospital about an hour outside of San Francisco. I'll be working hard, probably harder than I would have at most family medicine programs, but I'll be training in an environment where family doctors literally run the hospital, and I will learn to work in the Emergency Room, deliver babies, do cesarean sections, and take care of hospitalized patients and patients in the intensive care unit. And it is an amazing group of really caring, inspiring people that I will be working with. I couldn't be happier.
To add to the good news, Mozzi and I have decided to take advantage of this close proximity and live together in Oakland.

Mozzi and I on the beach in San Francisco as we contemplate the move across the Bay

The keys to our new place!
We actually just signed the lease (on my birthday) for a really cozy apartment surrounded by an incredible amount of flowers in the walkway and the backyard. We are both incredibly excited about our new place and this next step in our lives. Less exciting is the reality that I will, for the first time in my life, have to commute to work. Those of you who have known me since high school know that I've always vowed I'd never own a car, preferring to navigate Madison snow and San Francisco traffic on my bike. I'll be buying a car (as a small part of me dies inside) and driving about 30 minutes each way to work. I know this is actually a pretty normal or even short commute by American standards, but it is still taking a lot for me to process and come to terms with it. But I am really happy and excited about all that lies ahead. So many new beginnings!

Pupusas and Harry Potter in Cuba

The river valley of La Estancia
After the marathon of clinical rotations of third year and the endless lineup of tests, applications, and interviews that dominated the first half of fourth year, the freedom of these last few months has been incredible. No tests, no grades, no pressure, just time to do anything we can convince the school to give us elective credit for. For me, this was my chance to go back to Latin America and recharge the other half of my soul. I spent the month of February in El Salvador, living and working in a rural community called Estancia in Morazán province (in the Eastern half of El Salvador, near the border with Honduras). I went through an organization called Doctors for Global Health, who partners with a local community organization called Campesinos para el Desarollo Humano (Farmers for Human Development).

Dr. Juan Carlos Martinez and I
The doctor I was working with in the clinic is named Juan Carlos. He grew up in Estancia, and as he tells the story, one of his high school teachers said to him "you are smart, you should apply to this scholarship to study medicine in Cuba." He applied, got the scholarship, and went off to Cuba at 17 to the same school where I studied, the Latin American School of Medicine (ELAM). He graduated three years ago and has been working as the doctor in his community ever since. It is such an amazing, classic story of ELAM, and after spending so much time with students just like Juan Carlos from communities across Latin America, it was incredibly moving to work alongside him and imagine the future that my friends will have and what amazing work they will be doing for their home countries and communities.

Meggie with our drawings of vaginal infections
During my month in Estancia, I worked in the clinic with Juan Carlos and a couple other medical students, taking care of anyone who came in the door for any reason - parents worried about a one month old baby with diarrhea, children with cuts and scrapes and rashes, adults with joint pains, asthma, or high blood pressure, and eighty year old great grandmas who had walked two hours in 100 degree heat to get some Tylenol for their back pain. The clinic is well stocked with the most common medications, so we could give most patients everything they needed right on the spot. If not, we wrote them prescriptions to an outside pharmacy and if needed, filled the prescription for them and had them come back to pick it up. We also did a lot of house visits, when someone had fallen or was too sick to navigate the mountainous terrain in the hot sun, we would pack a little bag and hike off to their house and do a clinic visit right there. And finally, I also did quite a bit of health promotions, working with another medical student and the local health promoters to give outreach sessions about women's health and cervical cancer. 

As you can imagine, I absolutely loved the work, and really got a sense of what it would be like to be a rural community doctor. You can bet I'll be coming back!  

Sunrise from the top of Pelon, a mountain near la Estancia

On the top of Pelon

After my too short month in Estancia, I bused back to San Salvador and flew to Havana. I hadn't been back to Cuba since 2nd year of med school, and now all my friends were 4th years and in their clinical years at hospitals across the country. I hung out for a week with the US folks that I started the program with four years ago, and had such an amazing time. I cannot even express how warm a welcome I receive each time I go, how we fall back into such comfortable friendships it is like I never left. We did a lot of cooking -- homemade pizzas, hummus made by smashing garbanzo beans by hand with a cup, curries and Iranian stew. Each day was a glorious combination of familiar and new experiences. Some things never change, like when I went to buy vegetables at cuatro caminos and one of the vendors, a friend from four years, recognized me and walked across the market to give me a hug and some ginger tea. Other things were new - more formal signs and official food vendors, novel fashion (the union jack is the latest fashion and is blazened across shoes, pants, t-shirts man-purses, any clothing surface you could imagine) and new musical hits.
My amazing ELAM friends!

Sunrise over Cayo Coco
I also got to travel more in Cuba than I ever had before. I took a 7 hour bus ride from Havana to Ciego de Avila, which is around the middle of the island and spent a couple of nights with my friends from Mexico who are studying there. Ciego is a great little town with very few cars, almost everyone has a bicycle and uses it as exclusive transportation, although there are some horse drawn carriages around for hire when you find yourself without a bike. Especially at night, the bicycles totally rule the road and riding and it was so idyllic to ride around the town plaza, park, and pond, right in the middle of the road with only other bicycles to avoid! The next morning after I got there, we got up at 3:30 in the morning to catch a ride out to Cayo Coco, a couple hours away, and got there just as the sun was rising over the ocean! There were some significant mosquitos so we submerged ourselves in the still-cool water, but gradual the sun came out and began to warm the fine white sand and light up the crystal clear aquamarine water. It was heavenly! These are the sorts of places that tourists come to Cuba for, although they probably don't pack spaghetti and mayonnaise for lunch like we did to avoid buying expensive food in the restaurants and hotels along the beach.
With my friends Maritza and Rocio on Cayo Coco

A pupusa topped with curtido and salsa
After Ciego, I went back to the other side of the country: Pinar del Rio, where two of my best friends from El Salvador are now in their 4th year. I had actually been able to visit each of their families for a night while I was in El Salvador, taking tons of pictures and collecting letters and gifts from their family members. It was a real treat to be able to bring these treasures to my friends, as well as spend a wonderful weekend in Pinar. The highlight was definitely making Pupusas -- a typical Salvadoran food that is essentially a stuffed corn tortilla. I brought Maseca (dried corn flour) from El Salvador, since it is impossible to find in Cuba, and we had a blast making bean and cheese pupusas along with the smooth tomato salsa, and 'curtido' (shredded cabbage and carrot with vinegar and oregano) to top them. They came out incredibly well, just like in El Salvador.

While we were cooking, in one of those moments of global interconnectedness, the Harry Potter and the Prisoner of Azkaban came on Cuban TV, shown like all the Sunday movies in Cuba straight through with no commercials. We half watched it as we cooked, everyone intrigued by the British English and whether I could actually understand it. I was left marveling at how different a place and time and moment I was in compared to the first time I saw that movie at home in Wisconsin during high school. And yet it is all part of the same world, and the worlds within it are connected in the most mundane and profound ways.