Before packing for Peru, I read our Fogarty "survival guide" that said to bring a lot of English-language books since they are hard to find here. I packed about five and figured that would be more than enough as I doubt that I had read five books for leisure in the past year (now med school books... that's a different story). Anyway, I had no idea how desperate I would be for reading material! I would never describe myself as an avid reader but I enjoy reading and the hour-long bus rides to and from the hospital are perfect for leisure reading. Lately I read a book a week.
Here's the short list of what I've been reading lately and would love your suggestions/recommendations:
1. The Canopy by Angela Hunt (based in the Amazon by Iquitos, Peru, I enjoyed this adventure of a team searching for a cure for a deadly disease and the not-so-subtle message about faith and transformation)
2. Freakonomics by Steven Levitt (son of one of my med school profs)
3. Kite Runner by Khaled Hosseini (the first half was amazing, the second half was ok, and the movie made my cry at least 5 times)
4. Three Cups of Tea by Greg Mortenson (Wow! Great book and I would recommend that everyone reads it to better understand the philosophy "To educate a man you teach an individual, to educate a women, you teach a community.")
5. Stones into Schools by Greg Mortenson (More about building schools for girls in Afghanistan post-9/11)
6. Lolita by Vladimir Nabokov (amazing literary work and very witty but you have to get over the unusual erotic predilections of the main character)
7. Bridge over San Luis Rey by Thornton Wilder (based in Peru in the colonial era - entertaining)
8. Twilight by Stephanie Meyer
9. New Moon by Stephanie Meyer
10. Omnivore's Dilemma by Michael Pollan (very interesting/highly recommended - this book makes you think about what it is you are actually are eating and where it comes from. They say, "You are what you eat," which basically makes us a bunch of cobs of corn as we consume enormous amounts of corn-fed meat and high-fructose corn syrup.)
11. Food Rules by Michael Pollan (everyone should try to follow these simple rules about what you eat)
12. Hitchhikers Guide to the Galaxy by Douglas Adams (very entertaining)
Next up:
1. Eat, pray, love by Elizabeth Gilbert
2. River Town: Two Years on the Yangtze by Peter Hessler (in anticipation of my trip to China in June!)
3. (Your recommendations here)
Gracias
Sunday, March 28, 2010
Friday, March 26, 2010
Where are all my charts?
Ah the joys of research!
I have been working a ton lately and have not had much time for traveling. Oh the real world...
As a Fogarty Scholar I am doing cardiovascular disease research in Peru and despite not blogging a lot about it, my fantastic readers, today is your lucky day - I have something to blog about that's related to work! My work usually consists of spending a lot of time on my computer plugging in equations into STATA, making tables, re-making the tables 50 times because we keep changing the the methods and research question, searching PubMed for references, reading PDFs and highlighting them on Skim (a much better PDF program than Adobe or Preview and it's free), writing manuscript drafts, and Skype-ing with my mentors in the states. In the past month, I have spent more time on buses going to a from work than I have spent eating and exercising combined (sad, I know). I often take the bus over an hour each way to Cayetano hospital, tracking down doctors on the medicine wards and shadowing them until the have time to talk with me for 20 minutes and then take the bus an hour back.
I am excited to tell you about my new study: a retrospective chart review study looking at in-mortality after cardiovascular disease events. I am hoping to show a difference in in-hospital mortality between men and women and describe the factors that are strongly associated with mortality after a cardiovascular event in this population. My goal was to review 600 charts based on my sample size calculation and 10% missing charts, which meant we would review all the charts from 2005-2009. Luckily I have a partner-in-crime, the amazing Jennifer Milla.
She is a recent Peruvian medical school grad (so jealous), aka doctora, who is applying for residencies in Spain. We were supposed to start data collection 3 weeks ago but due to IRB delays and people being out of town when we needed their signature, we did not get approval to start until last week.
Soooo excited to have my first project stamp of approval!
That's when the trouble started... first, I did not exclude all the duplicate medical record numbers so in my list of 600 I only have 518 unique entires. Second problem, due to the large number of missing charts I'll be very happy if we get 450 (but realistically we will probably have around 400 - fingers crossed...). Third, our most recent pitfall is that the woman in charge of the charts, Senora Julia, refused to pull our charts last week and now will only give us 10 charts per day as it's "too much extra work" for her staff AND they will only look for them after 4:30pm! The hospital is not in the best neighborhood and leaving after dark is not a great idea for Jennifer or myself. Julia refuses to let us pull our own charts... oh how I wish they have electronic medical records! So at this rate we have officially completed 32 questionnaires and won't be done until July (and I'm leaving at the end of May) and that doesn't include the time it takes to enter the data. Oh well... we'll figure it out and we may just need to bribe someone so we can get it done. Welcome to the wonderful world of research!
Overall, it's a great experience and I find that I really only learn from my mistakes anyway (I hate how that works). I have enjoyed setting up my own project, writing protocols and ethics approvals in English and translating them to Spanish and then back to English again after they changed a dozen times. Thank goodness for Jennifer, who recently completed a thesis to graduate from medical school, who knew all the hoops we needed to jump through, like what little old lady behind the counter in the convenience store across the street from the University who you have to pay $1 to write the "official" cover letter presenting our protocol to the ethics boards and where the chief of medicine's office was and where he has coffee to track him down. Between our meetings and training Jennifer to do the chart abstraction my Spanish has really improved. We talk on the phone but we find text messaging and email to be a little easier as I still have a hard time discussing anything besides, "Where are you?" "What time are we meeting?" and "I'd like that chifa delivered, my address is...".
Learning what hoops to jump through in both the US and Peruvian systems had been very interesting and I find being flexible and having other projects to work on alongside is really the only thing keeping me sane yet a little crazy too because I am swamped with work right now. I enjoy going to rounds at the hospital in the AM and seeing a 39 year old patient who looked like she was in a concentration camp and weighed about 60 lbs. She has severe toxic thyroiditis where her body makes an anti-body to the TSH receptor and her thyroid is SUPER overactive and so her metabolism has increased and she is basically skin and bones. I don't think I will EVER see that again.
Medicine clinic waiting area
Basically, I am working on eight or so projects with four different groups/studies and have three IRB approvals (the bane of all researchers existence - especially in global health) and am waiting on one more for a total of four (the most that any Fogarty in Peru has had before me was two). I had one paper accepted in Diabetes Care and one abstract accepted, which I will be presenting at the World Congress of Cardiology in Beijing in June. The same abstract we are revised and are resubmitting next week to Atherosclerosis on carotid-intima media thickness in this population. I think it has been a very successful year and I'm happy to have accomplished most my goals, namely learning Spanish.
Cayetano
I'm standing in the middle of the street and on one side is the Cayetano University and hospital, on the other, a funeraria with a hearse parked in front. How morbid...
Adios!
I have been working a ton lately and have not had much time for traveling. Oh the real world...
As a Fogarty Scholar I am doing cardiovascular disease research in Peru and despite not blogging a lot about it, my fantastic readers, today is your lucky day - I have something to blog about that's related to work! My work usually consists of spending a lot of time on my computer plugging in equations into STATA, making tables, re-making the tables 50 times because we keep changing the the methods and research question, searching PubMed for references, reading PDFs and highlighting them on Skim (a much better PDF program than Adobe or Preview and it's free), writing manuscript drafts, and Skype-ing with my mentors in the states. In the past month, I have spent more time on buses going to a from work than I have spent eating and exercising combined (sad, I know). I often take the bus over an hour each way to Cayetano hospital, tracking down doctors on the medicine wards and shadowing them until the have time to talk with me for 20 minutes and then take the bus an hour back.
I am excited to tell you about my new study: a retrospective chart review study looking at in-mortality after cardiovascular disease events. I am hoping to show a difference in in-hospital mortality between men and women and describe the factors that are strongly associated with mortality after a cardiovascular event in this population. My goal was to review 600 charts based on my sample size calculation and 10% missing charts, which meant we would review all the charts from 2005-2009. Luckily I have a partner-in-crime, the amazing Jennifer Milla.
She is a recent Peruvian medical school grad (so jealous), aka doctora, who is applying for residencies in Spain. We were supposed to start data collection 3 weeks ago but due to IRB delays and people being out of town when we needed their signature, we did not get approval to start until last week.
Soooo excited to have my first project stamp of approval!
That's when the trouble started... first, I did not exclude all the duplicate medical record numbers so in my list of 600 I only have 518 unique entires. Second problem, due to the large number of missing charts I'll be very happy if we get 450 (but realistically we will probably have around 400 - fingers crossed...). Third, our most recent pitfall is that the woman in charge of the charts, Senora Julia, refused to pull our charts last week and now will only give us 10 charts per day as it's "too much extra work" for her staff AND they will only look for them after 4:30pm! The hospital is not in the best neighborhood and leaving after dark is not a great idea for Jennifer or myself. Julia refuses to let us pull our own charts... oh how I wish they have electronic medical records! So at this rate we have officially completed 32 questionnaires and won't be done until July (and I'm leaving at the end of May) and that doesn't include the time it takes to enter the data. Oh well... we'll figure it out and we may just need to bribe someone so we can get it done. Welcome to the wonderful world of research!
Overall, it's a great experience and I find that I really only learn from my mistakes anyway (I hate how that works). I have enjoyed setting up my own project, writing protocols and ethics approvals in English and translating them to Spanish and then back to English again after they changed a dozen times. Thank goodness for Jennifer, who recently completed a thesis to graduate from medical school, who knew all the hoops we needed to jump through, like what little old lady behind the counter in the convenience store across the street from the University who you have to pay $1 to write the "official" cover letter presenting our protocol to the ethics boards and where the chief of medicine's office was and where he has coffee to track him down. Between our meetings and training Jennifer to do the chart abstraction my Spanish has really improved. We talk on the phone but we find text messaging and email to be a little easier as I still have a hard time discussing anything besides, "Where are you?" "What time are we meeting?" and "I'd like that chifa delivered, my address is...".
Learning what hoops to jump through in both the US and Peruvian systems had been very interesting and I find being flexible and having other projects to work on alongside is really the only thing keeping me sane yet a little crazy too because I am swamped with work right now. I enjoy going to rounds at the hospital in the AM and seeing a 39 year old patient who looked like she was in a concentration camp and weighed about 60 lbs. She has severe toxic thyroiditis where her body makes an anti-body to the TSH receptor and her thyroid is SUPER overactive and so her metabolism has increased and she is basically skin and bones. I don't think I will EVER see that again.
Medicine clinic waiting area
Basically, I am working on eight or so projects with four different groups/studies and have three IRB approvals (the bane of all researchers existence - especially in global health) and am waiting on one more for a total of four (the most that any Fogarty in Peru has had before me was two). I had one paper accepted in Diabetes Care and one abstract accepted, which I will be presenting at the World Congress of Cardiology in Beijing in June. The same abstract we are revised and are resubmitting next week to Atherosclerosis on carotid-intima media thickness in this population. I think it has been a very successful year and I'm happy to have accomplished most my goals, namely learning Spanish.
Cayetano
I'm standing in the middle of the street and on one side is the Cayetano University and hospital, on the other, a funeraria with a hearse parked in front. How morbid...
Adios!
Monday, March 08, 2010
My longest bus ride in Lima yet - 1:45 min
Caraballyo
Last week I went to have lunch at my cleaning lady's house in Caraballyo, a peri-urban town on the outskirts of Lima. Ten years ago hardly anyone lived in these arid hills but now they are lined with colorful mud and brick houses built by migrants from the mountains. Many people who live in this area live in poverty and make less than $100 per month or just over $3/day. I pay her $3/hour which I think it a bargain and after I visited her house and realized how long it took her to get to my house by bus - over a hour and half - I raised her wage to nearly $5/hour! My apartment has an empleada's room with a bathroom and shower and I learned that it's because they don't have showers in the slums.
I'm not sure I can adequately describe their living conditions but basically they live in the Lima slums and they are very poor. They laid some bricks between two other one-story brick houses and left room for a door and moved in. Their walls are the outside of their neighbors' houses. Wall-to-wall is about 8 feet wide. Their front door is a piece of plywood without a handle or lock. They use a piece of bamboo to "lock" it. For the past three years, they did not have a roof over their house but last week they had saved enough money and her husband build a tin roof.
When I arrived, her husband was watching a DVD of a Peruvian band playing traditional music from Cayamarca where they are from. He invited me into the living room/bedroom/kitchen where I sat on one of two twin straw-filled beds with alpaca blankets and watched the music video on a small color TV. Behind the TV was a plywood wall that separated this bedroom, where Lucha's brother and mother sleep, from her "master bedroom" with a full size bed and an armoir with a large mirror. They do not have a bathroom - only a hole out back with a piece of wood covering the hole that you squat over.
Their kitchen table was used to prepare all the food and then wiped off and set right before we ate. There are basically no appliances - no refrigerator, no microwave, no blender, no coffee pot, no dishwasher, no counter space, no cupboards; only appliance is an old gas countertop stove. There are only two electrical outlets in the house and a single light fixture (a single bulb hanging from a wooden beam above the kitchen). They have one large utility sink with a cold water tap. They have two small chickens that peck at the crumbs on the dirt floor and since it is very uneven we used an old newspaper to level the table and chairs before eating.
In total, their house is about 8ft by 40ft mas o menos. It is very simple compared to where I come from or where I live in Lima.
It happened to arrive the day that they were having a "road paving" party for the 1.5 mile of newly paved raod that the government just finished. After a delicious ham served with potatoes and rice (carbs are a very common source of calories for poorer Peruvians and is contributing to obesity, especially among women) we moved the chairs outside to socialize with the neighbors. I was asked if I was Catholic and if I could be the godmother of Lucha's next door neighbor. I didn't know what to say (or if I had understood him correctly).
Luckily, the fiesta was starting in the park so we headed over to join the crowd. We all walked the full 1.5 mile of road, smashing champagne bottles every 200 ft and chanting and singing along with the guy who had the megaphone.
I was very impressed how proud this community was of their new road and despite living in rather poor conditions, everyone looked very clean and well-kept wearing big smiles wherever they went. I also found it rather ironic that they paved a new road yet hardly anyone owns a car. They get around by mototaxis or walking so I guess for now it's just a nice new sidewalk.
Breaking bottles on the new pavement
Lucha on the right with the family from next door.
My 12th visitor
My medical student friend, Bryan Sundin, visited me for a few days before going to Cusco for a 6-week rotation. He came to the hospital with me for a few meetings and we walked around El Centro and had a Cathedral Pisco Sour at the famous Hotel Bolivar. It was grea
Making ceviche at my apartment
Lucha and her husband came to clean my apartment last weekend and offered to make lunch. I had a few friends come over and bought all the ingredients for ceviche - raw fish cooked with the acid from lime juice - mmmmm sooooo good!! It cost 40 soles to feed 10 people delicious ceviche where it's usually 40 soles per plate when you go to a fancy restaurant (and they did all the dishes!) I'd have to invite them over more often!
I could eat it all! NOT!
Choclo (corn), papas (potatoes), and ceviche!
Other activities
We found a bar that actually has real beer and not watered down crappy Peruvian beer. Here is a group of my friends enjoying some good (and expensive) European beer and pizza.
Santiago's birthday
My Spanish teacher, Pierina, has a 5 year old son who specifically requested that I come to his birthday party at Bembos (like Burger King). The kids played in the indoor playground and danced to music. Even the adults were entertained by the magician pulling the rabbit out of a box. The cake was delicious and poor Santiago was very very sad when the party was over.
In addition to my Christmas in Peru, the trip to Caraballyo and Santiago's birthday party were cultural experiences that I'll never forget.
OK, back to work since I have to go to Guayaquil and Puerto Lopez, Ecuador, next week to renew my visa. Chau!
Last week I went to have lunch at my cleaning lady's house in Caraballyo, a peri-urban town on the outskirts of Lima. Ten years ago hardly anyone lived in these arid hills but now they are lined with colorful mud and brick houses built by migrants from the mountains. Many people who live in this area live in poverty and make less than $100 per month or just over $3/day. I pay her $3/hour which I think it a bargain and after I visited her house and realized how long it took her to get to my house by bus - over a hour and half - I raised her wage to nearly $5/hour! My apartment has an empleada's room with a bathroom and shower and I learned that it's because they don't have showers in the slums.
I'm not sure I can adequately describe their living conditions but basically they live in the Lima slums and they are very poor. They laid some bricks between two other one-story brick houses and left room for a door and moved in. Their walls are the outside of their neighbors' houses. Wall-to-wall is about 8 feet wide. Their front door is a piece of plywood without a handle or lock. They use a piece of bamboo to "lock" it. For the past three years, they did not have a roof over their house but last week they had saved enough money and her husband build a tin roof.
When I arrived, her husband was watching a DVD of a Peruvian band playing traditional music from Cayamarca where they are from. He invited me into the living room/bedroom/kitchen where I sat on one of two twin straw-filled beds with alpaca blankets and watched the music video on a small color TV. Behind the TV was a plywood wall that separated this bedroom, where Lucha's brother and mother sleep, from her "master bedroom" with a full size bed and an armoir with a large mirror. They do not have a bathroom - only a hole out back with a piece of wood covering the hole that you squat over.
Their kitchen table was used to prepare all the food and then wiped off and set right before we ate. There are basically no appliances - no refrigerator, no microwave, no blender, no coffee pot, no dishwasher, no counter space, no cupboards; only appliance is an old gas countertop stove. There are only two electrical outlets in the house and a single light fixture (a single bulb hanging from a wooden beam above the kitchen). They have one large utility sink with a cold water tap. They have two small chickens that peck at the crumbs on the dirt floor and since it is very uneven we used an old newspaper to level the table and chairs before eating.
In total, their house is about 8ft by 40ft mas o menos. It is very simple compared to where I come from or where I live in Lima.
It happened to arrive the day that they were having a "road paving" party for the 1.5 mile of newly paved raod that the government just finished. After a delicious ham served with potatoes and rice (carbs are a very common source of calories for poorer Peruvians and is contributing to obesity, especially among women) we moved the chairs outside to socialize with the neighbors. I was asked if I was Catholic and if I could be the godmother of Lucha's next door neighbor. I didn't know what to say (or if I had understood him correctly).
Luckily, the fiesta was starting in the park so we headed over to join the crowd. We all walked the full 1.5 mile of road, smashing champagne bottles every 200 ft and chanting and singing along with the guy who had the megaphone.
I was very impressed how proud this community was of their new road and despite living in rather poor conditions, everyone looked very clean and well-kept wearing big smiles wherever they went. I also found it rather ironic that they paved a new road yet hardly anyone owns a car. They get around by mototaxis or walking so I guess for now it's just a nice new sidewalk.
Breaking bottles on the new pavement
Lucha on the right with the family from next door.
My 12th visitor
My medical student friend, Bryan Sundin, visited me for a few days before going to Cusco for a 6-week rotation. He came to the hospital with me for a few meetings and we walked around El Centro and had a Cathedral Pisco Sour at the famous Hotel Bolivar. It was grea
Making ceviche at my apartment
Lucha and her husband came to clean my apartment last weekend and offered to make lunch. I had a few friends come over and bought all the ingredients for ceviche - raw fish cooked with the acid from lime juice - mmmmm sooooo good!! It cost 40 soles to feed 10 people delicious ceviche where it's usually 40 soles per plate when you go to a fancy restaurant (and they did all the dishes!) I'd have to invite them over more often!
I could eat it all! NOT!
Choclo (corn), papas (potatoes), and ceviche!
Other activities
We found a bar that actually has real beer and not watered down crappy Peruvian beer. Here is a group of my friends enjoying some good (and expensive) European beer and pizza.
Santiago's birthday
My Spanish teacher, Pierina, has a 5 year old son who specifically requested that I come to his birthday party at Bembos (like Burger King). The kids played in the indoor playground and danced to music. Even the adults were entertained by the magician pulling the rabbit out of a box. The cake was delicious and poor Santiago was very very sad when the party was over.
In addition to my Christmas in Peru, the trip to Caraballyo and Santiago's birthday party were cultural experiences that I'll never forget.
OK, back to work since I have to go to Guayaquil and Puerto Lopez, Ecuador, next week to renew my visa. Chau!
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