Love/Hate

Living in Tumbes has made me realize what I love and hate about living Miraflores (in Lima).
Love about Miraflores: having hot water and taking a nice hot shower
Hate: paying extraordinary amounts of money for rent and utilites (by Peruvian standards since it costs $350 to rent a 1br in Miraflores and 150 soles ($50) in Tumbes)
Love: being next to the beach (even though it's rocky) and watching surfers
Hate: that it's rarely sunny to enjoy going to the beach. Tumbes is always hot and sunny but we're inland from the beaches. After our trip to Mancora last weekend, however, I will say that cold showers feel good on your sunburns!
Love: friends with cars and motorcycles so that you don't have to worry about being run over on a mototaxi or being stuffed into a combi
Hate: the traffic in Lima; it's just like LA!
Love: not having guard dogs barking all night
Hate: listening to car alarms going off instead
Love: having a kitchen and microwave. you can only eat out for so many meal and when it's all rice and no veggies it get a little frustrating.
Hate: paying gringo prices at the tiendas and street vendors
Love: going dancing at the clubs
Hate: paying 20 soles to get in
Love: going for a run along the Malecon and the ocean rather than run stairs in my apartment in Tumbes
Hate: breathing lots of car exhaust
Love: sushi
Hate: over-priced food and menus (a set salad or soup, entree and desert for one price) since you can eat menu here for 5 soles ($2)
Love: good coffee since everything here is instant
Hate: paying for it - in a country that produces a lot of coffee you'd think it's be next to free but all the good coffee is imported from America and has imported prices.
Love: speaking English
Hate: being able to speak in English. Only Heather, Miranda, Colin and I speak English in Tumbes
Love: not having to wear bug spray because the mosquitoes eat you alive. I also love not having little bugs in my bed, and tiny ants climbing on my stuff and in the sink and shower.
Hate: how urban Lima is
Love: not throwing my used TP in the basura (waste basket)
Hate: thinking about where all my garbage goes - hopefully it's not in the big dump pile in the shanty town by the river...
Love: 24 hours/ 7 days a week electricity and never having to deal with power surges
Hate: 24 hour internet because I can work the entire day and never leave my apartment

Only two more days in wonderful Tumbes. It's growing on me even though there are only 4 reasonably good restaurants that Heather and I frequent for lunch and dinner on a rotating basis. I'm sick of going out to eat all the time, taking cold showers and not running every morning but I'm going to miss the blue sky and hot sun and the wonderful field workers. I will probably be back in March for a few months but we'll see...

Hasta luego!

Puerto Pizzaro and Mancora

Puerto Pizzaro



Puerto Pizzaro is a small fishing town 8 miles from Tumbes. The combis that I take to get to the Proyecto all go to Puerto Pizzaro so yesterday I decided to take the combi and not get off and explore Puerto Pizzaro. I had no idea what to expect and four hours later I was overwhelmed and stuffed. After arriving I was swarmed with men in neon green shirts who work for the motorized tour boats. I wasn't expecting to go out on a boat, I just wanted to walk around and explore, but after the 6th man came up to me to show me photos of the crocodiles, Isla de Amor (where lots of honeymooners go), and Isla de los Pájaros (where the Magnificent Frigget bird nest), I thought maybe I should go check out the mangalares (mangroves). I stopped to take a photo of the fishing boats (see photo) when a nice older man asked me if I'd like to go out on one of those boats. In Spanish, he explained that he has a motor/row boat and for only $10 (much cheaper than all the neon green t-shirt guys) I could have him take me on a private tour. The only stipulation was that if I liked it then I would tell my friends to go to him in the future.

It was the best $10 I've ever spent on a tour. I had my own wooden boat and 70 year-old guide, Juan, who took me on a romantic ride through a labyrinth of tidal channels to a crocodile farm. Then we went to see the frigget birds and then to the Island of Love where I sat next to the water and ate a big plate of chicarrones (fried calamari, fish, and shirmps) and listened to the waves.


The mangroves are a very important food source for numerous species of crustaceans, molluscs, fish and fauna and humans enjoy conchas negras. The tides change dramatically and by the time my tour was over the channel to the crocodile farm was too shallow for motorboats.




Thousands of magnificent frigget birds nesting on the island. Males have bright red breasts and the chicks are white. Quite an incredible site!

Mancora
Two hours south of Tumbes, Mancora is one of the greatest beach/surfer towns in Peru. My friend Heather who I'm working with in Tumbes and I went to spend the day in the sun and swim in the Pacific Ocean. My friend Miranda decided to meet us there and we had a great night (and day) in this surfer town eating delicious seafood, drinking Piscos and bad Peruvian beer and dancing at a club on the beach until 5am. It was a great day in the not-too-hot-but-feels-great-85-degree-sun if only my three applications of SPF45 would have been more effective! I'm totally fried (but really only in the places I forgot to reapply sunscreen). I bought a couple sarongs and Heather bought an awesome hammock for only 50 soles ($18) at the cute markets. I love Peru!

Me, Heather and Miranda enjoying some Pina Coladas at a restaurant on the beach.


Next week
I have one more week in Tumbes and then I am going to Lima for Halloween and to meet my boyfriend Seth there. We will be going to Cusco, Machu Picchu, Sacred Valley, and Puerto Maldonado for the next two weeks.

Field work

Most people have no idea what it means to go out and collect data in the field. Let me try to briefly explain what I am doing in Tumbes, Peru.

For the project that I'm helping with right now we are trying to answer the question "Did the 1997-98 El Nino have an effect on the growth of children in Tumbes?" In order to do this we need to screen over 2,000 kids to find a 0.2 difference in the age-standardized variation of children who were 0-36 months old during those years. Basically we go to these small towns in the Tumbes district where we recruit one child per household (that were randomly selected from the Proyecto's census records). We knock door-to-door (if there is a door that is) and confirm that the kid lives there. Then we ask to talk to an adult, preferably a parent but older siblings and grandparents are fine too, to answer a 30-minute questionnaire and consent to let us measure the kid's weight, height, triceps skin thickness and percent body fat the following day in school.

There are three local field workers who have been trained to collect the data and work full time, waking up at 5am to go to the field. We meet up with them around 8 to 10-100 miles away go to the schools. Some schools are only elementary school in the morning and in the same classrooms they have high school in the afternoon, and some are vice versa. Some towns are big enough to have two separate complexes for each. Basically we don't know what kids we are going to find until we get there and even then a lot of kids don't go to school everyday in which case we have to come back the next day.

This best park about this job is the kids. They are wonderful! They are so inquisitive and beautiful. They are very polite but love to stare at me. The families invite us in and invite us sit to on their very nice plastic chairs while they stand. Others have 1970 floral-patterned brown couches that are comfy. No one really wear shoes. Everyone has one television and a large poster of Jesus in their living room.

Motocars at one of the major intersections in Tumbes


If you haven't noticed, the entire area here is poor and rural. However, I can't imagine why anyone would want to move to Lima or the USA because they have everything they need here. People who are the richest of the poor have a nice life. Most people who are born here never leave and their entire family (and extended family) live in the Tumbes area. Downtown Tumbes has a church and center square and in total Tumbes is about 8 blocks long. Some "richer" families send their kids to the neighboring towns (that we've already been to the schools) but then we have to go back. The reason we can't do the measurements in the house is that most houses don't have a straight wall for use to set up the height measurements nor do they have plugs that won't blow our impedence machine. It's amazing how quickly you can tell what families are "rich" since their floors are "tile" and they own a horse rather than donkeys and occasionally have motocar (see photos) instead of bicycles. Most families make between 150-300 soles/month which is less than $100/month. I can't imagine but they all seem very happy and that's really what's the most important.

It's very interesting work and I love it!


View from Heather's third floor room - arguably the "best view" in Tumbes. Pretty nice, huh?

Buenos Aires and Tumbes

I am exhausted. I arrived in Tumbes less than 24 hours after arriving from Buenos Aires on one of the best vacations of my life! I have lots of work to do and I can't wait to get experience working in the field here but first a quick summary of my trip to BA.
-Thursday: arrived with 5 girls to the hostal and ate at Cafe El Federal in San Telmo.
-Friday: toured the old mansion and now museum El Zanjon. Very cool. Ate at a cafe on Defensa in San Telmo and for dinner got dressed up to go to Bourgognie in the Alvear Palace Hotel - super fancy and expensive but the best meal I can remember.
-Saturday: Ate delicious sushi in the tea house at the japonese gardens and then watched Argentina's Natonal team sneak by a horrible Peru soccer team in a world cup qualifier game while it was POURING rain!

-Sunday: San Telmo antique markets all day with tango in the streets.

-Monday: Met fellow Fogarty, Lisandro, and his wife and wandered around Monserraut and San Nicolas and then went to the Recoleta markets outside the famous Recoleta Cemetary where Evita is burried. Flew home in the evening, did laundry, uploaded photos, went to a few meetings in the morning and re-packed for Tumbes.



Lots of peaceful (and entertaining) protests in Buenos Aires during Ferria de Colon (Columbus Day).

Delicious ice cream on Calle Florida

This is 9 de Julio, the widest avenue in the WORLD! 11 lanes wide with a HUGE obelisk at Ave de Mayo.


Tumbes
The Proyecto Eliminacion de Cisticercosis has established a great place to do research in Peru. Fieldwork here is easy because of the great work they have done over the years. Quick background, Tumbes is the northern most district in Peru and where I am staying is only 30km from the Ecuador border. The Proyecto is on the PanAmerican Highway (yes we hitchhike the PanAm to get to and from here) and is a few acres surrounded by acres of rice fields (and lots of mosquitoes). There is a brick wall outside and inside is a clinic, a lab, a pig pen (where they are slaughtering pigs right now to study cysticercosis), a soccer field (of course!), a three story building with the first two floors are offices with lots of computers (and wireless internet) and an apartment on the third floor. There is another guest house with screens for windows and a kitchen which is where my friend Miranda is staying.

I am staying in an apartment with the neurologist from the Proyecto in the neighboring town 4km down the highway. Tumbes is a small city but has a main plaza and a few hotels and even fewer gringos (Americans). The community has lots of smaller neighboring towns and the whole area is very poor. We are measuring kids height, weight, body fat, and talking to families and having them fill out a questionnaire to assess whether El Nino has an impact on stunting children. I've never been in a place like this. We ride around in mototaxis which are motor bikes with carriages on the back. A nice dinner costs $3. We measure people's wealth by the number of animals that they live with. In one household you can have many families with all their animals (ducks, pigs, donkeys, etc).

Today we went to two schools, a primary school and a high school. It was very fun but it is hot and humid here and i was dying! Tomorrow I am going with the field coordinator, a RN, to do home visits to finish some questionnaires and then meet up with the other two field workers to do more measurements. These women are very nice and we hire a driver to take us and the equipment around all day for $20 (which is a ton of money). None of them speak any English! I'm already getting better. Hasta luego.

LimaKids

LimaKids is an organization that was started up a handful of years ago with the mission of providing medical care and outlets for street kids of Lima. They have weekly "rounds" in which they find and work with children on the street as well as a monthly policlinico in which a physician tends to their medical - and often social - needs. They've also organized an elaborate soccer league that has grown, and more importantly, has had great success over the past several years in building kids' self-esteem and teamwork skills. Teams are organized around orphanages, who come together weekly for games, with a final tournament at the end of the season. I am just finishing my season with the San Fransico 15-17yo boys team. The orphanage celebrated their 8th anniversary on Friday and the kids put on a great show for the teachers and members of the community who volunteer often. LimaKids has other projects as well and they're always looking for ideas/volunteers. Check out LimaKids for more info.

If you are in Lima and are reading this, there will be a great fundraising event for this great organization the weekend of October 17th in Miraflores. Email limakids@gmail.com for me info. It would be fantastic if you all could learn about and support what many of us here in Lima think is a great organization. If you can't make it and you're still interested in donating, use this site: donation link.

Eduardo with two orphans at San Fransico.

There is also a Facebook page, where you can get info for the event and become a member of LimaKids and donate to LimaKids. It's through the Saranac Rotary Club, which manages funds for the group so don't worry if it's not the right title, it's still the right org! Click here to join the facebook group

Muchas gracias a todos y espero que todo este bien. Thanks again.

I'm off to Buenos Aires with my friends Miranda, Kara, Rebecca and Ali where we will shop, eat, drink and dance all night and hopefully take a day to go to the beach and do some cultural things. On Tuesday I'm off to Tumbes for a few weeks doing field work. I'm very excited since it is something I have never done before and no one will speak Spanish. Hasta luego!

A week in the life of KTP (a post for another day).

So I prepared a wonderful blog post that was going to have photos of the places that I go to often - my wonderful apartment in Miraflores, the friendly doorman, my fantastic coffee shop Sama, my grocery store Metro, my corner bodega, my salon where we get manicures and pedicures for $8, my combi stop, the boys from the orphanage, etc. However, last Sunday I went to the annual culinary festival at Parque de Lima (it was similar to a Ribfest in the States where restaurants sell smaller portions of their best meals and you get to sample ALL of them) with my friend Romina and her cousins. After a whole day of eating delicious Peruvian dishes, like risotto, fried pork, and cerviche, eating desserts, like queso helado, drinking Pisco sours, getting interviewed by a local television station, getting the famous Gaston's signature in my "Native Potatoes of Peru" book, and shopping at the market where people were selling specialty items from all over Peru, my camera was stolen.
Stolen. Just like that, gone.
It was a little deja vu as less than four years ago when I was at the Olympics in Italy my camera was stolen out of my bag when I was on a bus after the short-track speed skating event. I was devastated then and I am devasted now.
We reported it to the police who were nearby who were sympathetic but said there is nothing they can do. Romina escorted me to my combi but I was hesitant to get on, hoping desperately that if I stayed around the park maybe I would find the thief. The light was about to turn green so I said goodbye to Romina and got on and rode home, very frustrated and ticked off. How could I be so dumb? Why didn't I put my camera back in my bag and not in my pocket where some 4'11" 40-something red-head Peruvian woman could take it? Didn't I learn anything from the last time? How am I supposed to get a new camera?

Well after beating myself up for a while I decided to look on the positive side. 1) I'm pretty good about uploading photos on a weekly basis so only the photos for this post were lost. 2) My camera was a little outdated. It was a Canon A710 with only 6 megapixels and a 10x zoom. Not shabby but there are better ones out there. 3) I have plenty of great memories and an overstuffed stomach to remember the day by and plus now I have something to write home about and maybe this will make a good "Christmas and Birthday" gift from my parents as both holidays are close together and tend to mesh into one anyways.
Hasta luego.

It's not about winning or losing

Today was our second soccer/futsal game with the team that I help coach, San Fransico. I woke up early (8am) and took the usual combi to the shelter/orphanage. Usually with traffic it takes me an hour to get there so I plug in my iPod and listen to Coffee Break Spanish and jot notes in my a notebook.

I arrived shortly after 9 and all the boys were yelling "Gringa, gringa es aqui!" "The American is here!" The private combi/van was supposed to show up at 9:30 to take us (me, Eduardo and his wife, and the 8 boys) to the game but by 10 I was getting a little worried. The kids were starting to get restless and kick soccer balls at each other and over the orphanage wall so that they would have to tell the security guard to open the 15 foot black metal door and they could have a chance to run away. It never works and I think they lose more balls that way.

Anyway, the combi arrived and it took us another hour to get to the orphanage where we were playing (for our 11am game). Good thing I got up so early! So I live in a posh area of Lima. All of our roads are paved and our houses have roofs. The area we went to for the game was in the north of Lima. We turned off the highway onto a dirt road with lots of burning trash, super skinny dogs, bodegas (convenience stores) with gates shut, lots of street venders selling fruits and vegetables, and little three wheel buggies transporting mother's and children around the neighborhood. The brick buildings that surrounded us looked like they were never finished being built but they were and people lived there. Their clothes hung from clothes lines on the roofs and an occasional satellite dish meant someone could watch the Premier league futbol (or maybe American Football, who knows) on their TV tonight.

The orphanage walled in but once we drove inside it was much nicer than I expected based on the surrounding area. A dozen small houses with lots of grass and trees a central futsal field. We played 5 versus 5 futsal on a cement court that was about the size of a tennis court. We lost the game 3-6 after hitting the post no less than 8 times and giving up three goals on turnovers by passing back after a kick-in (John Leaney would not be happy as he always told us, "Always throw it down the line."). The kids were pretty upset but got over it once we got back in the combi and they could look at all the pretty girls on the street and drink their Coca Cola - both are a treat when you are locked inside an orphanage all the time.

In work news...
I have been very very busy working on a few data analysis projects. Not only am I learning Spanish but I'm learning Stata and SPSS syntax. AH!

On a high note, I just found out I'm going to Tumbes for a few weeks in October (after I get back from Buenos Aires with 6 American girl friends) to work on a field project there. I will be helping collect anthropomorphic measurements on children as part of an El Nino study but more importantly I am going to be learning how to set up my own project in Tumbes, work with locals on data collection, and get to know this very rural town where NO ONE will speak English (except of course for the three other gringos who are there working on pig slaughtering and chronic obstructive respiratory disease studies).

Why Tumbes? You might ask. Well a number of years ago a researcher from Peru did a great job setting up an epidemiological study on neurocystercercosis and has been collecting census information on the area. It's a great size, we have data on everyone who is born and who dies, who moves in and out, and ever have all their animals accounted for. Tumbes is located on the beach and the ocean is warm and the sun is hot. It will be nice to get out of Lima for a bit. I can't wait!

Know your cardiovascular disease risk

I came across some interesting articles in my overwhelming literature search on what is known and not known about CVD in Latin America.

For busy physicians, there are four challenges in regard to a patient's CVD risk (Cooney et al. JACC 2009): 1) How do I identify people who are at increased risk of a cardiovascular event? 2) How do I weight the individual effects of all the causative risk factors when assessing a person’s risk? 3) How do I stratify that risk to determine who needs lifestyle advice and who needs additional medical therapy? 4) How do I ensure that I am not overmedicalizing those persons who are at low risk of an event?
There are various risk scoring systems that doctors use to answer these questions. The most well known is the Framingham risk score but it is unknown if it is a valid scoring system for different ethnic populations, say in Peru. That's one of my projects here.

So, do you know your CVD risk? Framingham and other risk calculators have been developed based on people who are at risk for events and emphasize secondary prevention after disease has developed. For young people (<45 year) your Framingham risk will be low unless you have a genetic profile that predisposes you to CVD (high cholesterol or triglycerides) but primary prevention and modification of risk factors at this early stage is where we have the greatest opportunity for prevention of CVD and subclinical disease. The earlier the better.

Did you know that it is recommended to exercise at least 2 hours per week? That's it. That's only 30 minutes 4 times a day or 10 minutes 2-3 times per day. How many of us actually get 2 pathetic hours per week? How much time do you spend watching the Twins or Viking (or Packers) games? How much time do you spend in your car? The elephant in the room in the healthcare reform debates is our culture of inactivity and eating poorly. Walking 2 hours per week can lower your blood pressure more than popping a pill and it can decrease your risk of CVD and stroke by 25% not to mention it can help you lose weight.

Below are current recommendations based in risk and age. See where you fit and take the first step in lowering your risk now! It may be cutting down on smoking, it may be going for a walk or a longer walk but we can all do something to lower our risk and put me out of a job! :)

Work update

Hola de Peru! I have been working a lot lately; lots of meetings with various people including my advisor here, Dr Jaime Miranda, the program director at NHLBI, Dr Cristina Rabadan-Diehl, and the Executive Director of UnitedHealth Group (based in MN) and former BMJ editor-in-chief, Richard Smith, and attending a conference on hypertension (in Spanish) so I'm sorry if my frequent (and fun) posts have fallen behind.
My Spanish comprehension is getting much better but I find that I talk to the gringos in English a lot and so my speaking ability is vastly behind. Unfortunately, my wonderful Spanish teacher, Rosalie, is moving to Spain to start a Master's program and is leaving me :( For one of our last classes we went to see the Cuerpo Humano (BodyWorlds) exhibit that was here and I learned a lot of medical vocabulary and taught her a thing or two about the body and diseases.

Research Projects
Here's a quick run-down of the projects I'm working on. There is a potential for this to turn into a two-year assignment as there is a lot of work to do and only one of me (and Antonio the statistician I work with) to do it.
Study 1. PREVENCION (a Spanish acronym) study looked at the prevalence of cardiovascular disease (CVD) risk factors in a cross-sectional sample of the adult population of Arequipa, the second largest city in Peru. The primary investigators are Dr Julio Chirinos and his mother Dr Josefina Medina. I got IRB approval from University of Washington last week to do data analysis and write manuscripts about the normal variance of hemodynamics in this population and specifically where prehypertensives and hypertensives fall based on healthy normotensive curves. We are using measurements from impedence cardiography (something in know little about) but need to train myself in so we can use this technology for study #2 in the spring. I hope to submit an abstract to the World Conference of Cardiology by the end of this month for the Conference in Beijing, China in June 2010.
Study 2. PERU-MIGRANT (PEru's Rural to Urban MIGRANTs) study was designed to investigate the magnitude of differences between rural-to-urban migrant and non-migrant groups in specific CVD risk factors. We will be continuing field work in Tumbes, which is near Ecuador, in the mountains region of Ayacucho, and in an urban area San Juan de Miraflores. The study was Dr Jaime Miranda's PhD work and is the basis for the NHLBI and UnitedHealth Group's Center for Excellence. We will be screening an additional 2000 people for CVD and 1000 for COPD starting in March.
Study 3. LASO (Latin America Study of Obesity) study combines over 12 databases, including the two listed above, to look at epidemiological trends in Latin America. I have not submitted a project proposal yet to LASO but if I run out of things to do with studies 1 and 2 (unlikely) then I always have this one.

Dr. Katherine Luke

This was an email I received a few days ago about a wonderful person who I've only met twice but will remember always for her bright smile and amazing personality. She was recently diagnosed with a rare form of breast cancer - the same terrible form that my dear friend and former soccer coach's wife, Carrie Leaney, also suffered from. Katherine will be dearly missed by many as a friend, mother, and wife but her spirit will live on in her memories and through her beautiful children. If you so desire, please consider contributing to her children's educational trust fund.
-
Dr. Katherine Luke, a graduate of Macalester College and a recent PhD in the Joint Doctoral Program in Social Work and Sociology at the University of Michigan, passed away unexpectedly on the morning of Saturday, September 12. Katherine shone personally and intellectually, leaving an indelible mark in the hearts of the many friends and colleagues who loved, respected, and admired her.

Two weeks ago, Katherine was diagnosed with inflammatory breast cancer, an aggressive and rare cancer. After finding out the cancer was quite advanced and had metastasized to other organs, Katherine began chemotherapy on Friday, September 11. This Saturday morning, Katherine passed away.

A memorial service and celebration of Katherine’s life will be held at the First Unitarian Universalist Congregation in Ann Arbor today, September 15th, at 2pm. All are welcome to attend to honor our amazing friend. The First Unitarian Universalist Congregation is located at 4001 Ann Arbor Saline Road in Ann Arbor, MI, 48103.

Anyone who had the opportunity to know Katherine knows that her children, Nicholas and Alexandra, were the absolute light of her life. Her husband Michael Pryplesh, mother Ginger Luke, and stepfather Don Cherry, have communicated to us that the best way to honor Katherine would be to create a loving network of support for her children—showing them how much they are loved and valued every day of their lives—not just today, but tomorrow, in five years, and when they’re twenty or thirty years old.

Future logistics for continued day-to-day support for the family will come in part via the Helping Hands site: Helping Hands. You can register on the site to receive updates as they become available on ways in which help can be provided.

If you have any photographs of Katherine, the family has asked that you please post them to the website above (or email them to zakiyal@umich.edu) so that that they may be included in the service.

In lieu of flowers, the family requests that donations be made to an educational trust fund established for Katherine and Mike’s two children, Nicky and Ali.

Donations to this fund can be made via check to: Ginger Luke and Don Cherry, 5202 Bradley Blvd., 5202 Bradley Blvd., Bethesda, MD, 20814.

Your love, support, and prayers for Mike, Nicky, Ali, Ginger, and Don during this terrible time, are greatly appreciated,

Sincerely,

The friends and family of the Luke-Pryplesh Clan

Arequipa and La Punta

Arequipa
A view of the main plaza in Arequipa with the Cathedral lit up at night.

Romina and I flew to Arequipa in the Southern Highlands of Peru on Friday in order to meet with Dr. Josefina Medina, a cardiologist and the principal investigator on the PREVENCION study. We departed the plane with a view of the full moon rising over the picturesque and dormant volcano, Misti. Dr. Medina is the sweetest Arequipenan woman that I have ever met and was very excited to show me all the technology that she has in her cardiology office. Thank goodness for Romina, my friend and translator, as my Spanish is improving but not sufficient to understand scientific meeting by myself. I was very impressed by Dr. Medina’s computer skills and by the wide array of cardiovascular prevention techniques that she uses in her clinic, including echocardiography, arterial pulse wave, sphygmography, and others.

La Punta
After our meeting we took a taxi on a winding mountain road with sheer cliffs down past Mollendo to La Punta, a small town on the beach where Romina’s family is from. We stayed at the Punta del Sur, the largest building in town besides the church. It didn’t take long for the gringos to become the talk of the town. Her uncle is a very prominent figure in the town and owns a lot of farm land and recently built the very nice hotel with solar panels for hot water which was a big bonus.
He drove us around in the back of his Toyota pickup truck up to the giant “Jesus Blanco” for a panoramic view of the beach and fertile green valley.


It was a stark contrast to the desert and dry brown mountains that we drove along.
Then, he took us along the beach and through his never-ending farms where he employs over 70 women to pick crops. Rice is his biggest crop and a close second are artichokes (photo below) since the value of sugar cane has dropped recently and export demands for artichokes have soared in the past few years. Next time you eat an artichoke heart, look at where it came from.


Next we went to the chicken coop where he keeps his prized roosters for cock fights.
There was even a cock ring where he trains these beautiful birds.
Photo of Josh and Tio (uncle) with the beautiful roosters.

Then he drove us through the valley to his prized possession – his bull. At nearly one ton it is an impressive animal and surprisingly friendly. He gave us kisses and let us rub his nose.

Later we went to lunch at this delicious restaurant with great views of the valley and river running though it where they catch fresh fish and crawfish. It was delicious until all of the gringos got sick the next day in which case I can only assume it was lunch.
Back to Arequipa
We returned to Arequipa and toured the city during the day. Since it is 7,800ft (2300m) above sea level, we undoubtedly felt a little altitude sickness upon our return and didn’t sleep much.
The city is nestled in the valley between towering, snow-capped mountains and it’s beautiful! The sky is always blue, the sun is always shining, the roof dogs are always barking, and the neighbor’s roosters are waking you up at sunrise. It’s weather and topography are similar to Arizona and nearby are the two deepest canyons in the world - Colca and Cotahuasi – that I will hike by the end of this year.

This colonial city is build of white volcanic rock, called sillar, and has largely withheld the test of time and numerous earthquakes. The Catedral de Arequipa is the largest building in town and forms one side of the popular Plaza de Armas. It was built in the 1544 and was reconstructed in 1844 after suffering much damage from fires and earthquakes. Recently, in 2001, a cathedral tower fell after a earthquake but has been restored. The streets are narrow and many are for pedestrians only and are lined with small tiendas (stores), cafes, and restaurants, while other restaurants have balconies that overlook the Catedral, Plaza and its central fountain.
Nearby is the Monastario de Santa Catalina (St. Catherine‘s Convent) that was established in 1580 shortly after the Spanish conquest. My proper name is Catherine Ann, after my great grandmother Catherine Youngquist and I believe she was named after this saint. I might start telling people my name is Catalina since when I say “Katie” everyone says “Que?” since it’s not a common name here.



At its peak, over 200 nuns and their servants lived in this city and since the nuns took vows of isolation it because a city-within-a-city. Currently 20 nuns still reside in a private part of the convent and the rest has been open to the public for 40 years. The narrow streets are beautifully painted with reds, blues, and whites, and flowers and fruit trees line the courtyards and streets. The nuns are famous for their baking and I enjoyed a delicious alfadore in the café after wandering this tranquil little city for over an hour.
I met my friends for another delicious meal at Tradicion – rocotta rellena (stuffed red peppers) and queso helado (yummy fresh ice cream) while a very talented band played traditional Peruvian music.



On our last night there were fireworks on this large bamboo structure in the main plaza but before the lit the big structure a man holding a bamboo toy on a stick with fireworks was in the street. My friend Jenni got caught on fire from sparks flying.


Romina and I about to board the plane back to Lima after a wonderful long weekend. I miss it already!

Half marathon

Video of the Nike 100th Media Maratón de Lima 21K race.

Map of the route.

I did it! The course was great and very flat. We started on the narrow streets in El Centro de Lima and it was amazing to see thousands of red shirts contrasting the yellow and white colonial buildings. There were fans and musical entertainment along the whole route and the police stopped all car and combi traffic so the air was clean. My friend Miranda came out to cheer us on as we ran by her apartment near the Malercon. It was so nice to have a fan.

I paced myself well and when everyone else was dying in the final 4 kilometers, I passed a lot of people. I find great satisfaction running with kilometer markers rather than mile markers as you feel a greater sense of accomplishment as you pass more of them (even though the distance is the same). The final stretch was beautiful though the Circuito Magico del Agua where you weave between these 13 amazing ornamental fountains but you are looking (or dying) for the finish and the water is blocking your vision until you come around the main fountain and 100 yards ahead is the big red banner with the clock ticking and a 10+ person orchestra entertaining the thousands of fans.

Last year at the Earth Day Half Marathon in St. Cloud I finished in 1:50:31 but yesterday and ran the Media Maratón de Lima in 1:49.22. Whohoo!!
A couple of Kenyans won it.

After the race I went to get a bandaid for my quarter sized blister and while I was chatting with the paramedic a girl got thrown into the truck who had collapsed. Having had some experience working with Dr Bill Roberts at the Medtronic TC Marathon, I helped check her vitals and her hands were freezing. I put her feet up and took her socks and shoes off and covered her in blankets as the paramedic was setting up oxygen by nasal cannula. After a few minutes she woke up and I gave her my gatorade and water while I went to turn in her timing chip and get her medal. She was about my age and she thanked me. It was great to get a little clinical medicine experience and practicing my medical Spanish (not quite up to par but working on it).

Final results: here. I was 31st in my age group 18-34, 563rd overall. Anyway, there were over 3000 people (about 800-1000 women) so that's not bad.


My friends, Beto and Kara, after running 13.1 miles (21 kilometers). Go us!

Today, I think I need a massage since my IT bands are killing me and stairs are a little difficult to descend. Ciao!

Paragliding in Miraflores

The classic view 5 blocks from my apartment of Larcomar (the big shopping mall in the cliff) in Miraflores with a nice view of the neighborhoods, Barranco and Chorillos, along the ocean.

The weather today was wonderful and sunny with a cool breeze off the ocean. There were lots of paragliders and surfers and it reminded me why I love it here. It's amazing how sunny weather can change your mood!



Eliot Brown, a friend of mine from Macalester, stayed with me for a few nights. It was fun to have my first visitor in Peru and we discovered the airmattress had a small leak so I'll have that fixed for the next person who comes, don't worry. We played ultimate frisbee at the US Embassy and ate delicious cerviche (raw fish and seafood marinated in lime with some picante) and tacus tacus (beans, rice, and lots of seafood) and drank chicha morrado (delicious juice made of blue/purple corn), mmmm. Ciao Eliot!

My Lima half marathon is tomorrow morning and I'm not quite ready, oh well. The weather should be perfect - 60s and overcast. My friends Beto and Kara are running with me and I'll post photos tomorrow.

LimaKids

LimaKids is a great non-profit in Peru that was started by a previous Fogarty scholar who's mission is to support for children and adolescents living in orphanages or in socially risky situations. Basically kids who are either living on the streets or in extreme poverty or both, and who are highly vulnerable to violence (physical, psychological and sexual), sexual exploitation and substance abuse. LimaKids runs a medical clinic and soccer clinics but their biggest project is organizing a soccer league for over 20 orphanages around the city.

I went to the coaches meeting last night where we discussed the rules for futsol (5v5 soccer played on a cement court with a heavier ball) and then all the coaches played for two hours in the park nearby. There were dozens of futsol cement courts, filled with people playing pick up, and a few grass fields with men's teams playing under the lights. There was a skateboard park and a few basketball courts as well but the action was on the soccer fields. It gave me the chills to see so many people out in the park late at night (9pm) playing my favorite sport ever - futbol!

I was not prepared to play; I was wearing my glasses, a nice shirt and dress pants since I had come directly from my clinical research training course at the pharmaceutical company, Merck. I played anyway because this was an opportunity I could not pass up and within 15 minutes marco cuatro veces (scored four times) and needless to say they were impressed and I had myself a small fan section from outside the park fence. I had a great time and I can't wait to help coach Eduardo's team, San Franscico (15-17 year old boys). Eduardo has never coached before but he is the only coach that speaks English which is why I got put on his team. I think we'll make a good team.

So I've never coached boys but I've coached pre-teen and teen girls for over 6 years so it can't be much different, right? Let's hope so...

Our games are every other Saturday and we train on Friday and Saturday's, which will keep me busy and get me out of Miraflores.

FYI. A group of us will be running a 10K in October and will be raising money for LimaKids. Any amount that you can contribute at that time would be amazing and really make a difference for the street kids in Lima.

Serving sizes

This is the popular Minnesota Lions Tap burger and this kinda stuff just doesn't exist in Peru! I ordered the mediano or medium burger from Bembos (the fast food chain here that's across from the McDonald's) and the serving sizes just aren't the same. The patty was like a normal size, the fries were definitely a US small and the drink was like 12oz (definitely a small). Next time I'm going to order the grande but it's no wonder we have health problems in the US.

My new job!

I am very excited about my new job at the Center for Excellence in Peru. My advisor is Dr Jaime Miranda who recently finished his PhD on the Peru MIGRANT study, which looked at the effects of migration on cardiovascular risk factors. Interestingly, migration from rural areas to Urban areas contributes a lot to obesity, especially in women. We have been approved from the NHLBI to enroll 2000 Peruvians in our epidemiological study on cardiovascular disease project and we'll enroll 1000 for the chronic COPD study. We will start field work early next year in Tumbes and Lima. I am currently working hard on developing some proposals for a few abstracts using the previously collected PREVENCION and PERU MIGRANT database, among other large databases in Latin America that our group has access to [the Latin American Study of Obesity (LASO) database]. I will help our group (of 4 people) apply for more grants to enroll more people or start other projects, like national stroke and myocardial infarction registries.

Today I am going to a clinical research training course at the Merck offices in Lima. It's two days of intensive training on biostatistics, research design, protocols, running clinical trials, etc. but in SPANISH! Eeeks! I'm bringing my medical Spanish dictionary in my bag, just in case :)

Altitude cares very little about your fitness level

The 4.5 hour hike to laguna rapagna in the central highlands of Peru was a moderately difficult hike, except given that we started about 11,000 ft, I'd say it was by far the hardest hike I have ever done. I hiked Bartle Frere in Queensland - 10 hours with leeches covering my legs and falling from trees - and that was nothing compared to the heart pounding, head throbbing, breathlessness that I experienced after hiking only 5 steps at 14,000 feet. I can't imagine ever being able to climb Everest (over 29,000ft).

From the moment we stepped off the coach bus from Lima I was dizzy and cold. It was a mere 2 hours from sea level driving on a beautiful winding road that reminded me of the drive from Loveland to Estes Park, CO, along a nice stream surrounded by sharp mountain peaks. This drive went through more mining towns and the road was very narrow that make it difficult to pass slow trucks and took twice as long as it would in the states. The sky was perfectly clear: baby blue and sunny. I had forgotten what the sun looked like living in Lima for the past 3 weeks where there is always a haze. I'm glad I had sunscreen today!

We packed headed up a rocky road that had endless cut-backs but passed a few farms with hay roofs and rock fences. Generally, I felt out of breath after about 25 steps and had to stop to slow my heart and sometimes find a rock to sit on to catch my breath. I even took my acetazolamide as instructed.

At the beginning, the group of 30 (half Peruvian and quarter Americans working at the Embassy and a quarter Fogarty-related people) were very slow moving as some people could only make it 15 steps before stopping. Two people had to turn around after 30 minutes. Basically for the next 6 hours, the group spread out based on how many steps (30 vs 20 vs 10 steps) you could go without resting. There were three Peruvian guides and their three beautiful guide dogs spread out to make sure everyone knew where they were going.

We hiked along a deep valley and passed over small waterfalls and streams. As we skirted around a number of mountains we were constantly climbing in elevation. As I reached the final clearing before the last big climb, one of the guides was waiting and we had a quick conversation in Spanish. My Spanish comprehension isn't great but I swear he said that it would only take about 30 minutes, maybe even only 20 for me, to get up over that "wall" to the lake (see tired-looking photo below). An hour and 15 minutes later after stopping every 4-6 steps to catch my breath, I made it and it felt great!





I finished my lunch and took a long siesta while I waited for my friends. In the end we all made it to the beautiful turquoise lake at 14,000ft surrounded by snow-capped Andes mountains. It only took about 2 hours to get down and we were very entertained by the llamas and sheep along the way.



It was a beautiful day! The views were unbelievable and my legs are unbelievably tired. I guess it's good cross-training for my half marathon next weekend, eh?


Llama's chasing Christina down the trail.



Llamas and sheep are skeptical of us and hesitantly pass us on the trail.