Cold Spaghetti

City shot of Lima. Looking over the Tennis Club, “Las Terrazas.” 

Parque de Emorada. Complete with couples smooching. 

It’s time for a little rest.

The past few days (especially yesterday) have been long and busy. I feel great, but there are a few things going on that are letting me know that I should stay en hogar this afternoon. Or at least en vecino. So I’m working at home (well, goofing off right now) reading articles, researching, and thinking through possible questions.

Yesterday, I left just before 8am via taxi to Hospital Maria Auxiliadora to meet with Michaela, the director of the MAMIS program. The taxi driver, an older gentleman who drove very nicely, did something that usually makes me nervous: he took back roads. I felt that I could trust him and his methods were obvious: you could see the major road ahead with traffic and he’d turn on a side-street just before the main road. The way we weaved in and out of the side streets felt uncomfortable, but I trusted my instinct of him and all was fine. (Taxi drivers are suppose to stick to main roads. There are local reports of taxis driving into back roads where they meet up with a gang that surrounds the car and robs you. So, we are advised to tell taxis to stick to main roads and be cautious about the details of how you both chose and engage in the use of a taxi.) It so happens that we got to the hospital in 20 minutes (wow). I probably should have asked him for his name and number for future calls, but the “back roads” method did not set well with me (Valerie has strickly schooled me on this and I felt a bit badly about not following her wisdom and experience) so paid and let him go. I arrived at the hospital grounds 40 minutes early.

Arriving early was a great thing. I got to observe the chaos of morning appointments. Under the SIS plan, Lima’s poor may enroll in government health care programs for children under the age of 18. (How poverty level is established and monitored by the program, I am still trying to figure out.) I believe that many appointments are first-serve: hence the incredible morning lines throughout the hospital. I also managed to speak to a guard and get into some of the main hospital, where I decided to sit in the cool hallway bench outside of x-ray. I wasn’t there more than a minute when I was joined by a young woman, no older than 20, and an older woman who must have been a mother or mother-in-law. The young woman had very recently endured a terrible beating to her face, she was in awful shape. As they sat down beside me, not noticing or making any motion toward me, I heard a whisper from the older woman to the younger, “dejeme hablar“. She was telling the girl to “let me talk.” The irony: I was there to meet with the director of the hospital violence program and was sitting beside a woman who was both an obvious victim of violence and a victim of silencing. What could I do? Options limited, I remained in my anthropologist role.

Moments later, the x-ray hall was filled with several nurses pushing a square office cart, filled with blankets at the top — babies. One of the nurses noticed me and promptly plopped down beside me to chat. She told me she was also pregnant (3 months) and did the obligatory “belly display” where pregnant women show their bulging middles pressing through their clothes. We chatted causally, the obvious questions… what in the world is a pregnant gringa doing in this hospital, on this floor, on this morning?! Once curiousity abated, she brought over one of the babies (there were three in the cart) as the other were brought one by one into the x-ray center. The magical moment: I held him, one day old, while the others went in!

The meeting with Michaela went splendidly. She proved to be a wonderful contact. Some surprises: she ushered me into the main offices and introduced me to the Director of the hospital(!) and several heads of departments. We discussed meeting again for a more formal interview (con grabadora) in the future.

After my meeting with Michaela, Angela met me in front of the hospital gates with a taxi. From there, we road off to Las Pampas, a puebles jovenes in San Juan de Miraflores. Las Pampas is the community most studied and programmatically served by PRISMA (local NGO I’ve mentioned in previous posts). Angela is conducting her disseration research in this community and I joined her — got a small tour of the neighborhood, met the staff, helped out with some IRB applications (specifically for a great photovoice project Angela is doing) and then took part in a focus group with 15-17 year old boys (part of Angela’s disseration). It was after 6:30 when we finally started the trek back to Miraflores.

Paul wrote a nice post about our frustrations with the tax situation in our States-side home, New Orleans. He also posted to the Uptown forum about the situation and the responses were very interesting. Some examples of the responses to his forum post:

“We pay the highest life insurance ratets, the highest car insurance rates, one of the highest electric/gas utility rates IN THE NATION, high if not highest health insurance rates, highest water/sewer rates ( did you know some places provide it free to their citizens?) and some of the highest property tax millages (for those of us who pay the tax, along with businesses) IN THE COUNTRY. I also am ready to leave, shut down my business, go somewhere else where it’s easier…”

“I have been here over 60 years, through thick and thin, have endured the heartache of violent crime, and generated lots of sales taxes, paid lots of property taxes. I’m afraid, though, that I’ve reached that “tipping point” where it doesn’t make sense to do it any longer, and that saddens me to no end. I want it to be different, but do not see that it will.”

It is hard to live in such a wonderful place and not be able to enjoy it. Between the high costs of daily living and incredibly high costs of child care (which is not specific to New Orleans, necessarily, but endemic of our society as a whole) we truly are slowly going bankrupt. It is a ridiculous situation when you consider our current earnings. Granted, I am a doctoral student, and by definition, we are seriously financially constrained folk. But now that I am done with classes, getting on track with a disseration, and do not have the requirement of being in the general vicinity of my program, does it really make sense to stay??

Which brings us to the question: where the heck do we want to live? The bottom line is that we have no idea. Added to that is our love of community: we adore our neighbors and we love our current quality of life. But, as discussed above, it’s hard to feel good about living there. Peru is looking better and better for the next 2 or so years while I work on my disseration — we have to be here for a least a year for the research phase of it, and there is no reason why I couldn’t stay here to write. Plus, with a committee member (Valerie) living and working here, it may be a great situation…? Still, the question… what do we do with our house in the States? Do we rent it? (This would happen most likely at a loss, getting what we need out of it to pay mortgage, taxes, and insurance is in all likelihood impossible.) Do we sell it? And if we do sell it, when? Before/after the baby? Do we still make repairs? If so, how much? And do we pay to store our stuff and go into the “2 year” countdown of putting our equity into another home? I think if we sell, we’d want to buy a small investment property… somewhere… to store our stuff. But again, where??

If anyone wonders what keeps us up at night these days, this is it!!

Out of nowhere, Will has developed an interest in sitting on the toilet. He tells us it’s “potty time” or announces the need for a “poo-poo” and prompty pulls off his pants. We are instructed (at penalty of a seriously upset kid) to put him on the potty. He sits there for a minute or two, announces he is done (nothing has really happened, he just sits there and says words like “tinkle” and “poopie” and sings for awhile) and then hops off to have his diaper and pants put back on.

Maybe my dream of potty training Will once we get back to the States (i.e.: before the birth of child number 2) is actually something that could happen?

Paul posted a link to this speech on his weblog. But it is important enough, sage enough, truthful, honest, and clear enough, to be posted on all weblogs.

Wynton Marsalis – Renewal Series Address – Tulane University – MLK: 1/16/06

Right after my spanish lesson this morning, I took a taxi over to Valerie’s lovely flat in Barranco. We met for a few minutes to collect our thoughts and then grabbed another taxi (after rejecting one who wanted to charge too much) out to “the southern cone” of Lima to visit Hospital Maria Auxiliadora.

Hospital Maria Auxiliadora is a large regional medical center. If you have a referral for anything remotely complicated beyond what an under-resourced community clinic can provide, you’ll come here. It is nestled between two “rougher” parts of town (pueblos jovenes) Villa del Maria Triunfo and San Juan de Miraflores.

Valerie needed to go out there to speak to a doctor about a Canadian medical team that has funding to do a double-blinded RCT on the effects of Vitamin A & E for the prevention of pre-eclampsia. She was going to meet with a head hospital OB about the study to gage their interest on behalf of the Canadian team. I went with her to check out the hospital.

As is the norm in field work, the doctor was unavailable and so Valerie joined me in my quest to “check things out.” Good thing, too — as she was more skilled than I at negotiating the long lines to ask questions. Bottom line: we found great information about a violence program for aggressors and hooked up with the hospital social worker who spends all of her time wrapped up in a program called “MAMIS,” a child and family violence treatment campaign. After feeling like stalkers for hovering around her office as she finished with a family, we finally managed to see her and talk briefly. It was a productive conversation; I’m going back in the morning to meet with her to talk more. It was a super great trip and I am very happy to have made this contact!

So tomorrow, after my morning appointment at HMA, Angela (cool doctoral student from Hopkins) is meeting me at the gates to the hospital grounds and I am joining her to Las Pampas, the barrio community most closely studied and served by PRISMA. Angela is focusing her dissertation on adolescents in this community. Added bonus: she arranged for us to meet with one of the community and PRISMA-affliated physicians before the focus group gets started. In other words, we’re gearing up for another full day!

Will loves Bob the Builder. And lucky for him, the family who lives here has a wonderful collection of Bob DVDs (from the UK, so Bob and friends all have that wonderful other-side-of-the-pond sound to their voices). We also get Bob in spanish: Bob el Constructor. Will loves it and delights in singing the theme song as we stroll down the street.

“Podemos hacerlo? Si! Podemos!”

Yesterday morning I went with a pre-arranged taxi for the 45 minute trip to San Martin de Porras, a very economically depressed community with high population concentration. (In other words, an urban “shantytown“.) Unlike other barrios which ring the outsides of Lima, San Martin de Porras has a long history and cannot claim it’s existence from the boom of desperation and poverty triggered by the double-whammy of the years of terror in the 80s and “Fuji-shock” of the early 90s that resulted in a huge internal migration to Lima during the last 20 or so years.

Met by Ruth (a public health nurse often hired by my mentor, Valerie, to conduct surveys), I was introduced to Dr. Guzman, her boss and the Director of Health for SMP, Rimac, and Los Olivos (two districts around SMP). I spent a good hour or more with Dr. Guzman — a wonderfully helpful and interesting man. We talked first about his impressions of the health of the community, his thoughts on the current challenges and limitations in both the health of the community and in his work, and spent some time going over data from the last full collection of demographic and health indicators from the communities he serves. I was surprised to learn the incredible impact of respiratory infections in this community: respiratory illness (Tuberculosis, in particular) is terribly endemic here. Of the 10 items listed as top reasons for clinic visits, 4 were related to respiratory ailments — consistent with both sexes and all age groups. With more than 19,000 people per km square (in buildings tightly packed in one to three floors), he felt that the lack of clean air, good ventilation, and many people in the same living quarters gave these districts the rich environment for the disease and kept it that way, In fact, when we discussed the future of the community, he quickly noted that the limitations and challenges were structural: namely, political and economic. This was refreshing to hear! Other interesting tidbits: rubella is currently in huge outbreak here. (In fact, my spanish tutor’s 9 month old daughter just got over a serious case.) Although a vaccine is available, there isn’t much of it here, and as a result, “sarampions” are everywhere. The graph for tracking it looked sort of like a seismograph hitting a sudden earthquake.

After my great meeting with Dr. Guzman, Ruth joined me to visit a smaller clinic a few kms away, “Clinica Salvadore” where we met the head nurse, Grimanesa. (Interesting note: Grimanesa’s brother, Pedro, was the pre-arranged taxi driver for the day and now my “go to” guy for pre-arranged rides. He was very, very nice and drove very sensibly and safely — something you don’t always get when you pick up a random taxi!) At the clinic, I also met Blanca, who provides counseling for patients. All were absolutely lovely: if I end up doing a clinic-based study based out of a smaller maternity-focused clinic, I would want to be here. I immediately felt welcome and integrated. After our tour of the facility and general questions and talk, the four of us (Grimanesa, Ruth, Pedro (the driver), and I) went out into the neighborhood to find a 9 year old boy who, several weeks before, had been diagnosed with tuberculosis. It allowed me a vantage to see the most vulnerable areas of the community (ie: those without water tap, which is only provided after a certificate of ownership can be presented for the property — in other words, these are long-term squatters who have not gathered up the resources to collect on such a needed and necessary luxury — yes, water, unpotable as is may be, is a luxury here). The mission allowed me to ask questions about the community, the building, the process of living here, the development of the region, and the challenges of serving it. The bottom line: poverty in urban Peru means illness and suffering, staff do their best to help when they can and enjoy the moments of success when they are able to provide care. In this case, there was no reunion with clinic staff and dispensing of medicine (the first line of which would have been paid by the government) — the sick child and his family could not be found.

Me, Will, and the bunny. I’m beginning to think we need our own silly animal to regularly pose with for tourist shots. Maybe we can find a stuffed wombat?