“I dream of being back in Huancavelica. In my dream, I was already there. Somehow I skipped all the flying and bus travelling. I was among the Andean mountains, hiking up to the highest peak, and looking down the gorgeous valley. From the horizon, the first blood-red ray of sunlight — untainted of any poison, undeterred of Spaniard conquistadors — rose behind the rugged mountains, painted a mural of warrior figures, llamas heads, potato fields, and cocoa leaves. I stood on top of the ‘montaña’ watching it come to life.”
Last summer, I was in Huancavelica, a rural area twelve hours north of Lima, Peru. Rich in its history, the city was a strategic Inca center before the Spanish arrived. Discovered for its mineral wealth, the Spaniards sent the indigenous to Huancavelica to work in the mercury and silver mines. The Quechuan people of this hidden land went through many struggles — the indigenous uprising in the late 19th century, the terrorist violence in the ’80s, and the socio-economic recession aggravated by progression of natural disasters. But the sedulous people were undeterred. They continued their unremitting daily life — herding their llamas and alpacas, planting cornfields, and raising their young. They slowly regained their prosperity rightfully belong to them. Standing more than 3,500 kilometers above sea level with its austere charm and churches adoring some hint of a pleasant colonial past, it is semi-hidden from the rest of the world.
“The road to Huancavelica is more than just a contour of mountains full of lush alpine meadowland with thatched-roof settlements and freely wandering herds of llamas. The hurrying ‘colectivos’ and sometimes buses full of mine workers filled the rugged path. It first serpentines up to a heavenly snow-filled peak then quickly ducks into a narrow valley with tiled-roof villages and a running river. Then it spirals downwards into the valley where Huancavelica lies.”
In Huancavelica, I had the opportunity to participate in a medical mission with physicians, surgeons, dentists, nurses, and an ancillary team. For over two weeks, I had a chance to observe and participate in general and pediatric care, surgeries, baby deliveries, and emergency procedures. We conducted medical examinations and pre-surgical consults in makeshift tents and benches in the front courtyard of a local hospital. Patients came before dawn and hundreds were already in line when we arrived every morning. Young mothers, with their newborns peacefully asleep in colorful ‘mantas’, or blankets, on their back, anticipated our arrival. Elder women with kyphotic gait and bony cheeks patiently waited outside our tent while knitting their exquisitely unique color-patterned ‘chompitas’.
A mother, barely seventeen, with her first four-month old boy, came in for neonatal care of her child. The mother looked like she is in her late twenties. The intense sun exposure from living at high altitude adds more wrinkles to the already hard-knocked life in the Andes. This was her newborn’s first medical visit. Her husband had been out of work so she has no access to medical care. Her baby seemed plump, active, and had dry red cheeks. He stared at me with his large round eyes. We performed Ortolani-Barlow maneuvers. We assessed developmental milestones. We listened to his heart and heard a murmur, a faint but audible mitral regurgitation. We sent the worried mother with her relatively healthy baby to a cardiologist, another volunteer physician, to the next tent for further assessment of his heart condition.
“A child with cleft lip, hiding behind his mother, both waiting outside my tent, took a peek at me. The surgeon consoled the mother that her son will have a bright smile and the operation is ‘gratuitamente’. She does not have to worry how to come up with thousands of soles to pay for the surgery.”
After clinic that day, we headed to another hospital, within walking distance, to operate on a boy with cleft lip. The boy was already admitted when we arrived. We waited for the scrub nurse to prep him. The boy, lying lifeless on the operating table, except for his chest heaving up and down, seemed so fragile, almost lilliputian. The anesthesia already worked its magic. We proceeded to make the first cut. The boy’s body didn’t seem to mind. The skillful surgeon performed an impeccable procedure, occasionally interrupted by my assistance — dabbing away oozing blood from a cut arteriole, awkward handling of surgical tools, and shaky grasp on the retractors. After a one-hour procedure, the boy was carried in the scrub nurse’s arms to be returned to the anxiously awaiting mother in ‘la sala de recuperación,’ an adjacent recovery room without any window. The mother trembled and almost burst into tears when her son was placed in her nurturing arms. The boy awoke from anesthesia almost immediately as if his body sensed the familiar scent of his mother and let him know that everything was okay.
“‘Por favor, doctor … mi hijo no tiene el seguro medico … puede por favor chequear mi nombre a la lista?’, an elder woman pointed me towards her young son dressed in an alizarine outfit with a warm color knitted cap staring at me with his big black eyes. His cheeks were dry and cerise.”
The majority of Peruvians have either types of insurance available to them, SIS (Seguro Interal de Salud), a minimal governmental aid, or EsSalud, individual insurance. There are many, however, who do not have any medical access because they do not have work (to obtain governmental benefits) or can not pay for insurance premiums. These patients are often turned away or perpetually ignored until dire situation requires hospitalization. Then it is often too late. Without charity and medical assistance from non-profit organizations, these individuals are sometimes forgotten amongst the bureaucratic process. Sometimes, the only medical cares these individuals can obtain are from external philanthropy groups who finance the procedures from their own funds. With limited conversational ‘castalleno’, I navigated through the bureaucracy of the hospital system to obtain x-ray films and ultrasounds for some patients whose deteriorating conditions absolutely necessitated these procedures. Though each ‘echografia’ or ‘x-rayos’ costs about 15 soles, equivalent to five U.S. dollars, it is still a lot of money for these patients whose daily earnings — from selling fruits, breads, or hand-knit clothes — are less than thirty soles a day.
“His eyes barely opened to acknowledge us. I almost did not recognize him. Yesterday, he had on a baseball cap, covering almost half of his face. All I could remember about him was his stocky frame and callous hands.”
One early morning, I visited a teenage patient in the surgical ward. According to the surgeon I went on rounds with, this young patient had endured a disfigured face for the past five years after he fell into an open fire used for cooking. Half of his face was wrapped in bandages. He could not talk much except for making some inaudible sounds resembling ‘sí’ or ‘no’ when being asked. I partially removed the bandage and his face appeared under the dim sunlight. I could see the contour of the skin graft around his right cheek. With rest and antibiotics, he would be going home soon, with a new face. We reassured him, then returned him to his solitude. The recovery room had no halogen light, no television, no heater, no electronic equipment of any kind around. The room was almost empty except for four metal frame beds and a glass saline bottle hung on a metal hook on the wall. Here, the patients lay in a cold semi-dark room waiting for their wounds to heal as they stare blankly at the ceiling. Sometimes, they would walk outside to a small courtyard, sit on the grass area, and catch a glimpse of passerby on the other side of the hospital fence. Hospital is the last place anyone here wants to visit. It’s a place for the dying.
“The screaming could be heard all the way down from the hall. The mother, probably in excruciating pain, held on the rail of her chair as she continued to push. I could see the head of the baby inching its way out as the mother continued to push. The physician softly grabbed the head and gave it a gentle pull. The mother, seemed like she was almost out of breath, gave it one last scream and a final push. The baby was ejected into the obstetric physician’s waiting arms, crying, kicking, and protesting his departure from the mother’s womb to enter this world.”
Most women here have children in the late teenage years or early twenties. Life is harsh in the region. Mothers may lose their young to extreme weather, diseases, or accidents. A healthy grownup child without any devastating physical disability is an additional able body to help further the survival of the family. Thus large family is not uncommon. However, gynecological and prenatal cares are sometimes not accessible to many women. Some have to give birth at home. Newborn fatality and stillborn rates are still high.
“It was early Friday morning, my last day in Huancavelica, when the surgeon, Dr. K, took me to a patient he operated on the night before. The patient was recovering from an open appendectomy. He seemed lifeless when we entered the room. We lifted his blanket to assess the suture. He was unresponsive, except for his fluttering half-closed eyes that were signaling us that he was in a lot of pain. ‘You will recover and go home to your family soon,’ Dr. K assured him. He slightly nodded.”
When it was time for me to depart, I did not want to leave Huancavelica. I wanted to stay for another month, or even another year. I wanted to see more of those innocent smiling faces of Huancavelica children waving to me each morning on my way to the hospital. I wanted to walk by the fruit stands, the alpaca fur shops, and the lady who sold delicious corn breads at the street corner right before I turned in to the familiar empty valley on my way back home every evening.
Those sixteen days forever changed my perspectives about global health, rural medicine, and poverty. I now understand the significant impact that medical missions and non-governmental organizations can incur. I learned a great deal about the Quechua-speaking people. And I fell in love with the life in the Andes.
“If the place did not completely conquer my heart, the people of Huancavelica did. For those sixteen days, I fell in love with its serenity, charm, and hospitality. Part of my heart was left behind. ‘Mi corazón está en Huancavelica’, as I would say.”
Columnist and Editor Emeritus: Former Medical Student Editor (2012-2015)
Arizona College of Osteopathic Medicine
Jimmy is residing in Phoenix, Arizona. He received his undergraduate degrees from California State University of Long Beach. Actively involved in research, his interests include internal medicine, cardiovascular medicine, and medical humanities.
Jimmy also volunteers at local community events and non-profit clinics in the Phoenix, Arizona and Orange County, California areas.
Web: jimmytamhuypham.com
