Post Script

It has been a week since I have been home, and I thought I would wrap up my journal from Peru with a piece of self-reflection. The day I got home I wrote my friend Matt who had been on the trip with me, "I just got home today and Im depressed. I want to go back to Peru. Even when it wasnt fun it was fun. Like, all the colors and sounds and smells and the thick human harmony in every street; the chickens and the dogs and the dust (so much dust, but such great boogers)... The US just feels so sterile and proper that I feel homesick for a place that is clearly not my home."

Matt sends back a quote from 'Men of Salt' about the country of Mali, saying, "I think it describes well the feelings we have for a place like Peru. The author says this upon his arrival after discussing how Mali is the 4th poorest country in the world and 25% of children die before age 5: 'But I also quickly realized that it's the type of country in which I like best to travel: one in which much of daily life takes place outside; where things function with no concern for liability lawsuits; where the local version of order closely resembles the Western notion of chaos; and where poverty does not equal shame, partly because so many people are poor, partly because riches don't increase one's status in the eyes of Allah.
The cacophonous, colorful markets; the sense of solidarity that forms among passengers crammed together in the back of a battered pickup truck that sputters like a wounded turtle along rutted roads; the groups of men arranging prayer mats on the sidewalks at sunset, kneeling and casting long shadows before them as the calls of the muezzins roll from minarets; even the littered streets and putrid gutters that are a regular feature of towns in the developing world—all these reminded me of other places I'd been, other places I'd loved. I felt an instant fondness for the country, a sense of homecoming, though I'd never been there before.' [Rachel, ] It sounds like you could have said those words, no?" I couldnt have said it better myself.

***

So what happened to me in Peru? I suspect that will take years to find out. I feel something changed in me, the way you feel a little difference, a tiny special space inside carved out for the one you love. But I am not sure what is in that space quite yet.

What did I do there – I learned a new language. I met people whose entire lives were completely different than mine; and I loved them. I saw mountain deserts, jungle, dances and costumes and traditions and dresses, and lots of different hats. I took some quiet time to think about myself, about what is important to me, about medicine and my future in it.

I think that is one thing about living in a country so poor; it sets in contrast the richness, in a sparkling clarity, and you turn those lenses on your own life. Here, family is number one, and friends and community are considered like family. Children are born without planning or worry about schedules or work or money, and welcomed with celebration. They are celebrated with parks to play in, colorfully painted, with attention and care to their education in music, art, tradition, as well as trying to prepare them for the future with English and Spanish. This value is in contrast to the orphanages in nearly every town – most children in there places have parents still but who cannot support them. But it does make the worry that we upper and middle class Americans (myself included) spend on how to fit a child into our schedules and budgets seem somewhat silly.

Kids here are adorable. Not because of their wind-chapped cheeks or dark inquiring eyes, but because of their fearlessness, their joy at simple things, their interest in the world around them. Cared for by mom, sister, friends, and occasionally dad or brothers, children grow up with no separation anxiety, no fear of strangers. The fact that parents work long hours and are gone often is an accepted reality, and that space is filled with friends, loving community members, grandparents. Many never really get to see themselves in a mirror and move with that total lack of self-conciousness that children in the US now lose so quickly. Its somewhat heartbreaking though to see such beautiful bright children with no future – for the poor mountain children, the odds are that they will be plowing fields, selling trinkets on the side of the road, weaving, and dreaming of a better life from now through old age. Given the opportunity, these children could change their situations, their country, their world. (As a side-note, I was saying to Avi the other day, the US does not have the monopoly on happiness, or health, or family life, but it sure does on opportunity. If you want to do something, make something of yourself, improve your life or the life of others, this is your platform. If you have other priorities, there are other countries which can better foster those aspirations; in fact, its difficult to have simpler priorities in America – Ill come back to this).

Ill tell you what I havent seen very much value for: ambition, titles, the professional climb. Of course it exists in modern cities, but very little in the countryside where I have been living. Its just so far down the list of important things, after the people you love, working hard to earn your keep, respect and knowledge of your traditions and culture, living well with good food, good drink, beautiful places. Probably Peru could use a little more ambition, maybe, to pull up the standard of living, but with most ambitious people acting corruptly in the political positions, you can understand the distrust of that sentiment. More than ever it makes me want to get off the wheel of climbing from better to better position, and just do what I want to do with time to appreciate all the things that are more important than work. On the other hand, Ive never seen any people work as hard as the Peurvians, much of it incredibly physical manual labor, and it reminds me how important is this value.

I think some of this different value system I wove into myself. I find myself hurrying less, and spending more time appreciating people. In the lab where I have started work, the slow pace of mixing reagents and running gels – something that has driven me to distraction of frustration in the past – is now a pleasure. It gives me time to talk to the people around me, smell the acrid chemicals, watch the stream formations rise off the liquid nitrogen, just be and wait. I dont look at the clock as much, since Im trying not to rush anywhere, but rather to just be present where I am. Checking off career boxes is less important to me now; I dont care much if I publish or accomplish or what will look best on my resume. Id rather read, learn whatever is being offered, and enjoy the experience.

Not that this is all a sudden change because of three months abroad, rather, I have been looking to get off the wheel, but didnt know how to mentally do so. My friends in Peru showed me how; they modeled for me what a life would look like without ascent and achievement as central pillars. As it turns out, its not empty or lazy at all, but filled with a labor of love for family and community. A slower, more mundane, and less recognized labor to be sure, but one that is filled with quiet personal meaning.

Will it last? Hard to say if this is the kind of change you can't take back, or if it will fade to a memory as I step back on the wheel and am enticed by the glittering opportunities that only the great USA could offer. It is tough even now for me to decide if, being born with such privilege, it is my obligation to trade in some of my happiness for the service of humanity (excuse the haute terminology, but that is what it is), or whether stepping back and just being present day to day, dancing at friends weddings and crying at their funerals, connecting with people and trying to do what I can at little junctions to help them out, maybe this is enough. I guess this is in the end what Peru offered; another way of life, another outlook and mindset. Not knowing how this will play out in the rest of my life, I have to leave this ending open-ended; I for one have little more healthy uncertainty – the kind that turns philosophies from black and white to shades of grey to – in the case of Peru – an explosion of color.

Last Day in Peru

We took a cab all the way back down to Huaraz, and boarded the little plane back to Lima (both of those adventures in their own right). We were the only people on the plane, along with a very important-looking gentleman with the key to some city and a security detail. Dad was curious and so struck up a conversation with the guy. He was the Israeli embassador to Peru, of course. He is also Druze, which is interesting, and rose up to be a Colonel in the Israeli military and then embassador to a number of different South American countries. So anyone who says Arabs in Israel dont have the same opportunities... But Im not wandering into politics here.

Our day in Lima was so much fun. We walked through the spooky 17th century San Franciscan monastery and the catacombs beneath. Then we shopped for last minute gifts and caught a cab to Miraflores. There we walked through the park along the high bluffs overlooking the sea, and we watched the parasailors take off and land there -- the same as Lony and I had done 2.5mo before. I showed Dad everything we had done in our first days in Peru, our apt and school and all the activities we did and the places we got food. We had some dinner and then walked through the art exhibit in the park. It was night by then and we cabbed it back to the airport where we started the long trip home. For me, it was a day of plane from Huaraz to Lima, cab around the city, jet Lima to Fort Lauderdale overnight, jet FLL to Washington DC where Trudy picked me up and whisked me home. I ate, showered, said quick hellos, and then got in my car and drove through periodic severe thundershowers and torrential rains 5.5hrs to Ohio where my cats and house were waiting for me in perfect condition and harmony, as if I just left.

I felt like Max, from Where the Wild Things Are, when he comes back from his dream to reality:
"and he sailed back over a year, in and out of weeks, and through a day ... and into the night of his very own room where he found his supper waiting for him... and it was still hot."

Huaraz

So with Mom and Hanna gone, Dad and I continued onto Northern Peru; maybe the most beautiful place Ive ever seen. The mountains are 20,000+ feet and tower over beaucolic farms and fertile valleys. First day we saw emerald lakes. Second day I took Dad bouldering. It was so much fun. We had no gear but a crash pad and climbed in our sneakers but we went as high at 25-30 feet. Apparent bouldering is just 3-7 meters off the ground and after that (what we were doing) is "free climbing" ie just climbing without gear, or "high balling" as its called in climbers slang (thanks google article). The rocks here were left by the glacial retreat and they are really just ridiculous large relics of another time. When you get to the top of one you are on this platform surrounded by valleys and mountains, and you feel like youre on top of the world. Dad loved it. Hed get to the top and go Woah What a Rush! I got a sunburn and one single black fly bite (there are a lot here but theyre really slow so I generally have been killing them before they get me), but it was such a great morning, I didnt even mind.

Then we came back, rested, ate lunch, and went out on horseback together with this guy Kirk. Kirk was everything. A dental student, had enlisted and done 4 years in the marines, a mountain guide and EMT, trained in search and rescue, ski patrol, a surfer, boarder, climber, and when I asked him why everyone in the world loved the Princess Bride so much, he said something has to fill the space when youre not watching the Neverending Story. Right on.

The ride was amazing. The horses were spunky but listened well and we galloped underneath the mountains and walked quietly through eucalyptus groves for hours. It is so silent here, the way it is at the beach where the water swallows up the sound. Occasionally we would come across people thrashing wheat with a stick or a little mule braying at the tall horses enviously, but often there was no sound at all, or just the wind. We came home just before sunset, and prepped quickly for shabbos. We were in bed asleep by 9:30pm.

This morning I was sick. Actually Ive been sick for the past 4 days with what I can only assume is post-street-vendor diarrhea (my first in my time here!), but have chosen to ignore it in favor of having fun and eating whatever delicious food came my way. But last night it brought with it some slight fever and chills, and imodium-worthy cramps, and this morning, I was out of commission. Couldn't eat breakfast, lunch, or dinner, but I did have some matzah that we have with us. Took some cipro and shivered in bed. Slept all day. But what better place to be sick – I watched the clouds move and the rain fall through the skylight. Out the front window I watched the country people chop their wood and the horses play and graze in the field. I slept through some hail and snow and cold rain, and by the time I emerged after shabbos was over, the sky had mostly cleared and the city lights blinked off in the distance and everything was peaceful.

H1N1

It finally happened. Hannah who was sick with swine flu for 5 days or so and then not eating or drinking anything since then, was vomiting this morning when we were getting ready to go from Arequipa to Lima and collapsed upon boarding the plane. There was of course a huge hullabaloo, the doctor was called on, and though they diagnosed her only with dehydration (no more flu), they wouldnt let her fly. So off we went, and into a very personal experience with the Peruvian medical system.

Overwhelming to tell the whole story, but after 1.5L we got her to Lima, much perked up I might add, and she and Mom departed just now (early) for Boston. Dad and I are staying on one more weekend. Updates to come. New pictures should be up on Picasa of our Arequipa trip.

Urubamba, Arequipa

To catch everyone up!

From the Jungle, we went to Machu Picchu, which was obviously magnificent beyond words and photos. It was a time warp into a different place, era, sensibility, and spirituality. Then to Edwin's in Urubamba. It was like going home. I must have kissed every staff member twice. We saw his farm, his medicinal gardens, his rock and artifact collection. He is a refined gentleman and a self-made man and a little boy in one – like all truly good men. It was a magical shabbat, punctuated by bleating goats, rooster crows, the Andean music carried on the wind from the adjacent farm. I cried when we left.

We flew to Arequipa, a very cosmopolitan city, and used it as our base for a trip to Colca canyon. The culture here, while still Incan/Andean, is notably different, even on a superficial level in the way people dress. We passed through beautiful mountain towns and the canyon itself -- deepest in the worlds (more than the grand canyon even) -- was quite beautiful. Condors, ancient vulture-like birds with wingspans up to 10 feet, use the thermal currents in the canyon to drift up and up. The rose like peaceful demons our of the depth, and soared over our heads, resting lightly on the wind.

Tomorrow, up north of Lima to the trekking mecca of peru, Huaraz. Sorry its such a short post, but I hope the new pictures speak for themselves: http://picasaweb.google.com/RachRoth/MachuPicchu?feat=directlink

Three days in the Amazon

Day #1 – I'm writing now from within the ghostly protection of my mosquito net, by the light of a candle. It is dusk. We're in the Amazon. Monkey roars, bird twitters, frog chirps; the occasional shriek of a macaw. There is something so other-worldly about being in the rainforest – even on merely a tourist expedition – a certain untamed wildness about these places that commands respect and caution.

A long story to get here, briefly to catch you up, my parents came on Friday, I showed them around Cusco, and we went to chabad. Expect for Hanna who wasnt feeling well. By the time we got back on Friday night, there was vomit on the coverlet and Hanna was burning up. Shabbos day we went to chabad, walked around, came home and rested and stayed in debating what to do about Hanna. She was still vomiting large quantities of fluids and couldnt keep anything down. We were all slated to go to Manu, the wildest part of the Amazon that is reachable in a few days, but with Hanna sick as she was, we werent going anywhere. Instead we put off the trip one day and waited her out. In the meantime we horseback rode in the Andean hills, over the cloudline, through golden grasses, eucalyptus groves, ancient Incan ruins, and mysterious tunnels and caves. A lovely day, but when we came home, the TV wasnt on, Hanna wasnt complaining about there being no food in the house, she was still pretty sick. What to do. After a lengthy debate, I sent Mom and Dad to Manu – someone should see it, and I felt resourceful and familiar enough with the area to entertain us for a few days while they were gone. So 5am Monday they left. I spent the day organizing our own trip to Puerto Maldonado, the more accessible (fly in fly out) part of the Amazon. That I did it was a feat of luck and persistence in itself, but by this morning when we were supposed to leave, Hanna was still not feeling well. Then the tough call, is she just in post-illness fatigue, or is she really still sick in which case this was serious and we couldnt go. I was ready to resign myself, but in a surprise move Hanna wanted to try – the idea of warm humid weather and getting out of her hotel room was enticing – so we went.

The flight itself was amazing. In only 35minutes we flew over the colossal Ausangate range (which if youve been following the blog, you know all about), and witnessed an impossible terrain change. Until the Ausangate range, it is dry dry arid foothills for miles and miles. After the range, it is instantaneously lush and tropical. The classic mountains-block-the-rain-from-passing weather phenomenon, but to the extreme, with the Amazon on one side and high altitude deserts on the other.

We deplaned onto the airfield, hit with a wall of heat and humidity. It is only 80 degrees here right now (winter) but the powerful sun and 100% humidity make an instant sweat. It was really interesting, a very true and not so touristy rainforest experience. See, people actually live here. A rainforest community. And so it is not pristine or beautiful at first. It is thatch-roof shacks, rickshaws, barefoot kids, and stray dogs. It is chickens running in the streets and papaya plantations. Everything looks about ready to fall down, and certainly not water-tight which makes me wonder about the rainy season here. Once we passes a car in the river. I thought the guy had been trying to drive it through and gotten stuck, but the I realized he had just stopped the car there to give it a bit of a wash. There is so much dust here; the condensation on my waterbottle ran brown. We drove along a dusty dirt road for an hour.As we rattled along, little brown monkeys dived off the side of the road to escape the bus, the rainforest looked disorganized, scarred in places, with vines growing up and down and every which way, such that youre not sure which direction the forest is growing. Weeds, vines, groves of fine feathery bamboo punctuated with giant flat ovals of banana leaves. There are trees here that look like Dr Suess came up with them; thin white perfect branches with no leaves at all, just tipped with bright red poofs at the ends.

After an hour on the dirt road, a boat was next. This is the accessible part of the Amazon, I remind you. Stepping on the boat, you go through a snow-globe of tropical butterflies. Attracted to the banks of the river by salt deposits, literally hundreds or thousands of butterflies create a cloud of flickering florescent colors and patterns. Theyre like pests here – people waving the butterflies off their faces, wincing as their covered in them – which is funny because had we seen any single one of them in the park at home, we would run for the camera. My favorites were little white ones with intricate black spirals on the outside of their wings, like dizzy zebras, and then when open, a luminescent tropical blue band set against black tips.

The boat ride was relaxing, an hour and a half up river, stopping to see a herd of caybata, he large rodent in the world, munching happily on the banks. They look like a cross between a hippo and a guinea pig. It was interesting they paid no attention to our boat, but when one of the tikitiki motorized canoes passed, they bolted. They know who hunts them and who leaves them alone. We saw big white birds with blue faces and lots of egrets, logs of sleeping long-nose turtles and one big caiman (crocodile family). Local gone miners on sluicing rafts waved as we went by. But the boat transporting Amazonian wood did not – the guide pointed it out to me, and said it was illegal, but with poor law enforcement, nobody cared – such is life here. Poaching anacondas for their good-luck heads, crocodiles for their delicacy meat and skin, turtle eggs for soup, nevermind the PBS drives to protect the endangered animals, the reality is here, with now law enforcement people do what they want.

We got to the lodge by 4pm, drank our very welcome starfruit juice. And I promptly took a cold shower (running water here from the river, but clearly no warm water). Hanna is doing really well. Sleeping when she can on the airplane, bus, boat, and now in the room. She is feeling pretty good and recuperating, and actually has a pretty good attitude about the whole trip, "thats a huge guinea pig. These mosquito net canopies are kind of cool." We're going out caiman-watching tonight, and we'll see what tomorrow has in store.

Day #2 – Last night we cruised up and down the river in the boat, listened to the night sounds of the jungle and saw lots of tiny caimans. This morning, 4:55am wake-up call for the hike. Breakfast was 5:30 and we were on the trail by six. This was really the Amazon, how do I know? Because it was uncomfortable. Alive and uncomfortable. First, Ive never seen such diversity of mosquito. Usually they all look the same, you know? But here there were big ones, small one, black ones, white ones, striped ones, and medium-sized polka-dotted ones, to names a few. And they were everywhere. We were like the pied pipers of mosquitos, bringing along a bouncing joyful trail of them as we walked. I could see the rainforest only through a cloud. They hovered, alighted, and sucked when possible. However, I had a wicked good protection strategy: 1. Cover up with clothes that cant be bitten through (no cotton or thin materials). I wore a gortex jacket with the collar flipped up to protect my upper body and back of my neck, and nylon rain pants that traveled into knee-high rubber boots. 2. Hat with a brim. Ive noticed that mosquitos always hover around the top of my head and face, so wearing a hat with a brim has them hovering around that instead, off my face. 3. DEET. Sure its carcinogenic, but so is barbequed food , and you dont see me saying no to a BBQed burger, do you. All over my clothes and hat and jacket, apply liberally (but not yet to skin). Key places to get are edges – hat brim, jacket collar, sleeve cuffs, waistband if exposed. 4. Baby oil for the skin. Good old Johnson&Johnson baby oil over neck and face and hands if you think they might peek out. All this for the excellent result of trudging 6 hours through the rainforest without a bite.

We didnt see much wildlife except the constantly spectacular tropical butterflies and their spiky neon predecessor catepillars, but the flora and fauna was incredible. By 9 we had reached a jungle lake, were they served juice and crackers (just want to note, a juicebox! What a joke! As if that was going to be enough fluids. They had told us to bring water but some people didnt). There was a platform over the water, and we could peer through the cracks to see little pirahnas feeding on the sardines underneath. We took out canoes and watched the birdlife on the water, rainforest chickens with blue faces and 4ft wingspans, colorful tanagers and circling vultures.

The truth is, just walking though the jungle is like being in a fairyland; with the calls of the birds, and the smell of hot earth and living greens. The floor is periodically littered with impossibly purple or red or pink flowers. They nearly glow, and with every step hundreds of iridescent butterflies take flight, as if they were the flower pedals come alive. Giant glowing powder-blue, and tiny transparent outlined wings which allow you to see the jungle through them, they look more like fairies than insects. Then there is the steam that rises from the earth creating a mist around the fauna. When a beam of sunlight penetrates the canopy, you can see the rising droplets and the falling nectar. Its like being on another planet. Every few steps we would walk by a tree or a plant which gave birth to a branch of modern medicine. The salicylic acid tree (aspirin), the quinine tree (anti-malaria), and when the guide offered me a medicinal stick to chew (but not swallow), I took it happily asking what is this for? In a few seconds my tongue started tingling, went numb, and the numbness spread throughout my mouth rapidly; anesthesia, she laughed.

Then it was time to head back. We took a different trail home and it was tough going. First, my mosquito strategy started backfiring as the temperature climbed. Black gortex-nylon-rubber is not the best choices for keeping cool, and drops of sweat ran down my back, but Id rather be hot than open my jacket to the hungry mob waiting just outside. I ran out of water. Of course, because I had brought only 1.5L (Im sure Avi is so annoyed), and I drew out the last drops over the final hours. Then, there was the mud. So much mud. It was, in some place, feet deep and made of heavy clay and as the day heated up, it steamed furiously as we slogged through it. As if alive as well, it grabbed my boots and determinedly clung to them as I tried to pull them back onto my foot. It was tough going, hot and mosquitoy and fighting the jungle that tried to hard to suck us in and eat us. The best feeling ever was when we saw the man-made steps out of the jungle to the lodge, and got a tall cold glass of passionfruit juice.

Hanna slept through all of this: The night activity and all through the morning hike (good thing, Im not sure she wouldve enjoyed), got up briefly to pick at lunch and went back to sleep within 5 minutes. So she hasnt seen much, but shes here, and shes not complaining, so its a start. Tonight, night hike (not sure about that after todays), and then tomorrow, home. This has been great but a little lonely with no one to share it with, and quite so authentic that Im ready for a break from the hot humidity and the cold water – how nice to think of cool mountain air and a warm shower.

Now its siesta time, the heat of the afternoon, though some of the staff are out playing soccer. There are moneys in the trees overhead and a macaw on our window sill. Otherwise, the steady hum of the cicadas indicates the heat, and I am just going to sit for the next few hours and watch the jungle baste.


Day #3 – So Hanna couldnt handle the night hike, so I arranged to redo the caiman watching she had missed the night before. But she didnt have energy for even that. So she went to bed, and I went again on the tour. It was really fun – I hadnt realized how much I enjoyed it the first night. The air on the boat in cool and wet with no bugs at all. The stars are brilliant and both Jupiter and Mars are visible in the sky, along with the famous Southern cross. The night calls are incredible, and there is a 10 minute meditation where they turn off the motor and you just drift along the river silently listening to the voice of the night. The caiman spotting itself is cute. Someone stands in the front of the skiff with a bright flashlight (hooked up to a handheld generator for power) and scans the shores for the two red caiman eyes to flash back. Then we sort of sneak up on them, as much as 10 people in a motorized craft can sneak, and inevitably they look at us for two minutes and then scuttle into the water. They are surprisingly fast when they decide its time to go.

I went to bed at 8pm as always here, to the perfect sound of the million cricket choir, and was awoken this morning at the standard jungle wake-up time of 5am, to nearby throaty roars in the jungle. After Costa Rica, I know enough to not think these are jaguars, but rather, huge Howler Monkeys, which to me is about as scary. By seven we were back on the boat, speeding home towards Infierno port and then the bus and then the plane. As far as Im concerned, the water is the only place to be in the jungle. As the sun rose, it gave color to the black forest changing it back into its iridescent green. The clouds began to dissipate and the furious blue charged out. I could have stayed on that boat forever, skimming the flat water between walls of Amazon.

Back in Puerto Maldonado was the reality of being a person trying to live in the jungle. The chickens and the poverty and the little motorscooters and the lazy shacks; an ugly city of the edge of such pristine beauty. It is interesting, the people here are somehow different from the Peruvians I have met so far. There seems much less joy here. First, everyone who worked at the lodge seemed sort of beaten down, doing it for work and not for pleasure, which while the reality most places, was not my impression of Peru in general. Like the taxi driver who took us up to the ruins in Cusco; he stopped off to show us his favorite spot with the best view of the city. That could have been another fare he was missing, but he enjoyed talking to people and showing them his city; things like this have been my experience here. In Puerto Maldonado, people seemed to have problems, they work 7 days a week, all year, including Christmas, and though they get one month vacation, the tourism business is just too much, and theyre burnt out. This is what they said to me. It reminded me of medicine, and I thought how everyone needs a break, no matter where they are or what theyre working in, people are only made to work so hard before they start missing the things that make life fun and meaningful. Another example is our guide who was 24 and had a 7 year old son. She had tried going to school in Puerto Maldonado, but the classes were poorly taught and the teachers always on strike, plus she needed money, so back to work she went. She is a woman of the jungle, and left only for 1 years before she couldnt stand being away from it anymore. This is how it is, the jungle is in their blood, and yet in a way, a dead-end. She dreams of studying environmental law, but previously there was no law school in the jungle. A new one opened so maybe she'll try it, seem how it is, a possible new path.

Today is a fast day and a travel day, since there is not much I can do besides sit in a boat-bus-plane-van-train which without exaggeration is the plan for today. Tomorrow, we'll be positioned for a different cloud forest and a different tempo; Machu Picchu.

Ancient deep tissue wisdom

My parents are here! And the hotel offers very cheap massages on the day of arrival. So at 3pm we all filed downstairs into the high-end spa for our massages. We were given the option of Relaxing or Deep Tissue. I should have known by the fact that Deep Tissue was in a whole separate classification -- set in opposition to Relaxing -- that this was not going to be fun. I have a vague idea that it would be painful, but clearly not enough to stop me from trying it.

The problem with deep tissue massages, for me, is that without a lot of meat or fat on me, the only thing deep to my tissue is bone. Wincing the whole first thirty minutes, I kept thinking, I cant survive this. Certainly not without crying out. It was a bone-crushing rub. The masseuse actually got up on the table so that she could throw her whole weight behind her elbow which was being pressed again and again over my scapular ridge. I wasnt a believer then; mumbling mentally about this being a pseudoscience. I thought my back and body might go easier than my neck and shoulders, the muscles being bigger there, but turned out that my muscles were just pinged against my ribs like a xylophone. And there was no love in it either. This wasnt a Bethany massage. It was borderline angry, just shy of sadism (not so shy actually, but I want you to keep thinking that Im a pretty normal person).

Then around minute 40, a transition happened. I started to enjoy it. I cant tell if my body had just warmed up, or if the masseuse was getting tired and so pressing less hard, but whatever it was, I started to really relax into it. By the last 10 minutes I was actually smiling instead of gritting my teeth, and when I got up, I was a new woman. A lot like the stretchy mother in The Incredibles, and very happy. Crazy but true, in one hour, I went from skeptical to sold on the ancient wisdom of deep tissue massage.

Ahhhh

Luxury. Im staying in a hotel. With wifi, television with English channels, movies, a bathtub, and hot matte de coca in the lobby. Its inexplicably rainy and cold here in Cusco, and Im planning on taking the day off from here on out. A hot bath, matte de coca in bed, with a movie and internet. What a great day.

La Ultima Dia

What an AMAZING last day. Wow. Storybook. Cant go into it all right now, will have more time tomorrow afternoon. Basically, the morning we drove way up into the mountains and blitzed out 125 patients in 3 hours. It was insane. But I had the time to sit and talk privately with a woman who lived with the stress of her father being an alcoholic. Not violent, but she was so worried about him and didnt understand his disease. That was probably the most effective thing I've done in Peru. Then at 1pm we headed to Lamay, the clinic was packed by Jackie, and we ran out for a 2pm meeting with the Mayor.

It was some meeting; it was a diplomatic banquet.

In the top of the municipal building, they had decorated the party room with streamers and balloons and flowers. Everyone was there -- the elders of the community, the clinic workers, municipal workers, and of course the Mayor and his wife. They served us vegetable soup (still dumbfounded why anyone would opt not to eat meat), and beautiful fresh fruit, and we sat and talked and enjoyed. There was Bach on in the background. Everyone felt like they were going to be asked to waltz. Then Guido got up to talk. He spoke about all the back and forth in the year before, and how excited everyone was when we got here. But more than that, he said how impressed he was by the compassion and attention and sensitivity that each doctor and student displayed towards the poor people that we treated. And of course how excited he was to have a partnership that will continue on into the future to effectively improve the health of the people of Lamay. Then he presented us all with two large plaques, written on leather and pinned to a framed background. They are of course hilariously Latin American and so wonderful. Then each of us got a "certificate" which we assumed was a piece of paper, but here apparently means a hand-painted wooden plate personalized for each person. Incredible. We all hugged and laughed and some more people gave speeches and I even cried a little. We gave small gifts to Guido and Lucia (who always made us lunch), and formally gave the microscope to the clinic... with a red ribbon and all, like in a perfect dream. So much friendship and good will. I cant wait to come back next year. They all stood in the street and waved to us until the bus was out of sight.

The Ultimate Penultimate

Strike days are always the best because we spend time with people in the community, and thats the most important work. For example today in the market we met up with Yanett, she invited us to her house. We ate cake and drank papaya juice in her kitchen and spoke with her parents about healthcare in Peru. She brought various herbal remedies from her extensive medicinal garden, and they promised to teach me each and every yerba when I come back.

But tonight was the best night. For me, the best night in Peru. Nothing in particular happened, but it was the culmination of all our efforts here in a feeling of family and good will and excitement over improving the future.

First we had our regular Tuesday night meeting, with presentations of patients (from epilepsy to GERD), with some extra reflection. The reflection ran along the lines of, what did we give these people, what did we accomplish, etc. And we came to a very important insight. Yanett's family was saying to us what we so often hear in the US: The last generation of doctors just dispensed pills, we need someone to listen to our problems, to care, and to tell us we'll be OK. Raphael Bendezu, the Peruvian doctor here, also offered a similar insight, saying that listening to these people and reassuring them or directing them within the medical system is the most important part of the medicine we do here, and indeed medicine in general. The very fact that people like us -- who seem impossibly wealthy, educated, and glamorous -- spend time holding hands, kissing cheeks, bandaging wounds, teaching and explaining, and treating the poor country people with the respect they deserve, is a new experience for them. And can do as much for their state of mind as temporary fixes like albendazole or tylenol. As Raphael said, much of what we see here is a product of poverty, which is a bigger problem than just us (worth tackling, mind you, but slow to change), but a caring and knowledgeable ear can do wonders. Especially when coupled with meds, supplies, and community action to improve the system. A special moment was when we reflected, maybe we did more to help than we thought.

During this meeting, Senor Guido (the mayor) showed up to seek us out, and refused to interrupt the meeting, waiting instead for us to finish. It was amazing, but he was like a changed man tonight. In the past, very reserved, austere, tonight he was all smiles and kisses. Kisses! He knew our names and our plans and was thrilled about the ideas of a mobile clinic and a womens shelter. More than thrilled. He was like a giddy schoolboy making faces and jokes. Jokes! I kept looking around like, is this really happening? He met with everyone and then stayed for dinner where the table talked regular social talk, trying (unsuccessfully) to explain American Football. It was an exciting energy, that we did great work, the mayor and community were our friends, more than that, like family, and we were planning for a future together -- a future dedicated to improving people's lives slowly but surely.

Dinner was the next phenomenon. We bought a huge cake to surprise the staff, and when dinner was over, everyone gathered and ting-ed our glasses and Anna stood up and said thank you so much, we feel like family here. Then Alida hustled the staff to sit down and we all served THEM cake and they laughed and ate and asked for our emails, and there was such a special warmth all around. Even Edwin had a piece of cake (one wont hurt). It was the perfect end. Guido and Edwin, the staff, some random stranger who became our friends after we fed them cake. Everyone was working together, using their power and lucky positions in life to help people less fortunate. Of one mind, and one heart. Sound cheesy, but thats how it felt in the room full of friends.

If nothing else, we built wonderful relationships with incredible people. Relationships to last a lifetime. This really was something to be proud of.

Strike!

This is Alida, Gita, and I at Hearts Cafe, an NGO we're making connections with in Ollantaytambo

Yep. It had to be that our penultimate day was quite Peruvian in that we cant leave the town. STRIKE!
This happens about once a week or once every other week. The strikes here are tranquilo, calm, with people parading, megaphones, and road blocks made of huge boulders that people roll into the road. No violence. Unless you try to cross the lines, then they slash your tired, throw stones, and maybe beat you up. But if you just walk over and dont provoke them by crossing union lines, tranquilo. So despite big plans to do a huge outreach program in Matinga, we are taking a forced administrative day in Urubamba. Its Ok. We need it. And tomorrow will just be crazy busy with all the stuff we couldnt do today!

Los Peruanos

Do you know, I love working in Peru. I really do. And there is one major reason for that; the Peruvian people. Unlike the stereotype some people have of South American countries -- siestas, fiestas, corrupt governments, manana-manana attitude -- Peru is quiet the opposite I have found. The Peruanos have huge hearts. They are dedicated to their people, and work often back-breakingly hard to support their families, friends, communities. They give charity at every level. They go out of their way to help a stranger as they would a friend. They laugh a lot, enjoy their chicha beers, are connected to their culture; know the old dances, language, philosophies. Values of community, physical work, connection with Mother Earth (pachamama), spirituality, centeredness, are so prominant, that people put aside more superficial values of money, fame, and success without thinking twice. The children are happy and playful, even with runny noses. Taught to work hard, the kids here are loved deeply, nursed and carried against moms safe back for years, but expected to be independent and to pitch in. One man explained to us the Ancient Incan morality as the famous phrase: Dont be lazy, Dont lie, and Dont steal. Its really these values that we see in the modern people.

So why is this coming up now? Besides every single day receiving an education from the Peruvians in generosity, selflessness, priorities (family, friends, community), today bore a special example.

We have been talking a lot amongst ourselves about the needs of the community here that we can work on in the future. A mobile clinic is a pretty straightforward goal which would be helpful. A more long-term one would be to establish a shelter for women and children subject to domestic violence. As I have mentioned in a past blog, we see many women bad situations (though my guess is that the numbers are comparable to the US; others here believe it is more pronounced because of cultural acceptance. Research question!). We saw this as a need, but it is most important what the community sees as a problem. Clearly we can only help out a community effort since a) were not so big and powerful b) were only down here one month a year and c) most importantly this needs to be a grassroots effort owned by the community (just aided by us) as this is the only way it will be embraced and sustainable. So today we had a meeting with Dr Sotomayor who works at the Lamay clinic day to day and spoke with her about our idea for a womens and childrens shelter but made it clear that we only are suggesting this as a possible course and her feedback would determine our course of action. She got really excited (for the first time as far as I have seen), and said she has been thinking about this need but never had any money or specific external push that could get it going. And she rounded us up and took us in the ambulance to the site that she has been plotting to use for this purpose. It is the old clinic. Abandoned for three years, in cobwebs and peeling paint and broken windows, we all looked at it and saw a brightly painted safe and healthy shelter building. She even showed us (though we couldnt get in because the bars on the front were rusted together), where the guard would sit, how the fence would run, she had this all thought through and just needed a little help to get it going.

This is how the Peruvians are. Forward-thinking, hard-working, and community oriented. When we think of an idea, they had thought of it already last year, but they just dont have the resources to do it. It is so rewarding working with them because they have all the elements and drive to better their own lives, they just need a little money and attention and energy to do it. And those are the only three things that we can really bring with us, so its a perfect partnership.

Pampallacta

Great day serving a very poor mountain community. Sang 80s music the whole ride home, for the ultimate in incongruity.

Today, clinic and Pisac festival.

Transportation

So we all listen to eachothers phone calls, conversations, etc – this is how it is when you share a lobby for internet calls and one bedroom with three other students. Tonight it happened to be hilarious, because I listened to Anna describing our daily commute to her boyfriend over the phone, and I realized, the mundanities need to be recorded. So from her mouth to my blog, here is an average commute home.

We ride the public bus one hour each way to and from Lamay. None of the public busses match. They are all different colors, are labeled incorrectly with the names of random places, are different sizes, but they do share the feature of never stopping entirely. They just slow down at stops while everyone walks/runs alongside and jumps in the open door. Then, as Anna was saying, at rush hour, people are just crammed in like sardines in a can. There is no courtesy and whoever gets on first sits. After that, you are just kind of smushed into your seat by pregnant women with babies wrapped in colors against their backs, old men with shoes fused to their feet, old women with all manner of grain, grass, potato, or livestock in their manta (cloth wrapped against the back to form a pack). Everyone smells like corn-meat-smoke and fields and B.O.

Theres two people work the bus, the driver and the guy who takes the money. The latter just walks around knowing who paid what and where everyone is going and so how much they owe. One of the eternal mysteries is how he keeps track. We cant figure it out. Apparently the guy who takes the money is also the guy who shows the registration (stored under a felt blanket on the dashboard) to the police when we get pulled over at a random checkpoint checking if we have too many people on the bus (We do. No one gets off though, the bus just pays a fine and continues on). While this standardness is going on, we just stand blankly, with everyone else, waiting for the bus to start up again and take us home. An old guy in the pile of people is grunting vamos vamos; sir the driver got off to talk to the cops. Ah. Vamos.

Then the bus spends a lot of time in the left lane. Sometimes for a cow, sometimes to pass a mototaxi (see below), but sometimes its just not entirely clear that the whole lane-distinction thing matters. Theres not much in the way of traffic, but going around mountainbends in the middle of the road does create a just-dont-look feeling in the pit of your stomach. Especially knowing that the bus coming the other way has about the same level of regard for lane-lines as yours.

Between Urubamba and Cusco, the way we go when we run our errands there, is only one city, Chinchero. In Chinchero, entertainment always boards the bus to keep us occupied until Cusco. A mentally retarded man singing Peru's top 40 hits (asking a sole for the privilege of listening), or a slick-talking salesman selling superfood and eucalyptus balm (he convinced me, I almost bought it).

Within Urubamba are the mototaxis. I frankly dont even write about these things because Ive gotten so used to them, theyre ubiquitous. The are motorbikes that pull a nylon box in the back that you ride in. I didnt realize the first night that we were here – until Satoko tried to get in the front seat with the driver – that there was no front seat, unless you straddle the bike with the driver. Strangely they are covered in decortaive stickers – it looks like a 6 years old girl picked them out. And they especially love batman stickers. I thought they just loved any stickers and that there must just be a wealth of batman stickers here since that is what at least 50% seem to go with, thematically speaking, but then today I saw one with no stickers but "BATMAN" handwritten across the top, so go figure. Maybe they really just love batman.

Once we get off at the bus station, there is the sigh of "were almost home," but first there are a few more obstacles. If its evening, you have to hop two fences to go the short way, or you have to walk all the way around the hill, to get to the road. Then is an uphill climb filled with swerving mototaxis. Then is the dark unpaved part of the road, and around the bend is the mad dog who tried to bite anyone in a group smaller than three. Then is the secret hole in the middle of the street that drops into the stream – perfect size for an ankle twist. Then finally, you ring the bell and the huge door swings open into Edwins paradise. THEN, youre home. Home, sweet, home.


Smushed on the bus!

El Hogar en Anta

Today was some organizing in the morning. We met with Mayor Guido about future directions in the clinic (see the write-up below), and planned the next few days. Tomorrow, the town of Pampallacta, a health fair, with en emphasis on womens health. Friday, half day in the clinic, and a cultural break to visit Pisac's festival of the Virgen del Carmen. Monday we return to Pampallacta to work with the children, specifically. Tuesday we go with Yanette to another region to work in Matinga. Wednesday is the last day in clinic, and then everyone leaves for the US.

Alida was great enough to write up some of our big discussions as to where this project should go next year. Here is an excerpt:
As you may have expected with our actually being and working here in person, seeing the communities first hand has led to an evolution of our ideas and perspectives on the needs of the communities here. The biggest unmet medical need that we have been seeing continuously day in and day out is a combination of women's health needs and domestic violence. Together with the Mayor of the town and the clinic in which we have been working, and with the indispensable help and guidance of Dr Falcone, we have begun to plan a women's health clinic and domestic violence shelter. Currently there is no shelter that allows women to stay with their children in the entire region, there may be one in Lima, but we are unsure of even this. The idea we are developing is to use a part of the clinic building that was built for women's health issues, but is currently not being used. The women would come in to get women;s health care, such as PAP smears, birth control, counseling education etc. If it comes up that there are domestic violence issues (as we have seen in patient after patient here as the root of many presenting chief complaints) the women would then have the option of being admitted into the shelter. A rehab program for alcoholism and education program is being developed in the community currently by the mayor and this, we believe, would be a perfect compliment and addition to the effort. The center would be staffed by local health care workers, a social worker and a nurse, and we are planning to write grant proposals to support a health professional student working at the center for a semester each term. Along side of this project we will continue to run the July rotation for the CCF and CWRU students who would like work in the medical clinic as an elective clinical rotation. We are also planning to write a grant to support the project itself, but this will be to supplement to the money provided by the government.

Well written, Alida. Thats just one of our many exciting schemes... theyll come out one by one, dont worry. Poco a poco.

Now back to today. In the afternoon after lunch with Lucia and finishing our patients, we drove through the most fantastic countryside up above the glacial peaks through golden cornfields, past surprising mirror lakes, to an isolated little city where we visited the orphanage that Peruvian Hearts supports. It was lovely and the girls were of course adorable and vivacious and each unique and different. We gave check-ups, socialized with the children, and all around enjoyed yet another interesting experience of being welcomed into a Peruvian community.

Birthday!

Today was the best possible birthday. First, it was a work day, and Alida and Elizabeth and I went to Cusco to get the Lamay clinic money account dealt with and pick up meds for an outreach program we're doing. It sounds boring but it was perfect. Normal, but meaningful, and really gives you the perspective that you need on your birthday. As we were driving on a bus through fields of plowed corn, varigated yellows and browns, with the Andes music piping surrounded by Peruvians who smell like meat smoke and maize.

I want to write about the whole day, but we have to be out of the lobby by 10pm so Ill post it tomorrow.

Tonight, we had dinner at Edwin's and then they served jello for desert (which clearly had gelatin and so I didnt eat), and we were prepping to finish dinner with out mattes, when the lights went out and a fire cracker popped and they came in with two cakes complete with candles and a wish (to come back next year, shhhh). One was from Edwin and the Group, the other was brought by Yanette, a Peruvian friend we met here who we're working with to coordinate care to very distant mountain towns. I was so surprised I blushed all through the dark and then served everyone two pieces of cake a piece. Wow, guys. Best birthday ever.

Everything is good!

Busy, we leave at 7:30, commute an hour, work until 4-5, home at 6, dinner then meetings/studying/reading on what I saw during the day. But tomorrow Ill blog, for SURE. :)

Shabbos Rest

I got up for breakfast at 8am, saw the Fikes off, and went back to bed. I was too stuffy to sleep but I moved my sleeping bag out to the huge porch and spent the day resting fitfully in the warm shade, reading my book and the parsha, falling asleep, sitting up to drink some tea, laying right back down. At about 3pm, I thought it was high time to get up. I took a cool shower to try to wash the sick sweat off, and felt much better, I made motzei, ate lunch, and continued to read and rest. Bill Fike taught me this awesome home-remedy for congestion that saved me today. One teaspoon of salt in 8oz of warm water, put it in a syringe, and flush it up one nostril until it comes out the other nostril. The salt pulls the fluid out of the boggy nasal membranes, and opens everything up. It made all the difference. So I pretty much was only conscious for the end of Shabbos, but I have to describe to you what it is like to watch the sun set from my porch overlooking the Andes:

The porch is a natural, earthen, red. It is quite large, and retains the heat of the day, so walking on it in bare feet allows you to soak up the sun through your soles. As the late afternoon comes, there is a brief, cool breeze, the changing of the guard, and as quickly as it came, it dies down. Beyond the green haven that my porch inhabits is lots of brown and yellow fields. The end of the corn husks being toted away by wheelbarrow. A peasant, knee deep in mud, churning it with his feet into smooth material to make the bricks of the mud huts. An escaped goat wanders along the road, munching happily on the other side of his fence. The daytime sounds of children's play, cows offended by the milkers, lots and lots of dogs barking at each other. Long shadows reveal the undulations of the mountains, each wave casting darkness on the next. Then the light drops away. An evening bird sings its night song as the children are called in by their mothers. It is suddenly cool and blue. The mountains looks flat, like disney-world facades which I could push over with a nudge of my toe. Jagged dimensionless silhouettes against a duskblue sky. The world falls quiet, with only the indistinguishable sounds of a nearby brook and the breeze. Everything is so still, you can hear the footfalls of the last people walking home on the dusty road. Tall, feathery eucalyptus trees rustle and sway, as if on their own. A yellow light comes on here or there in the huts. One star. Right in the middle of the sky. The twilight is heavy, it is difficult to see through, as if mist or dust formed a screen around the porch. And then it is night. Clear, perfect night. Thick heavy but perfectly transparent blackness, punctuated only by the stars.

Busy, busy

Sorry I havent written in the last few days. Weve been so busy.

Really quick update. Yesterday was a strike so we went on a hike to the nearby glacier, which, as it turns out, is not too nearby. We were lead by two kids from a local orphanage training to be mountain guides, and a local social worker who runs these sort of programs for the whole area. After hours of bushwhacking and scrambling up the sheer edges of the Andes, we had to turn around. But we learned from our guide about natural local medicines and the needs of the towns nearby and are actually working with her to make health fairs to deworm he kids and teach about nutrition and such. More on this later.

The strike is off today and were leaving at 7:30am to start work there so until then!

Week 2

So I have to start with this evening because there is some strange energy in the air tonight. First, it got cloudy today. Very unusual. Big dramatic stormy-looking clouds. And I even felt a few droplets materialize before they decided not to rain. Then we rode a van home, only half of us, and Alida and I got dropped off in the main square to hit an ATM, but though it was there yesterday, it was literally uprooted and there was no money to be found. So on the way home we used our last soles to buy pasta, avocado, and milk. We walked home in the dark, arms full of groceries, and delayed in the courtyard talking to Edwin about hiking the nearby glacier (we're anticipating another strike Weds and Thurs). When we came into the lobby, I waited for Alida to get her key, and from the darkness emerged the silhouettes of a couple. A very hassidic couple. My friends who run the chabad house, Ofer and Yael, came out of the shadows with a... "Rachel!?" The Rabbi and his wife are staying at Edwin's hotel. Not only that, they are old friends with Edwin and his family. They came out for a visit, etc. And they were throwing a BBQ next door. A BBQ. With kosher meat. After many meals of banana and peanut butter and yogurt and granola and the occasional avocado ("palta"), a barbeque sounded too good to be true. Amazing. Plus, I made plans to stay with them in Cusco over Shabbat, assuming the strike is over.

What a small world. I came to Peru when I saw Ana Dodson on TV one morning; she had adopted her town Lamay, whose Mayor is Guido, who worked with a higher political figure who connected him with Edwin, who funds projects for the town but who really lives in Cusco where he was connected with Ofer and Yael through the Chabadnik's uncle who apparently worked with the President of Peru, who of course knew Edwin as well, so they became friends. And I spoke no Spanish so had to come a month early to Cusco during which time I became friends with Ofer and Yael while learning to talk to Edwin and Guido, and now, with my arms full of avocado, delayed 1000 times, I was standing in the lobby at the exact right moment to intersect with both the Rabbi and his wife and Edwin. Go try and tell me that is random.

Anyway. We had a big meeting last night in which we reviewed the goals and accomplishments of the clinic thus far and planned for the next week. Today went smooth as butter. We saw 100 patients, of which a number of them (like 20 maybe) were only for glasses. If youre interested, this is what we're talking about and thinking about:

Meeting after week 1:

• Broad goals for next week
a. Sustainability
i. Interfacing with current clinic setup better
1. Discuss with Carla – set up meeting time
a. Emphasize that this is their show
b. Learn more about the community
i. Community Education how?
ii. What would you like us to teach?
iii. Domestic violence issues, engage religious leaders in community, group: living hearts, ask Guido for advice
iv. Do they have literature etc that we could work with in Public health campaigns
ii. Outreach: Pampallacta
1. Set up with Edwin details
2. Monday of the last week health fair
iii. What else is needed to keep this sustainable
1. Microscope, ultrasound
b. Better organization of clinic
i. Smooth running of clinic
1. The Cap: 80 - 100 medical
2. Separate glasses from medical by numbering system
3. Set a schedule daily
c. Educational componant
i. How to make Docs positions meaningful
ii. Improve 4th yr experience
iii. Improve 2nd year experience
1. Triage in the morning
iv. Other necessary seminars/study sessions?
1. Stagger second year students

To bear in mind:
Part I of their hopes for our participation is to see if we can help get them fitted with the missing pieces that will allow them to work with the Federal government and be self-sustaining.

Part II is to help the clinic gain the confidence of those not only in Lamay, but the thousands of underserved who live in the deep rural mountains and receive no medical care at all.

Shabbos

Today was quiet. Everyone left in the morning for Cusco except Jackie who stayed back with me to rest. I had breakfast at 8:30-9:30, then walked with Jackie to drop off the laundry downtown. Back at 10:30, I read then napped until like 1:30pm. Got up groggy, folded my stuff and cleaned the room, ate a banana with peanut butter, an orange, and a chocolate for lunch, with a little bread to wash and bench. Then we walked around the little town of Urubamba again, Jackie bought a cloth, and we came home, drank some matte, ate melons, and watched the sunset.

Last night was GREAT. On the way home from work, everyone was like, "do we have to meet tonight?" and I was like, "Yea... for pizzas and drinks and unwinding and talking not at all about the clinic" and everyone went "yay!" So we all went down to a pizza place for post-week 1 beers and pizzas relaxation and bonding. Everyone ordered 15 pizzas for 15 people and it wasnt even enough. There were at least 2 rounds of pisco sours (the local drink), and cervesas all around. It was great; so much good energy, everyone happy at the good work that week, high morale, feeling like we did something. We all laughed and told hilarious stories and got to know each other better. We toasted each other and ourselves and one week of incredible success at Clinica Lamay.

Smooth

A quick note before the morning begins. We are working hard here. Really hard. With a 30minute commute up and down the valley in an old bus, a 8-5 work schedule and really no breaks, strangely I feel like Im on a rotation. :)

Id say so far this week has been a smashing success. Yesterday we were infinitely more organized, seeing 80 patients in the same amount of time we saw half that yesterday. The level of teaching for the fourth years has been great -- we see patients on our own, present them with an assessment and plan, and have the doc look over the physical/history and do some one on one teaching. Everyone agrees they are learning a lot. The first years were paired with four years for a while yesterday. I taught Matt how to do basic things like take blood, give an injection, as well as STD differentials and such indicators. Today they will be paired to a doc directly, since now we have more doctors here (2 more arrived last night).

Yesterday we officially diagnosed the Leishmaniasis from the day before (unusual at this elevation but she had just come from the Jungle), as well as domestic violence, renal failure, UTIs, standard gastritis and diarrhea, hypertension, palpitations, quite a few hernias (inguinal, umbilical, ventral), and a very sad neurological birth defect. It was a full full day. Hilariously, the goiter shown below wasnt even a complaint, I stumbled across it on physical exam (how could you not), but she said she had it for 20 years with no problems, so there you go.



Today we round out our excellent week with a final day of 8-5 and then the weekend off to explore Cusco, the market in Pisac, and for some, Machu Picchu.

The Start

So yesterday the strike was on so we took the beginning of the day to sort medications, hold talks on derm, ID, and related pharmacology, and then we took a relaxing afternoon for group bonding over lunch, buying necessary foods in the market, and seeing the town. In the evening, medical Spanish practice sessions, and an early bedtime.

---

This morning there were no lazy clouds, only immediate blue skies and excitement. Everyone was down to breakfast and hour early and ready to go. I tried to prepare everyone (and above all myself) that it is likely to be a slow organizing day since the radio announced we were coming Thursday not Wednesday. We shouldnt be frustrated if it is as quiet as it was when we visited on Monday afternoon, we need the down time to prepare. I neednt have worried.

We were planning on getting organized in the morning, and starting to accept patients at 1:00pm. By 8:45am there was a line.

As we watched people trickle in steadily, it became obvious that the longer we waited to see people, the longer we would be at the clinic, and by 9:15 I was taking stitches out of a womans whose bull had impaled her. It was only her leg, but there was an entry wound and exit wound and it was infected and ulcerated of course, and why are the stitches still in three weeks later. Plus, do you have any idea of the kind of logistics necessary to treat even the smallest thing? First, just a place to sit. She sat in a spare dentistry chair. I squatted on the floor. Second, light. We left the door open for the hallway light, and I used my penlight to spot the stitches amongst the scab and the healing tissue. Third, water. That wasnt going to happen. Even if it was running somewhere in the clinic, its not clean anyway. Lots of iodine and alcohol. Then there is the issue of providing excellent treatment with limited medications and procedure options. Its really tough. There is always the "this is what the evidence says" and then the slightly different "but this is what we have in the medroom" talk. The woman took 45minutes. There were 10 people in the waiting room when I came out at 10am.

A local nurse was helping us organize, and at one point in the afternoon I commented to her, "this is really a lot of people" and she corrected what she thought was a Spanish error "you mean a FEW people." I looked at her, "no, a lot." She looked at me for a long moment and then decided to laugh, "Doctorita, espera." Just wait.

We had three people in triaje (triage) taking chief complaint, history of present illness, and vitals. Then passing them on 4th year students who filled in the gaps and did an exam, developing their assessments and plans and then staffing them with one of our three docs. Nearly every one requires the docs to consult each other. What did we see? Before we started there was a general question of whether we would see lots of common issues or many rare ones. The answer is both. We saw diarrhea and fever, lots and lots of back and leg pain (herniated discs, compression fractures, radiculopathy), depression and anxiety, hypertension. We saw brisk GI bleeds, severe gastric ulcers, corneal edema (possible slow cranial bleed), domestic violence, gaping sores on the mouth... maybe leishmaniasis. About 40-45 patients in all today, which means triagers and doctors saw about 15 each, examiners/students about 8 or 9 each. Remember that for each patient we do our own labs, we are our own pharmacists. No one stopped for lunch, everyone had to be pried one by one from their post to eat a banana and orange and drink some water.

We stopped taking new patients around 3pm and the waiting room was empty by 4:30pm. We were all shell-shocked and reeling, and got home after dark an hour later. Some went straight to eat, others straight to shower. Our nightly 1- hour debriefing session was delayed until 8pm (in fifteen minutes), while people collected themselves. There is so much to talk about tonight, it is wild. Tomorrow's goal is to be more streamlined, because Im afraid that really the masses will start pouring in.

Dawn

Its a beautiful morning here. No one is up except the cooks and the birds. Its still a little blue, the air, from the night, and has a
tiny bit of moisture in it, which for this climate is damp. Its a chilly 50 degrees and the normally accessible razor dry peaks are
hidden by wet clouds. A tiny split in the clouds showed the tip of the mountain, and it was glistening pink. Covered in frost and hit by sunrise, it looked like a little piece of heaven.

The Next Chapter: Clinica Lamay

Urubamba is a dusty road deep in a gully formed by the jagged but earthy Andes mountains. At the end of the road is a gate, and it opens to a little piece of paradise which we now inhabit.

This morning at 6:30am I met Edwin, the proprietor of the hotel, Guido, the Mayor of Lamay, and Gonzalo, a young friend of the Peruvian doctor who is sponsoring us, as we all stood outside the arrival gate at Cusco airport waiting for the group to arrive. We cheered as everyone stumbled one after another into the bright Andean sunlight, and straight away we loaded up the three vans and were off for Urubamba. I rode with Jackie and heard a little about the adventures. Everyone got through security with no problems until the last person, Matt, who had brought an extra box of supplies. They opened it, and demanded a letter of proof that this was done with the approval of the Peruvian government, which they produced (if fact, a packet from the consulate, NGOs, etc, that they painstakingly put together). Then security demanded an itemize list of what was in the box, which Matt amazingly had (it was the only box for which such a list existed). After looking through everything, and hearing that the whole group was part of this medical team, they looked over the group and said, any other medical supplies in the group that we need to go through? -- Stunned silence at the thought of not having lists for everything and having everything confiscated – And then innocent Alida pipes up and says, "in those bags? Just clothes" She smiled. Doctors need clothes you know. They waived everyone through with everything intact.

Everyone was tired after traveling for so long. Even I was tired, which I am aware is ridiculous, but last night I was up the whole night reviewing the chapter in my life that had just past and thinking forward to the new one. Like a whole night of turning the page. So we declared 2 hours of rest, snacks, and showers, and time to take in our surroundings. The hotel is beautiful. It is on a little piece of property that is green – so green – compared with the surroundings. A place of exotic flowers and butterflies and hummingbirds. A place which, speaking of energy, is at once tranquil and brimming with natural life. We students have four to a large room, comfortably, and our own little hut area with a large sunlit porch overlooking the mountains. We were met by the local tea and indeed a three-course free lunch specially to honor our coming.

It is incredible that such important people would take the entire day to pick us up, drive us around, entertain and teach us. Mayor Guido is an austere man, dressed very professionally, but entirely committed to his town. Lamay is lucky to have him because from what I have seen he is a true civil servant, working tirelessly to use his political favor to help his people. He built the clinic using local money, and clearly thought through every nuance, thinking progressively for room and resources to grow (will explain more later). Everywhere are signs of his careful improvement of the town. Water evaluations, a new children's swimming pool, a new ambulance. He is a professor of social science, and one can easily see that for him, it is not just theory, it is the workings of life.

Senor Edwin, the hotel owner, is a man out of a fiction novel. Friendly, kind, with an easy smile, he is a family man, telling us about his five children from age 1.5yrs to 30yrs and introducing his wife proudly during lunch. But as we drove up to Lamay, the depth of his character was revealed. I had thought that he was from Lamay which explained his connection and willingness to donate his own money and time to the town, but he is not, he is from Cusco. In fact I found out that Lamay is not the only town he does this for. There are at least three or four others in which he sponsors lunches at schools to feed the children who walk miles into school, that he donates time and money to improve poor towns all over Peru, and why? He doesnt answer, he just smiles a little. Its because it makes him happy to give back. Because he is a generous spirit who hurts to see a hungry child. Because he knows he was blessed with small success in life and needs to spread it over his people. Edwin does this because its the right thing to do in and of itself, with no need to advertise it or use it for secondary gain. Incredible. In addition he, like many from Cusco, is deeply connected with his Incan roots, and he runs his hotel here with traditional values. He knows everyone in the area and treats each with dignity because he appreciates the Incan value of community. He grows fruit trees and coca and coffee and maize on the property, all naturally with no pesticides, because of a deep connection with the earth and a respect for nature. As we drive through the countryside he shows me the rivers that come from the nearby glacier, their names and their routes to join the Amazon River. The water systems and city layouts, the history and the Incan stories, all of it he explains by heart. He is a man with a big heart that he wears on his sleeve, and Guido saw it and brought him to Lamay.

So here we all are. Living in Edwins hotel with the flowers and the butterflies, ready to roll up our sleeves and help Lamay in whatever way we can.

And thats a whole different story. To explain what we learned in the two hours at Clinica Lamay is very difficult. It would involve knowing a whole backdrop of expectations that were quickly shifted. But in short, the clinic is very big and clean staffed by one doctor, one nurse, one dentist, and a gentleman named Mario who dispenses the meds in the pharmacy. The clinic building is built for the big-time; a lead-lined room for x-rays (no x-ray machine), an OR (with no lights or equipment), a birthing room with a baby-warmer (proudly displayed as the piece de resistance since there are only a few in Peru), and so on. The problem as it seems to be, is that Guido managed to raise the funds for this and put it together, but the government created hoops to jump through in order to get government staffing and funding for a clinic. Among them, a microscope of their very own, and an ultrasound machine; they are getting together a list of the rest. So

Part I of their hopes for our participation is to see if we can help get them fitted with the missing pieces that will allow them to work with the Federal government and be self-sustaining.

Part II is to help the clinic gain the confidence of those not only in Lamay, but the thousands of underserved who live in the deep rural mountains and receive no medical care at all.

People dont come for a number of reasons beyond just monetary. They use herbs and traditional Incan remedies instead, plus they have been to the clinic once before, know the only services and meds offered are basic, and feel they need more help than the clinic can provide. This is what Mayor Guido is trying to change with our help. The idea that specialists come – and ones from the US no less – will instill a new confidence in the clinic as it grows slowly on its own. It will be credible, and so used by the target population. As part of that they have been broadcasting our coming on the radio, complete with which specialties will be here when, and the rate (2 sol if you can afford it, free if not). Its funny, in Cusco in the past month quite a number of people said to me, oh yeah, I know about your Lamay clinic, and I thought to myself, Im sure theyre thinking of something else, but now I realize that we were on the radio, and people know.

So here we are. In a post so long that I cant imagine anyone getting to the end of it. Alida and I are sitting in the silence of the stars, drinking coca matte and writing. This is only Day 1 of the chapter, and we have learned so much already. Tomorrow is scheduled a transportation strike that might prevent our working, but we'll see if it goes through. Until then.

Drumbeats and spirits

I wasnt sure what to write about but then I got interrupted with the offer of chocolate ice cream cake (this is why Im gaining so much weight here) and lured downstairs. I didnt want to be social but I wanted the ice cream, so I sat with Carmen, the new girl from Chile, who I found out it the boss of ECELA and trying to make the school here come alive. She was with as well one of the schools housemoms and we got in a discussion about why the Cusco school is doing so much worse than the others. We have like 5 students here, other locations have like 50, 80, or 100 even. Then Carmen said, Ive been meaning to ask you, Ygor told me that there is a ghost in this house. Do you still think so, because that would be one problem to deal with here? They took it so seriously, its as real a threat to the school as poor organization or bad PR. So I explained about the noises and the feeling I had of weird energy since I came to the house, and they listened like this was a totally normal conversation. And when I finished Judi, the housemom, said it sound like Presences but not a ghost. She told us how the Incas didnt have graveyards like we do, instead they buried their dead under the house where they could be near the family. So all of these old houses have many many bones under them and people who can feel energies sense the presence of the dead. Ghosts are an issue requiring shamans, but Presences are a fact of life in Cusco requiring occasional admonishment ("quiet down there, Im not dealing with you"). They also told me about the Incan traditions of human sacrifice, which when I ask tour guides and others, I am told is pretty much a myth. But oral tradition here has it that it was relatively common. I believe that it was as the people say and not as the tourguides represent it. Like, when we went to the Temple of the Moon which is a hidden cave within a mountain. And there was a sort of skylight in the ceiling of the cave through which a full moon would shine one a month, lighting up a smooth, round alter to the moon. Even when we were there (the day of a full moon) it was in use with coca leaves and voodoo dolls and animal hair. Ygor told us only plant sacrifices were given there; maize, coca, quinoa, and occasionally birds or even a llama. But I felt otherwise. It felt, not sacred per se, but filled with the pagan energy that permeates this place. It felt like warm blood and moonbeams and the beat of a deep drum. Judi tonight brought that as an example of places where humans were regularly sacrificed; often the virgins of the moon (since in all traditions, the moon is a feminine body, it was served by women here). This place is so full of mystical energy, even the most slightly open person is affected by it. Its interesting, in the same breath that people refer to their local Catholic father, they speak about Pachamac, the great spirit encompassing the three regions that roughly correlate to heaven (the condor), earth (the puma), and the underworld (the snake). It is interesting that even in pagan cultures there is a thread of Monotheism as well. Im coming to understand this theology, and it is really very rich and much more complex than the popular image of primitive paganism.

Daily Life

Its starting to be a place I live instead of a vacation. I run into people I know on the street, I know which vendors to shop at and who will give me false coins for change, I know how much to pay for things and where to find safe taxis, I speak the language. I stopped carrying my camera everywhere and parades are fun but also represent a road block to my destination. I feel safe. When people strike, I ask them why instead of running, I dont ask the police for anything. I carry my flashlight for when the sun sets but can walk around alone until 9:30 or so since people are out en masse until about 10. I prepare water in the electric kettle in the morning for my evening wash since you can count on them shutting off the water at 7 or 8pm. Ive hit a rhythm here.

News has become a lot smaller. I have an infection in my finger from a tiny cut that blew up when washed in the dirty tapwater here, but spoke Spanish quite well enough to get and discuss antibiotics, iodine, gauze, cream, and surgical tape in the local pharmacy. (yes, all that stuff is over the counter) I have to incise and drain it tonight on my own with no lidocaine. I did it last night and let me tell you, I&Ding an abscess on yourself hurts. A lot. And bleeds a lot. But Ill do it again tonight in hopefully a more successful way.

Ive become the local doctor as well. Mostly because I speak English and Hebrew. I get about 3 consults per day about everything from gallbladder pain to salmonella to STDs and abortions. I tell everyone Im not a doctor and I can only be a source of information, but still there is a steady stream of questions, esp re instructions that they received in clinics here.

My friends here are all great, many Israelis from Chabad, a few volunteers in other programs, a few local Peruvians who Ive met. Especially my Spanish teacher Millie. I hang with her family and am going to her nephews 7th bday next weekend. They speak ZERO English (like most people here), so its a challenging social scene but its great practice. My Spanish is now such that I can communicate fine. With lots of grammatical errors, but Im understood. Every week it gets better.

So thats it here. Regular life. The 24th is Inti Raymi, the biggest holiday here left over from the Incan Sun Worship (it is the solstice), so that should be what to write home about. The town has been preparing for it for weeks and there are nightly concerts, daily parades. I cant wait.

Ausangate

Ausangate.
In three days it was the adventure of a lifetime.

Prologue: I think I told this story already but it is the true beginning of this trip. Elana, our housemate Chris, and I came home one evening, arms full of groceries, chatting and laughing. Let ourselves into the apartment and started unpacking our things, when suddenly a distinct noise of something dropping and rolling down stairs emanated from the upstairs of the apartment. Chris had just finished telling us about how he experienced the identical situation in Bariloche, Argentina, when he came upon some thieves robbing his apartment, so we looked at each other and backed towards the door, slamming it behind us. We scurried out to the street asking each other what to do. Should we go back in and check it out? Seemed foolhardy if someone or someones were actually in there and especially if armed. We could wait a while and hope they left, but who knows when that would be and wed run the risk again of surprising them if we came home too early. The best course of action, Lony and I agreed, would be to walk down the street to the hostel whose common area was always filled with Israelis waiting for an adventure to come up, and get a group to come clear the house with us. Safety in numbers, and especially numbers of recently retired well-trained soldiers. So we walked over and explained the situation to the group who happened to be sitting there. They thought it hilarious and donned health-worker face masks and sunglasses as they burst into our apartment clearing each room with their fingers folded into guns. No one was here and everything looked untouched. We found out later that the water supply in the city was turned off that night as often happens in Peru, and the air in the pipes was clanging and gurgling to produce that noise. Or it was the ghost which clearly lives here, whichever you find more plausible. Well, if youve ever tried to get a big group of Israelis to do anything, let alone leave, youll understand why they ended up staying and hanging out for hours. We had had plans that night, forget about it, and poor Chris kept trying to get in a word through the din of everyone yelling over each other and laughing, and eventually he just left. The group immediately felt like family and invited us on their treks to Macchu Pichu and Ausangate (Lony went on both, I could only afford time for the latter). So from a little noise in the house we ended up meeting our newest addition to our family, and having an amazing experience.

Day 1: It was evident from the outset that whatever we had been told about this trip was just a whim; no one really knew what was going on, but for $40 for 3 days, it had to be worth it. We started all at the Israeli hostel where we caught cabs to the bus station on the other side of town ($1 for the cab). Station is an exaggeration. Its a sign-less place where the bus for Ausangate is known to pull over around a certain time. Vendors come and push their colorful and strange-smelling wares near the nearby abandoned lot/junkyard where you wait. The bus was a public one and included in our trip price (another $1), which apparently was the first-class fare meaning we had seats for the 4hr ride. Others presumably paid less to stand. With our backpacks and sleeping bags, went family's entire possessions as they moved to a new region, and we settled in with lots of giggling and anticipation to look at the people and eat the bananas just purchased outside. The bus wound up and up out of Cusco and into the arid surrounding region. The flat colors of the dusty land, cactuses and hungry dogs were punctuated by the bright rainbow colors that the people wore. Intricately beaded with mirrors and ribbons, with wide hats to protect them from the merciless sun, the brown, weathered faces and dust-colored feet in old sandals contrasted starkly with our white young faces and tan, black and white REI camping clothes.

We landed in a small village with a market along the street, as we waited for the next leg of the trip (of which none of us had information). We were treated by the locals with wariness, sometimes interest, and maybe some animosity for our expensive things and desire to photograph them as curiosities in their home environment. Some found us entertaining, mostly children, who ran along behind us just wanting to touch us or have their photo taken. But to me it seemed that most were just tired from trying to scratch our a living, and felt nothing towards us at all. We were too far removed from their experience to touch it.

Next leg was in the open bed of a cargo truck in which we rattled up the pebbly track through yellow fields of grasses for over an hour. Everyone laughed and jokes and sang traditional Israeli songs from the Kibbutzim and the Army, breaking occasionally into American Pop so we could join in. Talk with a mixture of Hebrew and English with some Spanish thrown in occasionally with the effect of me never knowing what language I was listening to or speaking, just understanding without recognizing. The air was cool and crisp and you could feel the altitude slightly in your head and lungs. Towering white mountains sat against the blue blue sky and the golden fields, and the energy was all friendship and positivity as we rumbled along.

When the truck finally stopped, it was still unclear where we were staying. We put on our packs and walked over the rolling hillside behind our guide. Rivulets of glacial water flowed freely through the tall yellow grasses, and the long light of the sunset lit up everything, including the 20,000+ft Ausangate. It looked as if we were tiny creatures weaving our way through an undulating golden sea. Our home that night was a "refugio," a refuge, which turned out to be the grain and potato storage shack of a family. The family spoke only Quechua, so we had no means to communicate except our guide for whom Spanish was clearly his second language (No, he didnt speak English, I didnt even say that before because it went without saying). The children were so dirty it was shocking, with snot stuck firmly on their faces and then caked in the surrounding dust and they seemed to be eternally sick, with wet coughs but wearing sandals in the increasing cold mountain night. We tried to talk with them and shared ouur oreos when they werent working by carrying heavy water jugs up from the stream or keeping house or bringing in the chickens for the night, and even though they looked at us with wonder, they seemed to appreciate being babied.

The homestead was a wall of stones stacked on top of each other and easily broken surrounding three mud shacks with packed dirt as the floor and straw thatch on the roof. It insulated poorly, but was better than sleeping outside, and with twelve of us like sardines in the storage space, it heated up slight to a refreshing 45 degrees. Of the other two areas, one was tiny and for extra food storage when summer comes (its winter here, remember), and the other was for the family to live. From my count it was grandma and grandpa, mother and father, and four children who slept in the two beds in the shack. On the floor lived a colony of twenty or so squeaking guinea pigs, all ages, for food on holidays, two abused and dreadlocked dogs and a number of chickens and roosters. The firepit over which everything was cooked bellowed smoke into the hut (no place for it to escape but the door). They hopefully made a lot of money from our huge group and they served us the local (vegetarian) food of potatoes, rice, onions, and spices, in a variety of forms, with the occasional egg mixed with flour to make it go further for protein. Lots of coca tea and the morning, tough bread bought in bulk at the market the week before, and a delicious fresh rhubarb jam which we put on everything to make it palatable. There was also an endless amount of fresh popcorn, since corn is a staple here, which made our hut cosy and fun as we zipped up our sleeping bags and played uno by the light of a naked bulb (electricity!).

At night, the stars were endless. At 14000 feet, the milky way was prominent and stardust was strewn across the sky. The sheer number of stars was truly like the grains of sand on a beach, and though there was no moon, towering Ausangate glistened in the starlight. The only was you could tell the horizon from the heavens was by the blackness of the land against the brilliance of the sky.

Day 2: It was cold that night, and though everyone wore all their layers, it was challenging to keep warm enough to sleep. I awoke around 5:30 to hushed Quechua and the clanging of the jugs as the children brought in water from the backyard. There was silence other than this. No birds, no bugs, no water, no wind. Mountain silence. The white ranges all around us were lit pink at this time of morning, and the previously golden fields were a muted grey in deference. Like every day here it seems, it dawned dazzelingly bright and cold. Breakfast and back through the fields to round up enough horses for the group. These were small horses for the most part, a Peruvian breed with square noses and mule-like tails, made for trekking at these high altitudes. They were well-fed on the infinite grasses, but for the most part resentful of being loaded up with gear and people, and were always feisty and ornery in the mornings.

The gear was minimal. All but one had rudimentary saddles (that one had clothes tied in the shape of a saddle), but there was no bridle or bit, just ropes tied around the horses face, and the stirrups were narrow home-made cages which didnt fit our big boots. We had a mix or riders and non-riders in the group but they didnt bother matching horses to people, and within ten minutes, two of the horses took off across the field, dumping their riders in the process. Elana and I were on two sleepy white horses and, being riders, volunteered to take the wild ones. There was no walking on these horses. And the ropes were more to hold onto than to really stop them when they took off. So Elana and I and two of our friends spent the day at full gallops, faster than the wind, running over the rolling tundra and leaping small streams, through herd of wild alpaca and beneath the ever-present white peaks and mountain lakes. Since no one died, it was a blast. But it did walk that fine line much of the time. The whole day was riding, laughing, feeling like we were flying while trying to keep the horse under control, and gazing at the mountainous horizon. It was cold but sunny and the work of riding kept us warm.

The last leg we hiked, as it was too steep to ride, descending from the tundra through furry cactuses, boulders and rocks left by the glacier, and into signs of human habitation again, walls of stacked stones and occasional mud huts with little boys shepherding their sheep. This was Aguas Termales. A town of about 20 or so sprung up around the natural hotsprings there. We were so ready. Arriving at sunset, when the temperature was fast dropping from a cool 50 degrees (55+ in the sun) to the low 30s, we jumped into our swimsuits and the 100+ degree water, and watched the sun dip below the horizon, campfires light up, and the stars burst through the night sky. Ausangate stood right over us, an arresting sight, and no one could tear their eyes from the mountain.

Dinner was pasta and sauce, but we were all too tired to really eat. We stayed in another refuge this night, but it was an upgrade. We were on the second floor up a tall rickety ladder, but it had floorboards and thin mattresses which kept out the cold, and the kitchen was below us so some heat came through the floor as well. With that and our exhaustion and the lack of electricity by which to play cards, we all spent 10 minutes marveling at the shooting stars before going straight to bed.

Day 3: I slept like a baby. Up at 6am, a few friends and I scurried through the 30 degree morning, put on our damp bathing suits and spent the first daylight hours in our steaming bath watching the sun creep over the mountain range, lighting the jagged edges one by one. We were warm after this and leisurely got into our 5 layers, ate a full if not delicious breakfast, and started for home on horseback. Both horses and people were calm this morning, after expending all our energy the day before, and rode down into the countryside just enjoying the views. The last leg we walked, sometimes laughing together, sometimes lapsing into comfortable silence, back into the colorful town where we caught the bus home. Everyone slept the whole way.