The meandering interviewer

For the last three days I have been going out to do interviews. Wait. It is more accurate to say that I have been going out to try to do interviews. There hasn't been an avalanche of information, if you get my drift. 3 days 5 interviews. To be honest it is about what I expected. Data collection is a slow, difficult process. Out of the 172 cases that I have (identified by the Ministry of Health) 51 had addresses. Those 51 don't always have complete addresses of course. Several are a street with just the block number. Others list there address as A.H. Vate Manrique. Luckily A.H. Vate Manrique is on my map. Unluckily it seems to indicate an entire neighborhood of the city. I have been told that it stands for Asociacion Humano - I won't insult your intelligence this time, I'm pretty sure you can figure out the translation. I can only guess how many people are a part of this association. Also sometimes people put down an address that doesn't exist. Or they put down the address of someplace where people don't live (my favorites so far: medical center and apostolic church). I don't think this is any more difficult than tracking down migrant farm workers in Traverse City, but at least then I didn't have to walk everywhere. Today my dogs were barking pretty bad so I thought it would be a good idea to sit down, put my feet up, and catch up on some paperwork. I went into this park and sat on a bench. I was immediately surrounded by 10 kids. They were all boys with ages ranging from 5-12. They were completely fascinated by me and stayed even if I wasn't talking to them. After talking to the boys for a minute about 10 more girls showed up. They didn't stay long as I think they were bored with me. All of the kids wanted to show me how they could count to 5 in English. Which they did over, and over, and over. One kid, the oldest but quieter than the rest, asked me if I was a missionary. He seemed almost nervous when he asked. After almost laughing out loud I assured him that I was not, in fact, a missionary. When I told them I was asking questions about Dengue half of them said that they had it before. I don't know this for a fact, but I have a pretty good feeling that the number of reported Dengue cases is hugely different from the number of actual cases. It would be interesting to go around and ask every person in Chulucanas if they had experienced symptoms of Dengue Fever this year and then take a blood sample to check for recent infection, just to see if the Ministry's data is anywhere near accurate. My guess is that it wouldn't even be close. But that's life and I have to worry about the problem at hand. Like how to find people when they don't give their address.

All work and no play makes Ryan something something

There is something to be said for being a tourist. I know, I know its better to be immersed in the culture and you can't really do that with a fanny pack and a camera. You stick out, and people treat you like a tourist. But, on the other hand, there is almost always hot water and good food. For the last 10 days I traveled around the country with friends and family and we were all gringos. I have to tell you, for the most part I really enjoyed it. Cab drivers took us for all we were worth and sometimes they tried to kill us (or our luggage). But other than that I had a really good time. Honestly, I've never had so many scary cab rides in my life. There was the guy driving 100+ km/hr in the mountains, playing chicken with tour buses and passing on blind curves. There was the tiny Daewoo hatchback that tried to pile all of our luggage on the roof only to have one bag slide off and another nearly take of the passenger side mirror about halfway through the trip. There was also the guy in a car that looked and sounded like it was held together by duct tape who coasted into the gas station on fumes and then pulled into oncoming traffic to try to make a left turn. But all that was good fun. Machu Picchu is breathtaking, indescribable, too impressive for words. Cusco is exciting, has a great night life and an amazing history. Lima is still overcast and dreary, but does have one of the most unique malls I've ever seen (on the ocean, and yes there was a Hooters there). The sand dunes and oasis at Ica were beautiful and the wine and pisco were delicious. In short I had a great time - probably due to the company as much as anything. I'll try to put some pictures up sometime soon. I took way too many to put on here. I'm back in Chulucanas with some good news. My study has been approved. I'm not sure when I'll start data collection, probably on Monday or early next week. I think it will be sort of tough (read: impossible) to finish up 300 interviews in 2 weeks or so, but that is life. I'll get as many as I can. Also I'm coming home a few days early so that is good. I'm ready to come home. I'm sure the last few weeks will fly by and I'll miss it and wish I'd had more time but right now I just want to be back in the states.

Back on track

What a difference 36 hours can make. Earlier this week and late last week I was frustrated and defeated. I didn't know what to do next and I was ready to come home. After talking to Claudio - el Jefe - I feel not only like I have something to do, but also slightly overwhelmed. Which is ok. I'd rather feel like I'm never going to get everything done than feel like I have nothing to do. So far on my list is to compare data from the Dengue outbreak this year to data from previous years, do hypothesis generating interviews, and learn how to enter data in EpiInfo (analysis software). On top of that there are some presentations that I may be doing in August, reporting the trends that I have found etc. AND Claudio said he was going to push the ethics committee to approve the case control study so that I could collect some data before I left. Sort of a pilot study. All of that and I really have maybe 3 1/2 weeks left of work time. Crazy.

El turismo es el desarollo. Protegemos las turistas.

The title of this post is a sign painted on a wall as you enter Chulucanas. Translation: Tourism is development. We protect tourists. I'm not sure if this is there to tell the people of Chulucanas to stop harassing tourists or to make tourists feel safer. Either way I played tourist yesterday. I went back to La Encantada (and of course bought even more ceramics). Then went to Piura and on to a small town called Catacaos. This time I wasn't traveling alone though. I went with Teresa (the doctor here) and Hector (the data manager). We ate lunch in Catacaos at this nice little restaurant that had a band playing. They were playing criolla (creole) music which comes from the Peruvian sierra and is their take on country music I think. All the songs are about lost love etc. The singer at our restaurant looked like he was about to cry every time he sang. While there we also tried Chicha de Joro which is a fermented drink made from corn. Apparently there are different types. I had clarito and it was surprisingly sweet. It looked sort of like beer but tasted nothing like it. It was good in any event and the criolla music and setting of the restaurant were relaxing. After lunch we went to see some ruins. Narihuala which means town of god is just a short mototaxi ride from Catacaos. The ruins are not huge but they are impressive. In Sipan the interesting part was the treasure found inside, but here there was enough of a structure that you could tell what you were looking at. A young boy named Julio acted as our guide and he loved to tell us about the human sacrifices that took place in a large courtyard in the center of the ruins. Apparently prior inhabitants of Narihuala sacrificed their first born son. If they did not have a son, they instead sacrificed a dog. Not just any dog mind you, a strange dog that doesn't have any hair. After the ruins we went to an artisan market in Catacaos. They are famous for their woodworking and there was a lot of pretty interesting stuff (along with some pretty cheesy stuff). A stop at the cathedrals in Catacaos and Piura and my day of tourism was done. Now I'm back in Chulucanas still waiting to find out what I'll be doing with the rest of my summer.

Note to self: always get a deadline

Today has been a bit of a roller coaster. I put the finishing touches on my protocol Monday and sent it to Kirk, Claudio, Juan Carlos (the epidemiologist here in Chulucanas) and a few others. Yesterday Kirk responded and told me that it looked good, that there was just one minor change he would make. After having some native Spanish speakers correct my grammar I thought I was done with it. This morning I woke up hoping to find an email from Claudio with comments or next steps. I also sent it to a woman named Ana who had been helping me with the consent forms. She is a member of the ethics committee at IIN so I asked her what the procedure was for getting approval, and when the deadline was. She informed me that the IRB was meeting tomorrow and I needed to write a letter presenting my study and send it to the president. Okay, that is fine. I was a bit stressed because I got her email at 3 pm and needed to submit the protocol with a letter I hadn't written by 5. Done. Finished the letter, submitted a protocol, and bought a new toothbrush by 4:05. Then I get an email. Ryan, blah blah blah must be submitted by the last day of the previous month blah blah fuck yourself. All this is fine. I understand why that rule is there. What I'm not sure I understand is why no one told me it was due on the last day of the previous month. Even though I only started writing it on June 20 I may have been able to finish it by the 30. At least I could have submitted something. I even sent someone an email on June 30 asking when the deadline was. Alas, no response and so I worked for the next ten days on something that has no hope of being approved. Awesome. At least there is a lesson in all of this. Know your deadline. I'm pretty sure I'll never make that mistake again. Glad I learned it the hard way, it makes it easier to remember. I would like a drink now...

I should note that I am being sort of dramatic here. There is still a slim chance that there is another way to get approval, especially since the study isn't all that detailed. The email mentioned above ended with a "We'll see what we can do". I'm not holding my breath though.

Happy belated birthday USA

Its strange to be outside the US on the 4th. To be honest I have only done it a couple of times. Once was in Mexico where I was with 65 other Estados Unidenses or Nortenos (the Spanish term for what we mistakenly call Americans - South Americans are also Americans) so that doesn't really count. On the one hand the 4th can be a bit overwhelming. Take, for example, any fireworks display. You have to sit in traffic for an hour, wrestle an old lady and her grandkids to get a good spot, then sit in traffic for the rest of the night. I didn't miss that this year, for me the 4th was just a Friday. On the other hand I probably would have chopped off the first hand to go to a barbecue on a lake somewhere. Anyway, back to Peru. I finally had the opportunity to go to La Encantada which is world renowned for its ceramics. Okay maybe only Peru renowned but you get the point. Anyway they've been making pottery and ceramics here the exact same way since the days of the Vicus and Tallan cultures. The owner of Ceramica Ynga is Aurelio Inga, the best ceramista in La Encantada. Side note: I think he is related to the guy who started the resurgence of this type of ceramics - Max Inga. Side note part deux: Aurelio, coincidentally, had dengue about a month ago - he said it was "really ugly". He showed me the oven where he bakes the ceramics and colors them with mango leaf smoke and shaped some palomas (pigeons) while I watched. Then I wanted to buy everything in the store. Instead I spent around $20 and have an entire box full of stuff that I have no idea how I will get home.
Here is a picture of Aurelio:


and his ceramics:


I'm still working on my study protocol. I'm really beginning to think that I won't get any data collected before I leave. Maybe I can get started with a couple of interviews. I don't know everything takes a while here and even if I finish it up early this week I'll be hard pressed to start doing any data collection before I leave for 10 days to go to Cusco and Machu Picchu. I guess I'll just have to cross that bridge when I come to it. Peace out.

One month down

I've been here for exactly 4 weeks now. I don't feel like its flown by, but it certainly hasn't gone slowly either - especially not the last 2 weeks. I don't really have much new to report on the work front. I'm still working on a questionnaire (the second draft was a big improvement over the first I think) and the protocol. I sent a copy of the protocol to the epidemiologist here so that he could review it over the weekend. The first thing he said today when I saw him was "It's pretty hard to write in Spanish, no". That is not a good sign. He then asked me how long I've been speaking it and if I've ever written in Spanish. I don't think he did it to be mean, but it was pretty clear that my scientific Spanish writing is quite a bit rusty. Luckily he said he would send me an email with the corrections he thought I needed to make. It is a good thing too because Claudio went to France for a vaccine trial conference and is out of email contact. There are other things on the list too - like writing a consent form. Hopefully I can get close to finished with some things before he gets back and everything will be ready to go. There is still an outside chance that I'll be headed to Cajamarca this weekend but I wouldn't bet the farm on it. If not maybe I'll go over to La Encantada and watch some ceramic making just to get out of the house a bit. All work and no play makes Jack a dull boy...