A beach to myself

Today I took a two hour (and $3 US) trip to the nearest beach. It is called Colan (with an accent on the a but I don't know how to make that happen here). It is just north of the city of Paita. This is the second beach I've been to in Peru, and the second ghost town. Apparently Peruvians do not like beaches during their winter. I maybe saw 10 people the entire time I was in Colan and that includes the cab driver and the waiter at the restaurant where I ate lunch. The restaurant was part of a beautiful resort that I found about a 20 minute walk from where the cab dropped me off. There were palm trees, a view of the ocean, and they served cold beer. I can't really think of anything else I want out of life. I sat for a couple of hours and watched the ocean and thought very profound thoughts - none of which I can remember now. On the walk back to the taxi I saw hundreds of small red crabs scurrying along the beach. They would scurry along until I got pretty close then they would freeze at the entrance to holes in the sand. If I took one more step towards them they would completely disappear. Colan is also famous for being the site of the first Spanish church in South America. If you showed me a line up of churches and asked me which one was the first in Spanish Church in SA I would guess this one. It looks old and like they hadn't quite decided on their style yet. The dessert also ran up to the beach here but it was much more striking than south of Lima. There it was a dusty desolate dessert, here large plateaus of colored rock gave way to the ocean. As I was leaving the sun finally came out, given the choice though I'd take a cloudy Colan over a sunny San Bartolo.

Pictures from my roof

For Michelle

Two nights zero crickets...I win!

The new strategy has proven successful! You wanna know why crickets? It's cause I'm smarter than you! Ahem, sorry. Other than that I've had a pretty uneventful couple of days. I'm starting to settle into a routine and I'm working pretty hard on getting my protocol and questionnaire finished. There was a bit of a hiccup with the sampling strategy that I was going to use. Mainly the hiccup was that I didn't have one. But all is well now, I have one and it is fool proof (that is sarcasm). I've been working hard to get this case-control study off the ground and I have come to realize that it almost doesn't matter whether it actually happens or not. I mean it would obviously be better if it did but if not I'm still learning an incredible amount about everything that is involved in study design. And isn't that what this all about?

The Egyptians were tough

Last night there was a plague of crickets. I'm not joking, the locals called it "una plaga". So here's how it went down. I went to bed about midnight, happy as a clam. Then around 4 am I woke up because I heard a cricket-esque noise coming from somewhere in the very close vicinity of my face. I jumped out of bed turned on the light and proceeded to spend the next half hour killing probably 50 or so of the little a-holes. I don't know how Ramses or whoever was Pharaoh during the time of Moses wasn't like "ALRIGHT, GET OUTTA HERE!" after the locusts. I don't mind a bug here and there, especially if they are just hanging out on the ground. But I didn't sleep much after I found them in my bed. I was sort of paranoid that I would fall asleep with my mouth open and one would crawl in. I know its dumb but it's all I could think about. Finally at 6:30 I decided it was pointless to be awake and unproductive so I got up and did some work with one eye on the door for crickets (there were a lot of typos). I've devised a new plan however. You see last night I was using big cardboard boxes to block the door. It didn't really work because the crickets would just come in under the crack and go into the boxes, where they apparently waited until I was asleep so they could ambush me. Tonight I've decided to go small and I cut a piece of wood to fit the width of the door. It also happens to slide just slightly into the crack between the door and the floor. I just hope I can keep it under 15 tonight. To be continued...

Holes in the ground and respecting paths

I went on a little trip to Chiclayo yesterday. Which actually makes me three for three on little trips during weekends. It was a good time. I met up with Dan Johnston - for those of you who don't know Dan he used to live with Jeff in Boston. He's traveling from Lima to Quito, Ecuador by his lonesome. Through the magic of the intertubes we were able to meet in the Plaza de Armas in Chiclayo (there is one in every town - this one was as good if not better than the others I've seen). After a quick bite we grabbed a room in a hostel which told us they had hot water. This was a filthy lie. Then we took a minibus to the ruins of Sipan. If you read the Lonely Planet excerpt on Sipan it makes it sound pretty damn cool. Au contraire mon ami. It is holes. There are 10 or so holes dug into the ground where they are excavating funeral chambers filled with treasure (the Lord of Sipan is supposed to be S. America's answer to King Tut). Of course all that treasure went on a world tour and now rests an hour and a half away from the site of the ruins. My suggestion if you ever find yourself in Chiclayo, even though I didn't see the museum, is to opt for the museum. I will cut the ruins a little bit of slack because they were only found 20 years ago, but still it was boring. Just to prove it I've posted a few pictures of different holes. Notice how they all look basically the same. I know what you're saying and yes there is stuff in one of the holes. It is a replica - the only thing real we saw in any of the holes was a bottle cap someone had dropped. Thus ends my complaining about Sipan. Also yesterday I finally tried a Peruvian beer, actually two Peruvian beers, neither was amazing to be honest but I liked Cristal slightly better than Pilsen Callao. Add in a cow, field after field of sugar cane, a second go round of chifa (this time better than the first) and Dan making fun of the "Respect the Path" signs at Sipan and I had myself a pretty good time in Chiclayo.

Chulucanas

Today I arrived in Chulucanas after a 14 hour bus ride to Piura and several hours shopping for a bed that I have to take back tomorrow. I'm going to go out on a limb and say that this is a bit different than Lima. First and foremost there is a lot more green. There still isn't grass, which confuses me a bit, but there are trees and bushes. The main street of Chulucanas is lined with them and it is a welcome site after the dull gray of the capital city. The house that IIN is renting is being renovated at the moment. Everything seems sort of temporary. Including the PVC piping in the shower (with no curtain) and the van seats that serve as a couch. I haven't seen any mosquitoes yet but I'm wearing insect repellent anyway, I'm not sure I'll be used to that smell even after 2 1/2 months. Tomorrow I am going to see a bit of the field work that the doctor from IIN is doing and possibly meeting with some Ministry of Health folks to see their data. It will be nice to get started on something that I know I am going to be doing for the next couple of months.

I told Claudio today that I wanted to go to Piura, and tomorrow I'm going to Piura. Well actually Chulucanas. I have to go buy bus tickets tonight and find some insect repellent so that I don't get bitten by mosquitoes. I'm not sure I expected things to be set in motion so quickly. Apparently there is a lot of descriptive data that I can summarize as well as do a behavioral case-control study investigating risk factors. It sounds pretty interesting and I am excited but nervous, regardless I'm off. The next time I write to you I will be in Chulucanas.

Jeff Sachs is right

It has been a couple of days since I last wrote anything here. The internet situation at the apartment I'm staying at has been, well, less than ideal. With any luck that will all be resolved by tomorrow or Monday. In the meantime, I have learned a bit more about my possible projects and spent an hour in what is quite possibly the busiest clothing district in the entire universe. First things first, the projects. I spent a day in Canto Grande (a slum or pueblo joven, young town, as they call it here) on Thursday. I have seen poor neighborhoods of Flint and Detroit, I've even been through parts of Mexico City that were very poor. I have never, ever, seen poverty like this. The lower parts of Canto Grande are very poor almost none of the houses have heat, the streets are filled with stray dogs and garbage, and many buildings have plywood in place of windows. The people who live here are well-to-do, however, compared to those who live higher up. Most houses are one room and if they are lucky there is a sheet to separate the bedroom from the kitchen. Several homes don't have roofs. Often there is no flat place to build so they burn rocks in order to break them apart and build foundations. Every once and a while an extremely ill looking rooster will walk buy looking for garbage. There are not even roads that reach these houses but rather a slightly worn path of rocks that are safe (or so I'm told) to climb on. A hose that must be as old as I am is the only source of water. It seems impossible to live like this and I am impressed by the warmth of the families that accept a stranger into their home while a nurse checks on their infant. It is absolutely a moral failing of every person alive (including yours truly) that this type of poverty has not been eliminated. The field staff at the clinic in Canto Grande is amazing, they are bright and energetic and I would love to work with them. They proposed, and I then developed, an idea to do a survey of the prevalence of over the counter antibiotic use to treat common colds. This is bad for public health because often it's a virus that causes their symptoms or they don't finish their dose and that leads to resistant bacteria. I think I'm still leaning toward the Dengue investigation but there are some aspects of this study that are pulling me in the Canto Grande direction. I have to decide by Monday and you all know me, I'll leave it until the last possible minute.

Time to make a decision

Okay, I met with Claudio and it is down to these two options:

1. Go to Piura (on the north coast) and do outbreak investigation on Dengue fever. It is a hot topic right now, especially in international health. I would be helping to define the epidemiology of this outbreak. I can look at whatever I want: diagnostic sensitivity, gender differences, cost effectiveness of control measures, etc. It will be a lot of independent work and could result in publication.

2. Stay in Lima and add a small study of my interest and design into a vaccine trial run in the Canto Grande clinic. I can look at pretty much anything I want to as long as it isn't too complicated. It is more structured and could also result in publication (best case scenario).

Feel free to give opinions, suggestions etc...

Tomorrow is the big day

Kirk and I met with an organization today called Salud Sin Limites (Health Unlimited). They focus a lot on human rights and health care. It was a great meeting and they seem like a really great group. If everything falls through with IIN I may try to work with them. Speaking of IIN I am meeting with Claudio tomorrow. I saw him briefly today and he seemed excited that I was there, I guess that is a good sign. Sometime tomorrow afternoon I should know where I'm going and what I'm working on (I'm not getting my hopes up though). Today I found my favorite part of Lima so far, Barranco. The architecture is colonial and the mood relaxed. There is a great view of the ocean and no one is in a hurry. It made me realize why Lima didn't feel Latin American to me. You see, throughout Latin America no one is ever on time. A student from Mexico City once told me that in Latin America "no respetamos la hora" (we don't respect time). That sentiment is not present in Lima, everyone is in a hurry. During rush hour (7am-9 am and 6 pm-9 pm) there is constantly a horn blaring. But Barranco is "chillin out max and relaxin' all cool" to quote one of the great poets of our time. That's right I am talking about the Fresh Prince of Belair and with only a slight exaggeration.

I remember why I don't excercise

Yesterday pretty much all I did was go for a 2 mile run in the morning. Well, it was more like a 4 mile run because I got sort of lost. I wasn't really lost but I thought I was, so I backtracked. Today my legs were sore so what did I decide to do? Play racquetball for 3 hours. I'm sore now, and I can't imagine how sore I'll be tomorrow. But I met a dentist named Alfredo and 3 other guys named Diego, Javier and Rafael. They were all very nice and we played at Alfredo's parents house, who happen to have one of only 2 racquetball courts in Lima. Alfredo is very animated and after every point he shouts "VAMOS" regardless of who won it. Oh and I bought a blanket today for 45 soles. At least I thought it was a blanket after I opened it I realized it was a mattress pad. I may keep it and use it as a blanket anyway. The end, I'm going to bed.

Is it bad if I only go to church as a tourist?

Yesterday I was a tourist. I went to La Plaza de Armas - the main square - of Lima and took a bunch of pictures and looked at a couple of churches. I saw a catacomb which is something I had never seen before and, honestly, is about as exciting as you would expect. I also got to see the changing of the guard in front of the Presidential Palace which was nice. I have never understood why armies danced and played instruments though. But I digress, on the way to central Lima I met a taxi driver named Charlie (aka Carlos). He introduced me to music sung in Quechua (Joseycha y la Banda Danelin Danelin) and told me that his favorite movies are XXX and anything with Will Smith. When I got back to the apartment a friend and former student of Kirk's had arrived and we left for the beach. We got on a bus which was more like a van with a few extra seats and 3 soles ($1) later were on our way. The bus ride was pleasant enough. It wasn't too crowded or too hot. We went 50-some kilometers (30 miles) south of Lima and it took us about an hour and a half to get there. The landscape there was incredibly desolate. There wasn't zero vegetation, but almost. There were many towns that are built right into the sides of massive sand dunes and the desert ran right up to the ocean. At one point we saw a sign on the side of the road for Country Club El Bosque (the forest) and past the wall there was nothing but piles of sand. San Bartolo was a tiny beach town that was clearly built on tourism. It reminded me a lot of a town like Macinaw City (only much smaller and, you know, Peruvian) and we were here in the winter. It was practically a ghost town. And what, of course, was the first thing we saw when we got off the bus? You guessed it, a skate-board park. I'm serious, these are the types of things I see every day. Anyway the beach was nice. We had it pretty much to ourselves and it was sunny and about 70 degrees. I put my feet in to test the water and it was quite cold. Right as I was saying "Wow that's cold I'm not going to go in" a huge wave crashed down and soaked me up to my knees. It wasn't the end of the world though I put my feet up to let them dry and watched the surfers pick waves and the Peruvian Boobies (its a bird, get your mind out of the gutter) dive for food. All in all this wasn't a bad way to spend a Saturday.

Raw fish and sunshine

I met with the director of the institute today. She described two studies on which I could work. The first would involve considerable travel but the topic isn't really very interesting to me. The second is in Lima, or rather Canto Grande, a slum just outside of Lima. It investigates the use of fortified milk to prevent anemia in infants. The topic is more interesting and the study may prove to be a bit controversial (it directly contradicts the "breast is best" folks). The controversy doesn't bother me, in fact I think it may be a positive. On Monday or sometime early next week I should be meeting with Claudio who is much more involved with infectious diseases. Other good news to report: the sun came out today. It had been cloudy since I got here. When it is cloudy in Lima everything is gray, so it was nice to see a blue sky today. There is a small park where people take dogs to do their business (the dogs, not the people) just outside the apartment so I went there and read some which was nice. Oh, I almost forgot. I ate ceviche today. Ceviche is the national dish of Peru and consists of raw fish, onions, aji (spicy small red peppers), corn and lime juice. I felt a bit weird eating raw fish that was not wrapped in seaweed and rice but I really enjoyed it. It has an incredible amount of flavor, I think I'll even eat it again. For those of you coming to visit if you don't want raw fish but want ceviche you can get the vegetarian and/or mango versions. Good food and a bit of sweet sunshine, I'm starting to feel spoiled by this city.

Don't judge a book by its cover

Okay, okay. I'll admit it. I didn't like Lima all that much when I first got here. It sort of felt like people were trying to show me how much the city was like the US. At first it bothered me, I just wanted it to be like a Peruvian city. I mean come on I've been here for two days and been inside an equal number of malls (and boy do I love malls). But then, through talking to some faculty from a med school here I began to realize something. One of the really great things about Lima is that it takes little parts of other cultures and makes them its own. Take chifa for example. It is the Peruvian take on Chinese food, and they are very proud of it. A woman today told me that I had to try it because that stuff we call Chinese food in Los Estados Unidos is "atrocious". Chifa she said, is like no other food in the world. And so I will try it just as I tried a drink made of purple corn this afternoon. I read online that Peruvians are also obsessed with Japanese culture and food. So much so that they once elected a president of Japanese descent (Alberto Fujimori). I took a little walk by myself tonight and tried to appreciate Lima for what it is: a melting pot of cultures with Peruvian flavor. I'm coming around, I still don't think it will ever be my favorite city in the world but I also think I'll be able to enjoy it a bit. Some other exciting news is that next week I will be traveling to Chocos, a village about 200 miles south of Peru that was practically destroyed by an earthquake last year. Roche Pharmaceuticals has a project there to help build earthquake resistant homes and a dam to collect rain water. I still don't know what study I'll be working on with the instituto and Kirk says if things fall through I may be able to get involved with this one. It is a good thing I don't need to have a plan, I think I would go insane.

But I am le tired...

I arrived in Lima last night at 2 am local time. On the plane I met a couple of guys that are going to ride across Peru on horseback. Frank must have been 70 and I'm pretty sure he was wasted. He kept calling me Bryan and told me I looked like a character actor from the original 12 Angry Men except, you know, much younger (he bought me a beer so I didn't mind). His friend was 27 and told me he had to beg Frank to bring a sleeping bag. We talked about traveling (Frank talked about drinking). Luckily the plane was practically empty so I got to stretch out a bit. The ride back from the airport was pretty uneventful. Lima looks a lot like a big city. There is a bit more contrast here though; I saw a lot of brand new buildings next to ones that have been abandoned. The city is huge, it's sprawling. Kirk's apartment is in a great neighborhood. The architecture is a mixture of classic and modern and the effect is actually quite stunning. It is a small apartment but very nice. We went to the office today and I had trouble focusing on anything because of the exhaustion. I should be meeting with the director tomorrow and should know what I'll be doing by Monday. Well I should know which study I'm working on by then, I may never know what I'm doing.

6 1/2 Hour lay over = boring

Its 6:24 pm on Tuesday, June 3rd and I'm sitting in the Fort Lauderdale airport. I've been here for over three hours so far, and I've got another three to go. I know some of you are thinking "That doesn't sound so bad." Don't take this the wrong way, but you're insane. Let me paint you a picture. There are people. Tons of people, many of them are angry because they are on their way home from vacation. There are crying babies, there are loud announcements every 17 seconds, there is one restaurant. I can't leave this concourse due to FAA regulations. It could be worse, could be raining (cue thunder). On the upside there is free internet. And in 8 hours I'll be in Lima. I still have no real idea what I'll be doing or where I'll be doing it but hopefully I'll be going to the office this week to figure that out. In the meantime I think I'll eat a hamburger that has been sitting under a heat lamp for at least an hour. Oh, I love airports.

p.s. What is the over/under on seasons before the new Pistons coach gets fired?