MDR-TB, Tropical Medicine and Soccer Jerseys

I (Rick) just returned from a trip to the high jungle town of Quillabamba with Dr. Bill Allen, his adopted son Vladi, and one of his clinic's nurses, Jasmine. The village is only 75 miles northwest of Cusco, but it took 6 hours of driving over snow-capped mountains and then down to the edge of the Amazon jungle along the Urabamba river. Bill has been approached by senior health officials in the Cusco region and Partners in Health to help them with the growing number of patients with TB and some with multi-drug resistant TB (MDR-TB). This increase in TB and MDR-TB cases is very worrying to public health officials because it is a respiratory disease. You can catch it simply by breathing the exhaled breath of someone who has the disease next to you in the market, on a bus, in your home, etc.
The very fact that the disease is even in the Quillabamba region is something of a mystery (and scary), because TB and MDR-TB exist primarily in densely populated urban areas like Lima and prisons. The two patients we met with who are receiving treatment and are recovering from MDR-TB have probably not been beyond Cusco or even Quillabamba (pictured below).
Therefore, Bill wants to figure out how these individuals got MDR-TB and whom else might have been exposed. He also wants to find ways to more reliably diagnose patients with TB and increase the likelihood that patients will receive proper and thorough treatment. It is excruciatingly hard. Appropriate treatment for TB consists of directly observed therapy (drugs taken orally) for six months, otherwise known as DOTS. MDR-TB treatment requires injections for 6 months and then 1.5 years of follow-up drug therapy. Currently, it cannot be delivered in places like Quillabamba. Patients are supposed to come to cities like Cusco and Lima to receive treatment, but that is almost impossible and extremely impractical for people with TB, because they tend to be poor and reliant on daily labor for their existence. Traveling to Cusco, much less Lima, for 6 months for treatment takes them away from their crops, families and/or daily work on which they depend. Bill's hope is to bring state-of-the-art diagnosis and treatment to them in their remote communities in order to help them survive and to halt the spread of the disease.
The clinicians with whom we met in Quillabamba were especially appreciative of Bill's efforts to collaborate and partner with them. They said that in the past some NGOs would come to the village to provide some type of medical care, but they would do so in isolation from the existing hospital and public health services. Consequently, their lack of coordination and communication led them to seeing far fewer patients, accomplishing little and eventually leaving town altogether. Bill's ambitions are to work closely with the local medical providers and complement the great work they are already doing and the extensive knowledge they have of the area. Why reinvent the wheel?
This trip allowed me to see my first ever patients with tropical, infectious diseases like TB and malaria. As one would expect, it is very different from reading books and articles or watching documentaries about them. It is much more emotional and personal to interact with a fellow human being who is suffering from a disease like Yellow Fever (for which I am very grateful to have been vaccinated). It is especially sad and painful when they are children.
On a lighter note, Jen and I have been enjoying our soccer games at El Arca Orphanage even more recently since we got all the kids red and white soccer jerseys. It is much easier to known who is on your team and whom to pass the ball to when everyone is wearing the same colors!

p.s. - Tim kicked his way to a yellow belt in Taekwondo, so watch out evil-doers! His reward was to be able to march in a parade in the Plaza de Armas in the center of Cusco with the board he kicked in two (video of dangerous kicking below).

Adventures in Bolivia, Bud Lenz, and a Visit from Jen's Parents

(our bus broke down on our way to Bolivia, so this was Tim and Ben's chance to pick flowers)

Adventures in Bolivia

We just returned from a few days in Bolivia, where we traveled briefly to have our passports/visas re-stamped for another 183 days in Peru (the maximum a tourist can stay). The trip went relatively smoothly until we arrived at the Bolivian border. The driver of the bus stopped at the military checkpoint and began speaking about "muchas problemas." We were so distracted by getting our boys through the passport/visa stations that we we didn't focus on why these "problemas" might be important to us. We soon found out. As it happened, local Bolivian elementary teachers had recently rioted about something. Part of their rioting included blocking the only road into Bolivia with large enough rocks and tree branches that all local transportation ground to a halt. Later on someone explained to us that this kind of rioting is the most common and effective form of getting the attention of local authorities. Why? It keeps the tourists and their valuable foreign currency from entering the country. It certainly got our attention, because we had to exit the bus, get all of our luggage, and start walking the last 8 kilometers to Copacabana. We were rescued by a passing van from one of the local hotels who took pity on us with young children. He was bribing his way through each rock point trying to pick up the hotel's customers.


Copacabana is a small fishing village on the southern tip of Lake Titicaca. They boys were bound and determined to do some swimming, although the locals thought they were crazy (the water temperature is somewhere in the 50s to low 60s and nobody in the area seems to do this sort of thing). The boys look especially comical next to the local women doing their laundry in the lake!

Bud Lenz

Bud Lenz is the "father" of the 35+ orphans at La Arca orphanage where we visit and volunteer regularly and are getting to know the children. I (Rick) was supposed to travel with a pastor to the town of Porto Maldonado, in the Amazon, this week to visit Bud and help him as he is building a new facility to accommodate their growing family. Upon our return from Bolivia, we received word that the trip was canceled because Bud had a heart attack and had been flown back to Cusco! Obviously, this is a huge blow to this (extended) family and the community. Please pray for Bud (and his wife, Laura) and for their children. Here are some pictures from the orphanage:

Jen's Parents' Recent Visit

We had a great time in early February when Jen's parents visited us. They were our first visitors and it was special for us to share "our world" here in Cusco with them. Jen took them to Machu Picchu for two days in addition to our activities around here. Below are some pictures from their trip:

Parades, Fireworks, La Arca Orphanage, and TaeKwon-Do

One of the things we have noticed, both from our visit last year and our three months living here, is that (without making an over-generalization) Peruvians LOVE parades and fireworks.

It seems that whenever we go to the main square in Cusco, La Plaza de Armas, the roads are blocked off and there is a parade or protest of some sort -- either large, with lots of different groups, or just one group -- marching with drums, trumpets, and other instruments, banners, and a lot of enthusiastic participants. This is a picture of Rick, Tim, and Ben watching a parade last month.


And fireworks are not only part of these parades (we still jump out of our skin whenever they go off), but are part of everyday life here. People set off fireworks at any time of day or night. We even joined in on the fun on Christmas Eve, when I think our elderly neighbors (85+) were out before us setting some off, too.

Below are a few pictures from the orphanage we visited last month, La Arca. They have since moved from this house, pictured below, which they had outgrown, into a temporary facility much closer to us (20 minute combi ride as opposed to an hour). So we are excited by the opportunity to visit them weekly as a family and especially to get to know the children. Our boys hit it off with them and can't wait to play "futbol" and hide-and-go seek on a regular basis.


Lastly, the boys have taken up TaeKwon-Do and are enrolled in daily classes this month with a group of Peruvian children. Here is a short video clip of Tim and Ben "in action":

Barbecue Bathing, Combis, Laundry and Tim's 1st Violin Recital

Barbecue Bathing

Above is a picture of the hot water heater and propane tank in our bathroom. Any time we take a bath or shower, the flames fire up and for the first few minutes the bathroom smells like a barbecue. Another unique aspect of this type of water heating is that you never know exactly when the propane tank will run out...until the water turns REALLY cold (instantly). Thankfully we've never had shampoo in our hair at that point.

Combis
The dominant form of local transportation here in Cuzco is the "combi" (pronounced "comb-bee"). They're 10-15 passenger vans that race all around town for 60 centimos per ride, which is basically 20 US cents. You often find yourself sitting next to a farmer with his or her bundles of produce or people with their various animals. Last week we rode next to a woman who had three bags of live chickens that were clucking and moving around.

Laundry "Old School" Style

We now think twice before throwing our clothes in the "dirty clothes hamper," because we have to wash everything by hand. Below is a picture of our laundry drying in our outdoor washroom. We are really going to appreciate the luxury of a washer & dryer upon our return to the U.S. (not to mention a dishwasher, kitchen appliances, an oven that indicates the temperature, hot water in our kitchen sink, a vacuum, etc.). Though we live in an urban home, we sometimes feel like we are enjoying life in "The Little House on the Prairie." It's actually a lot of fun.

The Inaugural Performance of Timothy "Itzhak Perlman" Mayes

Tim performed in his first violin recital last night. The way the recital was organized, the older and more experienced violinists played first and then with each subsequent song more kids joined in (whomever had reached that level of playing). Tim started his lessons two months ago and is still at the one-note rhythm point. He and his cohort were to play last in the concert keeping rhythm to "Estrellitas" ("Twinkle, Twinkle, Little Star"), repeating the one musical note that they have learned. Well, Tim was so eager to get up and play that when he heard mention of this song--which was for kids who could actually play it--he jumped onto the stage. His teacher was way at the back of the group and could not see him to tell him to wait. I (Jen) frantically tried to get his attention by calling his name and waving, which he interpreted as excitement and support on my part and waved back to me. I could not get there in time to get him off the stage. Below is a 13-second video clip of his memorable performance. My apologies for the shaking of the camera; I was laughing so hard it kept moving.

Love to all of you and Feliz Navidad!

Isaiah 9:6
"For to us a child is born and to us a son is given...And He will be called 'Wonderful Counselor', 'Mighty God', 'Everlasting Father', 'Prince of Peace'."

Tim's 8th Birthday and Weekend in Pisac

We spent this past weekend in the nearby village of Pisac to celebrate Tim's 8th birthday. Here are some pictures from our trip...

Family shot over Cusco on our way out of the city.

Lupe's son, Farik, joined us on our trip. Ben and Farik at the hotel bar.
Ben's not sure what to get. Hmmm...apple juice or Sprite?

The boys at the hotel pool. Farik had never seen a pool, let alone been in one. It took him a while to build up the courage to put his feet in, but once he did, he loved it. The rest of the day he kept asking, "Podemos volver a la piscina por favor?" ("Can we please go back to the pool?").

Lunch at the hotel restaurant.

Walking into town from our hotel.

Tim and Ben in the market with Quechua women in traditional garb.

Rick and Ben looking at the Incan (Pisac) ruins.

The ruins.

Tim, Ben and Rick with Pisac in the background on our way out of town.

Back home for birthday cake and ice cream.

We'll never forget Tim's 8th birthday!

Promesa, Neighbors, Adoption Update, & Zucchini Bread

Hi Everyone! Just some random updates...

The Boys' School: Promesa

The boys are attending a bilingual, Christian school here. They love it. Ben is going 5 days a week and Tim is going for 3 (the other 2 we're home-schooling him -- come December, when the academic year ends here, they will both be home). The picture above is of them playing soccer, which they do every day. They are two of the only non-Peruvian, English speakers, so they are learning a lot of Spanish. Ben actually hasn't figured out that most people don't understand him and just talks to them in English. He has two close friends there, Reynaldo and Sofia, and the three of them play together constantly (photo below). It's really cute. Tim has learned the expression "no entiendo" ("I don't understand") and tells us he has to use it frequently. He has also explained that he never gets in trouble in class because he can't speak the language. That's good...I guess. Anyway, they are both enjoying school and making a lot of friends.

Our Neighbors:

There is a cute, older couple who live in the home across the street (or passage, as they call it here, since it's a sidewalk that separates us). They are probably in their 80's. The husband wears a three piece suit all day, and on days when the sun is out he sits on a chair outside their house or walks up and down the sidewalk. He cannot see or hear very well, so when we greet him, we need to get up very close and speak loudly. Ben blows them kisses every time we see them, which I guess translates in every language. Last week the woman dropped off some sort of fruit (???still not sure what it was) from a tree outside their house. Tim and I went to the market later that day and got them breakfast rolls and fruit for the next morning. Two days later, on Saturday, our doorbell rang at 6:30am (thankfully we're early risers!), and our neighbor was at our door with some pears in juice and some yummy bread. So, now we're in an all out "I can't understand what you're saying, but I'm going to try to give you lots of great treats and show you what a nice neighbor I am" exchange.

Adoption Update:

For those of you who are interested in an update about our adoption, we are in the final stages of having our dossier approved. This means that our agency in the States and MIMDES, the government agency here in Peru that oversees adoptions, will begin to look for a "match" for us. This can often take several months, but we feel encouraged that we're getting closer. The process has been long and tedious at times, but we trust that God has the whole thing figured out already, so we are not getting stressed about the details or timing. We talk and pray about the little girl or sibling pair that will one day be part of our family. We're all really excited.

Zucchini Bread:
Lastly, Ben and I were very proud of our first baking effort in Peru: zucchini bread. It was no small thing given that 1) the oven doesn't have a thermometer or any way to gauge the temperature; 2) when we went to the store, I didn't know the names of many of the ingredients in Spanish; 3) all measurements are different here; 4) we have no measuring cups or spoons anyway, and, 5) the high altitude totally throws baking off. Oh the adventures of living -- and baking! -- abroad.

(Tim and Ben helping Lupe clean the patio)
(Tim is learning to play the violin.)