Our Medical Elective in Quisuar, Peru

In August 2018, Leeds medics Rachel, Alice, Heather and Katie spent their medical elective period at the LED Health Post in Quisuar, in Peru’s Cordillera Blanca. During their four weeks they also ran mobile clinics in surrounding villages, delivering school supplies en route. Here’s their report.

Elective Report

Over the summer of 2018 we as four 4th year medical students spent our medical elective period at the health post in Quishuar, a remote village situated in the Cordillera Blanca mountain region of Peru. The team consisted of ourselves, Tula a permanent nurse at the post and Juan, an interpreter and guide. The health post aims to provide basic healthcare to the 75 families of Quishuar and sometimes to surrounding villages at a reasonable cost of 5 soles per consultation. We aimed to contribute to the running of the health post, promote health education and also teach English to the local children.

Fundraising

Before departing for Quishuar, we raised funds to allow us to purchase some resources to contribute as well as donate to the charity that is responsible for building and supporting the sustainability of the post, Light Education Development (LED). LED aims to provide sustainable solar lighting, basic education and fundamental healthcare to remote communities in the developing world. We were inspired to start this following the walk to Dufton Pike in May 2018 where we met many of the people involved with the charity. We thoroughly enjoyed the day and saw first hand the commitment to the cause from so many people which was inspiring.

What makes Quishuar unique?

We found the Quishuar population had an inflated view of medical management, almost always preferring tablets over conservative or surgical management. We thought this may be due to a combination of lack of education surrounding common health problems and accessibility to alternative means of treatment, being so far away from a hospital (12 hours by car and significant expense) or other supportive services.

In terms of clinical practice, there were several differences to note that became apparent whilst working alongside Tula. This was most obvious with regards to the management of infections; we would often think that antibiotics were unnecessary, but it seemed the norm to readily give out antibiotics even when there was little evidence of infection. This was difficult to negotiate at times due to differing opinions as to what the problem was as well as the language barrier. Our antibiotic stewardship awareness is evident as we were much more cautious, however this may be less appropriate within a community where antibiotics are not so readily available and therefore resistance is far less likely.

Furthermore, there was an issue with non-returning for follow-up. It was unclear as to the main reasons for this, but we found that the knowledge that people are unlikely to return resulted in a change in our management, often distributing more medications at once and giving more long-term explanations of advice in order to pre-empt this problem.

Common presentations

One of the main problems was chronic dehydration, commonly manifesting as headaches and in many women, “urinary tract infection” symptoms. When asked, most people reported drinking only a glass or two of water a day and there was little understanding of the relationship between poor hydration and kidney problems/headaches. We tried to make the most of this situation, taking the time to explain this to patients during consultations. The language barrier made this challenging at times, with the level of patient understanding difficult to gauge but we got into a habit of asking every patient about drinking habits and advising them to drink 2L of water per day.

Giardia and worms were the two most common gastrointestinal presentations seen; often entire families came in with the same symptoms. We had a low threshold for treating these conditions as we had been advised they were common and recurrent, and quickly treated with a short course of medication. Hand hygiene was an important topic to raise here, as most people worked in agriculture and kept animals in and around the house, a major source of these infections.

A condition that we found particularly shocking was “pterygium” an ocular condition caused by sun damage. Therefore, one of our main education drives was sun protection; encouraging people to wear their hats low over their face and to purchase sunglasses if they could. A recommendation for future groups would be to collect sunglasses and provide them to the community to provide protection to as many people as possible.

Additionally, we saw several people with permanently scarred corneas as a result of untreated corneal ulcers. A case that was particularly upsetting was a young man who presented with a frank cornel scar, hoping for his longstanding blindness to be cured. His expectations were so far removed from what was possible making it a difficult conversation to have, especially as he was insistent on receiving medications to cure his condition. The frustration was only heightened due to the preventability of his condition. Whilst a corneal transplant was discussed (the only curative treatment here), it would never be possible for this patient to explore the options due to his financial position which was difficult to accept having only experienced the free services offered by the NHS in the UK.

Education

During our time, we had the opportunity to teach local children English in our afternoons. These sessions were well attended and we worked through different themes such as: weather, food and sports. The children were enthusiastic to learn and a joy to teach. Some would travel from neighbouring villages and all would work hard – even after a full day at their schools! On our last day we organised a mini-Olympics which was well received and got every child equally involved as they practiced their English through team sports. All the work that the children completed was handed out to them with a certificate, which we hope will keep them motivated to continue to work hard. We also taught about health education, the key topics being sanitation, signs of infection and when a doctor is required. We believe that this along with the water advice is invaluable to the community and it was great to take the opportunity to organise this. Another session we managed to organise was sex education with 20 attendees, aged between 14-17. This session was held with the help of Juan and lots of questions were asked at the end, demonstrating the engagement and interest in the topic. We hope there is scope for it to become a yearly event to help tackle high rates of teenage pregnancy and STIs. Our

Reflections

We can safely say that this was a unique and unforgettable experience on so many levels; both from a medical and personal perspective. From our dancing welcome party to our first taste of guinea pig we had so many new experiences in such a different environment and we all felt that we improved our medical skills as well as our Spanish speaking skills. The health post is evidently a very highly regarded epicentre in the village that contributes not only medically but also socially to the people of Quishuar.

A few highlights

2018LeedsMedicsElectiveReport12018LeedsMedicsElectiveReport22018LeedsMedicsElectiveReport32018LeedsMedicsElectiveReport4

Interested in volunteering with us in Peru or Nepal? Use the Contact LED form on www.lighteducationdevelopment.org or message us on facebook.com/LEDCharity to find out about opportunities in 2019.

Over £6,000 raised at this year’s LED Fundraising Weekend

Our Dufton Pike and High Cup Nick fundraising weekend raised well over £6,000, which will be a huge help to LED’s projects in Nepal and Peru, purchasing and distributing new solar lights as well as helping our health centres and local schools.

Thank you to all who supported and/ or came along for a great weekend on 12/13 May and an amazing fundraising effort. We were blessed with great weather and a brilliant time was had by all on the hike over Dufton Pike and High Cup Nick, and at the evening festivities.

Special thanks go to Liam and Sue at www.fellsidecottages.uk in Dufton for hosting the event and all of their organisational support, and wonderful puddings after dinner!

Also a huge shout out for the food and drink in the evening, provided by Helen and Mark Hunt, Denise Brown and the trustees of LED. Jan at the Wakemans House Cafe in Ripon made some excellent scones which we all enjoyed after the walk, and Reunion Ales from Twickenham, West London provided some exceptional ale for the evening.

Thanks again from Val and the LED team for the support through sponsorship, buying raffle tickets, lending organisational help, coming along and making the event so special.

For updates on our projects, fundraising, treks and other activities, follow LED on Facebook/LEDCharity and Twitter/LEDCharity.

Donations always welcome via our LED JustGiving page.

 

LED Nepal 2018 Report by Ross Gillespie

Leeds University medical student Ross Gillespie has recently returned from spending a month in Nepal, during which he distributed over 40 of LED’s solar powered lights, carried out eye tests and prescribed more than 50 pairs of reading glasses (kindly donated by Dave and Pat Booth) and conducted research interviews with healthcare workers about the primary healthcare system in the rural areas.

Here’s what he has to say about the experience….

Having worked with LED before in the Cordillera Blanca mountains of Peru, I was fortunate to have a second opportunity to work with the organisation, this time heading to the Himalayan foothills of Nepal in April. A combined project (alongside some research with University of Leeds) was the perfect chance to explore some of the more remote villages of the Dolakha region, north east of Kathmandu, as well as trekking through the stunning Gaurishankar Conservation Area.

Myself, Jenny (friend at University), Nima (guide) and Budi (porter) headed to the mountains on a 10 hour bus journey – public buses only for this route which is an experience worth having – and arrived in Singati, raring to go. After storing some extra kit with Nima’s family, we began our trek in the afternoon at Chyotchyot, with a solid two hours of uphill steps, to lead us to Simigaun. From here (approx. 2000masl), we ascended through Dongang, Beding, and Na, along the ‘Classic Rolwaling Valley’ trek through forests, fields and surrounded by brightly coloured flora. Accommodation consisted of small but comfortable guest houses, all hosted by the welcoming locals. The highlight of this first trek would have to be the day-visit to Tsho-rolpa lake and beyond (to approx. 5000masl) and after a little more exploring for another day we headed back down the trail. (In October season there is a pass that can be reached to complete a circuit but this is snowed over in April/May).

IMG_0795

With some extra time on our hands before Jenny moved on to her next destination, we explore more of the spectacular region – and although mostly dry, the heat (up to 30 degrees Celsius) made uphill stretches particularly challenging at times. Another highlight was visiting the women’s monastery in Bigu (great place to stop for your first hot shower in a fortnight) followed by the Hindu temple in Kallnchowk – both with far reaching views of snow peaks and rolling mountain valleys.

After two weeks of dedicated trekking, the real work began. Jenny left for Burma and Nima and I touched base at his parent’s house to draw up a plan. We spent 4-5 days distributing over 40 solar powered lights and prescribing more than 50 pairs of reading glasses (kindly donated by Dave and Pat Booth), in and around the Khare region. I also took the opportunity to teach some English in the local school. Following this, Nima and I took to the trails, walking from village to village to conduct interviews with healthcare workers about the primary healthcare system in the rural areas. Locals were very receptive to our work and appreciated the contribution made by our efforts. Whilst mobile, we did further eye tests though eventually ran out of glasses as we could only carry a limited supply. Whilst unfortunate, it means there is still much to be done.

Another two weeks passed in total before Nima and I headed back to Kathmandu. In addition to the trekking I managed to visit Pokhara, a fantastic tourist town with great food, some western comforts and a great mix of locals and travellers (especially at Busy Bee on a Friday/Saturday night). I also spent three days in Chitwan in and around the national park. At a muggy 38 degrees Celsius it’s a very different climate to the crisp mountain air, but there is lots to see and do. In particular I would recommend staying near Sauraha, and in low-season you can get great deals on Jungle safari tours, motorbike hire, and more.

All in all this was a fantastic trip with a great balance of charitable work, difficult trekking and touristy bits in between. As my first time in Nepal, I have thoroughly enjoyed my time spent here and will look forward to my next trip to the region. I would like to thank Val Pitkethly for organising and coordinating the trip, to Pat and Dave booth for their advice with prescribing reading glasses, to Nima for his hospitality and commitment as a guide, as well as Jenny, Samay and all the other travellers who made this a memorable experience. Finally, thanks to the kind people of Nepal – their kind, easy-going and positive attitude makes you feel very much included and welcome in this incredible country.

Namaste.

Ross Gillespie
Medical Student at University of Leeds

Photos from Ross of the two weeks he spent in Khare are available in this LED Facebook album.

Interested in volunteering with us in Peru or Nepal? Use the Contact LED form on the website (www.lighteducationdevelopment.org), or message us on facebook.com/LEDCharity, to find out about opportunities this year and next.

Quisuar Health Post Report – August 2017

Leeds University medical students Ella and Laura spent August at the LED health post in Quisuar, high in the Cordillera Blanca of Peru. Here’s what Laura has to say about the experience….

Quisuar Health Post

Our adventure starting by driving through the Llanganuco pass and trekking for two days to arrive in Quisuar. This was to be our base for the next few weeks. We were centred at the health post which has now been running for twelve years. The aim of the project is to provide healthcare and education to a less privileged and remote village in the Andes. In the mornings we ran the clinic seeing villagers with common problems, for example, worms, gastritis and back pain. In the afternoons we would teach English to the children.

Leeds medics, Ella and Laura, with the children, on their last day of English lessons in Quisuar

Ella and I, with the children, on their last day of English lessons in Quisuar

Skills and Attributes developed

There is no doubt that my confidence as a clinician has improved throughout this experience. Our previous exposure to patients in England has often been just observing and it is usually hard to get the opportunity to utilize what we have learnt. I was surprised at how much knowledge we had gained throughout medical school and how we were able to adapt these to the environment. One of the biggest daily challenges was communication. I had tried to learn Spanish before and during my trip. The problem however was that many of the villagers could not speak Spanish, but Quechua. As we learnt this is an impossible language to pick up in a few weeks. The consultations where therefore a lot less straight forward than we had witnessed in England. It was an invaluable experience, as we had to think outside the box in terms of communication. For example, many of the villagers could not read, so when testing eyes we had to point at pictures and things in the room instead.

Once the diagnosis had been figured out, then it was on to treatments. In England often patients leave with multiple medications, however, these were not available and this is not sustainable. Therefore, we had to think of ways to help which did not involve medication. For example, physiotherapy movements for pain and massaging using hot water and oils. It was often down to our judgement and an educated guess.

This experience has also broadened my cultural understanding. Peruvians are very superstitious and believe highly in non-medical treatments for diseases. They explained how they had cured asthma by placing the skin of a particular animal on their skin. It often effected compliance with the advice and medication we had provided, which with potentially life-threatening illnesses like asthma, can be very dangerous.

Benefitting the Wider Community

The project impacted the local community by increasing their understanding of certain illnesses and the importance of hygiene. We worked alongside a Peruvian Nurse Tula. We taught her how to conduct a Muscoskeletal examination of different joints and a thorough examination of the heart and lungs. We also taught her about different illness, for example the different types of diabetes and how you diagnose it. These are skills she can continue once we have left.

Ella and I (Laura) with our guide (Juan) and the nurse (Tula)

Ella and I with our guide (Juan) and the nurse (Tula), at the Quisuar Health Post

In conclusion, I loved my time in Quisuar, being fully immersed in Peruvian culture, without Wi-Fi and bucket washing for a few weeks. It was an experience I would love to relieve, I would recommend it to anybody that asks and hopefully one day I will return.

Laura Chapman

Interested in volunteering with us in Peru or Nepal? Use the Contact LED form on www.lighteducationdevelopment.org or message us on facebook.com/LEDCharity to find out about opportunities in 2018.