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

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.

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.

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.

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.

This summer, Leeds University medical student Ross Gillespie spent 4 weeks as a volunteer at the LED health post in Quisuar. Here’s what he has to say about the experience….

I have recently returned from Quisuar having spent 4 weeks in the LED health post, located in the captivating mountain range of the Cordillera Blanca. I’m Ross, a Medical Student of Leeds University, UK, and I’d like to share a short account of my experience over the summer.

My journey began in Lima, a vibrant and busy city with some real gems to offer. An 8 hour bus journey lead me to Huaraz where I met Val, Juan (translator and entertainer), the crew, and four trekking Americans, Janet, Meara, Tara and Nalini. After some acclimatisation walks and some generous meals in the local hotspots of Huaraz we stocked up on medications and food, prepped our kit and headed into the heights of the Cordillera Blanca.

As with previous visitors a private coach journey winding through various towns and villages and over the Llanganuco Pass would lead us to Chingil. Here we would spend the night, before the 4 hour trek over a 4450m pass to the health post in Quisuar. The surreal beauty of the surrounding landscape seen throughout this journey was truly unique and a clear sky allowed us to appreciate the peaks, which appeared from all points of the compass.

Arriving at the village of Quisuar we were greeted by the locals with a traditional welcome party of singing, dancing and general frolicking before arriving to our goal destination of the health post. Here we met Tula, the nurse and I settled in for my 4 week stay.

As mentioned in other reports, the location of the health post is quite unique with incredible views surrounding it. The health post is basic but is well stocked with basic medications and equipment, somewhat loosely comparable to a GP surgery. This allows for a generous consulting room and a private examination room (which doubles up as the bedroom) in which to practise, as well as a small waiting room and decent kitchen.

The first week was especially busy in terms of patients, but we quickly established a system that seemed to work. With Tula translating to Castellano (I must admit, life was made much simpler by being able to speak Spanish, although not essential), a comprehensive history was easy enough to obtain and follow with examination and an appropriate management plan.

Conditions we encountered were mostly chronic back pain, gastritis, infections (of varying types) and the usual signs of ageing (poor vision, aches and pains, loss of strength). The village would most certainly benefit from some dental care and education seems to be the key step missing to further develop the health of the region.

We spent two days in the secondary school teaching about nutrition, mental health and general health. We were keen to address sexual health, a topic which is too frequently ignored or avoided in this region given the reserved nature of its people, however it is essential that any proceeding visitors do their utmost to educate the teenagers about this. Persistence is key, and has been successful in the past with vast reductions in teenage pregnancy rates.

I spent most afternoons teaching the local children English, with ages ranging from 6-16. This was very rewarding and its nice to see kids who remember how to play, using their imagination, and not have their eyes fixed on a screen at all times! We also brought school resources and skipping ropes etc to share with the children and schools.

Juan would cook breakfast, lunch and dinner and free time during the week was spent updating computer records (kids height/weight, consultation records, inventory), training Tula and doing home visits. Weekends were spent trekking and visiting nearby towns and villages. Juan and I trekked to Pombabamba (about 12-14 hours the long way around) and spent a weekend their, restocking and buying gifts for the children. We also visited the two lakes and attempted fishing (NB: spinners or ‘mariposas’ are useless, you need to sink a worm to have any chance), and spent a day at the big Sunday football tournament in Pochgoj.

The political stance of the village is not easy to gauge, but with an elected president representing the people, there is normally someone who knows what is going on. With big companies trying to exploit resources by giving false promises and strange new laws on employment of teachers, it is quite unclear as to the political direction of the village. The most important thing is that the health post continues to have its positive impact on the community, and with consistent support from the majority of the local village, and in fact surrounding villagers, this should not be challenged any time soon.

Tula is great with patients and is keen to learn to further her ability to help others. She is trusted and respected by the patients, and is a key asset to the health post. Juan, who plays a multi-faceted role of translator, guide, cook, entertainer and friend is an easy going Peruvian, and with an innate ability to read people, he knows just how to keep spirits high!

Returning home, we took the lazy option of a coach to Pombabamba and a bus back to Huaraz (about 14 hours of travelling door to door). Back in Huaraz I spent a week in the local public hospital in general surgery/A&E, which was eye opening to say the least. Here the interns taught me and treated me as one of their own, generously inviting me to meals and nights out. They exemplified the welcoming and humble nature of the Peruvian people.

Overall I had an amazing experience, and one that I will surely never forget. I would like to thank Val, Juan, Tula and the Crew (Melki, Antonia, Freddie, Augustin (Cuchin)) for their help throughout my stay. I am also most grateful to the people of Peru who made the experience so rich and memorable.

Ross Gillespie

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 in 2017.

For photos, look at our LED at work – Peru 2016 album on Facebook.