Category — Peru

Someone requested that I write a post about scabies and acropustulosis a LOOOOONG time ago, but at the time, I didn’t think it was relevant to very many of my readers since scabies has been written about often and acropustulosis is considered to be pretty uncommon. I think it was probably more relevant than I realized, and I just got another request to write on this topic. Sorry to whomever made the initial request that I ignored until now! Better late than never, right?

Hopefully this post will be useful to those readers who have adopted, or will adopt from an orphanage with the oh so familiar scabies epidemic.  Jackson’s orphanage in Vung Tau was pretty much crawling with them, and every baby we knew coming out of there had a decent to bad case of scabies.  Shane’s orphanage, on the other hand, in Que Son, was TOTALLY scabies-free.  It was amazing.  Shane left that place with GORGEOUS skin, and still has gorgeous skin.  Jackson, on the other hand, still suffers from his post-scabies skin problems, along with his eczema. 

Most people already know you should bring a few tubes of Elimite with you, which is a prescription topical cream that gets rid of the scabies mite.  Ok, I’ll back up.  Scabies is a dermatologic condition that results from the body’s immune response to the eggs of the scabies mite.  It’s commonly found in unclean conditions where people tend to be crowded together (prisons, orphanages, homeless shelters, etc.). The mites burrow under the skin, lay their nasty eggs, which causes the body to react with itching and red “bumps.” 

Here’s a picture of a scabies rash:

In case that didn’t already gross you out, here’s a microscopic picture of what the mites look like:

They love to burrow in the creases between fingers, toes, and in the natal cleft (butt crack), so those are good places to check if you’re not sure if your child has scabies.  Because live mites and eggs are involved, scabies is a contagious condition.  However, it’s not nearly as contagious as everyone treats it unless your child has the most severe infestation (Norwegian Scabies) and you have a lot of contact with his/her skin before you treat it with Elimite.  You’re most likely not going to catch it from holding your baby that first day.  But if you want to be extra careful anyway, put your clothes with your baby’s clothes in a separate bag to take home and wash on high heat.  Anyway, here’s my advice:

1. The first night you come home from the orphanage with your child, you should cover them head to toe (avoiding the eyes) with Elimite.  I would do this even if you aren’t sure of the diagnosis, but see red bumps that seem to itch.  It’s a pretty benign treatment, and imo, the potential of getting scabies or having your child continue to suffer with them in the midst of his/her transition into your care is worse than the treatment. The guidelines are to “treat all contacts,” but unless you’ve waited to initiate treatment with Elimite and have been co-sleeping or living in very close quarters with your child longer than just that first day, it’s highly unlikely you get scabies if you treat right away. So, imo, if you slather your child in Elimite the first night, you shouldn’t need to treat the other family members who were present that first day.
2. Put the clothes they were wearing in a separate baggie to wash with high heat when you return home (most people keep that orphanage outfit as memorabilia for their child). 
3. When your child wakes up, which hopefully doesn’t happen until the next morning (HAHAHA, yeah right!), bath them to remove the Elimite.  This should be sufficient to get rid of the scabies.  VERY rarely will a child require a 2nd application of Elimite. 

However, successfully getting rid of the mite does not ensure you are totally done with this issue.  I’m talking about a skin condition called infantile acropustulosis, which is commonly reported after a bout of scabies has been treated.  It doesn’t require scabies to have ever been present, but it does often follow a known case of scabies.  Initially, it was thought to be a persistent immune response despite the mite having been eradicated.  It’s now known that it is not an immune problem, and it’s not a result of the mite recurring.  The etiology is unknown and it’s a pretty poorly understood and under-recognized condition.  It’s also not contagious.  It is more common in darker skinned people and usually presents with vesicles, or fluid-filled bumps, on the palms of the hands and soles of the feet (here are 2 good pictures), although in rare cases the vesicles can be on the trunk, face, or scalp as well.  The vesicles itch like hell, and probably cause your baby/child a lot of discomfort.  They also seem to be cyclic, so they’ll come and go.  Sometimes they last a few days, sometimes longer, and they tend to recur every few weeks.  The outbreaks are self-limited, meaning they resolve on their own and there’s really nothing you can do to hasten the resolution.  You can treat the symptoms with a topical steroid (like hydrocortisone cream), or an antihistamine.  Occasionally, pediatric dermatologists will use dapsone for really severe, refractory cases.  Your child will eventually grow out of the outbreaks altogether, thankfully!  Most doctors are NOT familiar with acropustulosis, and it’s believed to be underreported because there’s not much awareness about it.  Also, many doctors misdiagnose this as a scabies recurrence because they’ve just never heard of it, in which case they’ll have you using Elimite over and over with no results.  I had to tell our doctor about the condition, and she’s a really informed physician! 

Jackson has acropustulosis, although he hasn’t had a flare in a few months and I’m praying he’s finally outgrown it. During the flares, the itching bugs (no pun intended) the heck out of him.  He sometimes comes hopping towards us with 1 foot in the air saying “itch, itch!”  On occasion, he even has a hard time falling asleep because his poor little feet itch so badly.  On those nights, we give him Benadryl and apply a topical steroid.  We’ve learned to cover the hydrocortisone cream with a layer of aquaphor to seal it in so it doesn’t just rub off.  That helps a little bit, but it still really stinks when he has an outbreak.

Just out of curiosity, how many of your kids out there have acropustulosis?  If so, what did you have to go through to end up at that diagnosis (was your child given several rounds of scabies treatment?  skin scrapings?  etc.)?

I have no idea how it happened, but I swear, we went to bed on a train that left Hanoi on Friday night, and woke up 8 hours later in the Sacred Valley, Peru. Seriously, we CANNOT get over the similarities between Sapa and the Sacred Valley. Or some of the ethnic minorities here and the Quechua people in the Andes - their textiles, their communities, their physical features, their bright clothing and hats, and sadly, their recent dependence on tourism. Obviously, the resemblances I’m noting are very surface, as these are vastly different cultures with different belief systems and histories. But on the surface, looking at ethnic minorities struggling to survive in rapidly modernizing countries, there are commonalities that are easy to see.

Friday night was a little scary, as we bought the cheapie tickets for a local train that left a VERY seedy, dark train station. Several drunk men approached us to “assist” with our bags, and one grabbed my backpack, which had my laptop inside, and was so drunk he stumbled and dropped it. We grabbed it and raced onward. I had Shane in my sling while I pushed Jack in the stroller, and Travis carried a huge duffel, 2 backpacks, and some other bags with all our crap shoved inside. So our hands were full, and I was feeling VERY protective of my cubs. We were approached a few other times and I just couldn’t help but scream out “don’t touch us!!” I guess I yelled it loudly enough that it caught everyone else off-guard (including myself and Travis!) and they stopped dead in their tracks.

We finally boarded our train, got in our private little (as in, freakin miniature!) cabin, and locked the door. There were 4 beds, but each one was roughly the size of a twin bed cut in half. So Travis teetered on the edge of one, with Jack on the inside, and I balanced my belly on the other, with Shane against the wall. We’re pretty used to being crammed, since the 4 of us (+ Belly Baby) having been sharing a queen, but the train was tight even for us!

The boys did great - they slept just about the whole way! After they passed out (before the train had even left the station), Travis and I stayed up late talking and having fun. For a few minutes, I think we both forgot we’re late 20’s going on mid-40’s (no offense anyway, it’s just that we’ve felt a little beyond our years lately…ever since we joined the circus). It felt like we were 2 kids, without a care in the world, on a backpacking adventure through SE Asia again…until Shane stirred and we both panicked and pounced - me on Shane, to pat him and keep him quiet, and Travis on Jack, to reassure him and keep him from being woken-up by Shane! Hahaha, good times. Good times.

We arrived into Lao Cai, a border town with Southern China, at 5am and hopped in a car our hotel sent to meet us that drove us up windy mountain roads, amidst SO MUCH fog, and we arrived at our hotel in Sapa at 6am. Thankfully, we got a sweet deal on our hotel and the trip has been absolutely refreshing ever since! This is the view from the rooftop at our hotel at sunset yesterday:

Sapa is very different from what I expected. I had envisioned a Vang Viang, Laos type of small, rural town with only a few dirt roads and no real development. Instead, we discovered a mini-Cusco, with tall buildings, bustling streets, honking motorbikes, and lots of Vietnamese and international tourists. It’s still breathtaking up here, and obviously MUCH less populated than other cities in Vietnam (Sapa’s population is ~40,000), with really clean air, and a very pleasant temperature. As I said before, the similarities between this area of Vietnam and the region of Peru in which we spend a lot of time are just striking. The biggest difference is how fertile the land here is - Sapa is very wet. The mountains are greener, and the terraces much more moist. Contrast that with the very arid Andes, where access to water is a huge issue, and the altitude is much higher.

We met a few really sweet Hmong women yesterday who were so interested in Shane and Jackson. The history of the Hmong people is so fascinating, and, in many ways, so tragic. Travis and I have been wondering how much the Hmong here in Sapa identify as Vietnamese, since their people have been displaced and remain scattered throughout so many Asian countries. When we told them our boys were Vietnamese, they said “oh, you bought them?” Scary as hell, and not the first time we’ve gotten that response in Vietnam, btw! Makes you wonder…but that’s for a separate post. Anyway, we explained that they were living in orphanages and that we adopted them. They were interested, but in a very different way than most Vietnamese when they find that out. It seems that when we tell most people in Vietnam that Jackson is Vietnamese, there is a sense of entitlement over him. It’s something we’ve become very used to here, and we have done our best to try and understand that mentality and be patient with it, rather than being offended by it. It warrants a lot of parenting advice, and sometimes criticism, but I know it is all well-intentioned and that people here are doing it out of a genuine love and interest. But I did notice my parents didn’t get any of that when they were here with my blond headed little brother and sister, although everyone that saw them wanted to come and touch their hair and gawk at them (that was funny stuff!)! But back to what I was saying, the Hmong women’s reactions have so far just been different. I wonder how much of that might be due to the possibility that they don’t identify as Vietnamese as much as they do as Hmong.

Last night, Travis and I both passed out right when we put the babies down to bed at 7:30pm, so I think we’re caught up on sleep now too! We’re really looking forward to tomorrow, when we have a local Hmong guide whose name we got from some friends we met at our hotel. She’s ~20, speaks incredible English, and is really proud of her people.

Here’s a picture of Jackson and Shane having a little dance party in the hotel room:

Remember this outfit?

I’m sorry we’ve been really out of touch here. We are without internet in our room. We’ll check email periodically if anyone needs to get ahold of us. I’ll try and post again before we head back to Hanoi! As always, thanks for following our adventures and for all the kind comments (including the sweet ones from the “new” commentors!). Although I read all of them, I haven’t been good about responding to comments lately , but to really quickly answer a few of the questions from the last post: Lorri - like Joy, we got Shane’s blankie from BabysRus, and we love it! And Dawn - the swaddle takes some time for them to get used to, but we used one for Jack until he was 1 year and plan to do the same for Shane, who already seems to calm when he’s in it. I think it enhances the feeling of safety and security, and also keeps Shane from waking himself up by rubbing his eyes or nervously scratching his face. We are big swaddle fans! And Thao - both our boys are from Vietnam, and we’ve been here almost 6 weeks now but currently live in the US. And Thanh - thank you SO much for the info on where to get the Vietnamese lullaby CDs! For those who haven’t seen, check the comments b/c Thanh put links up to help us find more of that type of music.

1.  Receiving no prenatal care at all, or no prenatal care until 4 months pregnant - the gov’t doesn’t cover prenatal vitamins until 4 months gestation…studies have shown us that folic acid really doesn’t help prevent neural tube defects this far into nervous system development

2.  Eating only potatoes 3 meals a day, even during pregnancy.  Technically, there aren’t many people “starving,” but malnutrition is extremely prevalent.

3.  Hiking several hours just to get to a phone, to call an ambulance which is a 2 hr drive from where the road to your house begins, then hiking the several more hrs to get to the start of that road

4.  Doing that while in labor

5.  Delivering a baby on the mud floor of your 1 room home, with no pain meds or sterile instruments, no electricity or running water, where there’s no heater and it’s 40 degrees outside, in the same room your guinea pigs are kept because they are valuable, protected assets

6.  Actually making it to the clinic, where everyone tells you to deliver your baby, only to find you have to give birth in a cold, unfamiliar, scary room with a male doctor who requests to check your cervix, when no man other than your husband has ever seen you naked

7.  Having a 4lb full-term baby, likely because of the poorly understood effects of pregnancy at high altitude, combined with poor nutrition

8.  Delivering a stillborn baby twice because you never had access to a simple medication, Rhogam, for your blood type differing from your babies’

9.  Delivering 10 babies because you had no access to birth control, never having a laceration repaired, and suffering from vaginal prolapse the rest of your life

As most of you know, Travis and I have been in Peru since the beginning of June working on a public health project.  We were contacted about 1 year ago by one of the women who started the NGO, Leap Local, about a birthing center project.  She knew our non-profit had been involved in local projects, and that our primary interest was medical, as we are both medical students.  Since my main interest has always been women’s health, naturally, we were very interested in getting involved with the birthing center project.  It is VERY difficult to communicate or get accurate information when we’re in the US and our contact is in rural Peru.  So, we knew coming here that we’d be overwhelmed with information.  Never did I think we’d feel quiet this in over our heads, yet strangely inspired at the same time. 

We are still gathering statistics on infant / maternal mortality rates in the Sacred Valley, but we know the available stats are nowhere near accurate, as the vast majority of deaths go unreported here.  The majority of births in the Valley still take place on the mud hut floors of the homes up in the Andes.  There are many reasons, only a few of which we have been able to truly explore as most are cultural, as to why people deliver at home.  There are so many fascinating differences in birthing practices between the women in the local communities and the Western ways I’m used to.  For 1, women here prefer to deliver standing up - it is easier, faster, and there are less cord complications, according to the midwives.  For 2, once a baby is born, the concern is over the mother, who is attended to very thoroughly.  The baby, however, is secondary and usually not kept near the fire or near enough to warmth.  The infant mortality rate is about twice that of the maternal rate. 

As we discovered when we got here and began our “needs assessment,” there is a delivery room, if you will, in Ollantaytambo, which serves ~18 communities in the Andes. 

The single dirt road does not reach all 18 communities, and there are no phones in the furthest ones.  The most remote is a 4 hour hike from where the road ends, which is a 2 hour drive that only a 4×4 can do from Ollanta.  The town of Ollanta can only afford 1 ambulance, and has only 1 ambulance driver, who is on-call 24/7.  You can imagine then, that most women deliver before they are able to reach the clinic.  And most women don’t even attempt to reach the clinic anyway; they would rather deliver at home.  They say it is too difficult to reach the clinic, too unfamiliar / uncomfortable, and too much of a burden to leave their animals and other children to be tended to by family or neighbors. 

While each community does have what they call a “health promoter,” who are essentially community health workers with basic 1st Aid training, the health promoters are not trained as traditional birthing attendants (TBA’s).  TBA’s are common in small, rural areas, and have been helpful in parts of Africa to reduce vertical transmission of HIV and promote safer deliveries.  Here, in rural Peru, however, the health promoters have specifically been taught NOT to attend home births.  Apparently, public health officials feel training them would only further discourage women from seeking institutionalized deliveries.  A BIG mistake, in my opinion.  Sure, for the pueblitos within a short hike of the clinic there is no need, but there is no way we’re going to reach the women in the communities 19KM away and convince them to hike down to deliver in a sterile, cold, unfriendly environment while in labor when they’re used to doing that in the comfort of their own homes.  The harm reduction model would say at least a trained TBA is better than a friend, sister, or husband cutting the umbilical cord with the same knife used to slaughter guinea pigs and cattle.  Also, retained placenta and resulting fatal infection is a common complication of home births - not a total cure, but training TBA’s to deliver a placenta properly would certainly cut down on this occurrence. 

Anyway, the project we came down here to assess is the building of a Hogar Materno, which is basically a variant of a maternity ward, behind the clinic in Ollanta.  We have met with a number of officials, all who feel this is the first necessary step in luring women from higher up to deliver at the health post.  We went to see a Hogar Materno, after which we’d model ours, today in a community several hours from here that serves a difference district of Andean pueblos.  It was beautiful.  Their Hogar Materno had 5 rooms, each with a fire pit inside that vents out so that the families can come down and stay, as can the mother postpartum.  She can feel more comfortable because she can cook there, and it is built similarly to the inside of a typical adobe. 

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The idea is to promote safer, more hygienic deliveries by encouraging women to come to the clinic, reducing the incidence of possible complications and providing better access to a higher level health care facility in Cusco should that be needed.  Additionally, by building the Hogar Materno, we are trying to keep in tradition with birthing practices common to Andean women - they can deliver vertically with minimal invasion of privacy, then stay up to several weeks postpartum, while their bodies recover, before having to hike up the mountain and resume physical labor.  My fear is that without a MASSIVE public health campaign, we are just improving a birthing center without actually increasing access to services.  What I mean is, the women who would have made the trek down to deliver at the health post anyway would then enjoy improved conditions with some comforts and the familiarity of home.  However, the women from the most remote regions, where there are no roads or phones, still will not be able to access the facility. 

Thus, we are attempting to re-prioritize things with the health officials at Ollanta.  Our priority is first and foremost, to improve access.  To do this, we feel it is necessary to establish emergency satellite phone services in the most remote communities.  Thus, when a women is in labor, there will be 1 person per community in charge of the emergency phone who will call the ambulance driver.  The women will still have to make the 4 hour trek to the road, but will be met there by ambulance.  The next priority is building the Hogar Materno and launching a public health campaign to inform communities of the new maternity ward and the importance of delivering in clean conditions.  Hopefully, the Hogar Materno will make the women feel their birthing practices are respected and can be maintained, just in a safer environment.  It will also provide a place for them and their families to come stay during the delivery and postpartum periods. 

This is a HUGE project, and we’ll likely be back here in the spring (with both babies!) for a few months to continue working on it.  We will be seeking donations from friends, family, medical schools, rotary clubs, travel companies, and anyone else who might be able to contribute.  If you are able to contribute, you can do so through our non-profit and receive the tax write-off for donating.  If my stats are right, there will be ~3,000 people reading this.  Then if every reader gave $3,  the entire project would be funded!  We TRULY appreciate any and all help.  I will post a link with a way to donate and our tax ID number - we can provide receipts for write-offs.  If you are interested in coming to Peru to volunteer with the project, we can use you in that capacity as well!  The simple part about this project is its sustainability…which will lead me to a future post about additional projects that have come our way.  Stay-tuned.

On an unrelated note, please head over to Adventures in Daily Living for the Adoption Round-up. This month’s theme is attachment.

So our little man is all grown-up!  Well, not really, but I really can’t believe he’s a year old.  No longer an infant.  He’s changing so fast I can hardly believe it.  Now I know why people always say “don’t blink!”

• He’s talking all the time now and says “Mama” and “Dadda” a million times a day. 
• If you ask him what his name is, he can say something that sounds like “Ack.” 
• He can tell you what sound cows, cats, and dogs make.  He’ll also fill in the blank on occasion if you say “la baca/el caballo/el gallo/el perro/el puerko/etc. dice____.”  We’ve had great opportunities to practice farm animals lately, thanks to all the wildlife in Cachiccata! 
• Apparently he’s also made the association between “where’s your…” and tongue because you can ask him where his tongue is, and he’ll stick his out.  You can also ask him “Jackson, where’s your brother?” and he’ll also respond by sticking his tongue out!  (not to confuse anyone; we’re still awaiting Jackson’s brother’s referral!)

• He took about a week hiatus from eating after his viral URI, and in that time was spitting everything out and playing with the chewed up food.  Thankfully, he’s now back to himself.  He eats everything now, including guinea pig! 

• He still LOVES the outdoors.  If we’re outside, he’s happy.  He also still LOVES riding in my Hotsling.  We got a new one, BTW.  It’s the ZOIE and I really like it:

• We’re still signing to him and he’s so into copying right now that it’s pretty easy to teach him new things.  His most recent monkey-see-monkey-do trick is blowing kisses to everyone.  Oh, and yesterday, Travis got excited about something or other and did a fist pump with a “YESSSSSSS!”  Jackson then did his version of a fist pump and exclaimed “SSSSSS!” 
• He’s the happiest little guy and is always looking for a good laugh.  Anytime we’re joking around or laughing about something, he’ll look from my smile to Trav’s, then just start cracking up as if he’s in on the joke.  It’s too cute. 

In all his glory, pretending to be a tobogganer?

I really worried that taking Jackson from his “routine” in Colorado to Peru for a 5-6 weeks would delay our progress with attachment.  Suffice it to say this trip has been incredible for our little family.  We are together 24 hours a day, and although it probably wouldn’t be recommended by many social workers post-adoption, this adventure has been wonderful for us.  Jackson has gotten so much more affectionate lately.  I don’t even have to ask and he wakes me up by planting kisses all over me every morning!  He also melts into my body when I hold him now, as opposed to “throwing bows,” as we call the elbow to the ribcage!  He falls asleep all the time on us and snuggles in close for hugs now too.  I just love it.

• His newest interest is in squeezing his little body into the tiniest cracks and crevices.  Good thing I’m small too because he’s gotten himself into a few jams lately and I’ve had to cram myself under beds and between chairs to rescue him!

• He LOVES music and claps his hands together anytime he hears anything that even remotely resembles music (including me or Trav humming/singing to him). 
• He also loves books. 
• He waves with both hands facing himself anytime he hears the words “hola, hello, chow, bye-bye, or adios.” 
• He’s SO close to walking it’s scary.  He can walk along walls (with one palm against the wall and the other free), or holding nothing but one of your pinky fingers.  He is such a fast crawler I don’t see there being much motivation for walking, but he seems interested and eager nonetheless.  Everyone tells us he looks like he wants to go straight from crawling to running…he’s an Action Jackson, fast-paced, high-energy kinda kid, and we love him that way!

He was sick last week with a little virus and some URI symptoms + fever and now has the classic rash that’s tipped me off to it being roseola infantum, nothing serious.  He’s totally back to himself, and the rash doesn’t itch or bother him at all…it just gives me the diagnosis, so I can feel better.  He’s just happy as can be and loves Peru because there’s TONS of dirt here, and Jackson is a dirt kinda kid (that’s my boy!). 

• He has 3 teeth (2 bottom, 1 top), which we’ve started brushing, and tell you the truth, I’m not that eager for more to join the party just yet. 
• His hair has gotten so long and wispy that it doesn’t really fauxhawk on its own (or Phohawk, as my friend Mark pointed out!) anymore. 
• Jackson still has tons of hilarious little quirks, but his right foot seems to tolerate the grass now, so he’s grown out of that one!  He still falls helplessly asleep when I stick my finger in his ear canal, and has a new magic sleep spot if I scratch in between his clavicles in the center of his back.  Don’t get me wrong, this only works when he’s “going, going, gone” already.  He’s still a bear to put down to bed at night.  He’s never been a kid we could just give a bottle, then lay down in his crib when he’s done eating.  He has to be swaddled, rocked (the Lullaby rocker from Potter Barn was the best gift from my parents!), and likes his face gently touched as he’s taking his “ba-ba,” then the ear trick is the final touch.  Sometimes though, he fights sleep so hard and we could be in there rocking/patting our screaming baby for 1hr+.  Bedtime is often stressful, but that comes with the territory - high energy kids just don’t like to sleep!
• Anytime Jackson hears a baby crying, even if it’s faint and distant, he imitates the cry and wears an expression of true empathy.  It’s precious.  We’ll see how empathetic he is when his little brother becomes the frequent source of that sound (and it’s not so distant anymore)

So, that’s the low-down on our little munchkin.  He’s a wild man and we lov
e him to pieces.

We’re back from a wild weekend of all sorts of adventures.  I’ll post more of a Jackson specific update in the next few days, but will attempt to recap a little of our weekend excursions now.  First of all, the action started off when we got a bit lost on the hike from Ollanta to Cachiccata, one we’ve done several times.  We somehow got off track, ran into Alvarez, a drunk dude on a horse from the village on the other side of Cachiccata’s mountain.  Drunk Alvarez was a bit shady and his habit of mixing Quechua with Spanish made him very difficult to understand, but he was pretty clear about which path to take to Cachiccata.  We took his misadvice and ended up on a 2.5 hour hike that landed us up the side of a mountain overlooking Cachiccata, so we arrived slightly late to Klever’s family’s house for lunch.  But, we made it. 

Here’s Jackson playing with his little buddy outside Klever’s house:

Here’s Jackson with Klever’s mom:

I had the opportunity to check something off my life’s “To-Do” list after lunch at Klever’s…it was much harder than I expected!  Oh, and I later realized I was kneeling in cow crap.  Yeah, that green loveliness will be with me for awhile since I only brought a few pairs of pants to Peru.

The community threw a huge birthday bash for Jackson.  The guys in Cachiccata started preparing Patchamanca early in the morning.  Patchamanca is a pre-Inca method of cooking in which meat and veggies are prepared in an earth oven, and it is reserved for special occasions.  The community is very inclusive, so all were invited to join in the feast, which included Guinea Pig, sheep, chicken, sweet potato, dry potato, and several other potato types, beans, and chicha (the corn based alcohol that people in the Andes drink for nutrition). 

Here’s a picture of Jax gnawing on a guinea pig claw (look closely;)

They had a pinata and the kids went nuts for it!  They also had Cachiccata’s harpist play for Jackson’s birthday fiesta. 

The party raged on pretty late, and Trav’s poor tummy is still suffering for those extra cups of chicha he drank.  We camped that night and Jackson did great.  I have to say, it was a pretty darn cool 1st birthday, and I think Jackson thought so too.

My mother-in-law is visiting Peru for the first time and we brought her to the community for Jackson’s bday too.  I think culture shock may have arrived before the guinea pig on her plate, but that may have been what put her a bit over the edge.  She’s been a trooper, and even camped in Cachiccata with us! 

Here’s a picture from a previous trip of the campsite at Cachiccata:

Family picture in Cachiccata:

After we left Cachiccata, we hopped on the train to take Lynn to Machu Picchu.  This was our 4th visit, but it’s been incredible each and every time.  The weather in the cloud forest is totally unpredictable, which always makes it interesting.  We have seen it under a pure blue sky, rainy, shrouded in mist, and overcast.  It looks totally different depending on the conditions. 

Trav told me I look like I’m about to eat someone in this picture, but oh well, Jackson is smiling:

Here are our 2 troopers, Gramma and our littlest traveler:

Jackson has been amazing.  We’ve gone everywhere in planes, trains, and automobiles, and Jackson has been such a champ!  I’ll tell you all about our little traveler in my next post.  I can’t beleive he’s 1. 

Gramma Lynn leaves tomorrow, and Trav and I are moving our homebase out to the Sacred Valley so we can be closer to our birthing center project.  We’ll be conducting a few focus groups with the women from Cachiccata to use as a model since research has shown focus groups to be very accurate in providing information representative of communities at large.  We are hoping to gather info on things such as the cultural factors that lead women to deliver at home rather than seek medical care, when do they choose to pursue an intervention, common complications of pregnancy/delivery women have experienced, average family size, etc.  Since we have a strong relationship with Cachiccata, this is a good community to use in our rapid needs assessment.  Showing up in any of the other Sacred Valley communities, speaking broken Spanish, as American strangers, we may not engender the trust necessary to get accurate information.  Klever is going to arrange the meetings for us and will be present as well, making sure our Spanish and translations of their Spanish (and Quechua) are accurate as well.

We spent Father’s Day in the community where many of our Peruvian friends grew-up, Cachiccata.  We have been involved with this 280 person village for about 4 years now, and have truly grown to love the land and the people.  The leadership in Cachiccata has asked for help on several development projects; it’s been incredibly rewarding to have been able to coordinate resources and volunteers to help the community with a few of those.  The 2 room community schoolhouse is now equip with a computer lab, full of laptops and desktops donated by Travis’ former employer, along with educational software in Spanish that was donated by the company who makes that material.  We have sent a few groups of medical students down to do volunteer work, as well as raised money to sponsor a little boy’s surgery. 

Formerly, most of the boys and men in Cachiccata worked as porters on the Inca Trail, a job that until recently was totally unregulated and allowed most large tour operators to abuse their employees because there weren’t any better job prospects.  Farming has become increasingly difficult, as the water channel in the community, built during Inca times and dating back ~500 years, is no longer functional and much of the land is now unusable.  It is not an uncommon story to hear about 14 year old boys carrying packs and equipment in excess of 50kg , barefoot, along the Inca Trail for tourists who have every luxury while trekking.  Meanwhile, to cut costs, the big tour operators refused to provide food or tents for its porters on the 4 day journey to Machu Picchu.  Our good friend, Klever, was one of those little boys. 

He’s told us how he used to just sob the whole way, shivering in the cold at night, while the tourists ate, drank, and slept in warmth.  Thankfully, an advocacy group worked hard to establish very basic human rights that now exist for the porters.  Incidentally, the woman who founded this advocacy NGO is the same woman who approached us for help with the Hogar Materno (the birthing center) in the Sacred Valley. 

That said, portering the Inca Trail for wealthy international companies is just a way for people to get by during the high season.  The tour companies are prospering, but the porters are making just enough to stay afloat and feed their families.  Cachiccata is a unique community because the young people have organized themselves and recognized that their land has MANY Inca remains, is now a popular trekking site, and if they established their own company, there’d be no need to work for peanuts for HUGELY profitable international companies on the already overburdened Inca Trail.  They have partnered with 4 similar communities in different regions of Peru to form a company called CHASKI, which intends to basically cut out the middle man and allow the communities whose land is most impacted by tourism to at least benefit from it.  It beats being the bottom rung of the tourist industry when, afterall, it’s not only the hard labor of these men, but their land as well that make this kind of adventure travel possible.  And so few of the large tour operators give anything back.

The most recent project for the improvement of Cachiccata is the creation of a botanical garden.  It’s a reforestation project and the community is looking for people to donate $5 per tree to be planted in Cachiccata.  The botanical garden is one way to raise money for the community, encourage reforestation, beautify the barren areas, etc.  On Father’s Day, a large group of community members gathered and planted the first 100 trees.  It was a cute Father’s Day activity, and Jackson had a good time playing in the dirt, planting trees with Daddy, and being loved on by all the Cachiccata kids. 

The other day, our friend Klever told us that a group of our friends from Cachiccata had gotten together and decided they want to give us a piece of land in the community on which they’d like to help us build a small house.  WOW.  We are extremely honored, and considering coming back down next spring to do this.  The land is from Klever’s family, which owns quite a bit of mountainside land.  It’s absolutely gorgeous, and I can’t think of a neater place to be a rural doc.  It’s not exactly in the cards for us for awhile, but it would be really incredible to come down here and have a house to live in when we do. 

On another, semi amusing note, we are partners in a llama project.  The llamas serve 2 purposes: 1) tourists like them, so they’re good for promoting the Cachiccata trek and 2) they’re mildly useful, although dumb as rocks, and can carry packs and equipment needed for the treks.  So, we fronted a small (small to us…the going rate is $70/llama) amount of money along with several other community members for Cachiccata to purchase the llamas.  Well, apparently 4 of the 11 llamas have been picked off by a PUMA that lives in the mountains here!!  How sad, but slightly amusing in a sick sort of way.  Llamas are a huge pain in the neck in many ways, and SO freaking dumb.  I can just picture them trying to spit the puma away. 

This is “downtown” Cachiccatta:

The big struggle for Cachiccata and communities like it is the tug between developing / improving the quality of life and losing their culture / becoming totally dependent on tourism.  There’s a fine line there, and who’s to say when it’s been crossed.  On the one hand, there’s no question health and hygiene have been drastically improved with development and other recent projects, including the 30 new compost toilets scattered throughout the community that were built by volunteers.  Then again, what is the incentive to “preserve culture and way of life” when that life is a million times harder?  Why be a farmer anymore when you can work in tourism, make more money, have more time with your family, etc.?  Then again, we have seen the addition of electricity to many houses in the community over the last 4 years, and just recently, Klever’s own family bought a television.  We all know the outcome when MTV comes to town…

Trav and I have talked a lot lately about development versus preservation because the community’s latest idea is to create an adventure lodge in Cachiccata.  They want to create a hub for outdoor adventures that would start with ~10 bungalows, wher
e people could stay, and they community would have kayaks, mountain bikes, horses, etc. for rent.  Pretty much any outdoor activity you can imagine is possible in Cachiccata.  This could be an incredible thing for the people in Cachiccata, some of whom don’t have enough to feed their families.  It is sure to be incredibly transforming force.   One of the partners in the lodge would be the community itself, thus preventing future developers / international tour operators from buying land in Cachiccata and building their own enterprises.  Several investors from France, Chile and the US have already made offers on land in the community but have thus far been unsuccessful at closing the deals.  The lodge would at least ensure that the community retain ownership and control of its land, and should they choose to develop it, it would be a community-wide decision. 

Who knows if people will continue to speak Quechua, or perhaps generations to come will only bother to learn Spanish and English.  I worry that little by little, their traditions will be lost, their culture watered down, their land turned into an outdoor amusement park for tourists seeking off-the-beaten-path adventures.  On the flip side, who the hell are we to tell them what’s best for their community in the long-run?!  Who are we, with TV’s in our home, clean water, plenty to eat, warm clothes to wear, to tell them to slow down with the development projects because infusing too much money too quickly might do harm?!  It’s a complicated issue, and a hot topic among anthropologists, but it’s always discussed so theoretically.  Harvard professors drinking cappuccinos and discussing what a shame it is that these communities were exposed to tourism and gave up little pieces of their culture to stave off poverty. 

It’s so depressing that tourism and cultural preservation cannot truly coexist.  And I don’t count the cheesy places where people have begun wearing traditional clothes again because the tourists enjoy it - it makes for better pictures.  It is a very sad inevitability that development will eventually equal loss of tradition.  I hope that can be minimized, and that whatever negative impact tourism will have on Cachiccata, the benefit will be more significant in the eyes of the individual community members 20+ years from now.  Only time will tell.

This is our family crossing the bridge to Cachiccatta.  We’re celebrating Jax turning 1 year old this Saturday in the community with Gramma (my mother in law), who got here today!  Will post after the weekend’s festivities and our 4th trip to Machu Picchu on Monday.

The Jaxman in his new hat (a gift from Klever and Lily):

A Cultural Divide

The other day, we were eating lunch at a restaurant with friends and Jackson was his usual high energy self, discontent to sit still for more than 5 minute increments.  So, Trav and I took turns, as we typically do, eating and playing with Jackson.  He’s high maintenance, everyone who knows him would agree.  He loves to crawl at lightening speed and hold your fingers and walk faster than it would seem possible, given his tiny legs.  At one point, our friend, Klever, leaned over and said “everyone here thinks you are a little strange.”  As if that’s some revolutionary thought;)  Seriously though, he told us that babies Jackson’s age in Peru are not active like he is, something that we had also noted.  Most people here are shocked to see him move the way he does.  We have noticed that babies here are very late to develop gross motor skills, and at Jackson’s age, are not very interactive at all.  Klever pointed out that most are just sleeping, eating, and content to watch the world from inside their moms’ slings (if you will).  He said people do not interact with their babies like we “gringos” do, and their babies are not demanding of attention the way our baby is.  He also added that people find it odd that Travis shares my responsibility in caring for our baby.  They had never seen a man change a baby’s diaper, feed a baby, or even spend much time holding a baby…so of course they probably think Travis is a total freak for WEARING his baby (yes, he has 2 different patterned Hotslings, in addition to our hiking pack that holds Jax). 

The way we (Americans) rear our babies versus the way most Peruvians in Cusco do has made us think and discuss a lot lately.  There are so many things I think our culture has wrong, and one of those is the obsession with pushing our kids to do everything early, fixating on where our child is developmentally compared to his peers, and creating very rigid guidelines with finite goals our children should meet at ages x, y, and z.  Certainly there is a place for screening and identifying abnormalities early so that interventions can be made.  But I’m talking about things like throwing our kids in the pool at 5 months old so they figure out how to swim at that age.  Sure, maybe it’s a safety thing in some instances, but that’s a popular course in Colorado, and not very many people have pools or live near the water out there!  Or being in a hurry to feed our kid solids because some moronic pediatricians are encouraging breastfeeding moms to start solids younger than 6 months (which already seems too early to me).  Or being disappointed that your kid doesn’t crawl at 6 months old.  Most of us fall into these traps to some degree, but it’s a cultural thing.  No one here gives a crap or thinks your kid is superior if they can talk at 10 months, walk at 9, or crawl at 6.  It’s just not important.  But babies here are so attached to their moms.  They are with them 24 hours a day.  They co-sleep, breastfeed, spend every hour of the day inside their mom’s sling, and this goes on well into toddlerhood. 

On the flip-side, they are not interacted with much at all in the first 2 years.  Of course breastfeeding is interactive, but I mean in a verbal or playful sort of way.  Kids are not given Baby Einstein toys to stimulate their minds, or taught to be monkeys (ie: “How big is Jackson?  So big”).  I can step back and see that we do so many dumb things to help promote brain development, like over rely on toys, stick our kids in exersaucers, bouncy chairs, swings, in front of the TV and interactive games, and other crap that really just allows us to be lazy in our parenting.  We plug our kids into things with voices so that we end up having to do less interacting and less teaching.  Nicki had a GREAT post on this topic.  That said, I do think there’s something to stimulating our babies’ cognition and encouraging them to interact with the world early on.  And 0-12months is an important time for brain development, for sure.   There are better ways to promote that than the ways toy companies and television encourage us to, and I think in the US we overvalue independence and over encourage independent play.  The hard part is achieving a balance - the perfect mix of Quechua parenting style meshed with the way we Americans typically do it.  Attachment + independence + brain development + play = perfect.

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Funny story: our friend nicknamed Travis “Patch,” short for Patchikutek, an Inca King famous around Cusco for his power…in fact, there’s a statue of him near our house.  He got that nickname because 1 night, a while ago, when we had a few beers and somehow it came up that Travis has 3 nipples.  Yes, I’m serious.  It even has its own little tuft of hair and shrivels up when he’s cold!  Naturally, everyone was FASCINATED by this fact and told us the significance of his 3rd nipple…according to Quechua legend, it means that Travis was actually a twin in utero, but he was SO strong that he battled and killed off his twin and usurped the twin’s power and spirit.  The only proof of this duel is Travis’s 3rd nipple, which formerly belonged to his roommate in utero.  This is why Travis is a natural leader, and very strong, according to our Quechua friends!  So powerful Travis was nicknamed after the powerful Inca king, Patch for short.  Interesting, huh?  That Travis has an extramammary part AND the explanation we were given for it in Peru. 

Tonight, Klever & his girlfriend, and Holger and his girlfriend, and possibly some of Klever’s roommates are coming over our house for dinner and some Cusquenas.  Tomorrow we’re heading out to the community, Cacchicatta with our friend Pepe and his son, Jaoquin (coolest name ever!), to see friends, help build a meeting house for the Youth Association for the Development of Cacchicatta, hike, and camp.  Cacchicatta is a Quechua community in the Andes of ~280 people whose land still has Inca ruins, temples, and tombs on it.  The sad part is, it is currently unprotected land and raiders frequent the area to rob what’s left of the Inca ruins.  A few years ago, we were hiking with a friend who lives there and he showed us, only us, an Inca tomb he had discovered.  There were several skeletons, totally intact because they had been untouched by air until he rolled away the boulder and found them, with strands of cloth still attached to their bones. 

A few weeks later, we were informed that the tomb had been raided and was now totally empty.  Things like this happen all the time in Cacchicatta, which is why the community currently has a proposal into the World Bank (God forbid it does something humanitarian every once in awhile) for a grant and will then petition the government to grant their land “communal reserve” status.  It would make it so that every visitor on Cacchicatta land would be regulated and required to pay a small fee to the community, which would help them preserve the Inca ruins. 

We also have a goddaughter who lives in Cacchicatta - Klever’s niece - so we’ll get to see her too.  She’s 4 years old now, and I’m sure Jackson will be smitten with her (he is with every kid that age).  Oh, and Klever was just recently elected president of Cacchicatta!  He’s only 25 years old, and the most driven, intelligent, entrepreneurial, giving person in the world!  He was the first to go to college from Cacchicatta and is really an impressive guy.  He has already done so much for his community and has so many more huge dreams and plans to improve the quality of life in Cacchicatta.  We’re lucky to have him as a friend. 

I also want to say congratulations to my first sister-in-law, Jennie, and her husband Eric.  They recently delivered a beautiful, healthy baby boy named Barrett.  I call her my first sister-in-law because, although she is no longer married to my husband’s brother, she was my first sister-in-law, and I refuse to call her my ex anything.  It’s sort of like the first mom concept- just because she’s not functionally or legally a child’s mother anymore, it doesn’t mean she doesn’t exist or that she didn’t first hold that title.  Divorce is a terrible thing, and it’s so hard for me to understand why when 1 family member divorces someone, the entire family is expected to do the same.  That’s for a different post though.  My point here is, I am so happy for Jennie and her family.  Jennie is one of the strongest, most sensitive, compassionate people I know, and she and Eric are going to make incredible parents together.  Congrats guys, and I love ya Jennie! 

Here are some more pics of Cusco (Cuzco to Peruvians):

I want to give a shout out to the reader who found my blog by google searching “genital exam with an erection.”  Standardized patient, is that you out there? 

Oh, and I hope the searcher for “what sound do toads make” found a very useful answer in a past post here as well! 

Ah, ya gotta love Wordpress blog stats. 

Ok, so my real post is about the funny things that come up when trying to learn a foreign language.  You may recall my in-country post about the fun Travis had with the word for Vietnamese currency, DONG.  Good times, good times.  Then there’s his favorite Greek word, pouliki.  It means little bird, but is also used as a little kids’ word for a penis.  My creative husband has incorporated that one into the saying “a pouliki in the hand is worth more than a pouliki in the bush.”  Obviously based on a saying you wouldn’t think could come up in everyday conversation…but then again you might not know my husband.  He manages to weave it in quite often.  Well, his new favorite word is the Salvadorian Spanish word, PUPUSERIA.  You can take it from there.  Yes, I am a lucky woman, married to an oh so mature boy with a 14 year old’s sense of humor.  To be honest, I kind of get a kick out of it; I just try not to let him know that.

We have this great little pocket phrasebook that Travis keeps in his back pocket.  He was going through it and noticed a section for tourists titled “romance.”  He now knows how to say “easy tiger!” and “sorry, I cannot get it up” in Spanish.  Good work Trav, keep it up (pun intended;). 

Here’s a picture of an avocado as big as my head (Alex - it would probably look more like a raisin if held up to your noggin!

Here’s a picture of a festival we stumbled upon a few days ago in the main square:

Jackson has been a champ, sitting through several hours of language lessons a day and just loving all the attention he gets on the streets from everyone who sees him.  It’s hilarious because all the women here wear their babies in brightly colored cloth tied around their necks.  I have been stopped several times so that they can examine my Hotsling and figure out how to replicate the design (they love the no ties, continuous material!).  Jackson’s top right tooth is poking through though, so we’re in for a few rough nights I think - that’ll make tooth #3!