Bikepacking Peru – Huamachuco to Yungay via Pomabomba

Notes from the Road
Here is a story that will hopefully paint a picture of what it is like going to the hospital in Peru as well as make you laugh a little. I had plenty of time to write it; the last 4 days have been spent in bed.

4 days ago, after dragging ourselves the 19 miles into Pomabomba, Peru, I was elated to have the opportunity to purchase some Cipro. The last few days had been extremely difficult due to my illness, the terrain, and elevation.

Upon arrival, I went into the pharmacy and asked for some Cipro. The pharmacist said, “how many?” I asked, “how many for a full course,” and she said 14, so we went with that. I was back before Janet had even managed to buy a coke. In 2014, in Mexico, I confirmed that a doctor’s prescription is needed for antibiotics, but here the woman gave it to me quite willingly over the counter. I don’t necessarily propose that this is a good thing for global health, but at the time, it seemed like my life was being made quite easy. We were all smiles that day with our good fortune of making it into a town.

My ailment continued – in fact worsening over the next 4 days. I spent bouts of the night expunging liquids mostly green (which the internet taught me is the color of bile before it degrades into a more pleasant brown color).

This morning, we asked the kind owner of our hotel where to find a doctor. She said that the doctors now are all at the hospital, but in the afternoons, they “come down” to town. She advised me to go to the emergency room so I don’t have to wait behind loads of people. That sounded like a good idea – kind of like how it is at home.

Janet offered to accompany me, so we walked following the hotel lady’s directions. We walked past the ATM, where once again an early morning line of 30 or so indigenous women all wearing their costumes were waiting. Janet and I have tried to get money from the ATM each day after this line dissipates – only to find that it has run out of cash.

We continued to follow the directions as the route turned to dirt. I briefly questioned the directions, as this had been the route we had ridden the bike in on, and I didn’t remember seeing a hospital. I looked down towards the valley, but Janet went and asked some women chatting in the middle of the road if we were going the right way. I don’t think they spoke Spanish; she replied to us in Quechua – but she knew the word “hospital” and kept saying it as she directed us to follow her scurrying little legs. Even though she looked like she might have been 100 years old, she would have given Olympic speed walkers a good battle. We must have been too slow for her because as she edged ahead, she seemed to resume her previous itinerary instead of taking us to the hospital, which we shortly found.

I saw a sign saying “Emergencia,” and felt a moment of triumph. This hospital might actually function like the lady at the hotel said. We walked under the sign, and into a confusingly laid out building. There was no reception, so I asked around for “recepción” assuming that was close enough. Meanwhile, Janet had walked past rows of indigenous women, most of them with their babies lined up on benches in the dimly lit hallway, and found a window labeled “triage” (with that exact spelling).

At the triage window, they asked if I had insurance. I said no, so they told me to go to the cash register and pay first. The cash register is outside in the dirt parking lot, so I went there and answered the guys questions. I gave him my passport since I don’t have a Peru Identification Number. After I handed it to him, like many people in places we have traveled, he asked, “Que país?” (What country?) Never mind that this sentence doesn’t have a verb – I’m very accustomed to it now as people constantly ask us questions consisting solely of one noun. I mentally filled in the “are you from” that he left out… Usually, I restrain myself from being a smart-ass, but I said, “it says right there on my passport.” Without looking at my passport, he continued to look at me curiously, so I caved and said, “United States.” He seemed satisfied with this. Next, for the paperwork, he wanted to know my name, my mom’s name, and my dad’s name. Then asked my second last name, but then he smiled knowingly: “You Americans only have one last name, no?” I confirmed that this was the case. Next, I paid the 6 Soles for my doctor visit ($1.87), and took my receipt back to triage.

At triage, they told me “not yet…” now I need to go to “Admición”. I walked across the narrow hall, carefully avoiding the broken/missing tiles on the floor, and at that window, they needed my Peruvian ID number once again. Then, there was some confusion about my name on the receipt from the cash register window. “What is your second last name?” – you need that! A guy in the background gently reminded him that Americans don’t have a second last name before I started the explanation. This was enough, and they accepted my passport number in lieu of the Peru ID. They made me a neat blue folder – my medical record – that matched the many on shelves of medical records in the back, and I took that and my payment receipt all to triage. They said, “we will call you when we’re ready.”

I sat down on a humble bench next to Janet as a guy came up to us with a bucket wanting to sell us cheese. He said, “cheese?” We said no, as I rolled my eyes internally about people in Latin America choosing to exclude verbs from their sentences. Another woman walked by with several clear plastic cups containing watery food-colored gelatin for sale. The cheese man went about seeking other customers in the dark hallway, and shook hands friendly with the Admición guy.

“Michelle!” I heard being called. Since it hadn’t been too long, I hadn’t tuned out yet, and I realized that this was probably me. My middle name is Michael. I went over to triage, and the stern lady that looked like a 4 foot nun with thick rimmed glasses and a strong lens prescription that magnified her sunken and over mascaraed eyes. “How tall are you?” she barked. It took me a second to process the word “tallas,” briefly thinking she was asking “what size are you?” My pause was long enough for her to bark it again, and for the other patient in the room to start giggling. Actually, I don’t know my height in meters, so I paused again – vaguely thinking I could get a calculator, finally coming up with a lame, “is this necessary?” She shoved me backwards a couple feet – they had a measuring tape on the wall. The man who had been taking the blood pressure of the giggling woman came by and forcefully pressed on my face so my head would be against the wall, and they placed some wooden block thing on top of my head after grabbing the sunglasses out of my hair.

“How much do you weigh,” she asked. Having seen the scale right next to the measuring tape, I said, “can I use the scale?” She obliged, and barked something out that I didn’t understand while pointing at my feet. I assumed she wanted me to take off my shoes. I began to untie them, but that was wrong. I never found out what that command was, because next we both found that I was 70Kg after she worked the balance mechanism.

Taking my blood pressure and heart rate was not too much different from a non-mechanized version at home. She scribbled all these numbers in a notebook made from that same kind of flimsy brown paper our notebooks were made of in the ’80s. Then she grabbed a calculator and did some math with my height and weight. Normally, I’m “overweight” in the BMI (body mass index), but she reported that “Everything is normal, except your height.” If this was a joke, she didn’t smile. But for here, it’s true. While I’m so short in Norway that my legs are barely long enough to make the urinal work properly, here I can see over the heads of a sea of people at a concert.

I sat back down with Janet who was reading “George the cyclist’s” blog on what looked like a school bench from some US Catholic school in the 60’s. You know you love bike touring when you’re in the middle of a 6 month bike tour, and all of your reading material is other peoples’ bike tour stories. We often read these blogs to each other in the tent, and we sometimes (in the case of when the authors are traveling in Uganda or Mongolia) revel about how our bike tour is somewhat less challenging than those of our entertainment.

This is where the waiting began. From the bench, I took note that almost everyone here was female. Janet joked that the men had better things to do. I watched as a stray dog wandered down the hallway, looking for food.

I was called last – dangerously close to the lunch siesta time – about three hours after arrival. I don’t begrudge the long wait; I assume that my issue was less severe and/or we had arrived later than the others.

The doctor seemed quite intelligent and well informed. He asked what my second last name was… Anyway, I had made a detailed calendar of the progression of symptoms, and the response to my self-medication (and the Cipro dosage intervals). We discussed all the particulars, and the difference between bacteria, parasites, and viruses. I was still assuming this was bacterial, so I asked him if he had encountered pathogenic strains of bacteria that were resistant to Cipro. He said that in Peru, only in the coast. In the mountains, Cipro should work on all strains of bacteria that could be potential infectious agents. Therefore, we decided to do a lab test for parasites. He explained that this isn’t a very technical hospital, so they can only do a microscopy test – looking for eggs or the actual cells of parasites such as amoeba or Giardia. I confirmed the Typhoid oral prophylaxis that we had taken prior to the trip. Conversation was easy, as science and biological terms in Spanish hardly differ from their English counterparts. A lab exam was ordered.

I went the 6 feet back across the hall to the lab, but she said I needed to pay. I went back out to the parking lot and paid 10 soles ($3.05). Took my receipt back to the lab tech, and she handed me a small clear plastic jar, thankfully with a lid. Why the hell are these containers always clear? After asking for some slightly embarrassing help finding the bathroom (given what I was about to do), it was revealed that the bathroom was right on the other side of the 6 foot wide hall. The few wrinkled indigenous women remaining stared at my cup (or so I thought), so I stashed it in my pocket and went into the small room.

I had been dreading this part – and it was looking like it would be worse than I had imagined. No toilet paper, no toilet seat, and no soap. Hmm, no soap in a hospital? Great. So I tried a few manners of positioning, finally conceding to resting my body weight on the seatless toilet. The whole porcelain construction heaved and splashed – apparently it was not bolted down! Rebalancing myself, I focused on the task, carefully releasing a Hershey squirt that I had been saving all morning for this purpose. Upon inspection, I had miraculously delivered it expertly into the small cup with nary a splash. Feeling proud, and unsure of the required quantity, I released another dosage of the juice with no problem.

Even thought the jar had a lid, I restrained myself from pocketing it upon exit, hoping that the staring women wouldn’t notice as I walked across the hall, and hand delivered the now warm container to the young and nice looking lady who would soon be examining it under a microscope.

A few moments later, the lab tech called out about my sample, “Michelle, what is your second last name?!”

Anyway, it turns out that there is no inflammation, no blood, no mucus, no eggs, and no parasites in that swampy mire I handed them. We all know that there’s something in there, but the doctor doesn’t know what. After I went and found the doctor to review the results, he and I talked some more and said that it is really strange. Never heard of these symptoms before that also don’t respond to Cipro. So, I left the hospital with a prescription for electrolytes.