Friday, November 19, 2010

New life for a Glorious old Town

Walking through the town during my first visit in 2005 it was difficult to imagine that Zaña at one time rivaled Lima in wealth and grandeur and was being considered as the capital of Peru. Of course that was some 400 years ago, before pirates repeatedly looted and ravaged the city in the late 1600s, and a flash flood in 1720 completely destroyed the city, leaving only the massive Saint Augustine church standing.

Five years ago Zaña was the stereotypical ‘sleepy little village.’ Located 30 miles southeast of Chiclayo, burro drawn carts, sheep and cows competed with what little motor vehicle traffic there was for room on the dirt streets. The only sounds to be heard were the voices of playing children and barking dogs, along with the oohs and aahs of the occasional bus load of tourists appreciating the grand scale of the church ruins.

These days there is a different sound to the city. Dozens of pieces of heavy construction equipment bearing the name plates of Caterpillar and John Deere are the dominant sound as they tear up the dirt roads in preparation for concrete and asphalt. We were told that of the $15,000,000 allocated to the District of Zaña, a significant portion of that money is being used to replace the city’s dirt streets. And we can testify that every single square foot of every single street is under construction. In great wisdom or folly, the city administration decided to do the entire town at once. The work began last June and is on schedule to be completed by the end of December.

We were also told that $1,700,000 has been allocated to remodel and add on to the existing school – already large compared to schools in similar sized communities. While I have a hard time believing the financial numbers given to us, there is no doubt that the school has been upgraded substantially.

And it’s not just the school and roads getting attention. The city hall has also been remodeled. As we toured the offices we noticed that all of the furniture including desks, chairs, and file cabinets are new…very different from the typically dilapidated furniture usually found in village municipal offices.

The renovation is being done to bring needed modern services to the city, and also to encourage new commerce and increase tourism. I’m not sure that new business and increased tourism will result from modern roads, but there is no doubt that traffic will increase and soon the horns and engines of mototaxis and taxis will dominate the senses. I guess that’s progress. For me…I’m going to miss the sound of the little bell on the lead goat’s neck and the sight of the young child directing the procession of animals down Main Street.


Sunday, November 14, 2010

Medical care in Chiclayo Peru

On Thursday October 14th I experienced what was initially diagnosed as a stroke. For informational purposes I thought readers might be interested in the process I’ve gone through since then together with the costs incurred, as well as an assessment of the quality of health care received. Healthcare was a subject important to me prior to deciding to move to Peru.

Thursday Oct. 14 – I experienced stroke-like symptoms in mid-morning. I delayed seeing a neurologist until early evening when it became apparent my thought process was not clearing up and my speech remained slurred. The doctor listened to an explanation of the symptoms and concluded that I had a stroke. He wrote orders for a CAT scan and EEG. His instructions were to come back when we had the results. His manner was casual with no sense of urgency.
Clinic: Salud Vida
Doctor: Neurologist Carlos Rocha
Consultation cost: $7.20

Tuesday Oct. 19 –We visited an otolaryngologist, wondering if perhaps what I had experienced was actually a problem caused by the severe head cold/allergy symptoms I’ve been having. After listening to an explanation of the ‘stroke’ incident he said the issues were “independent” and suggested I continue seeing a neurologist. He diagnosed me as having chronic rhinitis and prescribed loratadine tablets and mometasone furoate nasal spray.
Clinic: Clinica del Pacifico
Doctor: Otolaryngologist Jorge Melendez Tuesta
Consultation cost: $28.80
loratadine cost: $0.72 each
mometasone furoate cost: $43.20

Later that day I had a CAT scan and EEG done at a different clinic. I was impressed with the professionalism of the technician who did the scan and the neurologist who performed the EEG. Waiting time was only minutes and the procedures were done back to back.
Clinic: Hospital Metropolitano
Cat scan cost: $86
EEG cost: $54

Wednesday Oct 20 – We returned to the above clinic and decided to have the neurologist who performed the EEG do the analysis of the EEG and CAT scan rather than return to the original neurologist. The results of both procedures were completely normal. His conclusion is that I may or may not have had a stroke, but based on three separate experiences I’ve had he is convinced that something is restricting blood/oxygen flow to the brain. He wrote orders for comprehensive lab work involving blood and urine samples, and prescribed two medications; ginko biloba extract to open vessels in the brain and citicoline to repair any undetected damage.
Clinic: Hospital Metropolitano
Doctor: Neurologist Ricardo Mallorga Velasquez
Consultation cost: $28.80
citicoline cost: $3.60 per tablet
ginko biloba cost: $0.72 per tablet

Thursday Oct 21 – Visited a third clinic where blood and urine samples were taken.
Clinic: Integra Salud
Lab cost: $25.20

Saturday October 23 – Returned to the clinic Integra Salud for lab work results. Clinical analysis of complete blood count, complete urine, glucose, cholesterol and triglycerides showed all results to be within normal ranges. The cause of my episodes remains undetected. Recommendation is to continue with present medication, monitor blood pressure twice daily, and return in 30 days.


Doctor availability is a problem. They may have an office at one or more clinics, but they ‘float’ to wherever the patients are. Their scheduled hours at each clinic are limited, not reliable, and vary from one day to the next. Also, the concept of a central coordinating doctor does not exist. For example, a neurologist, cardiologist and otolaryngologist treating the same patient do not seem interested in what treatment is being given by the other doctors or why, or what medications are being prescribed by each.

Family or patient health history forms do not exist to my knowledge, nor were any questions of that nature asked of me. Medical professionals are not accustomed to having the patient be a part of the diagnostic or treatment process. They listen only until they think they have a grasp of the symptoms and then reach for the prescription pad. You need to be assertive to make them listen.

The physical facilities and most of the medical equipment resemble vintage 1950s in the States, even in a clinic that was built just two years ago. The administrative systems and procedures are cumbersome and inefficient.

But the end result is what counts, and in my opinion the health care I received…from diagnosis to treatment has been of excellent quality. I would not hesitate to recommend the clinics and doctors I visited to anyone, provided you follow my advice and insist on being involved in the process. That includes not having a procedure done until you’ve researched it yourself and are confident it makes sense given your symptoms. The same for medications…I researched all of the drugs mentioned above before buying them. Learning that the procedures and drugs did make sense given my symptoms reinforced my confidence in the competency of the doctors.

One final comment based only on impressions. I was not involved in the emergency response system but have observed scattered pieces of it during my two plus years in Chiclayo. The system…from the initial 911 call through transport and reception at an emergency facility is slow and basic. For example, ambulance personnel I’ve seen in action more resemble furniture movers than trained medical technicians. In my opinion, if a situation is life threatening and minutes count you’re probably going to die. If time is not an issue, you have a good chance of receiving excellent medical care.