a year later... taking my final notes from the trip off my phone and onto here...

Scattered thoughts through deciphering my notes throughout the past months...

Peru:
Note on how the clinic I worked in was different from my norm
1. morning rounds with the entire team, at the bedside. Although it wasn't much talking to the patient and more talking over the patient, it was refreshing to see the entire team together and reviewing the cases with everyone involved
2. all paper charting... holy nightmare
3. Knowing or simple introductions to the patient and family was absent
4. answering personal phone at the bedside is acceptable, woah... weird concept for me.
5. lack of sterile technique used... reusing most supplies for lack of ability to get new one, including gloves
6. hand washing and "foam in foam out" non existent, no soap in the bathrooms even
7. patient rooms ALWAYS had accommodations for family members... so awesome
8. no interpreters available for non-spanish speaking patients, which is hard since the clinic gets a lot of foreign travelers
9. clinics here are more like mini hospitals rather than the typical outpatient clinics that the US is used to
10. ergonomics non existent... beds were old school and didn't change height/position... rough on the old back.
11. medications are for each patient are all kept in the drawer next to the patient bedside... didn't realize how uncomfortable I was with that and how little faith/trust I had in patients
12.  For each procedure that needed to be done, staff would go out and buy the supplies needed, nothing was stocked as to not waste money on expired or unused supplies, worried for me emergent situations
13. tips for nurses was highly encouraged, lol

Peruvian food:
Mote: large corn kernels
Choclo: large corn
Cuy: guinea pig, cusco delicacy
Lomo saltado
Frutillada: corn beer with fruit
Matasca: rice with stew
Creama de espinaca: green soup
Locro de zapallo: rice with italian pumpkin, potatoes, vegetables, cheese
Revuelto de fideo: noodles of different colors, meat, vegetables
Arroz Tapado: rice on bottom, top with meat, raisins, nuts, vegetables in middle
Alfajorcito de maizena: dessert

Restaurants:
Cicciolina: expensive place with courtney near plaza
Cusquenita: place where we ate cut
Morena: place with awesome pizza with Julia and lindsay before puno, flowers on food
Paddys
Jacks
Cappuccino: in plaza, great coffee, overlooks the plaza
Papachos: burgers, near paddys
La Bondiet: pastry shop with awesome chocolate cake
Ulrikes: place in pisac, ate at when we were really hungover

Peruvian music:
Mala Juntera: tu eres para mi
Juanes
Hill song music spanish
Fiel su presencia
Viva estas
HA-ASH
Fanny Lu
10/29/14 - concert we saw, Yarita yasa
**playing for change (Colombia)

Sri Lanka:
Blog ideas:
learn to not always ask questions about what I'm eating and just try it because more often than not, it is going to be delicious.. ask later.
Not did and never will get used to seeing army guys walking around with massive guns...
Crazy how unpredictable labor can be, for example seeing a 4cm primip deliver before an 8cm multip

Labor and Delivery work notes:
Dr. Saman - OB consultant
Vaginal deliveries: 42
IUFD: 2 (baby goes into cardboard box, no contact with mother)
Vacuum deliveries: 1
Twin deliveries: 1
Episiotomies: 41
baby to mom: 12 (approximately 30 seconds to 1 minute, never skin to skin)
manual placenta removal: 2
C/sections: 3
shoulder dystocia: 2

Differences:
1. episiotomies with every patient, if no episiotomy staff panic
2. intermittent catheterization after every vaginal delivery
3. one room with 7 beds, curtains used minimally
4. once admitted to labor room, patient stays in bed, no room for movement
5. no use of doulas... other than me
6. minimal pain medication used (fentanyl and pethidine and other before 6 cm, nothing after)
7. babies to warmer, minimal contact with mom until after episiotomy repair completed. no skin to skin. baby left under warmer unattended, no VS or assessments completed (1st day, I was assessing a newborn that turned blue... makes me wonder what would have happened if I hadn't been there)
8. 10 units pit given following delivery IV, no fundal massage or other third stage management. sometimes ergometrine, syntometrine
9. constantly have videos playing for breastfeeding and baby cares on their mother/baby unit, very cool
10. once mom is complete (10cm), they will start pushing... with or without contractions... how exhausting
11. patient given oral antibiotics after ROM... which is immediately once they are in delivery room
12. time of birth of very important for astrology purposes and is only told to the mom and dad
13. some cultures here, on the tenth day, the head of shaved, nails are trimmed and the naming process is started
14. minimal fetal monitoring, when done it's with a mini megaphone type thing, I couldn't hear anything... no monitoring once pushing has started
15. with manual placenta removal, after 10 minutes and injection of oxytocin into the umbilical cord, sometimes use pain meds, mostly not
16. always have an excess amount of staff
17. filaria/filariasis from mosquitos
18. vacuum delivery after one hour of being fully dilated and done by the doctor
19. push without contractions, one position to push in midwives push on the tummy to push baby further down
20. twin deliveries done by midwives and in labor room, no ultrasounds between deliveries
21. lack of sterile technique
22. no bulb suctioning after delivery, no VS or assessment on baby
23. king coconut water given to mom's during labor, nothing else

Things I have taken note of and hope to learn from:
It's crazy how much we/people are complaining/being critics 24/7... recognize that and understand that you have not right. There is a time and place for you to express those feelings
How important and how much I value independence
How much I value family and even little things like eating meals together
Importance of language in the work place, how lucky we are to have interprets but also how little the US stresses and values language... I've met so many people who speak 1-5 different languages, what an awesome quality to have.
mutual respect and mutual learning is awesome.
Communication among staff in the workplace is vital.
trusting in one another - here people want to know you and know more about you but in a genuine manner, stop thinking that people are being nosy or crossing a line when most the time they just want to know you on more than a surface level - ex: nurse that invited us into her home and introduced us to her family
value of privacy
importance of cultural humility and respecting cultural practices as difference and never bad
Importance of empathy and being gentle
how much people, myself included, need to come to terms/accept the way we are as us and not as what we think other people want to see.

Look up:
NICE guidelines
Magazines: MIDRS, BJM

Things I will miss about Sri Lanka:
the hill country... one of the most beautiful things I've ever seen
the storms... crazy thunder and lightening and so relaxing
the beach
Work, it's crazy how close we became with the staff in the delivery room, they never stopped amazing me with their skills and also their excitement to learn from me too
my host family/host sister, I can't begin to understand how hard it must be for them to do that, they were the most welcoming family ever and so interested in me but also SO excited to teach me about their culture
the buddhist culture, these people are so passionate and knowledgable and their cultural practices amaze me, one of the most interesting cultures i've come across
lazy afternoons reading
tuk-tuks - those things are crazy and sometimes life threatening but so fun
all of the exotic animals and lizards on my walls

Things I am excited for about being HOME
organized traffic
sidewalks
proper bathrooms
work
my bed. my bed. my bed.
christmas lights/holiday season/winter activities
coffee
stability

Wednesday 12/17/14 only ten days left :(

After work and lunch today, Felicia (another volunteer in my same hospital) and I met up with one of the nurses that we have gotten really close with. She has been saying for weeks that she wants us to come see where she lived and meet her 2 year old daughter. We didn't think much of the friendly banter until Friday of last week when she wanted to schedule a time. She picked us up in a tuk tuk and brought us about 10 minutes from the hospital to her home. She lived in a different part of Panadura than we had been shown. The neighborhood that we live in is right off the main road, close to all of the placements. Her house was further into Panadura and each home had a lot of land and gardens and shrubbery. It was very pretty. There was more wild life, a million different types of trees and plants. Her house was really cool because you went downhill on a longer than normal drive way to an opening in the shrubbery to her house. She lived with her whole family (parents, husband, daughter, house keeper). Her father and her were so excited to show us their land. Her father, who didn't speak much of any English, would start explaining and telling all these facts about the trees and garden area and our friend would have to translate. It was really nice to see how excited they were and how passionate they were on their way of life. The nurse's mother had prepared some pancake type dish with coconut on the inside, it was delicious. We tried a new kind of tea with ginger in it and it was equally as amazing. and the entire time that we were chatting and listening and eating, the nurse's 2 year old daughter was running around and speaking to us in Sinhala and so excited to have us there. She kept telling her mom and the grandparents to leave the room so that she could hang out with us alone. It was very fun. The little girl also wanted to show us "the bridge," so we took an extra little trip to a bridge that had been built about 4 year ago over a very pretty river. Apparently, before the bridge was there, there used to be a man with a boat and a rope that extended from one side of the river to the other. You would get in his boat (and pay obviously) and he would pull along the rope to bring you to the other side. So, the development of the bridge was a big deal. When Felicia and I got back into town, we went out and brainstormed little gifts that we could get for the little girl and the nurse as a thank you. It really was a generous day on her part and we really enjoyed it.

Tuesday 12/16/14 England vs. Sri Lanka

After work and lunch most of the regular volunteers and all of the 2-week special group traveled into Colombo for the England vs. Sri Lanka Cricket game. It was the last game of a seven game tournament type thing. We spent pretty much the whole game chatting with a guy next to us as he explained all of the rules. Cricket is an incredible complex game with a million rules/regulations and one game can actually last days. The atmosphere was awesome and made me really miss college football/college sporting events in general. Apparently, cricket is usually a very sophisticated game, people dress up very nice and the crowd is usually very quiet. Not here. Sri Lanka is so proud of their team because they are ridiculously good. Sri Lanka had already won the series by a lot. The crowd was CRAZY and I loved it. There were three Sri Lankan players that were retiring after this game, so it was a big deal and there wasn't an empty seat in the place. When we were walking in, people had actually broken one of the metal poles of fencing and were climbing through in order to see it. I would be really curious to go to a game in Europe and see how different it is. Overall, a super cool, unique experience.

Monday 12/15/14 Galle

Per usual, worked all morning. Work is still going really well. We are making really good relationships with the nurses and the doctors which is great because they chat with us quite a bit and are understanding us a lot better.
Right after work, we hopped on the bus down to a town called Galle. It is in the South of the island. We were specifically going to the Galle Fort... a place where the Europeans settled. It had lots of shops and old architecture that was beautiful. We had an awesome day so it was nice to walk about in the sun. I bought the coolest book end EVER. It is wooden and hand carved, one end is an elephant front and the other end is the butt. It's sweet and I'm gonna use it to display all my records which will be cool. I'm really excited about it, if you couldn't tell, except they wrapped the crap out of it, so I can't even open it up to admire it's coolness until I get home. We watched an incredible sunset on the way home but once the sun was down we ran into this crazy storm... plus the president was in Panadura today so traffic was completely bonkers. Needless to say, it was good to be home once we finally got there.

Saturday 12/13/14 Kandy

Last night we arrived in Kandy. It is a small town in pretty much the dead center of the island and is a popular tourist spot. We started out the day in the Botanical Gardens which were absolutely amazing. I happened to have my student ID from the UMN with me so I got a very nice student discount :) We wandered around the gardens for a couple hours but could have easily spent the whole day there. The place was gigantic with so much to look at. Without a map you could definitely get yourself good and lost. It was one of those places you wanted to be with your significant other, romantic stroll... maybe throw a picnic in there or something. You immediately think of that because scattered through the gardens, there are couples EVERYWHERE cunuddling (sp?). So it was a miss Tanner kind of morning :)
After the gardens, we went through the markets. We started off, apparently, in the wrong markets and one of the shop keepers walked us to the right one and proceeded to hang out with us through the markets and help us navigate our way which was cool. Bought a ton of stuff and definitely got ripped off more than once but oh well. The markets were nice and not as "in your face" and some of the others so that was a relief.
In the afternoon we went to a Kandyian Dance performance. It seemed similar to the ones that I had been to in Peru (obviously not Incan, but the general concept). A little stranger and not quite as elaborate. The end was the coolest part where two of the dancers sang a song and prayed before they walked on fire...more than a couple times. It was so cool and everyone got to gather around to see it up close.
The 2-week special group (16yr olds) were also in Kandy this weekend but had their own itinerary, however, we ended up seeing them at the conclusion of the night at the hostel. What turned into a leisurely chat with ice cream ended with me performing a sternal rub to one of the girls who walked off and went unconscious. A couple of her friends found her hanging over a balcony and luckily we had decided to go to bed at that time and we ran into them trying to wake her. Thankfully, but what took longer than I would have liked, she came around but took a long time to become oriented to what was happening. She had quite the sore chest the next day but was happy she was feeling better. They think she might have had a reaction to the malaria medication she was taking. So I went to bed that night a little on edge, but thankfully everything turned out just fine.
We did a little site seeing the next morning, but ended up taking a train back into Colombo around 10:30am. From what we had heard, the train was to take about 2.5 hr compared to 5 hr on the bus and the view was worth it. We got to the station and on the train almost 45 minutes early because we just didn't have anything else to do, and thank god we did because it was already pretty much full. Well, we came to find out that although the view is awesome, it may not have been worth the unbelievably PACKED, HOT HOT HOT, 4.5 hr train ride. But... it's all part of the adventure right?

Thursday 12/11/14 Balance

Today was Visa day. Two other volunteers and myself had to travel into Colombo to get our visa renewed at the immigration center. The whole process is incredibly long and causes quite a headache. You start by having to pay to get your picture taken which was stupid cuz they didn't even glance at the picture or really the form we filled out in general. Then you have to give them your passport which scared me a bit. You end up having to "take a ticket" wait 1 hr, "take a ticket" wait an hr, and the process continues until you get to the end where you have to pay..... and the clerk tells you your request doesn't exist and you have to start the process over. So that was fun. While waiting all of this time we chatted with our projects abroad visa rep and the topic of tattoos came up. After a long discussion the other night with my host sister about the Sinhala language, I had her write out "Balance" in Sinhala symbols in the thought of potentially getting that as a tattoo before I left. So during this period of waiting, I decide that today would be the day... just gonna do it. So after the visa process was completed we headed to a tattoo place (don't worry mom and dad, the place was recommended to us by a projects abroad staff and everything was sterile and went well). haha with that said, I never would have walked into this place otherwise. There were two places that we were to check out. One was super ritzy and with that, super expensive, so that was out. We walked down to the next one and from the outside it looks kinda like a tailor or small clothing store and then you walk behind a curtain and there was a one-seat tattoo parlor. cute family-run place with a little 1-2 year old boy running around and a movie playing in the background... it was actually a nice distraction during the inking. Overall, love the tattoo, it's on the inside of my left ankle and is totally awesome :)

Saturday 12/6/14 World's End

Last night we arrived in a town called Nuwara Eliya. It is in the hill country (the middle of the island) and is so beautiful. Just passed Adam's Peak, there is a national park called Horton Plains, which is where World's End is located. The whole trip is, generally speaking, a hike through the national park with stops along the way, one of which is "worlds end." We started the trip at about 0530 in the morning because in the hill country the moisture that settles on the land overnight starts rising once the sun rises and the place gets really foggy. The national park is absolutely gorgeous with lots of wildlife, different trees, plants and flowers (mom and dad, you guys would have loved this place, right up your guys alley). Our first stops along the trail was mini worlds end and a bit further is greater worlds end. We decided to go in the morning so that we could have a far view of the hill country. When you go on a really clear day, apparently you can see all the way to the ocean. We had wonderful clear weather but still had some clouds and there was just a little bit of fog so we weren't able to see that far. At about 10:00 in the morning is when the fog rises up through the national park and blocks all views of the land, hence why it is called World's End because when you get there it seems as though there is nothing left and nothing past the wall of clouds. These clouds are called the Cloud Forest. The views we had were amazing and we arrived before the fog so could see pretty far which was cool. The next stops were a huge waterfall and a pretty pond. We had to cross over a stream to get to the pond and when I attempted to cross, slipped off my rock and my foot/leg slid into a mud hole, so that was fun. Ended up jumping into the stream and attempting to clean up. Overall it was a great morning, nice weather, amazing views, per usual one hiccup, and a relaxing hike. Total it took most the morning, about 4 hours.
After lunch and a thorough shower to get all the mud and dirt off of me and my clothes and shoes, we went on a tea plantation tour. It was short but sweet. We had to wear really attractive outer clothing into the factory so we had fun making fun if each other. The weather turned a bit cloudy and a little rainy but we got the tour through the factory and learned how they made the tea and packaged it and whatnot. Apparently the tea plantation we were at sells its tea to only local companies which I thought was kinda cool. After the tour we relaxed and had an awesome cup of their tea.
After dinner we had such a relaxing evening at the hotel. We had a fireplace in our room... So romantic!! Haha but it was nice and warm (the hill country is significantly cooler than the costal regions, like pants and north face cool which is a nice relief from the heat during the week). We all cuddled up on the bed and fell asleep watching a movie.
Had such a nice and relaxing weekend.... It will be good for me because when I get home on Sunday, there will be 7 other volunteers staying in my host house for the next two weeks........all 16 yr old. Lol so that should be interesting... Stay tuned.