Peru Trip 2009: Stranded on Uros Island

It´s been a little over two weeks since Thomas and I have been traveling in Peru. We have received excellent hospitality in Lima, made our home in a little family-run hostel in the historical and beautiful city of Cuzco for one week, trekked the famous Inca Trail for four days to get to the Lost Inca City of Machu Picchu, slept on the small island of Taquile and set foot on the one-of-a-kind floating island of Uros on Lake Titicaca near the city of Puno.

We have met many interesting people and things were going very smoothly for two non-Spanish speaking people in a South American country…until we got to Uros Island. I was guilty of picking the convenience of going with a pre-arranged tour group instead of going independently, where the local people would have benefited more from my expense. I figured we only have about two days in Puno and did not want to spend that time trying to look for something myself given my language limitations.

We got into Puno on Friday evening and had our hostel arrange the trip for us the next morning. Things went smoothly and we got on the boat with six other people from our hostel at 7:00AM. We felt a little lucky to be with them because they know both English and Spanish. Our boat of about 30 passengers, left at around 7:30AM along with at least ten others, heading for Uros Islands, the only islands in the world made of totora roots and reeds. About 45 minutes into the trip, we arrived in a floating island with a big reed watch tower in the shape of a fish. The tour guide gave us a short history of the island and showed us how it was made, with the help of a local man and some visual aides. After the presentation, he told us we could take a ride on the reed boat for an extra charge. My husband and I got on the reed boat that was about to leave. We were enjoying the ride and took many pictures of the surrounding floating islands. Thomas even got to paddle the boat just for fun.

We got dropped off at an island across from where we landed, went into home made out of reed and got a glimpse of the life-style of these islanders. We were amazed to find that they were pretty technologically advanced in a certain sense. They have solar panels, televisions and radios in their homes. After the home visit, we walked outside and saw our boat taking off without us! We waved at it but it just zoomed by us. A wave of panic went through us. We helplessly explained to the islanders what just happened in English and they talked back to us in Spanish. We finally got another tourist to translate and got ourselves back to the island where we landed.

We talked to the captain and tour guide from another boat from the same company and they asked us the name of the boat and tour guide but we could not answer the questions. After numerous calls, they decided to take us to Taquile Island on their boat and assured us that they will help us find our backpacks with the stuff that we needed for the overnight stay at Taquile. We were really upset but tried to stay calm…

Our relief came when I looked over my pictures and showed the new tour guide our original tour guide. She then made a phone call and then assured us that our bags were still there and we would get them when we get to Taquile. What a big scare!

Peruvian Hospitality

Today was our third day in Peru but really the first day on our own! We have been spoiled by our host family, the Lopez, whose youngest daughter, Evita, is Thomas´former coworker´s current coworker! Evita learned that we were traveling to Peru for the first time and insisted that we stay with her family in Lima. What´s more amazing is that her older sister, Zara, is a travel agent and can speak really great English. She was waiting for us with a ¨Thomas Vuong¨ sign as we exited the baggage area. When we got to her van, she immediately said: ¨I have to go pay for parking. Please have a seat. It´s your car!¨ That totally took me off my feet because there I was, standing in front of a woman who I had never met or talked to before in my life and she was so nice to Thomas and I.

We received the same kind of warm welcoming when we walked into their well-maintained home equiped with all the modern American amenities. Lunch and dinner were made and brought to the table for us by Christina, the mom, and Gianina, the 29-year-old niece. No matter how hard we tried, they would not let us help them with the cooking or cleaning. In addition to the meals, we were given our own room (I later found out that the little brother, Benjamin, had to temporarily stay in the same room with Gianina so we could enjoy that luxury). All our other needs were well attended to and I felt so spoiled.

Zara spent the whole day off work on July 13 to accompany us on our tour of the city that she had planned with us the night before. Moreover, she refused to let us pay for the admissions fee to the San Francisco Monastary, the Cathedral and the Gold Museum and the expensive parking fees in different locations. I felt better when she did not resist letting us pay for a splurge in the ocean-front restaurant, Mango, for lunch in Miraflores.

The hospitality topped off with her waking up before four in the morning to drive us through the un-policed (dangerous) road to the airport. She also insisted on escorting us to the gate, but luckily, we managed to send her home before too long because of our five hour delay on the flight to Cuzco with TACA.

I don´t know how we can ever repay the Lopez family! Their hospitality, while well-received, leaves me feeling really uneasy.

Peru Itinerary

The much anticipated trip to Peru is finally here! After a lot of reading using the Lonely Planet and talking to others who have gone to Peru, my husband, Thomas, and I decided on the itinerary below. Most of the things written here are tentative. So far, we've only had the round-trip flight to and from Lima and the one from Lima to Cuzco booked. The Inca Trail Trek was also booked in late January to secure our spaces since the government only allows a limited number of people on this trail each day. We will play it by the ears on the dates and locations of other items on our list.

Here's what we have planned:

July 12-13 Lima
July 14-19 Cuzco
July 20-23 Inca Trail Trek to Macchu Picchu
July 24 Cuzco
July 25-29 Lake Titikaka Area
July 30-August 3 Ariquipa
August 3-7 Lima

Therapeutics-Oral Exam

Four hours before my first oral therapeutics exam, I panicked! My heart was racing and my mind could not focus on the task at hand: reviewing the materials that I still need to memorize! After a good greasy meal at Panda Express and a few minutes of stress reduction breathing techniques, I was able to calm myself down.

Thirty minutes of preparation time went by extremely fast. I barely had enough time to scribble some information on each column of the SOAP sheet for the two major conditions before time was up. I thought I was pretty calm before the presentation, but I found myself stumbling over my words and losing my train of thoughts a few more times than I would have liked. Luckily, the examiner was nice enough to ask me questions to help me bring up some of the points that I had missed.

At the end, the examiner had two minutes to evaluate my performance and she was very kind to say only good things. I asked her whether I got an automatic fail (it happens when you pick a contraindicated treatment that can potentially kill the patient) and she said no. If I had to assess my performance, I would give myself a 7.5 or 8 out of 10, which I think is okay for the first time. I wish it was better, but I'll try not to be so critical of myself.

Pharmacy Legislative Day in Sacramento

On April 22, 2009, pharmacists and student pharmacists all over California gathered in Sacramento to represent the voices of the pharmacy profession.

The day started with updates on the important legislative issues currently being advocated by the California Pharmacist Association (CPhA). The informative session ended with a light-hearted keynote address from Assembly Member Jerry Hill from District 19 in South San Francisco, encouraging the audience to be proactive in the legislative process. To drive home the point, he gave an example of the persistent around-the-clock phone calls by the same group of people repeating the same message they want his fellow colleague to hear. He added that there are many stake holders involved in the process of law-making and the quiet ones will usually be ignored. Therefore, if we do not want the politicians to dictate the policies that drive our profession, we need to make our voices heard.

We indeed did on that day by meeting individually, as well as in groups, with senators and assembly members from our respective districts. Among the important issues we asked for support was the bill advocating for pharmacist-administered flu and pneumococcal vaccines without protocol (prior approval from a physician). Allowing pharmacists, the first-line public health resources, to provide these immunizations will greatly enhance access and decrease morbidity and mortality from these diseases.

We commemorated the annual event with a picture of pharmacists and student pharmacists in white coats on the steps of the Capitol. It was truly amazing seeing so many in the profession moving it forward.

Therapeutics!

Spring quarter of the second year marks the beginning of a series of therapeutics courses that drives all of us to the brink of stress-induce anxiety episodes. The class is 6 units, which composed of 6 hours of lectures and 1 and 1/2 hours of conference weekly AND many many hours of self-study. It incorporates all the relevant subjects we have learned thus far in pharmacy school (physiology, pharmacology, pharmaceutical chemistry, biochemistry, etc) in one giant and scary class.

There is so much to memorize and synthesize. The worst part is that we don't get to use our notes in conferences, when we have to read cases and decide how to best treat the patients. There are so many acronyms and lab values that I have never seen before. Furthermore, it feels like I am racing through the materials without having enough time to digest them even though I have reviewed the relevant lectures before each conference.

Our first oral exam will be coming up next week. We will have thirty minutes to read the case, write all the pertinent information down in a Subjective/Objective/Assessment/Plan (SOAP) format and then fifteen minutes to present the patient with the treatment recommendations and counseling points to the examiners. I definitely need to practice with my classmates before the exam!

Positive Energy

I have heard a lot of great things about this elective called "Heart Matters in Pharmacy" and finally decided to squeeze it into my schedule. It's really interesting and unlike any other in the health care profession. In this class, we actually take the time out to tend to our right brain to achieve a balance in life. Each session would always start with a few minutes of feeling appreciation by first focusing our attention to the heart and breathing slowly and deeply. Then, we turn our thoughts to appreciating a person, thing or animal. This is called "the heart coherence technique" and the director of the course informed us that it has been proven to reduce cortisol (stress hormone) levels. I totally believe her, not only because she is a well-respected faculty member, but because I can feel the parasympathetic effects even with only a few minutes of practice each day. It reminds me of the period of my life when I actually took time out to meditate on a daily basis.

Practicing the heart coherence technique has a similar calming effect as meditation. However, I think I like the heart coherence technique better because it actually forces my brain to dig out the positive things in my life and be grateful for them. It feels much better to have positive thoughts and have an appreciation for life, people, animals and things.

Each class session, we also get to listen to our role models in the field of pharmacy (actual working pharmacists) share their stories and insights. Often, we hear about their tragedies and how they dealt and moved beyond them. They also share their insights about balancing work and personal life. Being at UCSF, we normally see and hear about the achievements and awards of these pharmacists/professors. It is a privilege to have the opportunity to hear the stories told from their hearts. I know it takes great personal strength to be seen in front of the class with so much emotional vulnerability.

This class is definitely one-of-a-kind in pharmacy school and I'm glad I am experiencing it. At the end of every 3-hour class, I feel rejuvenated and relaxed, as if I had just practiced yoga.

I Can Live with My Decisions

"A leader must be able withstand hostility and not back down on her position if she thinks she is doing the right thing," says a faculty member during our current conversation. That statement totally alleviated the little doubts that I had about my recent difficult decisions. For the most part, I believed that I was making the right choices, but that confirmation put my mind to rest. I will continue to live with angry people (at least for another week), but I am glad I did not trade making the right decisions in order to make others happy.

Standing up for myself is my new friend and our relationship is at best awkward, and leads to many negative reflective moments and emotions. I feel extremely blessed, though, to be at UCSF, an environment where that relationship is nurtured.

Human Relationship is A Work of Art

"I'm going to remove myself from the mass and live in the wilderness someday," I told my good friend as we were dreading the need to make small talks. I discovered that my art of language is not really as refined as I would like for it to be. I let emotions get in my ways and hurt others with my words and actions. Many times, I also do not say what I need to say in order to make my intention known in a gentle way. As a result, I get stuck in awkward relationships that takes months, sometimes years, to semi-normalize. Hurtful words are like knives; once it pierces the flesh, there aren't many ways to restore it to the original condition. A scar will form after the healing process, serving as a reminder of the unpleasant experience.

My Parasympathetic System is Not Working!

It's the last week before finals. I have not studied for any of the six exams that I will have to complete by the end of next week. I am dealing with angry forces in my apartment. I lie in bed at night, obsessed with negative thoughts. I can't focus in class or in my study because I am too sleepy. My bowels are not moving as they should. When will my parasympathetic system work again? After finals...perhaps? That would be too late. I don't know what a mess I will be by then.

Universal Healthcare

Health Policy is one of the classes that I really enjoy this quarter. I find the topics presented in class extremely thought-provoking. We learned that adopting a universal healthcare system for the United States can potentially reduce healthcare costs (currently 16% of GDP), lead to better access and quality of care and eliminate the 16% uninsured population. Proposals for universal healthcare has been tried and failed. However, the lecturers for our class seemed confident that if any big changes in healthcare were to happen, it would be more likely with President Obama in office.

Although I really hope to see a universal healthcare system in the United States, I would not be surprised if it does not happen during my life time. I think most Americans are too individualistic and capitalistic to think about the big picture. Unless there's a push with the magnitude of the Civil Rights Movement, our healthcare system will remain to be dominated by different players, each seek to maximize their own benefits.

Therapeutics

Although I'm excited about finishing up another quarter of my pharmacy school experience, I have to admit that I am slightly worried about next quarter's curriculum, which includes a 6-unit course in therapeutics, where we need to integrate all the knowledge that we've accummulated for the past five quarters and memorized many different medication dosages, side effects, indications, drug-drug interactions, etc. I hope I won't fail the first therapeutics exam like the majority of the members of the class of 2010 did during their first quarter of therapeutics. It sounds very scary!!!

Insomnia, My Stupidity and Lessons Learned about Human Nature

It's 1:30 AM and I can't even get a wink of sleep although I'm physically and mentally tired. My mind is clouded by a huge decision to make: to continue digging the hole that I have made for myself and make everyone happy or to go with my gut instinct, which has been tainted by a prior financially costly experience due to trust, and piss everyone off?

To the people directly involved in this sticky situation, my definition of "digging a hole" is really no big deal at all. They would say: "You are shooting yourself in the foot with this stubbornness. People don't play by the rules all the time. There's nothing to worry about." If I was 24 or even 28, without the nasty lessons that I had to learn the hard way, I would agree. However, this situation is obviously causing me enough stress to stay wide awake despite my physical and emotional fatigue. Contracts are there for a reason: people want to protect themselves against others. Humans are irrational creatures and their behaviors are not predictable. In addition, with very few exceptions, people usually look out for themselves before others. I don't believe that my concerns are invalid...

What has this mess taught me, once again? For one, I am truly not made for finance management and I will try my best to avoid them in the future. I will be happy if I can keep my checkbook balanced. Secondly, I need to assess things carefully before committing myself to any responsibility, thinking that I can do great things. It's too bad that I am beginning to question the purpose to the "great thing" that I had set out to do in the first place.

Capstone Project

All second year pharmacy students at UCSF have to complete a pharmacokinetics assignment called the Capstone Project. Working in groups of 4-6 members, we were responsible for asking an interesting and clinically relevant question related to pharmacokinetics, finding the answer to the question, validating the answer with calculations, graphs and charts, organizing the information professionally on a tri-fold poster board and presenting them to our classmates, TAs, professors and faculty members.

After spending many hours in research, discussions, writing and revisions, we finally finished the poster one day before our oral presentions. Our hard work and team effort culminated in a very professional poster and many skills and lessons learned.

I learned that although group work is extremely difficult (especially when everyone is so busy), when a team finds ways to work together and draw on the strengths of each member, excellent results can be achieved. I don't think any one of my group members alone could have produced such an amazing poster. Each one of us contributed to the project in different ways to make the project a success (although I must confess that I initially thought that I did not have much to contribute).

Without this project, I would not have learned so much about the treatments for patent ductus arteriosus, a condition in which the hole between the aortic arch and pulmonary artery does not close after birth. During the poster session/presentation, one classmate also told me a very interesting fact: adults with partially open ductus arteriosus should not dive because the high pressure can cause the duct to open, which can lead to death.

The process of completing the Capstone Project was slow and painful, but I see the value in it and feel grateful for my professor, who spent many hours beyond her call of duty to lead all of us into the right directions.

Cherry Blossoms

Late winter/early spring is one of my favorite times of the year in San Francisco! The side walks are filled with the soft pink colors of cherry blossoms. Although I was supposed to study for my midterms, I decided to capture the images of these fragile lives at the peak of their beauty. Here's one that I sort of like but wish I could get better images with the limited amount of time that I had to spare.

Hail

Yesterday morning, when I opened the door just less than 10 minutes before the physiology lecture, my first class of the day, I could hear the thunderous sound of the rain and see it pouring down heavily. I hesitated for a few seconds, thinking to myself: "Should I wait for the rain to die down before leaving the house?" With a lot of courage and the determination to be on time, I decided to brave the rain with my little bright blue umbrella.

Just as I walked down the steps, I saw droplets of pearls falling from the sky and immediately felt extremely lucky to be in the right place at the right time. This was only the third time in my WHOLE LIFE that I have seen hail! I took in every moment of it as I walked up the 45-degree incline of 3rd Avenue, while minding every step in fear of letting those tiny balls of ice roll me down the slippery slope. The sound of those heavenly gems hitting my umbrella and the sight of the green field covered with white balls of ice definitely were the highlights of my day! Ah, how Mother Nature has the power to bring joy through small wonders.

EXAMS EXAMS and MORE EXAMS

It's been hard to enjoy learning lately. All I do is studying for exams (we had two midterms last week and three this week). I feel like I'm not going to retain much of the things that I try to cram into my head in order to pass the exams. I wish I had more time to digest the materials and make studying a means for meaningful learning. Lately, it's been mostly about passing exams. When am I going to have time to learn?

Class of 2013

I had a chance to chat with the interviewees for the pharmacy class of 2013 today. I, along with other classmates, volunteered to accompany the afternoon group for one hour, with the intention of calming their nerves before the interviews. Their anxiety and eagerness reminded me of how I was two years ago, when I was in the same position. Although I no longer wish to go through the same kind of anxiety, I do admire their passion and enthusiasm.