Peru | Cusco and the Sacred Valley

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BY MIKA NAGAMOTO

Peru is an incredibly diverse country with endless adventures and destinations for travel. After my travel study program, I was eager to explore the areas beyond Lima. My family decided to fly out to meet me after my program and together we spent two weeks exploring Cusco, The Sacred Valley, and Machu Picchu. It was an unforgettable journey.

Cusco

The day after my program ended, I took an hour-long flight to Cusco where I met up with my family. Cusco has a whomping elevation of 11,152 feet so we wanted to make sure we were well acclimated before starting our adventures. We spent the first two days acclimating by exploring the many restaurants and museums in the historical capital of the Inca.

We visited several impressive colonial churches such as the Catedral de Cusco, Iglesia de San Blas, and the Compañia de Jesús. Entrance fees for these churches were about 10 soles for adults and 5 soles for students with a university ID. To learn more about the origins of the Incas we went to the Museo de Arte Precolombino. The “MAP” has several galleries of sculptures, textiles, metal-work, and artifacts from 3000 years of Andean art. My favorite destination in Cusco was Sacsayhuamán (spelled various ways). These are ruins located in the mountainous outskirts of the city. We explored the remarkable religious sites, enjoyed the open views of Cusco, and even played on the Inca slides made out of unique rock formations. Entrance to these ruins is around 70 soles and many companies offer transportation and tours in English. It is also only a two-kilometer hike to get to the ruins from Cusco.

We were overwhelmed by how incredible the food in Cusco is. For breakfast we loved Qura (a small coffee shop with the best avocado toast), Japeita Coffee Break (a locally owned coffee shop with great empanadas) and Monkey Café (the best coffee we had in Peru). For lunch and dinner, we went to Pachapapa (a cozy place for traditional Peruvian dishes), Limo (Japanese-Peruvian fusion with great cebiche), MAP Café (located in the Museo de Arte Precolombino, elegant but pricey food), and Chicha (Peruvian fusion with great drinks). While these were some of the nicest restaurants in Peru they were all pretty reasonably priced especially for the quality of food. We enjoyed every meal immensely and wish we had more time to visit many other great restaurants.

Sacred Valley

After exploring the city of Cusco we spent a couple of days visiting the Sacred Valley. There is an overwhelming amount of options when it comes to tour companies that you can use to visit Cusco and neighboring areas. We decided on the Sam Travel tour company because of their emphasis on fair-pay and using local guides. Our tour guide picked us up in a van and we spent the day driving to various locations around the Sacred Valley.

We visited the Santuario Animal de Ccochahuasi: an animal sanctuary where condors, spectacled bears, andean wild cats, andean geese, alpacas, and vicuñas find shelter and rehabilitation.Tours are given in both English and Spanish and visitors get a chance to have close interactions with the animals living there. This sanctuary also sells beautiful textiles made by local communities nearby.]

Next, we went to the Salinas de Maras. These are salt evaporated ponds where local families mine minerals from the streams flowing from the Andeas Mountains. It’s rather incredible how uniquely beautiful these mines are. The salt harvested from the Salinas de Maras is full of flavor and sold by the families for cooking and cosmetic uses.

Near the salt mines is the Moray Ruins. This fascinating archeological location is the site of agricultural experimentation conducted by the Inca. These concentric terraces of varying elevations created microclimates where farmers tested the ideal temperatures and elevations for different types of potatoes, corn, and other vegetables. Many researchers believe that the experiments conducted in these terraces led to the large varieties of Peruvian potatoes.

Our final destination in the Sacred Valley was the Ollantaytambo Ruins. These ruins were created by the Inca ruler Pachacuti as a ceremonial center for the surrounding town. Visitors can explore the terraces, temples, and storehouses built by the Inca in the mid-15th century. The town of Ollantaytambo also has a train station that many tourists use to transport to Machu Picchu. My family and I stayed in a hotel near the train station to prepare for our trip to the infamous Machu Picchu.

Mika Nagamoto studied abroad in Lima and Iquitos, Peru, in summer 2018: https://ieo.ucla.edu/travelstudy/GlobalHealth-Lima/

Peru | Revealing Disparities in the City of Pampas

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BY MIKA NAGAMOTO

A unique aspect of this abroad program is the opportunity to be in the field where healthcare systems are implemented. The field of global health encompasses a wide range of different focuses ranging from infectious diseases, to environmental impacts on health, to chronic non-infectious diseases, and many other issues that both directly and indirectly affect human health. One commonality amongst all of these global health focuses is the movement towards creating accessible and equal healthcare on a global scale. In order to make positive changes it’s necessary to go to the local area that is most impacted by the health issue of interest.

Starting in the 1980’s, Peru experienced internal terrorism sparked by the communist party in Peru called the “Sendero Luminoso” (the Shining Path). The Sendero Luminoso used guerilla warfare to create internal conflict, particularly in Andeas Highlands. Pampas is a community in the Lima region that was created due to mass migration of Peruvians in the highlands trying to escape the violence created by the conflict between Sendero Luminoso and the government of Peru. Although the internal conflict ended in the early 1990’s, the effects of violence and trauma are still prevalent in areas throughout Peru.

Visiting Pampas revealed the hindering of development created by internal conflict, structural violence, and poverty. After departing from our comfortable and safe hotel in Miraflores, seeing Pampas was a stark comparison and a humbling experience. This community was formed on land that had no infrastructure or public services such as water, electricity, or plumbing. In order to receive these basic necessities, the community had to come together, gather their funds, and advocate for their own needs. Shadows of past violence linger in the areas left un-built due to the concern that land mines may have been left over by the Sendero Luminoso.

Community members, non-governmental organizations, and healthcare centers, are all working towards providing sufficient and accessible healthcare for the community. Visiting health posts and health centers revealed the high demand for healthcare and the limited resources that are available. The healthcare centers are dedicated to providing care for all those in need regardless of whether or not they are able to afford it. However, long lines and limited hours serve as barriers to reach all of the individuals that seek healthcare.

Wealthier neighborhoods in Lima choose to go to private health centers where they receive optimal care and have the choice of when they go into the clinic. However, the majority of the population in Lima lives in similar neighborhoods as Pampas where poverty, a history of violence, environmental pollution, and limited healthcare create obstacles for the community’s quality of life.

Pampas is just one of many examples in which disparities are created by a cycle of structural violence and poverty. Walking through the streets of Pampas created a vivid and lastly effect on my understanding of global health. Reading about statistics and numbers may allow students to scrape the surface of understanding communities that experience disparities. Yet, the numbers do not capture the depth and complexities of these local contexts. This trip to Pampas puts my own privilege into perspective and gave me important insights into the challenges that public health and healthcare workers face.

The healthcare workers and community leaders in Pampas are passionate and driven to create change within their community, to empower their neighbors, and provide the healthcare that they deserve as a basic human right. I am thankful for the opportunity to have met some of these influential actors and to view the positive changes they are fighting for.

Mika Nagamoto studied abroad in Lima and Iquitos, Peru, in summer 2018: https://ieo.ucla.edu/travelstudy/GlobalHealth-Lima/

Peru | Peru’s Unique Cuisine

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BY MIKA NAGAMOTO

There is no denying that Peru has some of the most incredible food in the world. Every restaurant you pass by in Lima radiates incredible aromas of fresh cooked food. My friends and I made it our mission to try all of the best food in the area. As we began to explore the plethora of restaurants nearby, we noticed that the food in Peru is not only delicious but also incredibly diverse.

Ceviche

We decided to start out by trying some of the dishes that Peru is famous for. Ceviche (sometimes spelled “cebiche”) was first created in Peru and continues to be served on almost every corner in Lima. The traditional dish is usually made with whitefish, Peruvian yellow corn, ají peppers, thinly sliced onion, and lime juice. For our first taste of ceviche we decided to go to Punto Azul, a seafood restaurant located in Miraflores. I was amazed by how fresh the fish tasted and how well all of the strong flavors worked together. Some restaurants also make ceviche with various types of fish, peppers, and unique sauces. One of the “challenges” I faced in Lima was forcing myself to try other food because the ceviche is simply too good.

Menús

In Peru, most people choose to eat a large lunch and a much smaller dinner. For this reason many restaurants have special “menús” during lunchtime. These lunchtime bargains can be as cheap as 10 soles (about $3) and include an appetizer, a main course, and a drink. Many restaurants will serve ceviche as an option for your appetizer and this is certainly the best deal you can find in Peru for fresh and delicious fish.

Chifa

Chifa restaurants are extremely common and popular all around Lima. This unique cuisine combines the flavors of Chinese and Peruvian food. Common menu items include Arroz Chaufa (Cantonese-Peruvian style fried rice), Pollo Enrollado (chicken rolled in fried crust), Tallarin Saltado (Cantonese-Peruvian style Chow Mein), and Chicharron de Gallin (simmered lemon chicken). In order to try the best Chifa in Lima, my friends and I journeyed to Chifa Union in Barranco. Twelve of us from the program hopped on the metro to Barranco with excitement and empty stomachs. After asking our waiter what he suggested, we ordered six different large dishes and shared the food family style so we could all try as much as possible. My personal favorite was the Tallarin Saltado and the Pollo Enrollado. Both of these dishes had rich flavors, tender meat, and crisp vegetables. The portions here were huge and we left the restaurant with several to-go bags that we happily ate the next day for lunch.

Tripe

I have always been an adventurous eater and love to try new foods as much as possible. Often when my friends and I go to a new restaurant we will order whatever the waiter suggests. While exploring the restaurants in Lima, this often meant that we had little idea what we were eating until we later looked up the ingredients from the dish. After class one day, my friend and I found a place that had a Menú so we decided to try it out. Like most meals, we asked the waiter what her favorite dish was and she suggested the “Cau Cau”. Neither my friend nor I knew what was in this dish but we decided to try it out. When we got our meal, the dish appeared to be some sort of meat with potatoes and grilled vegetables. The meat however was an extremely unique texture resembling something like raw octopus only more jelly-like. After enjoying our meal, we later looked up the dish and found out that the meat was actually the lining of a cow stomach. Knowing this may have changed our perspective of the dish but also made us very excited to try other unique food in Peru.

Mika Nagamoto studied abroad in Lima and Iquitos, Peru, in summer 2018: https://ieo.ucla.edu/travelstudy/GlobalHealth-Lima/

Peru | Iquitos: Overcoming Health Barriers in River Communities

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Through my program, I had the very unique opportunity of traveling to Iquitos: a large city near the Amazon River that is completely inaccessible by car. This trip was designed to give us insight into the healthcare systems of unique communities where location, cultural differences, and environmental factors create disparities to healthcare access

When I got off of the plane at the Iquitos airport, I immediately felt a wave of heat and humidity spread across my face. We were in a completely different environment than Lima and I was very eager to learn more about the communities lining the Amazon River. Walking through the streets on the way to our hotel, we passed through bustling streets of vendors selling delicious fruits and frozen treats to ward off the hot, summer day. Motor taxis and motorcycles filled the streets and endless rows of fresh fish lined the side-walk, ready to be bought after the morning catch.

Researching Traditional Healing Methods

For our first excursion into Iquitos, we visited an EsSalud Research Center for traditional medicine to learn how plant and herb healing are being used for medical and scientific advancements. We walked through the botanical gardens of this center and learned about dozens of unique plants and the lengthy list of positive effects each plant has for health and healing.

Many of these plants and herbs we had seen being sold in the markets in Iquitos where these plants are used regularly by local Peruvians. An agricultural engineer from the center let us smell and taste many of these plants that most of us had never even heard of. He let us taste mint that can be used as a sweetener for diabetics, and a spicy flower that made your lips tingle and is used as a numbing cream for both internal and external uses. We smelled all sorts of different spices that can have medical effects on cardiovascular diseases, diarrhea, and even cancer. Throughout the tour the agro-engineer also explained how many of these plants are researched, tested, and produced in commercial packaging to be sold in pharmacies.

This unique experience revealed the collaboration of traditional practices and modern research as a form of creating new and accessible treatments and preventative medicines. Before we left the center, the agro-engineer emphasized that every modern medical advancement, once originated from research done on plants. I was amazed to see how nature is full of miraculous surprises and there’s no denying that there are still many possible treatments and cures to be discovered.

Tele-Medicina at the Ministry of Health

The ministry of health provides care for approximately 70% of the Peruvian population. In Iquitos, a ministry of health hospital is the designated treatment center for the entire Loreto Region which has a population of almost a million people. This single healthcare center provides care for around 2,500 people a day. Beyond what the numbers say, during my trip to Iquitos, it became very apparent to me that healthcare access and treatment are very limited. Our program had the opportunity to visit the Ministry of Health Hospital in Iquitos and we learned about many ways that these healthcare providers are working tirelessly to provide quality healthcare to as many people as possible.

When we arrived at the hospital we were introduced to the Director of Public Relations. However, this job title certainly does not encompass the many tasks that this man takes one to try to constantly help the people of Iquitos. He began with a tour that showed us all of the various units within the hospital offering a wide range of care options from neonatal care, to burn treatment, to dialysis, and psychiatric treatment. Along the way we began to see the improvements and reconstruction that this hospital was taking on. New sections of the building had recently been renovated to allow for more advanced care for a larger population of patients.

We visited the Tele-Medicina office were the hospital has implemented video and telephone technology as a means to diagnose, consult, and treat patients in remote areas. Additionally, doctors from Lima and around the world can also communicate with health posts and hospitals surrounding the Amazon river. Many families must journey up to 5 days to reach this hospital. Because of the expenses and length of these journeys, sickness has often progressed very severely by the time individuals will make the journey to the hospital. For this reason, the Tele-Medicina intervention is used to try to diagnose patients earlier and lessen the need for traveling such far distances.

Unfortunately, however, many patients will not be able to receive all of their care in Iquitos and so for further treatment they have to fly out to Lima. The Director of Public Relations explained to us the many difficult decisions that families must make when faced with the cost of travel and having to separate families to receive care. The director that we spoke to was one of the many hidden advocates for patients that are unable to receive care for reasons beyond their control. Limited funding and poverty lead patients stranded as they have no way of paying for the treatment that they need. The director that we met works constantly with social workers, NGO’s, community members, or individual donors to try to pull together the funds to help patients in his hospital.

This hospital served as the only form of healthcare for a far larger population than the resources could provide for. Furthermore, patients must face difficult travels and expensive care while battling illness and disease. With persistent efforts to innovate this hospital and advocate for patients, I was inspired to see the ways that these healthcare workers dedicated their energy towards looking out for their patients in Iquitos.

Isolated Health Posts in the Amazon Rainforest

Iquitos is surrounded by dozens of small, isolated communities that utilize the resources from the river and rainforest in their daily lives. These communities are often very remote and use small health posts as their only access to healthcare. For our final visit in Iquitos, our program journeyed to one of these health posts in the rainforest.

All of the students from my program huddled into long wooden boats as we weaved along the Amazon River passing fisherman as they dove into the water with large nets and local families as they washed their clothes and cooked by the river. We arrived at a community where rice, plantains, and pineapples farms surrounded the outskirts of the town. Immediately we were greeted by one of a nurses from the health post. This nurse, a midwife, and a medical technician were the only staff that served this community and 14 other villages in nearby areas. It was a very eye-opening experience to hear about the countless barriers this facility has to overcome to provide the best possible care they can manage under their given circumstances.

Limited supplies, delayed governmental funding, complicated local customs, and difficulties in reaching isolated communities were merely some of the many different aspects that these workers had to take into account. Many of the community members never see a doctor throughout their lives and immunization levels for children are a constant concern. Through home visits and education this health post has worked on increasing immunization rates however there are far more isolated communities that are unreached by the limited resources of health posts such as the one we visited.

This community faces issues of malnutrition, stunting, maternal morbidity, tuberculosis, diarrheal diseases, and adolescent pregnancy. I was genuinely impressed to find that despite this long list of health concerns and barriers the healthcare workers at this post were extremely dedicated and driven to continue to improve the health of the community they served. Not only were they helping their patients with medical treatment, but they also worked to create a pleasant environment where community members could seek help and care.

It is very difficult to explain the disparities and barriers that these river communities face in accessing healthcare. With such unique environmental factors, economic restraints, and limited resources, I could feel the great need for better healthcare accessibility. The healthcare workers left a genuine impact on me as I saw the relentless efforts that they put forth to improve the quality of life in these communities. Every healthcare center that we visited in Iquitos was working towards broadening their scope of care, no matter how difficult that may be.

Mika Nagamoto studied abroad in Lima and Iquitos, Peru, in summer 2018: https://ieo.ucla.edu/travelstudy/GlobalHealth-Lima/

Peru | Floating City of Belén

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BY MIKA NAGAMOTO

During our time visiting the Amazon Region of Peru we had many very memorable excursions that were unlike anything else in Peru. Iquitos is a city full of life, culture, unique gastronomy, and bountiful wildlife. Every day we had a new and exciting outing with our professors giving us the opportunity to explore the many unbelievable sights.

The Floating City

The floating city of Belén is one of the most extraordinary places in Peru. When we first arrived in Belén, it appeared to be just like every other neighborhood in Iquitos. Our guide, however, explained to us that during the rainy season in Iquitos this entire neighborhood is submerged in water. During this time, water levels raise up to the second story of every house. To accommodate for these extreme weather changes, families then move their belongings from the first floor to the second floor of their houses. Families who live closer to the river however have accommodated in a different way by building houses that actually float on the water. Our group had the chance to tour this community on wooden boats with local guides who told us about their experiences growing up next to the Amazon River. Daily life in this community is intertwined with the many resources that the river has to offer. Fishing provides the main source of food and jobs, boats serve as school buses for children and taxis for parents on their way to work, and families wash their clothes just outside of their floating houses. This beautiful city was full of life and energy surrounding the powerful Amazon River and our group was lucky enough to learn about such a unique location.

Belén Market

Only a couple blocks away from the river edge lies the bustling Belén Market. This market is a cluster of dozens of streets lined with stands stacked high with a vast assortment of meats, drinks, fruits, medicine, herbs, clothing, and many goods our group had never heard of. Our local guides walked us through the tight and busy streets as we passed giant paiche fish caught that morning, buckets of edible jungle grubs, amazon fruits like camu camu, aguaje, maracuya, and a rows and rows of traditional medicines that are made for every sort of ailment imaginable. The people who work in this market wake up as early as 3:00am to begin setting up their stands. Shoppers arrive soon after to buy fresh meats and ingredients for the day. The Belén Market is buzzing with people from all around Iquitos who travel to this area just to buy the many goods provided along these streets. The sights, smells, and tastes of Belén are rich with the culture and life of the Amazon River.

Mika Nagamoto studied abroad in Lima and Iquitos, Peru, in summer 2018: https://ieo.ucla.edu/travelstudy/GlobalHealth-Lima/

Peru | Amazon Rainforest Excursion

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BY MIKA NAGAMOTO

I never imagined that a college field trip would include a hike through the Amazon Rainforest or a visit to a manatee sanctuary. To my utter surprise these excursions were included in my program abroad in Peru. The Amazon rainforest is unlike anything I have ever experienced. Our class began our “field trip” by boarding a speed boat that took us beyond the bustling city of Iquitos and out into the vast area of winding river, tall trees blossoming with life, and a forest humming with biodiversity. Our local guide talked to us about the many indigenous communities along the water that practice the traditions that their ancestors have passed along from generation to generation. Understanding the cultures and lives of the people living in the Amazon gave us important context for our visits to local health centers. The more we heard about the local perspectives, the more we were able to understand what the healthcare system’s role in Iquitos is. Not only were our field trips exciting and interesting, but they also enriched our understanding of Peru and the intersection between culture and health.

As the sun reached the middle of the big open sky, our boat pulled off to a small dock under the shade of large almond tree. We unloaded and walked up to a jungle lodge where the smell of grilled fish and fried plantains filled the air. Two beautiful red macaws swooped above our heads as we were greeted by friendly guides who told us more about the plants and animals of the area. As our lunch was cooking, we were taken on a hike through the rainforest. Fitted in rubber boots provided by the lodge, we walked past wild orchids, giant cypress trees, birds of paradise flowers, and many plants that I had never seen before. Just as we were about to head back to the lodge, our guide leaned down and looked under a rock only to find two poison dart frogs. The tiny red frogs sat perfectly for all of us to admire before we started our hike back for lunch.

After touring the beautiful Amazon Rainforest, we took our speed boat to a manatee sanctuary just outside of Iquitos. The friendly staff of this sanctuary told us about the many growing efforts to conserve and protect the incredible wildlife in Iquitos through education, rehabilitation, and forest protection. We then took a tour throughout the sanctuary and saw dozens of different animals all receiving the care that they needed in order to be released back into the wild. Enclosures were made for monkeys, sloths, otters, ocelots, civets, caiman, turtles, tortoises, and of course, manatees. We learned about the dangers that these animals face and the ways that this sanctuary works with government and private funds to help these animals. The Amazon is a place that has endless surprises and incredible opportunities for adventure and learning. I was thankful to have experienced the excursions through my program that gave me a glimpse at the many different extraordinary secrets hidden within the Amazon Rainforest.

Mika Nagamoto studied abroad in Lima and Iquitos, Peru, in summer 2018: https://ieo.ucla.edu/travelstudy/GlobalHealth-Lima/