Huaraz Trip Report - November 2016

Wonder what a trip with Elevated Mountain Guides is like? Emily Mahaffey shares her experience from last year's trip: Day 1: Nikki and I land in Lima around midnight on November 21st. The next day we catch a day bus to Huaraz (about 8 - 11 hours of driving, depending on traffic) so we can see the journey from the coast the mountains. It was beautiful, driving through changing terrain and small mountain and coastal towns. We pass a long, coastal desert just outside of Lima that seems to stretch for miles. I look down at the shoreline a couple hundred feet below me and wonder how they’ve stabilized the road. It seems implausible and yet the road is host to heavy traffic with no apparent slides into the sea. I breathe a temporary sigh of relief.

As we drive closer to Huaraz, the terrain changes drastically. It becomes mountainous and the valleys have little towns that dot the hillside. You can see the terraced farming, cut into the slopes that look to be 60 degrees or steeper. It’s another miracle that crops and people exist on such severely angled slopes. We pass small mud and straw houses interspersed amongst the vegetation. You start to be able to pick out steep dirt roads and town centers, all tucked away into the mountain valleys. Political graffiti pops up like billboards all over the rocks on the side of the road as we pass by. The names and initials are foreign to me but they show up everywhere. At some point, it becomes clear that some of the graffiti is meant to be facetious and some is meant to be serious. I wish I knew more about the political climate there so I could begin to decipher the roadside code.

We stop for lunch at this little restaurant seemingly in the middle of nowhere about 4 hours into the drive. It’s hot and humid, but the temperature is a nice change from November in Utah. Nikki and I split lunch and a beer, for I’m about to learn how serious the Peruvians take their lunch and the portion sizes. There is no way I can eat that much food in one sitting.

We arrive in Huaraz around 6 pm. Gilf Laurente, our host and guide in Huaraz, is there to meet us and take us to his hostel, La Casa de Maruja. The hostel is named after his wife and is a beautiful, full service hostel just outside of downtown Huaraz. Gilf is the initial contact that Nikki made upon starting Elevated Mountain Guides and is an instructor at (school name). He and Maruja welcome us with open arms and Gilf lets us know what the plans are for the next day. Nikki and I settle in and prepare for our first day of teaching the next day. Let the adventure begin!

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Day 2: Nikki and I wake up early and eat a lovely homemade breakfast prepared for us by Maruja. We catch a taxi to the school and meet Gilf just outside the gates. The course starts very formally. The president of the college, the dean of the college, several professors and Gilf all give introductory speeches and thank us for offering this course. I start to feel my nerves a little bit but am super excited to get started.

The class has about 30 students in total. There’s a great mix of ages and abilities. Some of the students are professional guides already, some are 3rd or 4th year students, and some are brand new to the Tourism and Guide program. The degrees of English spoken also varies widely. Nikki and I soon discover that the language barrier makes things a lot harder than we originally anticipated. Nikki speaks moderate Spanish and I speak none, so the Spanish/English translation proves to be the hardest thing about day 1. Gilf is there acting our translator and heading the course for the students. The topics we cover are the Patient Assessment, Head and Spinal injuries and Airway and Breathing.

After a lunch break, we do hands-on assessments. The morning section was lecture and now we want to see how the students feel about performing assessments. They take their cheat sheets out with them and pair up to practice. At first, they are all a little hesitant to jump in and get their feet wet. Nikki and I have to guide them and help them figure what the next step is. By the end of the afternoon, the students are warming up a little bit and starting to understand why we do each part of the assessment. I’ve also learned most of the body parts in Spanish by this point so I can communicate a little better.

We stop for the day and Nikki and I find dinner. We go back to the Hostel and review and tweak the lesson plan for the next day. Due to the language barrier, we find things have to be adjusted and discuss how we want to broach certain topics. Teaching wilderness medicine, or any sort of medical knowledge, is a delicate balance. You have to be comfortable talking about the human body frankly and touching the human body. At the same time, you have to be aware of the culture and the environment you are in. Even in the United States, different subjects have to taught differently depending on the group of people in your class. One of my favorite challenges while teaching wilderness medicine is figuring out that balance and the mood of the students.

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Day 3: This was our second day of teaching. We spend the morning in the classroom. We covered Musculoskeletal Injuries, Hypothermia and Cold Injuries and High Altitude Illness. In the morning portion, we break it up by showing how to use C-collars, splint broken bones, reduce dislocations, and do general bandaging. We then ask the students to do all the practical stuff with the supplies they would carry and the results were pretty amazing. Their ingenuity was incredible.

We take a break for lunch (more gigantic portions) and then resume with the practical skills. We start to work some of the bandaging and splinting into the assessments. The students are becoming more fluent in the assessment and our spanish knowledge is expanding, mine in particular. It becomes easier to communicate and interact with the students.

The guides in the course become an invaluable resource. They have stories of dealing with hypothermia and frostbite, high altitude sickness and nose bleeds. We have discovered that the word for frostbite in Spanish isn’t commonly used in Peru and that raccoons don’t exist in Peru. That makes explaining the signs for a head injury really hard because the students are more interesting in what a raccoon is.

We make a lot of progress, both with the students and our spanish. The next day is the last day of the course and we prep them for the test.

Day 4: Today is test day! It’s exciting to figure out the test scenarios for our students, using our limited Spanish. We focus on what information we really them to retain and what information is the most useful and most often used in the field.

Nikki and I spend the morning teaching the students how to safely use climbing equipment. We teach students how to put a harness on, how to tie into the harness using the Figure 8 knot, and how to belay using the PBUS method.

P - Pull

B - Brake

U - Under

S - Slide

Your dominant hand goes on the brake rope and your other hand goes on the end of the rope attached to the climber. We emphasize that your brake hand (dominant hand) never leaves the rope once your climber is in the air. We review Spanish-to-English terms for lowering, belaying, figure 8 knot, etc. The students’ experience levels ranges from none to experienced climbers. The students who do climb are instrumental in helping out with the translation and helping the other students master the techniques.

We then split up into two testing areas: Nikki is testing the ropes and climbing equipment and I run students through a medical scenario. We have three different scenarios, one broken leg, one frostbite, and one high altitude. We test the students in groups of five and randomly pick a scenario. There are a couple of things I’m looking for from the students. I want to make sure each individual student understands the different steps involved in the assessment process. I want to see how students work together in a group to figure out what the next step should be and how the group dynamic can change the care you provide. I want the students to be able to recognize and assess each of the conditions that the patient presents with. The last major thing I’m looking for is that the students administer the correct care once they know what the condition is.

All of the groups do really well. Everyone remembers how to bandage, splint, and care for shock and frostbite. The assessment process is tricky to remember all the steps but the students do a fantastic job of putting all the pieces together in the order they need to go in. The difficult thing about any medical assessment is that the process is never linear. All of the pieces are there and need to be touched on but they are never in the same order each time. Each case, injury and patient is going to change the assessment and you as a care provider need to be able to recognize that and still provide the best care possible. That was one of the hardest things for us to get across to them and by the end of the course, they all picked up on it really well.

Once all the students are done and everyone has received their certification, we have a ceremony. All the students are given their certificate by Gilf Laurente and signed by upper members of the college. Nikki and I are presented with a thank you gift from the school.

Overall, the trip was incredibly successful. Nikki and I learned a lot about our teaching styles and backgrounds and how to mesh the two. I’m am so excited to create more curriculum and continue to teach classes. The students are amazing and the country is beautiful. I have such an incredible respect for the Peruvian people. The kindness and hospitality that was shown to us throughout the entire trip made every new experience that much better. We’re looking forward to many more adventures and continued opportunities with this incredible, vibrant community.