Julia Kenny shares her memories of her elective

Peru is a country of contrasts--the desert, the mountains, and the jungle, united only by the universal friendliness of its people. I chose to work in the capital, Lima, and then in the jungle city of Iquitos.

Lima is a huge, sprawling, overcrowded city. The gar ˜ua, or sea mist, that envelops the city for most of the year traps the visitor in a fume filled chaotic urban jungle. Peruvians, having fled their native homelands in search of employment and a better life, live in the dusty pueblos jovenes shanty towns comprised of overcrowded shacks along the banks of the River Rimac.

My destination each day was the grandly named Instituto de Medicina Tropical Alexander Von Humboldt, a department of the Universidad Peruana Cayetano Heredia. This is one of the leading centres for tropical diseases in South America and indeed the world. Numerous patients attend outpatients' departments with diseases varying from the common strongyloidiasis, taenia, or giardia, to rarities like neurocysticerosis or brucellosis. The department houses a 36 bed ward along with diagnostic and research laboratories. The doctors provide infectious disease skills to the neighbouring general hospital when needed.

The doctors were enthusiastic

I learnt how to diagnose, treat, and follow up various diseases using minimal equipment and medications. The doctors were highly skilled and eternally enthusiastic--the sight of one, normally very relaxed and calm, sprinting off towards the lab clutching a fresh sputum sample in his eagerness to demonstrate pneumocystic pneumonia to us will remain with me forever.

While the experience of Lima was unforgettable, I was not sad to leave the pollution and danger that the city offered. My escape was Iquitos, an isolated city--five days by boat or two hours by plane. I was expecting a tranquil haven, surrounded by dense lush rainforest and to be lulled by the sounds of nature. How wrong I was. The transport in Iquitos consisted of motocarros--converted motorbikes designed to carry four people which roar around the streets.

From January to March each year the whole country celebrates Carnival. Waterfights are the mainstay of the celebrations and the constant alertness required to stave off pickpockets in Lima was still needed to reduce the number of waterbomb hits. By February it escalates into a full month long water fight. Westerners make popular targets and have few defences--the novelty wore off very quickly.

The reality of the poverty is apparent

Iquitos seems relatively well off, the centre being paid for from the profits of rich tourists who can afford the expensive jungle tours. However, if you stray just a few metres out of the centre the reality of the poverty is apparent. My base was the Hospital Regional de Loreto, a government hospital and the largest in the Amazon basin. It was poorly equipped with the university hospital in Lima. Basic radiography was available most of the time and a few blood tests could be done, but often no medicines were available, even if the patient could afford it. It was difficult seeing the doctors so frustrated, wanting to help but not being able to offer any treatment.

The surgeons were rightly proud of their theatres. By an assortment of donations they had varying degrees of equipment but the results they achieved were amazing. One of my most treasured moments (once it was over) was spending the best part of three hours watching a cataract operation. A wire heated with a bunsen burner was used as diathermy, the lights kept failing or the patient would start rousing from the anaesthetic and all along a combination of Britney Spears or the latest Salsa hits were pumped out of a battered old radio.

Traditional healers play a large part in the Peruvian culture and are usually consulted first--a young boy with an open fracture presented to us several days later after the dung applied to the open wound had led to a severe infection. Having said this, more orthodox treatments were accepted and I was able to participate in the successful leprosy and malaria prevention programmes.

Travelling provided more highlights

Travelling after finishing work provided more highlights--trekking through the jungle, hiking to the depths of the Colca Canyon and the heights of the Inca Trail. Spending the coldest nights on islands untouched by the modern world, sandboarding down sand dunes, exploring hidden villages, and flying over the mysterious Nazca Lines, the experience was thrilling.

Going to Peru was not an easy option. Organising an elective was frustrating; communications are unreliable and the Peruvians very laid back over planning for the future. A basic grasp of Spanish is essential to get by. Peruvians will go to great lengths to help you, but, be warned, they are reluctant to say that they do not know and will frequently give you false directions.

Peru is a fascinating country and if you go with an open mind, a laid back approach, and a constant alertness you will have a fantastic time. I had an amazing experience and have gained a real love and deep respect of Peru and its people.