This photo was taken while on horse back between the Sacsayhuaman and Q’enko ruins. Pure beauty!
I kind of mentioned what a big deal Nacimientos, or Nativity Scenes, are here in Cuzco – but I thought that it’d be fun for you to actually see. About a week before Christmas sellers starting setting up camp in the plaza of Belen (Bethlehem) and stayed there until about New Years. You can get baby Jesuses in all sizes and colors, along with all different kinds of people and animals who might want to go to his birth place. Literally there were blocks and blocks of tents selling all different things that could go into a Nativity Scene, from moss and plants to the managers, to shoes for the baby. You have to see it to believe it . . .
S0, we’ll start with the flooring of your Nativity Scene . . .
What kind of moss do you want? There is a lot to choose from for about 20 cents a bundle.
Look kind of familiar? I briefly posted about this in Foto Friday 21- “Selling”.
Walk up the hill a little bit and you’re into the nativity pieces . . .
Camels, naturally.
Sheep and cows…yeah, that makes sense.
Gators? Owls? Pandas? Cats?
Ducks? Llamas (maybe)?
Teddy bears? Bunnies? Turkeys?
Goliath…or is that the angel?
The thing that is cool is that they use it all…and while I never really thought of toucans and pandas being at Jesus’ birth, when I actually saw a nativity scene with all of the random animals, it made me smile at its beauty – the entire created world, stopping to praise the newborn King.
~~~
Here are a couple Nativity Scenes I photographed throughout the season:
One that my coworkers set up in our office:
The one at the church where we attended Christmas Eve Mass:
The scene at our house:
This lady traveled from a neighboring village to Cuzco to set up camp for a few days, selling pieces of plants, two for 50 centavos (equivalent to about 20 cents) to adorn people's nativity scenes. Someone told me that many of them travel very far to sell these goods once a year - making in a week, about 10 soles ($4).
Kenzo and I had the honor of celebrating Christmas here in Cuzco with the Vallenas family!
As a part of Life Writing Photography’s Twelve Posts of Christmas series – I have posted all about our Christmas Eve Celebration HERE. So definitely check it out!
Working as a family therapist for Fundacion Cristo Vive, a site that attends to families where violence is present – I have seen several cases of domestic abuse over the past four months. Last month, I had the opportunity to walk alongside coworkers and clients, peacefully communicating women’s rights to live safely – protesting violence of all types. As I share the photos of the day (several are clients’ children who walked alongside us – which I just think is powerful for little boys, future men, to be holding signs speaking on behalf of their mothers, sisters, and future wives) – I promised to share the story of a client of mine. What proceeds is my translation of her story. I am putting it in quotes because it is from her voice, but it is not exactly what she has told me (as we’ve met now 5 times and I cannot remember word for word and then correctly translate from Spanish to English):
“When I was 18, my mom sent me to live with her cousin – he lived in Lima and was a professional and promised that he’d be able to find me a job. After months of not really doing much for me, one night, on the way home from a family party, as it was raining, he took me to a hotel . . .
I was so ignorant at the time – he told me that it was his friends house – but when we got in there, we had our own room and bathroom and it was obviously a hotel. He was 30, a policeman, and very intense. He took out his gun and pointed it to his own head and said that if I did not accept him sexually, he would kill himself – and I believed him.
I cried the whole time – it was my first time ever being with anyone.
Sign reads: "Love yourself Woman!"
After that, he started to beat me and control me and not let me leave the house. He’d try to come on to me and when I would push him away, he’d beat me up and then have sex with me. It was horrible . . .
7 years of hell.
And out of those years were born my two oldest sons.
When I was finally able to separate from him, I started to sell fruit in a local market. I could barely feed us, the money just did not last. So I started working in a restaurant – but it was hard to watch my boys. Finally, a friend convinced me to enter the field of prostitution – and for 10 years I worked in that, miserable, but able to provide for my boys.
Sign reads: "God created the woman and the woman created the home."
This is a fellow volunteer, Oliver - here from Germany with three others. I have no idea what his sign says.
It was in that line of work that I met my daughter’s [6 years old] dad – he was a client – and he was different. He wanted me to leave that work and get married.
So, we moved. And my time with his was the first time “that I felt like a wife.” But after four months of living together, I found out that he was married and had no plans to separate from his wife. So we separated, while I was pregnant with my third child.
After she was born, I went back into that line of work. Leaving my daughter with her two older brothers who were living in the house of their father.
Four years later, I met the father of my baby [a nine-month old little girl] – he was also a client . . .”
(Again my patient put her faith in a man who would eventually fail her, as he was also married with no plans to leave his wife … in therapy we have talked about her seeing men as saviors in her life, people to pull her out of her world, but when she’s meeting them as clients – where does she really think that they’ll take her?)
“Last year I decided to stop working as a prostitute. I planned to commit suicide. I wanted to make my most recent partner suffer as I was suffering. So I planned to throw myself in front of his car. But, before doing it, I decided to read my bible, as I always felt, even in the filth I was living in, that God was real and present. I opened my bible to Isaiah 44 and I felt as if God was talking to me:
21 “Pay attention, O Jacob,
for you are my servant, O Israel.
I, the Lord, made you,
and I will not forget you.
22 I have swept away your sins like a cloud.
I have scattered your offenses like the morning mist.
Oh, return to me,
for I have paid the price to set you free.”
"If you hit a woman, you stop being a man."
Now, the five of us are living here in Cuzco. We share one room. I am not returning to that life of prostitution like before, and I am free from the disappointments and abuses that men have brought me in the past – but, we are really struggling economically. My boys are wondering why I don’t make the money that I did before and keep asking me to go back to work, now that my baby is nine months old.”
The client whose story you just read continues to come for individual and family therapy. One of the things we’re working on in individual counseling is her abilities and likes…and seeing if within those we can carve out a new type of work. With the family, among several things, we are working to validate and then heal hurt pasts, as both of the older ones have feelings of abandonment from years of mom leaving them with dad or friends, for work or other men.
What I have seen in working with the battered women at Cristo Vive, specifically the ones living in our hidden house who have actually decided to leave their violent homes – is that they too struggle economically. And often, for years, they put up with abuse and mistreatment because of the financial security they have living at home.
I don’t really know how to end this except to say – thanks for listening to her story. If you’re a prayer – pray for these women that I have the honor of working with – and pray for me – that God would use me to reveal His plans in their lives.
Choose peace instead of violence. Love instead of indifference.c
Yesterday Kenzo and I went out to finish our Christmas Shopping and I snapped this photo. Pretty different experience than in the states. Merry Christmas!
Most people know, but just in case you don’t, I thought that I would tell you a little about what I am volunteering in here to make future posts make more sense. I am about two-thirds of the way through a Master’s Degree in Rehabilitation and Mental Health Counseling at USF – within the degree, I am getting a Concentration in Marriage and Family Therapy. All that boils down to say that eventually, I will be a Licensed Mental Health Counselor and Marriage and Family Therapist.
Because my undergraduate degree was in Spanish, I came to Peru very conversational in Spanish – and thus, offered to volunteer in two local agencies working alongside Peruvian Psychologists in therapy. Over the past four months, my Spanish and counseling skills have both improved tremendously. And I have been even more convinced that I have entered the right field for my talents and passions.
During the fall, I actually was able to enroll and participate in my Practicum II class – which is a requirement to graduate. This was such a blessing as I was able to share the various cases that I was seeing with my advisor and classmates back home on a weekly basis. I have averaged about 25 hours a week of volunteering in both agencies – and have totaled more than 200 hours of face-to-face contact with patients. Thus, I have seen several cases.
As the weeks passed by and Kenzo did an excellent job sharing about his cases, I kind of processed my cases with my class and supervisor, and saved my blogging time for fun – uplifting things about what we’ve been doing. All the time realizing that I have not 100% been sharing with you what my life really is like here because SO much of it are these patients that I am seeing week after week. I think that what has kept me from sharing is not really knowing how to process the harder cases (the ones that I think would be more interesting to share) in a way that I am then able to communicate them in a meaningful and organized way. Additionally, confidentiality is such a large part of the therapeutic relationship that, even though I don’t believe that my patients will be recognized by sharing their stories, I just have an uneasiness of doing so when some are so specific.
BUT – finally, I am ready to share a bit with you.
I am going to start tomorrow by sharing stories of women who have suffered violence – as I share with you more photos from the parade I participated in on November 25th with Fundacion Cristo Vive – a parade that recognized the Day Against Violence Against Women.
Until then – as I am thinking of my stories – please feel free to email (jakoike@gmail.com) or ask any questions you’d want. And enjoy these photos of women standing up for what they believe in – their own safety and well-being.
Last weekend Kenzo and I attempted the Senor de Huanca hike. Once a year, large groups of Peruvians do a Pilgrimage to the Senor de Huanca – leaving at night fall and arriving to the end for the sunrise.
We were told by a friend that it should be 4 hours on Saturday and 4 hours on Sunday. It was raining, and the family that we live with here was pretty worried about the two of us going alone . . . so we went, somewhat committed to the whole trek, but really thinking that we might just do the first leg and then head back or maybe not even go at all, if once we got to the trail head it was still raining. Haha. Our plans changed – we ended up doing the entire trek (and more…) and the entire walk took us 5 hours on Saturday and 7 hours on Sunday – but it was very fun!
We brought along the small camera (when we do it again – we will bring my camera!) and took tons of photos and a handful of videos along the way. Below I have posted everything in order that we saw it…and will take you through our great trip.
Meet Theodoro el Torro (bull) We’ve been taking this little guy all around Peru with us, as he represents the mascot of USF! You will see plenty more of him on the blog!
Haha – first video, check it out –
Enjoying being on the wrong mountain, and the view of our beloved Cuzco! (And yes, Dr. Pepper, I was Mrs. Green-zo that day).
Second video – “arrival” – kind of.
When we summitted the first (mistaken) mountain, we celebrated with a photo with Theo.
View of the city as we continue to walk, looking for a place to camp for the night.
Kenzo, surrounded by beauty.
Gorgeous – there are three crosses on the top left mountain-top overlooking the valley. Beautiful!
The view of Cuzco from where we made camp.
Video – 3 – Nightfall
Supposedly, the city of Cuzco is in the shape of a Puma. This was the first time we kind-of saw what they’re talking about.
We took another video at this point, but it was so dark nothing showed up. We had a wonderful evening, although it was freezing and we could not get anything to light on fire (so no fire…but, we did have a bottle of wine from our 5 Year Anniversary that kept us warm! And Kenzo just bought a stove for our next hike – so hot chocolate and food will be ours!)
Video 4 – “Sunrise” and Breakfast
Our view in the morning and what we thought was the city of Huanca. How wrong we were. It was actually the city where we should have been the first night. It took us about an hour to get down there to realize that.
En route to the little city we saw ahead, we realized that we were back on the trail!!
Proof:
“A donkey”. As we walked towards the little city that we thought was Huanca, we got to pass through a beautiful valley – all different shades of green. It was beautiful! It was probably 7am, so we were the only ones out…actually, we were pretty much the only ones out the entire trail, except for when we passed through the quiet little town.
Arriving into town around 8am – in the fog. By this time, we were talking about maybe heading back to Cuzco. I had a photo shoot to do that night and Kenzo was planning on working the night shift at the hospital. Since we had started the trip half-heartedly, we weren’t 100% a go for the morning hike. So, we arrived, and there happened to be a truck driver on the outskirts of town, and I asked him if this was Huanca. To which he laughed and told me “No, Huanca is a 4 hour hike from here.” “Oh” I said, “well can we get a bus back to Cuzco from here?” To which he laughed again and replied, “No – just the walk to Huanca.” I asked him if he was headed to Cuzco and he said not until after working all day.
So – we set out toward Huanca – expecting to be walking for about 4 hours.
The quiet little town – it was definitely third world, compared to our experience in Cuzco.
Llamas and sheep and donkeys oh my!
Haha. I guess we were interesting to them.
I love the llama valley photo above!
Leaving the town – we entered what Kenzo and I ended up naming the “Highlands.” They were beautiful, soft-green, rolling hills that we got to walk through for a couple of hours. (Below I am Maria from Sound of Music).
We stopped to rest and eat some fruit at the end of the highlands and 15 minutes later entered a new phase of the trail…which was breathtaking!
Video 5 – 360 degree view of Senor de Huanca (where the Pilgrimage people stop to worship and watch the sunrise)
“This is Peru” – Kenzo
After taking in the beauty for awhile – we began our decent to the town of Huanca. It was steep and long and the town completely teased us the entire way because it was in sight. And, we messed up – because we saw a city (which we believed was Huanca) and passed the town (of Huanca) by about 3 hours…not realizing when we made the commitment to keep walking, that the decent would take us that much more time.
Poor Kenzo had to carry this mother-load the entire trip – I offered to carry it several times and he finally took me up on it – but I could only last for about 20 minutes.
Although the last 3 hours were torturous and all that we wanted to do was get off the mountain, overall – we had a beautifully, wonderful trip! And – we learned a life lesson – “In life, you take the high road. But when you’re on a mountain and you do not want to be, you take the low road.”
The valley – that red roofed church on the bottom left is Huanca – oops – should have stopped a long time ago!!
You’ve probably seen more than enough, but just in case – here is a slideshow of our hike with more photos:
Case study from Hospital Antonio Lorena, within the obstetrical service.
HPI: 37 yo pregnant female of 32 weeks and 4 days gestation presents to the emergency room because of significant vaginal bleeding over the past hour. The patient also reports some contractions, but denies any continuing abdominal pain. She denies any recent trauma.
Past Obsetrical History:
-G3 P2002 (3 gestations, 2 full term, 0 pre-term, 0 miscarriages, 2 currently living)
-2 previous SVD’s (spontaneous vaginal delivery)
-Last birth was 9 years ago by SVD, weighed 3800 grams
-No previous obstetrical complications or morbidity
Past Medical History: None
Past Surgical History: None
Family History: Unremarkable, no history of twins or multiple gestations
Social History: Patient lives with her husband in the Santiago district of Cuzco. Denies any smoking, alcohol or other drug use during her pregnancy. Denies any spousal abuse. Completed elementary school, currently works as a housewife. Low economic status.
Current Gestational History:
-G3 P2002
-Date of Last Menstration: 4/11/11
-Estimated Date of Delivery: 1/22/12
-Estimated Gestational Age (based on dates): 32 4/7 weeks
-No prior antenatal care
Physical Exam:
Vital Signs: Stable (BP – 110/70, P – 72)
General Appearance: No apparent distress, appeared clinically stable
Skin: Elastic, capillary reflex < 2 seconds
Uterine Height: 30 cm
Fetal Lie: Longitudinal
Contractions: Present
Fetal Heart Tones: 144 x minute
Cervical Exam: Deferred
Brief Differential Diagnosis:
– Placenta Previa
– Placental Abruption
– Displacement of Cervical Mucous Plug
– Premature Rupture of Membranes
– Cervicitis
– Vaginitis/Vulvovaginitis
Diagnostic Tests: Transabdominal Ultrasound (see below)
Number of Gestations: 1
Lie: Longitudinal
Presentation: Cephalic
Position: Right
Fetal Heart Tones: 144 x minute
Fetal Movements: Present
Placenta: Total occlusion of internal cervical os
Discussion: Based on this patient’s clinical presentation, placenta previa was suspected and further confirmed by transvaginal ultrasound. Placenta previa is defined as the presence of placental tissue over or adjacent to the cervical os, and can be described within a variety of possibilities:
Diagram showing different categorizations of placenta previa.
Classically, the clinical presentation of placenta previa is painless vaginal bleeding in the second or third trimester. In contrast, placental abruption, classically presents with painful vaginal bleeding.
Risk Factors:
Below is a list of several risk factors that are associated with placenta previa. Our patient had several, including increased parity, increased maternal age, and residence in higher altitude.
List of associated risk factors for placenta previa. From "Bates Obstetrics."
Diagnostics:
Transabdominal (96-98% sensitivity) or transvaginal (almost 100% sensitivity) ultrasounds are the diagnostic methods of choice for confirming placenta previa. Ultrasound can not only diagnose placenta previa, but further define it as complete, partial, or marginal, which can have implication in how to manage the patient. Placenta previa that is diagnosed before 24 weeks of gestation should be managed conservatively, and a repeat sonogrophy should be done between 28 and 32 weeks’ gestation. Many cases of placenta previa that are diagnosed in the second trimester will resolve by the third trimester.
Patient's ultrasound image consistent with complete placenta previa (total occlusion). Compare with the 2 textbook images shown below.
Textbook image of placenta previa from "William's Obstetrics." Transabdominal sonogram of the placenta (white arrowheads) behind the bladder covering the cervix (black arrowheads).
Textbook image of placenta previa from "William's Obstetrics." Transvaginal sonographic image of the placenta (arrows) completely covering the cervix adjacent to the fetal head.
Cervical Examination:
A cervical examination was deferred in our patient, as appropriate management. Because of the risk of provoking life-threatening hemorrhage, a digital examination is absolutely contraindicated until placenta previa is excluded. Such digital cervical examination is never permissible unless the woman is in an operating room with all the preparations for immediate cesarean delivery—even the gentlest digital examination can cause torrential hemorrhage.
Management:
Women with a previa may be considered in one of the following categories:
Furthermore, as part of management, large-bore intravenous access and baseline laboratory studies (hemoglobin, hematocrit, platelet count, blood type and screen, and coagulation studies) should be obtained. If the patient is less than 34 weeks’ gestation, administration of antenatal corticosteroids should be undertaken (as was done in our patient) as well as an assessment of the facility’s emergency resources for both the mother and the neonate.
Some pictures below show the cesarean operation of our patient, and the delivery of a healthy baby:
Prepping the patient before surgery.
First incision.
Extracting the baby...
The baby is then transferred to the pediatrics team where they begin any necessary resuscitation.
Closing up the fascia and fatty tissues.
Sewing up the initial incision within the skin.
Final product after suturing is complete.
References:
1. Williams Obstetrics. 23rd ed. New York: McGraw-Hill Medical, c2010.
2. Gabbe: Obstetrics: Normal and Problem Pregnancies, 5th ed. Churchill Livingstone, c2007.
3. Emedicine
Cristo Blanco ("White Christ") stands above the city of Cuzco with his arms spread wide. For you - what meaning does that hold? PS... I love that the moon showed up in the background.
