Maybe it’s that this town is too small, or maybe it’s that we’ve been here too long, but everyone is starting to look pretty familiar. When we walk in the market, our patients greet us and introduce their families to us. We know the local “collectivo” driver, who races his white van up and down the sacred valley’s main road, transporting students, farmers and medicos with cries of “Pisac, Pisac” and “Coya, Coya” to wake his sleeping passengers. The local bus driver, with acromegaly, think James Bond villain Jaws, is a friendly face as well.  Doctorita, I’m called, to my delight. Sometimes I’m just called Mamita, but always with genuine kindness and warmth. Welcome to Peru, Doctarita, my patients say, and thank you for being here. In the Kausay Wasi clinic, I’m truly in my element. I’ve got a canister of liquid nitrogen, a procedure room for excisions, and a daunting list of 40 patients per day. Lena and Mimi alternate as scribes between Dermatology and Gynecology (they’ve both expressed clear preferences) and Julia plays with waiting children or joins me in my exam room to quietly read Little House on the Prairie. The local lunch options are almost non existent – this is a super small town – so the clinic arranged a lovely woman to come cook lunch for our family at the clinic each day. We meet up for lunch and share the highlights, accompanied by a fantastic staff that clearly love their work.

This is the most familiar clinical environment in which we have worked thus far. The formulary is robust and comprehensive, though lacking in topical treatments for the melasma which is so prevalent here. We start promptly at 8am, after entering the building past the gauntlet of patients lined up outside. They definitely eye us up as we enter, all of us dressed in scrubs, as if our gringo status wasn’t enough to demonstrate that We are the volunteer doctors. We’ve also seen our share of second opinions, though I have much respect for the nearest dermatologist over an hour away, and I’ve reassured several patients that they are receiving appropriate therapies. Frustrated by the appearance yesterday of a twenty-something young man who had walked two days to get to clinic for evaluation of his port-wine stain with hypertrophy and disfiguration of his lip, I promised to somehow find a way to get him the treatments he needs, probably in Lima.

The clinic has some amazing success stories – cases of prostheses provided to children, cleft palate repairs, uterovaginal prolapse surgeries, an active craniofacial microsomia repair program, and numerous other surgical brigades throughout the year. I’ve seen patients in follow up who have received amazing care at little or no cost. I’ve also seen the complications of in-and-out medical brigades. Surgical teams arrive for 5-7 days, perform a dozen cases daily, and then depart, leaving follow ups and occasional complications to a team of dedicated nurses and a superb primary care doctor. Questions about a tympanic repair? Dehiscence of a baby’s facial surgery? When things go perfectly, brigades are heroic. But when there are complications, and there are always complications, patients are left in a bit of a vacuum. I’m certainly not the first to describe this darker side to volunteer medicine, but I’ve seen my share  of patients returning with questions or problems, only to find that their surgical team won’t be back until next year.

So off we go, onto the next project, happy to have been a small part of local life for a short time, and hoping that our patients will be okay, until the next brigade.