A Journey to Peru

I usually don't blog about my daily activities, but I'll make an exception for special trips and international journeys. And here are some pictures.

Saturday May 11th, 2013

I flew out of Austin bright and early to present VersaSuite's full HIS and EHR to a UN hospital in Chiclayo, Peru with our local partner company, El Tumi Peru. After a brief layover in Houston, I took a 6.5 hour flight from Houston to Lima, where I landed at about 10:30PM local time.

I love traveling but hate the act of traveling (read: airports). However, I do appreciate the concentration I'm afforded. I try to capitalize on my lack of an Internet connection by reading long-form books, writing, and watching videos/movies. I read a good chunk of Ayn Rand's The Fountainhead, knocked out my entire short-form reading list, did a lot of Pristine reach out, wrote a few blog posts, and watched James Franco's latest movie, Oz The Great and the Powerful.

Lima's airport is pretty standard: nothing flashy, lots of taxis, ridiculous traffic on a Saturday night, swarms of people with signs for strangers, and of course the obligatory general sense of chaos and disorganization. El Tumi Peru hired a local who picked me up and brought me to my hotel, El Hotel Boulevard, in the beautiful Miraflores district of Lima.

Sunday May 12th, 2013

I woke up and had breakfast on the roof of my hotel, overlooking the hotel pool and small part of Lima. There was an excellent breeze; it was a great way to start the day. I had to wait until 11:00AM to meet Jose from El Tumi Peru, so I did some reading and writing on the roof.

I spoke to Jose for about an hour in the hotel lobby, then headed out to explore the city. I tried to map out my day via limited wifi at the hotel, but quickly gave up on the original plan as I began wandering about without an Internet connection.

The Lima coast is gorgeous, so I walked down it. There are all kinds of playgrounds and outdoor activities going on along the Pacific coast. I walked for 3 Km before I reached an enormous shopping district in front of the flashy Mariott hotel. I ate a superb steak with chimichurri sauce for lunch while getting intoxicated on Pisco Sours. After lunch, I walked around for another hour, then took a drunk nap in the grass along the coast. At some point a police officer woke me up to make sure I was alive, and I was, but then I went right back to sleep.

I woke up at 6:15PM, and rushed back to my hotel to meet the folks from El Tumi Peru at 7:00PM. I'm surprised I was able to find my hotel so quickly. They picked me up and took me to the airport to fly to Chiclayo. We blew through security and took a quick 1-hour flight. The hotel at Chiclayo wasn't nearly as nice as the one in Lima, but that was to be expected.

Monday May 13th, 2013

Jose, his mother Carola and I had breakfast at the hotel in Chiclayo. Like the day before, I demolished a platter of fresh delicious Peruvian fruit. On Monday it was primarily pineapple, watermelon, and papaya. We left to the hospital after breakfast.

The hospital looks much better than it did last time I came to Peru in July 2012. Then, it was clear that significant portions of the building were under construction. At the time, they were only using the building for outpatient functions, i.e. lab, radiology, pharmacy. They're still doing gardening work, but the building appears to be finished. They are now taking care of patients overnight in beds too. The hospital is licensed for 160 beds, though I'm not sure how many are being actively used.

My presentation went very well. It was brief, only about 1.5 hours, but the staff got to ask their questions and seemed engaged and interested. However, I do have major concerns about organizational readiness to take on an HIS+EHR project in Peru. I don't think anyone in the country understands the magnitude of an HIS+EHR project.

After the presentation, I asked to see some of the inpatient wings to assess EHR readiness. The hallways are narrow. So are the elevators. The proliferation of computer on wheels (CoWs) will create major ergonomic problems. The physicians are uncontrollable. They have no structure what so ever. They don't fill out any standardized forms for anything. They just scribble whatever they want in a large free-text progress note. It's up to the nurses to decipher the scribble to understand what orders need to be executed. Structured EHR and CPOE will are going to be jarring to the physicians.

After we left the hospital, we had lunch at a nice cafe. I didn't realize that soups here are entire meals; I thought they were just appetizers. So I had a double lunch - a delightful mixed seafood ceviche, and a rich Criolla soup. I also had two distinctly flavored Pisco Sours. The first was cinnamon flavored and not very good, but the second was passion fruit flavored and absolutely delicious. After lunch, we went back to the Chiclayo airport, where we hung out for a few hours with surprisingly decent wifi before taking off in the evening back to Lima.

Tuesday May 14th, 2013

I woke up bright and early at 7AM on Tuesday. After a quick shower, I went up to the roof of Hotel Boulevard and had a plate of fruit for breakfast. Then I spent 2 hours reading, writing, and taking care of some Pristine stuff until Jose and Carola from El Tumi Peru picked me up at 11AM. We went to a hospital in the poorest district of Lima and talked to the head of IT and the chief MD for about an hour. They weren't particularly interested in the screens, they just wanted me to verbally tell them what the software could do. Clearly, these people haven't been duped by that many software vendors before.

We drove back to the Miraflores coast. The entirety of the parks, hotels, and shopping districts along the coast are atop a 150 foot cliff. There's a narrow strip probably 200 feet wide at the bottom of the cliff before the water (see pictures below). That strip is primarily highway. There are a few peers going out into the Pacific. I had lunch with Jose, Carola, and the big boss, Felix, at La Rosa Nautica on one of the peers. I had Peruvian pork. In retrospect, I should have ordered steak, but the pork wasn't bad. Thanks again to the El Tumi Peru family for hosting me.

After lunch, I went back to El Tumi Peru's office, which is also in Miraflores. We chatted for a few hours about next steps. I really opened Felix's eyes as to what EHR and HIS implementations entail. El Tumi Peru most certainly didn't understand, and neither do the hospitals themselves.

The same driver that picked me up from the Lima airport when I landed a few days earlier took me to a bazaar where I did some shopping for friends and family. Then he dropped me off at the Lima airport to fly back to the US. The wifi was intermittent. To conclude my time in Peru, I bought 3 bottles of Pisco from the duty free store.

Wednesday May 15th, 2013

My United Airlines flight left on time at 11:50PM Tuesday night. Shortly after takeoff, the captain came on the PA system and told everyone that we had to turn the plane around because there was something wrong with the plane door.

After landing, we spent 30 minutes in the plane on the ground hoping that the issue would be fixed quickly so that we could take back off with only a slight delay. The issue was unfixable within a short time span, so everyone starting deplaning immediately. Unfortunately, they had to collect everyone's passport to cancel the immigration stamp as they deplaned. I was at the very end of the line and saw the enormous stack of passports. I refused to part with mine. I told the lady I would follow her wherever she had to go so that I could keep an eye on my passport at all times.

After waiting another hour in state of raging frustration just inside the duty free zone, they finally cancelled my passport stamp. Then I went to some hidden basement gate where they kept everyone waiting for another hour. Eventually a bus arrived to take us to the baggage claim. At this point, I realized that I needed to be in the front of the line if I wanted a chance at getting to the front of the main airport ticketing line. So I charged to the front of the bus line. I was lucky I didn't let them put my passport in the big stack. Many people still hadn't gotten their passports back by the time the first bus arrived.

When the bus arrived to the baggage claim, I charged straight towards the airport exit. A security guard stopped me. Within a minute, another 50 people showed up behind me asking to exit as well since they didn't have bags either. I heckled the security guard delicately, prompting the other passengers to heckle too. The security guard quickly caved. I burst out the exit, around the entrance and back to the front of the United ticketing line. I got the last seat on the American Airlines 7AM flight to Miami. I spent at least 20 minutes at the ticketing desk as the guy tried to figure out my flights from Miami to Austin. The passengers in line behind me were pissed. They thought I was haggling over vouchers and refunds while they were stuck not knowing how they were getting home.

I caught my flight back to America without any problems. After a few more bits of airline stupidity in the Miami airport, I flew through to Houston, then finally back home to Austin.

Morals of the story

1. Never let your passport leave your direct line of sight. Had I done as instructed by the United staff, I probably wouldn't have been able to be first in line at the ticketing counter, and would have surely been delayed a full 24 hours instead of just 8 hours.

2. Make sure everyone knows that you're pissed off like hell, but do not yell or be rude. The airline staff will treat you as if nothing is wrong unless you make it absolutely clear that you are rightfully pissed off. I was the most tense and frustrated passenger, and I led the charge got myself back to the US before every everyone else.

3. Demand vouchers, reimbursements, cash, and whatever else you can in compensation for the pain the airlines cause. Airlines will not go out of their way to apologize or rectify their mistakes. Extract every last penny from them that you can.

4. McDonald's french fries in the Lima airport at 4AM suck.

5. Fuck United Airlines.