I don’t see that many diseases that also do not exist in the United States. We live at an elevation of 9000 feet in the Andes, and so although we are in a tropical region, the climate is not tropical. So some of the unusual disease that I grew up thinking a missionary doctor would treat do not show up at Diopsi Suyana Hospital. However what I do see is diseases that I might see in the U.S. but in a far more advanced condition. Reumatoid arthritis definitely exists back home, but I rarely see someone’s hands looking like the poor woman in the picture above. People present to the doctor earlier, they get started on medication that slows the advancement of the disease, and they live a more normal life. In Peru, people tolerate the disease until they can no longer function or tolerate the pain, and then they present with hands looking like those above. I think it is making me a better doctor, because many times before I would hear non-specific pain complaints from patients, and then find evidence of an inflammatory disease in the lab work. Sometimes it felt more like treating an idea of what could be than an actual disease. Now I know better what those pain complaints and lab results lead to if not treated on time. The idea and rumor of disease has been made a reality.