Last week, Melody and I took a short trip back to Quito to talk with Maria Alicia about our last few weeks here, stock up on groceries, warm up a little, and continue working on some projects we started in Planchaloma. While we were there we also got to see the new Harry Potter movie (in English!) and visit the beautiful historic district. When we got back, the clinic staff had planned a surprise lunch to celebrate Nicolas’s birthday. Unfortunately, he got called away to a meeting at the last minute and we had to celebrate without him. He thought it was pretty funny, and was rather surprised, when we presented him with half of a birthday cake and told him he had missed his party.
We’ve also been talking and brainstorming with the clinic staff quite a bit about possible ideas for our individual projects. They mentioned, among other ideas, how popular Lila’s library from last year had been and how they would love to have an adult version, too.
After thinking about this, I realized that most people are not in the waiting room long enough to read a full-length book. Instead of putting in an adult library, I would like to create some educational, health-related booklets on problems that are common in this area, like TB, nutrition and maternal health. They would be short and pretty simple to understand, but hopefully get people thinking about these issues before they see the doctor, so they could ask any questions they have then. I’m still working on making these, and then I’ll sit down with Lorena, the nurse, and ask her to look them over with me to ensure that they make sense and have relevant information for this area.
In the mean time, we’re also working on coordinating some visits to other clinics that have a Lab in a Backpack. It’s hard to believe, but there are only have two weeks left in the internship portion of my trip!
Today was a very productive day! Saturdays are the only day when all of the clinic’s staff comes into work, including a lab technician, obstetrician, dentist, nurse and physician, and is generally the busiest day for the clinic. Because last Saturday we went out into a nearby community to observe and help with an experimental canola harvest, this was our first time to truly experience the clinic in full swing.
We were able to talk to the lab technician this morning when she didn’t have any patients and show her the Global Focus Microscope as well as the TB and malaria field staining kit. She was very enthusiastic about both! She really liked that the Global Focus was capable of fluorescent microscopy, and told us that the current microscope in the clinic is only capable of bright field and if she needed to use a fluorescence microscope she had to wait to use one at a large institute in Quito (about 1.5 hour drive from here).
She was especially excited about the prospect of using the staining kit and microscope on outreach trips into surrounding communities to test for TB. Right now if they want to test someone for TB they either take the sputum samples back to the clinic or the patient has to come into the clinic. Nicolas mentioned the other day that some of the communities this clinic serves are as much as a 3 hour trip away, so it’s easy to see how being able to test for TB in the field, and thus cutting down on how many trips someone has to make to the clinic, would be very advantageous!
Penni, Claire and Meredith also paid a visit to the clinic today. We were able to sit in on them interviewing the staff here regarding the Lab in a Backpack that the clinic received last year, and may be conducting some interviews at other clinics ourselves. It was great to learn about the work they’ll be doing while they’re in Ecuador, and get to show them around the clinic a little.
Today also marks the half-way point in our internship. It’s hard to believe we only have 4 weeks left, but I’m looking forward to all we’ll be able to accomplish in that time!
Since my last post, Melody and I have been able to give three more charlitas at daycares in surrounding areas. I’m happy to report that we seem to be getting better at, and more comfortable with, giving them. We’ve been getting more participation in the activities, and slowed down the pace of what we were teaching to allow for a lot of repetition. Probably the most popular change is our new activity to practice throwing away trash. We give the kids a small snack, which is something they really enjoy and grabs their attention, and then they have a wrapper to throw away into the trashcan!
Despite our progress working with kids, I keep thinking of more ways to improve upon our work (sometimes I think I’ll never be fully satisfied – there’s always more to do!). Now that we’ve gotten the kids engaged while we’re there, I’ve started thinking about what we can do to make sure the message sticks with them. We work with each guardaría for maybe a half an hour, tops, but what happens after we leave? How long do the kids remember when to wash their hands, and how?
This idea is still in the preliminary brainstorming period, but I’d like to create something that will stay with the communities and continue to spread the lessons we’re teaching, after we aren’t physically there anymore. I’m still trying to figure out exactly what that would be: a poster? coloring pages? some daily song or game they can play? I’ll have to keep thinking about it, as well as talk to the clinic staff about what is really feasible and sustainable.
Today, Melody and I made our first trip to a local daycare to give our charlitas about hand washing and throwing trash away. The daycare was about 40 minutes away, mostly on a dirt road through the mountains, and looks after kids who are up to 5 years old. We spent most of yesterday looking over the resources that the clinic had on these topics, coming up with activities to do with the kids and writing down what we wanted to say to make sure we knew all of the necessary Spanish.
Despite all of our preparation, actually giving the talk was probably one of the most challenging things I’ve done so far in Ecuador. We were having trouble getting responses out of the children, and it didn’t seem like they were understanding very much of what we were saying. Thankfully, one of the women there with us was a huge help in getting the kids involved, but I could tell that what we had planned just wasn’t working on its own.
Reflecting on my experience, I think there were a few main factors that contributed to this:
- I overestimated how much information we could teach the children. I didn’t have a clear concept of the attention span of 3-5 year olds, and also didn’t realize that these kids have not gone through any formal education yet. We were probably trying to teach them too much in too short of an amount of time.
- My Spanish was difficult for them to understand. While I don’t have too many problems talking with adults, who can interpret what I’m saying even with all of my strange wording and incorrect grammar, I may not have been making much sense to these young children.
- Melody and I were distracting from the lesson. Even before we started the kids were extremely shy in coming up to meet us, and would just stare at us when we asked them questions. In such a small community, anyone who isn’t there every day stands out, and the children didn’t seem very comfortable around us because we weren’t familiar.
Even though today was difficult, there are certain changes that we can make to our plan to improve it for the next school we visit. I’d like to include more games in the plan, even if they don’t have much to do with what we’re teaching, just so we can keep the children engaged. It also seems like a good idea to go over what we’re going to say with one of the staff members here, just to make sure we’re using kid-friendly language and not talking over their heads. Finally, spending time to play with the kids and make them comfortable around us before we start the lesson would make it a lot easier to get them involved once we start the actual educational aspect.
I know that these changes won’t make things run absolutely smoothly at the next daycare we visit, but I do hope they’ll help us move in the right direction. Personally, I want to focus on making sure the kids are having fun with us; it’s a little more nerve-wracking for me because I can’t make a ‘script’ or a concrete plan for having fun, but I know that it’ll help them learn the lesson better and we’ll end up having a better time too. I’m sure Melody and I will be doing a lot of brainstorming for specific activities we can do before Monday, when we’ll visit the next daycare center, but if anyone has any suggestions for us I’d love to hear them! As always, I can be reached at rjz2@rice.edu.
Yesterday we finally arrived in Planchaloma! We spent the afternoon settling into our room and cleaning the kitchen, as well as getting to know the clinic staff and exploring the small town here. Everyone has been so kind to us, and made sure that we have everything we need to really feel at home here!
Today, we talked to Lorena, the clinic’s nurse, about what we’ll be doing for the next few days. It turns out that all of the schools in this area have just closed down for their vacations, so instead of visiting them we’ll be going to daycare centers to work with kids there. Because these kids are a little younger than we had originally planned on working with, we’ve been changing around the material we want to cover, and will now mostly be focusing on hand washing and throwing trash away. We will still be making some TB resources for the clinic itself, but decided it would be too complicated to teach to pre-schoolers.
The clinic itself was pretty quiet today, as it is on most Thursdays because most people are at a large market held in a town nearby. We took the downtime to revise the activities we had planned for the school visits, learn more about the clinic, and practice taking blood pressure, temperature, height and weight. Apparently Saturdays are a very busy day here, so we’re hoping to help the staff out by taking the basic vitals of everyone in the waiting room.
Although the living conditions here are a little different than we had in Quito, it feels great to finally be working in the clinic! I’m really looking forward to seeing how the clinic functions on a day-to-day basis, as well as visiting and getting to know the surrounding communities in the coming weeks.
