Reports from Ecuador

Stephen and Yvette arrive

It´s been over 2 weeks since my last post, and since Andrea went into such great detail about most everything I´m going to keep the summary pretty basic. Going back to 4^th of July: honestly that day was kind of depressing because this was the first time in my life that I was unable to do a single thing to celebrate the 4^th. I know that we couldn´t really expect a big show, considering our location, but it still made us a little homesick. I decided to wake Andrea up with pancakes (not a common breakfast food here) as a small way to remember the US. The following week though was packed with excitement, as Yvette and Stephen arrived on Tuesday to work with us for a week. Yvette is one of the directors of Beyond Traditional Borders and Stephen is what I like to call ´the godfather of the backpacks,´ so we were excited to see some familiar faces from Rice as well as have time to talk (in English!!) about our progress and our experience. Because this was the first year that Rice sent students to Ecuador, it was especially important for them to get the low-down on the entire experience.

We first got to meet up with Yvette and Stephen on Wednesday morning as we were heading out to Tungurahua. We conducted a medical brigade in the community of San Isidro, which served also as an opportunity for Yvette and Stephen to see how the brigades of Fundación Futuro work. Also, this was the very first time that Stephen got to see the backpacks in action, which was cool for him because he spent all year toiling over making dozens of the lab-in-a-backpacks. The brigade/mobile clinic went pretty successfully, as there were plenty of patients who needed all sorts of tests. We also made good use out of the gynecological backpack, as there was one doctor who wanted to spend the whole day doing well-woman exams and Pap smears when possible.

The rest of the week we spent in the office preparing reports and waiting to hear if our planned trip to the Amazon was going to go through. Yvette and Stephen were pretty busy working with Fundación Futuro trying to coordinate the shipment of backpacks that was going to the Ministry of Health, so sadly we didn´t have a lot of time to talk with them. However, by the end of the week we finally confirmed that we were going to the Amazon (or Oriente, as they say here)! Our plan was to spend Sunday traveling, and then Monday tagging along with the ministry during a trip to one of the communities in which they were planning to do a bunch of vaccinations. Andrea and I excitedly packed up our malaria pills, rain boots and ponchos and were ready to go!

Entering the Amazon: view from the airplane

Adventures in the Amazon rainforest…at last!

On Sunday morning we flew out to the Amazon in a small plane accompanied by Enrique Estrella from Fundación Futuro, Yvette, Stephen, and all of our medical backpacks. It was only a half hour flight but it was awesome looking out the window and seeing the immediate change from the mountain highlands to the tropical rainforest. After a 2 hour bus ride we arrived in Coca, a small Amazonian petroleum town. Apparently a lot of oil companies have drilling projects in the Amazon, and therefore many small towns have sprung up around this business. We also saw a lot of ´gringos petroleros,´ who are white American laborers who live and work in these towns that are located close to the drilling sites. It was interesting to say the least to see oil trucks and pipelines snaking through the untouched wilderness of the rainforest – an ironic juxtaposition.

We arrived at our riverside hotel and were greeted by a zoo, literally! Many of the inhabitants of this hotel were uncaged tropical animals that had made the site their home, interacting with hotel guests (and begging for/stealing food, of course). Andrea, Stephen and I spent a while playing with and taking pictures of the Toucans, peacocks, squirrel monkeys, parrots, and tortoises before we all had to head over to the Ministry of Health branch – Orellana to talk about our trip the next day to the community of Cotóna. On our way back to the hotel we bought some bread from a bakery to take with us the next day because we would usually go without food on the days in the communities unless they decided to cook for us. When we got back to the hotel we saw one of the adorable little squirrel monkeys and were ´talking´ with it until suddenly we were surrounded by four more of its buddies, who then decided to jump on us! We were not sure what was going on until we realized what they were really after: the bag full of bread! We were playing tug of war with them as they tried to snatch the bag out of our hands, and finally after passing the bag between us we were able to break free and run into our hotel rooms! Only in the Amazon…however the next day we couldn´t stay upset with the monkeys because they were just too cute, so we made up and decided to be friends – we even gave them a peace offering of some animal crackers. That usually does the trick!

On Monday morning we headed out super early, as usual, to the community of Cotóna, which was nearly a 2 hour drive in total from Coca. We brought all of the backpacks with us, and when we arrived we were prompted to give the people of the community a short presentation about the backpacks. Because this was not a normal Fundación Futuro brigade, we were just using the opportunity to tag along with the Ministry and test out our packs in this environment the best we could. That also meant that the people were going to choose if they wanted to have any tests done (instead of a doctor dictating what they needed), and also they would not have to pay for anything. I was not sure if anyone would want to have a blood test or a Pap smear when given the choice, but after the promotores explained to the people in Quichua what was going on, people lined up to get glucose tests, urine tests, and Pap smears! The Ministry seems to have done a good job with this community with their medical education programs. Also, we did not have a lab technician with us, so this was the first time that we had to man the lab-in-a-backpack completely by ourselves. Luckily Yvette had some prior experience as a lab tech and she took over most of the testing.

Later in the afternoon we were asked if we wanted to go see the ´piedras de Shaman,´ or magical Shaman rocks. We thought that sounded pretty cool so went on a short trek through the jungle to the edge of a creek, where there were 3 rocks that had been carved with mystical symbols. The people had no idea when the rocks had been carved, so they knew that they were very old. Two of the rocks had abstract symbols on them that our guides told us were meant to represent man and woman. We also got to meet the local Shaman, who helped out Andrea by expelling all of her evil spirits!

The rest of the trip was pretty straightforward – hanging out in the pool, playing with our monkey friends, and then making the return trip to Quito on Tuesday. We sadly said goodbye to Stephen, Yvette, and two of the backpacks, all of which were returning to Houston and to Rice. We found out that Ecuador had recently put an embargo on the number of suitcases you could check, and we would be unable to return with the packs ourselves. It was sad to see them go because it also meant the end of our work with the medical brigades! We couldn´t believe that it had come to an end, but we felt like we had gotten some really good feedback on our projects that would help out Rice. It was also nice to know that Fundación Futuro was eager to get more Rice student volunteers next summer because they had enjoyed working with us! We definitely enjoyed working with them too and we feel like a continued relationship between Rice University and Fundación Futuro will be beneficial to both parties. María Alicia and QiQín again threatened not to let us leave, and are still constantly asking us when we´re coming back to visit! We always tell them whenever we have enough money for the trip, because we´re just poor students right now! It´s great knowing too that we have an Ecuadorian family now who will always welcome us if we come back.

Me with my adorable monkey friends! What cute little devils...

Yvette and Stephen hard at work in the community of Cotona

Trekking through the jungle on the way to see the Shaman stones

The last week – a little bit of work, a little bit of fun on the beach

Okay so that´s a lie, the last week was actually full of a lot of bit of work. Andrea and I were frantically writing detailed reports for both Fundación Futuro and for Rice University, essentially translating every document from English to Spanish or Spanish to English so that both sides could have full reports of every part of the experience. It was exhausting to say the least, but we knew since we´re the guinea pigs for the internship in Ecuador, every detail was important. ¡Chuta! I never want to write a 20-page writeup in Spanish ever again! Andrea and I were also determined to spend our last weekend in Ecuador at the beach, because that was the only region of Ecuador that we hadn´t yet visited (except for the Galapagos Islands, which was WAY too expensive for us to even consider). Therefore as soon as we finished our reports for Fundación, we set to organizing our trip to the beach ourselves, doing everything from going to the bus station to buy tickets and calling hotels to make reservations. Because I don´t want to write too much I´ll just summarize our trip to the beach of Atacames in bullet points:

• Playing loud horror films on an overnight bus trip is not conducive to sleep!
• It´s much easier to deal with cold showers when you´re in a hot, humid location.
• Our trip to the beach felt pretty authentic because we were practically the only gringos there! This also brought a lot of (sometimes unwanted) attention, and we´re pretty sure that we got ripped off by the locals. Oh well, what can you do?
• I ate and drank everything that I could that was made of coconut – from squid in coconut sauce to fresh coconut milk to coconut milkshakes to the Coco Loco. My personal heaven!
• Highlight of the trip: whale watching. We took a small boat ride out into the sea and were able to see 6 or 7 humpback whales feeding at the surface – close up, too! One of the most breathtaking experiences imaginable.
  

The beach of Atacames

I'm in coconut heaven!

Technology is not my friend!! I have the opposite of the magic touch

Death of a Laptop

Tuesday, our first day after getting back from Baños, we went straight to the office of Fundación Futuro to debrief Maria Alicia and Enrique on our successful trip and also get up to speed on the plans for the week. It was kind of sad though, because while we were off having a grand old time, Maria Alicia and QiQin each spent the weekend in bed with gripe (flu)! I was extremely excited to finally receive a Porta wireless internet connection for my computer, because that would mean that Andrea and I wouldn´t always have to borrow computers from others who still need them, and it also would give us wider internet access. However, this was an opportune time for the gods of irony to strike, because as soon as I had internet up and running on my laptop, my computer battery (which was already struggling) decided to completely shut down. My computer now can only stay on for 10-20 minutes at a time (plugged into the wall the whole time) and can barely handle the internet. This is a huge struggle for us because Andrea didn´t bring a computer, therefore we have both been depending on my sad excuse for a laptop, which is now basically out of commission. However, since we only have a handful of weeks left, we’ve decided to stick it out with my laptop in its current condition so I can focus on repair/replacement when I return to the US.

The portable orthodontics setup brought to Cunugyacu by the orthodontist seen here on the left

Brigada en la comunidad Cunugyacu

After freaking out over these last sad breaths of my laptop, we got up to speed on all of the events that Fundación Futuro was coordinating: the incoming arrival of Yvette and Stephen from Rice, the shipment of 24 lab-in-a-backpacks which are going to the Ecuadorian Ministry of Health, and the medical brigade plans for Wednesday. It seems like a lot is going to be happening in these last few weeks! On Wednesday we left crazy early in the morning, as usual, to go for a one day trip to Tungurahua for a medical brigade in the community of Cunugyacu. We stopped through in Ambato to join up with some doctors and nurses who were coming with us. We then passed through the community of Yatzaputzan to meet up with a few community health workers from the health center (Jambina Huasi) there. After we got our whole team together, we were 13 people in total, much more than the usual six we were used to working with! The craziest part was driving the (thankfully, short) distance between Yatzaputzan and Cunugyacu with 9 people in the tiny cabin of our little pickup truck. I´m still not sure how we managed that. The day proceeded from then on in a somewhat disorderly and frustrating fashion, and I´m not entirely sure why. It may have been due to the fact that there were so many of us working together but we didn´t really have a game plan going in, and we were trying to do too many things at the same time. Simultaneously we were running basic checkups, lab diagnostics, orthodontics exams and extractions, and Pap smears. Although we had 13 people working, only 3 of them were doctors so this probably caused part of the holdup.

I was also struggling a bit because some people wanted to do the 3 Pap smears in the same room as the rest of the exams, when it seemed like there were other rooms available that were more private. We ended up using 2 chalkboards as makeshift walls and balancing the metal stirrups on a small bench. It seemed to work out adequately, but it definitely did not appear to be the most comfortable situation for the patients, especially since a few people were needed just to hold up these makeshift walls during the exams to protect the privacy of the patients. The only reason I was frustrated with this setup was because we had better alternatives for Pap smear exam rooms and wider, more comfortable tables for the patients to sit on. In rural settings it´s definitely a ´make it work´ situation, but because I´ve personally invested so much time and effort into the gynecological pack, I want the patients to experience the most comfortable setup available. It reminds me of an example I read in our BTB manuals, explaining that Americans are unique because they tend to associate themselves very personally with their work. I have found that I am a perfect example of this, and I have to remind myself to chill out when people give me critiques or suggestions about the gynecological pack that I may not consider helpful or applicable. I have to remember that everyone is only trying to help out, but I can´t help but get frustrated when it seems like I´m not being understood, which could be due partially to the language barrier as well. Chuta!

Andrea, Stacey, and Maria Alicia demo the (amazing) gynecological pack and community health worker pack to representatives from the Ecuadorian Ministry of Health

Collaboration with the Ecuadorian Ministry of Health

Moving along: on Thursday we spent the whole morning in meetings with the Ecuadorian Ministry of Health, presenting the other two backpacks (gynecological and community health workers) to all of the bigwigs there. Although we made it clear that these were still first-run prototypes just in the testing stages, they seemed pretty interested in the projects and possibly even eager to request a few from Rice University in addition to the diagnostic laboratory packs that they were about to receive! We also spent a while talking with a couple of representatives about the possibility of tagging along with some of the doctors on a trip to the Amazon rainforest – therefore it would be an interesting medical brigade collaboration between Fundación Futuro and the Ministry, who usually do not have the same ideas about public health! It seems pretty likely that next week we´ll be spending a few days in the rainforest testing out all of our packs in a totally different climate and a completely different culture! Andrea and I are also excited to get a chance to go deep into the rainforest before we have to leave and go back to the United States.

Checking out Alfaro street in beautiful Baños

A week of office work

After a long week working in the office of Fundacion Futuro (we were unable to conduct any mobile medical clinic trips due to lack of lab technicians), and demonstrating the lab-in-a-backpack to the Ecuadorian Ministry of Health – which will shortly be receiving a shipment of 24 packs to distribute throughout the country – Andrea and I were able to get away for the weekend to recharge. QiQin asked us last Thursday if there was any place in particular that we wanted to visit, and I recalled the fact that Dr. Lorena very strongly recommended that we visit Baños. I really had no idea what was there, so only the name came to mind. Soon after mentioning this, QiQin had us online researching places to stay and things to do, because we were going to fly solo for this one! Scary but exciting, because we were ready to venture out on our own while also allowing our gracious hosts a little bit of personal space.

Piscinas de la Virgen - a natural hot spring pool fed partially by waterfalls

The glorious city of Baños

We arrived in Baños on Friday afternoon and realized we’d forgotten to bring our notes with information about our hotel and potential activities. Luckily we were able to remember at least the name of the hotel (well, a hostel actually), and due to the kindness of the locals we were able to eventually find our way there. We also knew that Baños was a very small town, so it wouldn’t be too hard to find our way around. Baños is absolutely spectacular, sitting in the shadow of Tungurahua, the largest active volcano in Ecuador. It erupts every 10-12 years, prompting a city-wide evacuation. The city is also known for its hot springs, waterfalls, and the fact that the edge of the Amazon rainforest is right in its backyard. And the pennypincher in me needs to gloat for a bit about our great find: we stayed in an extremely nice hostel for 3 nights at just $7.50 a night!! Andrea and I even had our own bedroom (none of that 6-bunks-in-one-room business) and our own bathroom, where I experienced the most amazing shower I’ve had in Ecuador (as hot water and water pressure have been generally nonexistent). Awesome awesome awesome.

Bike tour on the avenida de las cascadas

Cuyes asados, or grilled guinea pigs!

Adventure Time!

Saturday, our first full day in Baños, was one of the longest, craziest, most exciting days of my life. Even though I ended the day with a nasty fever (probably just heatstroke or dehydration), I still fell in love with the area. We started early in the morning by renting bicycles so we could ride down the ‘Avenida de las cascadas,’ or ‘Avenue of the waterfalls.’ We stopped at an area where a lot of people were clustered around and saw that people were bridge jumping – my name for what is essentially bungee jumping but with a more rigid cord. I was happy to just watch, but then Andrea asked me if I wanted to do it, because they could do two-person jumps and she said she would only go if I went too. I thought about it and realized I wouldn´t get another chance to do something that insane in South America, so then we literally took the plunge! The drop was about 15 meters of sheer terror before coming to a quick stop and swinging for a few minutes over the rocky Rio Blanco. What a great opportunity to freak out our mothers! Maria Alicia, essentially our Ecuadorian mom, almost had a heart attack when we showed her the video of our jump (kindly taken by a Canadian tourist). More adventures of the day included getting stuck on an open side-open top cable car 100 meters above a raging river in the middle of a monsoon. The rain put our bike tour to a halt and we had to jump on a chiva (tour bus) to get the 20 km back to Banos. Luckily by this point we had run into two other American tourists (med students from Seattle) and their guide, who invited us to come to some hot springs with them afterwards. They also invited us to go eat cuy (guinea pig) with them. I abstained, but was curious to witness the spectacle. Carnivorous Andrea of course loved it and even ate the tiny liver. Ewww. (Side note reminder: Stacey = vegetarian). The rest of the day was spent relaxing in the heat, and after the hot springs we got an appointment at a small local spa to get (cheap, but awesome) massages.

Sunday was also adventure time, as we had signed up for a full day white water rafting trip. We spent several hours on the Rio Pastaza in Class III+ rapids and nearly got thrown off several times, but despite my initial fear it ended up being a lot of fun. Andrea is apparently some sort of rafting champ and therefore she put the pressure on me when I started to waver – after hearing from other tourists that the river was really dangerous, and that two weeks earlier a tourist had drowned while rafting! Nevertheless, we are both still here to tell the tale, and I´m proud to say that I jumped off a bridge and went rafting in treacherous waters in the Amazon! Our rafting guide also spent a while joking – I´m not sure how seriously – about there being anacondas and piranhas in the river. All the better! I think Andrea and I are just a pair of daredevils.

We returned to Quito on Monday ready to get back to work, rejuvenated by our weekend adventures. 3 weeks to go! Here´s hoping we can make the best of it.

The scary cable car that Andrea and I got stuck on

Andrea and Stacey bridge jumping over Rio Blanco

Team of Doctors, Lab Technicians, and of course the engineers for week 2 in the communities

Two new team members: Mijínes

For our second week of medical clinic trips in the communities (organized by Fundacion Futuro), we traded out the two girls from last week for two male students, Carlos and Paul. They came from exactly the same laboratory science program in the Catholic University, but they couldn’t have been more different! The girls were mild-mannered and organized, while the boys were outspoken goofballs. They entertained us during the week by teaching us about the youth culture here, including slang terms and some not-so-polite phrases, which I will not repeat for the sake of decency. It was touching though when they told us that we were their ‘panas,’ meaning close friends, or the equivalent of ‘one of the dudes.’

Despite the informalities, the boys proved to be competent lab technicians, as they each only have one year left to complete their program. During the past week we were able to visit two communities, including the distant and nearly unreachable Cerro Azul (although they rewarded us for our journey with delicious freshly caught trout!) and the bustling community of San Francisco. At San Francisco we set up shop in a pasteurization plant and were quickly inundated with patients, with the daily total reaching over 70 (quite a lot, considering that we process all exams and tests on the spot). It seemed like this community was a great example of what can happen when the community health workers do an effective job of educating the people about the benefits of proper health care. While in some communities many are still hesitant due to gaps in communication, it was great to see a group of people lining up to get blood samples taken – something most people wouldn’t choose to do even when they know the benefits!

In the community of San Francisco we were also able to complete our first five successful Pap smears using the gynecological backpack. While we had to replace proper cytofixative with hairspray, it was still exciting to know that this was the first time any community member received this type of exam. I did however find out some information that was a bit troublesome, which is that the doctors and patients refuse to use metal specula, but then they insist on throwing away the plastic ones. I purposefully included both types so that we could see which type tend to be preferred, but I fear that their unwillingness to sterilize and reuse will quickly diminish our short supplies and then lead to unnecessary waste. Also, plastic specula are relatively expensive, costing at least $5 apiece. Considering that the foundation charges patients for use of disposable supplies, it makes the cost of a Pap smear considerably steep.

Carlos and Stacey conduct a urinalysis test in the community of San Francisco - check out all of those urine samples!

Unforeseen struggles

Andrea and I were pretty happy with the progress in the last week in Planchaloma and the communities of Cotopaxi, as we were able to treat a large number of patients and are continuing to learn more about how to properly implement the backpacks in Ecuador with the help of Fundacion Futuro. However, progress has come to an upsetting halt this week, because we were unable to secure more student volunteers from the Catholic University to serve as our laboratory technicians. They really are the key to the backpacks, because they are the only ones with sufficient knowledge and training to perform diagnostic laboratory tests. We’re also worried because Rice University is sending 24 more diagnostic backpacks to the Ecuadorian Ministry of Health this week to distribute around the country, and we have no idea how they are going to ensure that the technology is used properly, or even used at all. It was also a little disconcerting because last night Andrea and I had a chance to talk at length with a community health worker (promotor) from Tungurahua named Angel. While it was truly insightful to speak with him about his ideas of revolutionizing health care in rural communities and putting control of the system into the hands of the people, he seemed to be under the impression that he was going to man the lab-in-a-backpack himself. While we admired his ambition, we had to explain to him that you would need extensive training and experience to properly perform these lab tests. He told us that he just hopes that after we leave, they aren’t left back where they started, as if nothing had changed at all. We assured him that we’re trying to figure out everything we can to ensure that the technology in the backpacks will continue to be used even when we’re not here.

Some lighter notes: on nicknames and (non) political correctness

One of the more entertaining aspects of Ecuadorian culture is their use of names, especially nicknames. Many of their commonly used terms of endearment could be interpreted (in American culture) as politically incorrect or even insulting. As some examples, it is perfectly normal to call a parent, child, or close friend ‘Gordo’ or ‘Gordita,’ meaning ‘fatty’ or ‘chubby.’ Also, children are commonly referred to as ‘enanos’ (dwarves) or ‘piojos’ (head lice). More personalized nicknames can get even more creative, such as the use of ‘Mocosa’ (snot-nose) for both Andrea and I. Due to my unusual name (Stacey Skaalure, which is basically un-pronounceable in Spanish) I’ve acquired some hilarious new interpretations of my name. QiQin tends to call me ‘SiSi’ (he insists that’s what it sounds like when Andrea says ‘Stacey’), and follows it up with ‘Hace Scalor’ (a play on hace calor, which means that it’s hot out today) or ‘Excalibur,’ both of which I guess vaguely sound like my last name. Names that the boys, Carlos and Paul, gave me last week include ‘Stacey Malibu’ (apparently the name of a Barbie on an episode of the Simpsons), and ‘Cabeza Zanahoria,’ meaning ‘carrot head’ or probably ‘carrot top.’ Besides just nicknames, probably my favorite example of non-political correctness is the name of a popular local fast food chain called ‘Menestras del Negro,’ which literally means ‘Beans of the Black Man.’ To make it even more ridiculous, check out the drawing that goes with the name in the picture below:

¡Menestras del Negro! ¡Que Cómico!

The gang´s all here - our medical team for the first week

 

Meet the Team

On Monday afternoon we got everything packed into the truck (just barely!), picked up two girls from the Catholic University of Quito, and headed off to Planchaloma with our backpacks and all of our gear for the week.  Planchaloma was to be our weekly headquarters where we would gather our team, get our stuff ready and prepare for the daily trips to the communities.  We’ll be staying there nearly every week until the end of July, living in the new Health Center built there by Fundación Futuro.  Its newness definitely showed – we spent nearly a day trying to set up the hot water heater – which was a godsend when it worked, I was worried that I wouldn’t be bathing for the week; the water was so cold that I would rather opt for being dirty!  Also, the staircase that was supposed to lead to the second floor led to nothing (2^nd story not built yet), and 80% of the power outlets in the building didn’t work.  We all became extremely resourceful, by necessity!  Through all the mishaps, however, it was great to finally meet up with all the members of our team, or medical brigade.  A summary of ‘teammates’ follows:

Nicolas – Community health worker (promotor) for the Planchaloma area.  As a resident of the community, it’s his job to gather the people, keep them informed, and convince local indigenous people that it’s in their best interest to trust the mobile medical clinics coming through (meaning: us!).  Without him, we wouldn’t ever be able to come in and set up our clinics.

Drs. Lorena and Monica – Resident doctors of the health center who both work at the central clinic in Planchaloma and travel out to the communities to set up the clinics – therefore increasing access to medical care. 

Carina and Lucia – Two laboratory technicians who we ‘borrowed’ from the Catholic University’s school of laboratory sciences.  Things worked out well because we needed lab technicians to know how to do all our tests, and they have a degree requirement to work 70 volunteer hours doing lab sciences in poor communities – definitely a win-win situation.  Also, they knew how to take blood and other tissue samples, which was something I did not suspect but was great because we don’t have a nurse on the team and Andrea and I are definitely not prepared to do that!

Lucia and Carina setting up the Lab in a Backpack in Chisulchi Chico

Me, Andrea, Enrique – During the clinics we all function as mostly observers, as Andrea and I are taking notes on the use and inventories of the packs, while Enrique is taking down patient information and his own inventory list for the purposes of Futuro Foundation.  Andrea and I also oversee use of the packs and help with setting things up, going through instructions etc.

The children of Chisulchi Chico

The Maiden Voyage of the backpacks

Once the team was all assembled and everyone was more or less knowledgeable about the backpacks, we packed up and headed out to the communities.  In the past week we visited two communities – Chisulchi Chico and Chisulchi Grande – setting up a quick clinic in the local schoolhouses and seeing as many patients as possible.  Most of what we did was routine checkups for the kids, including hematocrit tests (and you would not believe how calm these small children were about having their fingers pricked and drops of blood squeezed out into a capillary tube – it made me remember the uproar my sister and I used to cause when presented with the same test).  The doctors were also handing out some sort of medicinal cream to the children that they were meant to apply to their wind-burned red faces.  We also ran a couple of urine tests, glucose tests, pregnancy tests, and hearing tests for the elderly, as well as general exams of pregnant women and some miscroscope tests (one using a stool sample) when there was indication of illness. 

One case that really shocked me was a young man who came in asking for a re-dressing of a wound.  He took off bandages on his wrist, shoulder and forehead, revealing deep gashes that exposed the bone beneath (we could see his skull in two places) and angry burned skin.  The wounds were three months old and were caused by an electrical accident while he was installing a lightpost – apparently the current entered his hand or wrist and then exited through his head, causing the two deep holes.  I was amazed that he could even survive such an event!  It also appeared that whoever had last dressed his wound had used cotton balls, which left behind fibrous residues that cause infection.  The doctors therefore spent quite a bit of time cleaning and re-dressing the wounds.

On Thursday came the first opportunity to use the gynecological pack, as two women requested to have a Pap smear.  This type of exam has never been conducted in the area before because it’s too complicated, so this was a nerve-wracking experience for all of us.  I got everything set up in the little school room as best I could and then left it to the doctors to conduct the exam while the rest of us waited outside.  However, the first run was a half-failure – everything worked out fine until they got to the cytofixative which is needed to firmly attach the cellular sample to the slide – important because the sample must survive until it reaches a specialized laboratory that examines Pap smears.  It seemed that the cytofixative spray that was in the gynecological backpack was empty – something I attributed to the plane ride.  I remembered opening up the pack after arriving in Quito and noticing that the cap had popped off of the cytofixative; however I didn’t think to check the contents because I didn’t want to waste any of the spray.  It seems that the can probably emptied itself in the plane due to the high pressure.  This was upsetting because I realized that none of the cans in the other backpacks likely survived.  However, I learned that you can actually use normal hairspray as an alternative, and hopefully they can buy some fixative in Quito as well.  Hopefully this means when we return next week we’ll be prepared with all the tools we need, including some type of fixative.

Setting up the wooden stirrups for the first Pap Smear in a backpack performed in Ecuador

Health Update

It appears that keeping the poor ‘gringitas’ healthy is one of the biggest challenges of this trip – as Andrea came down with some sort of cold while in Planchaloma and thus was named the new ‘Mocosa’ (a title which was previously mine, literally meaning ‘girl full of mucous’).  I was actually the healthy one in Planchaloma, so apparently the cold mountain air is much better for my health.  And believe me, it’s cold out there!  In Planchaloma the altitude is about 3800 meters and the temperature normally ranges between 2 and 13 degrees Celsius.  At least Andrea and I are escaping the sweltering summers of Texas!  However, as soon as we returned to Quito I developed a nasty sinus infection.  After a trip to the pharmacy we both got heavily medicated – one of the great advantages of Ecuador is that you can get any prescription strength medication over the counter.  What becomes slightly annoying after a while though is that if you have any type of illness at all, allergies included, people say that you have gripe, which here means flu.  Due to the swine flu epidemic it’s not in our best interest to have people going around saying we have the flu when we know we don’t, so we’re doing our best to keep our runny noses on the down-low!