Reports from Ecuador

Sally–the salad spinner centrifuge Lauren, Kelly, Nazima and I have spent the past year developing–made her Ecuador debut today!  Amanda and I drew six samples of blood and demonstrated the centrifugation process to María Alicia, Marisol, Daniel (a volunteer at the office) and a member of the custodial staff.  We centrifuged all six at the same time (meaning that one of the five comb segments was holding two blood samples).  The staff at Fundacíon Futuro seemed excited about the process for collecting  blood samples and loading them into the centrifuge, but was ostensibly disappointed that it would take 10 minutes of spinning for the blood to separate, a known disadvantage of the device.  However, everyone was surprised at how quickly the time passed, and so excited for the results!  Everyone took turns using the adapted reader cards, and they appreciated that we had marked the anemic zones directly on the reader card.  While we did not run control samples in the Zipocrit, the benchtop model widely used in the US, Sally seemed to work beautifully!  There was one exception: one blood sample did not entirely separate, leaving a pinkish region occupying about one-fifth of the blood volume.  We observed severalpossible reasons for this anomoly.  First, when we drew this sample, we were having difficulty collecting enough blood, creating three large air bubbles.  Of the other samples, there was a small bubble in about half of them, but not as big or as many as in this unsuccessful sample.  On that note, it was exciting to see that for all samples with bubbles, Sally worked well enough to force out the air, something that we had struggled with in lab.  Second, this blood sample was the one sample that was not centered within a comb; it was at the extreme end of one of the combs, although I did make sure that it was still lined up with the middle correctly.  The other possibility is that we drew this blood sample last, meaning that it had the least amount of time to separate naturally via gravity.  Hopefully we will be able to determine what exactly caused the problem when we take it to the communities.  Overall everyone at Fundación Futuro seemed very, very excited about Sally, so we are eager to see what the health promoters in Plancha Loma think about the design.

FYI: Given the unreliable internet situation, Lila and I have decided to split up blogging responsibilities so that our entries do not overlap.  To read about our experience in its entirety, visit ecuador.blogs.rice.edu.  Thanks for reading!

We took yet another day-trip on Saturday to Otavalo, a town about 2 hours north of Quito. On the way, we passed the Equator and a large sign welcoming us to “La Mitad del Mundo.” It was so cool that we were able to be in both the Northern and Southern Hemispheres at the same time! And once we were in Otavalo, there was non-stop shopping. Otavalo is essentially a massive outdoor market where locals sell their handicrafts. We were accompanied by Marta, Maria Alicia’s clever and savvy mother who showed us Americanas a thing or two about bargaining with Ecuadorians. Lila and I spent the day haggling for our souvenirs and finished it off with another traditional Ecuadorian-style meal, which included the inescapable Ají, along with moté, queso and llapingachos.

The sickness has struck.

Unfortunately, after our wonderful trip to Otavalo, I became very ill. Maria Alicia called a doctor to the house to make sure it was nothing very serious. Fortunately, it was simply due to the drastic and sudden change in my diet; the doctor gave me medicine and the order to rest so my body could adjust. I stayed at home in bed on Sunday and Monday to give my body time to recover and returned to the office on Tuesday to help Lila finish up the hand-washing and recycling posters. Lila also brought her Sally Centrifuge in order to demonstrate it for everyone here in the office, including Maria Alicia and Marisol. On Thursday, we will be leaving Quito and heading out for Planchaloma. We are excited to finally see the community and clinic there and to get to work with the Backpacks and Sally.

At our desks in the Fundacion office.

FYI: Given the unreliable internet situation, Lila and I have decided to split up blogging responsibilities so that our entries do not overlap. To read about our experience in its entirety, visit ecuador.blogs.rice.edu.  Thanks for reading! 

On Friday, a long and winding mountain road led us to Yatzaputzan, an indigenous community located about 2 hours from Quito and 12,000 feet high in the Andes Mountains. We were greeted by a breathtaking view of an endless expanse of green hills, crisp mountain air, a bout of altitude sickness, and the indigenous men and women of the community. We were given a tour of the clinic there, which was very different than the clinic in Guayaquil in that it was in a newly constructed building. Though this clinic was still partially under construction, we could tell that it was much larger than the other, having more amenities, rooms and space. The Yatzaputzan clinic is definitely a modern, affordable and trustworthy resource for the people in the surrounding communities.

The waiting room at the clinic

The other reason for our visit was to attend a ceremony for the welcoming of the new officers of the Women´s Cooperative. The Woman´s Cooperative is a partnership between Fundacion Futuro and the women of the community of Yatzaputzan and of the surrounding area. In 2008, the Fundacion began the Cooperative by giving the women of the community the seed money to start a small business, which could be something as small as owning a cow. Then once their businesses started growing, the women of the communities were able to lend money to each other to aid in the growth and maintenance of their businesses.

Marisol's amazing dance moves

FYI: Given the unreliable internet situation, we have decided to split up blogging responsibilities so that our entries do not overlap.  To read about our experience in its entirety, visit ecuador.blogs.rice.edu.  Thanks for reading!

Thursday featured a day trip to Guayaquil, the same coast city where our incoming flight from Houston landed to refuel before eventually arriving in Quito. After a half-hour flight from Quito, we spent the morning touring the city with Marisol, who is originally from Guayaquil, as our guide. We took a taxi to the base of a huge hill, and then climbed the 500 steps to the top in order to get an aerial view of the city.

After climbing back down the hill, we spent the rest of the morning walking along the boardwalk area, which is home to monuments, statues, beautiful flowers and trees, street vendors and lots and lots of people. The boardwalk let us to the bahía, a huge tent marketplace where vendors are eager to sell everything from artisan craft and jeans to watches and toys. We then took a taxi (which sounded like it was going to fall apart any minute) to the main plaza, where we were greeted by hundreds of freely roaming iguanas! We could not believe how many there were, and how calm they were!

We then continued to a nice hotel for typical Ecuadorian lunch: pork, a llapingacho (kind of like a mashed potato and cheese pancake), fried plantains and salad. After lunch we finally made our way to the neighborhood 30 minutes outside of the city where Fundación Futuro has a clinic. The community was obviously an extremely poor area, but the clinic itself was very nice. María Alicia and Marisol were there to administer an exam to the health promoters, and Amanda and I were the pretend patients. This was a great way for us to help them out and also see first-hand how their clinic system operates. When patients arrive, health promoters introduce them to the clinic. They emphasize that while the foundation supports them, it truly is the community’s clinic. Patients pay up to 50 cents for the visit, which does not cover the actual costs of their medical care, but does give value to the services that they receive. Health promoters than take their weight, height, blood pressure and temperature, and direct them to see the doctor in general medicine, dentistry, psychiatry or gynecology depending on their needs. It was such a privilege to see the foundation’s work up close and meet the people on the front lines of health care in this developing country. As we learn more about the foundation’s clinics, it becomes easier to envision the role of the technologies we brought from Rice. When we go to Planchaloma next week we hope to begin demonstrating the suite of backpacks along with Sally and the AccuDose. Until then, it’s been a great experience getting to know the people involved with Fundación Futuro and learn about the heroic work they do throughout the country.

FYI: Given the unreliable internet situation, we have decided to split up blogging responsibilities so that our entries do not overlap.  To read about our experience in its entirety, visit ecuador.blogs.rice.edu.  Thanks for reading!

After the weekend’s introduction to Quito, Amanda and I spent Tuesday and Wednesday working at Fundación Futuro’s central office. When we arrived on Tuesday morning, the amazing María Alicia explained to us the foundation’s mission and history, which would be essential for us to understand in order to best contribute to their work.

The foundation was started by Grupo Futuro—a collection of five companies in Ecuador including Tecniseguros, which shares its office with the foundation. The foundation originated out of the conviction that business has an obligation to not only producing quality goods and services, but also to give back to the community in order to protect the environment and improve the conditions of marginalized populations.

Today, the foundation supports medical clinics in six different rural, indigenous communities and two neighborhoods in Guayaquil, Ecuador’s biggest city. Each clinic is run by a network of doctors, nurses and health promoters who work together to provide general medicine, dental, gynecology, psychiatry and pharmaceutical services to patients at a minimal cost.  The foundation also supports educational and microfinance projects.  María Alicia emphasized to us that the foundation exists to support the needs and wishes of the community rather than impose a paternalistic agenda, and as such collaborates with community leaders in order to develop requested services and does charge a nominal fee for medical care.

Tuesday afternoon and Wednesday we worked on a promotional campaign for hand-washing to be used by the health promoters. Many people in the communities the foundation works with don’t have public health programs in place that teach such important hygiene habits. Luckily, I had worked on a hygiene education project for my BIOE 260 class, and had these resources available. So far, we´ve developed a series of activities for children that convey the importance of washing your hands as well as promotional posters for the clinics and other public places.

As we were designing these materials, it came to our attention that the lack of hand-washing is only part of the problem—none of the indigenous communities have access to potable water. I mentioned to María Alicia the SODIS (the protocol that disinfects water after 6 hours of sun exposure), and she suggested that we do a trial in Planchaloma, where they’re currently conduction a water quality study.

Once we make the final revisions to the hygiene materials, we’ll begin a similar project for recycling. Because many indigenous communities on recently began to use plastic goods, they have not yet implemented a recycling program, something the foundation would like to work with them to change.

So far the work has been really interesting and we’ve felt useful.  Hopefully this continues as we begin to visit the communities and work directly with doctors and patients!

After departing later than scheduled, taking a detour into Guayaquil Airport due to “mal tiempo en Quito”, and spending almost 10 hours sitting on Continental Flight 653, we finally arrived in the gorgeous capital city of Ecuador that is Quito.

Besides that crazy flight, everything went smoothly: the CHO and OB/GYN backpacks have arrived safely in our company, and we are ready to explore all that Ecuador has to offer while also helping in any way we can and making as much of a difference as two college students can possibly make in a developing country.

Maria Alicia has treated us so well and has opened up her beautiful and cozy home to us which we will be forever grateful. She has unofficially taken on the role of our own personal tour guide and encyclopedia of knowlege of everything Ecuadorian, especially her home city of Quito. Before the real work begins, she has made sure that we feel right at home and are seeing as much of this beautiful city as possible. Tomorrow happens to be a holiday in the city of Quito when El Festival del 24 de Mayo will take place. It commemorates La Batalla de Pichincha that took place on a mountain in Quito in the early 1800s and which showed that Ecuadorian indepedence from Spain was imminent.

We will be spending the remainder of the week in Quito with Maria Alicia. She is hesitant to talk about any kind of work yet; I guess she is fully enjoying the holiday and days of rest! The real work may begin on Tuesday; but until then, I will make sure to take in all that Quito has to offer the eager and mesmerized tourist.

Atacames

Vacation time! Stacey and I were originally supposed to come back to Houston this past Saturday, but our time was extended so we could enjoy more of Ecuador. We spent a long weekend at Atacames, a pretty nice beach town lined with stores and vendors all along a beautiful beachfront of the Pacific Ocean. The highlight of the trip, by far, was the whale tour! We saw about seven humpback whales – I even saw one come up head-first!!

We also took a gastronomical tour of the coastal region of Ecuador by trying their tropical fruits and all the wonderful fresh seafood that they had to offer!

Stacey and I got to read and tan on the beach for a bit, and unfortunately we now look like lobsters, but it’s all in good fun! Our characteristic pale skin is now a tinge darker, and Enrique has joked that we are no longer Casparinas! (Casparina is the Spanish version of Casper, the friendly ghost)

Saying Goodbye

After wrapping up all of our paperwork, we unfortunately had to prepare to leave all of those at Fundación Futuro.  After our last dinner together of eating typical Ecuadorian food, we said our final goodbyes. They told us that they were very sad to see us go, and they hope that one day we can return to Ecuador, for we’ll have a family waiting for us…

After catching the flight back to Houston in the early morning, I am now safe and sound in the United States.

Final Thoughts

It’s hard to believe that I’ve just completed two months of work here in Ecuador, and I can honestly say that it’s been some of the most memorable couple of months of my life.

I’d like to thank all those in the BTB program, most notably Dr. Richards-Kortum, who encouraged and guided my BIOE 260 team when we were designing the CHW pack this past semester, and Dr. Maria Oden, whose word in the final assessment and design of the pack was unbelievably helpful. Also, many thanks to Yvette Mirabal, who has been our mentor for the pack since the start, and whose insight really helped Stacey and me look out over the past few months and realize how much we’ve accomplished. The lab in a backpack now here in Ecuador would not have been possible without Stephen Wallace´s hard work, and his assistance to get me in the door at Medical Bridges really helped me out at crunch-time!

Also, a most important shout-out to all the doctors, nurses, community health workers, lab technicians, and patients we have seen throughout all of our medical brigades. I would especially like to thank a few by name. To Dra. Lorena and Dra. Monica, you are extremely inspirational people, and you have clearly demonstrated your love for others through your dedication in treating the indigenous populations of the Sierra. To Lucia, Karina, Carlos, and Paúl, you all have been the best lab technicians I’ve ever met! With your fun attitudes, you´ve brightened up our weeks at Planchaloma. Also, many thanks to Nicolas and René, my team and I designed the community health workers´ kit for you, and I welcome your feedback wholeheartedly.

I cannot say enough in gratitude to the people of Fundación Futuro. María Alicia and Enrique have opened their arms to us this summer. Stacey and I came in as two unknown strangers, but they welcomed us in immediately. María Alicia’s generosity has been outstanding, for she’s offered her home for us to stay at these past two months. She has let us into her life, and I can honestly say that I will be extremely sad to leave her and her beautiful family. Enrique has also welcomed us as daughters, and in meeting and spending time with his family, I have seen a glimpse of the life I hope to have one day. Marisol has also been more than generous, not only in helping us refill the supplies of all of our backpacks, but in simply brightening our day with her silly voices and contagious laughter. These people have helped us in the daily struggles in implementing our projects. More importantly, though, I will miss them personally…With their relentless sense of humor, laid-back attitude, and selfless care for others less fortunate than themselves, they have become my Ecuadorian best friends!

This program of Beyond Traditional Borders has provided me with an experience that I could have hardly ever dreamed of! Even though I’ve only finished my freshman year at Rice, I’ve been able to experience first-hand how to efficiently run mobile medical clinics and to see my own project being used by medical professionals in remote regions. Through living here and learning so much from the locals about Ecuador, I’ve come to know and love this tiny South American country. These experiences have also helped me grow personally: I’ve learned to become more patient, more empathetic, and more inclined to sit back, listen, and truly enjoy the company of others.

I´ll admit it – these two months have not been the easiest in my life. I’ve struggled with homesickness, parasites, and language barriers, but I have gained a stronger sense of strength and self-confidence to help carry me through these and future struggles. I hope to carry the lessons I have learned here for the rest of my life. The generosity, kindness, strength, and intelligence of the people with whom we have worked will always represent to me the essence of Ecuador.

Adiós, y gracias por todo.

Con todo mi cariño,

Andrea

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!

¡Hola mijines! Sorry for the wait!

Chillaxing

The Saturday of July 4 was pretty low-key. It turned out that both of our hosts had to work that day, and we weren’t sure if we were allowed to leave the house. In the end, we celebrated America’s independence by eating pancakes and rediscovering the world of Youtube. After all, it was the first time we’ve had Internet at home in 7 weeks!The next day was pretty great, since we ate lunch at a wonderful restaurant sitting atop Panecillo, the hill of Quito we had visited right after our arrival in Quito two months ago. We spent time with María Alicia, her mom, and her great-aunt, who’s 96 years old but still maintains a great memory! We also toured the central market of Quito – El Paisaje Artesanal – and shopped around for local handicrafts.

Monday and Tuesday we worked pretty solidly on the official report for Fundación Futuro. It turns out that revising fifteen pages of Spanish is not the easiest thing to do. We then prepared reports for Yvette (BTB director), who was flying in with Stephen (creator of the 25 lab in a backpacks) late on Tuesday night!

Medical Brigade: San Isidro

Early Wednesday morning, we joined up with Stephen and Yvette for a medical brigade! It was absolutely great to see them, since we hadn’t seen anyone from back home in so long! We drove the thee-ish-hours to Yatzaputzán in Tungurahua. I was happy to see that their clinic that had been pretty disorganized last week had greatly improved. After gathering our lab tech, family doctor, and nurse from last week, we met up with a new orthodontist and three community health workers to drive everyone back to San Isidro.

The brigade worked out pretty smoothly! We set up everything on the second floor of a cheese plant. In one large, central room we set up the CHW pack towards the front, and the portable orthodontics kit at the very back next to the lab in a backpack, which was again a hit with a high demand for urine, parasite, and hematocrit tests. Patients first filtered in through the nurse, who used basic diagnostic equipment, and were then referred to the doctor in the other room, where the gyneoclogical backpack had been set up. The community health workers were quite helpful this time around, for they helped the nurse in keeping all her records. I only have a few complaints: there was some confusion over the extra medical supplies we had brought, since they had been placed in separate containers and were not well-organized prior to the brigade. Also, the lab technician, who was by this time quite familiar with how to use the supplies from the LB, wrote down the results in a notebook and headed back home. When we passed the results to the doctor to interpret, however, she couldn’t understand some of the lab tech’s notations! We had no means of communicating with her, and although we figured it out after putting our heads together, it was a bit stressful!

Once the nurse stopped using equipment from the community health worker’s kit, I was able to go through my routine nutrition lessons. The children absolutely LOVED the Comida Buena / Comida Mala game! (similar to Red Light / Green Light). We also went through the coughing freeze tag game, which was great since they all got to run around for quite some time. Towards the end, though, they wanted yet another game. I decided to try and think of a new game on the spot…I remembered how much fun Marco Polo had been as a kid, in which one kid closes his eyes and tries to tag the others. I also remembered a very startling video I had seen in BIOE 260 this past semester, in which I learned how night blindness can be quite common in women and children who do not intake sufficient amounts of Vitamin A. I lectured the kids a bit over this topic, and ended with the recommendation to eat their carrots (high in carotene)! They all played Marco Polo, which they loved. The game turned out more to be an exercise of understanding the difficulties of blindness so as to scare them into eating their vegetables. Sounds like a good tactic to me!

Overall, I would say this experience was a definite improvement over Cunugyacu!

Preparations
Thursday we worked on our formal report (this time, in English) for Rice that summarized all of our medical brigades. We also simplified the user information sheet for the Ministry officials to use with the 24 lab in a backpacks coming in a few months. On Friday Stacey and I began working on our poster presentations for September. Then we made sure that all our paperwork was together for our brigade….TO THE AMAZON!

An Infusion of Culture
That Saturday, Stacey and I decided to take matters into our own hands and take a taxi to explore the city. We had never felt comfortable enough to do this before, but since María Alicia was having car troubles, we knew it was now or never. We decided to travel to the national museum, which is an amazing collection of roughly three thousand years’ worth of art from all over Ecuador! The “ancient” exhibit was definitely my favorite. We saw a beautiful collection of pottery from the Valdivia and Correrra cultures. Perhaps the most memorable item was that of a shrunken head!! We learned that the practice of shrinking heads was quite popular in the Amazon (where we were traveling to the next day!) A warrior would wear the shrunken heads of his defeated enemies around his neck as a sign of strength. The practice was also intended to soothe the victim’s soul and mitigate its desire for vengeance!

We also saw centuries of religious art inspired by the Spanish. The exhibit ended with very striking modern art, featuring pieces by Guayasamín. The plight of the indigenous population of Ecuador was a common theme in many of the paintings of the twentieth century, and I find it interesting that Americans haven’t seemed to reflect that same social conscience with our indigenous population in recent artistic movements.

_________________________AMAZON!_________________________

Arrival

Stephen, Stacey, myself and Yvette fresh off the plane at La Aguardia

Between La Aguardia and Coca

YAY! Finally we were heading out to the Oriente – the Eastern and wild Amazonian part of Ecuador! We woke up early and headed out to the tiny airport. Getting all three backpacks through security was a little bit of a hassle, but it worked out fine in the end! Soon enough, the whole team – Enrique, Yvette, Stephen, Stacey, and myself – loaded into the propeller airplane and took off! The views during the half-hour flight were unbelievable. We could see the peaks of the largest and most well-known volcanoes surrounding Quito, with Cotopaxi as the most impressive. Once we flew over the Andes, we saw huge stretches of pure virgin forest pass beneath us. We had arrived in the jungle! After landing we took a two hour bus trip to Coca, the town we would be based out of.

Our hotel was astonishing! Peacocks, toucans, and squirrel monkeys roamed around freely. That day we settled into the town of Coca by walking around the malecón, or boardwalk. For lunch I ate guanta – lowland paca – that tasted pretty good! It was certainly a first. Then Yvette, Stacey and I worked out at the hotel´s gym. It had been so long since I’ve exercised that I had forgotten all about endorphins!

We also had a meeting with one of the doctors from the Ministry of Public Health clinic near Coca. In Ecuador it is required that medical doctors spend two years working in the indigenous communities. This one doctor found that serving these populations was his calling! He spent twenty years working directly in the jungle, with those who have the most limited access to medical care. He was amazing! Behind his desk were huge fifteen foot spears – gifts from the people of the Guarani tribe, one of the most famous of Ecuador for their refusal to wear clothing of any type. It was quite exciting to the meet a doctor who had been so involved with the indigenous people of this region! He really liked the idea of the three backpacks, though expressed some concerns about the weight. Traveling light, he told us, is of huge importance for medical professionals in the Oriente. To reach the community of the Guaranis from Coca, for example, you need to travel 18 by canoe! In the end, the doctor assured us that we could use our backpacks in a medical brigade for vaccinations the following day.

Perhaps the most important part of that first day in the Oriente was my first real introduction to the squirrel monkeys. While carrying a few pieces of bread down the open-air walkway of the hotel that evening, I had looked up to see a monkey staring down at me from a beam. Before I knew it, two monkeys had jumped on my shoulders! They didn’t bite or scratch or anything of the sort – they just really wanted to get to the brown bag of food that I was carrying! After about ten minutes of the monkeys jumping back and forth between Stacey and me (they were certain that Stacey’s earrings were yummy insects), we were able to escape. What a welcome to the Amazon!

Squirrel Monkey Surprise

Cotóna: LAST Medical Brigade!

Getting to Know the Kids!

Waking up before the sun rose, the five of us hopped into a taxi to travel to the Ministry of Public Health clinic to catch the truck going out to Cotóna. We first introduced the three backpacks to more of the Public Health officials, including the obstetrician and community health worker who would accompany us. We all packed up in the van with the medical supplies, and traveled down a rocky path to reach our destination of the community of Cotóna. During that time we were able to talk with the community health worker, René. He told us some interesting facts about the wildlife, such as the local snakes whose bites are fatal, and of a type of fish that actually gives an electric shock to those who try and eat it!

The conversation was cut short when the truck pulled into an open field with a line of wooden buildings to our left. We had arrived! After dousing ourselves in bug spray (contracting malaria is not high on my to-do list), we walked in to a huge open room in one of the buildings with all of our packs. After starting to set up our packs, I looked up to see more and more members of the community sitting down on the benches that lined along the walls. Soon about seventy people had gathered, all staring at us. The community health worker then explained to us that we were expected to give a speech to the community about the new equipment!! Luckily, Yvette stepped up to bat first and explained the lab in a backpack. Then Stacey spoke about the gynecological pack, and I finished up with a summary of the CHW pack. During this whole time, René was translating our Spanish into Quichua. It´s interesting to note, though – the Quichua spoken in the Amazon is completely different from the Quichua we´re familiar with in the Sierra! After we had finished our talks, René asked them all in a loud voice, ¨What do you think? Are the packs worth it?” A rowdy applause broke out, as several men gave the thumbs-up sign and smiled. We passed!

The brigade was a hit! The obstetrician set up a women´s clinic in a small room across the field, where she saw a series of women throughout the day. In the large room, I remained with the lab in a backpack and CHW pack. It was a little strange in that there was no general practicioner or lab tech, so the community members could just go up to the table and ask for whatever test they wanted. Yvette and Stephen manned the LB, and we ended up doing mostly urine and glucose tests. The CHW pack was not in use, I was sad to see, so I started the nutrition games early. While some of the children were receiving their vaccines, I pulled others to the side and asked them to list the vegetables and fruits they knew. They said a few names that I had never heard of before (obviously, the kids here are familiar with different crops than the kids in the mountainous regions of the Sierra). We were able to play Good Food Bad Food, which they seemed to really enjoy! One of the boys even helped me be a leader in calling out the different types of food, which gives me hope that the kids will continue to play the games even after I’m gone. After running through a somewhat restricted version of the game (they couldn’t run around too much or leave the building in case René called them to receive their vaccine), we still were able to complete most of the games! Afterward, they really enjoyed taking pictures with my camera and poking at a local tortoise that they had found. I had the opportunity to talk to the teacher for the region, who was very kind and had a lot of great ideas for further developing the area.

After we had seen all the patients, we started wrapping up when we were offered to see a ´shaman´s rock.´ We piled up in the truck and then disembarked to walk along a muddy path with trees on either side. We were hiking in the Amazon rainforest!! All of the team arrived at a thatch hut, where we continued walking down a muddy path to the river. It was quite slippery, but I somehow managed to obtain a semblance of balance. When we got there, we saw three huge rocks, about waist high, that had moss growing over them. Through the moss we could see strange, ancient writing. They actually have no idea how old these rocks there, but I´m going to guess that they´re a couple thousand years old. How awesome! After slipping our way back up the path, we were greeted by a shaman! Although we could only stay briefly, we were able to talk for a little while. At one point he shook his wand made of palm branches over my head. I asked him what that meant, and he responded that it was a purification ritual to rid me of my evil spirits. Sweet! That doesn’t happen everyday!

Before heading back to Coca, we stopped once more at Cotóna, where they served us a delicious meal of pasta, rice, and fish. I found out later that pasta is very, very expensive for members of the community, so it was a great honor to receive such a gift! When we got back in the health clinic, we had a long discussion with the lab technician and obstetrician about possible improvements to the packs. In general, we’ve found that they are always requesting more and more complicated tests, but they already complain about the weight of the packs. In any case, it was very helpful to receive their feedback!

Purification Ritual!

Reflections and Basketball
Unfortunately, we couldn’t stay in the Oriente forever! We spent most of Tuesday taking the bus and plane to get back to Quito, and during this time we spent a lot of time reflecting on the experience as a whole. It´s absolutely mind-boggling to think that Stacey and I are coming back home in a week! Every time I even think about heading back home, I almost start tearing up. Ecuador has been my home for the past two months, and I have come to love the country and the people. At the same time, I can’t wait to see my family again! I don’t think I’ve ever gone so long without seeing them, especially in a country so far away. Until the day of departure, I’ve decided to do my best to finish up my work and enjoy Ecuador to the fullest!

After resting a bit on Wednesday, we were on our way to the office with María Alicia when she asked if we´d like to go to a basketball game. It turns out that the South American Women´s Basketball Tournament is occurring in Quito right now! With a sudden change of plans, we visited the Ministry of Public Health for some errands and then were dropped off at the basketball stadium. Stacey and I were able to see three basketball games: Uruguay vs. Peru, Brasil vs. Chile, and Ecuador vs. Argentina. During the first two games, I must admit, it was a little creepy. None of the audience was cheering, or even talking it seemed. As soon as the Ecuadorian team got on the court, however, everyone went wild!! Children were waving banners in the air and everyone was stomping their feet! I suppose the prior silence had been an expression of loyalty to their country. Ecuador ended up royally creaming Argentina!!! It was a great game! Ecuador´s going to play in the finals tomorrow (July 17), so try to catch a bit of it, if you can.

Drowning in Paperwork
Thursday and Friday (today) I have worked on more reports than I have ever had in my life. Stacey and I finished the write-ups in the formal reports of the past few weeks, and included a series of appendices for Fundación Futuro relating helpful information for future interns and for proper use of the lab in a backpack, which will remain with them. Fundación then requested another series of documents, in which we more specifically detailed how to improve the lab in a backpack and wrote more helpful hints for Fundación as a whole. Each document is written in Spanish, and then revised for grammatical errors by María Alicia or Enrique, and as such goes through a series of drafts. We´re also compiling several documents for Rice that chronicle our experience as a whole. It´s all helpful information, but there´s just so much of it!

Thankfully, we´re wrapping up with all the documents. As a reward, Stacey and I are spending a long weekend at one of the famous beaches of Ecuador (we´re told that there are whale tours!)

Next week´s blog post will be my last, dear readers!

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.