Reports from Ecuador

I cannot believe that this is my last night in Ecuador!  Quite a bit has happened since my last post, sorry for not updating more!

We left Planchaloma a few days before our internship ended to try to do some Lab In a Backpack interviews in the Amazon.  Unfortunately, many of the people we wanted to talk to were not at their clinics, and a broken bridge prevented us from even getting to one.  We did, however, get to see one heavily used backpack, and an entirely new part of Ecuador!

We returned to Quito for the last full day of our internship, where we visited a shop to get posters and booklets printed and tried to track down some final supplies for the TB and malaria staining kit.  As of last Saturday, our internship was officially over and since then we have been purely ‘turistas’, save for a few more BTB related errands we had to run.

We spent one day visiting the historic district of Quito and joining in the Indpendence Day celebrations, and then flew to Guayaquil, where we spent a day walking around the city, visited a park full of land iguanas and ate plenty of pan de yucca.  The next day we took a bus to Cuenca, where we admired the beautiful architecture and quaint city.  We returned to Quito yesterday and spent all of today buying thank you gifts and trying (unsuccessfully) to pick up what we had ordered at the print shop last week.

Early tomorrow morning, I’ll be boarding a flight back to the U.S.  My time here has been truly unique, sometimes extremely rewarding and other times very frustrating.  I’m sure I won’t fully realize how much I’ve learned and how much my perspective has changed until I’m back in the U.S., but I do know that the things I’ve learned and experienced here will stay with me for the rest of my life.

Thank you to all of the kind people who have helped me in the last 9 weeks.  My Spanish, and my English, aren’t good enough to truly express how grateful I am for all you have done.

For now, ¡chau, Ecuador!  I will certainly never forget you.

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.

On Thursday, Melody and I finally got to visit the Planchaloma clinic, where we will be spending most of our time here in Ecuador.  Planchaloma is a small community located in the mountains about 2 hours from Quito, and the clinic there is the largest we have seen yet.  It offers dental, OB-GYN and general medical services, and even has its own ambulance!  It was great to meet the staff and talk with them about our plans for while we are there, and also see Amanda and Lila’s projects from last year still going strong!

During our time in Planchaloma, we will be working on some community education programs focusing specifically on TB and the importance of recycling.  This will include going to schools where we’ll give talks and lead activities to teach children about these topics, as well as hanging posters in the clinic so that patients can learn about these topics while they wait.  As I mentioned earlier, we’ve been working on our TB posters and have tried to make them as pictoral as possible so that even patients who are illiterate will be able to understand the signs of TB.  Fundación is hoping that by increasing community awareness about tuberculosis, they will finally be able to control the disease as they have been able to do in the other areas they have clinics in.

Along with preparing for the projects for Planchaloma, we’ve also been busy getting the technologies ready to demonstrate!  This has included practicing using them as well as translating the user manuals into Spanish.  It’s certainly good that we started while we still have pretty readily available internet access, because much of the vocabulary we need is not what we learned in our typical college-level spanish class (or maybe I just missed the lesson describing how to read hematocrit levels!).

We also had a chance on Saturday to visit the famous market in the town of Otavalo, thanks to the wonderful Maria Alicia!  We spent the morning and part of the afternoon perusing the booths and picking up souveniers, and then visited some towns nearby as well.  It’s hard to believe we’ve been here for 2 weeks already, and I’m very anxious to get out to Planchaloma and start helping in the clinic and getting to know the community there.  We should be moving out there later this week, so chau for now so we can get back to our preparations!

Melody and I spent our weekend seeing the sights of Quito with our wonderful guide Maria Alicia.   We started with a delicious breakfast of hornado in the valley community of Sangolquí, visited La Mitad del Mundo and the famous Virgin of Quito, wandered through the historic region of La Ronda and even happened upon a ceremony to celebrate the summer solstice!  Plus, along the way we were able to find a shop that sold the dropper bottles we need for the TB and Malaria staining kit.

But now that it’s Monday, and we’re back to work!  We’ve just started our newest project, designing a community education program about tuberculosis for the Planchaloma clinic, where Melody and I will be working for about 6 weeks.  Although Fundación has been able to decrease the presence of TB in its Guayaquil and Yatzaputzán clinics, it remains a significant problem in Planchaloma. Because we will have to travel to the next town over to get internet access while we’re staying there, we’re trying to get as much done as possible while still in Quito.

We’re still in the early stages of research at this point: looking at other TB education campaigns, finding out more specifics about the community in Planchaloma and making some rough drafts of posters and brochures.  We’ll also be starting on an education project about the importance of recycling to support the recycling program that Amanda set up last year.  We have a visit to Planchaloma scheduled for Thursday, and it would be great to get feedback on our progress while we’re there, so back to work!

Buenos días from Ecuador!  Melody and I have only been here for 3 days and yet have experienced so much.  Yesterday we took a day trip to Guayaquil, Ecuador’s largest city at just under 3 million people, to visit the two clinics that Fundación Futuro runs there.  One was in the southern neighborhood of Isla Trinitaria, while the other was in the more central neighborhood of Plan Piloto.  The poverty in these parts of Guayaquil was striking, particularly in contrast to the flourishing city we had seen only a short car ride away.

In addition to getting to experience Fundación clinics for the first time, an especially important message I took away from today was something that Rocio, who showed us around all of the clinics, mentioned while waiting for our flight back to Quito.  She emphasized that the reason these clinics are able to help the communities they serve as much as they do is because of the people that work there. Again and again when I asked why people chose to pay a small fee to receive care at the Fundación clinics rather than visit the free government clinics, I heard that the Fundación doctors take time to really talk to their patients and the care is much more personalized than at the busy government clinics.  In settings where money is so scarce, the fact that patients are willing to pay even a small amount truly speaks to the quality of care provided.

Even during our short visit yesterday we saw and heard about many examples of workers going beyond their job expectations to help patients.  In Isla Trinitaria, the outreach worker knows everyone in the area and is able to use these connections to make the clinic an integral part of its surroundings.  The nurse is from the same neighborhood the clinic is in, and has an intimate knowledge of how the community functions.  In Plan Piloto, patients visit the doctor with physical ailments, but also when they simply need someone to turn to.  One of the women in the waiting room while we were there came to see the doctor because her sister had recently passed away and she was feeling sad.  Another of the workers, who had been there the longest, had recently taken action when the grandmother of a family passed away, leaving her grandchildren in the care of their alcoholic father.

While I find these stories of workers who truly make their clinic impactful inspiring, and admire the ability of these clinics to have such a close relationship with their communities, I also worry about other clinics.  Having such connected nurses, doctors and outreach workers is never a given, but they can factor heavily in the level of impact a clinic on a community.  Is there any way to ensure that clinics form the sort of connection with their surroundings that we saw in the Guayaquil?

I certainly don’t have an answer to this, but I do think that technology can play an important role here.  The less time a nurse or a doctor has to worry about the equipment they’re using, the more they can spend focusing on the patient.  It may be hard to ensure that clinics become an integral part of their community, but BTB technologies can help give them the opportunity to do so by providing devices that work in their setting and allow them to provide the best care possible.

We’re scheduled to visit another Fundación clinic tomorrow, in the more rural setting of Yatzaputzan.  I’m excited to see more of the work Fundación has done, and explore just how the BTB technologies can fit into their work.

It has been 2 months of hard work, experimentation, research, exploration, odd incidents, unique cuisine and gorgeous sights. This has been a wonderful and memorable experience for the both of us and we are going to miss the beautiful country of Ecuador and everyone in it so much. The reason that our work there was so enjoyable was because of the wonderful people who were there to help us along the way. We would like to thank Maria Alicia, first and foremost, for lending us her home, knowledge, time and money, and for also being our trusty chauffeur and tour guide when we would have been utterly lost otherwise. Thanks to Marisol, for being a great resource for us for our many projects, and to Martita for being our Mamita when we were so far from our own. Thank you to all the doctors and nurses at the clinic in Yatzaputzan who gave us such helpful feedback and ideas for the technologies. And a huge thank you to everyone in Planchaloma, including the doctors, promoters, nurses, volunteers, and even the patients and people of the town for making us feel at home, for complementing our elementary-Spanish, for letting us feel useful at the clinic, and for all the fun times and laughs we’ve had together. Last, but most certainly not least, thank you BTB, for allowing us to have such a life-altering, eye-opening, and enjoyable learning experience; without the time, money, hard work, planning, efforts, that everyone there has put into this program, this would not have been possible for us.

We hope that we have accomplished enough to make even the smallest difference. We have learned a great deal and will be sure to pass that knowledge on to BTB and to future interns in order so that the next technologies that go to Ecuador will be Ecuador-ready and able to help to many throughout the country. We hope that we have made an impact, however small, in the communities and have made BTB and Fundacion Futuro proud to have had us as interns.

Chao, Ecuador! Don’t forget us, because we will most certainly never forget you.