Reports from Ecuador

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!