Reports from Ecuador

El Reciclaje

The last week of our internship was a very busy and successful one. There was much left to do with our projects and the backpacks in preparation for Yvette’s and Dr. Oden’s arrival in Ecuador. At the beginning of the week, Lila and I went  to Quito to make yet another trip to the printing place to pick up our educational booklets for the CHO pack and the Zipocrit Reader Card booklets. We also took this opportunity to bring the recycled items from the clinic Planchaloma to the recycling company in Quito. Unfortunately, it didn’t really work out the way I had planned. I had hoped that the company would buy the recyclables for a fairly reasonable price of at least a few dollars. However, when we brought the bags of items and the workers weighed them, the final price for all of the recyclables was only a 34 cents! We figured that a little money is better than no money at all, but when we saw that the taxi ride back cost more than we received, we wondered if this was an efficient way to recycle the items. In the end, we figured it just wasn’t worth it to waste gas to drive the items to a company who will only buy it for a few cents. However, later that day we discovered a huge recycling bin that belonged to Techniseguros, the office where Maria Alicia works. This turns out to be a much more convenient way for Maria Alicia to recycle the items from the clinics and more environmentally friendly because it saves on gas. Thus, I believe my recycling project has had a successful start and is sustainable in the communities as long as the health workers encourage the idea and Maria Alicia picks up the items during her visits to the clinics.

La Biblioteca

Lila’s library was also off to a very good start. We set up a check-out system in which every book is registered in a records book and contains a pocket with a red card that reads “You forgot to register me!” Then, once someone expresses interest in checking out a book, the health workers at the clinic will record the date and person’e name, remove the red card from the book and replace it with a green card that reads “Don’t forget to return me.” The system is very simple and organized, and the workers and patients caught on quickly. Lila also quickly gained a few loyal customers. A group of small kids had tracked her down one day while we were at an internet cafe in Planchaloma and asked her if they could please borrow some books. Lila was absolutely ecstatic and she walked with them to the clinic, where they each checked out 2 books from her library. This same group of kids not only come back about 3 times a day to get more books, but they also told all of their friends and siblings about the library and even brought them all to the clinic to show them. It’s really amazing to see the people in the surrounding communities so excited about the existence of a such a simple, convenient system in which they can read books for free. It’s refreshing and inspiring to see their thirst for knowledge and their desire to learn. Lila’s project has most definitely been successful so far. Hopefully, the doctors at the clinic are able to buy more books soon to add to the library’s collection; because pretty soon, those little kids will have read every book there!

The backpacks

The Lab-in-a-Backpack is now being put to good use in the clinic in Planchaloma as well as in Yatzaputzan, now that both clinics have lab techs there at least once a week to run tests. And after all of our hard work, the new and improved CHO pack was able to be left at the clinic in Yatzaputzan, containing all of the items that they had requested to be added to the pack. Now hopefully the backpack contains everything that they would need to go on a brigade in the surrounding communities. However, unlike the other 2 backpacks, the OB/GYN pack was not as successful. Many changes and revisions must be made to the pack before it is ready to use in these communities and clinics. But we have received a lot of feedback on the pack and pass this information onto the next team assigned to work on the pack so that, in the future, the pack can be useful  and ready to use in Ecuador.

In other news…

Dr. Oden and Yvette finally made it to Ecuador! We were so excited to see them pull up in front of the clinic in Planchaloma. But when they arrived, everyone got right down to business. They met the new lab tech, Esperanza, who will be working with the Lab-in-a-Backpack every Saturday at the clinic. She made sure to let them know how much she enjoys working with the backpack, which contains almost everything needed to run her usual tests. She also voiced  her approval of Lila’s Sally centrifuge. She and the doctors all stated that they wished that we could’ve left Sally with them to use at the clinic and were a little upset when we told them that we couldn’t. Dr.Oden also brought m syringe clips with her, so we were finally able to demonstrate the clips to the doctors and promoters in Planchaloma. They were amazed at the simplicity of the concept and ease-of-use of the clip itself. They told us that they want a whole bunch of them of various sizes for both the 3mL and 5mL syringes. When I heard this, I could not have been happier. Of course, there is still a lot of work to be done to perfect them, but hopefully in the near future we will be able to send the desired amount of clips to the clinics.

Independent Project: Recycling Update

Since we last talked about Amanda’s efforts to start recycling programs at Fundación Futuro clinics, we’ve seen the project get off the ground with a great response!  Bins for glass, plastic and paper are now installed at the clinics in Planchaloma and Yatzaputzan, as well as the women´s cooperative in Yatzaputzan.  The bins in Planchaloma are currently overflowing and ready for transport next time we return to Quito.  Amanda found a company that is willing to buy recyclable items, so we are hoping to turn this environmentally-inspired project into a money-maker for the clinic.

Independent Project: Library

While Amanda’s project has been taking hold, I have started my own independent project.  Since coming to Ecuador I have been catching up on my ever-growing reading list.  One book that I particularly enjoyed was The Boy Who Harnessed the Wind, the account of a boy from rural Malawi who improved living conditions for his family and village by building a windmill–a project inspired and guided by books from his local library. The description of his village reminded me in many ways of Planchaloma–many people without proper healthcare, electricity, education, water supply, etc.  However, the people here do not have access to a library of bookstore.  While there is an internet cafe, its users are limited to children playing games after school.  With this in mind, we decided to launch a modest book collection at the clinic where patients can read where they wait for the doctor and check out books to take home.  Right now we have a modest selection of 82 books, ranging from science textbooks to children’s stories, but Lorena, the nurse at the clinic, had the same idea as Amanda and: the clinic has volunteered to use the funds produced by the recycling program to buy additional books for the library.

While most people were initially hesitant to use the library, once we introduced people the system and assured them that it was a free service, we have gotten a positive response.  We hope that word spreads around the community so that people are aware of this resource.

Lab-in-a-Backpack Progress

The clinic in Planchaloma recieved some exciting news this week with regard to the Lab-in-a-backpack: they have contracted a lab tech who will visit the clinic every Saturday to use the materials in the pack!  Amanda and I demonstrated the pack to her today, and she was very impressed with what all it contained.  We are relieved to know that the backpack will continue to be used once we go home next week.

We also had the opportunity to demonstrate Sally to the lab tech and her son, who is a doctor.  He was especially excited about the design since he himself had constructed a manual centrifuge using a bicycle in med school.

View From Our Window

So this isn’t exactly project related, but one of my favorite blogs has a “View From Your Window” series, and I thought I would post some pictures of the spectacular panoramic we are lucky enough to wake up to everyday (well, as long as it’s not too cloudy).

To the West: Las Ilinizas, which we affectionately refer to as the Lord of the Rings mountains

To the East: Cotopaxi, the volcano that lends its name to the province

In our spare time, we have tried to take in the amazing countryside, and one afternoon we hiked up a mountain (it’s really more of a hill, but at this altitude it felt like a mountain).

As long as we’re off topic, Amanda and I would like to take a moment to mention the weather in Planchaloma, which we have decided is more fickle than Houston’s.  Though today was the hottest day of our internship, it hailed.  Five minutes later, the sun came out and we were treated to an incredible rainbow over the cascading hills.

Ecuador Culture

Since arriving in Ecuador, and particularly Planchaloma, we have had the privilege of experiencing the rich, indigenous culture here.  We have gone to festivals, watched dance performances, and observed high school graduations.  It’s a great way to take a break from work and get to know the way of life here a little bit better.

Cuy, AKA guinea pig, one of Ecuador's delicacies. Everyone here thinks it's hilarious that Americans keep these animals as pets!

Throughout our visits to Yatzaputzan and Planchaloma, we have made slow but steady progress on developing both the Community Health Outreach and OB/GYN backpacks.

CHO Pack

We quickly learned that the CHO pack, originally designed for community outreach workers in Malawi, would be used by the promotores de salud at Fundación Futuro’s health centers in Ecuador.  We have talked extensively with Marta from Planchaloma and Angel and Evita from Yatzaputzan about ways to improve the backpacks, and have learned that while they have the medical training to use all the supplies currently provided, their focus is more on health education in the communities surrounding the clinic.  As such, we have designed a series of educational flipbooks (hygiene, oral health, nutrition, family planning, vaccinations and recycling) to put in the backpack that they can use with individual patients or during larger brigades.  We’ve also included a dry erase board and markers that they can use to improvise additional lessons.  They also requested additional medical supplies, including an adult scale, masks, suture kits, a WHO Colour Scale, a sharps container and a pediatric blood pressure cuff, some of which we have been able to find in Quito. We also need to find new containers for urine samples, since they only use sterile cups here.  We hope that once we finalize these changes we will be able to take the CHO pack on another brigade to assess the impact of these improvements.

Reviewing our new educational materials with Angel and Evita before printing the final copies.

OB/GYN Pack

This issue of sterility has posed several major challenges for the implementation of the OB/GYN backpack.  Patients here will not use speculums that have been used on other women, even if they’ve been properly sterilized.  Instead, they use disposable speculums.  Furthermore, the obstetricians use individually-packaged spatulas and brushes in order to keep them sterile, whereas those in the backpack are contained in one large bag.  Until these changes are made, we are unable to use the backpack in the field.  In the meantime, we have translated the backpack’s educational materials into Spanish, and have discussed the frequency of use of each of the backpack’s procedures.  While pap smears and birth control counseling are common, the doctors at the clinic do not perform biopsies, but rather refer patients to a larger hospital.

We are eager to finalize these modifications so that we can bring the new and improved versions into the field for use with patients.

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!

Wednesday marked our first day back in Planchaloma and another medical brigade to Yugsiche Alto. This time we were accompanied by Maria Alicia, Monica, a gynecologist at the clinic, and Don Juan, another health promoter from Planchaloma. When our truck pulled up to the school, we were greeted by a mass of smiling kids running up to greet and hug us. They even remembered our names! Once we got them to settle down a bit, Maria Alicia reviewed with the kids and parents what Lila and I had taught them the last week about hand hygiene and recycling. And they did very well on their little quiz! They remembered the important points that we covered the in our lesson week before. This is great news for Lila and me: our ‘charlitas’ with the kids are a success! The kids are actually learning and retaining the knowledge that we give them. Now, we just hope that they are using it as well.

During the brigade, the doctors from the clinic, including Lorena and Monica, took every child’s height and weight. Sandra, a health promoter in training, sat behind a small table and gave the kids bottles of multivitamins. Monica also gave all of the kids de-parasiting pills, which essentially will detox them of all the parasites that linger in their bodies and could potentially cause them extreme harm. Lila showed the ever-curious kids all of the devices in the backpack and how they worked. She also took care of various cuts, scrapes, and burns that the kids complained to her about by using the First Aid items in the CHO pack. After the wounds were taken care of, the kids found serious interest in Sally, which she demonstrated to them and let them take turns pushing the button for the allotted 10 minutes. I had most, if not all, of the adults ask me to take their blood pressure and glucose, a few of them telling me they were concerned about their health because of diabetes. I used the glucometer, test strips and antiseptic wipes from the Lab-in-a-Backpack to test their blood glucose levels and also used the blood pressure cuff from this backpack. There were no more lancets in the Lab-in-a-Backpack, so I used the ones from the CHO pack. I tested over 25 people and of these, one woman had a glucose level of 319. This is extremely high, given that normal is between 80 and 120. When I told her this, she said she knew that she has diabetes and has painful headaches all of the time. I asked her if she had medicine for this or if she had even been to the clinic to see a doctor about her condition. She responded no because she didn’t know that they could help her or give her medicine.

The kids using Lila´s Sally Centrifuge

After the brigade, the teacher and parents expressed their thanks to us and the doctors and health promoters that had done so much for them. In particular, the woman whom I had spoken to about her serious condition stood up and said that, if not for this brigade, she would never have known that anyone could help her, let alone give her medicine to help get her condition under control. She, along with other families, declared that they would be visiting the clinic in Planchaloma very soon.

The kids curiously watching as I take their teacher´s blood pressure

Once back at the clinic, Maria Alicia thought it would be a good idea for me to teach everyone who works at the clinic how to use the glucometer. It is a very simple machine to use and they caught on quickly. Now the health promoters as well as the doctors can use it for patients. Also, after seeing me use the blood pressure cuff on the patients in the clinic one day, Marta asked me if it was easy and if I could teach her how to use it. So, this next technology lesson will hopefully take place tomorrow, in which I will teach the health promoters in Planchaloma how to use and read the blood pressure cuff.

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!

This weekend was also successful in terms of my project. In Planchaloma, Lila and I noticed that there are plastic bottles, wrappers, cutlery and bags strewn all over: in the streets, bushes, pig pens and fields. Also, since there is no garbage truck that comes by to pick up the trash in the area, so the promoters at the clinic throw all the trash in a large hole in the back of the clinic and burn it. I thought this would be a good time to practice what we preach, so I decided to start a recycling system in the clinic in Planchaloma, and eventually one in Yatzaputzan.

The night before we left Quito, Maria Alicia brought me to MegaKvwi, where I was able to buy 6 large recycling bins to put in the clinics. The bins are absolutely perfect and were just what I was looking for. Since there are no recycling trucks that come by the community and it would be too costly to get a company in an near-by town to come pick it up, I settled on an alternative mode of transportation. I found a recycling company in Quito that will buy the recycled glass, plastic and paper. Since Maria Alicia visits the clinics very often, once or twice a month, she agreed to pick up the bags of recycled items when she visits, bring them back with her to Quito, and sell them to the recycling company. She has also told me that she feels very strongly about recycling and will make sure that the clinic’s members are indeed using the system that we have set up for them. On Wednesday, I set up the bins in the clinic and Marta, the health promoter, and both Lorena and Monica thought they looked very nice and all thanked me for starting such a simple system that will benefit the community and environment in the long run. Each of the bins are conveniently labeled with a list of what items should be put in them. However, today Lila and I remembered being told that some of the people who come into the clinic can’t read Spanish or even Quichua. So I placed signs above each of the bins with pictures of what should be recycled into that particular bin. I officially recycled the first items yesterday: a Mac&Cheese box and a jam jar (this should speak volumes about our diet here…).

Marta and I and the clinic´s new recycling bins

However, I feel that setting up the bins and transportation of the recyclables is not enough. I really want to find a safer way for the clinic to dispose of their trash. Such a large fire so close to the clinic can never be good. And after several years, the trash will eventually begin to pile up. Of course, all they have to do is dig a new hole, but that would make the back of the clinic a kind of landfill. Maria Alicia said trash disposal here is a complicated matter, but I am still working to find a safer and convenient way for the clinic to get rid of their trash.

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!

Lila and I on our carriage ride though Quito

After arriving back in the much warmer city of Quito, we spent our weekend being the ultimate tourists. On Saturday we accompanied Maria Alicia to the Historic District of Quito. While she had a business workshop to lead, we had a few hours to explore all that the city had to offer. We began by taking a tour of the most ornate cathedral in the whole country of Ecuador. It took 160 years and over 100 pounds of gold to complete it. We then took a 20 minute carriage ride (with the horse and all!) around the Historic District and scoped out some more places to visit. We bought guanabana-flavored ice cream and visited a few of the shops that are in the plaza. We bought movies, sweets, souvenirs, handicrafts, and a new digital thermometer for the CHO pack, since the one that was in it initially was inaccurate by a few degrees. We also found a few pharmacies in this area that could possibly have the items needed to restock the backpacks when the time comes.

On Sunday, Maria Alicia and her adventurous mom Marta took us to La Mitad del Mundo: The Middle of the World. There is a large monument in the small town of San Antonio where the latitude is 0*0’0”. At this spot, the equator is perfectly perpendicular to the solstice line, the path that the sun takes on the longest day of the year. After taking an endless amount of pictures, we could not resist the urge to shop some more, especially since there were so many of our favorite cute, bargain-priced shops selling local handicrafts. We finished the day off with a delicious lunch, a mound of chocolate ice cream, and a quick glide on the mini-zipline in the kid’s park. It took some convincing but we finally got Maria Alicia to give it a try; and she had a blast.

Lila and I at La Mitad del Mundo

Of course being back in Quito didn’t mean all fun and no work. On Monday and Tuesday we went back to the Fundacion office and started working on some more education materials for the lessons that we’ve been doing at the schools in Planchaloma. In our ‘charlita’ on handwashing and recycling, we decided to add another topic: nutrition. Many of the kids, and even parents, here are not getting all the vitamins and minerals they need to stay healthy and prevent sickness, especially in these conditions (such as non-potable water). In our lesson we will talk about what kinds of vitamins and minerals we need to stay healthy. We will talk about the kinds of foods that our bodies need and how much of each kind of food we should be eating per day. We also decided that the kids would get more out of the lesson if it were interactive; so we made it a sort of game. We made a large poster of a colored food pyramid, minus the food items. We printed and laminated pictures of various food items and, after our lesson, the kids have to place the food items in the right category. During our lesson at the next escuelita, we are hoping to incorporate our nutrition lesson into our talk and see what kind of response we get.

Having returned to Quito with María Alicia on Thursday, we made out second visit to Yatzaputzan early Friday morning.  This time, rather than working with the women’s cooperative, we were able to meet with the staff at the clinic in order to get feedback on the technologies we brought with us.

Though Amanda’s AccuDose syringe clips have not arrived yet (fingers crossed that they’ll be ready soon!) she had the opportunity to discuss the design with the “promotores de salud,” Fundación Futuro’s version of community health outreach workers.  Overall, the staff seemed very excited about the idea and certainly thought that the clips would help prevent overdosing.  They use 5 mL syringes and doses range from 1.5 mL to 3.5 mL, so we are hoping that the clips that are currently being made at Rice will be compatible.

We also reviewed the CHO pack with the promotores, who gave us great feedback on the design.  They told us that they do use everything currently in the pack, but they also requested an adult scale, thermometer (ours broke) and a pediatric blood pressure cuff (which we were unable to find in time for our trip).  Also, one of the main responsibilities of the promotores is health education in the community, so they liked our idea of including educational materials such as flipbooks and diagrams related to hygiene, family planning, vaccinations and nutrition in the backpack, something we’ll be working on developing this week.

Finally, we demonstrated Sally, the salad spinner centrifuge, to the promotores.  Again, they were disappointed that it required 10 minutes of spinning, but expressed that it would be useful in their clinic, which occasionally loses power.  Their apparent favorite aspect of the design was the reader cards.  Anemic hematocrit levels depend on age and gender (i.e. hematocrit of 38 is healthy for women but not men), so Lauren and I designed a set of reader cards (seen above) to accompany Sally that indicate anemia levels directly on the chart, making it eaiser to diagnose the condition.  With these reader cards, they would be able to test for anemia without the lab technician who visits only once a week.  While we’re working in Quito this week, we hope to make a similar set of reader cards for ZIPocrit so that they can screen for anemia more frequently.

On Wednesday of last week we spent the day at a school in Yugische Alto–about a 30 minute drive from Plancha–doing our recycling and hand-washing charlita with the kids as well holding a mini-medical brigade.

The doctors in Planchaloma were hoping to use Sally to screen the kids for anemia, but since it’s not ready for use on patients yet, we suggested using the tools in their lab-in-a-backpack instead.  Currently, the health center in Planchaloma lacks a lab technician, so they haven’t been able to use the lab-in-a-backpack as planned, but Amanda and I realized that there are many technologies in the backpack that with a quick training, the doctors and nurses could easily use themselves.  One such device is the ZIPocrit (the electrical centrifuge used to find hematocrit and diagnose anemia) that we used many times to evaluate Sally in the lab.

We arrived at the school, and the kids were really excited to see us once Nicolas, the clinic administrator, reassured them that they would not be getting any shots (little did they know that we would be pricking their fingers ).  They responded really well to the talk, and it was great to do it in front of the doctors and nurses from the clinic so that we can get their feedback on ways to improve the lesson.  After the educational portion of the visit, we went ahead with the plan to screen the kids for anemia using the lab-in-a-backpack.  While the process initially seemed straightforward enough, we ran into some problems.

We quickly realized that one finger prick on the small children did not produce enough blood to adequately fill the capillary tubes currently in the lab-in-a-backpack.  We went ahead and centrifuged the blood we were able to collect, hoping to use the tape measure to determine packed cell volume, but after five minutes in the ZIPocrit, the blood had not separated, and instead had clotted.  We believe that this can be easily fixed by using smaller, heparinized capillary tubes like the ones we brought to use with Sally.  That way, we wouldn’t need so much blood and the blood would not clot.

Since we didn’t have the alternate capillary tubes with us, we went ahead and used the WHO Color Scale with the kids, which was much easier to use.   It requires much less blood and is ready for interpretation in 30 seconds.  We discussed this semester in our independent research class that the flaw in the color scale is that its results are very subjective, which we did find to be true, but it seemed to be the best option given the constraints of the environment.

One big take-away from the trip was that contrary to their preconceptions, doctors, nurses and community health outreach workers can perform many of the tests in the lab-in-a-backpack without the help of a lab-technician.  Because lab technicians are unavailable to many clinics, we believe that with a quick training, these medical professionals can diagnose diseases that they currently do not even screen for.  This was a theme that would also present itself in Yatzaputzan…

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!

Lila and I giving our "charlita" at the school

After Lorena took our lesson posters to get them bound, we set off to give hygiene lessons to the students of Chisulchi Grande and Chisulchi Chico. These are two smalls schools in the communities about 30 minutes away from Planchaloma. On Friday and Saturday, we went with Nicolas to Chusulchi Grande to give the kids lessons on “Cuando y Como Lavarse las Manos” and “Por Que es Importante de Reciclaje” For the handwashing lesson, we have an interactive activity in which we use glitter to represent germs: Lila and I put glitter on our hands and then shook every student’s hand, and had them shake someone else’ hand, in order to show how germs spread. We also had a short sorting game for the recycling lesson in which the kids have a bag of items and have to decide whether each item should be recycled as Paper, Glass or Plastic. On Tuesday, we went to Chisulchi Chico to give the same lessons to a group of younger kids. All in all, the kids seemed to get the message of the lesson and really liked the activities. They were very attentive and engaged. Nicolas has a whole slew of schools that he wants us to visit within the next few weeks, to which we will be giving the same “charlita”, or little talk, to the students there as well.

Me explaining the recycling game

The kids and Lila engaged in the activity

Living in the clinic at Planchaloma has taught Lila and me a bit more about the constraints of the developing world. For the first few days, we had to take ice-cold showers because there was no water heater installed. There were also some electricity problems for the first few days. But we learned to cook and get along with only the minimal light of our solar powered flashlights (great idea, BTB!). Internet is also impossible to come by in the clinic itself, so we venture down the street to a conveniently located internet café. Worst of all: Planchaloma is very cold. We are over 9,000 feet in the mountains and the clinic is not heated. At night, we lock ourselves in our room to keep in the heat from the small space heater.

However, we are still immensely fortunate compared to the living conditions of the people in the community, who don’t have electricity, filtered water, a heater (or water heater for showers for that matter), or the luxury to spend $1 an hour for internet at the local café. Lila and I are by no means “roughing it”, but the conditions have put us out of our comfort zones. This is how the people in these communities live every day, and to us it’s uncomfortable; but to them, its home.

We arrived in Planchaloma on Thursday with María Alicia, Richard and Lorena.  Richard is a Belgian/German/Ecuadorian chemical engineer who is collaborating with Fundación Futuro in an agriculture project.  The aim of the project is to introduce canola as a crop here and eventually build a refinery so that people here can sell all-natural canola oil to restaurants in Quito.  It was so interesting to learn more about this out-of-the-box way to grow the economy in Planchaloma.  Lorena is a local sociology student who is also working with a foundation in downtown Quito.  She is shadowing María Alicia in order to learn more about how microfinance works so that her organization can implement it with the urban poor.  Having spent extended time in the US, she has been especially great in helping us navigate some of the cultural differences we have already encountered here in Planchaloma.

After a quick introduction to the health center here and a trip to Latacunga for “chugchucaras” (a typical local meal of pork, plantains, potatoes and empanadas) and groceries, we finally settled in at our new home.  We are staying in a room in the corner of the clinic with bunkbeds, a kitchen, and showers (which as of this morning provide hot water!).

The community is absolutely lovely.  The town itself (no more than 30 small buildings) is nestled in the mountains with Cotopaxi (the volcano that lends its name to the province) directly out our window.  Walking down the cobblestone street in front of the clinic, we immediately find freely-roaming pigs, cows, donkeys and sheep.  Everyone here has been so welcoming and generous.  The experience is more than worth the lack of amenities like consistent power, warm showers and familiar food.

We spent Friday getting to know the clinics staff–Nicolas, the system administrator; Marta, the health promoter; Lorena, the nurse; as well as the general medicine doctor, OBGYN specialist and dentist.  After observing the clinic’s routine for a while, we rode with the regional president (who was elected to preside over the communities in a 2-hour drive radius) to a local school to teach about hand washing.  We got to meet the children there as well as their parents, who came for the Día de los Niños festival.  They were so welcoming–especially the little kids who each shook our hands one by one.

Saturday is the clinic’s busiest day, but we managed to find time to demonstrate the backpacks to the staff there.  They seemed enthusiastic about the contents, but we are slightly concerned that they don’t need the backpacks so much as they need the supplies since Marta told us that they’ve been doing fewer brigades in recent years.  The real test will come on Wednesday when we go on our first medical brigade!

We spent this morning (a half-day for the clinic) demonstrating Sally to Nicolas, who really liked the concept of the centrifuge, but was disappointed that it wasn’t ready to test on patients.  We hope that somewhere down the line we will have Sally at that stage of development!

We’ll spend the rest of the week in two more schools and then on the medical brigade before returning to Quito for the weekend.