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!

The Best Hot Dog of My Life
After posting up my new blog post on Monday and finishing  some last-minute errands, Maria Alicia, Stacey, and I left the office pretty late. Driving back, our mentor asked if we’d like to stop by somewhere to get a bite to eat. I, official lover of the culinary, happily agreed. She then quickly suggested, “Oh I know! A hot dog!” Now I am generally not a big fan of this classic mystery mix of meat, but I thought I’d give it a shot. We pulled up to a little stand on a street corner, where there were about four businessmen gathered around a kiosk. Lined along the kiosk were tons of different sauces and relishes and toppings for the hot dog! For a little over a buck, I quickly was served a hot dog and loaded it with practically every dressing available. I tried it, and the rapturous blend of tastes was almost too good to be true…it was the best hot dog of my life!!!

Arriving in Planchaloma and Getting Started in Cerro Azul
After dreaming of my hot dog, I woke up painfully early to get ready for a head start to Planchaloma. Stacey and I gulped down our eggs and bread and hauled all of the needed suitcases and chompas, or heavy duty jackets, out to Qui Quín’s truck. There we met the two new bioanalysis lab students from the Catholic University of Quito, Paul and Carlos. We took another beautiful drive up to our now familiar ‘home base’ of the health clinic. A little after we finished unloading our belongings, we prepared ourselves to go to our first community for the week, Cerro Azul. The new and improved medical team packed in the van and headed out.

A view outside our window on the way to Cerro Azul – the community lay in the valley bellow.

The drive lasted about two and a half hours, which was a considerable amount of time, considering we were all quite scrunched together and acutely felt every rock we came across. We finally arrived in the community, where families had lined outside the schoolroom in anticipation of our arrival. We set up our clinic in the one-room schoolhouse, where all the desks had been pushed against the wall to provide a bit more room. The lab students used the teacher’s desk as their main workstation and quickly learned how to set up the microscope and centrifuge from the lab-in-a-backpack. As the patients started filling in, Stacey and I again marked the usage of each piece of equipment. We didn’t have any remarkable cases, although we noticed the tendency for all of the family members of patients to stand around to watch while he or she had to be prodded a bit for a blood sample for a hematocrit test. As a result, the classroom filled up quickly as the general noise got louder and louder. The doctors didn’t seem to mind, but I became a bit nervous. I’m generally not comfortable with large amounts of noise in a work setting, so I had to remind myself that I have to learn to be comfortable with other cultural norms. We finished up our record-keeping and the patients started thinning down. We treated a few more last minute patients when it began to rain fairly heavily. Unfortunately, I wasn’t able to teach any of my quick nutrition lessons since all of the children had taken refuge inside another building of the complex. The community members served us fresh trout for lunch, which we were obliged to finish entirely to avoid insulting the chefs. After eating so much food, I looked with dread to the two and a half hour ride back to Planchaloma. If I had a rough time on the mountain roads on an empty stomach, how could I take a return trip immediately after eating? By sheer will power, the whole medical team packed once again into the truck and somehow made it back to Planchaloma without anyone tossing their cookies. By this time, it was pretty late in the afternoon, so we all got to work on making dinner in the laboratory once again. We finished our meal and the great film of The Count of Monte Cristo, and headed off to bed.

A Painfully Slow Day at the Clinic
The next day we were to remain at Planchaloma and run any needed tests on the patients who walked into the clinic. Although we heard that Wednesdays can be relatively busy, we had very few patients walk in. Of those, the doctors only asked us to run basic urine diagnostic tests. After the hustle and bustle of all the patients the day before, the trickling in of patients was quite boring. We ended up cleaning the clinic a bit, which it needed. 

Being a Patient for a Day!
    Although I had developed a sinus infection earlier on in the week, my nasal problems that had been discussed in my last post were coming to an end. However, I knew feeling good couldn’t last for long. Assuming Stacey and I are still both subject to our self-discovered Law of Mutually Exclusive Gringita Wellness, Stacey generally feels awful in the city, and I get sick with something in the countryside.
    After dinner on Wednesday night, my stomach felt a bit strange. I thought nothing of it at first. When I was getting ready for bed, I realized that there was indeed something wrong, and I rushed to the bathroom to toss my cookies. I thought I was all better afterward as I headed back into my top bunk to go to sleep. A couple hours later, I woke up around 1 AM. I rushed down the ladder and barely made it to the designated receptacle. After going to sleep once again, I woke up four hours later to worship the porcelain goddess once more. As much fun as I was having, I realized that this was a little more than a run-of-the-mill case of food poisoning. The next morning, I woke up to find that standing up was a very unpleasant sensation. I felt as if my stomach were on spin cycle, and I felt so weak that I found myself learning against the wall whenever possible. After walking into the kitchen and then running out after smelling the omelets being prepared, I knew that food was out of the question. I was quite nervous, since I knew that we were planning on heading out to our final community for the week that day. I doubted my ability even to take notes of what was going on! I couldn’t ask Stacey to do my job and hers simultaneously!
    In the throes of mental consternation, I lied down on my bed and took a nap. I woke up to hear Dr. Monica and Dr. Lorena knocking on the door to check up on me. They listened as I relayed my heart-wrenching (or stomach-wrenching?) story of the past twelve hours, as well as other general complaints I was having. After using a stethoscope to listen to the groans of my stomach, Dr. Monica informed me that I had contracted a bacterial infection. She very kindly gave me antibiotics and pain medication, as well as orders to rest all day and drink plenty of liquids. She then brought great news – it turns out that the kids of San Francisco were taking exams, and we would have to wait until the next day to head out. YES!! I didn’t have to miss a day at the communities! After taking my medicine, I fell in and out of a stupor for the rest of the day. I woke up around dinnertime to ask how the day had gone – to find that I was the only patient that they had had! Everyone was dying of boredom, so I suppose my body had chosen a good day to get sick. I took it easy for the rest of the day, and even felt good enough to eat some crackers!

A Barrage of Patients at San Francisco
    T.G.I.F.! I woke up feeling considerably better, and glad I had slept the whole night through. I ate a simple breakfast – namely, tea – and got ready to head out to San Francisco! This community was only about a half hour away (thank goodness – I don’t think my body could take being shoved around for two hours again!)
    We arrived in San Francisco and were officially greeted by the leader of the community, a gesture of courtesy that I thought quite pleasant. We set up in a large room within a pasteurization plant (a little ironic, since the doctors had ordered that milk was still a no-no for me). The doctors began seeing patients, and the line to receive diagnostic tests grew longer and longer. The most popular order? Hematocrit tests to check for anemia, with urine tests in second place. The community health worker pack was not as much in demand, so both Stacey and I ended up working together for the lab-in-a-backpack. We needed to write down all of the items being used as well as help the lab students prepare their journal of the results of the patients´ tests to bring to the doctors. It was quite exciting, seeing so many patients in one day!! We had over 65 come in!

Paul, Stacey, and Carlos huddled over the centrifuge with a long line of patients at San Francisco

I’m a Kid Magnet!
  We took a break for lunch, which was generously prepared for us by a few of the members of the community. I was luckily able to have the chicken soup they served, although I had to refuse their spicy ají sauce with much regret. Once returning from lunch, when we usually don’t have many patients, I realized that I still hadn’t been able to talk to any of the kids. Looking up, I saw a few being shuttled out of the way by their parents. Thinking that Stacey could manage the now  steady stream of patients coming in, I decided to step outside our “clinic” and see if I could run a quick nutrition lesson plan. I ended up making quick friends with a few of the children outside. I tried to start off talking about the importance of eating well-balanced meals, but naturally, that didn’t quite draw a crowd of kids. It wasn’t until I began with my classic Red Food Green Food game (Red Light Green Light using nutritious and unhealthy food names instead) that more and more children appeared. I had updated the game by asking Qui Quín about more specific vegetables that they were familiar with, as well as brand names of junk food commonly sold in the area. This new information improved the quality of the game quite a bit, and I felt that there was enough variety, as well as enough repetition, to get them thinking  if their normal food such as chupetes, or lollipops, should really be something that they have everyday.

    Red Food Green Food worked out quite well for a while, so I decided to move to the Monstrua de Infección game! This game involves chasing the kids around in order to anthropomorphize a cold virus, or some other infectious particle. We continued this game of tag for quite some time, when I realized that I needed a quick swig of water. I excused myself to take a break and encouraged the kids to keep playing. I asked who wanted to be the new infection monster, but all the kids shook their heads. Even when I picked on one, he or she would simply refuse. I felt a little down about this, since I was hoping that some of these games would be sustainable enough that the kids would continue to play them without me.
    I helped with record keeping a little bit before going out to the kids again. They needed to play a game that could be entirely self-sustainable. Thinking on my feet again, I remembered what used to be my perennial favorite of Duck Duck Goose. After coming outside to finding the majority of kids that I had left, I gave them instructions to for “Sano, Sano, Enfermo” or “Healthy, Healthy, Sick.” The rules of Duck Duck Goose applied perfectly, where one kid would walk around the rest of the kids seated in a circle. He would pat each kid on the head and deem him “healthy” until he would yell, “SICK!” for one kid, who would then have to run around the circle and become the new “infectious particle.”  I played with them for a little while, who all really seemed to enjoy it. It was a little funny, though, when I would hear a few whining that they never got picked. So I guess I found a small problem with my design: with this game, kids wanted to be sick!!

sano…sano….sano….¡Enfermo!

  I stayed a few minutes longer, and then I thought I’d quickly say goodbye to the kids so I could slip back to the clinic while they kept playing. My evil plan didn’t work, however, and soon I looked up to see three children standing over me and the usage forms for the lab-in-a-backpack. I realized that I had played with them for too long for them to give me up easily. I asked why they didn’t want to play “Sano, sano, enfermo” anymore, and one child responded shyly that they wanted me to teach them more new games. Relenting, I handed the form back to Stacey, who was well in control of the record-keeping, and went back outside. I realize that the kids had already gotten a bit attached to me. It might be the fact that I´m someone new and different, a gringa – someone who´s willing to pay attention to them and even play among them! It might also be all the crazy, dramatic facial expressions I tend to make, which always tend to draw a laugh from the kids.
    In any case, I decided to try once again the Cubre La Boca / Cover Your Mouth game, this time with a space restriction so they couldn’t run out all around and create complete chaos. I must not have explained myself well, because as soon as I yelled, “GO!” all the kids left the designated square and ran out to the field. Despite this misunderstanding, the game worked out really well! Everyone followed the rules perfectly! A fog had settled on the field, creating a very surreal atmosphere. Running around with all the other kids really made me feel like I was eight years old again!

Playing Cubre La a Boca – take note as one boy reminds the other in red to cover his mouth after he´s tagged!

After that point, the kids taught me some of the games that they commonly play. One of them, I was happy to see, involved listing a series of fruits, where each participant had been named a specific fruit! When it was time to go, I recapped the lesson, and said my goodbyes. What a great day!

Last Day at Planchaloma
On Saturday, we got ready as per normal and set up the lab-in-a-backpack to receive patients at the health clinic. We ran several centrifuge tests, urine tests, as well as tests for the presence of parasites. The most memorable patient was a young, very depressed-looking nineteen-year-old man who walked in. The lab students examined his stool sample to discover that he not only had a very serious bacterial infection, but also that he had several major parasites! They had laid eggs in his refuse, which were clearly visible with the microscope. Poor guy!

Lesson of the day: Parasites are no fun.

Carlos is not a fan of the stool exams

A Short Weekend
We then cleaned up the clinic as best we could. Being perfectly honest, it was a little disgusting. The laboratory – our kitchen – was filled with fruit past their prime and dead insects hidden behind appliances. We scrubbed, mopped, and swept away what we could and packed all of our belongings. Maria Alicia drove us all back, and we stopped at an amazing café in the middle of the countryside to have lunch. After dropping off the lab students and coming back to Maria Alicia´s home, we watched a couple movies on TV. The next day we met up with Marisol’s family once again, where we had some great seafood and (surprise!) watched a movie. Later that day Stacey and I were able to call our fathers for Father’s Day!

Explanation of the Blog´s Title
The bionalaysis students who worked with us this week taught Stacey and me a lot of cool, “hip” phrases that young people say these days in Ecuador. My favorite word, by far, is the equivalent of “dude” – “mijín.” The lab students called each other Mijín for the duration of the trip; they also liked to give us nicknames. One of the ones they gave to me, signifying someone who is particularly skinny, is “tripa seca” – meaning dried tripe!

Coming Soon
For this upcoming week, we were unable to get any bionanalysis students to come up to Planchaloma, so Stacey and I are staying in Quito. We’re going to work on record keeping and present the lab-in-a-back to the Ministry of Health…wish us luck!