Reports from Ecuador

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

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.

Talking to an Angel
    When we had first joined Fundación Futuro, Maria Alicia and Qui Quín had shared with us plenty of stories of setting up the healthcare system in the indigenous communities, and particularly how key the community health care workers have been. One of the most amazing stories was that of Angel, a community healthcare worker from Tungurahua. When he first joined, he was a very shy young man who talked in a barely audible whisper. After a few months of training and working in the communities, he became one of the most influential leaders in the community. He became not only an effective health care worker but also a stellar speaker in the “capacitation” sessions, in which he’d discuss a health topic of importance to a large group of other community health workers.
    After completing a pretty full day at the office this past Monday, Stacey and I were able to meet him! We had the opportunity to sit down with him one-on-one and have a serious conversation about the problems he’s encountered. He fully believes in “the system,” for Fundación enlists an entire family under healthcare coverage, and is able to give them needed prescription medications on the spot for a discounted price. He also cleared up a question I had harbored for a long time – why does Fundación absolutely insist on a membership fee and fees for each medical service? It turns out that every cent of that money goes into a fund that Fundación watches over while they are with a community. After the organization ensures that there is enough medical staff and that the system is strong enough, the fund turns over to the indigenous organizations to aid in the cost of running the healthcare system on their own.
    We also learned more about the involvement of the government. Recently, they’ve become more involved in providing healthcare, and at no cost. Although many people are now receiving medical care from them, many faithful believes in Fundación Futuro, like Angel, are a little concerned about the sustainability of these programs. They’re hungry to establish and build a healthcare system of their own, without dependence on anyone else.
    Angel, personally, was pretty awesome. He asked Stacey and I if we missed home, which of course we do. He nodded and added that just after one day, he couldn’t stand being away from his family. He had a baby girl about to turn one-year-old at home. He also said some pretty fun expressions, like working at the office all day gave his brain blisters.

Visit to the Ministry of Health: Meeting the Big Wigs
    Tuesday passed by without a glitch, where we continued to do a bit more research. The previous day, Angel had mentioned how important it is to prepare the people of Tungurahua for the tests that the lab-in-a-backpack can do. For example, for most of these people, they’ve never in their lives received a hematocrit test, and perhaps may have never had blood drawn. For most of Tuesday, I drew up a hypothetical question-answer report of why we have to run these tests, including the importance of detecting anemia and tuberculosis.
    Wednesday finally came! The big visit to the Ministry of Public Health in Quito! We were presented the lab-in-a-backpack to several top officials in public health. The meetings went particularly well! They seemed really excited about the practicality of the pack. However, I was slightly concerned how sure they were that any doctor could simply pick it up and run all the needed tests (we’ve found that a lab technician tends to be quite helpful, especially when visiting a community where a doctor could have around fifty patients in one day). In any case, perhaps my favorite part was meeting several health officials who, after being introduced to the pack, were eager to try it on! They all laughed and joked how if the smallest doctor among them could carry it, surely they could!

From Errands to Fiesta: The Beginning of a Break
    The next day Qui Quín, Stacey, and I headed around town gathering price quotes for all the supplies we need to refill for the lab-in-a-backpack. When we were almost done finishing up our errands for the day, Qui Quín noted that we didn’t have much more office work that needed to be done for Fundación that week. He then wondered if we’d like to go somewhere for the weekend, when Stacey piped up that she had heard from the nurse in Planchaloma that a town nearby Quito, called Baños, would be worth a trip. Qui Quín agreed, and suggested that we head out the next day. That night Stacey and I researched tourist attractions for the city and packed for our trip!
    After we finished packing, Qui Quín and his family picked us up for a peña! Peñas can most be likened to small concert venues featuring a series of famous local singers. They had been quite popular in the 70s and 80s, when the dictatorship in Chile and Argentina had been particularly awful, and a series of protest songs sprouted up from grassroots support such as that found in the peñas. We heard a great round of singers (including the famous Ecuadorian duo Los Hermanos Nuñez), and I even learned a little bit of salsa! It was a great window into Ecuadorian culture!

¡Vacación! A Weekend in Baños

A typical view of the town

Iglesia de la Virgen del Agua Santo – Church of the Virgin of Holy Water
   

    Stacey and I had the opportunity to spend a long weekend in Baños, a few hours outside of Quito. It was absolutely beautiful – surrounded by about 60 waterfalls and close to the Amazon, the town attracts tourists from all over the world. The day of our arrival, Stacey and I walked around the town for a bit and talked with a few travel agents to finalize our plans for the weekend.
    That Saturday we woke up pretty early in the morning for a bike ride. We had heard that it was quite a common thing to bike ride to Puyo, a neighboring town in the Oriente (the Amazon proper). We rented a bike (only $5), grabbed a few water bottles and headed out. It felt absolutely great being able to ride again! We haven’t been able to get much exercise during our time here, so this was a really welcome change! At one point we came across a bridge over a river – El Río Blanco. We saw that a series of tour buses had stopped and a bunch of people were peering over one side of the bridge. We joined them to see what all the fuss was about – people were bungee jumping!  Well, to be fair, it wasn’t actually bungee jumping: the cord was thicker and the movement was more of a swinging motion than a straight drop. The bridge was about 20 meters above the river, and the adventure guides would strap up the willing participants to a harness, after which they would simply get on the other side of the railing and jump! Stacey and I decided to join in on the fun!!! It was such a thrill, especially the initial half a second when we jumped off the edge of the bridge and felt as if we were free falling! A Canadian tourist we had met there volunteered and took a video of us (we´ll upload it soon to Youtube and post a link to it here).
    We then took a cable car to Manto de la Novia (Bride´s Veil), one of the most famous waterfalls in the area! At that point, though, it started pouring. I’m talking about a full-on, clothes-soaking, typhoon-style rain that seemed as if it wouldn’t let up for hours. We ended up having to hitch a ride back on a bus back to Baños, where we warmed up in some hot springs. I also tried cuy (guinea pig) for the first time in my life! It’s very popular here, and has been rated as one of the most exotic foods of the world! The next day we went rafting along the river Pastazo (class III+ rapids, yo). Our boat was pretty fun – along with our Ecuadorian guide, we were rowing with people from France, Italy, and Belgium! That night, during dinner at a Mediterranean restaurant, a couple sitting nearby us overheard a conversation between Stacey and me. They introduced themselves, and it turns out that they’re also from Houston! The woman had even attended a sister Catholic high school to the one I had gone to!! Later that night I was able to catch Mass at the Iglesia de la Virgen del Agua Santo – one of the best Masses I’ve been able to attend in quite some time. Afterward Stacey and I headed out to a night time tour of the active volcano next to the city – Tungurahua. This past week it’s been spewing some smoke, so we didn’t quite have the best view of the volcano itself, but we were able to take some great pictures of the city at night.
    The next day we headed out to the hot springs located downtown and packed up our bags and left. Baños has been, without a doubt, one of the most amazing places I’ve ever visited!

Stacey and I on the cable car heading to Manto de la Novia

At the river that leads into the waterfall

Manto de la Novia!

Office Space
    After a weekend of altering adventure with rest, Stacey and I were refreshed and ready to put our nose to the grindstone. We essentially spent the rest of the week at the office, once again completing our norm of eleven-hour weekdays. We spent most of our time writing up a report summarizing all of the work we’ve done and the data we’ve collected from the medical brigades. I was also able to add more information to a teaching session we’ll have with the community health workers in Tungurahua. That was actually kind of fun, because I had to research different types of parasites to teach them about the horrors of eating uncooked foods. Good stuff!

Medical Brigade to Cunugyacu 
    This past Wednesday, all of us woke up ungodly early to head out to a medical brigade in Tungurahua. Along with Maria Alicia and Enrique, we drove for about three hours to reach the town of Ambato, where we picked up a doctor and an orthodontist. We kept driving another hour to reach the town of Yatzaputzán (a town I had written about in my second post). It turns out that the health clinic that we had seen just about a month earlier had been taken over by the Ministry! Later we heard how there’s a dramatic political undercurrent in the communities, where some of the leadership is promoting working only with the government for healthcare matters. Quite a few of the indigenous population, however, wants to keep with the current healthcare system, where they’re able to see doctors whenever they need to and receive needed medication. Fundación´s clinic had moved to a community building down the street, where they had hurriedly boxed away and moved all their supplies. It was such a shame to see them kicked out of their own clinic!
    We then picked up a lab technician and another general practitioner, as well as four community health workers, to complete our health worker team. All of us (a total of 13) then drove another hour along a series of twisting mountain roads to reach Cunugyacu, a small, insulated community. After carrying in all our equipment, soon the room was flooded with children and parents. With such a huge medical team, things got a little unorganized pretty quickly. It was also a little stressful since it turns out that we have several headstrong people on the medical team, each of whom feels very entitled to their opinions. Everything was settled in the end, and the packs were set up alright. The basic diagnostic equipment from the CHW kit was again a favorite, and the nurse was particularly excited about the thermometer covers (they’re single-use and really cut down the time that the nurse would have to sterilize the thermometer after each patient).
    I also walked around a bit and was able to talk to the some of the kids. They were particularly shy, and didn’t quite feel like running around or playing any sort of game. I then opted for the ´sit down and lecture´ style, and I hope their wide eyes and silent nodding indicated that they picked something about the importance of hygiene and nutrition! In any case, we were quite productive in this little pocket of the world, but it turned out to be the most stressful medical brigade yet!

A Morning of Meetings –> Amazon Trekking?
    The next day we presented our other two backpacks, the gynecological pack and community health workers´ kit, to the Ministry of Public Health here in Quito. One of our audience members was a doctor who coordinates medical brigades to the Amazon. It’s super exciting, because after talking to several of the officials, they agreed that it would be worthwhile to try out the backpacks in some of the more remote communities in the Oriente. I´M SO EXCITED! The naturalist in me has wanted to go hiking ever since we arrived in Ecuador, and this just might be our experience of “roughing it” with our packs! SWEET! Dear reader, you’ll be sure to hear a bunch about that trip next week!

I´m the one with the jazz hands on the far left, explaining the CHW pack. Public health officials to the right.

Some Tidbits about Ecuadorian Culture, Pt. 2
Manners: People here definitely interact differently than in the United States. For example, I can’t even count how many times I’ve passed a fellow Rice Owl in a hallway, or even along a walkway at Wiess, without acknowledging them. If you don’t know them, why would you say anything? They’re probably busy, anyway, thinking about life, or work, or whatever. In Ecuador, when you walk into a room, even if you don’t know them, you great everyone around you. Good morning, good afternoon (sometimes my sense of time is off and I get confused) are all proper greetings. There’s one morning greeting that’s commonly used among the older folk, in which one says in one breath, ¨!Buenos dias!¨¿Cómo le ha pasado? ¿Cómo ha amenecido?¨” / “Good morning! How are things going? Did you start your day alright?” Also, if you walk by someone else who’s eating, you politely nod to them and say “Buen provecho!” – basically, “Enjoy your meal!” If you’ve met someone previously, then when you greet them you also kiss them on the cheek. That’s led to lots of fun awkward moments. All of these customs are a little friendlier than I’m used to, but it’s pretty interesting!

On the Road Again: Traffic in Quito is pretty awful. As Maria Alicia explained to us, rush hour runs from about 6 to 8 in the morning, then from 11 to 2 in the afternoon, and finally from 4 PM until about 9 PM. Needless to say, rush hour is a pretty familiar state to us. To pass the time waiting in traffic, we often play a game. The goal: be the first one to see and call out a “Pichirilo” – basically, any model of a Volkswagen Beatle. You have to call out PICHIRILO, its color and then, if you´re fancy, the time of day that they´re situated (at 6:00). The latter’s pretty hard since cars tend to be moving, so you end up saying something like, “2:00! Okay now more like 5!” Anyway, it’s a pretty fun way to pass the time. Another thing you can do is denounce the hated abuseros. The term is actually a play on words and refers to bus drivers – buseros – who tend to drive horrendously and just generally abuse the traffic laws. The term abuser – abusero – is then used. If you´re ever in Quito and can´t quite think of a conversation topic with a local, just mention the term abusero and you´ll be sure to hear quite an earful.

Another Look at Family:  So I know I´ve mentioned it previously, but it´s worth noting again. Making sure that there’s enough family time is always a top priority. It´s also a little weird, since Stacey and I are of marriageable age, at least in their eyes. Never in my life have I been asked so often if I’m in a relationship, or what I think about marriage. It’s pretty funny, actually, since at the age of eighteen, marriage is just about the farthest thing from my mind. It’s write up there with “research retirement homes.”

Everyday Expressions: As you’ve probably figured out, the term “gringa” is used to describe any foreigner but is most commonly applied to Americans. Stacey and I have been affectionately called gringita for the duration of our time here, and I feel like it’s a legitimate nickname now. Another term that I hear and say many, many times a day is the term for “wow” – “chuta.” I’ve gotten so used to saying “Chuta!” whenever I hear something surprising, that I’ve even started saying it during my phone calls to my parents! A common greeting that’s used, particularly by Qui Quín, is the question, “¿Qué dices?” Literally, it translates to “What are you saying?” So whenever I silently walked into the room, and was asked that, I would reply with a confused expression “Nothing…?” It took me a ridiculously long time to figure out that Que Dices really translates to “How are you?”

Ecuadorian Painter – Guayasamín: Walking around Quito, I´ve seen countless striking paintings of a very distinctive style. I was really drawn to them, and saw that they were by the same painter – Oswaldo Guayasamín. I did a bit of research and found that he was born of an indigenous father here in Ecuador. Throughout his life, he has taken to heart the oppression of the indigenous populations throughout South America, and most of his paintings reflect the struggle against injustice. If you´re interested, I´d recommend checking out his work. Be warned, though! He´s pretty intense, so don´t expect watercolors of sunsets and butterflies!

Food: The food here is absolutely amazing. I’ve mentioned the guinea pig that’s quite popular here, and it tastes great! (A little like turkey, actually) Their seafood is also of course very fresh. The grilled oysters here are the best I’ve ever had, and are seasoned perfectly. Although I do miss Mexican jalapeños, Ecuadorian food satisfies my spicy tooth with a famous sauce – ají. It tends to vary by region, but it always has a kick to it and typically includes a mixture of onions and peppers. This week I was able to stop by one of the parks, where vendors set up their grills and tons of locals gather around to get a bite to eat of typical Ecuadorian food. I was able to try a bit of tripe (my namesake, haha), as well as try an empanada of cheese, or known commonly as a “wind empanada,” for its fluffiness. All in all, the food here´s pretty wonderful, and I´m trying to learn how I can prepare some so I can enjoy it back in the U.S., too!

Local cooks prepare tripe…mmmm!!!

Coming Up Next Time
AMAZON!!!! Also, Stephen and Yvette, both staff from Rice’s Beyond Traditional Borders program, are coming to visit. YAY!! MORE GRINGOS!

Checking out Alfaro street in beautiful Baños

A week of office work

After a long week working in the office of Fundacion Futuro (we were unable to conduct any mobile medical clinic trips due to lack of lab technicians), and demonstrating the lab-in-a-backpack to the Ecuadorian Ministry of Health – which will shortly be receiving a shipment of 24 packs to distribute throughout the country – Andrea and I were able to get away for the weekend to recharge. QiQin asked us last Thursday if there was any place in particular that we wanted to visit, and I recalled the fact that Dr. Lorena very strongly recommended that we visit Baños. I really had no idea what was there, so only the name came to mind. Soon after mentioning this, QiQin had us online researching places to stay and things to do, because we were going to fly solo for this one! Scary but exciting, because we were ready to venture out on our own while also allowing our gracious hosts a little bit of personal space.

Piscinas de la Virgen - a natural hot spring pool fed partially by waterfalls

The glorious city of Baños

We arrived in Baños on Friday afternoon and realized we’d forgotten to bring our notes with information about our hotel and potential activities. Luckily we were able to remember at least the name of the hotel (well, a hostel actually), and due to the kindness of the locals we were able to eventually find our way there. We also knew that Baños was a very small town, so it wouldn’t be too hard to find our way around. Baños is absolutely spectacular, sitting in the shadow of Tungurahua, the largest active volcano in Ecuador. It erupts every 10-12 years, prompting a city-wide evacuation. The city is also known for its hot springs, waterfalls, and the fact that the edge of the Amazon rainforest is right in its backyard. And the pennypincher in me needs to gloat for a bit about our great find: we stayed in an extremely nice hostel for 3 nights at just $7.50 a night!! Andrea and I even had our own bedroom (none of that 6-bunks-in-one-room business) and our own bathroom, where I experienced the most amazing shower I’ve had in Ecuador (as hot water and water pressure have been generally nonexistent). Awesome awesome awesome.

Bike tour on the avenida de las cascadas

Cuyes asados, or grilled guinea pigs!

Adventure Time!

Saturday, our first full day in Baños, was one of the longest, craziest, most exciting days of my life. Even though I ended the day with a nasty fever (probably just heatstroke or dehydration), I still fell in love with the area. We started early in the morning by renting bicycles so we could ride down the ‘Avenida de las cascadas,’ or ‘Avenue of the waterfalls.’ We stopped at an area where a lot of people were clustered around and saw that people were bridge jumping – my name for what is essentially bungee jumping but with a more rigid cord. I was happy to just watch, but then Andrea asked me if I wanted to do it, because they could do two-person jumps and she said she would only go if I went too. I thought about it and realized I wouldn´t get another chance to do something that insane in South America, so then we literally took the plunge! The drop was about 15 meters of sheer terror before coming to a quick stop and swinging for a few minutes over the rocky Rio Blanco. What a great opportunity to freak out our mothers! Maria Alicia, essentially our Ecuadorian mom, almost had a heart attack when we showed her the video of our jump (kindly taken by a Canadian tourist). More adventures of the day included getting stuck on an open side-open top cable car 100 meters above a raging river in the middle of a monsoon. The rain put our bike tour to a halt and we had to jump on a chiva (tour bus) to get the 20 km back to Banos. Luckily by this point we had run into two other American tourists (med students from Seattle) and their guide, who invited us to come to some hot springs with them afterwards. They also invited us to go eat cuy (guinea pig) with them. I abstained, but was curious to witness the spectacle. Carnivorous Andrea of course loved it and even ate the tiny liver. Ewww. (Side note reminder: Stacey = vegetarian). The rest of the day was spent relaxing in the heat, and after the hot springs we got an appointment at a small local spa to get (cheap, but awesome) massages.

Sunday was also adventure time, as we had signed up for a full day white water rafting trip. We spent several hours on the Rio Pastaza in Class III+ rapids and nearly got thrown off several times, but despite my initial fear it ended up being a lot of fun. Andrea is apparently some sort of rafting champ and therefore she put the pressure on me when I started to waver – after hearing from other tourists that the river was really dangerous, and that two weeks earlier a tourist had drowned while rafting! Nevertheless, we are both still here to tell the tale, and I´m proud to say that I jumped off a bridge and went rafting in treacherous waters in the Amazon! Our rafting guide also spent a while joking – I´m not sure how seriously – about there being anacondas and piranhas in the river. All the better! I think Andrea and I are just a pair of daredevils.

We returned to Quito on Monday ready to get back to work, rejuvenated by our weekend adventures. 3 weeks to go! Here´s hoping we can make the best of it.

The scary cable car that Andrea and I got stuck on

Andrea and Stacey bridge jumping over Rio Blanco

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!

Hello outside world!!! Sorry for the long wait for this post – it turned out that we didn’t have access to Internet in Planchaloma this past week. I’m going to break up this entry in blocks because there’s a whole lot of information!

Practice Makes Perfect! (Presenting, presenting, presenting…)
    The next couple of days were pretty filled with presenting our backpacks over and over, as well as finishing up some documents for our upcoming trip to the communities. The big event on Wednesday (June 3rd) was presenting all three backpacks (community health worker’s, gynecological, and lab-in-a-backpack) to the directors of Fundación Futuro. Presenting generally involves pointing out all the included supplies in the backpacks, and especially how the connections work with the independent power supply. Just a reminder: everything, and I mean absolutely everything, is said in Spanish. It’s essentially a demonstrative speech in a foreign language, and heavy on medical terminology. My heart was beating so fast!! I definitely felt the pressure to present the CHW pack well, since my group and I had worked on it for so long. I was especially nervous for the lab-in-a-backpack, for I would be representing several years’ worth of collaboration. Once everyone arrived at the meeting room, Stacey and I began.
    It went alright! One of the directors was particularly excited since he had seen the previous version of the lab-in-a-backpack (LB) and loved the new developments that made the backpack’s use even more intuitive. The other director expressed some concerns that some of the equipment in the LB would not be used, but he agreed that he will learn more from the reports of the backpack’s use when we get back from visiting the communities…Phew! It was over!
    Back in the office on Thursday! I spent the morning making a comprehensive instruction manual for the weighing equipment in the community health worker’s screening kit. It included a lot of pictures so it could be understood easily, even if the CHW is illiterate.
    When we got back from a late lunch, our mentor, Maria Alicia, notified us that we’d be presenting our backpacks in the adjacent room. At this point, this had been the third day in a row that we’d presented these packs. These talks are not easy or short: the community health worker’s screening kit introduction can take as long as half an hour, and the two other packs take about an hour each. Stacey and I, sighing under our breath, grabbed our packs and performed our speeches yet again.
    Despite our initial hesitation, this session turned out to be extremely helpful! We presented our backpacks to Maria Alicia and Marisol, her coworker, as if we were presenting to the community health workers in the communities. Afterwards, we each got a comment card of a list of things that we should work on. A lot of the comments were geared to the population we’d be presenting to. For example, I learned that the talks had to be much more of a dialogue than a speech. I also learned to stress certain points, such as that Stacey and I are NOT doctors, and we’re here primarily to improve these backpacks’ designs. I really took to heart all the comments that I got, and committed them to memory to improve for next time. That night ended up being pretty fun, since we all went out to one of the malls in Quito to see Terminator! Pretty exciting stuff!
  Friday: last full day in the office before we head out to the communities! This was the last day of about two weeks of preparation for getting our packs out and ready for the medical brigades. I spent most of the day completing a very detailed inventory in Spanish of every single item in both backpacks. This information is essential for the Fundación in order to gauge how much they should charge for each of the examinations.

Relajando en El Jardin y La Mitad Del Mundo / Relaxing in The Garden and The Middle of the World
    Our second full weekend in Quito ended up working out really well! On Saturday we visited El Jardin, yet another of Quito’s ginormous malls. We went grocery shopping, and for lunch I had an amazing pork chop with mote and beans for a little over $3! I’m definitely going to miss the food (and the price) once I come back. After lunch, we stopped by an ice cream shop, followed by watching Noche en el Museo 2. It was entirely in Spanish, but the plot was straightforward enough that I understood it!
    The next day, Maria Alicia, Stacey, and I stopped by Maria Alicia’s aunt’s house. She’s 96 years old, but is in absolutely amazing shape! She takes care of the house entirely on her own, and her memory is better than most people my age! The house itself was really interesting. It’s about 150 years old and was designed such that the ground floor had an uncovered patio area surrounded by the rest of the house, and whenever you looked up you could see clouds drifting by through a rectangle of uncovered roof. The layout reminded me a lot of the setting of a play I had seen in my Spanish literature class, La Casa de Bernarda Alba, which takes place in Spain in the nineteenth century.
    After going to Mass at a beautiful cathedral nearby, we headed to La Mitad del Mundo, a little town built around the 0º latitude line. It was really cool – I had one foot on the Northern Hemisphere and one in the Southern! They had a mariachi band playing, and we saw a bullfight! There were also small exhibits there, my favorite being an insectarium with live Hercules beatles and tarantulas! Many were native to Ecuador, I was excited to see. All in all, really great weekend!

 I´m in the middle of the world!

Leaving Quito and Off to Planchaloma
    On Monday we spent the morning in the office in order to print all of our manuals in color. It was hard to believe that this would be the last I would see of Quito for quite some time! I decided to pay extra attention to my surroundings. One of my favorite activities when Maria Alicia drove Stacey and I to work would be to read the graffiti on the walls. Unlike a lot of American graffiti, replete with colorful not-so-appropriate language, the graffiti here gears more toward delivering potent political messages. One of my favorites refers to one of the local officials running for mayor in an upcoming election. The statement reads “La alcaldia no es juego de gua guas.” The statement itself is in a mixture of Spanish and Quichua, and essentially reads “The municipal government is not a child’s plaything,” referring to the inexperience and youth of the candidates.
    After eating lunch and packing up of all of our backpacks, we headed out with two lab students, Lucia and Karina, who would be spending the rest of the week with us and using the equipment in the lab-in-a-backpack. We stopped by a grocery store and bought food for the rest of the week. The view on the way to Planchaloma was absolutely beautiful, and it seemed as if every time I looked out the window I saw another postcard view…it was so nice!

A great view of the active volcano Cotopaxi

We got in that night to the health clinic in Planchaloma, which would become our “home base” for visiting the communities the next two weeks. The acommodations are pretty nice, except we wouldn’t have hot water until the following night. Also, some of the lights weren’t working, and we didn’t have access to the Internet as we thought we would. Still, we each had our own bed, and all in all it was a pretty cool place. We all had an amazing dinner, prepared in the health clinic’s laboratory! We went to sleep pretty early, exhausted from the traveling.

World Premiere of the CHW Pack at Chisulchi Chico!
    Tuesday was absolutely fantastic! We woke up to a brisk morning (it’s generally pretty cold in the communities – layers and layers tend to be the most desired fashion choice). After cleaning up our breakfast, we got ready for presenting our backpacks to the doctor and nurse of Planchaloma, as well as to the lab students. Once everyone got settled, we began with the presentation. It went great! The nurse, Dr. Lorena, really liked the community health worker’s kit. It got rave reviews such as, “¡Me parece completo!” (Seems complete to me!) and “¡Perfecto!” Stacey presented her gynecological pack, which everyone also loved. When I brought out the lab-in-a-backpack, the lab students were absolutely amazed! They went through all the stains and talked with the doctor and nurse right there and then about all the tests they could run. I took down a lot of helpful notes about possible additions to the lab-in-a-backpack (LB). For example, with a Wright stain they could analyze the morphology of the blood cells. Also, they pointed out that the diagnostic urine test strips in the LB aren’t as complete as those used in the gyecological pack. After we finished our presentations, they were really excited to start working with the packs!
    We started getting all of our backpacks together to head out to our first community, Chisulchi Chico! When Nicolas, the head community health worker of Planchaloma, put on the CHW pack, I nearly cried. I couldn’t believe it!! After a semester’s worth of work, I was standing an hour outside of Quito, Ecuador, watching as someone who lives and works with the community will use these simple tools to help deliver healthcare to patients in remote regions. We drove up the mountains about half an hour to reach Chisulchi Chico. We set up the backpacks in one of the small classrooms, which basically meant setting up what we could of the LB on a table, while the doctors used some benches around the room to put down their stuff. It’s definitely in these types of rustic environments that these backpacks were designed for!
    The rest of the medical brigade went pretty well. Whenever a patient would come in, they would be seen immediately by Dr. Lorena and Dr. Monica. If either of the doctors ordered that a test should be run for that patient, he or she would be referred to the table at the other end of the room, where Karina and Lucia were manning the lab-in-a-backpack. Stacey and I reviewed both the CHW pack (mostly used by the doctors) and the LB, noting how many times each item was used and the age of the patients. Because we were literally right next to the school, we had a huge line of children come in for check-ups. The rest of the patients that came in tended to be elderly, with only a few middle-aged people coming in. Everything seemed to work out pretty well; the doctors ordered a lot of hematocrit tests, so we definitely got to put the centrifuge to a decent amount of work! The doctors used the measuring tape and stethoscope from the community health worker pack. It was a little weird since all of these general items could also have been found in the LB, but it worked out for the best since we were able to look at the number of patients who received general examinations in comparison to those who had to receive tests. We had over 25 patients that day.
   

The whole medical brigade team at Chisulchi Chico: Dr. Monica, Dr. Lorena, Stacey, myself, Qui Quín, Nicolas, Lucina, and Karina. The building on the right is where we set up clinic.

    After seeing all the patients that had come, we met with the children and community leaders for a while. We had a quick talk with the kids reminding them of the importance of washing their hands and covering their mouths after they cough. Right before lunch, when Stacey and I were taking photos of the surroundings, a few girls of about six or seven shyly ambled by. After talking to them a little while, more kids came, and I saw that they might enjoy a game of Luz Roja,/ Luz Verde (Red Light, Green Light!). Sure enough, the kids had a great time.
    We were treated to a very nice lunch prepared for us. We had a huge pot of mote and mashua, a yellow, wrinkled starch that’s pretty tasty. We filled ourselves up and headed back to home base, the health clinic of Planchaloma.

Living at Planchaloma: Brainstorming, Running More Tests, and a Little Bit of Soccer
    I had a little bit of time before dinner that day, so I brainstormed a bit about possible nutrition lessons for the kids. As has been reiterated to us from several community health workers, the problem of malnutrition is rampant, and is particularly troublesome for children. I worked out a few simple ideas to help kids realize the importance of eating right, and to identify the foods that are the most nutritious, as well as the ones they should watch out for. Inspired by a group from my BIOE 260 class as well as how well the game of Red Light Green Light had gone, I thought about creating a game involving the kids running or stopping, depending on whether I shouted out a healthy food or unhealthy food.
    After a long day, Stacey and I cooked pasta a la gringita (a la foreigner), involving a really hearty pasta sauce. It tasted pretty good! Surprisingly, we had transformed the laboratory into our own Top Chef kitchen.
    The next day, Wednesdsay, we woke up to hear that school in Chisulchi Grande, the community that we were planning on visiting that day, had been canceled. As such, we postponed the visit one more day. We spent the rest of the morning and afternoon in the health clinic, attending to the families who came in. We only used the lab-in-a-backpack, and the expert lab students were again able to help out the doctors by running a lot of hematocrit tests. They also were able to test for bacterial vaginosis, which was a new test using the LB supplies.
    After the clinic closed in the afternoon, we were able to catch the Ecuador vs. Argentina fútbol (soccer) game. It was really exciting! Argentina was ranked #1 in South America, and Ecuador #6. I had heard about this game in the past weeks, and knew that fans all over the country would be cheering for Ecuador! We watched the game at a little restaurant in a town nearby, famous for their fried pork dish called chugchucara, which I enjoyed while watching the game. After a scoreless first half, Ecuador came back to score TWO goals against Argentina!! We won 2-0!! Whenever Ecuador scored a goal, the owner of the restaurant, an elderly woman, smashed a plate to the ground – much to the glee of all the soccer fans in the restaurant. It was a great way to end the day!

Chisulchi Grande: Expanding Healthcare

Photo 1: myself, Qui Quín, Stacey, Karina, and Lucia setting up the lab-in-a-backpack. Lucia happily holds the centrifuge!

Photo 2: Dr. Monica and Dr. Lorena attending to a patient (the blood pressure cuff is from the CHW kit!) I am standing by with my trusty yellow folder to take notes.

    Thursday morning, and all of the team (Lucia, Karina, QuiQuín, Stacey, Dr. Lorena, Dr. Monica, and I), pack into the van with all of our things and head to Chisulchi Grande. The school there is considerably bigger than the one we had visited on Tuesday, and we set up all of our equipment in a little room lined with benches. We had a pretty steady stream of patients, again mostly children and the elderly. The hematocrit results were all very promising, as they all were fairly constant for each of the children and was well within the healthy range. The most memorable patient was Juan, a young man in his late 20s. Three months ago he had suffered a fairly serious injury while trying to install an appliance, resulting in current running through his right arm and exiting through the top of his head. He took off his bandages on his wrist to reveal a deep gash that ran halfway until his elbow, where you could literally see bands of muscle. He then took off his hat to reveal more bandages. The electricity had burned the top of his head such that we could see the pasty white bone of his skull in two separate places…Whoever had last attended to his wounds had used cotton balls – which are absolutely awful for first aid because some of the fibers can easily infect the wound. The doctors called immediately for the first aid equipment in the community health worker pack. They used a lot of the iodine, antibiotic ointment, and gauze to clean and rewrap his wounds. It was definitely a thrilling experience, seeing some of the items I had bought in CVS only a few weeks ago being used to treat someone who was very obviously in need…

Chisulchi Grande: Nutrition Lessons Pilot Project
    After the line of patients trickled down, a few women arrived who wanted to have Pap smears. Stacey began setting up the gynecological backpack while the rest of us packed up to leave the room for the patients’ privacy. I ended up chatting with a few families outside. A gaggle of kids were standing to one side, and I asked one of the girls her name, which she proudly recited. As soon as some of the other kids saw that this strange gringa was talking to kids their age, more and more came by.
“Can I tell you something?” I asked a few of the girls in Spanish. They nodded silently. I began my nutrition talk, which was also met with a few nods. I then decided it was time to test out some of the nutrition ideas to make sure that the lessons hit home.
“¿Quieren jugar?” ( Do you want to play a game?) I asked them.
“¡Sí!” responded a chorus of kids.
    I then led them to the courtyard area, where I turned around to find that as many as thirty kids had followed! School had already let out by this point, but not everyone had headed back home yet. We played the Red Light Green Light game, where I shouted out food groups such as “Vegetales” or “frutas,” to which they had to run to me, at the other end of the courtyard. I would yell at “evil” words like sugar, desserts, and Coca-Cola, to which they had to stop running immediately! It went well, though I found that I ran out of names of specific foods they’re familiar with pretty quickly.
    After about ten minutes, I tried to teach them a freeze tag game in order to teach them the importance of covering their mouths when they cough. That ended up resulting in more chaos than I would have liked, leading me to believe that I have to restructure a game with that same lesson. We then started the Red Light Green Light game again, except I found that it was becoming increasingly common for a few kids to linger behind me and try to scare me rather than run back to the start. Seeing that this was a sign that the kids were getting bored, I decided to try a bit of improvisation. I held out my arms straight in front of me, in a zombie fashion, and declared in a loud voice, “Soy la monstrua de enfermedad!” (“I am the sickness monster!”) and ran around trying to tag kids. I would occassionally stop to cough and sneeze really dramatically before continuing on my quest to “infect” everyone else. After I tagged a few kids, they excitedly adopted the “zombie” pose and tried to infect all the other children.
    After a while of this running around business, I realized I was pretty fatigued. I said goodbye to the kids after explaining that the Sickness Monster had taken her medicine and rested to find that she was healthy once again! All in all, I had a great time with the kids, and I hope that they had a great time while learning!

Last Day at Planchaloma for the Week
  That Friday we attended to the patients coming into the health clinic at our home base of Planchaloma. We got to run pregnancy tests for the first time! I was there when the lab technicians were able to announce to one of the patients that she was pregnant! I think I was more excited than her to hear the news, actually.
We then packed up all of our things and headed back to Quito after saying goodbye to Lucia and Karina, who had done such great work with the lab-in-a-backpack. We’ll return to Planchaloma with two new lab students the next week and visit different communities.

Weekend Back in Quito: Festival of Saint Anthony of Padua, and Family Time
    Stacey and I were absolutely delighted to visit a pharmacy during the weekend, where we stocked up on Kleenex and decongestion medication. We also got to see the new Disney / Pixar movie Up, dubbed over in Spanish. That night we met up with several members of Maria Alicia’s family, where we attended a local church’s celebration of the Festival of Saint Anthony of Padua. I’m Catholic, so it’s very interesting to see the religious celebrations in Quito (more than 80% of Ecuador is Catholic). Apparently they celebrate the saints’ days quite commonly here, which is something I wish were more common in American Catholic traditions. The festival lasted a few hours, and included a series of bands singing worship music. At the very end was a series of pyrotechnic displays, such as the “crazy cow” and the “castle,” both of which were wooden frameworks strapped with a series of fireworks and noisemakes that set each other off in series. It was really fun to see!
  The next day was Election Day for electing Parliament members. It was mandatory for all citizens to vote, so Stacey and I accompanied Maria Alicia and her mother to their respective voting centers. The schools were not at all as crowded as I expected, and we were in and out relatively quickly. We spent the rest of the day relaxing with Maria Alicia’s cousin’s family.

Sickness Hath Struck!
    Aside from an upset stomache at Chisulchi Chico, I’ve felt great the past few weeks. Not even any migraines, which tend to be more commonplace in the city. I thought I was pretty homefree until…
 A VIRUS ATTACK! At some point in Chisulchi Chico, I’m pretty sure I contracted something. The next day my throat hurt, and I noticed I had some pretty serious sinus pressure. At Chisulchi Grande I had to deal with several sneezing bouts and a nose that insisted on running. I ended up using four travel Kleenex packs and the rest of Stacey’s supply of Kleenex that day. Before going to bed, I made some hot lemonade (Karina’s suggestion) to feel better, and woke up to find I was less congested. As I write this, I feel a lot better, though I will continue to keep Kleenex packs nearby!

Some Tidbits about Ecuadorian Culture
Time: Time definitely moves differently here. Stacey and I learned early on that when you’re told something will be done “soon,” that could mean anywhere from a few days from now to a few weeks. Also, deadlines are much more fluid than you would expect. Whenever we were told that we should leave by 8, it turns out 8:45 is the actual time of departure. I think I’ve learned to be more flexible, as this whole system is quite different from how I live during the schoolyear, where I essentially have to create a schedule for what needs to be done during each block of the day. After adjusting to the slower pace here, I’ve found that everything still gets done when it needs to be, and I am relatively not stressed during the process. Perhaps a mentality I’d like to take back with me to the States!

Family: Family is HUGE here. It’s very common, for example, for children to live with their parents through college and until they get married. Grandparents and extended family, if they don’t live in the same household, tend to live very closeby. Children are also treasured highly in Ecuadorian culture. It’s heartwarming to see the attention that parents give their kids, whether playing with babies or involving the seven-year-olds in the “grownup” conversation. Despite all this coddling, the children certainly don’t act spoiled. I’ve yet to see a child act out in front of his or her parent in public. Even in the communities, the children were extremely well-behaved and didn’t shout and scream when they had to get their finger drawn for blood. At the same time, I’ve also heard parents refer to their children as dwarves, or even lice! They use the diminutive forms of these nouns in Spanish, such that even these names become affectionate!

American Influence: It’s interesting, and at the same time a little unnerving, to see so many traces of American media and culture here in Ecuador. KFC, for example, is widely loved by the people here. Eating there is almost seen as a luxury – you can expect to be served your fried chicken by waiters in a very well-kept, modern atmosphere. Listening to popular radio stations, it’s not uncommon to find some almost entirely dominated by 80s American songs (for some reason, Madonna is extremely popular here). I was quite surprised to see over three-quarters of the movies shown at the theaters produced in American studios. Although I suppose all this media and familiar sights provide some sources of comfort to ease some of the homesickness, I almost wish American media didn’t have a foothold as strongly as it does here…

Injustice Is Afoot!

A not-so-happy camper

    Today – Monday, June 15, I had an unfortunate run-in with the Ecuador Postal Service. My mom had sent me a package containing chocolates, a book, and some of my old jeans that I could wear in the countryside. Now you would expect a package to simply end up on the door of your home, right? It turns out that it´s not so easy.  Maria Alicia ended up going to the post office to pick it up. Due to a new series of regulations that went into effect of February of last year, we would have to pay a huge chunk of charges. Because it weighed over 4 kilograms, I had to pay for the fact that it had clothes – even though they were my own, used clothes! They heaped charge upon charge, all claiming that it was simply “regulations,” until they handed over a bill of $150.
    $150 to receive a package of my own stuff!?!?! This was insane!!! I was extremely upset, especially since it had already cost me close to $100 to send over the package in the first place. The postal workers shook their heads in empathy, saying that this wasn’t the first time they’ve seen someone upset over the prices. It’s not uncommon for some family members to work overseas, and then send clothes and other items home to their kids. To receive these packages, prices run as high as $300, and for families who are already struggling to get by, paying that huge sum simply is not an option.
    As we continued arguing with the postal workers over my charges, I noticed a man nearby listening to the whole ordeal. It turns out he worked for an Ecuadorian TV station, and was interested in interviewing us and a few other irate customers about their issues with the postal service here. A camerman interviewed me of why I was upset. I explained my situation as best I could in Spanish, and showed them the bill with the exorbitant price. Perhaps something will change, perhaps not. I found it interesting later on when I heard that some people have enocuntered similar problems with the postal service, but they couldn’t speak out because they worked for the government, or an organization funded by the Ecuadorian government. How ridiculous is it that a foreigner is the only one who feels comfortable of speaking out against injustice?

The gang´s all here - our medical team for the first week

 

Meet the Team

On Monday afternoon we got everything packed into the truck (just barely!), picked up two girls from the Catholic University of Quito, and headed off to Planchaloma with our backpacks and all of our gear for the week.  Planchaloma was to be our weekly headquarters where we would gather our team, get our stuff ready and prepare for the daily trips to the communities.  We’ll be staying there nearly every week until the end of July, living in the new Health Center built there by Fundación Futuro.  Its newness definitely showed – we spent nearly a day trying to set up the hot water heater – which was a godsend when it worked, I was worried that I wouldn’t be bathing for the week; the water was so cold that I would rather opt for being dirty!  Also, the staircase that was supposed to lead to the second floor led to nothing (2^nd story not built yet), and 80% of the power outlets in the building didn’t work.  We all became extremely resourceful, by necessity!  Through all the mishaps, however, it was great to finally meet up with all the members of our team, or medical brigade.  A summary of ‘teammates’ follows:

Nicolas – Community health worker (promotor) for the Planchaloma area.  As a resident of the community, it’s his job to gather the people, keep them informed, and convince local indigenous people that it’s in their best interest to trust the mobile medical clinics coming through (meaning: us!).  Without him, we wouldn’t ever be able to come in and set up our clinics.

Drs. Lorena and Monica – Resident doctors of the health center who both work at the central clinic in Planchaloma and travel out to the communities to set up the clinics – therefore increasing access to medical care. 

Carina and Lucia – Two laboratory technicians who we ‘borrowed’ from the Catholic University’s school of laboratory sciences.  Things worked out well because we needed lab technicians to know how to do all our tests, and they have a degree requirement to work 70 volunteer hours doing lab sciences in poor communities – definitely a win-win situation.  Also, they knew how to take blood and other tissue samples, which was something I did not suspect but was great because we don’t have a nurse on the team and Andrea and I are definitely not prepared to do that!

Lucia and Carina setting up the Lab in a Backpack in Chisulchi Chico

Me, Andrea, Enrique – During the clinics we all function as mostly observers, as Andrea and I are taking notes on the use and inventories of the packs, while Enrique is taking down patient information and his own inventory list for the purposes of Futuro Foundation.  Andrea and I also oversee use of the packs and help with setting things up, going through instructions etc.

The children of Chisulchi Chico

The Maiden Voyage of the backpacks

Once the team was all assembled and everyone was more or less knowledgeable about the backpacks, we packed up and headed out to the communities.  In the past week we visited two communities – Chisulchi Chico and Chisulchi Grande – setting up a quick clinic in the local schoolhouses and seeing as many patients as possible.  Most of what we did was routine checkups for the kids, including hematocrit tests (and you would not believe how calm these small children were about having their fingers pricked and drops of blood squeezed out into a capillary tube – it made me remember the uproar my sister and I used to cause when presented with the same test).  The doctors were also handing out some sort of medicinal cream to the children that they were meant to apply to their wind-burned red faces.  We also ran a couple of urine tests, glucose tests, pregnancy tests, and hearing tests for the elderly, as well as general exams of pregnant women and some miscroscope tests (one using a stool sample) when there was indication of illness. 

One case that really shocked me was a young man who came in asking for a re-dressing of a wound.  He took off bandages on his wrist, shoulder and forehead, revealing deep gashes that exposed the bone beneath (we could see his skull in two places) and angry burned skin.  The wounds were three months old and were caused by an electrical accident while he was installing a lightpost – apparently the current entered his hand or wrist and then exited through his head, causing the two deep holes.  I was amazed that he could even survive such an event!  It also appeared that whoever had last dressed his wound had used cotton balls, which left behind fibrous residues that cause infection.  The doctors therefore spent quite a bit of time cleaning and re-dressing the wounds.

On Thursday came the first opportunity to use the gynecological pack, as two women requested to have a Pap smear.  This type of exam has never been conducted in the area before because it’s too complicated, so this was a nerve-wracking experience for all of us.  I got everything set up in the little school room as best I could and then left it to the doctors to conduct the exam while the rest of us waited outside.  However, the first run was a half-failure – everything worked out fine until they got to the cytofixative which is needed to firmly attach the cellular sample to the slide – important because the sample must survive until it reaches a specialized laboratory that examines Pap smears.  It seemed that the cytofixative spray that was in the gynecological backpack was empty – something I attributed to the plane ride.  I remembered opening up the pack after arriving in Quito and noticing that the cap had popped off of the cytofixative; however I didn’t think to check the contents because I didn’t want to waste any of the spray.  It seems that the can probably emptied itself in the plane due to the high pressure.  This was upsetting because I realized that none of the cans in the other backpacks likely survived.  However, I learned that you can actually use normal hairspray as an alternative, and hopefully they can buy some fixative in Quito as well.  Hopefully this means when we return next week we’ll be prepared with all the tools we need, including some type of fixative.

Setting up the wooden stirrups for the first Pap Smear in a backpack performed in Ecuador

Health Update

It appears that keeping the poor ‘gringitas’ healthy is one of the biggest challenges of this trip – as Andrea came down with some sort of cold while in Planchaloma and thus was named the new ‘Mocosa’ (a title which was previously mine, literally meaning ‘girl full of mucous’).  I was actually the healthy one in Planchaloma, so apparently the cold mountain air is much better for my health.  And believe me, it’s cold out there!  In Planchaloma the altitude is about 3800 meters and the temperature normally ranges between 2 and 13 degrees Celsius.  At least Andrea and I are escaping the sweltering summers of Texas!  However, as soon as we returned to Quito I developed a nasty sinus infection.  After a trip to the pharmacy we both got heavily medicated – one of the great advantages of Ecuador is that you can get any prescription strength medication over the counter.  What becomes slightly annoying after a while though is that if you have any type of illness at all, allergies included, people say that you have gripe, which here means flu.  Due to the swine flu epidemic it’s not in our best interest to have people going around saying we have the flu when we know we don’t, so we’re doing our best to keep our runny noses on the down-low!