Reports from Ecuador

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?