Reports from Ecuador

Team of Doctors, Lab Technicians, and of course the engineers for week 2 in the communities

Two new team members: Mijínes

For our second week of medical clinic trips in the communities (organized by Fundacion Futuro), we traded out the two girls from last week for two male students, Carlos and Paul. They came from exactly the same laboratory science program in the Catholic University, but they couldn’t have been more different! The girls were mild-mannered and organized, while the boys were outspoken goofballs. They entertained us during the week by teaching us about the youth culture here, including slang terms and some not-so-polite phrases, which I will not repeat for the sake of decency. It was touching though when they told us that we were their ‘panas,’ meaning close friends, or the equivalent of ‘one of the dudes.’

Despite the informalities, the boys proved to be competent lab technicians, as they each only have one year left to complete their program. During the past week we were able to visit two communities, including the distant and nearly unreachable Cerro Azul (although they rewarded us for our journey with delicious freshly caught trout!) and the bustling community of San Francisco. At San Francisco we set up shop in a pasteurization plant and were quickly inundated with patients, with the daily total reaching over 70 (quite a lot, considering that we process all exams and tests on the spot). It seemed like this community was a great example of what can happen when the community health workers do an effective job of educating the people about the benefits of proper health care. While in some communities many are still hesitant due to gaps in communication, it was great to see a group of people lining up to get blood samples taken – something most people wouldn’t choose to do even when they know the benefits!

In the community of San Francisco we were also able to complete our first five successful Pap smears using the gynecological backpack. While we had to replace proper cytofixative with hairspray, it was still exciting to know that this was the first time any community member received this type of exam. I did however find out some information that was a bit troublesome, which is that the doctors and patients refuse to use metal specula, but then they insist on throwing away the plastic ones. I purposefully included both types so that we could see which type tend to be preferred, but I fear that their unwillingness to sterilize and reuse will quickly diminish our short supplies and then lead to unnecessary waste. Also, plastic specula are relatively expensive, costing at least $5 apiece. Considering that the foundation charges patients for use of disposable supplies, it makes the cost of a Pap smear considerably steep.

Carlos and Stacey conduct a urinalysis test in the community of San Francisco - check out all of those urine samples!

Unforeseen struggles

Andrea and I were pretty happy with the progress in the last week in Planchaloma and the communities of Cotopaxi, as we were able to treat a large number of patients and are continuing to learn more about how to properly implement the backpacks in Ecuador with the help of Fundacion Futuro. However, progress has come to an upsetting halt this week, because we were unable to secure more student volunteers from the Catholic University to serve as our laboratory technicians. They really are the key to the backpacks, because they are the only ones with sufficient knowledge and training to perform diagnostic laboratory tests. We’re also worried because Rice University is sending 24 more diagnostic backpacks to the Ecuadorian Ministry of Health this week to distribute around the country, and we have no idea how they are going to ensure that the technology is used properly, or even used at all. It was also a little disconcerting because last night Andrea and I had a chance to talk at length with a community health worker (promotor) from Tungurahua named Angel. While it was truly insightful to speak with him about his ideas of revolutionizing health care in rural communities and putting control of the system into the hands of the people, he seemed to be under the impression that he was going to man the lab-in-a-backpack himself. While we admired his ambition, we had to explain to him that you would need extensive training and experience to properly perform these lab tests. He told us that he just hopes that after we leave, they aren’t left back where they started, as if nothing had changed at all. We assured him that we’re trying to figure out everything we can to ensure that the technology in the backpacks will continue to be used even when we’re not here.

Some lighter notes: on nicknames and (non) political correctness

One of the more entertaining aspects of Ecuadorian culture is their use of names, especially nicknames. Many of their commonly used terms of endearment could be interpreted (in American culture) as politically incorrect or even insulting. As some examples, it is perfectly normal to call a parent, child, or close friend ‘Gordo’ or ‘Gordita,’ meaning ‘fatty’ or ‘chubby.’ Also, children are commonly referred to as ‘enanos’ (dwarves) or ‘piojos’ (head lice). More personalized nicknames can get even more creative, such as the use of ‘Mocosa’ (snot-nose) for both Andrea and I. Due to my unusual name (Stacey Skaalure, which is basically un-pronounceable in Spanish) I’ve acquired some hilarious new interpretations of my name. QiQin tends to call me ‘SiSi’ (he insists that’s what it sounds like when Andrea says ‘Stacey’), and follows it up with ‘Hace Scalor’ (a play on hace calor, which means that it’s hot out today) or ‘Excalibur,’ both of which I guess vaguely sound like my last name. Names that the boys, Carlos and Paul, gave me last week include ‘Stacey Malibu’ (apparently the name of a Barbie on an episode of the Simpsons), and ‘Cabeza Zanahoria,’ meaning ‘carrot head’ or probably ‘carrot top.’ Besides just nicknames, probably my favorite example of non-political correctness is the name of a popular local fast food chain called ‘Menestras del Negro,’ which literally means ‘Beans of the Black Man.’ To make it even more ridiculous, check out the drawing that goes with the name in the picture below:

¡Menestras del Negro! ¡Que Cómico!

The 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!