Our hospital is on the complete opposite side of Quito. The four of us that have to get there have decided that sleep is more important than money. Therefore, we share a $4 cab ride(about 20 minutes) to the hospital and take a $.25 bus ride (about 30 minute bus ride and 25 minute walk) back in the afternoon. Some of the more interesting things we had seen were groups of goats and donkeys hanging out on the corners of major thoroughfares in Quito. We couldnīt quite figure out what these gangs of hoodlums were doing just hanging out and polluting the sidewalks with their deposits. On Friday, our cab driver was kind enough to inform us that they are brought down from the mountains and their owners sell their milk fresh on the street. Nothing like a little carbon monoxide with fresh goatīs milk on the side. YUM!
On the bus ride home one day, we saw a group of workers sitting on a pretty large highway median that had lots of grass on it, surrounded by cows. The cows were just munching on the grass while the workers ate their lunch. A little further down the road were more cows on the grassy sides of the highway. Weīre not sure what they were doing with the cows, but my theory is that they are an inexpensive lawn mower and that is how they keep their miles of highway clean and trim in Quito.
Work has been very interesting. I have become very familiar with sewing up machete injuries as that is the major mode of assault here. One patient had the tops of three fingers chopped off, a cut on his neck, and some tendons torn on his left hand. The last machete patient had an exposed ulnar fracture and his ulnar nerve cut. Ouch is right!
I think that preventative medicine is a huge problem here. One morning during triage we diagnosed 2 women with some kind of uterine cancer and another with gastric cancer. They wait too long to come in and when they do itīs too late. Itīs very sad.
We had the weekend off and a group of us decided to go sight-seeing to a town called Baņos were there are many hot springs. We got there on Friday night and stayed at this gorgeous hotel up on top of a mountain in a log cabin. (All for less than $25.) But, we were in for a little surprise. I was sitting in a chair enjoying a bottle of pure water when out of the corner of my eye I saw something large and brown. Oh my god, it was a scorpion! Mind you, it was only about 6-7 cm long, but arenīt these things deadly? I start yelling and get all the other girls over to come inspect it and none of us wanted to kill it. There were 7 of us hovering in a corner opposite of where the scorpion was trying to figure out what we were going to do. Some of us took pictures of it thinking the flash may stun it and others wanted to deet it to death. Another suggested throwing a shoe at it to see if it was even still alive. Finally, three very brave girls ventured over with a tennis shoe. The first hit only made it run, but with the following three hits we said goodbye to the scorpion. We then inspected every nook and cranny and under the covers and in every shoe before we were able to go to sleep. It was a very eventful night.
To make up for it, we spent the next day lounging by the pool of our hotel. Then we walked around the city to take in carnaval and the sights. We also took a tour to see the volcano Tungurahua, which is an active volcano. Baņos was evacuated as recently as 1999 when the volcano went up to orange alert. By 2000 most inhabitants moved back since it had not erupted and everyone was desperate to get back home. The volcano is currently on yellow alert (scale: white-yellow-orange-red; orange=90% chance of major eruption over coming weeks or months). So, we all piled into a bus and took a death defying bus ride up a mountain to check out the volcano which can be seen spewing out some ash and the like at the very top. However, it was pretty cloudy and rainy and we ending up mostly listening to the rumbling of the volcano.
On Sunday, we got on the bus and went to Ambato to see the great parade of fruits and flowers that takes place for carnaval. There were so many people there and it was so crowded that we only stayed for a short time. All the floats were intricate and it was amazing the designs that they made from the flowers and fruits. Afterward, we headed back to Quito for a relaxing night before going back to work.
Another interesting note, I was able to last 3 weeks before getting the Big D. Thank goodness for Pepto-Bismol!
Yesterday I began working at the Hospital del Sur- a 500-600 bed hospital on the southside of Quito. Because it was our first day yesterday, we had to go with the directors of the program to get everything set up. They also had to take everyone else to their respective clinics. So we didnīt get to go into the hospital until 11:30am and we are supposed to leave at Noon.
Iīm not totally sure how to describe the experience... intense...sad...devastating
...overwhelming. We got split up based on what we are going into. I guess the donīt have room on the general medicine teams because they wanted me to stay in the ED. Within the half hour we were there, we started with a tour. I saw probably easily 70-80 people waiting to be seen. There was one person on a stretcher in the hallway covered in blood and yelling in pain. Another person had a hole in his chest that was being stitched up in the hallway. One person arrived via ambulance and had what looked like a gunshot wound in his abdomen (a gaping hole) also yelling in pain. He got taken to a trauma bay, had an IV placed and then was transported to another hospital. I also worked with an ob-gyn and saw two patients. One who doenīt know her due date and they had no info on and she was coming in for follow-up. Another, who possibly had pyelonephritis and was having contractions at 32 weeks. She was going to get admitted. What struck me the most was the tremendous lack of resources.
Today I worked ER triage. It was abdominal pain day. Everyone had diarrhea, fevers, vomiting. It was hectic. The resident I was working with didnīt even have gloves to use when starting IVs. The EKG machine consists of metal discs that you have to attach via suction. Itīs hard to explain, but there is a bulb on the end of the metal disc and you squeeze the air out and then place the metal disc on the skin to get it to stick via suction. I had obviously never seen one of these before and it was an interesting experience trying to figure out how to get it on. The good thing about today is that I learned that my Spanish is much better than I thought. I was able to do histories and physicals on everyone without difficulty. I still have to learn how to write everything out though, and learn their abbreviations here which are very different. The medicines also all have different names here. I have to go back and learn all the generic names. I think that it will be a great experience and will give me a new found appreciation for the health systems in the US. But, I wonīt know for sure until I have completed the experience.
Well, I have to catch you up on lots of exciting things. So, on Tuesday, as I stated previously, I hiked up Fuya-Fuya with friends. I just wanted to clarify some details. We hiked up 500 meters, which is about 1,500 feet, to the very top of the mountain, which is about 14,000 feet. Despite being surrounded by clouds for most of the day, I quickly discovered that you still get sunburn through clouds.
On Wednesday morning, I woke up in a bit of pain from my sunburn. Most of the day I spent doing research on my presentation (Health Systems in Ecuador). Wednesday night, though, I think was the highlight of our stay here so far. We traveled by bus to a small town named Iluman, where we went to see a cleansing ceremony by a Yachac. Atscko, a fellow student, volunteered to be cleansed. She had to dress in a sports bra and some shorts. The ceremony began with the Yachac praying in Quechua. He had Atscko rub some scented oils over her body and some water with herbs. He also spat some alchoholic fluid on her that she had to rub into her skin. He used some plants, one called Ortiga, with really small leaves, and used them to "beat" her. He also cleansed her with some eggs and placed an incense fire under her. The yachac also spat fire at her by drinking some alcohol and spitting it over some candles. It actually singed her hair and burned the hair off her arms! In conclusion, she received a necklace. These necklaces used to be used in marriage ceremonies and were a symbol of the union between husband and wife. In Atsckoīs case, it is a symbol of her "marriage" with positive energies. The plants and eggs that were used to cleanse her body of negative energies get buried somewhere sacred, like near a river, to make sure that no one else finds them and then absorbs her negative energies. I took lots of pictures of the whole ceremony, so someday you can see what I am talking about.
On Thursday, we visited a small village called Mojanda and went to their local community clinic. We met with one of the directors who gave us some history about the clinic. I couldnīt believe that this place services about 1200 people (600-700 families) on an annual budget of only $7000 and in only a six room building! Each family in the community is asked to donate $1-2 dollars for services. The remainder of the budget they get from donations from the US. They do everything from pediatrics to ob/gyn. Some years they also get an MD from the states to come for a year and help out. It definately seemed like a worthwhile cause.
After the clinic we visited Casa Mojanda, which is a resort on the side of one of the many mountains surrounding Otavalo. The resort is run by an Ecuadorian-English couple. They also started and help to run the Mojanda clinic. Itīs a great place to escape for some peace and quiet and to just be surrounded by nature. Just wait til you see my pictures!
Friday morning we headed back into Quito. Luckily, we didnīt encounter any road blocks this time. We arrived at our new hotel and unfortunately, they screwed up our reservations. We were supposed to have suites that had kitchens in them, however, they already had those rooms occupied. So, we each got doubles to stay in and we have full access to the kitchen in the hotel so we can cook some food for ourselves. Overall, I think the accomodations have been pretty nice. You just have to get used to some of the local customs, like not flushing toilet paper-you have to put it in a waste basket. We also have to be pretty careful about brushing our teeth with purified water and not tap. You have to be really careful, especially when you go out to eat and remember not to eat salads or anything uncooked and not to get drinks with ice. The first thing Iīm going to do when I get home is have a huge glass of water filled with ice! Iīm also going to eat lots of apples and grapes and veggies! (Canīt eat anything you canīt peel!)
Saturday morning we got up early to go on a tour of the National Park of Cotopaxi. Cotopaxi is Ecuadorīs second tallest volcano and one of only seven active volcanoes in Ecuador. Ecuador actually has about 400 volcanoes in total. Cotopaxi is also the tallest active volcanoe in the world. We had a tour organized with a couple geologist who gave us lots of information regarding the park. They also do research on the volcano and told us that they have various methods (seismographs etc..) to get information about the volcanoīs activity. Apparently the volcano hasnīt erupted since the early 1900s but thay have been getting data from the inner core and it has been quite active. They believe that the volcano will erupt again within the next 10 years and they are working on methods of evacuation because even though itīs about a 3 hour car drive from Quito, the lava from the eruption would flow down to Quito in less than an hour! When you get to the park, you can actually drive up 2000 meters to get to the hiking area. From there, we hiked 300 meters to the very bottom of the glacier. The top of Cotopaxi is actually a glacier and is covered with ice. Every year, it has been receding due to global warming. At the very bottom of the glacier, we were at an altitude of between 15,000 and 16,000 feet. There were amazing views everywhere you looked. On our climb up, we could see the remains of what once was a huge lake. The lake is actually 1 million years old, but it has been drying up due to changes in temperature. We asked if there have ever been excavations to look for fossils, etc, but since it is a national park, there canīt be any work done in the area. On our way to the glacier, we had to climb over and through tons and tons of rocks. These rocks have all been there since the last eruption and are essentially pieces of the top of the mountain that were blown off with the eruption. It was a great way to spend the day and of course, I took a ton of pictures to show you all!
Today, Sunday, I took the day off and just wander around Old Quito with 3 of my companeras. We climbed up the top of the basilica of Quito where you have views of both old and new Quito. I again took some great pictures.
Tomorrow, I am starting to work in the hospital. I will be working in the Hospital del Sur on the southside of the city with 3 other students from my group. I will fill you in on the experience later this week.
Happy Valentineīs Day everyone. To my husband...I love you too.
I have been informed that my entries donīt read very well. I just thought that I should explain that I am usually very rushed to make my entries and I donīt get very much time to think about them. I am just trying to get the main points across. Forgive me for not being eloquent.
I will update on the rest of my week which includes stories of fire and ice!
On Monday we visited a clinic in Otavalo named Jambi Huasi which practices traditional medicine. We met with the director of the clinic and saw a video about the clinic. After the video we got to meet all of the different people that work at the clinic. There is a Fregadora who specialized in massages with special ointments that she makes with medicinal plants. She uses them for arthritis and sprains and strains. Then we met with a midwife who sees patients for prenatal care in the clinic and then goes to the patients homes for the deliveries. The most interesting person was the Yachac who is like a shaman, but here the people believe that Yachacīs are wiser. When he sees his patients, he does a cleansing ceremony with a guinea pig. They believe that the guinea pig absorbs all the bad energies from the patient and then you can dissect the guinea pig and find out what illness the patient has depending on what organ system is affecting in the guinea pig. Apparently, guinea pigs have been here since before the Incas and they are used in many ways, including as a delicacy which is called cuy- an entire cooked guinea pig. The Yachac also does ceremonies with medicinal plants and herbs and everything that he uses is natural and he picks it himself.
Rachel, in answer to your questions, I donīt know that I am necessarily learning something that I can apply in my treatment of patients. But I am learning what the traditions and cultures are and how the people here take it very seriously. So, I need to learn how to be able to respect their beliefs and also teach them about how Western medicine can complement their traditional medicine.
After the clinic, we went to San Luis Hospital de Otavalo and had a tour. The conditions are pretty poor and currently the doctors are on strike for higher wages. They strike from 8 to Noon on Monday and keep adding an hour every day to the strike. This is pretty common. The resources are scarce and they even recycle their gloves. We saw them hanging everywhere. I donīt quite know how they are sterilized without being melted, but then they hang them to dry. They have cots for beds and the paint is peeling off the walls. The other terrible thing is that with the strike, patients can be waiting all day to be seen and not even get seen and be sent home to come back the next day. Medical care here is on a first come first serve basis, so if there is not enough time for you to be seen your stuck waiting until the next day. The experience made me realize how fortunate we are in the US and also that I would really like to do more to help, I just donīt yet know how.
On Tuesday, we had the day off. We organized a tour to go on a 2 hour hike up a mountain where on a lear day you can see 3 lakes and 10 volcanoes. I didnīt think it would be too tough to do. So, our tour guides drove us to Lagunas de Mojanda. But, then we climbed about 1500 feet to the very top of the mountain and most of the climb was at least at a 45 degree angle! It was tough. For some parts I pretty much crawled and had to use my hands to pull myself up. On our way up we saw a herd of wild bulls and from the top we were able to see 2 of the lakes pretty well, but then the clouds rolled in. It was still amazing to sit at the top of the mountain eating lunch and being surrounded by clouds. Our hike down also included some rock climbing. On our way down the sky cleared up and we had gorgeous views of beautiful rolling green valleys. We also saw a few eagles flying around us. I definately felt like it was a great accomplishment to climb this mountain and see so much wonderful nature!
Today, Wednesday, we are all working on different research projects about Ecuador. My groups project is to talk about the health systems in Ecuador. Tonight we have more spanish classes and conferences and after that we are going to visit a Yachac to see an actual cleansing ceremony. Two people in our group have to volunteer to have a ceremony performed on them. It should be pretty interesting. Iīll try to take some pictures of that too!
So, I don't want you guys to think that all I am doing in Ecuador is just going around touring everything and not doing any work. We have been doing work with practicing our spanish, but the problem is that most people here are not as advanced as I am and so they use the first 2 weeks of the program for us to take it easy and get used to Ecuador and the culture and the people. So they do take us on lots of tours. The last 2 weeks we will be in clinic. They also have showed us some videos about the country, specifically of Otavalo. One in particular was pretty interesting in that it was a collaboration between a native Otavaleņa and an anthropologist from UCLA. The ecuadorian woman helped the anthropologist to make a documentary about the people from Otavalo and she even went to LA to finish the movie. She spoke a lot about the culture and how people from Otavalo are taken advantage of by tourists who come here and take pictures of them for example while they are working in the Indian Market on Saturdays. They find this very disrespectful because they are working. Even though we may just be trying to get a picture of their wonderful native dress, they feel we are not being respectful of all their hard work and they would never think of coming to the US and taking pictures of us while we are working. It is also pretty hard to go to the market and try to bargain with all the vendors especially after seeing this movie and you learn how it takes them so long (like 2 months) to weave a tapestry or a week to knit a scarf. But, you are supposed to do it because it is expected. I think for a lot of the people on this trip, it has been a reality check that people in the world do live in poverty and do not have many amenities. I pretty much had an idea from my own family in Mexico, but I think that financially it is worse in Ecuador.
On Sunday, our directors had arranged a whole day of touring. We started off in a small village where we learned how to do some special weaving of mats. From there, we visited Laguna de San Pablo at the base of the mountain Imbabura, which is a huge lake about 4 km wide, where every year there is a race to see who can swim across it the fastest. The prize is $1000 which is A LOT of money here. The natives start preparing 2 weeks prior to the race and they spread snake fat on their bodies to help them retain their body heat. From there, we went to another small village named Carabuela and met one of the few traditional weavers. He taught us how to work the wool and how he spins it on a loom that has been in his family for 120 years. I bought some beautiful tapestries and scarves. We then visited the house of the Ecuadorian woman who helped make the documentary about Otavalo. One thing I have to say about the Ecuadorian people is that they are all so wonderfully nice and accepting! They take you in like you are family. She showed us her little organic farm and gave us some fruits to try. We tried some granadillos which are like pomengranates only orange and some guavamachete a big green fruit shaped like a machete that has a furry white flesh with big black seeds. I did not like that one too much, but the granadillos were yummy and it was fun to try. After having lunch in Otavalo, we finished our day in Cotacachi a town where they specialize in leather work. There are tons of little towns up and down the street that all sell a bunch of leather products. Then we finished at the best site of all. The laguna de Quicocha which is a huge lake that formed in an eroded volcano. I have never seen anything so breath taking- I took a ton of pictures.
So far today, we went and visited a clinic in Otavalo where they practice traditional medicine with shamans and then to the San Luis Hospital of Otavalo. I will write more about that tomorrow.
I miss you all, but I do not miss the weather!
Early Saturday morning we boarded a bus and headed north to the highlands to Otavalo. We were taking the Pan American Highway - a pretty significant stretch of road that starts in Alaska and goes down to Chile. On the way there we stopped for a break and tried an Ecuadorian fruit called chirimoya. Itīs called a custard fruit. The outside is green and tough, somewhat resembling an artichoke and you peel it open and eat the meat which is white and very sweet. They were yummy! After getting back on the bus, we didnīt get much further on the Pan American highway when we encountered a road block. Apparently, people in Ecuador take action against the government when they arenīt getting what they feel they deserve. In this case, bus drivers and flower truck drivers had parked there respective vehicles diagonally across the highway so that no autos could pass. They were protesting against the government because they had applied for some kind of permit and it had not been given to them. So, our bus had to do a 3 point turn (which turned into an 8point turn) on a 2 lane highway. We finally made it to Otavalo via a different route and went to our hotel in Peguche just outside of Otavalo. Then we were off to the Indian market, the largest market in Ecuador, which is held in Otavalo every Saturday. There we did lots of bargaining and shopping. I also discovered that while they donīt have super soakers here, they have balloons filled with water. I learned that this week is the beginning of carnaval - a celebration they have the week before Ash Wednesday to celebrate the start of Lent. Their tradition here is to celebrate with water fights. They donīt do it to be mean- they expect you to join in and throw water back. They have lots of fun.
At dinner we had an Andes band play music for us. David, I know you would have hated it. Lots of songs with those pan-flutes you canīt stand. But, there were cute Otavaleņa girls that came and sang and danced. I took lots of pictures to share with you all soon.
It's my third day in Ecuador and I have already been to two major cities...not on purpose. My flight down to Ecuador was pretty nice since I got to go business class (thanks ma and pa weinstock!). However, I had a layover in Miami (yes, I fully took advantage of the Admirals Club) and we were an hour late leaving (thank you American Airlines). Our pilot was not quite with it and apparantly didnīt have the correct documents he needed for us to take off (like our flight plan, maybe?) so we sat on the tarmack for an hour while we waited for someone to drive out the paperwork. Finally, we took off and began our descent into Quito around midnight. Well, the Quito airport closes at midnight. Only we were told that there was a very bad fog and so we were diverted to Guayaquil. (Did I mention the last time I flew AA they lost my luggage for 3 days...when I was having my residency interviews?) But, I have to hand it to them, they put us up in a nice hotel overnight. They quickly ushered us out of the airport and all our baggage had to stay on except our carry-ons. I didnīt know what we were doind or where we were going. I just had some woman who kept saying "siganme (tln. "follow me") and the next thing I know Iīm getting boarded into a tiny yellow bus, which took us to the Hotel Oro Verde. Very nice. I donīt think that Guayaquil is known for this, but they have the largest crickets Iīve ever seen. If you have ever been to Mexico and seen a water/sewer cockroach they are pretty similar. They were about the size of my thumb and they were everywhere. It was impossible to not step on them. They were even in the lobby of the Hotel Oro Verde and it is a 5 star hotel. Finally, the next day at 2pm we flew out to Quito. The view of the city from the plane was amazing. Itīs located in a valley between mountains. Itīs beautiful. I didnīt do much that first day other than meet the other 12 people in my group-the advanced spanish speakers group. There are also another 16 people here who are in the beginners group. If you ask me, they have it much easier and they have interesting activities planned such as a week in the rain forest which we donīt get to go on since we will be going to clinic and attending spanish classes. We did go to an Ecuadorian restaurant for dinner. The delicacy here is guinea pig cooked whole and no I didnīt try it.
So today my third day here we did some exploring. We had an assignment to go to the Peace Corp and learn about what they do in Ecuador. While walking to the bus stop, I was standing on a corner with 2 other girls in my group. I see this bus approaching with this little kid in a school uniform hanging out of the open door (prettycommon here...people also just jump off the bus to get off). What I didnīt notice was the giant super soaker in his hand....until my friends and I were completely soaked that is! Needless to say, my Spanish came in handy as I yelled some not so nice things at him. We made it to the Peace Corp without any more events despite the trauma of trying to find the right bus to get on and jumping off of it. We decided on the way back to take the trolley instead.
Tomorrow we are off to Otavalo. They have a great indian market there on Saturdays and we will be touring around the mountains. Hopefully, super soakers arenīt sold around there.