Malnutrition Program Meeting

 Marisol finally made it home from Quito, but quickly got sick again with a virus from the children's home. Her lungs were too fragile still to handle the virus in combination with the altitude, so after stabilizing her in the emergency room, we had to send her back to Quito.

 

 

On Friday, Mike, Hermicu and I hosted a gathering for all the families who participate in the childhood malnutrition program. After a very slow arrival period due to long travel distances and rain, we ended up with a very good turnout. Twenty mothers, fathers, and grandparents showed up, with their 20 plus little people. We each gave talks on various themes, Mike on childhood development, and myself on personal hygiene, food hygiene, and hygiene of the home.  Mike and I were both very touched when several parents stood up at the end, in front of the audience, to say thank you and goodbye. Then they each presented Mike and I each with beautiful scarves as thank you gifts, for which each family chipped in to contribute to the gift. Then we all go to eat a big lunch together at the end of the lectures. We all had a good time, and hoped that some of what was learned will help the parents help their child grow better.

 

Venturing to the coast once again.



Last weekend Mike and I went to the central northern coast in a small town called San Mateo, to visit some friends who are volunteers for the same OMG organization that the hospital is affiliated with. They have been living in Ecuador  since the 1970's when they first arrived as volunteers in Zumbahau. They helped to build the hospital in which we now volunteer, raised five of their own children here, and then over a decade ago, moved out to the coast to continue their mission-work in a new community in need.

While the community that they live in was much less affected by the earthquake, there were still many families sleeping outside, over a month after the earthquake, either for fear or true structural damage to their homes.  We enjoyed helping Maria on her morning visits to see her diabetic and other ill patients. We also helped organize all of the medications she had received, in order of category, to help stock their one room clinic. In the afternoons and evenings, we enjoyed walks on the beach and watching the sun set over the water.

 

Very proud of my very newly organized medication cabinet.

...So is Mike :)

Makeshift shelter under a tree in the town of San Mateo.

 

One day we took a long day trip farther up north along the coast to one of the harder hit areas by the earthquake. We went to a national park called Isla del Corazon (Heart Island). We happened to be the very first tourists to this park, in over 6 weeks since the earthquake. We felt both honored to be the first ones to help restart the tourism in the area, but also saddened for the hardship it meant for the local people and economy. They showed us immense hospitality and enthusiasm for our visit.

The island was beautiful, and we got a private tour in part motorized boat, around the island, and then in paddled canoe into tunnels amongst the mangroves. The mangrove island is home to an amazing array of species dependent on the unique tree habitat, including Frigate birds, which happen to be in mating season. The males have a huge red balloon-like protrusion on their breast, that they puff up, and make a rattling noise, to attract a female. They then are the one's responsible for sitting on the egg in the nest. The female is responsible for feeding and bringing water to the male, because if the male is to fly with their inflated breast, and happened to puncture it on a stick or something in the water, they could then die. Some of them, as we saw, did not heed this rule. It was an incredible site watching the male birds sitting bright red in the trees, and the female flock around.



Entering the mangrove tunnels in canoe.

Mike with our guide Francisco.

Frigate Birds flying over the island, the one in the bottom left corner is a male with this red gular pouch which he has inflated.

Helping to replant new mangrove sprouts.

 

Then we returned from the park to the city nearest to it, Bahia de Caraquez. The town, beautifully located right on the beach with a bay at the entrance to the river, was eerily quiet. The schools were closed, the hospital collapsed, the tall hotel buildings for tourists empty and damaged beyond repair. Every community space and park was full with tents and make-shift tarp-shelters. The alleyways between homes filled with tarp shelters with chairs and mattresses beneath. The bus terminal had been made into a temporary military base, a resource station to distribute food and water, and behind it, rows and rows of emergency tents, comprising a huge refugee camp. It was both fascinating and disturbing to see the huge amount of damage and the major impact it has had on the lives of the people both displaced from their homes of who have lost friends and loved ones.

Tents in a small space of community park.

School building. Schools in the area have now had to delay their start dates by several months, if not more.

Collapsed clinic or hospital.

Makeshift tents in an alleyway.

Rows of military tents at a displaced persons camp.

By the time we passed through the area, most of what had been collapsed buildings, looked like this... empty lots with a few pieces of rubble left behind.

On a relaxing weekend day...

Today has been a lovely day in Zumbahua. On Sundays like today, we don't have hospital rounds until 9am, therefore I got to sleep in, drink my coffee in bed, and made pancakes for our breakfast (Mike, myself, and Justin our visiting medical student). On morning rounds we got to discharge 4 out of our 5 pediatric patients to their home, always an exciting thing when you get to see the kids make a full recovery.

After rounds, I proceeded to go wash all my clothes by hand. Normally I am a laundry procrastinator, but when you are doing it by hand, you really don't want to let it build up, because even a small amount of washing is quite an upper-body workout. Workout for today... check. Then, since there still wasn't much in the way of pediatric emergencies, I came down to the house to make lunch for everyone. After lunch, a short walk with Mike down to the nearby river. Since we work 10 days straight, it is nice to get outside the hospital compound once in a while, even if it is just nearby for a few minutes. Outside it is a beautiful blue sky day with a light breeze, rare in Zumbahua,  and the mountains surrounding the town are clear and vibrant green. We commented on how much we will miss this beautiful scenery.

Now, as I write this I am sitting in the kitchen, waiting for my big pot of water to boil for 5 minutes, so we have drinking water this evening. I am trying my hand at making boxed brownies (thank you mom!) in our primitive oven, but they are coming out disappointingly flat, probably because of the altitude.  

I enjoy these days when I get to do some of the things that remind me of the comforts of home... leisurely drinking coffee in the morning, backing or cooking in a kitchen all to myself, walks on sunny days. I think it helps prevent burn-out in a place that is wonderful, but can also be very challenging and frustrating at times. It is amazing how fast these last 5 months have flown by. I only have about 2 1/2 weeks left here in Ecuador, and I am trying to enjoy every moment.

 It is neat to reflect back on how much I have learned, how much more confident I have become in a clinical capacity, and how many interesting things I have gotten to experience. I sometimes wonder if in future practice settings I may be bored or Jaded with the run-of-the-mill colds and tummy aches, after being exposed to so many children here who have such complex health needs or "really" illnesses. Or perhaps it will be a nice relief. Either way, I am certain that I will never again have an experience such as this, and I am so grateful for every colleague, patient, family, and especially Mike, who have taught me so much along the way.



Enjoying the view from outside Ibarra, Ecuador

Adventures in Ibarra

On our last weekend off, we took a trip with my friend Sophie, and her husband, to her husband's home-town of Ibarra, in the northern highlands of Ecuador. It was very fun traveling with them as we got to see and do many activities that we would not have known about, or would not have been able to access without a vehicle.

My favorite event of the weekend was when Pablo, Sophie's husband, decided to cook us a crab feast for one of our lunches. We picked up the crabs early in the morning from the market, where they were still live, and tied together in a bundle of 13 or so. Total, was had about 26 crabs, probably brought in fresh from the coast in the early mornign. Pablo preferred to keep them alive until they went into the boiling water, so the real adventure was cleaning the crabs with a scrub brush to get them clean, without getting pinched by the crab. I was a bit tentative at first, letting out a few squeeks and "ahhs" now and then, but eventually I got the hang of it. Occasionally one would get away in the big wash basin, and scurry to the drain, where it would clamp onto the drain grate so tightly that you could not pry it away. The crabs, once scrubbed clean, were a beautiful array of purple, red, and orange.



Our live crabs from the northern coast of Ecuador.

Carefully cleaning each one with Pablo.

 

All finished, ready for cooking.

Eating them was another story. As Mike and I are used to larger bodied crabs, with accompanying shell cracker tools to access the meat, we had small bodied crabs, with only one shell-cracker for the table to share. It is obviously an acquired skill, because Pablo and Sofia skillfully used their teeth the crack the shell, and mouths to suck out the meat. They had devoured a handful of crabs before I had gotten through one and a half, with sore fingers, and crab meat flung all around my plate. They were delicious though.

A few hours later, Pablo's mother heard some clicking in the family dining room, down the hall from the kitchen. She went to investigate and found that one of the crabs had leapt out of the bucket on the floor by the boiling water, while awaiting his turn to be cooked, and had run away, trying to escape his fate. Which he did for about 4 hours, but to no avail, he got eaten later for dinner.

View on our drive up to Ibarra.

Getting to know Lago San Pablo.

Mike holding a falcon at an bird rescue park.

Trying Cuy (Guinea Pig) for the first time.

Volcanic crater lake.

Trying to get an Avocado down from his parent's tree in their back yard.

Re-enacting an Incan sacrifice on a ceremonial sacrifice stone.

Just kidding.

Ibarra by night.