Daily Life, Podcasts, and Bus Rides

Apart from the 40 hours a week that I work here, which tends to be fairly busy during the day, life in the afternoons and evenings is relatively slow. There are no televisions here, so no catching up on those latest Netflix or Hulu hits. Also, no internet in the house that we stay in (only if I want to walk back up to the hospital offices). Some nights Mike and I cook dinner together for the rest of the house guests. Some nights are more successful than others with the ingredients that we can muster :) Generally we have tea or some kind of hot drink in the evenings, and we may play a round or two of RummyKub, a favorite with the hospital director we live with. Other nights, I might just read a book while Mike studies beside me for his MPH classes, watch a movie on my laptop from the volunteers' collection of burned DVDs, or my favorite... trip plan for our next weekend travels, or my parent's upcoming visit in March.

I feel blessed to have my best friend and favorite partner in work and play here with me, to share in this amazing adventure. Thanks to Mike, I have not once felt lonely (as I imagine I probably might if I were here on my own), nor has the general phase of "reality sucks," set in, which is common in the acclimation process, and hopefully it won't. Often I find myself enjoying this slower pace of life, with fewer outside distractions. I often go a week at a time without leaving the hospital compound, but so far I never have felt trapped or restless. We have the benefit of having a community of other Ecuadorian healthcare staff and some Italian volunteers also living here, who are nice to have a round.

I have had the Serial podcast recommended to me many times by friends back home, but have not until recently actually pursued listening. A few weeks ago, I finally downloaded the podcast, and Mike and I have been listening to it on bus rides as we travel over our long weekends, twice a month. We are a bit distraught that we have almost come to the end of the available episodes, and are hoping for more to come soon. It has been an excellent way to pass the time, and almost look forward to the less than enjoyable public bus rides.

Whether the podcast listening will be available on any given bus ride is a toss of the dice. Often the regaton, bachata, or cumbia music is blaring entirely too loud to hear anything else, or a terrible action movie with non-stop shooting noises is playing overhead. Or we may board mid-route for the bus, and end up standing in the aisles, squished between other passengers, trying to brace ourselves as the bus swings around the corners of the mountainous terrain. But when the conditions are just right, we pull out our ear buds with glee (one person gets the left ear, one the right ear bud) and settle into the mystery story.

Last weekend Mike and I decided to take the 8 hour bus into the southern highlands to a colonial city called Cuenca. Our first mistake was thinking that taking an overnight bus would be a great idea to get an extra day in, and save a night on a hotel cost. Well... after departing at 9pm, we didn't sleep a wink due to the frequent stops and very poor temperature control. Not to mention to two drunk guys who happened to board mid-way into the trip, be rather loud in the seat right behind us, then finally fell asleep. They proceeded to miss their stop by several hours, which they realized finally once they woke up, and again proceeded to talk loudly about what they should do, because they had not enough cash to get off and catch another bus. At this point, one began to vomit, which went all over his seat, and seeped down on the floor under our seat to where our backpacks were sitting. Needless to say, we got off the bus at 4:30am, exhausted, and rather disgruntled. Besides that, the rest of our adventure in Cuenca was lovely. Lots of good food for a change, and some neat museums and sightseeing. There is a beautiful river running through the south end of town, with a historic walkway along the bank. Luckily, our bus ride home yesterday during daytime hours went much better :)

Mike is turning campesino.

Typical food near Cuenca. Seen all along the streets in neighboring communities.

Evening view of the main cathedral in Cuenca.

My favorite part of the trip, walking along the river.

Malnutrition Program

Most days I attend to children who come to the clinic, and are of a "pediatric age." Here the cut off tends to be a bit lower, where as I could see children up to age 21 in the states, they usually only send kids my way who are about 14 years and under. Maybe this is because kids here grow up a lot faster, and many may be parents already by their late teen years. I think word has spread through the communities that two "foreigner pediatricians" are in town, because our numbers of patients each day have started to steadily increase.

Yesterday, however, was a different day. It was a Monday, and since there is no clinic that day, Mike stayed here to do pediatric Call, and I got to go into the community and participate in the childhood malnutrition program. This is a program that has been around for almost 11 years. When children are identified in the hospital, or clinic as being underweight and malnourished, they are enrolled in this program. In my five weeks of working here, I have already enrolled a handful.

The main star of the show is Hermicu, a native Zumbahuan, who visits a total of 24 communities over the span of two weeks. Therefore, each child is visited by Hermicu every 14 days. She tracks their growth with her portable scale that she hangs from the rafters, and the measuring tape that she uses in the doorway of the home. Then she plots it on a chart to track their progress. Each child also receives a bag of non-parishable goodies, such as fortified formula, quinoa, rice, pasta, etc. to help lessen the families' burden of feeding the child generously. Lastly, she talks with the parent in their native Kichwa language, to see if there are any concerning signs of infection or reasons the child should come to clinic to be seen. If Mike and I are along, we do a brief little assessment of the child, make a few recommendations, and write a brief note of our visit.

On Monday, Hermicu and I visited the village of Iracunga, about a 30 minute drive from the hospital. We get dropped off by the car that continues on in a nearby village visiting the elderly. With heavy food bags in each hand, we begin hiking on steep trails toward the houses. Even though Hermicu is in her traditional clothing, with a skirt and penny-loafer type shoes, she is like a mountain goat, more nimble than I who has the fancy hiking boots on. Small school children out for recess chase behind us as we walk along the dirt road, teasing and asking if we are here to vaccinate.

We visit four houses that day. Most are made of cinder block, with a tin roof, usually a few large rocks placed on top to prevent the wind from lifting it up. Inside, the homes are dark, generally having electricity, but conserving it for the most essential times at night. All of the homes have a dirt floor, packed down and swept clean. The beds are modest, with falling apart mattresses or foam pads, and layers of alpaca blankets upon them. When furniture, such as dressers and wardrobes are rare, most of the families hang their clothes from the low rafters of the ceiling, one item piled on top of another.

Getting ready to head out into the community. We start out by car, in the make-shift ambulance. The white bags contain all the food stuffs that the families each receive.

View from the ambulance.

View on our drive up to the community.

Sibling of one of our patients, next to the can of pediasure-type powder that all the little kids get to fortify their diet.

Looking at one of the homes we visited across a blooming potato field.

Hermicu, with her hanging scale. I promise we are not strangling this child, even though it may look like it.

Getting a height measurement.

Typical family dwelling.

Mindo

 

 

During our last 4 days off, Mike and I went into the cloud forest into a cute little town called Mindo. The mountains surrounding the town were beautiful as the low clouds and mist drifted in and out of the valleys. One of the days we were there, we took the Tarabita, across the valley, and hiked to 4-5 different waterfalls.

View from our hostel.

The open air Tarabita cart that zips across the valley on a wire.

Transfers and Bathrooms

 

I have now been here over a month, and am feeling very settled in. I know most of the staff now by name. Most days I feel pretty good about my clinical knowledge and decisions, but am also continually confronted by new cases I don't know much about, or conditions that I need to study up on.

During our first week here, we got to attend the birth of twin girls. Each day after, until they went home, we did a full assessment, monitored their labs, and made sure they were ready to go home. They were so cute. Most of the time, they were huddled together in a basinet, under piles of too-big clothes and blanket, and all you could see were their little faces peaking out. Faces in photos have been blurred for privacy of the patient.

 

 

Mike puzzling over a patient's chart during morning rounds trying to decide the best course of action, with our hospital medical director, Dra. Anita. Our little patient in the background on an oxygen nasal canula.

Daily, I find myself wishing I could do more for many of my patients, but am limited by resources or referral options. For example, I have seen several children with very complex eye conditions, such as congenital glaucoma or cataracts, that they have had for some time. Unfortunately, the only ophthalmologists are over an hour away, and not part of the ministry of health system (in which all healthcare should be free), so most of our patients can't afford the initial consult, and if they do manage that, they are usually soon after lost again, with no follow-up.

Or sometimes patient's wait too long at home, before finally seeking care. One little girl had gotten a caustic material splattered in her eye. By the time her parents brought her in to be seen, a day and a half later, the entire white part of her eye and under her eye lids were bright red and her cornea had started to cloud over. By that point, irrigating her eye was of little use, and we had to send her onward another hour, to seen an ophthalmologist. She was so sweet and brave, and when we asked if it was hurting her, to give her some pain medication, she replied, "no, it just stings."

Mike and I recently completed our first weekend of being on-call. This meant that we would round on all the patients in the hospital once or twice a day, attend the births, and help with any pediatric cases that presented to the emergency room. Needless to say, we were kept busy, thankfully mostly during the days, and nothing major requiring our presence at night. The first child presented  to our ED in an ambulance after having fallen out backward, onto his head, from a moving pick-up truck. He was fairly responsive when he arrived, but proceeded to vomit several times, became more confused, and eventually became unresponsive to verbal stimuli by the time we got the ambulance back to our hospital to take him an hour to Latacunga (the next largest hospital with CT scan and surgery capabilities). Mike went with him and his mother in the ambulance to make sure that he made it there safely.

The next day Mike got to take this 2-3 hour round trip journey again with our on-call obstetrician, when he had a potential breech delivery. We do not have surgery capabilities here, so any pregnancy complication that might warrant a c-section need to be transferred. We had just finished cleaning up lunch, and were in the midst of doing laundry when we got called. He went ahead, and by the time I got up to the hospital a few minutes later, he had already been whisked away in the ambulance again.

I tell this next part of the story, with Mike's permission mind you, because he made me laugh so hard when he told it, that I just had to share it. As he arrived an hour later, after being in the back of an ambulance with no windows and curvy roads, he delivered the patient into the other hospital's emergency room, then urgently had to use the restroom. The first bathroom he tried was clogged, and not usable, so he proceeded down the hall till he found another. This one was available and clean, but he soon realized there was no toilet paper. So he proceeded back to the first bathroom to get the toilet paper. By the time he returned to the second bathroom a second time, he walked in on a child patient, with a parent accompanying, IV pole and all, who had forgotten to lock the door. At this point, he realized the parent and child had no toilet paper either, so he handed off his hard-earned wad of paper, so that the others could carry on with their duties. By this time, four bathroom visits later, and without success, he finally asked a custodian if there was  a third option. She kindly pointed him to a staff only bathroom which was clean and thankfully well equipped with toilet paper. After all this ordeal, he was finally able to rejoin the crew in the ambulance.

I find this story highlights a certain undertone of my time here. I find I am way more aware of my bathroom habits here, than I ever am in the states. You always need to be prepared with your own toilet paper, have 15 cents available, because they aren't always free, and when you encounter a place that has a very clean looking bathroom, use it now, even if you don't really have to go, because you don't know what the conditions will be like at the next one :)