Shuar

Our current home city, Puyo, is essentially the last bastion of organized civilization in eastern Ecuador before the Amazon starts  in earnest. Last Tuesday, we took a bumpy, hour-long car ride further east to a well-worn trailhead that provides access to the shadowy depths of the jungle. There we met our guide/host, Gustavo Moncayo, a middle-aged, nimble little man whose eyes seem to perpetually shine—a smile never far from the corners of his lips. Gustavo is a member of the Shuar community, the still-prevalent Amazonian jungle tribe, and he lives with his family in a tiny 20 person village in the rainforest.  He sat waiting on the edge of the road with two of his ten children—15-year-old Milka, and 10-year-old Danilo. Gustavo is happy monogamously married, but it is still commonplace for Shuar men to have multiple wives.  Gustavo greeted us with a calloused handshake, swung his machete over his shoulder, pointed out over a thickly jungled mountain, and simply (though cheerily) said, “Home’s this way!”

With that he promptly turned around and started walking the other way. We exchanged confused looks and started after him before his kids stepped in and informed us that he was off to buy supplies for another son (who is attending high school in Puyo) and that he would catch up. And so we set off, three Americans following the young, energetic Shuar kids out into the rainforest.

The trail we travelled is the only means of accessing three jungle villages that are scattered throughout that small western chunk of the Amazon. The villages typically consist of two or three families, range from 15-30 members, and are completely self-sufficient. We quickly discovered that the trail wasn’t much of a trail at all, but more of a 10-mile long river of mud and rock spilling down from an obnoxiously tall mountain.  To call what we did “slogging” would be a dramatic understatement. For every step forward, you slid half a step back and sank 8-10 inches into the wet, sludgy clay. Any solid-seeming foothold usually turned out to have been a mirage, as rocks sank, logs broke, and termite-infested stumps crumbled away. With a 50 pound camping pack on your back, every slip and fall was drastically magnified, and before too long we were all slipping, sliding, and stumbling all over the path like so many drunkards.

Nicer section of path, relatively speaking

Easy section of path, relatively speaking

Tough trek

Tough trek

By the time we took our first break 1.5 hours in, Gustavo had caught up with us and was miraculously mud-free. It was mind boggling, but we were really cowed when, as we sat there, an 8-year-old girl caught up to us… with her 3 year old sister in a sling on her back. As we sat there, sweating, panting, and cursing, she just kinda tilted her head to the side—as if deeply pondering what these giant white kids could possibly be doing sitting in the middle of her path. It turned out the sisters were the youngest two daughters of the only other family that makes up Gustavo’s village, so they followed us the rest of the way—all five hours—with a considerable amount more grace and dignity than us.

As tough as the hike was... views like this made it worth it.

As tough as the hike was… views like this made it worth it.

Amanda, Brittnie and me

Amanda, Brittnie and me

By the time we finally made it to the village, situated in the fork of a river deep in the jungle, we hardly had the energy to greet our new hosts. We stumbled into the river fully clothed, and lay down to try to recover.

The rest of Gustavo’s young boys, after managing to resist the urge to swarm us for a polite 3 minutes, stripped down and ran laughing after us. The six young boys—Danilo, Christian, Alex, Jose, Jackson, and 1-year-old Ricky (a grandson of Gustavo’s, not a son like the rest)—were ecstatic to have company, and they quickly set about impressing us by floating their boats (logs upon which they laid belly down) by us down the rocky river. They wrestled and splashed and laughed and generally just cheered us up with their exuberance.

Gustavo's son Alex showing off in his boat

Gustavo’s son Alex showing off in his boat

****Side note—we figured they’d eventually run out of energy, but we were sorely mistaken. They were relentlessly, hilariously out of control for the duration of our four days there—demanding Caballo! (piggy back  rides) and Avión! (airplane rides) literally non-stop for the entirety of our stay. It was only made worse by the fact that we brought them some candies and snacks… that could have been a mistake. It was an absolute madhouse. But in a good way.****

Eventually, after finally dragging ourselves out of the water, we returned to the house to move in and check the place out. Gustavo’s family’s compound consisted of 3 buildings—a sleeping cabin for the family, a sort of pavilion with a loft (where we slept), and a round kitchen hut. The pavilion was decorated with the skulls, skins, and hides of the various animals that had been unlucky enough to wander into the compound under Gustavo’s watchful eye. Two tiger pelts hung beside two anaconda skins which were hung beside various deer skulls and turtle shells. Not an unimpressive sight. While there was a generator that serviced a lone, bare lightbulb for emergencies, there was not a single other electric appliance to be found (which explained the kids’ fascination with everything from our watches to our cameras to our cell phones—pretty much anything that made light or beeped). They had running water out back behind the kitchen hut—a hose that simply ran down hill from a nearby river. Clothes lines ran back and forth between every building, but with the daily rains, most clothes just kinda hung until they were needed, at which point they were thrown on, damp or not. There was another family with a similar setup about 100 yards away. Gustavo’s oldest daughter married into that family a few years ago, and now lives over there—just out of sight. Between the two families was a tiny school building for children to attend until they reached the middle school level, at which point they move into Puyo alone to continue their education. A bumpy dirt soccer field with netless log goals lay just outside the school. Countless ducks and chickens wandered aimlessly among the buildings, searching for scraps, dodging kicks, and avoiding the three mangy (but still pretty darn cute) family dogs.

Washing room

Washing room, school in the background

Neighbors/Clothes Lines

Neighbors/Clothes Lines

Home! Pavilion in the center (we slept upstairs) kitchen hut to the left, family sleeping to the right.

Home! Pavilion in the center (we slept upstairs) kitchen hut to the left, family sleeping quarters to the right.

Home!

The neighbors

Home! Our loft. My bed was in the far left corner

Our loft. My bed is in the far left corner

Some of the unfortunate critters killed by Gustavo

Some of the unfortunate critters killed by Gustavo

That first day, we rinsed off in the river, unpacked our backpacks, and then went to the kitchen to eat dinner. The family has a sizeable field of corn, numerous plantain trees, and so just about every single meal consisted of the two, plus the occasional potato and maybe a small chunk of meet if some beast wandered too close. On our final morning, we were awakened by a gunshot at 3 in the morning and found capybara meat on our plates the next morning.

After dinner that first night, Gustavo’s children dressed up in traditional clothing and danced a “welcome dance” for us, botching most of the words and forgetting most of the steps, but it was still pretty cute. We even got to dance along a little bit. Then it was off to bed at about 8:30.

Welcome dance

Welcome dance

After the welcome dance

After the welcome dance

They had sooo much energy.

They had sooo much energy.

Showing Jose some of my photos. They had no mirrors, so they loved to see pictures of themselves

Showing Jose some of my photos. They had no mirrors, so they loved to see pictures of themselves

Over the next two days, we learned a ton about the Shuar lifestyle. That fist morning, Gustavo’s wife taught us how to strip leaves to twist into twine, cauterize the ends, and then thread dried seeds to make traditional jewelry. In the afternoon they taught us how to make homemade (and freaking delicious) tamales and salsa, then we played an epically muddy game of soccer before invading the river to splash around and clean off. That night we stayed up chatting about their different options of medical treatment should something happen out there in the middle of the jungle before cashing in just after dark. The next morning we rose again with the sun and hiked out to a waterfall that, according to Shuar lore, holds mystical powers. Along the way we stopped, examined, and tried out various herbal/natural remedies (the knowledge of which having been passed down from generation to generation by the Shuar people). When we finally made it to the waterfall, we were respectful of it’s legend for a few minutes… and then we all dove in the water to cool off and play. Gustavo mashed up the meat of a certain tree that, when mixed with water foams, acts as a pretty solid natural substitute for soap.

At the waterfall

At the waterfall

That afternoon we returned home and learned how to fish. Ever clever, Gustavo showed us how to knit a series of bamboo-like stalks together so that water could seep through, but not a whole lot more. We made it about 6 feet wide and then brought it down to the river where we used rocks to divert a small section into a sort of hand-made stream, and then laid our trap down so that the river flowed right into it, but the back of the stalks was elevated out of the water. This way, any fish that swam that way would be cleverly plucked right out of the water. We coated the sides and bottom of our canal with leaves, then covered the top of our trap so that no fish could flop out once caught. To really function, the trap would have had to be a few times as big as ours, but it was still a pretty ingenious method for fishing.

That final night we feasted again, and then sat out under what was our first clear jungle night. The stars were incredible, and we probably could have stayed up forever out under their light, but the fact that we were to rise and depart at 7, combined with some mysterious rustling in nearby bushes, convinced us that it was probably bedtime, so we retired for the final time in the jungle.

Not bad, eh?

Pretty neat, eh?

Last night. Pretty beautiful.

Last night. Pretty beautiful.

The next morning, we said our sad goodbyes to the kiddos, and promised we’d send them pictures with the next group of students. Then began our awful 5-hour hike back to the main road. Even after only a week living in the jungle, we were all weary down to the bone, and so it’s impossible not to have an immense amount of respect for these people who live this life every day. I am incredibly grateful to have had this experience, but despite what I might have previously thought—I’ve no delusions that I’d struggle mightily to keep up with the jungle lifestyle. But that said, this past week has definitely been the most incredible part of my journey this summer, and it alone was validates my coming for this trip. Again, I’m super grateful for having had this opportunity.

Goodbye dance

Goodbye dance

The Crew

The Crew–Gustavo in front, a few of his kids, and then Amanda and Brittnie

Jardín Botanico La Orquídea

After visiting the monkey sanctuary that Monday before departing for the Shuar village in the rainforest, we continued with our original plan to visit Jardín Botánico Las Orquídeas (“The Orchids” Botanical Garden). We were definitely ill prepared for how awesome the visit would be. In 1980, accountant Omar Tello bought 7 hectares of pastureland just outside of Puyo—where the rainforest had once thrived. His patch of barren land was just like thousands more surrounding the area in that it had been stripped bare of vegetation so that it could support horses and cattle. But he had a plan to change all this. His dream was to restore this degraded patch of broken, grassy land to a lush, thriving tropical rainforest habitat. He started by erecting a fence to enclose his land, then he set about correcting the damages that the livestock had done to the soil. He used natural fertilizers and worked minimize soil erosion and was rewarded before too long by finding a few new plants species sprouting in his reserve. Each new species did its small part in stabilizing the ecosystem and gradually, the reserve’s biodiversity grew. Eventually trees began to sprout as undergrowth lived and died, continuously enriching the soil, and when the trees were tall and shady enough, vines began creeping their way up the trunks in search of sunlight as moss slowly followed, inching along year by year. Today his small patch of jungle, young as it still remains only 30 years later, boasts a higher floral biodiversity than any part of the jungle within hundreds of kilometers.

But as he worked to restore the vegetation in his reserve, Mr. Tello also began to catalogue animal life. Every species he found, he meticulously photographed and identified, slowly building a digital archive of the restoration process. At first, only destructive cicadas were to be found in the barren fields, but slowly butterflies, moths, and beetles began creeping in (no pun intended), and their presence allowed predators such as spiders and scorpions to follow along. Milipedes and a variety of snakes followed, and before too long, jungle frogs began to appear. Soon after, bats and monkeys and other mammals arrived, and the ecosystem finally, after 30 long years, began to resemble that of a healthy patch of rainforest.

In the Garden museum nestled among the vines of the garden jungle, you can follow the explosion of faunal biodiversity along the walls, each year labeled as a heading with photographs of the new creatures discovered in the garden that year. With thousands and thousands of documented new species, it’s impossible for him to display them all, but the series of cross-sectional slices of the new inhabitants of the jungle really gives you a sense of how each successive level of animals is more sensitive than the last, and can only thrive when the ecosystem has been properly stabilized by all of the predecessors.

With a left-to-right sweep of his arm around the room, Omar commented that “It took so much effort to stabilize the ecosystem enough to build the biodiversity up this way” but then with a slash of his arm around to the left he said, “but the slightest disturbance in the ecosystem, and you begin losing species in order back the other way”. His display really drove home the fragility of the ecosystem, as none of the successive species could thrive without the support of its predecessors. It’s incredible how complex the web of life really is.

Meticulously put together, Mr. Tello's catalogue of insects moving into the park each year

Meticulously put together, Mr. Tello’s catalogue of insects that had moved into the park each calendar year

Some fuzzy inhabitants

But with that, we began our tour in earnest, which turned out to be a 4 hour hike, circumnavigating what felt like the whole park as Mr. Tello stopped periodically to introduce to us what felt like all of his best friends. He went through all of the medicinal plants, describing in incredible detail how indigenous people once used this plant to treat diabetics, that plant to help facilitate cervical dilation for childbirth, this plant to treat stomach ulcers, and a combination of those plants to treat for cancerous tumors. Keeping in mind how many complex modern drugs (especially antibiotics) are manufactured by minorly modifying chemicals found in natural plant remedies, it completely blew my mind to learn about the hundreds (and I’m sure Mr. Tello could have kept going into the thousands) of natural treatments discovered by ancient peoples. Granted, Omar was mixing the knowledge and uses of each plant accumulated by a multitude of different indigenous peoples over thousands of years, but it’s still impossible to try to imagine how all of these remedies were discovered. It was incredible, each plant seemed to have at least 5 uses—the bark of plant X was ground up for poultices, the meat of the stem ground to use for paint, the leaves crushed to treat ulcers, the seeds harvested and used for artisanal decorations… and so-on ad nauseam.

But clearly the pride of his park was its namesake–the orchids. His garden boasts over 300 different species of orchid, and it felt like we met each one. The white orchids with their symbiotic spider companions who protect them from hungry insects, the beautiful yellow ones that can only find the right amount of sunlight about 5 meters off the ground—so they grow on the side of trees, the miniscule red ones that stay out of the sun by growing on the underside of trees’ leaves, and hundreds more. It felt like he knew every single orchid in his park, and was like a proud parent showing them off. There was one orchid (pictured below) that I noticed had been tied onto a tree. When I inquired, he told me that this unlucky guy had fallen off in a storm, and he found it and rescued it, retying it to the tree at the proper height.

If you looked close enough, you could find dozens of plants that had been "repaired" by Tello's caring hand.

If you looked close enough, you could find dozens of plants that had been “repaired” by Tello’s caring hand.

It was a wondrous experience in that forest, and even after 5 hours, it felt like the garden and its caretaker remained an endless fountain of surprises and knowledge. I’ve been in contact with Mr. Tello since that day, and I’m considering asking if he’d be willing to sponsor me if I apply for a Fulbright to do research there. It really was an incredible experience.

Not bad for what was a pasture only 30 years ago

Not bad for what was a pasture only 30 years ago

Mr. Tello

Mr. Tello

Monkeys!

Last Monday, in preparation for our week in the jungle, we planned on spending the day in Puyo’s two incredible botanical gardens to learn about the flora and fauna native to the Amazon. But when our guide at the first garden didn’t show up, we found ourselves with half of a day to kill, and happily fell back on our backup plan—the monkey rescue center/sanctuary just outside of Puyo. This center was set up in 2001 by a Swiss couple who had a concern for the degradation of the environment, and wanted to do what they could to help out. Because monkeys are awesome, they chose to set up this rescue center/reserve to protect the furry little critters who suffer from a horrible variety of abuses at the hands of human beings. There’s a fairly large market  for illegally trafficked monkeys, and they are often horribly mistreated and even mutilated. The center does what it can to rescue monkeys from the hands of their abusers, and offer a sanctuary where they can be medically treated and psychologically rehabilitated. Many of the monkeys are unable to return to the wild due to either psychological/social or physical damage, but here they’re offered a quality alternative with veterinary healthcare, a ton of space to roam, monkey companionship, and constant affection from the staff/visitors.

Sweet little squirrel monkey

Cheeky little squirrel monkey–clearly adapted to the loss of her right forearm during her abusive past

P1020801

This monkey—aptly named Bruja (Witch)—has clearly adapted to the injuries left over from her past abuses well enough to thrive in the sanctuary (she’s stealing chapstick out of my pocket in the first photo). Despite warnings that she wasn’t very friendly, she rode around on my shoulder for most of our time in the reserve—letting me pet her and even falling asleep in my hand at one point. A lot of the squirrel monkeys (of which Bruja was one) are  free to roam around the sanctuary while some of the larger or more aggressive species were contained in large, lush, fenced-in swathes of the jungle. Because it was a slow day and we were getting along quite well with our new monkey friends (one of the refuge employees named me “monkey whisperer”… kind of a big deal, I know), we were allowed into one of the enclosures to meet Sandra and Bebe (pictured below). Bebe was a typical teenager—too full of energy and jealousy–so he’d climb all over you, nip at your fingers and feet, and pull your hair, especially if you ignored him to pay attention to Sandra. Sandra, on the other hand has a reputation for being docile and affectionate—one of the staff members described holding her as the closest thing she’s felt to holding her own kids. I’ve clearly never had kids of my own, but after Sandra spent 20 minutes latched onto my face a la “Alien” (If you don’t know what I’m talking about, Google “Facehuggers, Alien”) in an  affectionate—although admittedly somewhat smelly—hug, I’m not sure the staff member had ever held a kid either. Not to mention, the whole time she was latched onto my face, I was blindly fighting off Bebe who thought it’d be a nice moment to start removing chunks from my calves.

Bebe

It was a pretty overwhelmingly awesome experience, worth a dozen times over the $2.00 price of admission, and it’ll definitely remain one of my treasured memories from my time here in Ecuador.

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Another squirrel monkey

Roads

Driving is dangerous, but I like driving. I don’t, however, like being a passenger while other people (with probably the sole exception of my dad) are driving. I hate being in a car when a stranger is driving. I abhor being in a car in Ecuador when a stranger is driving. Traffic laws here are mere suggestions at best. Stop signs, in the rare, rare case they actually exist, are laughably ignored. Traffic lights are usually obeyed if there are people around, but after dark a red light doesn’t even warrant slowing down to check the corners. Instead of checking the cross-streets before entering an intersection, drivers will just honk the horn and assume the other drivers have heeded and slowed accordingly. Problem is, every single driver in Ecuador honks about 5 times per minute for any variety of reasons, so they pretty much lose their meaning. Double yellow lines here have absolutely no bearing on whether someone will pass you or not. Nor do blind curves. You’re going 65 and the guy in front of you is only going 63? Unacceptable. The typical driver here will speed up to 80 to get around such an obnoxious inconvenience. Blind curve? No problem. We won’t even get into the appalling lack of seatbelts in 85% of cars.

I wouldn’t go so far as to say that being a passenger in an automobile here is downright terrifying… but it is an experience that’ll sure get your heart rate going. I’ve lost count of the times I’ve surreptitiously told a taxista or bus driver that we’re not in a rush, we have plenty of time/money, so there’s no reason at all to drive fast. It occasionally works, and I usually get picked on for being such a ninny, but that’s okay by me. Unfortunately, nobody’s quipping anymore.

Last Friday night, four of my program-mates were involved in an horrific bus accident. The four of them survived, somehow. According to the news, all 7 fatalities from the accident were passengers/employees within the first few rows of the bus. The girls occupied the 4 seats of the second row. Two of them got off (somehow) with bumps, bruises, and stitches, the third had what appeared to be a broken orbital and tore every single ligament in her left knee. The fourth was thought to be dead by the first responders–they found body limp and blue. Someone had the wherewithal to double check among all the chaos, and found that she had a pulse. She broke 6 ribs, collapsed both of her lungs, damaged 4 vertebrae and crushed a fifth.  When I visited her in the hospital she, by some miracle, had never lost feeling or mobility in her lower body. Somehow she was actually pretty peppy too, even though she couldn’t speak for the breathing tube that was keeping her alive. When I retrieved her bloodstained journal from the tattered remnants of what had once been a backpack, I opened the first page to verify it was hers. Under her name/date, I couldn’t help but notice the first line she’d written: “Today was undoubtedly the scariest day of my life”. It was written on the first day of our program, so I’m sure she was referring to the nerves of the transition to Ecuador. Funny how things can get put into perspective in an awful hurry. The three other girls have left for the States, but she is remaining under observation for a few more days. Her father has arrived, she’s off the breathing tube and it looks like she’s going to be okay.

The scenario in which the accident occurred still infuriates me when I think about it: Full passenger bus, traveling down a steep grade at night in the rain. Slow moving car in front of the bus. Driver decides it’s a good idea to pass, not only on a curve, but on a curve that had been previously dubbed “Curva de la Muerta” which literally means Curve of Death. He flips the bus, which rolls over the guard rail and down what the newspapers described as a abyss, before finally coming to a rest. Why anyone would decide to try to make pass going downhill in the dark in the rain at night going around a blind curve called “The Curve of Death” absolutely blows my mind.

But that gets back full circle to the broader problem: en masse, Ecuadorians have an astonishing lack of respect for the dangers of driving a vehicle. I’ve discussed it with all of the doctors I have shadowed and they agree that, while some people are perfectly sane, the vast majority of drivers are completely insane. It’s like the wild freaking west. I was once in a car that was passed by a pick-up truck with 12 passengers total—7 in the bed, 5 in the cab. I have  seen motorcycles driving around the city with complete families on board–4 people, including a nursing baby (actually nursing as they drove around, again), zero helmets.

There are a ton of great things about Ecuador—I love it here. The countryside is incredible from the oceanside to the highlands to the rainforest. The people are super outgoing and super amiable. The food is great (though very different), and there’s always an adventure to be had. But it’s hard not to have the whole experience tainted by the complete mess that is the roads down here. I love it here, but I have a hard time seeing myself returning unless there’s a dramatic change in how the roads operate.


Bus Accident

No Vale la Pena, or Why a Chief of Medicine Aspires to Become a Taxi Driver

My first day in the Puyo clinic, and things were rather slow. This seems to be a pretty common theme in this tiny city of ~35,000, everyone claims that they prefer Puyo to Quito because it’s “mucho más tranquilo”. And although tranquilo is a kind of a false cognate (it translates more directly to “quiet” than to “tranquil”) I can’t help but feel that the connotations surrounding the word “tranquil” actually do the city better justice. It’s situated a on the edge of the Amazon rainforest in the crotch of the “Y” at the intersection between the lazily meandering Río Puyo and the larger Río Pastaza. Everyone seems to know each other, and the whole city is within walking distance.

And so, on a lazy day, my host doctor and I sat in his office chatting, but when I began to ask him about his life as a doctor he became noticeably agitated. He was eager to talk about his situation, but it didn’t make him very happy. There’s a sort of general unrest about the state of the government right now in Ecuador, but it seems that doctors have been acutely adversely affected. While the government has been commendably spending a ton of money to subsidize/promote quality education (although unfortunately the majority of the money has been going to top students/schools, rather than being more evenly distributed), there has been a burgeoning mistrust for medical professionals. Wages have plummeted as the boundaries for what constitutes medical malpractice have  broadened, and this creates quite the uncomfortable environment for the current Ecuadorian doctor.

Dr. Jimenez, general surgeon and chief of medicine at a small but high-end government-run hospital, makes under $22,000 per year. Granted, there is a lower cost of living in Ecuador than in the US, but it is apparent that the salary is not substantial enough. With the growing prevalence of lawsuits, skyrocketing lawyer fees, and the inherent need for doctors to be part of a global community/market, this is clearly not  an adequate salary for a doctor, let alone a chief of surgery. To stay on top of his craft, Dr. Jimenez explained to me how he studies for hours each night after he returns home. But even to do this, he’s got to buy the latest medical textbooks, which run upwards of $300.00 each. That’s a quarter of his monthly paycheck gone, just to try to stay up-to-date. It’s just not sustainable.

But the government has been reducing salaries while tightening regulations. Initially you might think that it’s a good thing to tighten the rules to regulate malpractice, but when doctors live in legitimate fear of being thrown in jail for a misdiagnosis or flawed treatment, it’s impossible for them to work at full efficiency.

It’s like you’re shooting a free throw at the end of a basketball game. There’s tons of pressure, and even the best shooters in the world are going to miss once in a great while. But for doctors, rather than maybe losing a basketball game, they get tossed in jail.

No vale la pena” (It’s just not worth the pain).

Dr. Jimenez sat pondering the state of medical affairs and eventually looked at me and said, “It’s just not worth it, I can’t keep this up for much longer. Once my kids are out of college, I’m going to try something new”. When I asked him what he was thinking, he responded, “I’ve put some thought in… think I’m going to become a taxi driver”.

Emergency

Since my return to bustling Quito, I’ve been stationed in a local emergency room for 8 hours per day. In my first shift, I’m pretty sure I saw, learned, and did more than I had in the rest of my clinical experience combined. At 8:15am a patient walked in needing an electrocardiogram and my host, Doctor Cadena, bustled me over to watch an intern administer the test. At 9:00am another patient walked in needing an EKG and Dr. Cadena nudged me over and said ahora tú. My turn. A little surprised, I couldn’t help but grin at the opportunity and I was pleased to find that I remembered where all 10 electrodes went (which is definitely more of a product of my good teacher than of my good memory). At 10:00am a third patient walked in needing (you guessed it!) an EKG. We’ve all seen the sharp bumps and dips of a heartbeat, but I still had no idea what any of it meant. Maybe I just had a sneaking suspicion that doctors look at the mysterious charts, stroke their whiskers, grunting and nodding, and then pretend to have gleaned some important information. Either way, when the patient left, I asked Dr. Cadena to teach me how to understand the readouts. Next think I knew, I was shirtless, covered in electrodes, staring awkwardly at the ceiling as the little humming machine recorded all the electrical impulses whizzing about my chest. For some reason, the good doctor decided it’d be more fun for me to learn on my own readout. We spent the next couple hours poring over the little pink sheet, him pointing out the meanings in all the bumps and dives, me furiously scribbling notes in a jumbled mix of Spanish and English. In that (oft-interrupted) couple of hours, I managed to get the basics, and from that point forward, he has let me take the first glance at EKG readouts to tell him what I think.

This is not to paint the picture that the ER here is as quiet as a classroom—it’s far from it. While there is a decent amount of downtime, there are also a decent number of terrible injuries. Maybe that’s why the ER has begun to have a bit of a draw on me—there are such a variety of problems that could walk through that door, you kind of have to be prepared for anything. The most notable injury we saw that first day was a poor guy who had been struck in the leg with a friend’s machete as they worked to clear a section of jungle. He was hit just above the knee, his femur was cleanly chopped in two—just above the head—and a few layers of hamstring muscle and tendons was all that held the two pieces of leg together. During the ride to the hospital (he had to be carried part of the way in a horse-drawn cart), the leg had twisted around, so the two parts of the femur were disconnected, resting side-to-side instead of end-to-end. By some miracle, the guy was still conscious and reacted to some sharp prods in the toes—he still had the tendons and nerves connecting his brain to his foot and so should have been able to keep his leg. But there was still the slight problem of the lower half having twisted around on top of the upper half. Dr. Cadena ran down the hall and returned with a traumatologist friend. One held the thigh while the other pulled on the foot, twisting and scraping the bones back  into the proper orientation. After about 10 minutes of grunting and tugging (the poor patient had long since passed out from the pain by this point), his leg resembled a leg once more, and he was sent off to surgery. It looks like he’ll get to keep his leg. While all of the nurses, interns, and myself were busy cringing at the severity of the injury, the two doctors leapt right into action—grimly tugging and grinding bones together to try to save this poor guys leg. It was pretty incredible to watch, and I definitely gained a newfound respect for the both of them. But that’s not to say they were completely unfazed—just about every two hours every day since then, the traumatologist has poked his head in the door with a grin to ask if we had any more machete injuries he could help deal with.

One final note—on that first day, I saw four men come in with injuries sutained in motorcycle crashes.  Nothing was too serious, a couple broken bones and a strained knee-ligament… but it was definitely enough to make me reconsider my lifelong dream of buying a motorcycle so that I can ride around California like Tom Cruise in Top Gun. (Because of copyright issues that first clip couldn’t have the REAL soundtrack, so to get the full effect, mute the fist clip, and play this one in the background)

Side note: This scene, the motorcycle and the inexplicably 40-minute-long sunset, is probably about 96 percent of the reason I went to California for college.

Final final (random) note: I can honestly say that I’ve seen Adrian Peterson hit the gaps with less force than old Ecuadorian ladies do when they’re trying to squeeze on the trolley during rush hour traffic. I am very, very fed up with public transportation.

Lost

Stark

“I was born lost and take no pleasure in being found.”

                                    -John Steinbeck

Alone

Steinbeck

“To awaken quite alone in a strange town is one of the pleasantest sensations in the world.”

                                                                 -Freya Stark

Man! Woman! 1, 2, 3, 19!

Last Wednesday, our host Doctor had an afternoon meeting and so we left the hospital early. For the first time since our arrival in Chone, we had a free afternoon, and under the blazing early-afternoon sun, we decided to go spend the day in the Platanales river, about an hour away. We got there, tossed the ‘ol pig skin, did some swimming, tried to learn how to fish like the locals (which involved a giant net, some shaking of the reeds lining the river, and apparently a lot of cursing and  luck). As we toweled off to head out, a group of pre-teen Ecuadorian boys, just done with school for the day, arrived at the opposite bank of the river. Delighted at our presence and desperate for the attention of us as foreigners, they did anything and everything that came to mind to try to get us to stay. They flexed their skinny arms, pushed each other around, flipped and even tossed each other into the water, but when all else failed, they resorted to shouting the extent of their English vocabulary in a last-ditch effort to get us to stay. They mustered up the incoherent phrase, “Man! Woman! OneTwoThreeNineteen!” and got us laughing at the least, so we stuck around for a few minutes before heading home. The randomness of their vocabulary really tickled me, and I thought it’d fit the theme of this blog entry nicely—an assortment of random anecdotes from my time in the hospitals down here. None of these felt like they merited a full blog post—some are just random observations—but I thought they’d be nice to share

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The hospital itself is a rather shoddy-looking old yellow box of a building, but it sits right inoutside of “downtown” Chone, across the road from the top elementary school in the area. From 8 am until about 3 pm, it’s a hub of buzzing activity, but then families go home, the last rounds are finished, and most doctors either lock themselves in their offices to study or sit around the break room to shoot the breeze. This is where we tend to congregate at the end of the day, as it’s the best time/place to get to know doctors.

Speaking in terms of education, capability, and professionalism with patients, Ecuadorian doctors are very comparable to their US peers. But they’re fairly perpetually undersupplied, so there’s a pervasive understanding that you’ve just got to make do with what’s at hand. A friend and I independently, almost simultaneously, came to the realization that the vast majority of doctors in our hospital are women. Nurses are fairly evenly men and women, and every single department-head is a man. I find this telling of a general trend that the scientific (and general) community has been recognizing of late. Simultaneously, three forces seem to be causing a partial redistribution of the stereotypical gender roles within the hospital. First off, the nursing profession is slowly but steadily gaining a perception of gender neutrality. I say perception, because there have been male nurses for decades, but only now is the stigma being forgotten about men working in what was originally a woman’s field. Secondly, for a variety of reasons, more and more young girls are getting steered towards the hard sciences as more and more young boys choose to steer clear. I’ve noticed this trend  since high school, and it has only been furthered in college (I was one of two guys in my 25 person Developmental Bio class this past Spring). I find it interesting that this trend holds true here in Ecuador. Finally it appears that, mirroring the vague trend in the medical field in the States, men are holding on to upper-managerial and executive positions while the tide shifts slowly below there feet towards a woman-dominated workforce. I just found it very interesting to encounter everything I had read about the changing landscape of gender in the United States workplace  encapsulated in the microcosm of Hospital Napolean Davila.

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There are also some cultural oddities that seem to be amplified by the fact that we’re spending 8 hours per day around Doctors with whom, when there are no patients around, the fourth wall is completely obliterated. For example, the first surgeon I shadowed in Ecuador spent the 30 minutes prior to his first surgery schmoozing with the young lady residents. The continuously risqué stream of flattery, flirty slaps, and thinly veiled innuendo seemed completely inappropriate in a sterile pre-operation room, especially considering the age/power difference between the two young lady residents and the middle-aged surgeon. Not to mention everyone was scrubbed up from head to toe—not exactly flattering garb.

I was initially shocked at how obviously he was flirting with the ladies and ignoring the young male residents. But I slowly came to realize that there was a switch, flipped in a patient’s presence, that reverted him to the capable surgeon, as skilled and professional as any I’ve ever shadowed. It still felt odd about that situation until I shadowed my second and third surgeries and realized that this is just kinda the norm here. I’m still not entirely sure this behavior is a cultural difference, or if this is just how doctors act behind closed doors. But I sure found it interesting and unexpected.

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Another thing I’ve realized is that the concept of racism (and the constant hyperawareness of political correctness that comes with it) doesn’t exist very strongly here in Ecuador. People just tend to speak their mind and that’s the norm, as blunt as it may seem to outsiders. One of the girls on my program, Xuan Li (pronounced shwahn), was born in China but moved to the US with her family when she was very young. Ecuadorians cannot get enough of her. Without fail, every single day since we’ve arrived she’s either been asked if she is related to Bruce Lee, been greeted by a doctor or nurse pulling the corners of their eyes horizontally, been recommended “this great Chinese food place nearby”, or asked if she’s Chinese or Korean “yanno, because it’s impossible to tell the difference”. Initially, the rest of us were shocked, but Xuan, unfazed, took it all in stride. Later she told us about how this is nothing new to her in her travels. It seems that in many countries outside the US, these interactions wouldn’t be viewed as even slightly racist. Maybe is the US that lies outside the general trend in that we have a much more strict definition of what constitutes racism, and a heightened awareness of political correctness to go along with it. Keeping in mind our own nation’s rather blemished history, our stricter social norms are obviously based on very substantial grounds. But I definitely found it interesting to learn that a lot of the rest of the world operates on slightly a different set of social guidelines.

One other social difference that became shockingly apparent very quickly is that it’s completely acceptable to answer a phone call at any point in time. Whether it be the speaker at a meeting, the doctor or patient during a consultation, or even a professor during class—there does not appear to be a wrong time to answer the phone. One of our doctors even had a handless headset so he could take calls during surgery.

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Last Thursday, our host Doctora Diaz brought us upstairs to internal med to show us a recent snakebite victim. As we were leaving the room, a toothless, legless, but nonetheless chipper-looking old man rolled by on his wheelchair, whistling merrily. He was on his way to another room on the ward to check up on an old friend. Our Doctora told us he’s slowly losing body parts to complications of diabetes, but apparently the one thing he refuses to give up to the disease is his sunny disposition. He was a pretty remarkable guy.

As Dra. Diaz told us about this jolly old fellow (who seemed to have a very personable relationship with every living person in the hospital), we came to learn about the dietary issues that have been plaguing Ecuador of late. There is no all-encompassing reason for the sharp decline in dietary health in Ecuador, but Dra. Diaz summed the problems up nicely in saying, “farmers are growing fruit and vegetables, so that they can sell their crops to the United States, so that they earn the money to buy the fast food and soda that has begun to filter down from North America”. It’s a pretty twisted cycle, if you really think about it.

A final quick note is that, unlike in the US, doctors down here often have to deal a variety of different beliefs in odd alternative medicines and antidotes. For example, I noticed a particular bottle on the bedside table (next to the omnipresent 1-liter coke bottle) of an overweight older lady with dangerously high blood pressure. In bold letters on the side, the drink claimed to clean out the drinker’s arteries in veins, thereby lowering blood pressure! What a miracle! When I pointed it out to Dra. Diaz, she shrugged her shoulders with a tired roll of her eyes, and explained that she’d long since given up on that particular battle. The patient remained adamant she felt the benefits of the drink.

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All told, our time in the hospital here in Chone has been amazing, and it’s drawing to a close all too soon. On Wednesday night we’ll be leaving the wonderful Dra. Diaz to bus back to Quito for the end of the program. I’ll be departing soon thereafter to continue my adventure in Puyo, but it’ll be sad to say goodbye to all of the new friends who are leaving after this first four-week program. Either way though, I’ll try to keep the blogs coming (sorry for this one’s obnoxious length), and be sure to keep an eye on my flickr account! (No need to sign up for anything, just click the link and (hopefully) enjoy.)


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Guinea Pigs and Shamans

Two weeks into my Urban/Rural comparative health, and I finally had the chance to see the rural side of the Ecuadorian healthcare system. It involved a shaman, some oily rocks, rhythmic chants, and a (briefly) living guinea pig.

I had spent my first two weeks in bustling Quito, the  vibrant capital city of Ecuador, shadowing doctors in standard western practice hospitals. It was a great experience watching surgeries, learning how to conduct patient interviews and examinations in Spanish, and picking doctors’ brains about various specialties and their lifestyle implications. In all, an incredible experience, but not unlike those I had in Chile last year, or those I would have been able to have in the States if I had remained at home this summer.

In our meeting with Quito’s CFHI medical director, we were warned that the traditional medical methods practiced by portions of Ecuador’s indigenous population could be quite shocking to the unprepared—Ecuadorian and foreigner alike. But even then, we had no idea what was in store when we stepped through the door into the Jambi Huasi alternative clinic in the town of Otavalo. After getting a tour and basic overview of the services offered by the ~10 bed indigenous clinic, we were notified that a limpia con cuy was about to start downstairs, and the four of us were bustled into the room to quietly observe. A limpa con cuy directly translates to “wash with a guinea pig”, and is pretty much exactly what it sounds like, only about a million times less cute.

The patient and shaman, both weather-wizened older ladies still spry and full of energy, chatted amicably while the former disrobed. Once she was down to her undergarments, the limpia began. Still distrustful of Western medicine, some indigenous people maintain the belief that a “copy”—for lack of a better term—of one’s malady can be transferred into the body of a guinea pig and that the guinea pig can be examined to decide on the best course of action. This transfer is made by vigorously scrubbing the patient’s body up-and-down with a live guinea pig. The scrub continues, with the poor animal flopping like a rag-doll by its neck and feet until its squeaking subsides and eventually stops altogether.

Once the cuy had stopped squeaking, our patient re-clothed herself and pulled up a chair to hover over the shining steel washbasin procured by the shaman. With a few deft cuts, the shaman had the cuy skinned and disemboweled, leaving only the thoracic organs, liver, and kidneys. Setting aside her knife, the shaman spent more than 30 minutes poring over of animal’s remains with the patient, pointing out abnormalities and explaining their significance within the patient’s body. As the two conferred mostly in the indigenous Quichua language, we weren’t able to decipher much, but in the end it appeared that the guinea pig’s entrails suggested a pending renal failure in the patient. She stood up and gravely thanked the shaman, nodded to us, the pale foreign observers, and exited with dignity.

As an outsider, I was initially shocked at the seemingly pointless, wasteful and overly brutal nature of the ritual. But then my conversations with the shaman led me to believe that she wasn’t a mean person. And her stolid belief in the worth of her ritual, combined with the complete, faithful confidence of the patient, forced me to take pause and try to shed my cultural bias, to try to understand that the ritual is important and valid from the point of view of the believers. So although I still cannot personally understand the value of the ritual, I have a hard time condemning the continuation a practice that has been passed on by the Quichua ancestors, generation to generation for thousands of years.

After that eye-opening experience, I returned to Quito to head off to Chone, the coastal town where I will be continuing the rural portion of my comparative program. For the next two weeks I will be shadowing with five of my peers in the much more traditional, though somewhat undersupplied, hospital Napolean Davida. I’m very excited to get back into the western hospital setting and to continue working to grow within and understand the healthcare system in place here.

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