Alone

Steinbeck

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

                                                                 -Freya Stark

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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.

*****

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.

*****

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.

*****

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.

*****

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.

Baños

We woke up Friday morning with our bags packed, went to our clinical rotations, grabbed a quick lunch, and then headed to the bus station–destined for Baños, a southern mountain town close to the rain forest. A winding three-hours later, we arrived just before sundown. Stepping off the bus I was immediately struck by the sweet freshness of the rural mountain air, and even though the city is at a higher elevation than Denver Colorado, the descent from 9,000 foot Quito meant that each breath felt twice as rewarding. Relishing in the fresh air we left the bus station on foot—in the wrong direction, of course—and eventually landed in our cozy Hostal Erupción. We dropped off our bags, took a quick shower, and set off in search of dinner.

Though we did meet the occasional American, Baños turned out to be mostly filled with Ecuadorian tourists seeking a respite from the bustle of Quito. This was rather unique to me, as most of my forays from Santiago last year landed me in packs of gringo extranjeros (American foreigners) unceremoniously carted around by local tour guides. And although these experiences were always quite enjoyable, it was rather refreshing to instead rub shoulders with tourists haling from elsewhere in Ecuador.

Even as the sun set, the streets of Baños bustled with activity; nameless restaurants simply advertising “Dinner: $2.00” nestled among tiny tiendas selling alpaca-knit clothing, carved wooden knick-knacks, fútbol jerseys, and fake Nikes. Men hollered from the doors of tour agencies, eager to fill the last vacancies for the morning’s adventures while street vendors offered roasted cuy (guinea pig!). Colorful candy shops offered sugarcane strips and hand-made sugarcane taffey to all passers-by, while stray dogs with crooked tails meandered around the cars bustling down the city’s tiny one-way streets. And everywhere televisions were on, showing the pre-game for that night’s Ecuador vs. Peru World Cup qualifier match. With the two countries’ recent history of military conflict (as late as 1995), the match carried with it an added emotional anticipation–the small city was virtually buzzing with excitement. We found dinner in a tiny out-of-the-way café, and then headed back towards our hostel to find somewhere to watch the game.

Baños Streets

Cuy

Cuy! (Roasted Guinea Pig)

Baños is famous for its sugar cane taffey

Baños is famous for its sugar cane taffy

Though the game didn’t turn out to be terribly exciting (1-0, Peru—though that one goal was an incredible one), it was an electric atmosphere in the bar where we watched the game, and although their team lost, the patrons shared a certain national pride that couldn’t be blemished by a tough loss. Although as the only non-Ecuadorians in the room, we were obviously out of place, the rest of the bar was cordial enough, thumbs-upping the Selección Nacional jerseys we’d bought on the way home from dinner, and (although we were definitely relegated to the fringes of the excitement) making sure we had a good view of the TV. After the game, we left for bed in preparation for an early morning of activities.

We awoke at 7 to rain and a rather nasty bout of food poisoning that incapacitated two of our four group members and left me feeling rather queasy. Ditching our original plans for a mountainous mountain-bike ride, my friend Sharleen and I left the sicker ones at the hostel and went to meet with another group of friends for white-water rafting. The rafting took us through the misty middle earth-like countryside, and aside from the numbness that set in after 30 minutes, and the rafting guide with the penchant for pushing people overboard, we quite enjoyed the experience. We returned at 1 PM, exhilarated, if a bit blue in the knuckles, and changed into warm clothes for the second activity on the docket.

We had coordinated with the rest of our larger group from Quito to rent a Chivas bus for the afternoon. Chivas busses, essentially freight trucks whose trailer platform has been retrofitted with benches, speakers, and dance lights, are popular in Ecuador as vehicles for sight-seeing without the boring in-between parts (not that there are many of those, when you’re winding around a valley with incredible sheer mountain faces rearing up on each side). Though we knew it was coming, the first stop of the Chivas bus hit us way to quickly. A 300-foot bridge set up for bungee jumping, we all nervously agreed to give it a shot, but then faltered when staring that beast in the face. After watching the guy in line in front of us survive, we decided we couldn’t back out, and one-by-one we stepped up to the edge. On the edge, staring down past my toes at over 300 feet of nothingness, I felt a mix of exhilaration and terror… but before I even knew what had happened I was at the end of the jump, swinging back and forth below the bridge.

In that moment, swinging 150 feet above the water, I felt the most incredible combination of relief (at having managed to jump, or at having survived, I’m still not sure), awe at the rugged gray beauty of the canyon into which I was dangling, and pain at the harness digging not-so-gently into my butt. The memory of that moment will not be one to fade any time soon.

Bridge Jump! (300 feet)

Bridge Jump! (300 feet)

That day was just about over, with 12 of us having jumped, and so we missed out on most of the rest of our mountain tour, but everyone was too exhilarated to care. We returned to town for dinner and then went out for a couple of hours of (watching Ecuadorians be really good at) salsa dancing before bed.

We rose early again on Sunday to head back into the mountains for what we had planned to be our final adventure—rappelling down a series of waterfalls. And although the experience was incredible, high water levels due to recent rainfall prevented us from doing the final 150-foot falls, and so we left an hour early, a bit bummed out. Without anything else planned, the majority of our group left back for Quito, but four of us stayed behind in a last-ditch effort to try to catch the last few vistas that we had missed on Saturday night. We found an ATV rental shop, and the four of us rented two road-legal buggies to go explore.

We took off out the city and motored along the winding mountain roads—stopping about every mile to have our minds blown, again and again, by the incredible scenery. We drove about 10 miles down into the mountains, stopping at miradores to look out over the river, ziplines to cross back and forth across the river, and cable cars to go hover over the spray of the falls.  At a certain point, it felt as if my mind was oversaturated by the magnificence that is was constantly trying to process, and when my copilot and friends echoed that sentiment, we turned back, climbing back up into Baños to return our buggies, pick up our bags from the hostel, and head to the bus station for the return trip to Quito.

Mountain Buggie

Mountain Buggie

ATV in mountains

ATV in mountains

Laura, Patrick, Sharleen, and Me

Laura, Patrick, Sharleen, and Me

Cable Car over Watfall

Cable Car over Watfall

It was an incredible ending to an incredible weekend, and although it feels like I’ve been in Ecuador for a month already, and that I need a week off to recover from all of the excitement… the new week—my last week in Quito with this group of new friends–has already started, and so the pedal will stay to the metal, activities-wise. I can’t wait.

Thanks for reading!

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Quito

The first four week program in which I’m enrolled here in Ecuador is an Urban/Rural comparative observation. I spend two weeks here in Quito experiencing the city clinics, and then two weeks in tiny Chone to observe how Ecuadorian doctors overcome the challenges of rural healthcare provision. Because I only have two short weeks here in Quito, I’m desperate to experience all of the city before leaving. This is obviously impossible, and so each day consequently feels way too short. But because I feel the perpetual time-crunch, I have been packing as much as possible into every single day, and so it feels as if I’ve been in Quito for months already.

Upon arrival in the Quito airport, I was pleased to find that my Spanish skills hadn’t atrophied too badly in the 6 months since I had left Santiago, but there was still, unsurprisingly, quite a bit of initial confusion. In the crowded baggage claim area, I grabbed my bags and entered the nearby line to pass through customs. Only after I got some odd looks from the people in front of me did I take a sec to really look around… and I realized that I had somehow managed to insert myself into the front of a winding 100 yard line. Embarrassed, I risked a glance over my shoulder to gauge the reaction of the person in front of whom I had inserted myself… and found myself looking into the chest of a 6’5 bear of a guy. Luckily he appeared to be about as confused as I was, and after attempting to apologize and excuse myself in Spanish, realized he was an American. After talking for a few minutest, it turned out he was on my program. And living in my home stay. He actually ended up being my roommate and good friend, so I guess things worked out okay.

Sunday through Tuesday of that first week was a fairly intense cultural/language orientation, with 7 hours of daily Spanish class. I was pleased to realize that, although some of my peers had spent a significant time studying Spanish, I was one of the only students to have studied abroad before in a Spanish-speaking country,  and I was happy to discover that, while I’m a bit rusty with the technical details of the language, I have a much easier time than my peers actually conversing in Spanish. This has provided a nice balance as the majority of the others participating in CFHI are already in med school, and so when clinical rotations started last Wednesday, we were able to combine our various levels of language skills/medical knowledge to piece together just about everything going on in the surgeries/consults.

Unfortunately, after 7 hours of class/clinic, it’s difficult to find motivation to get out and explore the city, but frequent coffee shop stops help. And although I didn’t get half-way through my list of ‘must-sees’ around Quito, we were able to explore quite a bit of the city during that first week. I initially tried to keep to a “new food every day” routine, but after an unfortunate run-in with a pig intestine/blood soup, I decided the occasional hamburger is okay. My favorite spot in Quito so far has been the top of the Teleférico. The Teleférico is a cable car that snakes up one of the enormous mountains that rears up on the Western side of Quito. One of the vertical cable car ascents in the world, the Teleférico brings you from the base at 10,226 ft., all the way up to the peak at 12,943 ft. This vantage point, almost  4,000 feet above the city proper, affords the most incredible view of the city. Though I had previous read about Quito’s odd shape/location (9,350 feet of elevation, ~25 x 3 miles long, sprawling out less than one mile from latitude zero to fill the valley in between two majestic ranges of Andean peaks)  I didn’t really understand it all until I reached the peak of the Teleférico. The opposing range on the other edge of the valley felt like a stone’s throw away, rising up clearly while the city of Quito extended into the mist in either direction. On the mountain face away from the city, the peaks extended off into the clouds, poking out like  islands from the ocean. And as the sun set, the lights began twinkling on in Quito, sprawling out below us, and that was one of the most incredible views I have ever witnessed.

Cotopaxi over Quito valley Cloud Valley Quito at Night

Sorry these posts are so sporadic and lengthy! But as I said, I feel the time crunch so I don’t often write, but when I do… there’s a ton to say. If you enjoy, please click the “follow” button that pops op at the bottom right corner of the screen, and for more pictures, check out my flickr account by clicking on this link: http://www.flickr.com/photos/lukemayer/.

Thanks for reading!

Day 1 (posted on day 2. Sorry, my internet’s been all wonky.)

            This morning I woke up in my bed in Hartland Vermont. Tonight, I lie falling asleep in my bed in Quito Ecuador. Sometimes it doesn’t make a lick of sense that what I just did goes by the same name, travel, as what people did  75 years ago. The fact that I can get into a car, fall asleep, board a plane, fall asleep, board another plane, fall asleep, and then wake up in a completely foreign place, 3,200 miles away, still kinda blows my mind. I almost feel like I’m cheating—that the ease of it all somehow invalidates my travels. Part of me wants to know what it would have been like, travelling this distance by train or by horseback—some more intimate means of transportation that would lend more of a sense of the overwhelming bigness of the world. Instead I hop into an air-conditioned tin cylinder and fall asleep while the miles whizz by, largely unnoticed. But then I realize that my trip took 10 hours, rather than 10 months, and I’ll be home in time to catch summer’s end in Vermont… and my nostalgia for the good old days is gone in a flash.

            I like going to new places. But new is unknown and the unknown is scary, so by the transitive property I like scaring myself. Kinda twisted, I know. But just as I discovered in my time in Santiago, I am amazed by how quickly that fear of the unknown dissipates after leaving the airport. I’ve found that once I’m done thinking about how terrifying things will be, I realize that new really isn’t that different from old—maybe a different accent, a slightly different skin tone, and a marginally higher ratio of cars going backwards on the highway to cars going forwards. (Seriously, I’m very confused by the traffic laws in Quito.) But otherwise, it feels pretty nice to be back in South America. Granted, I’ve been in Quito for a grand total of 2 hours so I can’t make too many comparisons… but it’s been surprisingly comfortable so far, transitioning back to salsa music, spikey fenced-in houses, stray dogs, and strip malls devoid of recognizable stores. All told, I’m glad I like scaring myself, and as much as I already miss my family, friends and summertime in Vermont, I’m excited to be starting something new again.

 

These are my digs for the next 2 weeks. Then I’m off to Chone on the coast for 2 weeks, back here for a week, then off to Puyo on the edge of the rainforest for three weeks.

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