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.

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!