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

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.

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.

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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!