Week 9 & 10: Back in Quito

Hey strangers,

This post is a bit overdue but after returning from Chone, Quito was pretty slow and I kind of forgot/procrastinated on writing my weekly posts.

The week we got back, Maddie, George, and I were placed on the same rotation in surgery. The program asked what we were interested in seeing after Chone and we all said various specialties of surgery, but none of these were available so the next best thing was general.This was the exact same rotation I had week 2 with Dr. Vargas... the really intimidating surgeon. This time he seemed to be in a bit of a better mood and he actually was quite helpful, trying to get us into as many surgeries as we could watch. Again, I saw several gallbladder removals and hernia operations. One unique case we saw was a twisted colon, but we spent most of the surgery watching through a window because there were too many med students in the operating room. A little disappointing. 

Also during week, George and I finished up our last few hours of Spanish class with a new professor, Luis. He had just returned from Spain where he was finishing his master's degree in screenwriting. He was a really cool guy. We spent  whole day talking about the education and political system in Ecuador and it was completely fascinating. The opportunities possible in their education system seem almost too good to be true.

My whole last week here was dominated by parties and festivities in Quito. The capitol's independence is December 7th so the whole city was focused around celebrating day and night. I only had two days of clinic this week at a family/woman's clinic in a neighborhood way outside of Quito. It was about an hour and a half bus ride each way. We didn't really see anything new at this clinic. There were a lot of sick kids and women complaining of stomach pain. One woman had a breast engorgement. This is a hardening of the breast milk. I had never heard of this before and I can't imagine how painful it must be. The woman was doing everything she could not to scream when the doctor and I were feeling the mass.

Our group joined the parties this week by going out to Ladies Night in the new part of Quito and to La Ronda in Old town. At La Ronda we met up with some friends and ended up getting invited to a semi-random neighborhood tent party. We were the ONLY white people and probably the only people that didn't live in the neighborhood. Our friends kept buying us crates of beer and soon we were doing conga lines and forming dance circles in the middle of the dance floor. Super weird, but really fun!

I'm glad my time in Quito ended with this week of celebration, it was fun to see the whole town come out and party together. I was sad for my program to come to an end, I have learned more than I can express and this trip has only made me more excited to start a career in health care. Everything I have seen has only fueled my curiosity and made me hungry to go more places, challenge myself out of my comfort zone and learn new things. I am so blessed to have had this opportunity and am so grateful for all the doctors, nurses and random friendly Ecuadorians who made me feel so welcomed here!

All that being said, I can't wait to get home and celebrate Christmas with my family and friends. 

Also, IMPORTANT MESSAGE FOR MOTHER: Words cannot express how excited I am to eat your chocolate chip cookies again. I have only been waiting 2 1/2 months for those!

Week 8: Chone week 3

Our last week in Chone did not disappoint!

By now, all the guards, doctors and nurses recognized us so we had the freedom to go wherever we wanted. Usually we would wander between surgery, Emergency and external consults.

In Surgery, we saw more gall bladder removals and hernia operations. I have probably seen a dozen of these now and they have gotten a little repetitive. They aren't boring, just not the most exciting procedures. Ever wonder what your gallbladder looks like? Well look no further! (vesícula in Spanish)

We watched two surgeries on broken elbows. One was a quick one to remove the medical pins previously inserted and another was to realign the bones and insert pins. There was a pretty scary moment during one, when the patient woke up from the anesthesia in the middle of the surgery. The doctors seemed surprised but not alarmed. They just asked him if he could feel any pain and he said no so they went back to work and eventually put him back under. I can't imagine how freaky that would be! However, in almost every operation below the waist they don't put the patient fully under, just numb them from the waist down. Its pretty weird because sometimes the doctors will have conversations with the patient as they are operating. 

I scrubbed in for two surgeries. The first was a busted kneecap, the patella was broke into 3 pieces and there was a giant hematoma. First, the surgeon cleaned out all the blood clots from the hematoma. Then they realigned the pieces of bone, drilled in two nails in an X formation, and twisted a wire into a figure 8 to hold the patella together.  I helped hold the skin flaps back, provides suction, and clamped the bone together as they drilled in the nails.

The second surgery was a broken big toe. Again, the patient needed a medical pin inserted to stabilize the bones. They drilled in a nail then took an X-ray to see if it went through the bone. The first try they missed the second bone so they did it again and took another X-ray. When they take x-rays, everyone leaves the room because of the radiation... except the people who are scrubbed in. And we didn't have any protective vests or anything. So that was a little unnerving! Once they got the nail in position the surgeon let me cut the nail with these gigantic pliers.

The best part of scrubbing in is being able to touch the bones and injury. We see the breaks on the X-rays all the time but it is a completely different experience being able to hold two parts of a bone in your hands and run your finger along the fracture. Often, the surgeon will guide my finger along the injury and explain characteristics of the wound like what needs to be sewn together or cut away. I am always fascinated at how much the human body can withstand. Surgery is not a delicate process at all!

The interesting cases we saw in emergency this week were: a boy who fell and split his head open, another child who fell into boiling water, a man who accidentally electrocuted himself (he was laying pipes and swung one above his head and it hit a telephone wire), two machete wounds and two motorcycle accidents. 

Emergency Room

One thing that has really affected me here is their attitude towards safety. The lack of concern is shocking. I know accidents still happen no matter how cautious you are but I have seen so many cases that could have easily been avoided. Motorcycle accidents are the most obvious example. When you put four people on one bike, without shoes or helmets, riding on dirt roads through crazy traffic, you are just asking for something to happen. Its not just accidents either, the sanitation here is terrible. Its hard to look at all the crying babies sick with rota virus, parasites, and dengue, knowing that if their parents just washed their hands and food this could be avoided. What it comes down to is there is no education here on preventative measures, whereas in the US we have safety campaigns for nearly everything.

Another huge part of our time in Chone was experiencing the difference in their culture. Chone is tiny, has dirt roads and cows. People live a lot more simply and everything is more relaxed. Almost every house has hammocks hanging outside and old men napping in them. There is absolutely nothing to do in town, hardly even any restaurants. Socializing is built largely upon family and neighborhood.

We were probably some of the only white people in the whole town and they loved it. Every day we would get called out to on the street while walking to lunch. They liked test out their English on us so it was often high school boys yelling "hello beautiful" or "hello I speak English good no?" it was pretty amusing. Also, I got a lot of comments on my blue eyes because they don't see those here. Everyone has a dark complexion with brown eyes. We never had a bad experience with a person, everyone was incredibly patient and helpful. Our taxi drivers would always ask us where we are from, why we are in Chone, how we like their food, etc. They are proud people and liked to tell us that Chone has the most beautiful women and bravest men in Ecuador.

Road we took to the hospital

Vacas! (Cows) near our house

View of town from the hospital

I cannot say enough good things about our host family. We lived with Mariana and Pepe and they were the sweetest and most welcoming people I have met since coming to Ecuador. They are an elderly couple whose children and grand kids live close by so every day there were kids running around the house doing homework or playing. They have a mango, cacao (fruit chocolate comes from), guanabana, and papaya tree and Pepe taught us how to tell when each fruit was ripe. The mango from their tree was the best fruit I think I've ever tasted! One afternoon we came home and Pepe was excited because one of the cacao fruits was ripe. He split it open and we tried the seeds. When you eat it raw you don't bite the seeds because they are extremely bitter. You just suck on the white fleshy coating. It tastes sour, very weird to think this is what chocolate comes from!

Cacao

Michella our host dog

I am sad to leave. Everyone at the hospital was so welcoming and including of us. They took the time to explain procedures and really looked out for us. Doctors would tell us where the best lunch places were or come find us and let us know if something cool was happening in the ER. By week 3 we had inside jokes with a lot of the nurses and doctors and really felt like we made good friends. I will miss Mariana and Pepe, they were a huge part of our great experience here. 

Now back to Quito for two more weeks!

Week 7: Chone week 2

This week was a lot less structured than last. We have become mini celebrities in the hospital, and have gotten to know some of the doctors so we had the freedom to go wherever we wanted. We spent some time in pediatrics with Dra. Diaz and in her external consults, but most of the week was spent in Surgery and the ER.

On Tuesday Maddie and I watched a surgery to fix a broken tibia and fibula. The surgeon inserted two metal plates with pins into each bone. You know that unspoken rule at dinner: "what you touch is what you take"? Yeah, I would assume that would apply to the medical pins during surgery. Or at least, if you touch one then decide not to use it, you don't put it back! I am telling myself they re sterilize all the pins after the surgery but I have a bad feeling that's high hoping. Here are some pretty pictures.

Remember that foot from the motorcycle accident last week? Well the patient ended up needing the big toe amputated and it was very obvious why after the surgeon removed the medical nail. The toe was literally holding on by a piece of skin. This surgery was one of the craziest for me to watch. Not because it was gross, but because the fact that one minute this guy had all his digits and the next he is forever missing a toe. Just a really weird thought.

And this is me totally keeping my cool during the amputation.

There was also two laparoscopic  gall bladder removals, a hernia operation, a busted kneecap and a skin grafting on another foot wound.

Surgeries usually ended by 1 or 2 every day, so in the afternoons we wound hang out in Emergency. There is a lot of down time in Emergency so we had the opportunity to get to know the ER team. They really got a kick out of trying to speak English to us. We had some impromptu language classes which were pretty hilarious. Most of them know some of the common phrases and simple words so they like to shout at us everything they know and nod their head like "yeah? yeah? I'm speaking English, right?!". At one point one of the nurses kept telling me "guur affshoe" and it took me several minutes to realize he was saying "good afternoon".  Scary because, that's probably what we sound like to them! 

One afternoon in the ER it was really slow and we were about to leave early for the day when an ambulance pulled up and two stretchers were rushed in. The moment they pushed though the doors, the whole atmosphere in the room changed. Everyone went from joking and hanging out to serious. It was a big adrenaline rush. The accident was two high schoolers who were in a motorcycle accident on their way home from school. The girl was 14 and the boy was 16, both still wearing their school uniforms. The boy only had some road burns and cuts on his legs and arms but the girl was pretty messed up. The whole right side of her face was missing skin, her knees had huge gashes in them, and her right arm had bad road burn. I was fascinated by the methodical and focused way the doctors handle the situation, even while the girl was wailing and resisting treatment. 

I still am really enjoying Chone. Because it was the second week, we are starting to get recognized around the hospital so it felt a lot more welcoming and more like we belong there. Even if we still get stares and pointing wherever we go!

Week 6: Chone week 1

On Sunday, Maddie, George, and I took the 8 hour bus ride from Quito to Chone to begin the rural part of our comparative health program. As soon as we stepped off the bus we were hit by the thick humid air and a cloud of dirt... Welcome to Chone! We are spending all three weeks at El Hospital Civil. Chone is very different that Quito. The culture in general is more relaxed and it is a slower pace of life. This is definitely reflected in the attitudes of the doctors at the hospital. They tell us to take pictures of anything we find interesting throughout the day, even encourage it. So, this post does contain some fairly graphic pictures, just a warning before you continue! Dra. Diaz is our supervising doctor for our time in Chone. She is a little wacky, but in the best, most welcoming way. Dra. Diaz is a pediatrician so typically, days spent with her are on rotation in pediatrics and in her external consults, seeing kids with various illnesses. Almost all the patients we see are children with severe diarrhea due to parasites or intestinal infections. Parasites are very common here because of the poverty and dirty water conditions. One of the best indicators of a patient's condition is poop. So its no surprise Dra. Diaz LOVES poop. With nearly every patient we go into in depth discussions about the color, consistency and smell (she smells poopy diapers like they are flowers) of the deposits. Fun stuff. Monday, we met a 13 year old girl who was involved in a random shooting. She was shot in the wrist and leg (x-ray below). Her mother was also wounded and was recovering in another part of the hospital and her cousin was shot and killed. The girl was in a lot of pain and when we were standing over her bed I noticed there was blood soaking through her bandage and pooling onto the bed. When I told the nurse, she just shrugged her shoulders and when we came back 3 hours later it was still the same bloody bandage. Things like this are what remind me that I'm not back in the States! Another interesting case we saw was a little 4 year old boy who was pushed into boiling water (don't know if it was an accident or violence) and received burns all over his back. Although he was screaming and crying, his mother couldn't hold him or give him a hug because of the burns. She just had to watch him lie there in pain. It was heartbreaking. But by Thursday when we saw him again, he was a lot better and the mother was able to hold him in her lap a little. Tuesday was spent in the surgery unit. We saw 3 surgeries throughout the day.The first surgery was a cleaning of a foot wound. The patient was in a motorcycle accident and pretty much destroyed his foot. Motorcycle accidents are ridiculously common here, and if you walk around town for 10 minutes this won't surprise you at all. Every day I see families of 4 or 5 (with the family dog!) all piled onto one bike without helmets or shoes! This was the second, of three surgeries for the patient to try to save what they could of the foot. They flushed it with iodine and cut away the unsaveable skin. I literally couldn't get close enough, it was SO NASTY and I loved it. Here is a picture :) enjoy! Oh, and yes that's the surgeon wearing FLIP FLOPS during the surgery! Nuts!

The second surgery of the day was another motorcycle accident. The man needed stitches for two deep lacerations on his left leg. Usually, we just walk into the surgery say, "Buenos dias" then stand back and watch, but this time as soon as we walked in the head surgeon told George and I to go scrub in. We thought they just wanted to be cautious about infection but when we came back they put a gown and gloves on us and pushed us towards the table to assist. Can you say intimidating?! I held the leg still (even under anesthesia the leg jerks and twitches), pulled on the belly of the muscle together helping the surgeon aligned the stitches, soaked up the blood as he sewed, and cut the excess string of the sutures. As the surgeon sewed he taught us how to suture and we taught him some medical terminology in English. Having the opportunity to not only see, but feel the site of injury was hugely educational. Easily, one of the most fascinating and interesting experiences of my life.

The rest of the week was spent in various parts of the hospital. Wednesday, Maddie and I spent the morning in NICU where we saw a bunch of incredibly tiny babies and two c-sections. The unit also does various surgeries for women's health so we saw an ovarian cyst removal as well. When they cut into the cyst liquid literally squirted across the room! The surgeon in this unit was VERY friendly and we had a nice long talk about drugs, God, Madonna, and Nazi Germany.... all in Spanish. You could say it was a little strange.

Here is a photo from the C-section, the exact moment this life came into the world! See his little hands? Absolutely awesome!

Otherwise we spent the week in External Consult, pediatrics, or Emergency. Emergency was hit or miss, sometimes it would be active and other times nothing. Throughout the week we saw several broken bones, minor stitches and burns. One patient in Emergency was a 15 year old boy who broke his arm in 5 places. When we asked what happened he said he fell off a horse, but we later found out that he actually fell while doing a celebratory dance on the soccer field. He was just embarrassed and wanted to sound macho! This is his X-ray.

So far I love Chone! This doesn't even begin to show or explain everything I have learned here and everyone is incredibly kind. Every day is an adventure and I'm always excited when I wake up about what I will see at the hospital.

Week 5: Emergency at the Maternity Ward

I was supposed to go to a Woman's clinic this week but my doctor ended up not being available so on Sunday night they switched me to Emergency at La Maternidad.  I was a little disappointed about the change, but excited because La Maternidad was my favorite rotation thus far.

On Monday I met my doctor for the week, Dr. Gomez. He was kind to me and took time to teach me things but he was not a very friendly man. He also had a strange obsession with his stapler. I'm not exaggerating. Every single paper that came to his desk he would carefully remove the existing staple, throw it away, and replace it with a new one.

My first day I helped the nurses roll the beds down the hallway (totally Grey's Anatomy status) and watched a few ultrasounds. Emergency is very hit or miss with activity so that was as exciting as Monday got. Other than that, virtually every woman that came in this week was either in labor or diagnosed with a UTI (Urinary Tract Infection). I learned how to identify the symptoms of a UTI and diagnose it using a urine sample. 

Urine test

Many women here don't know how many weeks pregnant they are so Dr. Gomez taught me how to calculate the number of weeks from the date of her last period. It took me forever because I haven't done long hand math in ages but he was able to calculate all of them in his head in seconds. He also taught me how to examine the pregnant abdomen and how to determine the position of the baby. I got pretty good at this, and by the middle of the week Dr. Gomez had me preforming the full exam and find the baby's heart beat. He would only come over and check my work afterwards.

For some reason this week, everyone kept mistaking me for a nurse. There was one morning when I was standing in the waiting room and one of the nurses asked if I could help her take down patient information. Okay not really ask, she kind of just shoved a clip board and chart into my hands and sat me down with a patient. I had been listening to the questions they ask all week so I figured I would pretend like I knew what I was doing and give it a shot. I made it through about two questions before I realized that they used a bunch of acronyms in the charts that I had no idea what they meant. When I confessed to the nurse, she looked shocked and apologized because she thought I worked there. Another doctor asked me to take a patient's blood, and when I told him I was only a student and didn't know how, he responded that it didn't really matter. I still didn't do it because it seemed pretty unethical.

Dr. Gomez's office

There were also several doctors who told me my Spanish was excellent this week, but I'm pretty sure its because I have learned the art of disguise. I have become very good at nodding my head and responding in short 3-4 word sentences. I also do everything in my power not to conjugate verbs. Plus it helps that I have heard most of the vocabulary used in emergency already, when I was in the maternity ward so I could pick up on what was happening faster than usual. 

I had a good week in emergency. For the most part it was slow but I got to participate a lot more than usual. Also, I was able to talk with the other medical students who are fascinated with the school system in the states and kept asking me how much I pay to go to college (its free here). They were horrified when I told them! 

And this is my face after seeing what seems like my 100th pregnant woman this trip.

Living in Quito

This will be my 5th week in Ecuador, so I thought it was time to share some of the lessons I have learned outside the hospital. Here are some survival tips for living in Quito!

• Everyone says "buenos dias/tardes/noches" as a greeting and often with a kiss on the cheek. It is considered extremely rude not to, especially in the hospitals. Also, people say "chao" instead of "adios" here. It took a while to realize we stuck out like major gringos saying "hola" and "adios" all the time.

• Taxis. We take them almost every day. Mostly because the trolley and bus get so crowded at rush hour that they a huge pain in the butt. Plus, the average taxi ride around Quito is about $4 so split between a few people its not bad at all. However, the tricky thing about taxis is they are all over the city but not all of them are safe or legal. Legal taxis are all yellow with numbers on both the top and side, an orange registration sticker on the door, and the company name on the back. This is only about 1/3 of the taxis in Quito. So we often have to wave by the illegal taxis that stop for us... along with the random personal car driven by a creepy man wanting to pick us up. Also, never slam the taxi door, they hate that!

• Ketchup here does not taste like Ketchup at home. Very disappointing. Same with milk and yogurt. Also, they don't refrigerate eggs which freaks me out. AND they love KFC here, but instead of mashed potatoes its rice!

• There are street venders selling tiny adorable little puppies for $2 in Old Town and you can't look them in the eye. They will spot you and try to make you hold the puppy and fall in love. Its pure evil. 

• They only have two types of beer in Ecuador: El Club and Pilsener. Some restaurants have a few options of American beers but they cost $5-6 which is absolutely crazy expensive for here.

• No one here can make change for a 20 dollar bill. It is actually ridiculous, they would rather lose a sale than make change. Its a small miracle when a restaurant or store will take a $20 and they immediately win favor with us.

• Ecuadorian card games are impossible and involve way too much math. Yet, I still seem to have great luck at them. We play Cuarenta (40) which is a mix between black jack, speed, and crazy 8's.

• Cars, buses and trolleys do not stop for pedestrians. In fact, they speed up, especially for gringos. Every day walking to class or clinic is a suicide mission. 

• Ecuadorians are OBSESSED with this song (and I have to admit, now I am too) and everyone knows all the words!

• Besides talking with the other students, I talk solely in Spanish. Surprisingly, hardly anyone here knows English because it is not taught in school. We have met a few people who study it on their own or at a university but they aren't very willing to speak because they are embarrassed. I think its a culture thing. But they love to tease us about our Spanish. I had one doctor ask me how I liked the birth I saw that day and I responded "Fue muy interesante pero un poco grosero" and started laughing at me. I didn't realize my mistake until I got home... the word "grosero" means rude, so although I tried to say "It was very interesting but a little gross." what I actually said was "It was very interesting but a little rude."

• None of the public restrooms provide toilet paper.

• Privacy isn't really a thing here. Ecuadorians love public displays of affection... literally anywhere. On the bus, in the streets, parks, restaurants, waiting rooms at the hospital! And, women openly breast feed everywhere as well.

Week 4: Family Clinic

To be completely honest, this week was pretty slow. I was in a family clinic in a neighborhood called Cochapamba with Dra. Sancho. Its exactly like any family clinic in the states. I saw a lot of kids with colds, rashes and parasites. The few unique cases from the week were a boy who broke his knee riding his bike, a grandpa who voluntarily decided to stop talking (she sent him for a psych consult) and a baby with a heart murmur.

Dra. Sancho was very nice and took the time to explain each patient's case to me. She is also an incredibly patient woman. They try to have a waiting room system but the patients grow anxious and begin cutting each other in line. They even would knock on Dra. Sancho's door while she was with another patient to ask to be seen sooner. One mother actually burst into the office to tell Dra. Sancho her daughter needed immediate attention but it turned out to be nothing more than her daughter was having menstruation cramps.

Dra. Sancho had a meeting  Thursday and Friday so I was sent back to the adolescent clinic for those two days. I saw pretty much everything I have already seen, but it was nice to go back after a few more weeks of Spanish under my belt and see how much more I understood.