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.

Week 3: Maternity Ward

Okay. First thing I would like to say is GO GIVE YOUR MOTHER A HUG. Child birth is insane.

Second, sorry if this post is a little graphic, just describing what I saw.

This week I was at La Maternidad, the maternity ward of a large public hospital in Quito. This was my first solo rotation, so I was pretty intimidated Monday morning until I met my doctor for the week. Dr. Marquez could not have been more welcoming and kind. Every morning he would meet me outside the unit to lock my backpack in his personal locker and he was constantly checking in on me to make sure I was understanding what was going on and to see if I had any questions. He also spoke nearly perfect English which was a huge bonus! Lets just say, he was very refreshing after last week.

The unit is designed like a production line. As each woman arrives, she is brought into the "Labor Room" where about a dozen women are lined up on beds in various stages of labor. Here, the doctors and med students go from bed to bed monitoring the cervix dilation, baby's heart beat and head position, and mother's pain level. Once the woman has reached the second stage of labor she is wheeled into the "Delivery Room" where she gives birth. As they wheel her down the hallway all the nurses and doctors call out "Parto! Partooooo!" ("Birth! Birth!"), to notify everyone. After, the baby is immediately taken away to a different part of the hospital while the mother rests in the "Recovery Room" until she is able to get on her feet. Then she joins her baby in the post-delivery ward (the place where I spent my first week's rotation). Also, I should mention that these women are completely alone. No one, not even the father of the child is allowed in the unit. Seeing these women give birth without any form of support was shocking.

Over the course of the week I saw two C-sections, five abortions, four natural births and two episiotomies. The C-sections were fascinating. One moment you are watching the doctor cut through abdominal muscle then the next thing you know, they are pulling a human out of her stomach. SO COOL. On my first day I saw a laparoscopic ectopic pregnancy abortion. An ectopic pregnancy is when the embryo implants itself outside of the uterine cavity. It is necessary to abort because it is fatal for mother and child. Later in the week, I saw three D & C's, an abortion technique used during the first trimester. The procedure involves dilating the cervix and surgically removing the contents of the uterus by curettage. I also saw one woman who was having a spontaneous abortion. This is when the body terminates the pregnancy before 20 weeks, characterized by heavy bleeding, abdominal pain and cervix dilation. I'm usually not a very emotional persons, but seeing this woman in so much pain and sobbing for the loss of her child while alone in a room got to me. You could literally hear her crying out for God down the hallway.

 Abortions are illegal in Ecuador. In fact, last week the country was trying to pass a bill to legalize abortions in the case of rape. It almost went through until the President called his cabinet and threatened anyone who supported legalization would need to find another job. However, abortions are legal when they are medically necessary, which was the case in each abortion I saw.

 I didn't see a vaginal birth until Wednesday and I'm going to be completely honest. It was traumatizing. For each birth, I stood right between their legs, and every time was just as horrifying as the one before. Some people say birth is beautiful and makes them cry. Well yes I agree, its beautiful and incredible AFTER all the pain, blood and screaming. I am still in shock that this is the way the human body is designed. It seems impossible until its done. But, the two episiotomies were the worst to watch. An episiotomy is when they cut the woman's perineum during the second stage of labor as a preemptive action against vaginal tears. OUCH.

Dilation and labor reference chart

The conditions at La Maternidad were hard to believe. I have nothing bad to say about the doctors I met this week, but the practice here is so different, its hard not to judge. The ratio of med students/doctors to patients is overwhelming. And their lack of professionalism is awkward. There were several times when a pregnant woman would be escorted into the room and have to wait for a bed because all the med students (and even some doctors) were sitting on the empty ones taking photos of themselves and playing games on their phone. Also, there is no restriction on who is able to examine the women. Sometimes, four or five different people would check the woman's cervix dilation without instruction to do so. This involves inserting two fingers inside the vagina to check how open the cervix is. It is painful for the women, and extremely invasive to have multiple people do this when its is unnecessary. The beds were nothing more than a plastic mattress and each woman was given a pack of diaper pads to use as their pillow. Just like the weeks before, the sanitation was frightening. The doctors never washed their hands between patients and they replaced the women's diaper pads without gloves! Also, you can imagine what it would be like in a room with a dozen women in labor.... a lot of screaming. However, I never once saw anyone comfort a mother in pain. They all ignore the cries, even roll their eyes and tell them to be quiet. This bothered me a lot because some of these women were young teens and it must be terrifying for them to be all alone, in this much pain.

On my last day I ended up having a very interesting conversation with one of the med students, Catalina. She surprised me by agreeing that the conditions are poor and explained to me that although the doctors at La Maternidad do their best, the hospital just cannot afford the time or resources to make the conditions more comfortable. She told me that many reasons behind the treatment is just the culture here. 

This week really surprised me. I found everything completely fascinating and I couldn't get enough of it. If I have the opportunity, I would love to do a second rotation at La Maternidad with Dr. Marquez. 

Week 2: Surgery

THIS WEEK WAS CRAZY.

I had my surgery rotation this week at the Military hospital in Quito. Monday morning George and I arrived at 8 am after spending nearly half an hour trying to hail a taxi. We were told to arrive in our scrubs and lab coats so we wouldn't get questioned by the guards but we still found ourselves being denied access to the elevators and having to sneak into the stairs and climb all the way to the 9th floor. Once we got to the surgical floor we met our doctor for the week, Dr. Vargas.  He is easily the most intimidating man I have ever met. Picture a Latin version of Dr. Cox (from the show Scrubs) with a hint of Professor Snape. 

The rest of Monday was spent following Dr. Vargas and his med students around as they did pre and post-op visits. Its general surgery, so there was a lot of appendicitis, gall bladder infections, and hernias. After, George and I were ordered to sit in silence for two hours as Dr. Vargas lectured his students on each patient and their case. And by "lectured" I mean he was red in the face, yelling across the table at these poor med students for being "incompetent and lazy morons." Somewhere between the yelling, George and I realized we weren't going to see an surgeries today. We left the hospital disappointed and a little terrified for the rest of the week.

El Hospital del Militar

Tuesday I woke up sick and couldn't go to rotation, so George faced Dr. Vargas solo. He befriended one of the med students that day who told him that in 1986 Dr. Vargas' uncle, General Frank Vargas, kidnapped the president of Ecuador and held him for ransom. The Vargas name is famous in Ecuador and mixed with Dr. Vargas' temper he is notorious in the medical community.

Wednesday we went into surgery right away. The first surgery was a hernia repair on a middle aged woman. It was incredible. From beginning to end I was standing shoulder to shoulder with the doctor as he opened her up, cut through the abdominal muscles, located the site of repair and sewed in a mesh net to reinforce the walls of the organ. I was completely absorbed by the surgery and forgot all about Dr. Vargas' temper until one of the nurses informed him they were missing a towel. Every gauze towel used in the body is carefully counted to avoid misplacing one. The nurse counted 9 towels entered the body but only 8 left. Vargas exploded and began screaming at the surgical team about how its their responsibility to count, not his, and that its his license on the line. The next 20 minutes were very tense as Vargas dug through the body cursing and the rest of us started looking under the table and through the trash. He finally found the missing towel jammed deep in the body. This is a common medical malpractice issue, and it was a very eye opening to see just how easily it can happen.

The second surgery of the day was a laparoscopic gallbladder removal on an elderly woman. We watched a TV screen as Dr. Vargas used the robotic arms to cauterize and cut away the inflamed gallbladder. His skill and speed were impressive and at one point I turned around to the window and saw a group of other surgeons watching and taking pictures from outside. Although I still think Dr. Vargas is unnecessarily frightening, I can see how he gets away with his temper. He is a very skilled surgeon and I'm glad I had the opportunity to see him work.

after 4 hours of surgery

Thursday Dr. Vargas sent us with another doctor to to watch a surgery because he didn't have any scheduled that morning. We watched a second laparoscopic gallbladder removal done by a female resident. It was virtually the same procedure as the day before except this time she put the inflamed gallbladder inside a condom before pulling it out of the body. This allows the surgeon to cleanly remove the gallbladder without worrying about it bursting all over the body. Very creative!

Friday was a nation holiday (don't ask me what it was, I have no clue) so we didn't have rotation or class

This week more than the last, I found myself realizing obvious differences between the United States and here. For example, I was never once told to wash my hands, before, after or between surgeries. The doctors kept the same booties, masks and hair nets through the whole day, throughout multiple procedures and I counted 5 doctors/nurses playing games or texting on their phones DURING surgery.

I learned SO much this week just by observation. I had no idea how much the human body can withstand and how resilient it is. It is incredible.

Week 1: Adolescent Clinic

Monday and Tuesday were spent in 8 hours of language class. I am in the intermediate class with 3 other students in the program. We are only allowed to speak Spanish during school hours so class consists of a lot of hand gesturing and blank stares at the professor-especially from me! She is very patient with us, but strict. There is a special kind of head ache you get from only speaking Spanish all day and by 4 o'clock when class gets out we are all too tired to do anything but go back home and lounge on the couches until dinner.

The classroom

On Wednesday I began my first hospital rotation. This week George and I are with Dra. Carrera, a pediatric doctor at a hospital in north Quito. I was nervous, because up until this point, I had not spoken Spanish with anyone except for our professors, host mom (who all know English and can bail us out if we need help) and a few taxi drivers. I didn't know what to expect.

At this adolescent clinic, prenatal and postpartum care is provided free to all mothers between the ages of 12-18. Dra. Carrera explained that many of her patients are abandoned by the fathers and at such young ages as 14, 15 or 16 these mothers are uneducated and unprepared to take care of a child, so most of her work involves educating the mothers and making sure they have some sort of support. 

We spent the next 3 days with Dra. Carrera. Each day started in her office where she would see 3 or 4 patients for a routine check up. She would lecture the mothers on the importance of breast feeding, prescribe vitamins and preform a quick physical exam of the baby. Next, we would go to the post delivery ward. This was three large connected rooms with 10 beds in each. Every time I walked in I was hit by how young the faces staring back at me were (the oldest mother we saw this week was 17). You could feel their nervous energy in the room as they sat on the bed with their day old babies. The mothers were suspicious of me to say the least. I'm sure it made them uncomfortable having an American girl wearing a white lab coat, only a few years older than them, staring down at their child. 

Dra. Carrera gave each baby a physical exam where she would draw blood, check for jaundice, and test their reflexes. She had us listen to their heart and lungs and showed us how to feel the soft spots on the skull. My previous anatomy knowledge really helped me here as I was able to engage with the doctor in naming the cranial bones and explain the formation of the skull. Even with my broken Spanish she began to realize my level of understanding and would turn to me more and more and ask me the cause of this or that. It was intimidating, but it helped me learn a lot.

We saw some unique cases over the three days spent in pediatrics. One baby boy had an undescended right testicle, another baby had a misshaped skull because of her position in the womb and the pressure of the mother's organs on her head as she developed, one  mother was 17 and already had a 5 year old son at home (yes she had a baby at 12!), and one baby's nose was broken during birth.

I couldn't have asked for a better first rotation. Dra. Carrera was very helpful and George and I actually got invited to a party by some of the nurses we worked with.