Arte

I went to an art gallery up on a hill today while exploring the Historic District. Although my favorite "piece" was a collection of microscope slides with Spanish pick-up lines printed on them in size .0001 font, the rest was pretty impressive too.

This one's not for the kids:

The weather in Quito is very sporadic. It can be hot enough for shorts and a tee shirt one minute, and cold and rainy the next. This was one of those moments:

The Grand Finale

This week I worked at Tierra Nueva, a small hospital towards the Southern end of the city. It takes just under an hour to get there by bus from where I live. Unlike other hospitals where you're stuck with one doctor, here they let you pretty much choose where you want to go. The first day I chose the Emergency Room, thinking I would get to see some real action. I soon learned that wasn't the case. Most of the time I was sitting and talking with the ER physician, and there were a few patients that came in. There was a little girl that had fallen on her head the day before and had a lot of swelling, so they sent her to get a brain scan. She was clear of any hemorrhaging in the brain so mamá left pretty happy. Two women that appeared to be in horrible pain came in, one with an unhappy sciatic nerve and one that fell down her stairs at home. The latter didn't have any visible injuries, just a stiff back and neck.

The next day, the doctor we were supposed to meet and tell where we wanted to be that day didn't show up, so the best option for me was to go back to Emergency since I already knew the people there. Another slow day, but I did get to clean some stitches. The day before, a man fell while working on a city bus and had to get 7 or so stitches on his palm. Because he's a mechanic, naturally his hands were covered in grease when it happened. And because this is Ecuador, his hands were STILL greasy when we removed the gauze. Whoever did the stitches the day before didn't deem it necessary to fully clean him up. So I spent a while wiping the grease away with gauze and solution.

On Wednesday I went to the Quirófano, the operating room. I watched a cholecystectomy (gallbladder removal) and two surgeries to remove masses on the nasal septum that were obstructing the airway. I learned that I have absolutely no problem watching incisions and hands inside open abdomens, but when it comes to shoving things down people's mouths and noses, it gets hard to watch. The plastic surgeon was leaning over, filing away at the masses deep, deep inside the nose with all the elbow grease she could muster. And by deep, I mean I was a little worried she might cause brain damage. I was asking the anesthesiologist a question while he was waking the second septorhinoplasty patient, when blood started gushing from the plastic tube in her mouth. I backed away immediately and he yelled succión, succión! The surgeon was gone by then by but the anesthesiologist was on top of it. He put her back under, cleared her throat of blood and had things calm again in a few seconds.

I went back to the OR on Thursday. I got to watch a C-section and a hysterectomy. It was cool to see a uterus the size of a small human followed by one the size of a large grape. That thing can strrreeeetch.

For Spanish class that day we went to a local market and bought things to make tacos and ate in the classroom. For dessert, I bought a cherimoya fruit. According to Wikipedia, Mark Twain called it "the most delicious fruit known to men", and I'm a believer. At $4 it's pretty expensive as far as fruits go in Ecuador, but it was enough for 5 people. When you first bite into it your tongue does a double take, thinks it's died and gone to heaven, then realizes what's going on and never stops wanting more. That's probably the best way to describe it.

Friday was my last day at Tierra Nueva and I decided to go back to surgery. There are two operating rooms, and when I got there one had a 2 year old girl getting deformed teeth that she was born with reconstructed, and the other had an abdominal hysterectomy. The woman who got the hysterectomy the day before had started having trouble breathing at night, so they put her under anesthesia and had her hooked up to a breathing machine in the recovery room. I watched them suction out mucous from her lungs, which was a little hard to watch because she had to be awake for it. She was basically fighting for air and had to be restrained every time the tube went in.

So now for the "grand finale" of the week. A woman was scheduled to have a C-section at 11:00 am, but they found out she ate something that morning so they had to wait another hour and a half. Technically I'm only supposed to be there from 8 to 12, but since there's no class on Fridays I decided to stay. I had bread and coffee with the nurses while we waited. When the nurses were preparing the OR for the surgery, I asked if there was anything I could do to help. I was thinking along the lines of setting out tools or covers, but the head nurse walked over to the doctor and told him I wanted to scrub in and assist. He said sure. So I washed up, they put a gown and sterile gloves on me, and I was one of four people standing over the patient. I used gauze to dab any bleeding as they cut through the layers, then after they pulled the baby (boy) out I used suction to clear the pooling blood out. I kept the area dry and visible while the doctor stitched up the uterus and other layers as they closed her up. One thing I really liked was how the rectus abdominis (ab muscles) flexed involuntarily as he cauterized bleeding vessels. When he got all the deep suturing done, the main surgeon left. His assistant started suturing the skin back together, and she let me do the second half. It was a different technique of suturing than what I learned in Peru last summer in that it was continuous and parallel to the opening instead of perpendicular with separated knots. At this point I was very glad I'd been practicing on banana peels. Having a nasty Keloid scar of my own, I was a little worried that my lack of experience might end up leaving her with a more visible cicatríz, but my half looked just like the first half and she assured me it was just fine. While I was suturing the nurses were calling me guapo and telling me I need to take them out for ice cream and dancing that night. I did end up going salsa dancing, but sadly not with them. 

Baños

For our first excursion out of the city a bunch of us went to Baños, a small tourist town about 4 hours by bus from Quito. Its name comes from the natural hot springs caused by the active volcano that borders the town, not because it has particularly special bathrooms.





Travel buses here are surprisingly comfortable, and end up costing less than a dollar per hour. The price makes Greyhound seem like straight up robbery, but it's far from luxury. As soon as the bus gets out of city limits and starts to pass through small towns, it picks up anyone who needs a ride and before you know it the aisle is stuffed and it resembles the public transportation in Quito.
We arrived Friday night, unpacked, and went out to some bars and dance clubs. Having been to Perú and experienced the “Pisco Sour” culture, I decided to try Ecuador's version of the drink. Contrary to the name, it was very sweet; and also blended, not shaken. This would be enough to make any Peruvian furious, and honestly, I felt a little offended myself. The next morning we went on a mountain bike ride to some waterfalls. A couple of hours in, a girl (the one I worked with the first week) crashed on the side of the road, and split her chin open. As soon as I saw it I knew she had to get stitches. It must have been the visible fat and muscle that gave it away. The only problem was we were 10 or 15 minutes away from town by car, and the only way to get back would be to hitch a ride. Luckily some Spaniards that were biking to the waterfalls had a car following a few minutes behind, so I went with her to the hospital while the rest of the group went on. I wanted to make sure they used clean instruments and to be a translator in case she was too shook up to understand. Apparently they get enough tourists getting injured that their equipment is decent for a rural town. She had 2 or 3 deep stitches and 5 superficial stitches. I'm not sure how they handled the bikes we had to leave behind, but all I know is they ended up back where they belong.

That night, after taking a dip in the hotsprings, we all hopped on a Chiva bus. Chiva buses are really popular in Ecuador. They're basically open party buses. Everyone gets their drink of choice beforehand, and the bus drives around for a few hours while music plays and people dance. It took us up a mountain to get a view at the volcano, which is often glowing and spewing a little, but it was too cloudy that night. We got dropped off at a Latino dance club and walked back to the hostel after a couple more hours there.

On the Chiva bus

Making jugo de caña, sugar cane juice. I bought some and after a few days it was fermented. My host dad and I tried some and it was pretty good, although any more than a sip would probably have given me the runs judging by the appearance of it.

A view of the town of Baños

I watched the World Cup final with my family after coming back on Sunday. It was a different feeling to watch soccer in a country that actually enjoys it. Kinda nice.

Week 2

This week I've been working with Dr. Salazar, a gynecologist at El Hospital IESS, one of the biggest hospitals in the city. Gynecology was never on my list of fields that interest me, and although I did see some interesting things this week, it's definitely going to remain that way. On Monday I watched my first surgery: they inserted a camera and a "picking" tool into a patient's uterus through the abdomen in order to cut away at a benign mass on the uterine wall. Afterward they said that she might as well get a hysterectomy because although the mass was benign, she wouldn't be able to have kids. That night I went running for the first time, which I found out the next morning was a horrible idea, and saw Toy Story 3 at a nearby mall (for only $3.50!!).

A group of Ecuadorian med students that work at Hospital IESS are friends with my host sister's boyfriend Andres, who also works there. After working with Dr. Salazar I would hang out with them for a while. If there's anything to do they let me do it/show me how, but if not we just talk about music and stuff. Today I took blood for the first time with them. They hadn't even shown me how to do it yet and they asked in front of a patient if I wanted to try; I could see the look of absolute relief on her face when I said I'd better watch first. My first go at it wasn't perfect, but I got the job done. I was surprised to feel so undisturbed about sticking someone when I hate needles so much myself.

This weekend we're going to Mindo, a place known for its jungle ziplines and butterfly sanctuary.

Week 1

Sorry about the delay, the past week and a half I've been working on getting my daily routine down.
For those of you aren't quite sure what the trip is for, it's a medical internship through Child Family Health International (CFHI). CFHI is a non-profit organization that sends pre-medical and medical students to underdeveloped countries to intern and learn about healthcare abroad. A good amount of the fees go toward compensating the doctors for teaching us and to help out the hospitals and clinics. I'll be spending 7 weeks in Quito, the capital and 2nd largest city, which is nestled in the Andes mountains at 9,400 feet in the Pichincha province. The other 3 weeks will be spent in Chone, a small rural town near the coast. The internship is a urban/rural comparison, so I'll get to see the contrast between healthcare in Ecuador's more developed regions versus a less developed area. I'm staying with an Ecuadorian family and their dog, Rosquita.
Every weekday I have clinical rotations in the morning for 4 hours, followed by Spanish classes at the Amazing Andes Spanish School. We've been switching between grammar, medical terminology, and situational stuff that would happen in a hospital like describing symptoms and interviewing patients. Andrew (another Beaver) and I are the only ones in the group that aren't in med school, so some of the medical stuff is a little over my head but the other students are helping me out with that. The anatomical terms are almost all identical to the English terms, so that makes things easier.

I'm still trying to get to know the city; the only place I've been to so far is La Mariscal, aka Gringolandia. It's a really popular area with tons of dance clubs, bars, and European style pubs.
Every week we switch Doctors and hospitals. Last week I was with Dra. Guamán, a family physician that travels around the city to different clinics every day. The first day, we (one other intern and I) observed for a couple hours at a clinic in the west side mountains in a poor area, and then they had a ribbon-cutting celebration for their new second floor. They had us stand in front of the community members with them as if we were important people, while the administrators, engineers, and doctors gave speeches.



Then we were given wine to toast with and cake. So all in all it wasn't a very stressful day. On Friday we went to a day care in the mountains to check up on the growth of the kids and to check for malnutrition. One girl was malnourished and tachycardic, and it was apparent; she was small for her age, skinny, and was really quiet in comparison to the others. She's on the right in the pic:




Last weekend a bunch of us went to Baños, a small town with a lot of waterfalls, a hotspring, and tons of adventure-type things to do. More on that, and an interesting story about emergency stitches in a rural Ecuadorian hospital, later.