Back in Quito

The bus back to Quito took about 6 hours. On the bus' TV's our entertainment was a pirated copy of the new Karate Kid movie with Jackie Chan, dubbed in Spanish. It was filmed by a home video camera in a movie theater, and you could hear the audience laughing like a laugh track during the funny parts. On street stands and in movie shops pretty much everything is a copied version, never the original, and movies go for about one or two dollars. Piracy is still illegal there, but the police just don't do anything about it. Even video games are copied and sold for a couple dollars. The only places I noticed that sold legitimate media were the malls.

As much as I liked Chone, after 3 weeks you start to wish for something more to do than go to the hospital, eat and watch TV. I was glad to be back in Quito where I still had plenty to explore. I decided to do another rotation in Hospital Militar with Dr. Vargas, the general surgeon. Militar was the most interesting clinical week I had before Chone, and since pretty much everyone was gone we had freedom of choice. After seeing plenty of surgeries in Chone, which can sometimes be described as a “bloody mess”, I appreciated how precise and clean Dr. Vargas and the other surgeons in Militar were. They went slowly and make sure everything got cauterized so that the area was as dry and blood-free as possible. Dr. Vargas would sometimes cuss out a vessel that gave him any trouble. He went to school in New Mexico and has the “perfectionist” attitude that is pretty much legally required in the States, but completely absent in Chone. The first surgery that week was on a man that had been diagnosed with duodenal cancer. They opened him up, but couldn't find anything wrong with the duodenum. Then they found that the pancreas was inflamed. He had been wrongly diagnosed, and Dr. Vargas was pretty pissed about that. The two possibilities were that he had pancreatic cancer, a very serious cancer that would require them to do a risky surgery called a Whipple, or pancreatitis. He ended up just having pancreatitis, very good news. After case presentations the next day we walked to the adjacent building to Dr. Vargas' external consult. We were climbing the stairs when he stopped to say hi to a man, then afterward he said, “I saved his life. I made him a new esophagus out of his colon”. I don't know how much more badass it can get than that. During lunch there was a news story on TV about a woman from the Guayas province on the coast that is 124 years old. She was able to walk around on her own without a cane, and they showed her dancing to the radio. It wasn't exactly salsa, but the best dancing I've seen from someone in their 120's. She had sons still alive in their 80's and 90's.

Later that week I saw a surgery to reconnect the small and large intestine after the patient had part of his colon removed. He also had no ab muscle between the intestines and the abdominal wall, so they used permanent internal sutures with metal wires instead of thread to provide more support. I caught the end of a c-section, but the baby wasn't breathing. They intubated her and tried to get her breathing on its own for a long time, and she was getting bluer every minute. Eventually she started breathing, but I hope no damage was done during that time. There was another c-section, this one a placenta previa (the placenta grew at the bottom of the uterus instead of the top). It was probably the bloodiest thing I saw in Ecuador, but at least other than that it went smoothly.

After clinic we walked around old town and got something to drink at a cafe in Plaza del Teatro. We sat there for a while, watching a man as he set a mat down in the center of the plaza and started stretching, meditating, and doing 3-point headstands. At first we thought he was some kind of yoga performer, but what he was doing really didn't seem that impressive. Then he brought out a makeup kit and painted his face completely white. A crowd started gathering, but we were still trying to figure out what exactly he was there to do. That's when he started doing the usual mime tricks like pulling the invisible rope and being stuck in the invisible box, but was talking at the same time. Apparently he didn't get the memo that mimes don't talk. I wanted to get closer to hear what he was saying to the crowd because whatever it was, it was attracting quite a few people, but we remembered that the last time we approached a street performance as the only white people in the crowd they made us the main attraction.

That weekend I finally made the trip out to La Mitad del Mundo, aka the equator. It's called La Mitad del Mundo because the Spanish word for equator is ecuador, which could cause some confusion. It means “The middle of the world”. It's about 30 minutes by bus to the north of Quito. There's a giant monument with a yellow line running through it representing the equatorian line. It was by far the most touristy place I visited in Ecuador. But still, I felt it was my duty as a gringo to take one of the most cliché photos in the world of traveling, straddling the equator with the “world” in my hands.

In the 18^th century some French scientists found the area to be the center of the world, and in 1979 a smaller monument was replaced by the monstrous one that sits there today. Then GPS came around and woops! They were off by 240 meters. There's a small museum outside La Mitad called Intiñan (Kichwa for sun path) which has the real line running through it. It was a pretty interesting museum; we saw gigantic preserved snakes and spiders from the amazon, a parasitic worm known for its tendencies to swim up penises, a real shrunken head; we walked through tradicional houses of the different indian tribes and petted some oh-so cute and delicious guinea pigs (cuy). But the coolest parts were the experiments they did on the equator. They had a sink of water which they drained on either side of the line, and the water cyclone went in opposite directions but drained straight down directly over the line. I balanced an egg on the head of a nail, which was hard to do at first but I noticed as soon as the wind died down I was able to do it in seconds. They had us walk straight along the line, foot to toe with our eyes closed and hands out and it was pretty hard to stay balanced. A few people nearly toppled over after the first step. So the equator isn't a place you'd want to take a sobriety test. We also did a test where we would stand on the line with our hands in a ball directly in front of us, and the guide, not standing on the line, could easily push our hands down despite our resistance. She explained why, but I don't really remember what causes it. Something about physics.

I swear, officer, I'm not drunk!

A shrunken human and sloth head

Some ladies finishing up a traditional Ecuadorian dance

When we got back to Quito, we had our hearts set on Peruvian food for dinner, and I knew of a place. I knew of it, just not exactly where it was. So we walked around for probably an hour and a half, nearly starving to death, when we decided to go into a mall and use the internet to find it. That's also when I had the best McFlurry of my life, not because I was so hypoglycemic, but because everything fast food is just made better there. We got the directions and made it there in time to eat before they closed. It was by far the most expensive meal I payed for in Ecuador, at about $12. Peruvian food is some of the best in the world and it made me really want to go back. Afterwards we rushed to go see a movie that was starting soon, but traffic was bad because of a 10K race that night. It was La ruta de las iglesias (The route of the churches), a race that goes around the historic district and passes by all the old churches. When I heard about it in the first week of being there I really wanted to do it, but I forgot about it. Being back at 9,400 ft for less than a week after 3 weeks at sea level, running a 10K probably wouldn't be the best idea if I didn't want to spend the next day in the bathroom. We watched El Origen, or Inception as it's called up North. There was just as much hype in South America for the movie as I'm sure there was in the States. It was in English with Spanish subtitles, which is good because although my Spanish improved quite a bit, it was hard enough to follow in English.

Hospital Napoleon Davila Cordova

For 3 weeks we shadowed Dra. Diaz in Chone's main hospital, Hospital Napoleon Davila Cordova. It's small as far as hospitals go, but it's by far the biggest building in town. Its age shows in the peeling walls and dim lighting, but it has what it needs to serve the patients. Dra. Diaz is a pediatrician, so every morning, after waiting for someone to unlock the gate that keeps creeps who would want to steal kids out, we met up with her in pediatrics and did rounds. In Quito I didn't get much of a chance to see patients as they came in, were treated/had surgery, and recovered because of the switching hospitals every week. Here we got to see them everyday, and there were a few kids who were there the entire three weeks. Here's a few:

Oscar, 12 years old, burnt his left leg from gasoline in a trash fire. He was really shy but always smiling. His leg looked a lot better as the weeks went on.

These two were the first kids we saw in Chone. They were there for malnutrition. The little girl was worse than her brother, and they both gained weight steadily.

This is Kevin. His faced was burnt, along with his mom's arms, when a gas tank exploded in their kitchen. He had skin grafts the week before. I sat with him for a while playing with cards and my camera, and he was just like any other curious, playful kid at the hospital for a checkup.

Most of the cases in pediatrics were infants with diarrhea, and I learned that Dra. Diaz is an expert at examining caca-ridden diapers. I felt like she would make a good fortune teller or palm reader, the way she could determine the state of the baby just by its poop. There were also a lot of fevers and lung infections. One girl was sick from eating bad shrimp ceviche. Unfortunately, there were a few kids that had never had any vaccinations because their parents didn't bother taking them in, even though most of them are free. One woman that wasn't a citizen of Ecuador never took her two kids, the younger one 4 years old, to get vaccinations or to go to school. The doctors drilled her about getting the kids to school despite how far of a walk it may be, and to become a citizen so they could take advantage of free healthcare.

The surgeries there were pretty interesting. Most of them were orthopedic. The first day I saw them fix a tibial fracture with metal screws and a broken elbow with 3 nails. The mother of the kid with the broken elbow asked for the pictures I took of the surgery, so we met up at an internet cafe later. Turns out she wanted them as proof for insurance that the surgery happened. I figured a doctor's signature and an arm in a cast would be enough. Some of the more gruesome ones I left out. Two of the surgeries were completely fractured femurs. The femur is incredibly strong, so when it breaks it's pretty serious. They were both older men; one was in a car accident and the other was walking on the sidewalk when a trailer hit him. Both surgeries highlighted the fact that this was the rural part of the experience. The first man was diabetic, and the surgeons cut into him before the anesthesiologists had him fully stable. He was out, just not quite ready yet. They argued throughout the surgery about who wasn't doing their job right. Halfway through, the patient woke up and I helped keep his arms down. I didn't want to pick sides, but even if I did it would have been hard to decide who was the lesser danger to the patient. I started to get used to restraining the arms of patients coming-to after a while. They still can't feel anything, they just come out of their sleep and are really confused. What I think it is is that they try to use as little anesthesia as possible and they often underestimate. Then there's the other femur patient, who was awake the whole time, content as one could possibly be while they hear the sounds of power drills putting holes in their bones and getting jerked around from tugging on legs and putting metal rods into place. I still have no clue how he didn't get nauseous, I don't even like hearing my teeth getting scraped at the dentist (no offense, mom). There was a tall guy at all of the orthopedic surgeries scrubbed in who seemed to know most about the procedures and the tools. He was also usually the most calm person in the room minus the nurses. We figured he was the head orthopedic surgeon, and that he was teaching the others because he rarely did anything other than help them use the hefty, specialty tools. Turns out he was just a representative from the company that sells the equipment, and not even a doctor. I guess in terms being a salesman he chose a pretty interesting job.

On our last day in Chone, Andy and I scrubbed in for an intestinal surgery. A little boy around 5 years old was riding his bike when he crashed. The handlebar hit his stomach hard enough to make a small puncture in his small intestine. He had surgery to repair it the day before and seemed to be recovering, but during the night he started bleeding internally. There was too much pressure on the injured area, so they made incisions on either side of it and connected them to make a second pathway in the intestine to relieve the pressure. After that he was fine.

I spent some time in the emergency room a couple times in the afternoon. One of the first patients was a diabetic woman with hypertension that fell unconcious at her house. She seemed pretty out of it, and after being on the bed for a while she had a seizure. There was also a case of burnt legs, severe back muscle pain, a bad alergic reaction, a big splinter from a bike crash that was deep enough that I got to give him 4 stitches, and one of the more interesting things I've seen: two policemen brought in a newly-arrested 18 year old in handcuffs for the doctor to check for signs of police brutality. Apparently every time they arrest someone they need to take them to the hospital for a doctor's signature to prove they didn't beat the crap out of them. I like the idea, but I wonder they ever wait until after getting the signature to beat them up. Hearing them talk, I picked up something interesting. The spanish word for handcuff is esposa, which is also the word for wife. Interesting...

La Fundación Gerontologica "Jacinta Polo de Zambrano"

On our second to last day, we went with Dra. Diaz to a retirement center in the afternoon. It was only a few blocks from where we were staying. We were surprised how nice it was- with green lawns, a well-kept garden, lots of activities to keep them busy; it seemed almost out of place among the pothole and trash-ridden dirt roads and run down houses just outside its walls. The people there sleep in their own houses, but spend all day there. We walked into a room, surrounded by everyone sitting on chairs against the walls, and introduced ourselves. We answered some questions about what we're in Ecuador for, what do we want to do in the future, etc., then the 3 of us sat at separate tables and we interviewed them one by one. We asked about their family, their life, how they like the center, their medical issues, and any random thing that they wanted to talk about. A few people I talked to had 8 kids or more, but I'd say the average was about 5. I asked each one what kind of tropical disease they have had in their lifetime and everyone had had dengue fever at least once. One man was a truck driver for 45 years and had multiple surgeries related to bouncing around on his butt for most of his life, as well as losing most of the hearing in his left ear, the side most affected by the sound of the engine out the window. A woman told me a story- and I couldn't completely understand everything she was saying- about how she broke her leg as a child, so her grandmother did something with the blood of a black dog, and she healed right up. Everyone who was capable of walking told me their favorite activity there was dancing. They have a lot of birthdays every month so they always celebrate with a party and dancing, in addition to the weekly dancing they do anyway. Andy was talking to an old fellow for a while who was pretty difficult to understand, and the topic of urinary troubles came up. He told Andy he had “mal de orina”, meaning urinary problems, but Andy heard “mandarina”. A few minutes earlier someone had given us all mandarin oranges, so he replied No thanks, I've got one already. That created quite a bit of confusion between them, and Dra. Diaz couldn't stop laughing when she heard the story.

I forgot to write about our second trip to Canoa. We went the weekend before heading back to Quito, for one last taste of saltwater. We took a bus to a small town near Chone called San Antonio, where we bought tickets for Canoa and waited around for about an hour for the bus to arrive. Thinking that we had reserved seats because we bought tickets, we didn't bother rushing onto the bus when it got there like everyone else. That turned out to be a mistake because no one really cares about reserving seats, let alone buying tickets beforehand. People just get on and someone goes down the aisle collecting money. Long story short, I had to stand in the aisle the whole way there. We got there after dark, and walked down the familiar road parallel to the beach in search of a hostel. “El Coco Loco” is what we decided on. After eating hamburgers out of a van-turned-kitchen (we were short on money), we sat at the hostal bar with 3 German girls, British guy, an Irish guy and 2 Ecuadorians that live on the Galapagos Islands. They were passing around a coconut shell with a straw, which was needless to say more than just coconut milk. At that hostel they cut holes in coconuts, mix the milk with the sugarcane alcohol aguardiente, cork it up and bury it in the sand for about a year. Hence the name Coco Loco. We went out dancing with them afterwards and I slept most of the night on a hammock outside our room.

The next morning, I stood under a hot shower for the first time since leaving the US. We have hot water in Quito, but it's expensive to run so I have to turn it off to soap up and the whole process is pretty rushed. It was a luxurious 5 or so minutes. Due to some bank troubles, the other two in my group were both completely out of money and couldn't get anything out of the bank for a while. My cash that I brought for that weekend had to sustain us three, and even if I had brought my debit card, it wouldn't have done much good because Canoa doesn't have a bank or an atm. So while on a morning walk on the beach I did some calculating and realized after buying bus tickets back to Chone and some other required expenses we would have $.75 to spare for food that day (we thought that our hostel had free breakfast, but it was just clever advertising). You can find some cheap meals in Ecuador, but a quarter won't get you very far. Just as I was accepting the fact I would have to starve until getting back to Chone, Fransesca miraculously found a $20 bill in her luggage. We ate some brunch and headed back home. After getting back to Chone we went to the store and bought fruit, vegetables, meat and pasta to make dinner with. We were alone in the house most of the evening so we fended for ourselves. It was nice for us to finally cook our own food, even though the end product wasn't exactly up to par with what we'd been eating. In fact, it was almost a disaster but we were hungry so it didn't matter.

Experimenting with coastal cuisine