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