Última semana

I chose to go back to Tierra Nueva for my last week. I was there for week 3, and had a pretty good time in surgery. The nurses and residents all knew me by the end of the week, and I told them I might come back in a month or two. When I went they were still in an old building, and I heard talk of a new building and them slowly transitioning over. By the time I went back, all the departments were moved over. It was about 15 minutes farther south from the old Tierra Nueva (Tierra Nueva Vieja, we called it), so the trip took over an hour in total. Andy was with me that week. We got off the trole at just before the south bus station, then walked through a really nice new park that reminded me of an Oregon campground to reach the hospital. I couldn't believe how nice it was inside. It looked like something you would see in the States, and even had that “sterile” smell that was absent everywhere else. We met with Dr. Estrada at the door. Dr. Estrada had a reputation with me of not being very helpful, just making us wait for a while then showing us where to go. That's if he even showed up. The first day was no exception, we waited around for about 45 minutes while he was just on the other side of the door. When he was finally ready, it took about a minute to get us to the surgical unit. Every day after that we didn't bother checking in with him in the morning.

After giving them our ID's to rent scrubs and getting dressed, putting on caps, masks, and booties over our shoes, we walked in and a nurse that called me “Matty” recognized me so we talked for a bit. We watched two surgeries where they removed the prostate through the abdomen. In one of them the man was awake and started gagging, I think due to the anesthesia, in the middle of the surgery. I got to see what the gag reflex looks like on the inside. They turned his head and set a bowl by him just in case. For lunch we ate at a place I went to the first week, when my friend and I had the urge to be a little adventurous and eat at a hole-in-the-wall. Looking back, I realized my definition of hole-in-the-wall is completely different now. The place actually seemed pretty nice compared to some restaurants I'd eaten at since. There were lots of customers, no flies, an actual menu... a lot can change in 10 weeks. Being that we hadn't seen many new faces since we left for Chone after week 4, we stopped by the Spanish school to say hi to some new people that just arrived that weekend. That night we went out to Gringolandia, to the same bar we went to on our first night out.

The next day at Tierra Nueva we saw a laparoscopic gallbladder removal and a hernia repair. The anesthesiologist was German man who was there for 2 weeks. He said his son was a doctor working there full time, in odontology. His English wasn't great, but we got by with an English-Spanish mix. One of the most entertaining things that week was listening to his conversations with the Ecuadorian anesthesiologist. They both spoke in broken English to each other, making hilarious mistakes but to them it probably sounded like flawless English. I found it so funny because I knew that was most likely what Andy and I sounded like when we had Spanish conversations. That night we had our last meeting with Dra. Alvear, then went to the theater to see a very cheesy horror movie called 100 Feet.

On Wednesday we watched another gallbladder removal and a nasal septum repair to remove masses obstructing the airway. The same plastic surgeon was there that did the nasal surgeries I saw at Tierra Nueva 7 weeks earlier. Andy and I had popcorn and coffee and talked weather and Oktoberfest with the surgeons and the German anesthesiologist in the breakroom. After the rhinoseptoplasty there was a cesarian. By then I had seen enough births for it to not be too exciting, but every time they pull out that little floppy, confused human I always get hit by how incredible it is. How the most complicated thing in the universe is made unconsciously in only 9 months. Something almost equally astounding was the $1.50 pizza + beer place Andy and found for lunch that day. Also, “Only in Ecuador” moment 301: I realized the nearby liquor store was a drive-through.

That night was the final game of La Recopa, or South America Cup for soccer. It happens every year and the best club teams in South America compete for the trophy and the right to put another star on their team logo. Quito's best team, Liga Deportiva Universitaria de Quito, or just Liga, was the defending champ and played against a team from Argentina. We went out with one of the younger Spanish teachers from the school, Jorge, and the new people to a popular bar/restaurant to watch the game, but when we got there we realized they had a concert that night and wouldn't be playing the game. By the time we got to La Mariscal in hopes of finding a sports bar with an open table, the entire main plaza was already packed. You could hardly move around in there. We watched the game on the street through a store window for a while. At one point I heard a man behind me yelling; there were some presumably drunk kids peeing on his business' wall, so he took his bucket of water that he probably keeps for that purpose and soaked them. We walked over to a more spacious area where a giant crowd was watching the game on a projector screen. The game was coming to a close; they were tied but Liga had won the first round so as long as Argentina didn't score they would win. Some shirtless guys climbed up on the stage in front of the screen and started cheering and doing what drunk fools do. The crowd responded with throwing their 600ml glass beer bottles at them. I thought that was pretty dangerous, but when the game ended and Liga earned their star people started throwing bottles nearly straight in the air. There were bottles flying 20 feet over everyone's heads about every 5 seconds. Then someone lit a couple flares and threw them up as well. One of them hit a person not paying attention in the arm. A guy wearing a Liga jersey and cape ran in front of an ambulance trying to get through the plaza with a nasty cut on his jaw. He kept yelling ¡Ayúdenme! ¡Sangre, sangre! But the ambulance didn't want to pick him up. Eventually they got tired of him standing in their way and someone got out of the back and took him in. Luckily, we were a safe distance from all of this before it happened, but we knew that because the game was over the crowd would soon disperse, sending hooligans our way. We went to a club for some dancing and high-fiving with random people over the win, then to a small salsa club.

Thursday at Tierra Nueva, my last day of going to the hospital, was one of the coolest surgery days of the trip. I watched a saphenectomy, the removal of the great saphenous vein, which runs from the upper inner thigh to the foot. It is very superficial and not essential, so they remove it to use in heart bypasses. In this case they removed it because of varicose veins caused by deformed backflow valves. They had mapped out the vein and its branches on the leg with a marker. The surgeon went through each intersection, clamped the branch and cut it until it was just the one long, detached vein. Then they took a long metal wire with a cap on the end and threaded it through the vein, from the foot all the way up to the groin. When the end cap went through it took the vein with it, and when it came out the other side the vein was about an inch long, scrunched like an accordion. After that was over they were starting a posterior cruciate ligament (in the knee) repair in the other operating room. It was a laparoscopic surgery, and they used a really cool tool that worked like an electric toothbrush that cleaned the bones with heat. By the time that was over, they were getting ready for another saphenectomy and I asked if I could scrub in. It was a 26 year old girl, very young for needing this kind of surgery. Instead of using the metal wire to pull the whole vein out, they removed it piece by piece through small incisions. I helped pass tools, dry up blood, hold clamps, and suture the incisions back up when they were done. In anatomy class almost two years ago I read about that procedure and the uses of the saphenous vein and thought it was interesting, so it was cool to actually assist in it. There were some nurses there that day that I talked to a lot my first time at Tierra Nueva, the ones that invited me to ice cream and dancing as I was suturing my first human being. Andy and I got pictures with them before we left.

We walked around Old Town for a while, looking for food but in reality we weren't that hungry. That night we would be having free dinner on the Spanish school so we decided to head home and just eat some fruit. That's when I saw a giant empanada in the window of a small restaurant. I had eaten plenty of empanadas already, but I could never seem to find the monstrous ones I read about on the internet. There was only 1 ½ days left, so I seized the moment and ordered one. It was filled with slightly sweetened cheese and sprinkled with cane sugar. Everything an elephant ear wishes it could be.

That night I went to Rosita's house (the head of the school) and returned my Ecuadorian cell phone they gave me at the beginning of the trip. I had dreaded that moment for a long time. I remember the 4-week interns turning in their cell phones and thinking “glad that's not me”. It means that in 48 hours you would be sleeping in your own bed in the US. We took taxis with the new people from Rosita's house to a fancy restaurant that I had my eye on for the past few weeks called Crepes y Waffles. I had Peruvian style chicken in a bread bowl, followed by a very stylish cup of ice cream. I hurried home because Andrés and Ana were going to get a couple friends together to go out for a goodbye party, but Andrés came down with a bad flu and one of the guys, Sebas, broke his ankle playing soccer that day. So I stayed home and worked on this blog and packed a bit, although I didn't get very far.

I woke up early the next morning to meet Andy at El Ejido park, where we took a taxi to the Teleferiqo, a gondola that takes you about 5,000 feet above the city to the active volcano Pichincha. We first packed some fruit from our houses and freshly made candied peanuts from street vendors. To get to the actual peak there's a few hours of hiking after the gondola ride. We hiked about an hour farther than the first time we went up. It was a gorgeous day and we could have gone all the way up, but I was running out of time before meeting up with a girl I met in Otavalo the weekend before. It was painful to descend the mountain without reaching the top because most days it is cold and nasty up there, making it dangerous for people not familiar with it to climb. To save time we ran down, which I'm sure did a number on my knees. We took the gondola down with an Ecuadorian family. I could tell they were from the coast because the dad spoke without pronouncing his S's, but I didn't want to directly ask him if he was a Costeño. The general view of Consteños by people living in the Sierra, called Serranos, is that they're noisy, mischevious, and vulgar. They call them monos, or monkeys. On the other hand, Consteños consider Serranos to be hypocrites and untidy. They were from Guayaquil, a coastal city and Ecuador's biggest. I took a quick shower when I got back and took a taxi in the lunch rush to La Plaza del Teatro to meet with Carolina. We checked out two churches, La Compañia de Jesus and La Basilica. La Compañia is very impressive, with gilded walls and incredible detail on every surface. It is said to be the most beautiful church in South America, and is considered by UNESCO to be one of the 100 most important buildings in the world. I had been to La Basilica, but I hadn't climbed it yet. You can pay a dollar or two and take stairs up to the clock tower, and use catwalks, ladders, and old metal stairs to get around to higher points and great views of the city. There's also a restaurant and gift shop up there.

I made it back in time for dinner at Archie's Pizza with Andy, Francesca and Dra. Alvear, the local coordinator. We talked about our experiences, what we liked, didn't like, which doctors were nice and which ones we couldn't stand, etc. After dinner Andy and I went to La Mariscal to meet with Carolina and some of her friends, and we all went salsa dancing. We went to the same place as the night of Liga's win, Mayo 68; a small, dim, two-room club with low ceilings and handwritten messages all over the walls. We stayed until about midnight, then Andy and I took our last creepy trole ride, and I took my last night time stroll to my house, keeping my valuables in my sleeves and watching for ladrones (thieves). I had yet to do most of my packing, but just getting back from dancing salsa, I didn't feel like preparing to leave Ecuador. So I wound down by watching a TV show on my laptop, then got to work. I finally got to bed around 3am, and woke up 3 hours later to catch my flight. I had breakfast, said goodbye to my family, and hopped in a taxi. The Quito airport is surprisingly small considering how large the city is. It was really sad to watch Quito get smaller and smaller; all the hospitals I spent so many hours in, the places I had so much fun in with new friends, the houses of my Ecuadorian panas, slowly becoming unrecognizable.  

El Mejor Fin de Semana

As far as weekends go, I couldn't ask for much better than our last one. After clinic on Thursday we went to Otavalo, a small town known throughout Ecuador for its giant indigenous market. That weekend they were having their corn harvest festival, called Yamor. Kind of like an Ecuadorian Oktoberfest. Yamor is Kichwa for corn. But first, I needed to get money at a bank in Quito. I used the ATM, then went inside to get smaller bills I could actually use there. I asked the lady at the counter, in Spanish, for x amount of $5 bills. She looked at me confused and asked again what was it that I wanted. I told her again, as clear as I could, but she still didn't get that I wanted to change the twenties I had in my hand, waving in front of her, for fives. Then a man in line behind me told her what I wanted using basically the same words, and she goes Oh, cambio? Yes, please! I've never had a problem with locals not hearing past my accent, so I still don't know why there was any confusion. I laughed and asked the guy behind me, Mi español está bien, no? He said he understood me, and shrugged at why she didn't. She looked pretty embarrased. After, I met up with Andy a few blocks away. I was waiting for him, sitting on a short concrete wall when a lady walked up and asked for directions to some street. At first I thought it was a joke, asking the only gringo in sight in a busy street full of locals for directions. By chance, she was looking for a street that I knew of and I got to flex my Quito knowledge and point her in the right direction. When Andy showed up he realized that somewhere between walking from his house to me, someone had cut a hole in his backpack with a knife hoping for something nice and expensive to fall out, like some kind of cloth piñata. Luckily there wasn't anything in the pocket he cut, and Andy got to practice his suturing later fixing it. We found Francesca and headed out to to the North bus station. We were the only ones on the bus when it left the station, but on the first corner it stopped at outside the station enough people got on to nearly fill it up. Two young kids that worked as ayudantes, the ones who lean halfway out of the bus and yell at people to get on, hopped on the bus and started talking to each other. They were having a normal kid conversation, every now and then giving each other a playful shove, but as soon as we neared a bus stop their eyes would light up and they'd jump off the bus and run alongside it yelling ¡Otavalo, Otavalo! and try to help people with their bags whether they wanted to go to Otavalo or not. I've seen street vendors selling some strange things, but the most random was a guy along the road before we got out of Quito selling cheap plastic brooms. I wouldn't have thought much of it, but the bus driver stopped, stared at the brooms for a good 30 seconds while the vendor described how awesome they were, and decided to buy one. The ayudante made the exchange and put the broom in the overhead compartment above us. That was about the 300^th time I thought on my trip, “Only in Ecuador”.

After we got to Otavalo and tossed our stuff in the hostel we went searching for dinner. There was a drunk guy sitting on the sidewalk that asked us where we were from every time we walked by. He listed all the countries he could think of where white people come from. We ate at a mexican restuarant located at the roof of a 5 story building that was otherwise completely empty. Just a concrete shell of a building with a restaurant on top, overlooking the plaza that would hold the center of the indigenous market on Saturday.

The reason we left on Thursday was to go to the indigenous clinic in Otavalo Friday morning. The Kichwa people have a lot of unique beliefs when it comes to illness and treatment. For example, a common way to be diagnosed is to go to a curandero, or a shaman, and be cleansed with a cuy. The curandero says some prayers in Kichwa while smoking and blowing it all over you, spitting alcohol on you, then rubs a guinea pig over your chest, stomach and back. They shake the guinea pig so hard that it normally dies in the process. Then they cut open the cuy and look at its organs. Whatever ails you is supposed to transfer to it, so if its liver is inflamed, you have hepatitis. If its kidneys or stomach or lungs are inflamed... you get the idea. We never got to see the cleansing with the cuy because there were no patients for it, probably because of the holiday weekend. What we did see wasn't as strange, but still pretty interesting. After waiting around in the clinic (which looked like a hotel) for a long time, the coordinator told us to follow an old lady into an office upstairs. She must have been in her 70's or 80's, dressed in tradicional indigenous clothing, walked really slowly and never said a word. We wondered what she was there for until she put on a blue coat, and we realized she was the doctor. The first patient she had was a pregnant woman. She was there to have her check her out and tell her how the baby is doing. She poured olive oil on her stomach and massaged it for a couple minutes and said a few words in Kichwa. Then she told her the baby might be dying. I felt like that was kind of a drastic thing to say after only touching the stomach. But the mother either didn't believe her or was being optimistic because she didn't seem to be effected by the news. Later, a mother brought in her 2 year old son with “mal viento”, a children's illness that they believe is caused by spirits. After massaging him with olive oil, she rubbed two eggs all over his body while saying more prayers in Kichwa. Like the cuy, the eggs are supposed to absorb whatever's wrong in the kid. Above the exam table there was a picture of Jesus. A lot of people I met were Catholic, but there are still a lot of Incan beliefs that carried on. A lot of religious Ecuadorians can remember when their parents took them to see the shaman. There was a Yachak at the clinic, a healer who supposedly has known the secrets of using herbs and his connection with the gods to cure people since the day he was born. He looked like a normal guy to me. His office smelled strongly of herbs, incensce and jungle medicines. I asked if we could go inside to see what he uses and possibly see him work with a patient, but he said it was forbidden. I later found out that was bullcrap because a girl on the trip who went a few weekends earlier had pictures of the inside.

Entrance to the indigenous clinic

Offices

I wonder what eggs taste like with extracted evil spirits inside...

Can of olive oil

When she wasn't seeing a patient, she was knitting

For lunch we had $1 burgers at a hole-in-the-wall. While we were eating, a Canadian guy sits down at the table next to us, orders, and starts talking to us. When we told him we were there on a medical internship, things got kind of wierd. He treated us like rock stars. In fact, he literally said that it was like meeting rock stars. He talked about our personality types and how we think compared to other people. Then he talked about the TV show Scrubs for about 15 minutes. I like Scrubs, but not enough to pick apart individual episodes with someone I just met and will never meet again. And somewhere in all the awkwardness the conversation shifted to World War II for a bit. I don't remember how, though. We got out of there as soon as we were done eating, not a second more.

During Yamor, they make a lot of traditional food and drinks. Chicha is one that I've been wanting to try for a long time. It's one of the oldest alcoholic drinks in the world, and it's made with corn. Originally, the Incan women would chew up the corn and their saliva would start the fermentation process. They use a different method now but it's still made using the same kind of ingredients, clay pots, etc. It tasted much better than it smelled for some reason. It was very earthy, a little sour, and with lots of sediment from the corn. On the wall of the place we ordered it at there was a collection of postcards from all over the world. About one in four were from Oregon, and above the postcards was one of those stickers with a heart in the middle of an outline of Oregon. The guys working there noticed that we were looking at the Oregon postcards and asked us if we were from there. He had a few friends from the Portland area. I met a handful of people who had either visited Oregon or had friends or family that lived there. One guy had even been to Corvallis.

Chicha de jora

That night there was a big parade. And by big I mean about 5 hours long. It was mostly dance group after dance group, with a float mixed in every now and then. The dance groups were from all over Latin America, and one from a sister city in Germany. Mexico, Peru, Honduras, Brazil... a few of them were groups of Ecuadorian citizens from foreign countries. After a while we realized it wasn't ending anytime soon so we went to eat pizza. There was a TV in the restaurant that showed a scrambled live video feed of the parade, complete with commentary. Later we squeezed through the crowds to a giant stage for a salsa concert. Andy and I mustered the courage to climb on an elevated platform in the middle of everyone that was used for VIP seating for the parade to dance salsa with some girls, but they had boyfriends watching intently from down below. It didn't take us long to find others. Later I was talking to the cousins of the girl Andy was dancing with. They were passing around a steaming hot fresh blackberry and sugar cane liquor, taking turns sipping like they always do in groups there. They asked me where I've been to in Latin America. I told them Mexico a bunch of times, Peru, and now

Ecuador. They asked me which was my favorite in a jokingly threatening tone, and of course I said Ecuador. Then their very inebriated friend, who had been glaring at me and not saying a word the whole time, put his hand on my head, got really close and said ¿Cuál es tu favorito? I repeated, Ecuador, and he slowly backed off, then punched me in the face. He was too drunk to make it hurt, so it was more surprising than anything. His friends held him back and apologized for the idiota. I didn't mind, it was actually the first time anyone had punched me seriously, and I was glad it happened in such a cool place under such interesting circumstances. A few minutes later they invited me to a cocaine and weed party in a nearby town that Sunday night. That was about the time I decided I was done with those guys. Besides, I had clinic on Monday. Not the best thing to show up high on cocaine to.

Selling cotton candy before the parade

We called it a night around 2:30. I got up the next morning at 8, had breakfast and headed down to the market. It didn't take me long to find it. I thought it would be just in the plaza that's designed for setting up shops, but nearly every street in a large section of town was lined with people selling things. It's amazing that they do that every Saturday. It's best to get there early because the sellers believe it's good luck to start the day off with a sale, so they're more likely to let things go for less. A few times I was able to bargain pretty steep because it was their first sale of the day. Another thing that helped me save a few bucks was speaking the little Kichwa that I know. Before coming to Ecuador I learned the numbers and a few simple phrases like good morning/afternoon/night, yes, no, thank you, how are you, etc. I got a few double-takes when would I walk up to a stand and say alli puncha (good morning). They were all happy to teach me more words, and one lady called all her nearby friends to come see the Kichwa-speaking tourist. There was a woman selling spices of nearly every color you can think of. I showed some interest in what she had, so she made me sample every single one. The people selling things were surprisingly mellow. I'm used to markets in Latin America being a constant fight between you and people dragging you this way and that way, telling you want you need. “No gracias” becomes a reflex response to anyone speaking to you. There was a little bit of pushing every now and then, but in general just looking at the merchandise was accepted. It didn't feel like glancing at what they had meant signing a contract that you'll buy something.

Typical market scene

Just before we left we ate the traditional Yamor dish that they only make that one time a year. It was a mound of different types of corn, fried banana, fried pork and chicken, potato, avocado, and salad.

Mmmm...

We drank a type of chicha called Yamor, which is what the festival is named after, made from corn and a bunch of other grains. My favorite Yamor food, though, were the little empanadas. The night before they were selling them for 20 cents each and I had my fill. On the way to the bus station I bought a chirimoya from a woman sitting down, selling fruit on a blanket. It was bigger and half the price of the one I bought in Quito, so I had my suspicions. But it was delicious and didn't make me sick. She even gave me another smaller one for free.

When I got back to the house in Quito I immediately fell into bed and slept for 3 hours. I needed the rest because that night I was going to Andrés' graduation party. Being the head of the class, he organized the whole thing. It was from 10pm to 7am, at a mansion about 30 minutes outside of town. He and his classmates were having dinner together at 7, then taking a Chiva bus over. After a quick stop by the mall to try out Ecuadorian Taco Bell with Andy, I got ready for 9 hours of dancing and headed out with my host sister Ana, her friend and some of Andrés' friends. We stopped by his house to pick up his brother and sister.

When we got there someone came around and put oversized foam ties and masks on us. The mask didn't stay long but the tie was kind of cool. The drinks were all free, and even though everyone could get a cup if they wanted, our group still took turns with the same drink. There was easily more than a hundred people there. It was really cool to see some people again that I met on week 2, when I worked in the hospital that all the graduates were at. They were surprised to see that I was still there over 2 months later. After a little while the dancing started up and didn't really stop until about 6:30am, with a few exceptions. At midnight we all went outside to see a fireworks show. At 2 in the morning there was a chicken soup break, and at 6 we had a shrimp ceviche breakfast. Toward the end of the night (or beginning of the morning) Andrés and his school buddies were hugging and crying telling stories about their 6 years of med school together. By the time we left I was deliriously tired and slipped in and out of consciousness during the ride back. Just like the previous time I arrived at the house, I went straight to bed.

I woke up around 1pm, the same time Ana did, and we had lunch. Cristina, my host mom, was really interested in hearing all the details. Later I ran to a mall to buy more minutes for my phone. On the way back it started pouring rain, and it reminded me that in less than a week I would be back in Oregon. I knew, back in the first few weeks when I had all the time in the world, that when last few days came around I would still feel like I had just arrived. That's exactly how it felt. I studied Spanish that night for the first time in weeks, and watched ¿Quién quiere ser millonario? With my family. One of the contestants was a man from Guayaquil, Ecuador's biggest city. Ana jumped up off the bed (the TV is in the parent's bedroom) when she saw him because he was the ex-boyfriend of one of her friends. He didn't leave with much money because out of a list of wine, he chose Merlot over Chardonnay to be the white one. The top prize on Ecuadorian “Millionaire” is $50,000. My family asked what the prize was in America, and their jaws dropped when I told them.

Semana 9

For my 9^th week, I worked with Dr. Barrera at the Centro de Salud #4. There are a bunch of Centros de Salud around the city. They're mostly located in the poorer areas of Quito, and provide free medical care when they can and at the lowest price possible when they can't. Dr. Barrera mainly sees patients with diabetes and/or high blood pressure. Every morning he would pick me up on a corner about a 10 minute trole ride from my house, and we drove up to the clinic. During the drive we talked about various things like current events, healthcare in our countries, sports, etc (we both agree that baseball is boring and golf is an activity, not a sport). Two things that happened around that time that made big news were the immigrant massacre in Mexico and a terrible bus crash South of Quito where 38 people died when the bus driver fell asleep and drove off a cliff. There were a few Ecuadorians among the 72 killed in Mexico, and the only survivor was an Ecuadorian man. That got us talking about the anti-immigration laws in Arizona and the proposal in Florida, and Dr. Barrera wasn't the first person I talked about it to, but the general view on it is that it's racism and the whole country is in agreement with it. I was pretty embarrased to hear that my country has earned itself a racist reputation, and all because of two states.

There were two other Ecuadorian medical students in their last year working with Dr. Barrera. They would see patients while he went off for smoke breaks. Smoking and drinking are pretty common activities among doctors there, from what I hear. I took the blood pressures of a few patients and listened to some hearts, nothing too exciting after spending a week in surgery and what I saw in Chone. On Tuesday there was a group of 6 first-year medical students in the consult with us. The room was packed. Despite the blinding white light from the wall of lab coats, the patients didn't seem to find it unusual. They were all 20 years old; almost 2 years younger than me and already on their way to being doctors. In South America, you go into med school right after high school, but med school is 6 years instead of 4. The highlight of that day was seeing Dr. Barrera drain A LOT of pus out of the hand of a woman, caused by her diabetes. There was also a 101 year old woman that came in to have her glucose checked.

Almost everyday I heard people drive by our house yelling something into a loudspeaker. Finally I asked Cristina, my host mom, what it was. They're two guys that drive around the neighborhoods taking anything old and unwanted from people. Anything: furniture, electronics, clothes, pets... whatever they can turn around and sell. Everyone seems to find them a nuisance. That day was Cristina's birthday, and also the day that Andrés, my host sister's boyfriend, graduated from medical school. He was the top student in his class of 80 or so. For dinner, we brought out the bottle of Rex Hill wine, made just a few minutes from my house in Newberg, that I gave to them the first week. It was very good, and the Oregon marionberry jam we had a few months earlier was a hit, so they must think that everything we eat and drink is absolutely delicious.

On Wednesday, Dr. Barrera couldn't pick me up because of the new Pico y Placa law. It restricts cars with license plates that end in certain numbers from driving one day a week. I took a taxi, and he decided to take a “shortcut” through the mountains on the west side of town, even though the clinic is on the east side. We ended up getting stuck in traffic and spent probably 15 minutes in a tunnel. I could tell he was pretty embarrased by his intuition. Because of that I showed up late to the diabetes presentation Dr. Barrera puts on every Tuesday for his patients. There were about 60-70 people in folding chairs in front of a projector screen showing a powerpoint in what looked like a large storage room. One of the two medical students went over the basics of diabetes and tips on how to stay healthy. Some of the things they talked about was getting support from your family, eating small meals five times a day to keep glucose levels steady, and putting blocks underneath the posts on the foot of your bed to incline it and keep blood from pooling in the legs. My favorite bit was when Dr. Barrera described circulation to them. At first some people weren't following him, then he used the example of what happens when you cut the neck of a chicken and suddenly everyone knew exactly what he was talking about. He told them he was working on getting them free laser treatment for diabetic foot fungus at Hospital Metropolitano. Everyone cheered and said ¡Gracias, doctor, gracias! After the talk was over we measured the blood glucose of everyone there. I must have pricked the fingers of at least 40 people. That was the first time I had done fingerpricks before, and there's nothing like taking something new and doing it again and again on flinching, cringing people to get decent at it. Later, in the consult, a patient gave us each a bag of apples as gifts. I saw quite a few people give gifts to the doctors there. My second week in Hospital IESS, the husband of a patient gave Dr. Salazar a bottle of expensive whiskey. Quite a difference from the US where doctors are more likely to be sued than given gifts. We taught the daughter of a recently diagnosed diabetic how to measure her blood glucose. They were given a glucose meter to use for free. I asked Dr. Barrera how they can afford to give meters out, and he said they don't give them out, they borrow them out. When a patient is having high levels and needs to keep a closer watch on it, they give them one until they work it down to the point where they can get it checked just when they come in to the clinic. Almost all of his 200+ patients with diabetes don't have ways of checking their glucose at home.

The front entrance

Tuberculosis information