Heading to "El Campo"

The gynecologist and me in the room where she saw patients. It was HOT and humid!

This weekend I went along with physicians and volunteers from the CAS Clinic on a "medical caravan" trip to a small town an hour away. A general medicine physician, pediatrician, dentist, and gynecologist saw about 150 patients. I helped assist the gynecologist. Very eye-opening difference between the culture of a small town only an hour away from Portoviejo. It seems that women generally have many children, marry very young, and often are illiterate. The community that received us was very kind--cooking huge pots of rice, soup, and chicken.

Hills around Caña--covered mostly by farms filled with bananas, yuca, cacao, zapote, oranges, corn, and avacado.

Mechanics of A Clinic

Last week I served as an assistant-translator for a gentleman visiting from the U.S. on behalf of Children’s Medical Missions. While normally I am in the clinic, my work this week highlighted the importance of patient advocacy. With local volunteers, we visited the poverty-stricken home of a twenty-one-year old woman's family. Since birth, she has been severely mentally disabled and bed-ridden. The purpose of our visit was not to suggest new clinical treatments or an operation, for nothing of this kind would be of help. Rather, we spoke with the mother about fitting her daughter for a specialty wheelchair and dropped off medical supplies. Other work throughout the week included helping a young paraplegic man repair his electric wheelchair and installing an electric generator for the new clinic. It was quite humbling.

Moreover, not being extremely knowledgeable in the world of machines, generators, and wheelchair mechanics, I learned some basics and quickly picked up some Spanish words for mechanics:

Learn 5 words now:
Tools- las herramientas
Screw- el tornillo
Washer- la arandela
screwdriver- el destornillador
hammer- el martillo

A Week at the Clinic with Visiting Medical Team

This is the view from the clinic window. Only at the beginning of December, there was no green. Now, with rains, some of the trees have gained color. Up on the hill, there are a number of houses mostly made of brick and sugar-cane like material. Laundry drying on lines dots the hill. A bus terminal is off to the left in the photo. Often, loud music from the little cantina at the bottom of the photo, can be heard in the clinic.
Part of the group here the past week for plastic and orthopedic surgeries along with volunteer physicians from pediatric clinic. It was fabulous to have the opportunity to learn from such a wonderful group of people and care for children here. Much of the week, I was the only one translating in the clinic--this gave me a great respect for the capability of those that normally perform this work.

Back on the Coast and in the Clinics

As of last week I am back on the coast. The past two days have been spent at CAS clinic, helping with preparing patients for physicians (weight, height, blood pressure) and shadowing a gynecologist, Dr M.* I really enjoy learning from Dr. M and assisting her with examinations. Women from many walks of life, from teenagers to seniors walk into the extremely modest exam room. Yet with the little resources available (no patient gowns, no change of patient bed sheets), I admire how Dr. M is able to talk compassionately with patients, test, diagnose, and counsel.

The heat here is a bit unbearable (33 degrees Celsius)…but knowing how cold it is at home, I realize that I am happy my toes are not numb from subzero temps. It was even featured in the local newspaper today that temps in Miami have dropped to below 32 degrees F. Eek, South Beach brrr.

*All names in hospital/clinical settings changed for privacy. Clinic names shortened for privacy.

Poco por Poco

Visiting Orthopedic Team and Local Physicians

Bit by bit my Spanish, medical vocabulary, and ability to assist at the clinic are improving.

Still, the learning curve was steep this past week. A surgical team from the U.S was at the clinic the whole week. The team—an anesthesiologist, bilingual RN, orthopedic resident, and two orthopedic surgeons—very kindly allowed me to work by their side and learn from them. The first day, the team saw somewhere around sixty patients in clinical consultation. I was surprised to find myself translating much of the time when the RN was unable to assist in translating two cases simultaneously. While many peds patients were from nearby, others were from a pueblo four hours away and still others had traveled on horseback to reach this pueblo before coming to Portoviejo. Clinical concerns ranged from club feet, to complications arising from poor casting of feet or ankles after former operations at other medical facilities, to removing an excess digits patient’s feet.

Translating, helping with the patient records, and photographing limb deformities for later physician referral—I felt useful. Many patients were told to simply wear una férula (a brace) on their wrist or ankle and observe changes in limbs throughout the next year. Yet about fifteen children were asked to return that week for an operation.

In the OR the rest of the week, I learned from the local nurse how to best be of assistance from pre-op to post-op—translating, cleaning, opening sterile equipment for the surgeons… After many operations, I helped the physicians explain to expectant parents how the surgery went and instructions for cast-removal and physical therapy. While the majority of parents nodded, some seemed more in shock than their children and gave a blank stare.

Me & New Med School Friend

The kids here are tough. Most went home the day following a major surgery involving reconstruction of bones and joints. While given what meds were available, they definitely weren’t sent home with the same deluxe gift-bag of pain relievers available in the U.S.

While most time was spent with children or adults (I am not a real adult yet…right?) I also translated two lectures for medical school students. Eek! While I am not one to have stage fright or be overly anxious about public speaking…I did have a few butterflies before walking into a classroom of fourth year med students with the visiting physicians. (As students here don’t go to University with an undeclared major, the university is a combination of college and professional school. Med School here is six years, maybe seven. Translating two lectures about hip dislocations & upper extremity anatomy and pathology proved tricky. It also involved a great deal of gestures and pointing to various parts of my arm. All in all, I think it went well though—I judge this by the fact that many students came up to ask the physician questions after the lecture—always a good sign. Moreover, two students returned to the clinic the following day with x-rays of wrist injuries, looking for medical advice.

Best part about the week: The days flew by and I again feel a confirmation that I want to study medicine.