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.

first day on the coast

Today was my first full day in Portoviejo, Ecuador. Thirty kilometers from the Pacific Ocean, I stepped off the plane and was greated by a wave of warm, humid air. Throughout my past week in Quito, plenty of quiteños had told me what they thought of the coast: Watch out for the way the costeños speak, so fast! They lovingly call the people of the Manabí province monos (monkeys), due to the prevalence of bananas in their diet. One taxi driver in Quito went on for ten minutes describing all the bugs of the coast—complete with detailed descriptions of size, color, and any known poison. I got the idea that the spider-crickets inhabiting Hoyas basements pale in comparison to los bichos here.

Mayra (my intercambio mami and pediatric surgeon) greeted me at the airport with a huge hug and kiss. A seasoned mother of her own three children and exchange students, she explained what I can expect both in the home and as a clinic volunteer. Today she drove me to CAS, a clinic for adults that I will be volunteering at for two-ish days a week. Like most all buildings, it was a single level made of concrete bricks. Inside a central large waiting area, I could see doors clearly marked for different specialties—Gynecology, Ophthalmology, Pediatrics…. In the center, two receptionists filed away patient information in bookshelves. CAS is currently expanding and the architect/engineer of the new building handed us hard-hats and showed us through the new building still in construction phase.

Also currently in construction, is the new home of the Peds Clinic—which is expected to open sometime in March as the only pediatric clinic in the province of Manabí. Walking through the construction site, it was obvious that the doctors had planned the building according to the flow of patients and to ease movement from clinical consultations, to surgery, to post-op areas.

Tomorrow will be my first day at the clinic with Mayra. I am excited to begin learning at the clinic so that I can be a valuable volunteer after a few weeks!

Between the Pages I. --A Cafecito Story by Julia Alvarez

Having Read Alvarez’ novel In the Time of the Butterflies, I quickly grabbed this bilingual novella from the backseat of the family jeep. Easy enough to finish reading in less than an hour, the Spanish was right at my level—enough words that I already knew and many to still learn.

Alvarez tells a parable of a Nebraskan man in a bit of a middle-age crisis. Having grown-up on a family farm in the Midwest, he leaves behind his job for a vacation in The Dominican Republic. Bikini babes and resorts don’t satisfy his appetite for something deeper. Instead he travels to the mountains, befriends coffee farmers still using sustainable methods, and becomes their ally.

Simply and beautifully written, Alvarez transports readers to her homeland in the Dominican Republic and asks that they become supporters of Free Trade goods.

Here in Ecuador, the most common form of coffee is instant coffee, usually Nescafe. I had a cup for breakfast. It was satisfying, but certainly not what Americans who drink Colombian and South American brewed coffee from Starbucks might expect. I am under the impression that the best beans are exported…I’ll look into this.

Hiking around the Lagoon

Johana and Me

la laguna (lagoon)-- an area of shallow water separated from the sea by low sandy dunes. (dictionary.com)

Lagoons make me think of the “Kiss the Girl Scene” from the Little Mermaid. Vegetation from all sides…like a bayou-swamp, something out of a fairy tale. I am not sure why the Lagoon at Cotochaxi is called a lagoon rather than a lake, if only for the reason that it looks like it is straight out of The Lord of the Rings.

Aragon and Robbie

Johana, Robbie, Aragon el perro, and I took a four-hour hike around Cuicocha, a volcanically formed lake (similar to Crater Lake in Oregon) that sits at the base of Cotacachi Volcano. Steep-climbs up Andean slopes were rewarded by brief moments jogging down the other side of the mountain. I will admit, at 10,649 feet (to give you an idea—Denver, CO sits at 5,280 ft), I was breathing a little harder than usual—not that I am using this as an excuse. The view was gorgeous. To one side, the lagoon with a mountain-island, and to the other side, a valley surrounded by higher mountains climbing into the clouds. Aragon provided constant laughs, trying to drag a 2 meter log to play catch and incessantly retrieving our mandarin peels we tossed into the brush.

A half-hour into the hike, I recognized that I had visited this lagoon two years ago, only I didn’t have the pleasure of a hike, only a brief stop to see the crystal clear water. When two of my fellow students dove into the lagoon, splashing a boat of French tourists, we were quickly ushered back to the buses, and followed by a trail of French profanities.

First Few Days in Quito

Monday I flew out of Minneapolis airport. I was surprised that there were delays due to snow in October! After a brief stop in Atlanta, I boarded the plane to Ecuador for the 4 hour and 50 minute flight.

I am spending this week in Quito, catching up with my host mother from the Summer of '07, registering my visa, attempting to get back into speaking Spanish, and spending time with friends in Cumbayá, a small suburb of Quito. Click for map.

View of Quito from Basilica of the National Vow

Let me explain why I returned to Ecuador. My introduction to Ecuador was during my senior year of high school through a friend, Johana, an Ecuadorian exchange student. While studying in Quito two summers ago, I spent time with Johana and briefly met her family. Through a series of serendipitous events, I will be volunteering the majority of the year in Portoviejo, Ecuador at a pediatric surgical clinic where Johana's mother works.

Yesterday, I successfully navigated my way via buses to Zeheivy, my host mother's apartment. A wonderful cook, she made a delicious lunch of cream of brocolli soup, chicken and brocolli, rice, plantains, and fresh pitahaya (dragon fruit) and mango juice. Yum. When I left her home two summers ago, she said that all exchange students said they would return, but most never did. I am happy to be in the minority of students that has surprised her with a return visit and expect to spend time with her throughout the year.

Why "the youthful hue"?

"Now therefore while the youthful hue,
Sits on thy skin like morning dew...."
Andrew Marvell 1621–1678 "To His Coy Mistress"

Consider it a tribute to one of my favorite English courses, TS Eliot's 1922 poem, "The Waste Land." Through this class we analyzed much of TS Eliot's work and read excerpts of the numerous allusions within his classic poem. One allusion to Andrew Marvell's poem "To His Coy Mistress" repeatedly led me to read the poem time and time again.

Opening, "Had we but world enough and time," the poem describes a man's plea to a woman to seize the day and youthful love. While a bit melodramatic, it is romantic in the sense of a whistful way of life--rosey-hued and fanciful.

I think the title is fitting not only for my experiences this year volunteering, but also a bit of a motto for life--to live with a youthful hue and perhaps a bit more maturity and wisdom each year.

Conductor Erich Kunzel

Only a little over a month ago, I was was lucky enough to spend an evening at Wolf Trap. Gazing over the audience seated in the pavilion seats shielded from the rain, I hunkered down on the grassy slope, while around us rain fell from the sides of the pedestrian bridge. Erich Kunzel directed the music of John Williams (soundtracks of ET, Star Wars, Indiana Jones, Harry Potter…) The music was beautiful and the Conductor Kunzel was spunky. During the Star Wars pieces, Hans Solo, Darth Vader and droids descended on the stage. Kunzel dueled against Darth Vader using his conductor stick—it didn’t look very effective in relation to the light saber. Kunzel was genuine and gracious to both the audience and the musicians. Not being a classical music aficionado, I was thankful for the opportunity to see Kunzel conducting. He passed away Sept 1st, 2009.

On the 3rd of July, without knowing it, I also heard Kunzel conduct during a dress rehearsal for the 4th of July Concert. Here is "Rhapsody in Blue" from "A Capitol Fourth--on the 4th of July."

NYT Obituary