Time to Update

I have elected to not update during the week in Chone. Spanish keyboards are a pain, and its too much work to upload pics without a jump-drive. I figure its easiest to start out with whatever first comes to mind... which is surgery. The two Docs I shadow are orthopedic/trauma surgeons: Dr. Vera and Dr. Robosky. Both are great surgeons and always work together... not sure how common that is amongst orthopedic surgeons. They work Tuesday and Thursday and it is one of the highlights of my week.

The latest surgery I saw as the amputation of a man's left leg. He was diabetic and cut his foot on the inside of the his heel. He didn't take care of it and he was admitted the day before surgery with some pretty bad necrosis. The tissue had died in an area about four square inches on the inside of his foot. As one can imagine the amputation was pretty gruesome. They just did local anesthesia to block him from the waist down... the poor guy was conscious for the amputation of his left leg. They started by just cutting skin with a scalpel, then used cautery to cut pretty much everything else. The docs showed us the sciatic nerve and also put my finger on one of the major arteries (I was scrubbed in), which was cool too feel/see an artery directly. They cut his leg about mid-femur. When they got to the bone they used a file that looked like a rope with two T-handles on both sides and see-sawed right through the femur like it was nothing. The patient kept picking his head up and looking, and the surgeons kept telling him to stop... not sure what I'd do in his situation. Then they sewed him up and it was only about a 30 min procedure not including anesthesia. 

The above picture is of the OR. I believe there are five total, I haven't seen them all. The fore-mentioned surgery was this last thursday. Tuesday we had two patients. The first was a 9 year old girl who cut the top of her foot and needed to top tendons/muscles on her foot sewn back together (it was a lot like the machete wound, but the foot). The second surgery was a young boy who broke his radius and ulna playing soccer. It was pretty bad break, both bones were broken completely in half. They put a rod in the radius and a plate with five screws in the ulna.

Above is the public hospital in Chone where I work: Hosptial Napoleon Davila Cordova. Its the only public hospital in the city and within a two hour bus ride for that matter. The hospital sees mainly people from Chone and the "campo" outside of the city, but its public and open to anyone. There's also a social security hospital in the city that is private. The pediatric ward can hold 40 patients as with the floor above (internal med). All hospital employees are government employees and all the care provided is free to Ecuadorian citizens (paid by the Ministerio de Salud Público). I still start every day with pediatric rounds with Dr. Díaz and then depending on the day I end up somewhere else (tuesdays and thursdays are surgery days). Friday we did a tour of the Neonatal ward in the hospital. There was one baby boy who was born premature (27 weeks 4 days). It was pretty sad/incredible to see the little guy on a ventilator. Everyone was kind of on their toes not knowing if he was going to make it. Today the word was he was doing well and his O2 sats were good off the ventilator. However, I don't believe Chone has an MRI so theres really no way to tell if he has brain damage. The rest of Neonatal was mostly newborns with colds or fevers.

100% Chonero

Lets talk Chone. The name says it all. Chone is Quechua for "Inferno" and yes, its VERY hot. My host family tells me that this is actually the colder time of the year. The rainy season from January to April-ish is much hotter. Its plenty hot for me. Just doing rounds in the morning and walking home after clinics I am dripping with sweat. There's no such thing as hot showers, and it would seem relatively pointless anyway. My family in Chone is great. Mariana and Pepe are "mom and dad" and their son Javier has a small family practice that he runs out of the house. Mariana's son-in-law, also named Javier lives "junto" to their house, so pretty much the same house. Mariana is a great cook and very helpful.


Since this is an urban/rural comparison program, lets compare. So far I have seen only two hospitals in Quito. La maternidad is not what I would consider an advanced hospital, but i've heard good things about other private hospitals that are pretty nice. Axis, which i've only been in non-clinical, is very nice and it looks brand new inside. The public hospital in Chone is not the fanciest hospital in the world. Its probably the tallest building in the town, the concrete is cracking, and they're undersupplied. One of the best things i've noticed about comparing the two cities is regardless of what the hospital looks like, the personnel are extremely smart and caring. The doctor who leads the Chone part of my program, Dr. Díaz, is a pediatrician and is one of the best doctors I have shadowed. She is incredibly smart, caring, and somehow makes every one of her patients and their parents smile, laugh, and love her. She is a great teacher and takes time to make sure we understand everything. One of my favorite things about working in Chone is not a single patient, doctor, nurse, or intern speaks english. At some times it seems like they're speaking two foreign medicines (spanish and medicine).

We start every morning with Pediatric rounds, which are very interesting watch. Tuesday and thursday we had surgery. Yesterday (thursday) was a great day for surgery. The first patient had been attacked with a machete, and used his left forearm to block the blade. It cut most of his extensor muscles. The docs first tried to block his whole left arm with lidocaine, but he could still feel it, so they had to knock him out. It was really cool to see them checking with muscles went where because they could pull on a tendon and his fingers would move. They made a pretty large incision in his arm and sutured the tendons and muscles back together, and the surgery was a success!!
The next one we saw was pretty gruesome. A man had fractured his his Tibia and had a plate put in. The plate became infected and they had to remove it. A very large incision was used to open it up. Upon removing the plate the docs discovered that two of the screws had broken inside the bone. They spent a fair amount of time removing them. The poor guy was concious the entire time, they just blocked him with lidocaine from the waist down. It must have been pretty tough for him to listen to the scraping, drilling, and cutting of infected bone. It was pretty crazy to watch the block being put in his spine... lesson: Don't break your leg!!!!!

Internet is expensive and charged by the hour here and i'm being cut off.... thats all for now, i'll post some pics tomorrow.
Adios!!

Pre-Chone

Well I finally found WIFI... not in Chone however. Part of the Quito group met Sam and I at a small Costal town on the southern part of Ecuador called Montañita. Its a pretty touristy type town but its still pretty laid back and I can still find my $2 lunches. The people here are pretty mellow and are always down to stop and chat in Spanish. Surprisingly there is a large population of northern Europeans here. The water is warm, the food is good, everything is cheap, and you can get an ocean-front hostel for $10 a person for per night. So if you can picture where i'm at in your head: Small internet café on a small quiet street, Ecuadorian music playing in the background, fresh fruit and fish vendors cruising by on their bikes, and the smell of food and ocean which is three hundred feet away.

I want to go back and touch on the Pichincha volcano climb. The climb starts at the top of the gondola which seems like cheating but it would take all day without it. The summit is 15, 413 with is a small rocky top. At 15,000 feet the concentration of oxygen is only 55%. It climb itself looks less than intimidating but the lack of oxygen makes it incredibly difficult. Toward the top we could only go for about a minute without stopping. It was a very humbling experience, I was really surprised how long it would take me to catch my breath. I'm really leaning towards climbing Cotopaxi, so i'll have to do it again after spending three weeks in Chone. The picture above is me reppin' OSU over 15000 feet up in the middle of the world!!

I know I know, this is so cliché especially because I bring my Powered by Orange shirt everywhere, but its just one of things you "can't not" do when you're that close to the equator. Its not that exciting there apart from the fact that you can stand on two different hemispheres, which is pretty cool, but theres really nothing else to do there unless you want to pay for cheesy tourist trinkets or weigh yourself on the equator for 50 cents..... Bob Marley just came on.... peeeerrrrfect!!!

Latest and Greatest

well this will be short and sweet. im now in chone, which is definitely more rural than quito. the only internet access i can find is a little shop in the center of town where you cannot use your own computer... needless to say the keyboards have a different layout and are kinda confusing, plus i cant post any pictures. last saturday the quito group climbed pinchincha, which is a mountain to the east of quito. a gondola takes you part of the way, but the rest is a pretty difficult but rewarding climb. it goes up to over 14000 feet so its pretty difficult to breathe. the clouds rolled in before we got to the top which was a bummer but it was still pretty cool. my first clinic day was pretty interesting. the main doctor i work with does pediatrics, so sam and i did rounds which was pretty fun, and then did some routine check ups in her office. today was great. we had two sugeries that we scrubbed in for. the first was removal of a sinovial cyst and the second was removing some metal rods from a guys leg. the first surgery i got to hold the skin back with some utensil, i don´t know the english name for it. after removing the cyst the surgeon let me finish the suture which was incredible. im glad i had practiced, but i was still nervous and my hands were shaking haha, but i did a good job. im hoping for another shot at it soon. we have surgery again thursday. thats all for now. i´m hoping to find a place with wireless so i can use my laptop`but we´ll see.

The Saga Continues

Wednesday is done... that means two things. I'm am done with spanish lectures until I return from Chone, and Its my third day of ER in the Maternity hospital. Its very surprising how common Pre-Eclampsia is here. According to the Doc its mainly do to lack of access to good healthcare, and unhealthy food. Probably the second most common problem is infection. Its very common as well.  I want to touch again on some of the differences here. There is definitely a more laid back feel here. The doctors actually play music the whole time on their computers which would most likely be deemed unprofessional were a Doctor to play music in the ER. Yesterday was extremely slow for an ER but thats how it goes. Today it was upbeat as soon as I walked in. The patient was a mid 30s woman with acute (agudo) abdominal pain. We wheeled her down the corridor to get an ultrasound. The hallway and the waiting room for the "sonografista" was full of women waiting which was also much different than the states. I wasn't exactly sure what was going on because it WAS an emergency so the Doctors were talking really fast and i'm not too keen on reading ultrasounds. What I did get out of it was they were extensively checking her kidneys. It turns out they initially thought she had some form of kidney issues but it turned out to be an appendicitis.

The whole day was fairly hectic. With the Ecuadorian music in the background and the high tempo of the ER yields quite the contrast. The hospital had to send quite a few patients to "el hospital del sur" which is a bigger public hospital in the southern part of Quito (i'm fairly north). There was one patient who was the first Ectopic pregnancy (the egg implants outside the uterus, usually the fallopian tube) I have seen this week. As one can imagine she was not happy to hear she couldn't be admitted and had to go to another hospital for surgery. Other than that there were a few concerned mothers about their babies "not moving" (no se mueve bién mi bebe) and others with "contraction-like" pain.

Spanish classes were getting pretty difficult and frustrating. Everyone in the class was in the same boat because what we're learning really has no direct translation to english, therefore its hard to comprehend.  Thats all I have for now,
Adios!!

First Day of Clinic

Judging by my last post I'm sure it sounds like this is just one big vacation, but I promise it is an internship and I am actually working! Which leads me to my first day of clinic. It was at a hospital called "La Maternidad" which is a Gyno/Obstetrician hospital. After waiting in the lobby for a while, Jessica (another student) and I got our scrubs and met up with one of the Docs (Dr. Gomez). He doesn't speak english, but he was really good about speaking much clearer than most people which was nice considering pregnancies are confusing enough in english (for me). There are obviously many differences between this ER and one in the states. One that jumped right out at me was how the doctors have their designated "office" with their computer and examination "bed". We started out with a lesson on long division and calculating how long patients have been pregnant based on their last cycle. No one uses calculators, even the docs write it out on paper.

One of the most common problems seen in Quito is Pre-Eclampsia. The tell-tale signs are Protein in the Urine (Proteina en la Orina), Bruising/Swelling (Edema), Headaches and Ear Aches (Dolor de Cabeza o Oido), and High BP (alta presión). Of the 10 patients we saw, I believe six were diagnosed with it. Another difference is they patient-doctor relationship. At least in the ER it seems almost all about cranking out patient after patient here, which it was similar in the US but not as much. For example my time observation time was almost four hours and one Doc saw ten patients. The lists goes on for things that I saw today, but I think I'll leave it at this for now.

El fin de una semana

OOOOOkay here we go, this is going to be a novel. In several hours I will officially have one week of Ecuador under my belt. I'm just going to jump right in. In my previous post I spoke of Tapas and Vino, well that fell through. It turns out it costs 40$ a person, so we elected to go to another place across the street. I can't remember the name but it was basically the same deal: Unlimited wine or beer (one has to pick, and stick with that selection) and some great dishes like anchovies, Quiche, and a whole slew of others.

This unnamed place was in Mariscal, otherwise know as "gringolandia". And while i'm on the subject, i'm going to digress for a second. My host mother, Rosita, gave us a lesson on why white people are called gringos. It originated during the Mexican-American War. The americans wore green suits and to make a long story short, the mexicans wanting the americans to leave would say  "green goes". Back to gringolandia. Our group got on the subject of how medicine should function: With an ethics-centered approach or more towards the business side of the continuum. After much discussion and beer/wine, we concluded that there is no correct answer that could ever make the entire medical world happy.... no duh!! We then somehow got to the subject of religion versus science, but I wont go there!!

After leaving the no-name restaurant, the group split up. I went to a bar called "el bote" with some of the group and the others to another adjacent bar. We chatted with some locals about our age that were playing a form of pictionary with movies and they would draw on a blackboard. Some movies included Pulp Fiction (that was the one I had to draw, and I had a hard time!!), Silence of the Lambs, Top Gun, among others. Almost all the younger crowd smokes in Ecuador, especially the bar-goers. Unlike the states, there are no laws regarding smoking in bars, so it definitely burns the eyes and one reeks like smoke after leaving. Let me add that the party never stops in Quito, there is no 2am last call and the streets are packed all night.

The next morning a group of three of us hopped a bus to a small surf town called Canoa. Let me just say that a bus ride like that is a culture experience in and of itself. First off the bus drivers would give Jeff Gordon a run for his money if he were driving his pregnant wife to the hospital. I do not believe there are passing/ non passing lanes and if there are no one pays attention to them. The roads to the coast are very windy with very deep ravines on one side, so its always in the back of your mind.... guard rails are too frequent. There was a lot of construction on the way over and as I side note I was surprised to see how all the equipment (i.e. Excavators, Back Hoes, Graders, and Rollers) was brand new. On the cultural experience. After getting out of the mountains, everything is fairly flat compared to the Andes. This is where "Ecuadorian time" really comes in. The bus stops all the time to pick up people. When the bus stops, vendors hop on the bus and try to sell you things.... mainly food and drinks. They'll hop on and walk up and down the bus saying "agua agua agua" or "pan y pan y pan" or "agua jugo cola". Basically you can get the entire Ecuador experience form an 8hr bus ride for about ten dollars. Everyone packs into the bus, combined with the Ecuadorian music, food, and sights, and good ole personal space goes out the window.... oh and the humidity combined all adds to the cultural immersion. Its better than TV... cheaper too! For many this may not seem ideal but I loved every minute of it.

We had a pit stop in San Antonio (no not texas) to change buses to Canoa. The whole "blending in" thing goes out the window with six white people standing on the corner. Another side note is yes, people stare, and they stare a lot!! Waiting for a "trole" in Quito there was a group of young Andean girls who were simply mesmerized by the sight of me. There about four of them with their mother and these little girls just stared and stared and stared. The bus ride from San Antonio to Canoa just the same, with Jeff Gordon behind the wheel. I was airborne a few times out of my seat. One thing I found that was different was how the streets were mostly paved but every now and then there would be a 50ft patch of dirt, and the pavement would continue again.

We arrived in Canoa around 7pm. Above is a picture of the roads (dirt), my favorite place to eat (on the right), the hotel we stayed in the first night (to the left), and where the party went down (the end of the road). When we arrive we all headed straight to the water to see how warm it was. Just as I suspected, it was very warm. Surprisingly, it wasn't as warm a the pacific of Costa Rica however. Then we checked into a hotel and headed for the bars. The bars in Canoa are amazing. There is a stretch of bars, restaurants, and huts all along the beach. The bars have no doors, for the most part no walls, and not a cover charge in sight. And yes the beer and tequila is cheap, and the women are beautiful. Every bar plays music extremely loud so one has to stay out until the bars close. We spent most of our time dancing, and when it got too hot, we would go jump in the ocean and do it all over again. Later we made our way up to the street above where they blocked off the road, put up some very large speakers and projection screen. It was a party for one of the local surfers who was going to represent Ecuador in some competition (he was the self-proclaimed best surfer in the country). There was great music and lots of dancing in the middle of the dirt road... it was great. Some of the locals brought out some gasoline and made a ring of fire that they were dancing in. They were doing a lot of "dance fighting" (if you don't know it, look it up) which was cool to watch.

The next day was mostly exploration and laying out on the beach. We tried to find some caves we heard about to the north, but I think you can only get there at low tide and via kayak. Even though it was cloudy for the whole day, it was warm and humid and I got a little too much sun thanks to the Doxy. Around two, we went to in my mind the best restaurant in the town. I'm not good with names but it was the furthest north restaurant. The camarones (shrimp) are spectacular. Four of us spent about five hours just hanging out. The atmosphere was great. The costal feel, humid, warm, Ecuadorian-Reggae music, palm trees and sand made it hard to leave. 

We then checked into "el coco loco" hostal (above). This hostal was really cool (in spanish its hostal). Everything was made from concrete and palm trees, even the beds and spiral staircases. The night continued with more dancing and intermittent trips to the ocean (only a few hundred feet away). Go figure the weather cleared up the morning we left, but i'm not sure I was ready for that kind of heat. It was only Mid morning and I was struggling if I wasn't in the shade.

This is a view of the beach and also how fishermen get their boats to the ocean. They basically leap frog the logs and slowly roll the boat up/down the beach. Its fun to watch them head out to sea because they hit the waves head-on and the boat gets practically vertical. 


The bus ride back was less than convenient of well planned. In the end I felt it was fun because it honestly felt like I was on the amazing race. We started in Conoa and caught the only bus out of town to San Vicente. It is very frustrating to not be able to understand people for directions considering this will be my ninth year of studying spanish, but a lot of people honestly just mumble when they talk so its impossible to understand them. From San Vicente we went to San Antonio (but we should have stayed on the bus) due to either misinterpretation or bad directions. From San Antonio the only direct ride to Quito didn't leave until 2am. We caught the first bus to Chone (where i'll be next week). From Chone we had to catch another bus to the Chone bus terminal which was nice to get a preview of the city. The bus terminal in Chone was insane. There were people everywhere yelling at you trying to get you to come on their bus. We went to Santo Domingo because the only direct ride to Quito was at 4pm (it was 1:30). The Santo Domingo terminal was crazy as well. People everywhere and it was a 1hr wait just to get a ticket. It rained so hard there that the rain on the roof of the terminal made it sound like a jet was landing on top of us. From Santo Domingo we finally made it back to Quito and everyone was pretty burnt out. That was around an 8hr trip of hopping from bus to bus. 

Escuela

Second day in Quito and its going great. At first I was feeling pretty full of myself due to the fact that I was having no trouble adapting to the high altitude (~9000ft). Hitting the gym was a humbling experience. Initially I had no intention to go the gym while i'm here but its one block from my house so I couldn't resist. Needless to say the altitude has an immense effect on me. It is a humbling experience feeling like i've never worked out in my life. Two minutes into a stationary bike warmup I was already struggling. After pushing it a little bit I struggled to finish each set without feeling like I was going to pass out!!! But enough about the gym!!

My second full day of spanish call was great. My teacher's name is Betty which is an ironic name for una ecuadoriana. Seven hours of speaking nothing but spanish one definitely sees immediate improvement. With interest in both medicine and spanish, the combination of the two makes it that much better. One more day of full classes and its on to a three day weekend. The group is going to start the weekend right with a celebration of one of the girl's birthday at a place called "tapas y vino". Tapas is a Spanish style dinner where you eat several small dishes and well you can guess the second part of the name and I hear they're generous with the vino! Speaking of vino i've caught word of a place in the city which is a nunnery where the nuns have devoted their lives to producing fine wines... so I imagine they're exceptional!!

On to the weather. It reminds me of Costa Rica yet again. The mornings are warm, sunny and beautiful. The humidity combined with the the sunny weather feels like a nice extension to my summer. Then, just like clockwork, four o'clock hits and the thunder, lightning, and rain hits. I haven't seen it rain here nearly as hard as in Costa Rica but i'm sure it does. The rain only lasts for a couple hours and then it just stays cloudy for the rest of the day. The consistency in temperature is a nice touch too. At night it tends to clear off a bit and the cycle starts all over again. I've only been here two days but word is this is the trend for Ecuadorian weather for this time of year.

As fore-mentioned, its off to the coast this weekend. We're going to grab a bust to Chone, which is the town where i'll be spending three weeks. From Chone, its a short bus ride to a mellow costal town called Canoa. In all its about a five hour bus ride that costs... well five dollars.... not bad if you ask me. Which reminds that i'd like to comment on the prices here. My favorite place to eat is (at a loss for the name) a little place about three blocks from the school. They have a different meal every day but in Ecuador every meal starts with soup. Today it was chicken soup with beef, rice, and orange juice. All homemade of course and for the price of $2. While i'm on the prices of food, bottled water is 50 cents and a cup of coffee is 80 cents... again, not bad.

Thats all I have for now. I'm ready for clinics next week and i'm sure i'll have some great stories next week... still working on the pictures, I try not carry anything of value with me when i'm around the city.

He llegado

After fourteen hours of traveling I made it to Quito. Airport seats on continental planes are much smaller than I remember. Today was my first full day in Quito. As expected it is very humid but it never gets very hot in Quito so it stays comfortable. Quito reminds a lot of San Jose, Costa Rica. The smells, the humidity, and the crazy traffic feels the same. I live in a house with a host mother named Rosita, and she also houses six other students in similar programs as me. The other students range from Dental students, Med School Graduates and undergrads. We all have breakfast and dinner together at the house. Rosita is quite the cook and the food never runs out! Its a great experience to sit and eat at a table where everyone is speaking spanish.... it really accents the "immersion" of the program. Spanish classes lasted seven hours with small breaks and a lunch break. Due to my late arrival I will not be starting clinics until next week so its spanish classes for me for the rest of the week. It sounds like a trip to the beach this weekend is in order, so we're taking a 5hr bus ride the northern coast where I hear the water is very warm. The last two days with no sleep are catching up to me and I still have tons of homework to do.... the first day!! So i'm cutting it short. Desde luego... Adios!

Check One-Two

This is my second attempt at a functional blog so here we go:



Welcome all who are interested in what i'll be up to for the next ten weeks. I wanted to start out by giving a little background info on Ecuador. Nestled between Peru and Columbia on the Pacific coast of South America (no its not in Europe) Ecuador is a relatively small country, about the size of Nevada. However, don't judge a country by its size!! Ecuador is very diverse with the Amazon basin to the east and the pacific coast to the west with the Andes splitting right down the middle.

  My initial destination is Quito, which is the capital sitting in the middle of the Andes range about 9000 ft above sea level. Contrary to what many may think, Quito is a very urban and modernized city.

Ecuador is a very politically oriented country with a republic government. A perfect example is the current coup attempt on current president Rafael Correa. Due to cuts in benefits police began barricading roads and part of the military shut down the Quito airport, delaying my arrival date.

To start my internship, the first week I will be attending a spanish school called Amazing Andes and beginning my clinical rotations. Until next time, goodnight, and good luck.