Ecuador 1

I will try to sum up the interesting things I´ve seen in the last three days in as concise a way as possible, but I am losing the ability to speak or think in English so we´ll see how it goes.

martes - tuesday

We went to a ICU hospital in Guayaquil where we saw patients with lupus, TB (from a distance), an abscess infected with Klebsiella, and CT scans of a patient with HIV and toxoplasmosis and - or lymphoma. The hospital has been the biggest culture shock so far - docs rarely if ever use gloves and nobody washes their hands. The ER was packed full of random people and there is no triage system - it seems to be based on when you get there. Also there is a shortage of paper which is weird. Patients´ files are written on the backs of old EKG,s etc.

miercoles - wednesday

In the morning we watched a histology lecture given to dental students by Dr. A. Students learned by hand-written notes from microscope slides, light boxes with pictures of tissue preps (which they took pics of with their camera phones), and drawings from the white board. There were no laptops present.

Later in the day we went to Duran to see the clinic - Derecheros de los Pobres. I`ll never forget the drive in - on dirt rodes while stray dogs and children ran by, passing houses made of reeds and corrugated metal and pools of stagnate water, listening to Frank Sinatraçs `Ive got you under my skinÇ. What a culture shock. We did two OMM treatments in the clinic - muy impressivo.

Later still we visited Padre Damien house - a live-in clinic for Hansen´s disease (leprosy). It´s run by an incredible nun, Sister Ann, who is a firecracker from Brooklyn. She stressed the humanism of patients - esp those shunned by society. The patients were incredible - so friendly and welcoming. The men make hammocks and play dominoes. Sister Ann described how the clinic was when it was gov`t run - full of rats with unpredictable plumbing and disgusting food. The facilities now are brightly painted with murals, everyone has their own bed with clean sheets and the patients seem happy. She also purchased a plot of land in the cemetery to bury patients when they pass and holds masses for them - this was very important to them. Her major objective is restoring dignity.

jueves - thursday

we took a trip to the infectious disease hospital in Guayaquil and saw a patient with an infected necrotic snakebite, three AIDS pts. one with toxoplasmosis, one with TB, and one with histoplasmosis, and a man with dengue. The AIDS pts. were in induced comas for treatment. The hospital conditions, as previously described to us by Sister Ann, were pretty awful. The patients were naked in bed under thin blankets with holes. We followed a class of medical students who swarmed a poor old confused woman with pneumonia (and probably some dementia) in order to learn EKGs while leaning over top of her. Patient rights do not seem to be considered here - esp. in the infectious disease hospital which is free for the poor.

sorry again for the terrible grammer as my english is failing me.

Last dayts in Guayaquil

Hey Everybody!



Sorry it taken me until my last night it Guayaquil to write my first blog post, so here it goes. The last week or so in Guaaquil have been amazing and fun. Last week was packed with medical experiences that range from doing soft tissue techniques on patients to seeing a pneumonectomy.

The weekend was also a blast saturday we took a bus to Salina´s in the morning and laid around all morning on the beach eating empanadas and what ever food happened to walk by us we then cought a bus that afternoon to come back to Guayaquil. Sunday was A free clinic in duran, which was held at one of the local schools. The clinic, which was open to the public, ran from 9am until 3pm and provided family medicine, pediatirics, obgyn, clothing, pharmacy, and dentistry to the community.

This monday started out at Orames Gonzales as i saw that matt had already told you. on this day i was working in the emergency room and got to see about fifteen patients. For the most part most of them had no serious injurys just respiratory problems and GI problems.

Tuesday night was the first time that Dr. aguirre took me and christina to his clinic in duran. This was a good experience to see other parts of duran, also we got to work our OMM magic on some patients of the doc´s. After seeing close to twenty patients it was 1030pm so we headed home for some well needed RandR.

On wednes day we got to go to Duran and do OMM on patients at alicia house for the mornig. We also got to see the clinic which is almost done and looks really good.Sorry i dont have any pictures but hopefully the next group will post them when it is completely finished

peace, jeff

Update for the last full week!

Hey everybody!

So we're having a good time and getting a lot of work done our last week or so in Guayaquil. Yesterday we went to the Maternity Hospital Orames Gonzales. We all split up and did different things so the other too can explain more about the hospital because i went out into the city of Duran for the day. We were doing a Health Survey of a local area. There were about 5 doctors and myself. I had thought I had seen the poverty of Ecuador before, but it was nothing compared to the area we went into. Our job was to go to each house we could find and do a survery of how many people were living there, and their health situation, and finally we would end by inviting them to go the Orames Gonzales if they ever need anything (FYI it is a free, government run hospital).

These 3 hours in Duran were the most moving of my trip so far. Most of the houses were built of sugar cane or loose pieces of wood. They were up on stilts because in the winter month the land floods up to about 3 to 5 feet of water, yet in the summer it is incredibly dry, and the air is filled with dust. Unfortunately this leaves the ground disheveled, uneven, and hard to stand on. I was amazed at the speed the people living there walked across the ground, as we went very slow for fear of falling down with one wrong step. The houses were open the air in many places, so tended to be full of flies, and did little to keep out the heat. The water was miscolored and stored in barrels out in the open. And the children ran around in clothes that had lost their original colors and all seemed to be the color of dust. At first sight I was deeply saddened by the condition of this area, because this was not some small poor area of a city, this appeared to go on for miles. But the people themselves helped lift my spirits. Many were glad to have visiters, and quickly brought us inside their homes and found us somewhere to sit (often times they would give us their only chair) and would talk to us for as long as they could. They were happy for conversation and excited by the help the doctor I was with offered them. Some notable examples of people I met. 1. A family of 10 in a house that was 1 room, but content and happy. A battered woman with 2 kids whose husband had 2 other girlfriends, this was a tough case and the doctor I was with said it is a very common case in this area. A family with 2 girls, 13 and 15, both married and pregnant. A pair of twins who were studying for school (mathmatics). A house where 2 of the 5 family members didn´t know their birthday. And finally a house (which was just framework with blankets thrown over it to make it whole) with a young man who lost most of the use of his legs (which had all but wasted away). He had been shot in the back, and suffered spinal damage, but didnt have the money to have the bullets removed. He didnt try to exercise or move his legs, so had lost more mobility, and the bullets have migrated forward giving him stomach pain. The doctor arranged to have an ambulance pick him up next week, and surgery to be done in a free hospital.

Overall the experience was very humbling. It was very sad, yet at the same time enlightening. Even though these people had near nothing, they were not sad, nor angry. Most of them seemed cheerful, and helpful, and willing to give up what little they had to make us comfortable.

Today we went back to Padre Damien (I played some more domino´s with the guys), but we also got to talk to a very interesting gentleman. His name was Portanando. He just turned 90 year old (yup, and still in good shape). He told us about his life, his family, and God. He was very happy to have someone to talk to, and wouldn´t stop complementing us and how generous and thoughtful we were, we of course told him how much we enjoyed going there, and how much we enjoyed talking to him, and he just blushed and complemented us more.

Update from Matt

Hola mis amigos! Como estan. Todo esta bien en Guayaquil. Este Semana estamos trabajando muchisimo! El Miercoles trabajamos en Duran en la casa de Alicia. Hicimos terapias osteopáticas de seis o siete personas. Fue muy bien. Pudimos ver la differencia despues de nuestro tratamientos. En la tarde fuimos al hosptial seguridad social a reunirnos con cynthia. Los otros dos fueron a cirugías y yo trabajé con cynthia en traumatologia. Yo vi una fractura radial distal y mucho otros casos de articulaciones. Hoy fuimos al hospital otra vez y vimos una cirugía de cáncer de pulmón. Y despues fuimos a la casa de Padre Damien y yo jugue dominos con los pacientes. Yo Perdí los primeros tiempos , pero por fin gané cinco veces de hacer campeón. ¡Estamos aprendiendo mucho!

For those of you who cant speak spanish I will sum it up for you again in English (note this is not a direct translation of the above).
We have been working a lot this week at a variety of different places. Yesterday we had the opportunity to practices some osteopathic manipulative medicines. We had a steady stream of patients from when we started until we left! We performed all sorts of techniques including a lot of soft tissue, muscles energy, and pedal pumps to help their respirations. They were very greatful for all of our help, and we noticed a difference in many of them when we finished.

In the afternoon we went to the hospital and met up with our friend Cynthia. She took Jeff and Christine up to watch a few surgeries and I stayed with her in Traumatology. I got to talk to a bunch of patients, and helped check them in and send them off for X rays. I saw a radial distal fracture and watched the doctor set it back into place. I also saw a couple more broken bones, and got to talk to a patient with viral encephalitis who had broken an arm, as well as a woman who fell on a rock and injured his knee. Basically I had a great time, and it really reinforced my opinion on emergency medicine.

Today we went back to the hospital early in the morning to watch another surgery with Cynthia and her fiance Jonas. Ill let Jeff tell you about it as surgery is more his thing than mine, but it was also a great experience. In the afternoon we went to Padre Damien. Christine and I talked to a few of the patients for a while about food and Ecuador. They are some of the friendliest people i have ever meet and love telling stories (even though christine and I struggle to follow them in spanish). After this we went and played dominos with some of the men. I ended up staying for 3 hours playing dominos. I quickly lost the first few rounds, but eventually won 5 which made me the champion! They liked having a challenge and asked me to come back soon and play some more!

Thats it for now! more to come later!

Clinic in Duran

While I have this CD and some time on the computer, I realized that I still have yet to upload any pictures of us at the PFH Duran clinic...but that is because it recently began construction and we haven´t been able to work in the actual clinic much since we arrived. I have a bunch of pictures of the construction as it has been coming along, and hope that we get to see the final product before we depart in two weeks!

Jeff and Matt outside the clinic, pre-construction

At the start of the construction - changing the clinic from 2 patient rooms to 3, and making space for a dentist and a gynecologist!

The family med (L) and gynecology (R) rooms

Jeff checking out the family med room

(the hole in the wall is the site of a door in the near future)

Tomorrow will be fun and interesting...we are scheduled to do osteopathic treatments in the PFH clinic, but due to the construction, we will be working on Alecia´s patio with our osteopathic table - she is one of the two amazing women who live right near the clinic and volunteer their time to help gather information and keep the clinic running smoothly. The other wonderful lady, Anita, can be seen in the photo below, checking out the room that will be the check in desk and the dentistry room. Hasta luego!

Getting our hands dirty

This has been a great week so far, and I know it is only Tuesday; however, yesterday and today were packed with learning and seeing medicine in action, and all three of us are definitely excited for what is to come for the rest of our time here. Unfortunately there wasn´t really a good time to take pictures yesterday or today, but I will try to get some later this week and get them on here asap.

Yesterday, we spent the morning at the government clinic in Duran, in an area called Orames Gonzales. It was originally mostly a maternity clinic, but it has now expanded into a huge facility with pediatrics, dentistry, emergency medicine, family medicine, and obstetrics. The three of us split up, and shadowed three different physicians. Matt followed a family med doctor and got to help with physicial examinations for various problems...but he ended up seeing mostly respiratory issues, which are common here due to the dust that is constantly in the air in these impoverished communities. Jeff got to follow a pediatrican and saw everything from babies who were literally only 12 hours old, to school aged children.

I got to follow an obstetrician, and not shockingly, I loved every second of it. To those of my friends who keep telling me they think I will end up as an obgyn, I kind of think you are right. I saw women who were anywhere from 3 months to 9 months pregnant. When I first got to the obstetrics room, there was a young woman who was having terrible labor pains, and when I heard the doctor ask her date of birth, I thought she said something in the 1990s but I assumed 1990, which would have made the girl 19. However, I was wrong...when I asked a few minutes later, I realized she was 13 (!!!!!). It sounds like it is extremely common for girls who are 12 and 13 years old to get pregnant due to the lack of education about birth control methods, as well as for women who are upwards of 40 to get pregnant with their 8th or 9th child. I know that unplanned pregnancies are common in young women in the US, but I have to be honest that the youngest pregnant person I´ve seen was probably 16...for some reason, age 13 came as a real shock! Anyway, it was great to help out with the examinations and I look forward to returning next week.

Today, we got up early and headed out to the hospital where Matt´s host dad works - the government-run social security hospital. He is the chief of intenal medicine so we got to spend some time learning about the 15 or so patients they had in the ICU, and then he took us down to the emergency department and we met a med student from the University of Guayaquil named Cynthia who spent the rest of the day showing us around and introducing us to patients, doctors, and other students. She is currently working with the department of cardiothoracic surgery, so she asked us to come and scrub in on a surgery on Thursday morning! All of us are really excited about it - the doctors are removing a lung from a patient with metastatic lung cancer, and we got to see the xrays and cat scans today to give us an idea of what the cancer looks like right now. Obviously I won´t be getting any pictures but this will be the first surgery I have physicially scrubbed in for and I´m really excited about it.

Tomorrow we have a crazy day planned - from osteopathic treatments in Duran in the morning to spanish lessons in the afternoon to an evening shift at the social security hospital. More to come soon!

Visit to Cuenca!

Apparently the boys aren´t into blogging right now, but I´ll hassle them to post sometime soon so that this doesn´t become solely my trip blog.

This weekend, we ventured to Cuenca to visit Matt´s family. I don´t want to steal his thunder in case he decides to post about it, but we had a wonderful time - thanks especially to his aunt Fabiola and her friends Veronica and Piti who showed us around the city and kept us constantly entertained!

Below are a few photos from our weekend, and I´m really hoping to upload some pictures to previous posts tonight, so scroll down and check them out!

Myself, Jeff, and Matt at El Chorro, a waterfall on the outskirts of Cuenca

The boys after they ventured under the waterfall

The three of us after a night of some serious dancing to everything from authentic Latin music to the YMCA...