Busy Week

The week was a jornada or medical group offering primary care to the town of Paquisha, and 5 of its surrounding rural <barrios> or villages.

The group itself was led by a nurse practitioner and retired faculty member from Idaho and altogether included 6 providers, 1 pharmacist, and 2 translators.


We offered medical exams, and a large assortment of medications and glasses brought from abroad.  It cost patients $1 each, inclusive of medications and eyeglasses.  

In all, we saw more than 1,100 patients in the week we were there!

Who's the Missionary

I'm starting my 7th month in the clinic, newly designated as Day-hospital, and fretting about supplies: we have 1 gauze roll (count 'em), a couple dozen pads, 1 1/2 working blood pressure cuffs. 

There's a second doctor newly arrived, a German woman with her two school age children, and I'm wondering whether there's enough work for the 2 of us.  Not to worry: I'm there past closing most nights finishing patients, writing notes 'til past dinner.  Maybe word is finally out, I'm here long-term; or they just want to try out the new doc. Still trying to set up the next surgical team visit.
   
All my concerns were blown away today.  My last patient was a 12-year-old girl, born with a severe skin disease: bullous epidermolysis, similar to Pemphigus.  She has painful boils all over her body, gradually healing until new ones arise.  The sloughing skin cuts off circulation, so she has gradually lost all her fingers and toes. 
   
Her family faithfully cares for her, changing dressings daily, treating her just like her 6 sibs still at home.  I saw her for an unrelated problem (intestinal parasites), while she and her (healthy) 12-year-old friend giggled secrets.  As she left, she smiled and extended the stump of her right hand for me to shake. 
   
No tears came, but my eyes were a little moist later.  I usually feel confident taking care of patients - good thing, too, no backup here.  But then someone like Maria comes along, bearing a burden most of us can't even imagine, with a smile.  Makes me wonder who's the missionary bearing the Good News - me or my patients.  We do what we can, and God sorts out the rest.

This past week the Catholic Medical School in Loja visited us, bringing a dozen physicians and 50 medical and nursing students over the week. Things got pretty snuggy, both in the Hospital where there was a premium for exam rooms, and for housing. The volunteer house grew from 1 resident (me) to 8, with 15+ gathering here for lunches / dinners / evening guitar music. It was fun if at times hectic to be around all the 20-somethings.

I usually had 2 students with me in clinic, who took turns consulting patients while I watched. This was the school's first such visit, but with the promise of more to come, and eventually performing surgeries with the medical residents.

On Tuesday Padre José requested I make a home visit. Padre, the catechist and I drove 10 minutes in his SUV (you really need one here) to a tiny farm with two buildings. The cinderblock house had a kitchen and two bedrooms; the tin roof was raised 2 feet above the walls, for air circulation, however no birds flew in while I was there. Their 40 year old son with hemiparesis greeted us when we arrived, victim of a fall with intracranial bleed some years before. Their other 10 children left home years ago.

The patient was an 86 year old man, Andres, sitting astride the wooden bench in the kitchen, saying his knees hurt so much he could barely walk. His left femur was broken years before, with a large bony deformity just medial to the knee. He had bone-on-bone in the knee that was painful just to feel. The family showed me pills from a recent visit to the government doctor, including some for prostatitis (he also had problems with incontinence). I told him to come to the clinic tomorrow, take a taxi, and I could give him knee injections.

Padre told Andres, God wants a clean heart to receive communion, so the wife, catechist and I went outside while Padre heard the man's confession. His wife talked to me nonstop in the back yard, about their trip to the bank to get money for the roof, their plot of land, trouble growing food. She apologized for speaking in Shuar to her husband instead of Spanish (I only understood a third of what she said anyway, but I kept that to myself). We all returned to the kitchen, where Padre gave Annointing of the Sick to the wife, son, and Andres, and communion just to the husband. On the way home I told Padre I wasn't expecting to see two sacraments during the visit. He corrected me: no, three. The next day Andres came in for injections of both knees. I also wrote for an alpha-blocker for his prostate, they were happy with the care. Even though there's no cure here.

This weekend is the calm after the storm. Chance to catch up on emails to the local med school, to the ENT docs coming next Friday from Germany, to the dentists arriving in a few weeks. I'm finding out, if you're a good listener, it doesn't matter if you miss some of what's said, it's the time you spend that's most important.

Rusty

Visitors

After my month alone as the only English speaker, an American couple came with their twin 7-year-old daughters.  It's been wonderful.  The girls have boundless energy, giggle about everything.  Also tears: from the one twin Clarissa: “more people have Patricia's name than my name! (sob)”  

Veronica Escobar is the mom and a family practice physician.  She sees patients in the mornings and takes children to their new friend’s in the afternoons while I work.  Our pastor, Padre Jose, put out a short publicity notice on the local radio, and business has tripled.  Not sure if it's Padre's announcement, or people just want to see a new face, but we're all glad.   

Veronica's husband Jim is a computer programmer, has resurrected the broken website for our hospital in between child care duties.  He's as welcome, or more so, as the doctors.

An ophthalmology team arrives in 4 weeks, expects to stay a month.  Besides performing over a hundred operations, typically the general medical clinic is swamped with patients, as families who traveled 3 or more hours trying to take care of their other needs.  Right now I'm enjoying the calm before the storm.

Most patients travel long distances to see us, an hour or 2, sometimes 6.  Guadalupe is the only volunteer day hospital of its kind in Ecuador.  I often ask patients, I'm glad you came, but why did you travel so far? 

We charge an all-inclusive $5. per visit, versus 50 or more in private clinics, that's certainly part of it.  In a country where the average laborer earns $400. a month, that's still a bargain.  But were it not for Guadalupe, many patients would effectively have no health care.  The Ecuadorian government tries hard to provide universal free health care to all its citizens, but the system is overworked and underfunded, wait times are a month or more.  Especially for those on the brink of destitution (there are many), the choice is either long waits for free care or rapid care that they can't afford.  

All doctors and dentists here are volunteers.  Patients know they won't be charged for things they don't need, not always the case in the big clinics.  We can feel the trust when the patient first walks in.  And we don't compete with the local doctors, almost all of whom relocated to the large cities once their mandatory year of service is done.  It's a good collegial relationship.

Padre Jose enjoys the visitors as much as I do.  This past Sunday he drove the 5 of us to a local wilderness park, where we trekked 2 kilometers through mud down a mountainside to a series of waterfalls.  There's lots of them here in the foothills of the Andes.  I'm starting to walk normally again as my muscles slowly recover; the twins (after much needed cleanup) never slowed down. 

The clinic reopened here in Guadalupe a couple of months ago, after heavy remodeling and is now certified as a Day Hospital.  Since then our census is slowly increasing as word gets out among the community.

We have a local dentist, Mayra Paltín, volunteering for a couple of months.  She trained in Ecuador, but did a couple of year’s internship in Argentina.  She is exacting and particular with her patients; mercifully gentle with me and my stumbling Spanish.  We were the only ones in the Volunteer house, before the arrival of the American physician Veronica Escobar Jim and their daughters. 

  

Mayra tells a story from her training when she and a medical student were doing community outreach, going door to door in a poor farming community asking about health habits.  An elderly woman answered their knock, told them, 'wait a minute', came back with a plate of boiled yucca.  They declined but ate the offered food when the woman insisted.  Washed it down with a small juice glass.   When they were done, the woman told them that was all she had to eat for the week.  The students' tears came, and would not stop; Mayra couldn't help thinking of the widow's mite.  When they finally went to the next house, the residents had all kinds of fruit, offered to them.  The two took a bagful back to the old lady, and visited a while.  The woman had relatives in walking distance, but they seldom came to see her.   Mayra shared that she had learned more that evening than in a month of classes.

A few words about my nurse.

My third day here, a young lady introduced herself as Paola Espinoza, said she was a nurse and wanted to volunteer.  Her 4 year old daughter finished preschool at noon, so she had to leave by then.

Her husband has steady work for the city of Yanzatza 30 minutes by bus from here.  He's one of the lucky ones, the average wage here is US$400 a month, when jobs are available. 

Paola's takes blood pressures and weights, gives IM injections, but her most important function here is interpreter.  She speaks no English, but her Spanish is normal speed and clear; she rephrases things nicely.  But often I hear her saying exactly the words I used to the patient, and they understand.  We all have expectations of others that influence what we hear.

Last week a patient arrived after a 2 ½ hour bus ride with a large lipoma of the back, some 8cm (3 inches) across.  The growth came out nicely.  I had Paola make a few snips with the scissors and put in a skin suture, first time she'd done so.  She said she learned a lot, I wanted her to feel her time was valuable to me, all in all things worked well.  (Understandably, the patient didn't want to look at the specimen).  Pathology's not readily available, which limits what we can safely remove, but this case was clear.  I hope the clinic can hire Paola once more funds become available.

End of my first week in Ecuador.

Friday 25 May 2018
I found out late Thursday night that yesterday was a national holiday, the battle that won Ecuador its independence from Spain but celebrated today. Our pastor (Padre Jose Berru) asked me yesterday if I had any plans, other than catching up on sleep didn't have any so I stretched the truth and told him no. He was visiting one of the 15 outlying barrios in the parish today, invited me to come along, ¿porque no?

So Jose showed up at noon and we fried plantains, cooked rice, and vegetables without setting the kitchen on fire. Washed it down with a warm yellow herbal tea. Mealtime is always egalitarian, everyone who eats helps clean up, so we washed dishes/pots and pans and were done by 1PM.

At 2:30 I walked the 50 meters to the pastor's house, we started off in his SUV, but he pulled in the next dirt path in the church complex. We got out of the SUV, and he proceeded to feed the chickens, 30 or 40 of them. Soon 35 of them escaped and were wandering around the yard eating bugs. Jose called to a half dozen children sitting in the covered rotunda, and asked them to come help. We broke off small tree branches, started chasing and sweeping them with our branches while saying something in Spanish. Order restored within 10 minutes. Threw slop to the 4 pigs in the next pen (mostly food scraps), and we were off on a 20-minute ride to Guaguayme alto.

That's a barrio of maybe 400 people, there's a central garden and plaza with paving bricks, and what looks like a giant covered picnic pavilion maybe 30 meters wide. The church was in ruins, nothing but the high entrance arch and the sacristy in the back, being rebuilt slowly by the townspeople. There was a small low-ceiling room being used as a chapel, beautifully decorated as are all the churches here. There were enough fresh flowers around the altar to put most US weddings to shame.

The chapel was filled to overflowing, people sitting and standing in the hall.

Today was the feast of Our Lady of Fatima, a beautiful sermon. Padre praised Mary's role as an example of obedience; she's was a missionary to those around her, an example for mothers, At the end, he spoke a couple minutes about the re-opening of the clinic as a Day Hospital, acknowledged my role here for the next year. Mercifully I didn't have to say anything but had to listen to the unavoidable applause. He's getting a lot of justly deserved credit for saving the clinic, more on that in a later blog.

Saturday 26 May 2018
Jose was scheduled to say 4 masses today, starting 10AM in another barrio. Plan was to pick me up at 1130 and drive to Yanzatza, where he con-celebrates with the bishop at noon. An employee drove us to the barrio where another fiesta was in progress. There were 2 picnic tables and 200 people, I sat across from Jose, and next to a woman who it turns out was the deputy director of the region (something like the Lt Governor).

Next, off to the half-built chapel, we had visited 4 days ago, for their first prayer meeting. It had an intact roof, good thing considering it rained cats and dogs; half the walls were finished stucco, the others cinder block.

Mass at 5PM. Halfway thru the sermon, Padre asked me, at how many months would an Xray show a fetus? Answer, 2; took me by surprise, glad I wasn't daydreaming. He was talking about Mary's visit to Elizabeth, how did Liz know Mary was pregnant?

They'd set up a tent covering near the chapel door, so people could stand around in the dirt and mud (instead of puddles) and eat more soup. Padre and I were invited up to the house not 40 meters away. The house held a single bedroom and a kitchen. Jose and I were given the only two seats in the place, a bench on their porch, ate our soup but declined the rice & yucca (still digesting lunch) so it was packaged for us.

What I remember most, though, was a young mother carrying a child on her back, older than usual. He was obviously post-toddler, just looked around. He weighed a good 12kg (25 lbs). We asked the mother about him, he was paralyzed from birth, now 4 years old, she also had 2 other children. Wonder how long she'll continue to carry him around, what will become of him as he gets older.