Thursday, July 28, 2011

It's a jungle out there

Alissa and I choose a program called RICANCIE to introduce us to the jungle. RICANCIE is an organization run by 9 Quichua communities that created a community based ecotourism project. In their programs, you live within a Quichua community to learn about the history and culture of your chosen community and partake in their daily activities.

We choose the community of Rio Blanco, which is 1.5 hours out of the city of Tena and a 2 hour hike from the Napo river, because of its remoteness and the community's knowledge of medicinal plants. About 30 years ago, 5 shaman from a nomadic Quichua clan founded the village of Rio Blanco. Going from being hunter gatherers to farmers and cultivators was a drastic change for the people of the community, but the community soon began to prosper which was only facilitated by opening the village up to ecotourism and by selling their cocao beans.
Motorized canoe down the Napo River with our guide Ramon

Sangre de Dragón
Good for bruises, makeup, and inducing abortions

Our tour guide was Ramon, the 19 year old son of one of the original founders. Timid and shy, I was doubtful that he would be a good guide, but he soon proved himself to be attentive and knowledgable his own quiet and sweet way. We learned that Ramon was in University in Tena, a level of schooling that not a lot of Ecuadorians, especially those from remote parts of the jungle, reach. He lead us through our 2 hour uphill hike through the jungle and through the medicinal herb gardens of some of the homes in the community. Ramon broke apart leaves from each plant for us to smell, and each had its own interestingly distinct characteristics. We learned about many plants which can be used for things like headaches, sore throats, and wounds. Others such as Hierba Luisa and Canelo were good to make teas in the morning. One plant in particular that I found interesting was called Sangre de Dragon, or Dragon's blood. The sap from the tree was a liquidy black juice that Ramon said was a good analgestic and was also often used for bruises, makeup, and inducing abortions. Hm pretty multifunctional.

That night we met the other group traveling with us, a group of kids studying abroad from the University of South Florida. They came with a professor, Michael, who had been coming to Rio Blanco for over 10 years and knew the community members very well. Michael proved invaluable to Alissa and I because of his knowledge of the community, and let's be real, because he spoke Spanish and our Spanish still kind of sucks. It was from him that we learned about the history of the community, the tensions between the different tribes, and how the community began its ecotourism program. He also invited us to join them on their trip to the shaman, which was not originally on their itinerary. Ramon's father, one of the original founders, was also the senior shaman of the community and would conduct our cleansings.

Ramon explained that the process of becoming a shaman is long and arduous. Firstly, the future shaman must be the child of the elder shaman. Mostly boys are chosen for this task as it is seen as too hard for girls, although girls are not prohibited from becoming shaman. Most start training between the ages of 25 and 30, and are not allowed to have the title of shaman until at least the age of 40. During this time the shaman will learn the names and uses of many plants as well as numerous healing rituals. Ramon said that his father only had 2 sons, of which he is the older. I'm not sure if he wants to follow in his father's footsteps however, as he expressed interest in running a tour that travels throughout Ecuador. However he says that he is learning about many of the plants and rituals from his father.

Plant used to make ayahuasca

A common type of healing ritual is the cleansing ceremony which we were to take part in. The "limpieza" is a traditional ceremony that has been conducted by the Quichua community for generations. It consists of taking ayahuasca, a drink made from many plants containing hallucinogenic powers. Those that take the ayahuasca with the shaman follow him on a journey into the jungle and it is intended to clean the body of bad spirits such as sicknesses or evil ideas. Then one by one the people participating in the ceremony sit in front of the shaman while he gently beats you with paja toquilla leaves while reciting a chant. Not everyone that wants to be cleaned has to take the drink, and many avoid it since it makes most people vomit. Alissa and I both decided to try the ayahuasca along with three other kids from the USF group since hey, when else am I going to get the chance to try hallucinogens in the Amazon forest? After nightfall the ceremony commenced starting with the ayahuasca. The muddy looking concoction tasted exactly how I expected, like bitter Chinese medicine. We blew out the candles leaving us in pitch black darkness, and waited for the drink to take effect in the shaman before he continued the limpiezas of each participant. About 15 minutes later, I heard the sounds of many people vomiting over the side of the patio. Alissa and I didn't end up vomiting, but I definitely felt nauseous a while into the ceremony and the sounds of people puking their brains out in the background certainly didn't help. It's hard to say if I had an experience with the drink. I know that when I closed my eyes the world started spinning and I would see neon lights. I also felt like I was daydreaming on speed, and I'd see images of random things that didn't make sense. But when I opened my eyes I was oriented and didn't see anything at all. I'm going to assume that what I saw didn't mean anything, since I can't interpret anything out of a pixelated girl riding a pixelated unicorn into the sky. One of the girls, who was really severely vomiting, said she had a really good experience however. She said she got the answer to one a personal question she was focusing on, and the solution was something she hadn't thought of before. Michael also vouched that he had taken the drink on several occasions and had experienced the jungle journey with the shaman. He said sometimes it takes more than one time for the drink to have an effect, and the person taking the drink has to be extremely focused as well. I believe the drink definitely has some powers, but I'm not sure of what to make of the pixelated unicorns or sock puppet frogs I saw in my "visions." The ceremony was incredibly long, as each person got at least 10 minute cleansings with the shaman. Alissa and I couldn't make it through the whole ceremony as sitting in the dark for hours took its toll. The next day Michael told us that the shaman was actually having a fight with another shaman from a nearby village. It was incredible because he was coming in and out of his visions, making sure that those that were sick were ok while at the same time continuing with the cleansing and fighting with another shaman in his visions. We heard that afterwards he was so exhausted he couldn't even stand after the visions were finished.

The next day we particpated in "mingas" or communal work. The other guide, Edison, took us to his family home where they harvested yucca and plantain plants. We each got to uproot a yucca root, and in its place we put a branch of the plant which would regrow into another plant in 6 months. Afterwards we cleaned and peeled our yucca and learned how to make a chicha, a traditional fermented yucca drink. We were also baptized in a nearby stream and given a name in Quichua. I was baptized as Suma Huarmi, which means pretty girl or queen (hey, I didn't choose the name the guide did). We also gave our guides names in English as well for the closing ceremony we would have with the community. We named Edison Lewis and Clark because he was such an excellent guide, Ramon was baptized as MacGyver since he had a solution for everything and was always there to catch us right before we ate dirt, and Maximilian (the little brother of Edison) was baptized as the Mad Hatter since he helped make our leaf crowns and was a little jokester.

Waterfall we swam in
Supposedly was home to an anaconda before but legend has it the people
made peace with it and it hasn't bothered anyone since

During our last night in Rio Blanco some of the people of the village came to our cabanas for an intercambio or exchange of our cultures. The community shared traditional songs and dance in their traditional wardrobes, including one of a wedding ceremony. In exchange, we taught them the hokie pokie and I taught them how to make a paper boat that my grandfather had taught me how to do. In the end everyone participated in song and dance. It was a really nice little fiesta, and we all left feeling very unified even though our cultures were so different everything had to be translated in 3 languages. This community, with its unique culture and warm hospitality has definitely left an impression on me.

The new road they were so proud of and a traditional house built on stilts

During our last dinner, Michael brought up some changes he'd been noticing in the community. Recently the community has been beginning to prosper through its ecotourism project and production of produce. The fruits of their labor (no pun intended) are begining to modernize their community, starting with a road that was built last year from the edge of the Napo River to their village. They are so proud of this road, because it means that their children can more easily to go Tena for school and because they can bring their cocao, yucca and plantains to sell in Tena. However this has led to more destruction of the rainforest to make way for more fields. By next year they will have a generator that will provide electricity to all of the village. As Michael said, you can't blame them for wanting to develop their community and provide a better future for their children, but this is coming at what cost to the rain forest?

I wonder what will happen to Rio Blanco and to Ramon in the future. I wonder if the village will become just a tourist attraction and the virgin forest destroyed, and if Ramon will end up taking his father's place as shaman. I hope one day I can make it back to Rio Blanco to visit this beautiful community. I hope also that as it progresses to the modern age, it never loses its innocent charm.

Wednesday, July 20, 2011

Tea cures all

Agua de manzanilla (camomile) probably the most commonly prescribed medication in all the places I've visited in Ecuador. Literally they use it for everything. Tonsilitis? Have some aguita de manzanilla. Vaginitis? Put some manzanilla up in there. Internal hemorrhoids? Steam of agua de manzanilla. I actually did a little research on camomile tea, and apparently it is supposed to help with inflammation and stress. I think I'm going to take a couple kilos with me before I go back to school then.

Birth control

Flavio told the 16 year old high school girl working with us that watching a birth is the most effective form of birth control. He was right. Another 16 year old girl came in in labor scared shitless, and after she was settled on the birthing bed she proceeded to vomit everywhere. Covered in her own puke she started pushing, but wanted to give up after the baby's head came out screaming no puedo no puedo. Thankfully after one last push she was finished. However it was definitely not a pretty sight.

Things like this never fail to frustrate the doctors. They say they don't understand why, when IUDs, birth control pills, injections, and implants are completely free, when they go to schools to help educate the children about safe sex, why do people still have unwanted pregnancies? And why are so many girls still getting pregnant so young?

They say that the culture is at fault for some of this. According to the doctors in Puembo, some of the women want to be on birth control but because of machismo the men don't want to use condoms or for their women to be on the pill. God knows why. Others believe the word of their neighbor more than that of their doctor. For instance one woman thought that tubal ligation would give her cancer, which is completely false and unfounded.

The scary thing is that birth control isn't just for the sake of population control; putting women through unwanted pregnancies can have dangerous repercussions. Since like most of Latin America Ecuador is a Catholic country, abortion is illegal throughout. The combination of not using birth control and abortion being illegal have made illegal abortions the third most common cause of maternal mortality in this country. Which is a scary statistic. And if abortions won't be legalized anytime soon, it's time to focus our efforts on preventing unwanted pregnancies to begin with. However it's probably easy to say that with a fresh pair of eyes only looking in. After seeing the frustration of the doctors and all the work they have put into this cause, how do you know if you need to try harder, or if the people just won't change?

Sunday, July 17, 2011

Dar la luz

Literally translated "dar la luz" means "to give the light" but in Spanish they use it to mean "to give birth." It's a beautifully poetic phrase, and its and especially appropriate phrase to describe the events that occurred last night.

I think I'm beginning to develop a thirst for blood and guts, which is why I asked to do a Saturday night guardia. I was promised blood, guts, and babies and that promise was kept. We were up to our knees in births starting around 10PM last night, with a total of 3 normal vaginal deliveries and one that I will never forget.

Around 11PM while we were tending to a knee injury (about a 4 inch cut, deep enough to see the aponeurosis), we were interrupted by screams of a pregnant woman crying that her water had broke. Immediately we rushed her to the sala de partos, fixed her in a bed and screamed puje, puje! The woman pushed, and to our horror a small arm started to emerge from her vagina. The doctors gasped, backed away, and someone left to find a hospital in Quito that would accept her for an emergency cesarean. Dr. San Pedro, the doctor attending the birth, sighed, looked at me and told me that this is one of the worst things that can happen in a delivery. With each contraction the baby's shoulder and torso would be pushed down on the umbilical cord, asphyxiating the baby.

If this had happened in a private hospital in Quito, or if we had been in the States this would still be bad news bears. But this dangerous medical emergency was compounded by the fact that we didn't have the staff or the equipment to do a Cesarian in the madrugada of a Saturday night. Instead the baby would have to suffer the hour long trip to a bigger hospital in Quito where they could preform the surgery. I watched the seemingly lifeless arm coming out of the mother's vagina as they attempted to find the fetal heart rate with a doppler to no success.

"Un mil lo sientos señora, one thousand I'm sorries, ojala que su bebe vive, I hope that your baby will live" said Dr. Favio to the mother, who seemed to be in no distress at all. "This is a very grave situation señora, do you understand? It is necessary to get you to Quito as fast as possible or else you will lose your baby" Dr. Alvero explained. No response. She had said before that this was her second child. After being asked again she said it was her third. It wasn't until she got to Quito that she admitted it was her ninth child, and she had not received any prenatal care past her second month despite the fact that it is completely free in this country. One visit to an obstetrician could have prevented this unfortunate circumstance. With one ultrasound or with the maneuvers of Leopold the doctor would have easily known that the baby was in a transverse lie, which can be corrected in the clinic. Instead Dr. Favio spent the trip to Quito with one hand in the woman's vagina to prevent fatal umbilical cord prolapse.

The baby made it, by some miracle. Luck was on its side that night.

At the same time that light was being given to newborns last night, one went out. A 24 year old boy came in with a deep chest wound to his left side which punctured his lung. When I got out of the last birth and returned to our humble 10 bed emergency room (literally a room with 10 beds) he had a Glasgow score of 6 out of 15 and was being kept alive by manually pumping oxygen into his lungs. His heart rate was 34 and dropping. They fed him some epinephrine which made it spike to 60 but then drop immediately back to its starting point. Finally it was decided that there was nothing more we could do for him, and the doctor stopped giving him air. He explained to the boy's mother that they had tried their best but he was not going to make it. The mother started shrieking, blocking the doctor's exit from the side of his son's bed and begging him to continue but the doctor refused. Other family members came in and were stricken with the news that the boy was dead. "Levantate levantate, get up get up!" his brother screamed. Grief soon turned into anger. "You killed my son" the mother screamed in the doctor's face. "No, THIS killed your son" Flavio said as he ripped off the makeshift compress they made over the 5 inch stab wound. It was such a tragic scene. I couldn't help but think of the irony of just giving life to 3 babies as one was going away. I'm not a very religious person, and usually not a very corny person either but I hope that this boy found his light as well.

So much commotion for our humble hospital in one night. I am back again tomorrow, hopefully I will have more stories to share.

Saturday, July 16, 2011

It´s not even 10AM yet and already I have cleaned 2 children, both under 2, with second degree burns on at least one fourth of their bodies. The sad thing is that these aren´t even exceptional cases here, it´s the most common reason small children come for curations. In developed countries this would be considered neglect. Small children should never be left in the kitchen unattended, as this is where most burns happen. They should always be supervised while the stove is on. Why don´t these parents know this? Your tears won´t take back what pain your children are experiencing right now. And I, even though I am helping your child, can´t take away the excruciating pain, screaming, and crying either. The interns have told me that you would never clean a burn the way we do in America, where the child would always be anethetized before even attempting to treat the burn. But here there is not enough anesthesia, and the children have to suffer more for it.

I don´t think my heart can take any more children like this.
Give me something to sew please.

Wednesday, July 6, 2011

My Turno

Which Jordana calls a guardia but she also calls an esfero a boligrafo. Anyways in Yaroqui a turno is your turn to do a night shift call. I feel like so much happens in Yaroqui that I can't remember everything even when it just happened.

Firstly, I did my first set of stitches!! It was on some dude that cut himself on a nail. Luckily for him though he didn't cut through the underlying facia, but he did need around 8 stitches. They let me do everything, from the lidocaine to the stitching and wrapping. Super chévere.

I also rode in an ambulance for the first time with a pre-eclampsic woman. We stopped by McDonalds, and the rule holds true: Micky D's ice cream cones are always better abroad.

The next patient was a 25 year old boy who tried to commit suicide by ingesting grass weed killer. He came complaining of stomach pain (duh), and he also had fresh cut marks on his wrists. I got to insert the stomach catheter via the nose, where we aspirated what was in his stomach and injected charcoal to inhibit the absorption of the poison. It was kind of heart breaking, because at one point the intern, Luis Fe, asked if he was having any problems with his family or spouse. To which he nodded and responded "no me quieren" which means they don't love me. This morning he looked a lot better though, and he was discharged and referred to a psychiatrist, which most likely he will not see. Hopefully this was only a cry for help though, and he won't try to commit suicide again.

In pediatric emergencies, there was a 5 year old boy with a zipper clamped on the foreskin of his penis. Like that thing was stuck like the jaws of life. And the kid was such a trooper too. He wasn't even crying, and when he was asked if he anything hurt all he said was "no." He was sent to Quito to get the zipper removed though.

Que más...2 more births, I've been promised the next one so fingers crossed!

I finished off my day by observing a labaroscopic cholecystectomy, which Jordana helped with. Super, super chévere. They said I could even help with one in the future.

Sigh...currently fixing my debit card issues because I didn't think to check my expiration date before I left...

Then I'm off to sleep like a baby.

Hasta luego!

Monday, July 4, 2011

Only in Ecuador

Last night a drunk man came in with a ruptured anal sphincter. He had been bored by a bull in the anus.

I haven't talked a lot about what I've been doing clinically lately, because up until last week I wasn't doing anything. Ecuador has 4 tier health care system, and for the first week I was in the first tier which they call the subcentros. The town I was in was called Pifo which is about an hour away from Quito by bus. The subcentros are where people living in rural areas go for the non emergent things, like common colds and lab tests. And the doctors there weren't super friendly either because my Spanish really is not up to par, and they didn't seem to like to teach a lot. It was nice to be able to see patients in a rural setting but at the same time I wasn't learning anything.

Fast forward 2 weeks, and I changed to the second level in the system, to a hospital in Yaroqui. I should have done it so much sooner. I'm currently working in the emergency room, and I get to be so much more hands on. I've learned how to clean wounds, stitch, do EKGs on an ancient machine, and the next adult that needs an IV line is mine. Also so many babies are born at the hospital, so I've gotten to see one and hopefully I can help in the next one.

Although I'm having such an amazing experience, at the same time the hospital just breaks your heart. They're constantly running out of equipment or supplies, and there is always a shortage of workers. You can also see how the public health care system screws over many of their patients. This one middle aged man was recently diagnosed with precancerous gastritis after being bounced around from specialist to specialist for 14 years. And it is unlikely that any specialist will see him now that he's been through them all, and he is most likely going to die. I've also seen so many teenage pregnancies in Ecuador due in part to the lack of reproductive knowledge. Most of the girls that are pregnant for the first time are in their teens or early twenties. And in one tragic case that Alissa and Jordana saw, a 13 year old girl was raped and impregnanted by her step-grandfather. Stuff like that just breaks your heart.

Tomorrow I do my first overnight shift, hopefully I have a lot more to report back.