end of July

For the most part, my last week of July has been tedious, full of work, and a little tiring. But above all this, it´s been very rewarding to finally be able to start what I came here for- my project on the health of the children using the clinic. In these beginning stage, I´ve been exposed to the wonders of paper medical records.
Not just paper medical records- paper medical records in a non-profit clinic. 7000 records down and a couple more thousand to go, all i can say is I am extremely grateful that in a few days I should finally be done with the scouring, and hopefully be able to computerize the information I have found. The only thing the 6 years worth of records have in common, is that, like i previously mentioned, they’re all "paper."

Starting with the first record ever made at the clinic and continuing through the history of patients, I immediately noticed the progression of medical record style. The centro medico originally started out with lined paper that had "historia" across the top. From there, in about a year or so, it appears as though they transitioned to a more formal record style with actual spaces to fill out information concerning the visit and/or the patients, and in 2008 I guess that either funds were low or there was a paper shortage, because for about 4 months, every of record was recorded on anything from scrap paper cut into post-it sized squares, to ripped out pages of magazines. In all, the entire experience of medical record revision has given me a brief exposure to the history of the clinic, accentuating how far the community has come, and how great the potential it still has to improve.

This weekend, to relax and give my paper-cut fingers a break, I´ve decided to wear-out my legs a little bit instead. Ajay and I are going to be waking up early tomorrow, hopping on the first bus to Quito, and meeting a climbing group that will then depart for Cotopaxi National Park. With a little luck, lots of sunscreen, and the help of the guide & included snacks, we´ll hopefully be on top of the 19,000+ mountain by Sunday afternoon.

According to this description on a web-site i came across while researching what we´re getting into, it sounds like it may even be a “religious” experience:
"Cotopaxi was also once worshiped by Ecuador’s ancient civilizations, thought to be the bringer of rain and prosperous crops; and the top of Cotopaxi was considered to be where God resided."

We´ll see what the world’s second tallest volcano has to offer…



Wish me luck!

pictures

BAÑOS

the whole gang going horse back riding




just "the men" preparing for canyoning

...I went first- probably because i was this serious about things

a shot from another angle

the real waterfall (the yellow speck is Ajay- just to give you an idea of how far of a drop it was)

accomplished

BLOOD PRESSURE AWARENESS

my post outside the clinic

pretending to know what i´m doing...

the start of the presentation

answering questions

La reunión

With the end of Blood Pressure awareness month approaching; come last week, I had to change my customary schedule from taking blood pressure in the morning and finalizing the proposal of my Child Growth Standard project in the afternoons (which involved having what I thought was decent Spanish, continually corrected by my advising crew here at the clinic; Jennyfer and Paola.). Instead, I began to work primarily on my support group presentations in the afternoon after continuing my publicizing of the meeting in the morning.

Being able to spend the mornings taking blood pressure was surprisingly fulfilling. Not only did I become a pro at quickly being able to find arterial pulses and work the sphygmomanometer, more than anything, the patient interaction was humbling and rewarding. The majority of the patients I tended to were either waiting for a family member to be seen by the doc, or were passing by the clinic and figured they had little to lose when the word “free” was involved. The range of victims was immense. From small children that were fascinated by stethoscopes, to teenagers, to adults, to even small indigenous women that reminded me of my nana; I was able to interact, practice my awkward banter, and genuinely become acquainted with the community in a manner I couldn’t have ever anticipated. The sincerity of each person I had the pleasure to meet (which up to this point has been over 110) made the early mornings worth it; however, as fun as it was, with July 22nd approaching, I had to shift my focus to the reason why I was even able to meet them…the support group meeting.

In reality, I pictured the presentation to be a bit less time consuming than it ended up being. After practicing my basic explanation of hypertension, its risks, suggestions for healthier pressure, and answering any questions, I felt that I would easily be able to conceptualize my knowledge into a presentation that would last an hour or so. But, after realizing this knowledge only covered about 5 minutes of information, I knew I had a bit of preparation before Thursday.

So I jumped right into the topic of “la hypertension.” Fliers, pamphlets, information sheets- I read any and everything I could get my hands on in which ever of the two languages I’ve had running through my brain the past 6 weeks. For hours on end, I tried to synthesize the information, hoping to find an interesting and interactive way to present the info, finally realizing that the good old friend of mine, power point, would be able to provide the information in the most visually appealing and straightforward manner.

With the help of Dr. Andrade and the ideas catalyzed by what I gathered from talking with the patients regarding their knowledge over blood pressure, I set out to work on the presentation with the intention to motivate people to actually make changes in their lives. After looking at the lists for the past support group meetings it looked like something was missing- there was basically an entirely new group every time, and it sounded like the meetings were more lectures than providing support. Most of all, I wanted to give people a reason to come back to the August meeting.

Before anything though, I knew it was necessary to set forth a foundation of learning before delving into any advanced topics or lifestyle changes. As one gentleman was telling me after discussing his abnormally high blood pressure, although he had been taking medication for the past two years (well, at least saying he was taking medication; I’ve found even those with prescriptions usually don’t have the means to buy the expensive pills, often resorting to sporadically taking them, or reducing the suggested dosages to a point of inefficacy…), I was the first “medico” that had ever explained to him anything more than that he had two numbers of a greater value than they should be. Therefore, afternoon after afternoon I worked on setting forth a logical way to present the information necessary to truly understand what blood pressure is; my outline went through the most basic development possible: The importance of blood; the circulatory system; why we have blood pressure; what our blood pressures mean; and then the risk & development of hypertension.

Slide after slide, and animation after animation I attempted to make the presentation as interesting as possible, in addition to also encompassing themes and diction that I wouldn’t slip up on, or make a fool of myself trying to pronounce (“asesino silencioso” is pretty hard to wrap your tongue around when you’re half way through an hour long presentation…).

But then came the fun part, or at least the part that didn’t involve deadly pathologies of the disease or anything. Opposed to leaving the group with a dismal feeling about their maladies I tried to present reasonable and easy ways to change their lives- suggestions of sorts- that including things from dietary changes, exercises, how to lose weight, and lifestyle changes. Another thing I was excited to test, was the follow-through of the group. To give them as much incentive as monetarily possible (considering monetarily I couldn’t offer a thing) I decided to make a calendar hand out for each person that came to the meeting. Included on this were spaces for keeping track of dietary consumption, whether they did any form of exercises, and spots for specific goals that we would fill out during the presentation. Hopefully, with a little push, I could try to increase participation in the meeting, and more than anything, give people a hard copy of something to motivate them to change, and continue, healthier lives day after day.

Then finally the day of the presentation came. I had made my phone calls, practiced my presentation a few times, and had my hand outs printed off; by the time 5 pm rolled around I felt exceptionally prepared.

Ok, not really; I’d say I felt fairly prepared- ready to give the presentation and all, but a little nervous about forgetting all of my Spanish while standing alone in front of the group. Regardless, the moment the first members of the group made their way into the waiting room, I realized my nerves were misplaced, and that really, other than the possibility of being a little humiliated if I forgot how to pronounce a word or two, I had nothing to lose.


In all, 16 people ended up attending the support group meeting. From the first slide to the last, I scanned the audience and could tell that in the very least, I had their attention. Although, honestly, I was a bit nervous to begin with Dr. Andrade, Paola, Jennyfer, and the other volunteers all watching, it was actually relieving to see their supportive glances as the presentation went on. When all was finished- the most gratifying part came to see the smiles and appreciation on everyones faces; at first it caught me off guard, but every person who had come to the meeting went out of their way to introduce themselves, say thank you, and make the whole past month feel like it was worth it.

Since the support group, things have been relaxing. I decided to stick around Tumbaco opposed to go out and cram something into the weekend, and as I sit writing this, relaxed, content, and just having finished and submitted my medical school application, I feel more at ease than I did soaking in warm mineral baths.

The next week will probably be a little more laid back than the past, but if I’ve learned anything here, you’ve got to roll with what life brings you opposed to being set in any expectations. So for now, I’ll just keep carrying on, and hope that everyone at home- family, friends, fiancé, and all- are doing the same.

Buenas noches,

drew

Hace una semana

Wow- it’s been too long.
The past two weeks have flown by in a sense- at least in the sense that you get after tirelessly trying to accomplish something and then finally getting a chance to look up. The majority of the past 15 or so days have been spent focusing on Blood Pressure…

But before I get into describing “business” though, I can’t go any further without mentioning the reason why I was unable to update my blog last weekend; sadly, I decided to relax a little bit…

Since I arrived in Ecuador I’ve heard from almost any person I end up talking to about possible tourist destinations that “Baños” is a must see place. I know, I know, all of you out there with any background in Spanish are probably thinking that this must have been some sort of joke, or that I would’ve definitely already visited the baño, but to clarify, Baños is a small pueblo about 4 hours away from Quito known for its thermal baths and incomparable scenery. At the foot of an active volcano (don’t worry Moms & GrandMary, not too active) the city serves as home to a fairly small population of people devoted to tourist activities, and a pretty constant flow of visitors from all over the world. In fact, other than the section of Quito known as “gringolandia,” I hadn’t seen such a concentration of toe-headed short-wearing persons since I left the states.

We decided to take off for Baños Friday afternoon in a mix of excitement to begin the weekend and acceptance that waking up at 5am the next day to compensate for the bus ride wouldn’t exactly fit under the “relaxing” agenda. Ajay and I left work following a patient-filled morning, headed home, packed backpacks. Then hit the road to Quito. After making a pit-stop to grab some schwarma before leaving the city, we hopped in a cab to the bus terminal in the Southern valley. Oddly reminiscent of the University of Denver campus, the metro area of Quito is confined to the only space available atop the 9,350 ft mountain it rests on- an area only a mile or two wide, but tens of miles long.

Normally, it isn’t a problem to journey through the city, but because of this characteristically narrow design, when going from the Northern valley of Tumbaco to the Southern terminal in Quitumbe, you are basically traveling the longest distance possible through the urban landscape. Throw in the most viscous traffic you can imagine, and to traverse this distance of under 15 kilometers takes a little more than an hour and forty minutes.

Not knowing this at the time, we set off for the bus station around 5 pm; arrived at the terminal in time for the 7 o’clock bus to Baños, and then made it into town with about a sitcom to spare before midnight. The ride, in general wasn’t extremely memorable due to the darkness that hid anything worth seeing, but one thing that has been getting to me lately is the fact that no matter where you go, disparity is undeniably present. Whether it’s driving by house after house constructed only of a mixture of grey concrete and dilapidated wood, or being asked by a 4 year old boy in tattered clothes if you would please buy some of the candy he’s managed to procure; 5 pieces for 25 cents, or 10 for 50. At every stop we'd pick up a new group of children trying to make a living, and at every stop I'd get the same sad feeling in my heart. I find myself overwhelmed by a mix of feelings, mainly describable as disheartened at first glance, but humbled and grateful for the opportunities I’ve been blessed with after. And more than anything, I can't help but feel motivated to continue the work that I’m doing, motivated to help improve these situations in any way possible.

When we arrived in Baños we decided to head to our hostel and get a full night rest in lieu of the adventures and action packed day that was in our plans. In short, the hostel was more accommodating and welcoming than money could pay for. Run by a Kiwi couple that decided to move permanently from New Zealand to Baños after working as tour guides, the eco-friendly “resort” of sorts, involved a free (and extremely delicious - not a common combination) breakfast buffet consisting of fresh fruit, granola, and home-made bread. Also, due to the connections the staff had, we were able to easily acquire numbers and information of reliable tour companies; which, Saturday, included a “manly” adventure to go canyon-ing, and later, a horseback ride up the mountain juxtapose to the volcano. In Baños we met up Regina and Ben (two other volunteers from the clinic), and as part of the compromise Regina proposed to Ben, as a way to convince him the “thermal spa” town would be more interesting than the jungle, was that Ajay and I would do sufficient adventurous, guy activities. So, along these lines, we three men decided that the best outlet to enjoy our escape from estrogen would be to rappel down cliffs next to raging waterfalls; a.k.a. go “canyon-ing.”

The guide did a great job of explaining the logistics of the reverse mountain climbing, and as I descended down four different waterfalls, even in spite of the extremely slippery rocks and water splashing in my face, I had a pretty good time. I'll throw in a few pictures to give a more visual idea about what the experience looked like when my internet connection isn't so slow, but even then, they hardly will do justice to how fun it was.


The final waterfall was a leap of faith. About 140 feet vertical drop, the last plunge involved about 5 meters of rappelling down a sheet of water, and then jumping off the rock ledge into a graceful descent alongside the falls.

After drying off and getting some food, we picked up Regina from the hostel and the four of us volunteers rode rented horses through the town, up a scenic path that wound alongside a ravine, and into the mountains of the Andes. The scenery was unlike any other I’d experienced before. Even growing up in Colorado didn’t prepare me for the awesomeness of the landscape; protruding mountain tops jutted out from either side of the river, rising above my line of sight and surpassing the blanket of clouds that enveloped the evening. A distinct and vibrant emerald green, flourishing with plant life I never even knew existed, these mountain tops redefined the power of nature for me. And as we continued to trot through the valley, although the ultimate goal of seeing the volcano Tungurahua was unfulfilled due to the prominence of the aforementioned cloud-cover, I felt a peace that only the sounds of the meandering stream could even begin define.

The next day, believe it or not, I slept in past 6:15 a.m. That’s not to say that I didn’t have a little help (in addition to being tired from all the adventuring, a night spent out trying the local sugar cane alcohol until the point that we ended up singing Hotel California at a karaoke bar might have contributed…), but it was refreshing to get up after the sun for a change. Following breakfast we packed our bags and headed to the name-sake thermal baths. My companions didn’t feel that they were necessarily warm enough or up to par with what they were expecting, but I found it hard to complain looking up from the semi-steaming pool and seeing the jungle covered peaks that surrounded us as we sat neck deep in water. In fact, with the 6 hours of buses that followed, my body was thankful to have had any sort of time devoted to its relaxation. We made it home safely, and even though Ajay lost his credit card in the process, other than stiff feet, legs, back, and a sore neck after the bus ride, I’d say the weekend was a success. In the very least, it allowed me to approach the upcoming week with a little more enthusiasm and vigor- which upon reflection, I'm really glad I had.

1/3 of the way down

So this week, in light of the need to finish my med school personal statement (that, now that my baby/ best writer I know has looked over, has a bit of correcting to do before I even begin to feel that its ready to show anyone else) I figure I´ll let some pictures do the talking.

Tuesday through Friday, I came down with an intestinal infection. Stereotypical, I know, but luckily my friends/ doctors at the medical clinic were able to run all sorts of exams, ultimately giving me some antibiotics that have since gotten me out of bed. As a result, I was able to visit Otavalo this Saturday with Evelyn Falck, her friend, Lucha, and my new room mate Ajay.



Which, by the way, this past Tuesday we received a new addition to our family; Ajay Premkumar, a recent graduate of Emory University who will be working at the clinic for the rest of July and into August. We´ve already formed a friendship from the start, and it seems like I´m gonna have a pretty good time here with someone to travel with, or at least someone to deflect the dogs.

Otavalo is a small pueblo an hour or so outside of Quito devoted to selling artisan crafts and local foods above other things.


(spices)


(Ajay getting swindled)


(comida)


Basically, it was a pretty amazing place.


After the market we headed to a town that I will not even subject to my poor spelling skills, but it started with a "C." Here we ran into some friends of Ajay´s (really, a family that´s children were having their education provided by Ajay´s favorite professor back in the states- the same one that recommended the program to him)



In all, it was a pretty exciting weekend full of amazing scenery, great food while watching the Final at Elsa and Jorge´s friends house, and transitioning back into not being horribly sick.



(scenery)



(lake in a volcano crater)


(sangria and snacks- viva españa!)

I´ll keep you up to date in the coming weeks, but hope that the U.S. is treating you all very well

hasta pronto

drew

mixed feelings

As I sit in the living room, listening to what appears to be some mixture of love songs and Spanish-Jazz playing over the sounds of Elsa cooking, I’m hesitant to say that I feel like I’m at home, but although it’s nothing like the life I’ve left, or the houses I’ve been in before, in all honesty, it’s gotten to the point that this “casita” has become my home. For the past three weeks I’ve woken up to the same scenes, the same smells, the same food. I’ve gone to work, I’ve gotten to the point where I’ve seen and eaten the same lunches over again, and I’ve even grown accustomed to the some-what lumpy bed that barely contains my stature. In all, good or bad, this is my home for now, and over the past week I’ve been dealing with the realization that this is going to be what I call my home for another two months.

Don’t get me wrong, things are still going really well- the past week I began to get into a rhythm with my schedule, prepared what I feel like is everything I will need for the upcoming month of “blood pressure awareness,” and put the final touches on my proposal for my growth standards investigation; yet, as the novelty of living in a new place began to fade, and stresses from Medical school applications, constant translations, and a bit of sleep deprivation began to build, I guess you could say, I just began to miss home. I began to miss the comfort of having milk and cereal for breakfast opposed to “huevos and pan;” I started to miss being able to just relax- sit on my front porch and people watch, and not necessarily take everything in for the first time; and honestly, I really started to miss those closest to me: my family, my friends, and most of all, my best friend; my fiancé, and the person I feel incomplete without, Caity. This past fall (in addition to the past 4 and a half years), being together and studying abroad in Spain opened my eyes to a level of happiness, and excitement, and love for every second of life that has since been something I’ve brought to everything I try and do; but here, without her, I’ve begin to realize how much I never want to take her presence in my life for granted- and how much I can’t wait to change the world with her at my side! Along those lines, this time away has given me a chance to reflect on all of the people around me who have supported me up to this point- and more than anything, it’s made me realize how lucky I truly am. For this, although it doesn’t even begin to do justice, I want to say thanks.

There’s really no way to describe how lost you can feel when you’re surrounded by people who you can only express your feelings to in limited terms. Salutations, small talk, and discussing the world cup matches are great- but at some point, the basal level forms of expression only scratches the surface of how you really feel, which over time, becomes increasingly frustrated or, as I have found, just exhausted at times. In the end, being on my own has significantly reassured all of the feelings, and excitement, and determination I had before I got the plane a few weeks ago, and for this, I cannot even express my gratitude, but with 60 or so days left on my journey, I guess it’s good that I’m starting to feel “at home” in one way or another; becasue right now, I'm missing mi propia casa a bit.

To sort of change gears, things this past week at the clinic have been going smoothly. Monday I traveled with Paola to two of the pre-schools to conduct inventory of ALL the things the schools currently have. From chalk boards, to chairs, to broken pencils; we counted, separated, judged, and recorded any and everything that was of even the most miniscule value. Interestingly, one means of categorizing the materials was based on who donated them to the school. Often times, the teachers weren’t exactly sure if it were the parents of the children, the Rotary Club Foundation, or other non-profits that had helped in the past that were responsible for the majority of the necessities, but I was caught off guard by the donations deemed to be from el ministerio de la educación. Sadly, these "gifts"/ obligations usually consisted of things of very minimal worth, including: plastic chairs with rickety legs (some of which were only 75% in tact), stuffed animals that were “new,” as to say newly donated, (which appeared to have been left over from foster homes or garage sales), and some old books with numerous pages missing and/or covers tattered past the point of recognition. In all, it was an eye-opening experience that changed my perspective on what resources were truly at hand here in Ecuador, and at the same time, made me grateful for the public education I was able to access throughout my youth, in spite of whatever negative connotations might be associated with it back in the states.

Tuesday to Friday, my life involved a handful of translations varying from: donor letters, certificates of appreciation for other volunteers that were leaving, yearly updates on children in the schools, and even having to translate a list of 100+ pieces of dental equipment that a group of American dentists will be bringing in late August (needed for some sort of customs formality I think). By the end of the week, these tasks, along with the finalization of my proposals for the upcoming months, left my head spinning, aching, and- thanks to the homesickness I mentioned- a bit out of sync.

The best way to relax, I found, was in keeping myself distracted. And even though it isn’t the first thing that comes to my mind when I think of “relaxation,” this past week marked the start of my summer rugby training program, and the start of any sort of formal exercise for the first time since I landed. Given that my body has more or less adjusted to the altitude here, and any worry of passing out or having a heart attack had subsided after last week’s rugby practice, going on a jog every other day and doing some push-ups actually felt pretty good towards the end of the week. Not to mention that it gave me something productive to occupy my time during the somewhat lonely nights, in between coming home from work and waiting to eat dinner and drink coffee with the family. In fact, I even got to know the neighborhood in ways my parents hadn’t even explored; which, Friday night, came back to bite in more ways than one.

As I had started every day before, my jog around the barrio involved a quick stretch, talking to the front gate guard Jaime, and then heading up hill; other than being a little unusually over-cast and a bit windy, this Friday seemed to be nothing out of the ordinary. My customary route involves trotting through the main street that our conjunto is on, dodging the empty bottles and loose rocks that line the gutters and making my way between cars and school buses as they head to their destinations. For the most part, the first ten minutes or so of the jog is fairly easy, with a slight incline and some decent scenery ranging from a water treatment plant to a campo with cows and wild grass. Then, abruptly, at the end of the road there is a fork that splits into two paths: one, being what looks like a drive way (and thus I’ve yet to find out what it really is); and the other, a steep inclined road that traces the profile of the mountain separating the valleys on either side of Quito. Immediately when I arrived at the foot of this “hill” the first time I knew I had a goal- make it to the top, and since, have tried to climb a little by little, to at least a height further than I had the days before. On this Friday evening, when I arrived at the base of the road my legs were a bit shot after a week of doing this customary run, but after painstakingly convincing them to carry me past the bus stop, past the street vendor, and past the old abuielita I say hola to every time I crawl up the precipice, I made it to a point where the incline subsides and I felt satisfied with my progress. Amidst catching my breath and trying not to roll down the hill, I distinctly recall the red-ish orange sunset that greeted me as I looked down into the valley, peered onto Tumbaco, and stood (actually hunched over) in the presence of the most amazing view of Quito I’d seen yet; represented by the gleaming edifices of ten story buildings nestled between two protruding peaks of densely vegetated mountains on either side. After catching my breath and taking a mental picture, it was time to carry on.

Down the hill I jogged, passing the people I’d seen struggling to walk up it along the way, and reaching the road in probably 1/16th of the time it took me to ascend. With all the momentum from hill, it was almost (but not entirely) easy to make my way through the rest of my customary jog, as I followed along the path that brought me to the hill and then made a left down the street I suppose is known as, calle cinco, due to the scribbled graffiti on the brick wall that lines the corner. Down 5th street, the scenery is a bit more rural, with sprawling fields to the left, and the road being composed of individually placed river rock that has since formed an uneven, but charming, pathway to lead the few people that call this area home to their front steps. I made my way down this route as I had the Wednesday and Monday before, focusing on my footing as not to fall, and taking the streets back south to my home where I could eventually rest. Today though, as I approached the first turn in my path, I saw an oddly cute puppy, wearing an orange sweater and sniffing around in the tall grass alongside the road. As I passed it, it ran in front of me, sprinting down the path and away from my sight; that is, until out of the silence, I heard a quick bark, that transitioned into a chorus of furious yelps and growls that barreled down on me from behind a set of bushes to my right. Within seconds -or however long it took me to turn my head and see what was the matter- a pack of four dogs, one that used to be white before living on the streets, a black-matted lab, and two fierce looking canines that if I had to guess were probably boxers, were sprinting the 5 or so meters that separated us towards me. Before I could even react, two of the dogs had already latched onto the side of my leg and back of my knee, only lessening their grips following a few kicks and yells. They retreated to where-ever it was that they came from, as I sprinted off in a direction towards home, hoping that I wouldn’t accidently set off again whatever animal instinct caused this reaction in the first place.

Once out of sight, I slowed down and assessed the damage to my leg, quickly realizing that, although pretty bloody, there had been no significantly life threatening damage. Relieved, I headed home, only stopping to pick up a stick in case I ran into any other trouble along the way. For the rest of the evening, I got to experience the Ecuadorian health care system from the patient’s perspective; first coming home to clean the cut with hydrogen peroxide and whatever Jorge could find me, and then heading to the emergency clinic at the Universidad San Francisco de Quito. There, I was able to take all precautionary steps (a.k.a get a shot and a schedule of the next 4 shots I’ll need over the course of this month) to make sure I don’t transform into some rabies-crazed zombie while here.

For all the mothers or fathers or future wife that may be reading this, since this some-what hectic evening, everything has been fine, my leg looks to be healing, and other than the hospital bills and new-found desire I have to throw rocks at every dog that barks at me the wrong way, it wasn’t that bad of an experience. And as I sit here now, looking at the teeth marks that’ll probably stay scarred with me for the rest of my life, I realize it could’ve been a lot worse, and if it’s any consolation, at least this way I’m covered in case any other animals decide they want to see what gringo tastes like.

I hope all back home is going well and that everyone reading this (and even those that aren’t) is having a happy Fourth of July, and more importantly, a happy blood pressure awareness month!

Sinceramente
drew