using "we" instead of "i"

is the theme of the last 9 days. Julie and i (we) had a fantastic time together - seeing, doing, experiencing, talking, talking, talking, listening, eating, hiking, sleeping a little, and just enjoying a grand adventure. i was the primary communicator with anyone who speaks Spanish, and it took a few times to get used to asking questions with the "we" form of all the verbs. one of the hardest things for me in this new language is the conjugation of verbs, but it was a pleasure and delight to get used to using the "we" form for 9 days.
to give an overview of our travels:
Feb 19 julie finally arrived, 12 hours late after being diverted to Guayaquil, Ecuador due to thick cloud cover over Quito. Much rejoicing and a fairly quick turnaround to the bus that took us 5 hours south to Shell. arrived without incident. basically went to bed.
Feb 20-21 my last day on call. and a busy one. julie kept the camera all day and took many photos of me "in action" as well as was an excellent resource for a very complex medicine patient who came in at 2 am. she ended up in the ICU and i don´t know what happened to her yet. we basically didn´t sleep that night and i wrapped things up the next morning at the hospital (see photo - some of the people i worked with and my favorite patient, Darlen with her mom. Darlen was burned badly about 2 months ago and comes now for dressing changes. she sang songs for everyone including my favorite, "arriba doctorita!"). in the afternoon we went to a wildlife preserve and saw some jungle animals. great fun! (see photo of julie with rebecca the monkey on her head).

Feb 22-23 goodbye Shell and off to Baños, small city in Ecuador where i would want to live if i had to pick a place. Baños = Baths. as in thermal springs from "al dentro del volcán" (inside the volcano) which have been channeled into pools where people can go and soak. we went only for about 45 minutes (way too short) and paid $1 each for this fantastic experience. also around Baños we hiked, visited some INCREDIBLE waterfalls and soaked up this charming, quaint little town at the foot of majestic mountains. a highlight of Ecuador for me. (Photos: Pallon del diablo waterfalls, thermal baths at the foot of a waterfall and our dinner entertainment)

Feb 24 goodbye Ecuador... off to Perú. Landed in Lima(so nice to fly with a friend!) and were welcomed warmly by various Peruvians who helped us get to our lovely hotel. We both decided that this busy, loud city of 9 million people was NOT the highlight of the trip, but it served to allow us to travel on to the next adventure: Machu Picchu.

Feb 25-27 Cusco, the Sacred Valley and Machu Picchu. Not having known all that much about this wonder of the world, i was eager to go because it is renown the world over and especially in south america. and i´m here... so i should see it. well my tune has now changed after seeing it: Machu Picchu is a MUST SEE in this world. the price in money and time to get there is completely worth it. proabably the most incredible thing i´ve seen in my life. Julie and i had a grand adventure getting there, complete with multiple modes of transportation: plane to Cusco, little van to Otallantaytamba, train to Aguas Calientes, feet to Machu Picchu, bus back down the mountain. these pictures aren´t going to do it justice, but perhaps give you the itch to visit. it is steeped in history and mystery (and rain when we were there...). incredible, incredible... no tengo palabras sufficiente! (i don´t have sufficient words...) Photos: boarding the train, the mountains from inside the train, Aguas Calientes, Julie starting to ascend the steps to Machu Picchu which we started at 5am using our headlamps, and the ruins.

And that was the way i spent the last 9 days. Fantastic. Julie - thank you so much for coming to a different hemisphere and continent to encourage me and have a fantastic adventure! it was a JOY to spend such great time together in these amazing places.

what i do every day...

i thought after looking back over the last few posts that anyone reading really doesn't have any idea what i do on the days i'm not flying over the jungle, spending time in Makuma (which has been a total of 3.5 days out of this month, notable though they are...) or buying ridiculously cheap, delicious fruit/vegetables at the market. And at one point i had posted a synopsis of my day/night on call (called a "turno") but it has disappeared into the netherworlds of cyberspace and is not on the blog now... if anyone has seen this missing piece of my musings, please return it to it's home here.

So here's a typical day.
7:30 Devotions and Rounds at the hospital - in spanish, a summary of the patients and presentation of any new "ingreso's" (admissions) from the night. such presentations are done by the Intern (of which i am one) on call the night before.
8ish dressing changes on patients already admitted, assisting in surgery for the morning, or taking a spot in the ER to await patients that come in for more urgent issues.
i've spent most of my days in the ER.
some of the things i've seen -

• a lot of pregnant women who are starting to go into labor
• kids with vomiting/diarrhea/fever/cough/pneumonia who have often been brought in by their parents after 8+ days because they live so far away and can't afford to come in for every little bug their kid gets. often, too, these families from "al dentro" (literally, the inside but used when people are from the jungle) speak an indian/tribal language so getting the real story can be tricky or impossible. the other night i admitted 3 infants under the age of 4 months all with pneumonia and one with dehydration, all from "al dentro". they're all doing much better now and their mothers probably saved their lives by bringing them in when they did. much more time with pneumonia and dehydration could have been fatal.
• what else? snake bites. amazing that these are becoming fairly routine for me to handle in the ER. but true. i've seen at least 5 snake bite patients. i have yet, however, to see the snake that did the biting - apparantly sometimes people bring it in too.
• various skin infections.
• stomach pain.
• oh, and the one that i was woken up for at 3 am the other night: "i've had pain in my back and my neck and my arms for 10 years..." how long? (thinking my spanish was a bit shaky at 3am and i hand't heard correctly)... "10 years". and why did you decide to come in ahora? (now) ... i never got a good answer. on exam, he had no pain to any of my palpation and was able to function pretty well, so we gave this dear old man some IV pain medicine and told him to come back in a few hours for a more in-depth evaluation. he and his wife (also very cute) thanked us and went back out into the night.
• fever for a month/weakness/weight loss/pain all over... turned out to be malaria.

so that's what i've been seeing.
midday try to steal away for a quick lunch at home
5pm home, unless on call and then i stay until there are no more patients in the ER.

that's pretty much it. i have another call day monday-tuesday and then that's it. ... off to do a little traveling with dear friend JULIE who is coming tonight!!! and then to Peru. for one more month.

sick

so i've now joined the distinguished ranks of those who have endured sickness in foreign lands... and lived to tell about it.
sue - malaria in zambia
caron - typhoid fever in india
jen caye - some bad GI problem in india
daphne - i'm sure you've had something but i just don't know where or what
brook - same for you in zambia

well my bout started on friday as i was treking, tromping, slurpingthroughmud and hiking in rubber boots up a large, large mountain to get out of the jungle. led by our teenage guide who was being corralled into being our guide by his dad, dan and i made it after 6 hours of the aforementioned journey. wet, dirty - filthy, thirsty, hungry, sore, exhausted, we ended up on the closest thing to a road we had seen in hours. 6 to be exact.
so we found some beverages. and a waterfall. and later a river. and eventually a bus. and then another bus after waiting on the side of some road. which took us to 2 bridges we had to cross on foot over the raging Pastaza River. to another bus. to Shell. at midnight. we started at 9am.

so i fell into bed shaking after my hot shower (praise the LORD) and knew that my body was not well. the next day i was on call and tried desperately throughout the day to lay down for a little rest, but kept getting called. and lasted (barely) until about 11:30 pm when my housemates convinced me to own up to how horrible i was feeling and tell the doctor on call with me that i had a fever after 1g of Tylenol and 400mg of Ibuprofen... that i ached all over... that my cough was getting worse and i was feeling weak and dizzy. so i did. my blessed roommate Emily took my calls from Saturday night at 12 midnight until monday morning and i stayed in bed for about 36 hours.
they did all sorts of tests and have given me all sorts of medicines to "cover" whatever it is. not sure entirely, but i did have some intestinal parisites which are soon to be history after i take the second drug to de-worm myself. pleasant, isn't it?
Gracias a Dios, today i have returned to the Land of the Living. i'm praying i'll stay here for quite a while.

Makuma - otra vez

Makuma - again.
this time for 3 days. Dan (another hospital volunteer, a Radiographer from the UK) and i along with some other Ecuadorians were flown in to Makuma's airstrip on Wednesday last week. Upon our arrival, we met Alexandra (another HCJB volunteer from the UK, an engineer leading the water project there) and the Headlands as well as many other Makumans. that afternoon consisted of Alex assessing the status of the "minga" (the work day) and sorting out where Dan and I could best be put to work. We ended up at the "bodega" (a little shop that sells medicines and other items) helping 2 lovely Health Promoters learn to take blood pressures. it is hard enough teaching someone to take a blood pressure reading in english, let alone in Spanish! ... and then what is normal, why it is important to know, and what it can indicate in the whole picture of a person's health. Alex and Dan helped me, and we took turns all taking one person's blood pressure and hopefully getting the same result. they learned quickly and by the next day, Dan reported that they were all getting the same reading each time.

Health Promoters are amazing people - they are volunteers from their community who are being trained by a nurse practitioner or doctor to be more eyes/ears/hands/voices of health to those around them. the often act as nurses to 'triage' patients who may need more medical attention and are educators, in as much as they themselves are educated, on hygiene, nutrition and prevention of illness. Miriam, the nurse practitioner who has been working in this community for 20-some years, is back in the US for a few months, so i did not have the opportunity to work with her.

Screenings at the Colegio (high school more or less)...

• 36 youth.
• 4.5 hours.
• 4 really sick kids. (referred to the new doctor in the community)
• 32 others who don't drink enough water or eat sufficient food for their 30 minute to 2 hour walk to school every day, soccer game each afternoon and same walk home.
• and a marked difference between the children from clean-water communities and no-water-system communities.

i asked the same questions to each of these children all morning long, and with the exception of a gal with 10? days of fever and vomiting, a boy with 2 days of fever and bloody diarrhea, a gal with a nearly-infected decaying tooth, and one girl with some skin problem i didn't have a clue about ... the complaints each one had were: head ache and stomach ache. and after hearing that they only eat yuca (a potato-y type starch) and drink yuca or a bit of water but have few symptoms of parasites or other more serious reasons for either complaint, i gave the same 'prescription' to every one:
start drinking at least 6 cups of the clean water here at school every day
eat more/different than yuca for breakfast (if anything), lunch and dinner

after seeing all these children and making notes about where they live, if there is a water system there, their age and complaints, Alex and i spoke with the director of the Colegio. it was very encouraging to be able to report that the majority of the youth we saw were generally "healthy" - in that only a few were acutely ill... that the problems were not medical but rather environmental and habit-related. the kids from clean water communities are visibly (skin is without rash/bites from bathing in the river) healthier. they aren't used to drinking water because for ages, the water makes you sick if you drink it. she assured us that there ARE other natural or very cheap sources of food than yuca - but that many people just don't know how/what to cook differently so as to have protein in their diet. and that the families who have attended classes on nutrition have been able to make changes in their diet which still fit within their culture and environment.
i met the doctor later that evening and we spoke at length over these issues. he is newly graduated from medical school in columbia and is in Makuma for a year before starting his residency. he agreed that changing habits will effect the greatest change. i was encouraged that this new doctor was eager to educate and help this community grow in understanding how to take care of themselves and their future.

i'm very thankful for the opportunity to visit Makuma again. the people there are lovely.

one more note on the "minga" -
this is a work day for the water project... but not by 'paid workers' to install clean water to people's houses... it is a work day for the people who want water for their houses to get it there. there have been many mingas for this project and will be more. if you or someone from your family doesn't work on a minga day, your family owes $5. this is how the project is being accomplished. it's a fantastic approach to community development. the community really "owns" their system this way. no one has done it for them. by the sweat of their brow and the labor of their hands they will have clean water in their home.

(NOTE: picture is me in the tiny plane over the Pastaza River, i think.)

my first "turno"

In the States we call this "being on call". Well no matter how you call it, it usually involves a lot of hours at the hospital, not much sleep, and needing a day to recover afterward. I had no idea how I'd fare with this first "turno" in a different language, limited hospital resources and diseases/conditions I've never encountered in my brief medical experience.
The way it works here is that the interns (4th year medical students) see each patient first, evaluate them in the ER and then start deciding what needs to be done while consulting with the resident on call. It could also include being called in the middle of the night (la mitad de la noche) for emergency surgery or anything. I live close enough to the hospital that I go home and keep the phone beside my bed, half sleeping, expecting to be called. I'll have a total of 6 turnos, one of those coming next weekend both Saturday and Sunday.
So yesterday/last night, I had a steady stream of patients to evaluate (only about 5 from afternoon until 12:30 am)... and of course here all things take more time.
1. an 8 month old girl who had just had a seizure but was doing fine. Her mother kept saying they didn't have "plata" (money) to see the neurologist in Quito (5 hours and $5 by bus if the buses can get through the land-slide-prone road...). So we gave her some anti-seizure medication to start and insisted she return to the clinic next week.
2. a 45? year old man with sinusitis and a rough throat
3. a 15 year old gal with abdominal pain for 8 days and fever. No diarrhea, no vomiting, but no appetite. The 35+ man who was with her I discovered was her husband. I was just about to try to ask some more sensitive questions (how in Spanish I'm not sure yet...) when the resident came swooping in and got right to the point ... are you pregnant? The test that came back about an hour later revealed the answer: YES. And it showed she had a pretty bad urinary tract infection. They live "adentro" ... meaning in the jungle, more or less.
4. a 41 year old woman came in with her husband who knew nothing of her history because they've been separated, except that she was in the hospital in another city for 3 months with "sickness of her brain"... and that since then she doesn't talk normally, not much more than "yes/no/I can't/I don't know" . And earlier she had had an "ataque" (attack...) of some sort. This sketchy history was confounded by the odd physical findings - some weakness, confusion, and as I listened to her heart, it was very irregular and her oxygen saturation was low as well. She had an elevated white blood count indicating infection - but we don't know where. We ended up admitting her with our list of possibilities being very long. And this morning we still don't know what her difficulty is. We only have so many tests available here.
5. and at 12:00 midnight, an 11 year old boy was brought in by his dad because of leg pain for 2 hours. Dad was worried that he was going to get the same condition as his cousin who has a ? – a degenerative muscular or neurologic condition due to which he doesn't walk now. The boy was happy, strong, walked fine... and on a bit more questioning, he had been playing a lot of soccer lately. So I tried to explain 'growing pains' to this Ecuadorian man and assure him that his son was completely fine. We gave them some Tylenol anyway.

and no calls en la mitad de la noche.