Do I have an Ecuadorian Tale for you!

If it weren't 6:37 am I would have time to tell it, but I have to get ready for clinic. I will have to tell my story later. All I can share now it, don't send packages to Ecuador that weigh over 4.5kg (and even that might be pushing it). More to come of this later (even though I wasted the cool heading already).
SHawn here in Tminus 3 days! HOly COW!

Only In Ecuador

Friday's Spanish moment of the day:

Brit and I were flying solo doing exams - and totally rocking! In the middle of one of Brit's physical exams, a man walks in the room, with one of the clinic volunteers and Dr. Montero close behind. (Being interrupted in the middle of an exam is pretty normal here). The man is holding a black plastic bag. I am frantically scribbling prescriptions and Brit is listening to lungs when suddelnly the man pulls out of the bag.... a human skull of a 20-something yr old. WTF? He was trying to sell it to Dr. Montero to study or for a collection for $300. A human skull!! Can you believe it? Craziness!! As you can imagine Brit and I were flabbergasted, jaws on the floor, beet red and laughing. The volunteer grabs the skull and comes to sit by me asking me if I want it and is trying to hand it to me. I slowly inched away in my rollie chair. After the man left (Dr. M told the guy $300 was way too much) Dr. M told us it's common for people to bring bones of all types to the clinic to sell. It was craziness!!

Spent yesterday afternoon (Guayaquil'sindependence day) with Brit's family at her house. How fun!! Way more fun than my family. We ate almuerzo, had cake and ice cream, sang a little birhtday song and some spanish karaoke and all the festivities nearly ended their dear 90yr old grandmother as she was frightened of all the noises and party-popper suprises. Then last night we went to the Malecon with her host family parents and just walked around. We missed the fireworks, but it was neat to see some of the festivities for 25 Julio! Her dad bought us a hot dog and on the way home a McDonald's ice cream cone. Today when Brit swung my house to walk to the mall, she brought me a slice of cake her host mom had sent... since she said I told her I really enjoyed it - which I did!
2 weeks left and Shawn will be here on Friday! He is in need of a big break from all the work he's been doing. He has been working his tail off (as usual) I don't know how he does it sometimes working 7 or 8 day straight with the patient load they have. ALl I know is how proud I am of him for hanging in there, taking care of the house this whole time and the pups. He's done an amazing job!!

Wow

yesterday I saw 19 patients, by myself in just over 2 hrs. Not too shabby, not too shabby at all, this also meant we got out ... a little early (which is actually on time) So glad I am actually making pogress!!

I taught Shawn on the phone how to ask for me when he calls in spanish - can't wait for him to have to use. I also taught him two functional words: Chevere (Ecuadorian for Cool) and explained to him the use of -ito, -ita, here they use it for everything! Want a little sopita (instead of sopa, or my snot is a little amorillita (instead of just amorillo - yelllow) ( when you you the -ito and-ita it means a little bit or when used with ninos, cute little...) so I taught him nalgita. Look up the world nalga.
I am so excited he'll be here in a week!! (ok 1 week and 1 day - but who's counting). We are going to have a chill weekend and then I am going to take him to clinic with us to experience the bus ride and the clinic. I am so anxious fo rhim to have his first passport -stamping experience.

I rocked my Spanish presentation the other day on Dengue - yup going to add that to the CV: Presentations in Spanish: Dengue, I have one more about Lepra (Hanson's Dz)

Que mas? This weekend is a huge fiesta for Guayaquil's inde[endence day or something like that. There are flags everywhere. There's also a scary circus set up that we see on our way to clinic. And when I mean scary I 'm not scared just because of the "C" word (although those are extra scary here), the tent, the rides, the whole thing just looks scary. Although I think the water show would be interesting, there are half-naked mermaids pics posted for that... hmmm only here in Ecuador.

2 more weekends here. It's going to fly by!

Language

I encountered the first issue with being a foreigner with just enough Spanish to NOT being able to explain exactly what I mean and having someone else in a more authoritative position tell me I am wrong... case in point 66 Hep B shots given to 2nd graders instead of the 2nd dose to the 7th graders... I actually had to sit on some kid to give the shot... I feel terrible. Did the RN today really think it was a good idea to send a volunteer who knows nothing about what we are suppose to be doing, and 2 foreigners 1 who speaks just enough Spanish to a school with a bag full of needles, an icebox full of vaccine and an empty water bottle for a sharps container? Nope didn't sound good to me either.
What a crappy day.

Brits parents are leaving tomorrow. Shawn will be here in 11days. Totally unable to talk to Shawn tonight despite my best efforts to be looming near the computer room when the phone was ringing... is it really that difficult to pick up the phone people? grrrr. so frustrated.

At least I might have another encounter with a 4 foot iguana tomorrow on my way to school or at school. Craziness.

headed to the highlands

Well as I recover from my little bout of Ecuadorian pneumonia I'll be headed to Cuenca for some much needed fresh air, and time out and away from the Ecuatorian family. (And after consulting with an upcoming PA it was decided I should also take a 5 day course of Cipro to better cover my lungs).

1month and 7days until boards, less than 1month until graduation, 14 more days of clinic, 3 more weeks here, 2 weeks until Shawn comes to visit and 2 Spanish presentations (in spanish of course) to go. Amen!

Swine Flu?

I would have enjoyed Quito more if I hadn't gotten really sick on the morning of day 2. Fever, chills, body aches and a wicked cough.

I'd been running a 3 day temp of about 100-101.5 until today when the tylenol finally kicked in. I also went to the doctor, dx: pneumonia.
So, after being tested for swine flu- results on Wed, I am confined to bed -taking my atbx (amoxil) and my expectorant.

I am missing home more than ever!

Who knew?

Learned a lot about Bolivia tonight from film night with the international office. There were us 4, one more American, a 6ft gal from Canada, eh and an Austrailian girl with dreds. (there are actually more americans here but these undergrads left before the showing...) Anyway, learned lots about Goni, an expresident of Bolivia living in exhile outside DC and about the American influence (and actual consulting from Americans for foreign ministries) and how this affects a campaign, for better or worse. I also learned to never discount the leader of the coca workers (cocaine plant) because even if he doesn't actually win the election, he will ultimately win one way or another.
Check out: Our Brand is Crisis.

2 hemispheres, 1 moment

Spanish moment of the day: Our morning bus rides are typically uneventful. It´s a short ride really only about 5 or ten minutes. I think thus far, the most eventful occurence was Brits juice box being stolen as we pushed thru the crowd to get off the back of the bus, like salmon swimming upstream, as people tried to load the back of the bus to avoid paying the whopping $0.25 fair. But today we were in for a treat. An older man, probably in his 50s with white longer hair and matching white linen outfit serenaded the bus with his Spanglish version of hotel california by the eagles, complete with air guitar accompaniament (sp?) and hand percussion on his cheeks. We aren´t sure if he actually new all the words or just made simlar noises but I know I clenched my teeth not to giggle at the man trying to sing his way to a daily living. I wonder if the Eagles are planning on a Latin American Tour?

Headed to Quito tomorrow for the weekend with the international students and of course the other three. It may be a full weekend but will well be worth it to stand in 2 hemispheres in 1 moment. (secret fact: the actual line isn´t where the tourist spot is, it´s a little further down the road)

Un milagro en calle 3era y rio vinces

A couple days ago I experienced a miracle. I was prepping myself for a chilly shower and the temp was pretty chilly (compared to what it had been all day) as I cautiously put my head under teh water, careful not to let the water touch anything else I realized, oh my goodness, the water is almost tepid. I decided I could withstand tepid water enough to actually take a proper shower. All of a sudden I realized... the water is getting warmer and warmer and yes, even hot! I rushed thru my shower afraid that it would disappear just as quickly as it had appeared. I was astonished. My host sister had told me that there is no hot water in the house, so how did this happen. After much contemplation, I decided to ask my mother if this was normal... long story short (and sparing you the spanish) there's a switch hidden behind the door in the kitchen (like a breaker box). Turn it on 20min before you want hot water. Good to know... so now, so long as no one flips the switch off whlie you are in the shower, there is warm water.

I decided not to write about clinic yesterday, I was really frustrated and decided it was better to wait and write when I had a better day. I hate feeling like I speak like a 4yr old and I constantly fear sounding stupid - which I do. I have been at the school doing "control excolar" which are basically complete physical exams head to toe, ins and outs, height weight ppsych soc questions, the whole works. The first day, the day I didn't write, was very frustrating for me, I couldn't convey what i needed to convey. I alone..no doctor or nurse at the school to help me... little 10 and 11yr olds who don't speak any english.... I have to convery the whole puberty thing and what happens and what to expect and all the changes and about how they can become pregnant. Today was much better. I was able to do everything on my own and better yet they understood me. I only hope for the same success when I give the sex ed talk in the coming weeks.

Going to Quito this weekend. Quito is where the equator is. I remember learning Latin American Capitals and I would tell myself, "don't Quit at Ecuador, you're half way there" to remember the capital. There are tons of things scheduled, which I am looking forward to. Also going to Otavalo where apprently there are a lot of artisans. Quito is 8hrs away by car but luckily we are taking a flight which is only 30min. yay!

The four of us ventured to Mega Maxi today... sounds like a store for women during "there time" but it's like a Fred Meyer or Walmart... only with high end appliances too. I didn't find my mini shampoo and conditioner but I did find a small bag to take to Quito instead of my mochila (bookbag) because it's a little too small for 3 days worth of clothes, but still small enough to carry on. It was less than $5. I also bought some off brand Galak, hahaha (why am I laughing, right? it's a long story which I will save for later... we are all 4 *well at least Brit and me * are addicted to Galak and not just regular Galak - the sanduche kind. Our Spanish class joke is ... We're going to need some more Galak for that. Seriously, google it if you are that curious and just can't wait for the story)
Time for be tengo mucho sueno (and I hate that the computer keyboard at home is an ENglish one, I don't know how to do a tilde - so my words never look right) I'm really tired, it was my host sister's b-day last night - 25. I bought her a small sterling necklace, although having seen her accessory collection it would be like finding a needle in a haystack. She had about 20 people to the house last night for appetizers and home made mojitos... I helped grind the mint although my orange juice was just fine for me for the night. I was afraid I would embarass her amongst her friends since my spanish sucks, but I found a girl, a vet, who needed to practice ENglish and I needed to practice spanish. We exchanged emails too after a long night of talking about medicine and the differences between vet and human med and about our babies... our hubsnads and dogs. It was nice to be able to speak and not worry about how I sounded... just talk (and she helped improve my grammar along the way and I returned the favor)

Case of the Lunes

lunes = Monday
We finished in clinic early today.. maybe we are getting the hang o fthings now. yeah! Again I was with the ginecologo, Gregg got to go with the Pediatria (you guessed it, pediatrician). Guess she was great and efficient. My gyn patients were really interesting today - although I don´t know when obstetric and gyn patients aren´t. We have only one size plastic speculum in the clinic for everyone, which in reality works 90% of the time, although with no lubricant it can be a challenge still. I am proud to say I am finding the cervix with 100% accuracy now, a long way from not being able to find the land of "os". Today I found the speculum (especulo) exception. A small girl of 16 or 17 (1 child already via C-section) a tiny tiny little girl... [warning: grafic in nature] her opening was about the size of a pencil... I tried gently to eas theunlubed speculum but I could see I was hurting her and more importantly I could feel myself close my legs tighter and tigher as I tried to do the exam. No luck. The ginecologo returned and I try and explain: el esepculo es tan grande. Necessita una especulo mas pequeño. He grabs the speculum and stretches her as if she were going to deliver a baby... she doesn´t make a sound but I can see her scrunch her face ( i actuallywas thinking how the heck did she get pregnant?). He pushes and pushes and somehow manages to get the speculum in far enough to do the pap. As she limped out of the room I could only empathize that being female her would be difficult.

Another interesting patient: 15 yr old girl, was supposed to have a sonogram (ecografia)to determine exactly how many weeks pregnant (cuantos semanas tiene) but she didn´t go and her mom didn´t think it was that important (without the sonogram it´s difficult to tell how many weeks along if the baby has dropped toward the canal and here it´s not an exact science, the obstetrician guess by fundal measurements how many weeks) SO I measure the girl´s belly and as >I do I can feel a tightening... a contraction... she´s term. The obstetrician is not happy. H e went and grabbed the mom and talked really fast. Most of what I caught is : this isn´t a game, she should have had a sonogram and she didn´t now this is her mess to deal with, but she could go into labor at anytime. I felt so badly for this little girl, who look like she was 12. Babies having babies. Que Lastima!



Spanish Momentito of the day: we take 2 buses like I said before, one to get to the bus terminal and then one to the clinic reverse it for the way home. While waiting for the bus to go home (from the terminal) we were all chit chatting. There were a lot of buses there since it was around the noon hour/almuerzo time. I look up and see our bus,#81 in the street a bit, down farther than usual. I think we missed our bus I say to Brit. Then I notice he is waving for us to come on and get on the bus. You know you stick out when the bus driver recognizes you and motions for you to get on the right bus.

For more fun Ecuadorian tales, Nancy is also keeping a blog, more detailed than mine: nespelin.blogspot.com

Clinic Day 2 and el fin de semana

Here's the run down:
I'm with the ginecologo who seemed to have lost his patience with me from yesterday, even though I actually have a clue what he is talking about now and what prescriptions he is having me write. He's hard to understand, but I like the way he talks to his patients, most of whom are young women reluctant to have paps or who forget their oral contraceptives. His notes say something like: last period was (insert date)... her for a consult; forgot to take two days worth of contraceptive pills, I advised to continue taking them since she says she has not had relations.
Interesting that for a society that is nearly all Catholic, everyone is on the pill, although if you forget to take it, just like in the US, you can become pregnant at age 14 or if you forget to take the minipill after giving birth you can become pregnant... like my 3rd patient (age 17) found out as she held her 1 1/2 month old child.

Gregg has been completing "censos" the census. How many people live in the home, their health etc.
Nancy with Dr. Montero, seeing patients
Brit went to a school and gave vaccunas (vaccinations), then to the clinic

When Brit, Gregg and I are finished in our respective jobs we join Nancy. We don't usually finish until 2pm...mostly because we are so slow in figuring everything out. Dr. Montero is very patient despite the mispellings, misunderstandings and slowness of the 4 of us.
Can you imagine being a preceptor with 4 students at once... and they don't speak the same language? I would be pulling my hair out. But not once does he seem frustrated, he just keeps repeating himself and trying to push along. After about a week in our respective positions we will change so we can all experience each area of the clinic.

Everything is free at the clinic. The medicines, the care, the lab. It's amazing they get along with what they have and don't have.

Montero is huge on milestones for kids... we had our first retardacion mental grado 2.... it was sad, the little boy didn't speak. He followed some commands but not all. What type of life will this little boy lead? He has also has some of the worse dentition I have seen here, which is surprising. The dentition here is about that of the pts in the US. I hate to make comparisons to the US... since this place is not comparable but it's interesting to see how things are different and similar between societies.
Nearly all the women I have seen bring their children, one two, sometimes three or four. All are well behaved. No disciplining, no yelling, they sit quietly or entertain themselves. Kids smile when they are tickled and are still frightened of the otoscope.

Spanish moment: (again from Nancy - bless her heart she is trying so hard): in trying to tell a patient this won't hurt (no le duele) she said no duerme (no me sleep).

My mom was going to take me to the beach today to the family beach house, but apparently there were tings to fix and the plumber came so we didn't go as I realized this as the time ticked by, so I tried to study, would have prefered to go to school for this as it was really muggy in my room today, the pages of my book were sticking together. I watched some tv in spanish. Level 9 was the name of the show... it was interesting, I could follow it at least. Awesome lunch today, my host mom understands I don't eat veggies really so made legume soup with blended veggies, it was good and a rice mix with mini sausages and scrambled eggs, yum!! I had two huge helpings. I wasn't a huge fan of the plaintain and fish we had last night. We also had fresh squeezed raspberry juice tonight! Yum again! (la mopa?) Had Yucca bread tonight, it was not filling but will tie me over until morning. Hopefully we are going to a movie tomorrow - it's only $2 here to go to the show. Brit and I went to the mall yesterday, it's only about a 5min walk. We were expecting some good bargain finds but it was uber Americanized. (did I already write about this? having de ja vu) It was the equivolent to the Plaza in KC, I was looking for a Gordmans, Ross or Oak Park mall... Abercrombie, Tommy Hilfiger and high end boutique stores we could hardly afford just to walk into each place, we will beheading down to Las Penas one of these weekends and el malecon by the black market to do out shopping we decided. We did find an awesome set of 3 human body posters in Spanish for $0.86 each - what a steal, I may actually get another set just to have. There is also a Cinnabon (will definitely be eating there at somepoint - it smelled so so good) and then KFC, Burger King, Pizza Hut and a few more local flavor fast food places. I tried a hamburger from a local "burgerville" type place that is a "must try" when in Guayaquil according to the guide books. It was fair, I asked for plain but still had some special sauce on it... not too shabby.

On the home front: Shawn's in Omaha with his parents and aunts and uncles. Hopefully they had good weather to grill and golf. Happy 4th everyone!

Not sure where to start

That about sums it up. My brain is exhausted. I don't think I have ever thunk this much. I am trying to remember what it's like to be in clinic, throw in some Ecuadorian medicine and culture oh and doing all of this in another language. When I have more brain cells, hopefully tomorrow I can write about it, but today I'm pooped. I can say this though - privacy non existant in the clinic. I did 2 paps today... without lubricant...ouch...and the girls just sorta take everything off from the waist down right in front of you and hop on the table and spread their legs.

The gynecologist (ginecologo) I worked with was patient, which I appreciate but I felt so lost. We also did a home visit for a woman 25years old, gave birth to 7th child 3 days ago and now has fevers chills and abdominal pain - we prescribed antibiotics, pain meds and told her part of the placenta must not have delivered...if not better in 24hrs go to the hospital.

Spanish class - learning how to say things more PC which is nice I can sound more fluent and less like an American trying desparately to speak Spanish. Have already learned some clutch things like what mi papilla is and mi bebida. Almost ever kid has parasites and also gets an antibiotic. The word of the day for me however was "cosita"... never would have picked this up as an important part of the conversation and would have missed entirely the meaning of the conversation about her who-ha area.

Spanish Funny of the Day

Tonight was our first Spanish class - it's medical spanish. Although I found it to very basic (and the teacher very easy to understand), the other 3 have had no formal Spanish training (how frustrating for them, although Brit was doing great!)and so it was a rough go more or less. We reviewed the parts of the body... which was good. I ask the following question (all of this in Spanish of course):
Can the word "pechos" be used for women as in breasts or is "senas" better. The teacher replied senas is ok, but many women will use chi-chis. Nancy , my classmate is writing furiously, how do you spell that? (meaning senas). Nancy writes as the teacher spells chichis which confuses Nancy. Thinking Nancy is still confused on how to spell the other word, the teacher (very embarassed she has to do this next step with other people in the library watching) writes on the white board "Chi-chis" I just about fell out of my chair...

Tour of subcentro

Today we took a tour of "subcentro" the clinic, which techinically does not qualify to be called a clinic as it only provides the most basic of care, has 2 exam rooms, one of which is a gyn room a small pharmacy and a dental area oh and a small lab - for very basic screenings. Dr. Montero seems nice, he speaks really fast but I think the blank stares on our faces helped him realize he needed to slow down, and he did. We will also be going to area schools and to the neighborhood homes to do routine health checks. We take 2 buses to get there, bus to Santa Anita to terminal then bus 122 and get off at the San marcos pharmacia near the jardin de esperanza ( a well known cemetary) tomorrow we will be taking a taxi to unload our medical supplies. Should be interesting and keep us busy. I'm just glad I speak a little spanish and understand the rest.

Tonight we start Medical Spanish but will get together after almuerza (lunch) to study for pance. woot.

The best part of the day: I talked to Shawn for 20minutes this morning. WOOHOO! It was hard to say goodbye, but I had to go to school. We aren't people who can go days without speaking, it's just not how we run. I know this trip will be the hardest on us but in the end I know there will be good from it. I realized today the importance of emersion to learn a language. Classes are great but I am a learn by doing, so this will help me tremendously, which is one of the whole points of me being here, so far away from my Shawnee.

Other interesting things: 1. yesterday I was nappnig despues almuerzo (after lunch) and I awoke to a rattling and the rabbit ears on the the broken tv falling to the floor, all my seashells rattled on the table and onto the floor. Wasn't sure what happened but went back to sleep. It was the 4.5 earthquake that hit here, no big deal. so, slinical year: hurricane check! earthquake check! 2. We are just barely above sea level so they bury their dead likein New Orleans - above ground and have large ornate funeral processions.

Awkward moment of the day: while touring a highschool, in an enlgish class the teacher lined us up (in front of the 5th grade class) and says, who is the most pretty of them all? Who do you want to keep? WTF? They picked a girl that looked most like them with dark tan skin and dark brown hair, very very awkward moment.