Fishing in the Macuma River

Stopping for minute to check out a creative fishing net on the Macuma River, just before we crossed the river for the second time. The young man pictured here was a member of one of the families who acompanied us. Now adays on the principle jungle trails the only real dangers are the poisenous snakes and swollen rivers.

Regional Airport

So Alex and I were waiting at the Macuma regional airport for a flight out of the town, but due to fuel shortages we were told there would be no flights until sometime the following week. So instead of a 30min flight to our desitnation, we would be walking 5-6 hours though the jungle and taking a 4-5 hour bus ride home. Here you have a sick Ingeneira Alex bemoaning the possiblity of the hike.

Macuma: Reproductive Health

Sorry this isn't a good picture, but it has a story: I was maybe a little bored with the idea of spending 4-5 days in Macuma just talking about latrines and hand-washing (though this is of very important), so I asked the gentleman who runs the town clinic (building in the background) if he knew of any reproductive health programs for the young women of the high school (girls in the foreground).... next thing I knew I was talking (with the local Shuar Pastor David Chu) to the 150 students (men and women) of the regional high school about sex education from a Chrisitan perspective and promising the director to return in Febuary with more course materials and dedicated teaching time. These kids live in a confusing clash of cultures where traditional Shuar culture demands that girls and boys grow-up seperately and the influencial un-censured sensual modern world says anything goes. You can imagine in such a world, the idea of discernment is a little hard to come by. Teachers in this high school have fathered children of fourteen-year-old students without dismissal and often young mothers are left of fend for themselves and their babies.

He who has clean hands.

While teaching a health and hygiene course in the Shuar town of Macuma one weekend to some community leaders, Alex and I took advantage of the moment and asked to speak with children... in the midst of playing games about hand-washing and trash-picking, we asked for evidence of their clean hands (this is after a very rigorous washing and examination).

Chimborazo Days.

So this past week I was back in Chimborazo in the follow-up communities of Apunag, Shanaycu, Gaunan, and Puruyaipampa, hiking 8-10hours a day, doing house visits, checking on the wee-folk, and taking pictures of latrines, faucets and breast feeding mothers. It was a lovely, satisfying but tiring and at times not very glamorous job. Why so many pictures? Because I love Chimborazo.

Motherhood.

First a tribute to the breast feeding women of the world! Tio Elias, I understand it is not very P.C. (not like you know what that means) but this woman is absolutely beautiful and she liked the picture!

Gordita Sospechosa.

Now a tribute to all the cute, chubby, breast-fed babies of the world. I called this lovely wawa “gordita” with all the love in my heart. (Same goes to you for Isabella.). In communities where 80% of the women have lost at least one child, this is a beautiful sight.

Signing Informed Consent.

A lady in Apunag signing the informed consent on the follow-up questionare. And yes, because of HIPPA I cannot reveal her name, age, telephone or home address. But come visit me and I’ll introduce you!

Dolor de diente.

Yes my dear, I see you have a bad tooth! This little lady was about 3.5 feet tall, with global static mental development problems, a very large goiter, beefy red tongue, and a rotten tooth. We communicated with smiles, concerned nods and lots of gestures. Promise I’ll go back and see her in a couple of weeks Mom.

Walking to Shanaycu.

It was early morning and we were walking over to Shanaycu from Apunag on the main road. This young women ran over to ask us what we were doing. (Joe, I was trying to get something like your Havana-road-side shots.)

Sample Faucet.

Just a sample a still-life-faucet for Huong.

Sample Latrine.

Just a sample of a better-than-a-Hatian-latrine for Ana.

Cuyi Delicious

Wondering what was on the menu most days? Well besides potatoes, in the sierra we always have plenty of cuyi (guinnea pig). Sorry Nirali, close your eyes! (And Tina, only tell Timmy that I'm eating his pets relatives if you feel he's up to it).

Home Visits.

Just evidence that I was actually there ; ) (Janice, I’ll return the shirt!)

Doctora Babena

Babena came in because she was having diarrhea, but got more than expected. Here she is listening to her grandson's heart. The Waorani, while considered a violent indigenous group, are now most often incited to retaliate - such was the case with the recent spearing of a trespassing lumberman.

Tree of Life

The trees of the LORD are well watered, the cedars of Lebanon that he planted. Psalm 104:16. A tree on the Rio Chichugui, Waurani territory.

Wau Elegance

This is one of the elegant Waorani women of the community of Nuneno. The group of women here were straighforward and unusually talkative, particularly Marta, the health promoter. Births here are at home, with mothers and sisters helping, as there are no trained midwives or experienced parteras. For more information on a movement of Indigenous Midwives in Ecuador go to www.amupakin.com!

How beautiful are the feet of those

We were on our canoe (a very modern metal one) to a Waorani community that Compassion International works in (www.compassion.com) sponsoring children to go to school and providing medical care (in this case me). This was an accidental picture of Romelia's feet... but aren't most beautiful things in life accidental and unexpected?

Ciudad de Coca

So apparently this is one of the more dangerous cities in the country, due to factors such as the narcotráfico and tensions between indigenous populations vs the petróleros and the lumber folk. Just to share, this the view I was tortured with for many hours on the rocky road to the Puente de Tiwino. Horrible thing was that the only thing I could think of was that I needed to pee. What a painful experience.

Leaving again.

Am finished with my two month rotation in Shell, at the hospital, and am back in the world of community development. Am again in Quito preparing for a trip to the Sierra communities outside of Riobamba. And the schedule is looking good. Today I leave for the Waurani community of Taxococonanaco (phonetically at least) with Compassion International to do some well-child checks. Apparently the kids have been taken out of their jungle communities and are waiting for us in a small road-side town. The drive is about 23hours from where I am now... near El Coca (aka near Columbia).

Am very sad to have left Shell. Funny thing was that I left a lovely house full of women: including Kristen, an adventurous older Swedish lady who loves to dance, Elizabeth, a gentle pre-med student from Ohio who is a fabulous chef, Bonnie “Bonboncita” Chen a wild M4 from UCSF who has a contagious laugh and a talent for telling stories (and who is currently contaminated with big bad jungle scabies) and various other guests…. And now I’ve moved into a quiet Swedish Hostal where the residents are generally conservative middle-aged working men from the Iglesia del Pacto. Big change in house dynamics.

Ok my dears. I’m off to the bus station now. Off to Taxococonanaco .

A moment ago.

Just a moment captured in the city of Esmeraldas, where Texaco has a massive petroleum refining center and where corrupt government officials have sold off logging rights in national parks, leaving the once-emerald coastal province stripped bare and writhering in drought.

Gifts for Life?

These are the lovely hand-pumps that are installed at wells, often before a community receives "agua entubada" (running water). More than 2 million people die every year from water-borne diseases. Clean water one of the best regalos you can give a community. Are the gifts I give ever meaningful? hummm. This Christmas, I'm thinkin' of shopping at www.giftsforlife.org.

Borbón

Last week I went to the devastatingly-deforested Province of Esmeraldas with a group from Water Projects (Community Development) and Life Water (a EEUU/US based NGO), to take a look at some wells. Here you see a rincón in the city of Borbón, where the water runs acouple hours a day and the HIV/AIDS incidence is unsualy high compared to the rest of Ecuador... thanks in part to poverty and prostitution.

El Wawa

This is just a cute 31weeker (which here in the jungle usually means the baby does not survive). By now he was off oxygen, gaining weight slowly, and making his mother wonder when they could go home! Wawa, is Kichua for baby.

Life as Art.

I simply love this picture. Again, thanks to Doctorita Bonnie "Bonboncita" Chen for documenting this. Wonder how cotton ball are made? Here in Shell the nurses, when they have a free second, sit down and hand-roll cotten balls, dipping their fingers occasionlly in a little cup of water. So here's the proof. Life is art.

Free Air!

Does this freak you out? If not, it SHOULD!. This wasn't my patient but when Doctorita Bonnie Chen (my fellow "interna," aka medical student) showed me this I was impressed. Apparently the lovely gentleman he had some anaerobic gas-forming abcess that developed from his incarcerated incicional hernia. For my dear medically-savy-sisters: they went in, cleaned him up, cut out the rotten parts, and stiched him back up, and killed the bad bugs. All ended well and he later cam in bringing in half a ton of queso fresco del oriente (greeeeat cheese) for everyone.

World Cup Mania

So the 2006 World Cup celebration has officially begun for Ecuador. Tying the game with Uruguay this weekend meant Ecuador has now officially qualified... for the second time in history! This guy, like Duther and I, was there at the game to document the craziness. Brasil (of course) and Argentina (ugh) are also qualified.
See you in Germany, 2006?

Dra. Priscila

I guess sometimes I can be helpful. Here, still in Charapacocha, I played doctor with the help of Dr. Steve, diagnosing cutanous larva migranes, listening to pulmonary tuberculosis, considering leshminiasis, and treating lots of pain, impetigo, and other bad "bichos."

Prayer in Charapacocha

Charapacocha is a Shuar community that has been touched by the waves of falcipirum malaria sweeping north from the jungles of Peru. Doctor Steve, Nurse Elisabeth, Pastor Herman, and Medical Student me were there last week doing malaria tests and running a clinic there. While there, Pastor Herman also led the church and its children in prayer. I know I should follow suit. But when I speak are you listening? Jeremiah 29:12-13

Fixin' the finger

I had a hard time deciding whether to put this picture up... but its the least dramatic of them all. This picture is of a gentleman who was working on the tunnel San Fransisco here... a rock slide nearly severed his finger. There are several men who come in each week from the tunnel work crew with a variety of injuries. Do let me know, for the non-medical people, if this photo is a little too much.

So I am working

So I am actually now in Shell working... basically q3 (every third night) in the small 3-room ER. Am seeing lots of fever and diarrhea, ascaris-induced pancreatitis, trauma, deliveries, ect.

My favorite person on the floor this week is Moises, 13 year-old boy who fell out of a tree with an armed weapon while hunting a tasty rodent. The firearm exploded on inpact and shot bullets into his leg and thigh. Today I helped put in his skin grafts. The cutest person on the floor this week is a 1.2kg, 2 day-old baby girl (no name yet), product of a 33 week-old gestation in a severely preeclamptic 23 year-old mother who was finaly induced. The bravest person of the week is definately Don Carlos M., cachectic 48 year-old gentleman with terminal colon cancer who comes in every day for his 8mg of morphine and dressing of his developing abcesses vs fistulas (no more surgery in his case). He always smiles for me and today he came in with glaring white sneakers that his wife had just bought to encourage walking.

Sorry for the unusual narrative. Will try to be more traditional next time.

My friend the bug

I was reading Bendiceme Ultima (great book by Rudolfo Ayana) in my hammock one morning when I noticed I was no longer alone. Here's who was sharing my personal space. Very cute. By the way, if you are, perchance, looking for classic Ecuadorian literatute, try Cumanda by Juan Leon Mera (my current read). Many streets and buslines named after the author. He's something special.

Taller than Everest

So this is my favorite view (thus far) of the tallest point from the center of the earth. Don't have the numbers on me, but "Google it" and you too will discover this nugget of truth. Shawna first read this to me from her guide book several weeks ago and since then I've been proudly sharing it with anyone who listens. Now that includes you.

Burdened with gifts

This space is saved for my commentary on our follow up trip to the communities (particularly Apunag, Gaunan, Shanuaycu, and Puuhuaipamba). Still slacking about writting it all. But patience and it will come. :) love to you all. pri

Sra. Mishqui

This is the beautiful Sra. Mishqui, currently thirty-some, wife of Segundo Andres Mishqui and mother to her 8yo neice Maira. Lovely woman, very generous, cooks great cuye (guinnea pig) and potato soup.

Field Visits

Again in Apunag, we made our way on our house visits... but it seemed like only the very old or young folk were at home. Where were they? In the fields of course. By 7am every morning everyone is working. So Simona, Socorro and I made our way to where everyone was. Here we are visiting with some gentlemen in the potato and barley fields. After each visit were we given many gifts, namely potatoes and raw eggs.

Mother and Child

In Apunag, a community of some 60 homes, two hours or so outside of Riobamba, Socorro and her 2mo son, were our guides. Clambering up and down the mountain at such an altitude, I sometimes felt faint... but not this young lady. What is interesting, is that though the landscape is composed of massive mountains covered in dull velvety colors, the Quichua people love intense colors and clothing. Red, the color of blood and sacrifice, is a favorite.

Waiting. Planning?

Right now my life revolves around bland* administrative work in Quito, namely comming up with community tallies, sorting out what medication regimen we will use, figuring out where we'll get the meds, wondering when I'll get my visa sorted, ect. I'm living in one of the upstairs bedrooms of an Ecuadorian lady who often takes on boarders. Its just across the street from HCJB, so I just have to roll out of bed to go to work. Sadly, I see very little of my land lady, who insists on calling me "Dr.Ribeiro" (she says she has to get used to it) or the compadre of elderly pastors from Spain who are here on a miraculous healing campaign. I've have met few other HJCB people but fortunately have taken up the use of Quito's great public transportation system (including buses, trollies, metro-trollies, taxies, and of course my own two feet). The most lovely trips, however, have been Duther's rooftop guide of Quito's cafes.

The hope and plan is for me to leave on Wednesday after I'm handed over a package of Praziquantel, a gift from some doc on the Onchocerciasis team.

* "Bland" b/c compared to field work and medicine, paperwork and the sterile, square computer head humming at me are empty and without personality. But of course it is all very important!

On her way home

We were waiting, as usual for the kids to show up in Puruhuaipampa. Time was passing. And so we sat watching the traffic come down the main village road. This lady was bringing her sheep down from the hills. I don't know her name. I don't think I'll see her again, but she is beautiful, isn't she?

Listen to the Butterfly

This gentleman was the president of the community of Gounan. After I had seen all the little kids in the community, he came up to me and said he'd been having some trouble hearing for the last several months (a common complaint amond the elderly population). But unlike other folk, he was pretty sure what had been the problem: a butterfly had flown into his ear while he had been working in the fields. Sure enough. Here's Shawna, my friend and a fellow medical student, pearing into confirm the diagnosis.

Transportation

By the end of the two weeks, this lovely Kombie was called the Dust Mobile. Here it looks clean and crisp against the clear mountain sky, but don't let this decieve you. Al fin de las dos semanas viajando cerca Riobamba, nuestra Kombie se transformo num Dust Mobile.

Technical Text

These last two weeks have involved data gathering for an epidemiologic evaluation of communities with and those without clean water projects. The goal of the project is to verify the effectiveness of HCJB's Communitee Development Program's clean water projects in improving the health of the kids in the Quichua communities. The team currently consists of two medical students (including me), five undergraduates, several local community development workers, one family practice doc, and one epidemiologist. Our days began by driving to a given communittee, setting up a registration table, mini-clinic, and several interview stations (there the undergraduates do the public health questionare). My responsibilities were, for the most part, registering the children and doing occasional physical exams and hom visits. I will be returning to these communities in several weeks to treat the kids that have parasites. As of now we only have supplies for the children enrolled in the study (one child between the ages of 1 and 5 per family). We are hoping that perhaps the Ministry of Health (who we are working with), the Department of Indigenous Services (who we have spoken to) or the UN (which has shown interest), might be able to supply us with meds to treat all the children of these communities.

¿How tall are you?

Did you want evidence that I´m actually doing something usefull here? Well, here I am taking down the measurements of a beautiful little girl at one of the roadside communities outside of Riobamba. Very little clinical work as of yet, but that is yet to come. Queires evidencia que estoy realmente trabajando aqui? Pues, aqui estoy tomando las medidas de esta guapa niña en una communidade fuera de Riobamba. Todavia no estoy haciendo mucho trabajo clinico, pero esto voy hacer en tiempo (espero este proximo mes).

Chimborazo province

This is a view of the beautiful countryside I see on our way to the villages every day. I hope you enjoy it too!

Nap time

Dr. Brad Q, very tired, taking a snooze while we wait for the women and children to show up. The villages we visit are variable in size, with the number of children between the ages of 1-4 ranging from 2 to 50. Dr. Brad Q, cansado, dormindo encuanto agente esperava para as mulheres e crianças venhao.

Tunnel Vision

I don´t know if you can see, but there are a group of little kids at the end of this tunnel. With this sort of vision, you can imagine what a joy it would be to work. Nao sei si voçes consegem ver, mais no fim dese tunel tem um grupo de crianças. Com esa visao, dar para imaginar com que gozo alguem pode trabalhar.

Almost mama kangaroo

This is the way they Quichua women carry their children. The ladies of one of the villages we were in kindly taught me how! Este es la maneira que las senhoras Quichua cariegan sus hijos. Una de las senhoras me enseno.

Scrumptious

Mae e Pai, esas flores sao para voces. Sei como Pai sempre gostava de fotos de flores... entao, esas sao da provincia de Chimborazo en Ecuador. Voces reconhecem? E anis (aka dropias)! Mom and dad, these flowers are for you. I know how dad always loves pictures of flowers... and so there are some from the province of Chimborazo in Ecuador. Do you recognize them? It is anis (aka licorice)!

Hometown

So this is my new home town, Riobamba, Chimborazo. Today, Saturday, was spent wandering the streets trying to find a church and eating bread. Am still trying to find a family that could and would take me on as a boarder. Aqui es donde yo voy vivir por los proximos meses. Hoy dia pase el tiempo caminando pelas calles e comiendo pan. Todavia estoy buscando una familia que podria alugar un quarto para mi.

Serious business

Realmente no me acuerdo do nombre de esta nina, pero claramente ella estaba cuidando bien de su hermanito. Ella vive en la communidade de Apunag. I realy don´t remember the name of this young girl, but she clearly was doing a good job taking care of her little brother.

Outside learnin´

Aqui estan algunos de los hermosos ninos que estan participando en el estudio. Son ninos de la communidade de Casto Alto, Ecuador. Here are some of the lovely children who are participating in the study. They are kids from the Casto Alto, Ecuador community.

St George Island

Mom and Bella expertly handling a crab. Yummmy.

These are my favorite women in the world!

Daddy I love you! You are soooo cute!