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!