Last Friday we said goodbye to Quito and began our journey towards "la selva" (the jungle). Along the way we stopped in the town of banos(there is a ~ over the n but it does not seem to work when typing). Banos is in a river valley and while there we took part in white water rafting, canyoning (aka repelling down waterfalls), and hiking. It was an adventure!
Our journey continued on to Puyo, a small town at the edge of the Amazon jungle, by way of a small bus ride on winding roads. Our hosts have welcomed us with open arms into there families. We have started the week with 2 days in clinic. Kimmy, Jason and I went to a clinic in the nearby village of Pitirishica (1 and 1/2 hours by bus away from Puyo). At the clinic we worked with two young ecuadorian doctors who are in their first year of practice that is mandated before they can specialize. We saw many patients with bites, abdominal pain and infections. Our Spanish is improving and we are also practicing our physical exams.
Tomorrow our journey takes us deeper into the jungle. We will spend 5-7 hours hiking to a Shaur village, where we will spend two nights getting an introduction to jungle life and Shaur medicine. Knee high rubber boots have been purchased (for wading through mud), sleeping bags and "mosquetero" (mosquito nets) have been borrowed, we are prepared for the adventure to continue.
Tuesday, June 28, 2011
Two Days at Hospital Voz Andes
For the past two days, Justus and myself have been at the Hospital Voz Andes in the small town of Shell. We've made it to 8am rounds both times, so I'll say we've been fairly successful. Actually understanding what is being said at rounds in Spanish is a bit harder, but we've been making progress.
The first day, I shadowed Dan, a family medicine doctor from Idaho. The first thing he did was show me a young baby with severe malnutrition and an unknown nasal infection. This was the first time that I had seen this extreme manifestation of hunger made flesh. It was haunting, this skeletal infant, whose every bone could be seen through pale skin. I wonder what the effect of malnutrition will have on the future development of this child. To make matters worse, this kid had an unknown nasal infection, similar to the one seen below. Any ideas on what this could possibly be?
We left the child with his mother, and proceeded on to a day of seeing other patients in the clinic. There were many cases of gastritis, well-child physicals for school, checking newborns to see how they are developing. We even applied the results of the Framingham study to see whether or not to counsel a man to take statins or an aspirin. Twenty patients later, our day was one and it was back to Puyo for dinner and to celebrate Meredith's 24th birthday at the Volcano! (That's a story for another time and place).
The second morning was spent observing three endoscopys, which was very cool to see done. It was pretty amazing to update ones mental imagery of the GI system with actual video of a person in front of you. I can now say that I have updated visual memory of the esophagus, stomach, and duodenum which is superior to the one from Costanzo. Down time was spent researching the malnourished childs mystery infection, which we narrowed down to mucocutaneous leishmaniasis or as it is known down here as espundia.
Leishmaniasis is caused by a protozoan parasite, which is transmitted by the bite of a female sand fly. The site of infection was biopsied and sent off to the lab. A picture of the kid will be sent ot a leishmaniasis expert in Quito, and hopefully th e kid will be started soon on some medication, and it will clear up. He'll be disfigured due to parts of his nasal septum being eaten away, but he'll be alive, provided if they can figure out why this kid is also malnourished.
Tomorrow we head off to the jungle to spend some quality time with the Sh'uar people. There will definitely be more posts on that, and hopefully plenty of pictures.
Un abrazo,
Matteo
The first day, I shadowed Dan, a family medicine doctor from Idaho. The first thing he did was show me a young baby with severe malnutrition and an unknown nasal infection. This was the first time that I had seen this extreme manifestation of hunger made flesh. It was haunting, this skeletal infant, whose every bone could be seen through pale skin. I wonder what the effect of malnutrition will have on the future development of this child. To make matters worse, this kid had an unknown nasal infection, similar to the one seen below. Any ideas on what this could possibly be?
We left the child with his mother, and proceeded on to a day of seeing other patients in the clinic. There were many cases of gastritis, well-child physicals for school, checking newborns to see how they are developing. We even applied the results of the Framingham study to see whether or not to counsel a man to take statins or an aspirin. Twenty patients later, our day was one and it was back to Puyo for dinner and to celebrate Meredith's 24th birthday at the Volcano! (That's a story for another time and place).
The second morning was spent observing three endoscopys, which was very cool to see done. It was pretty amazing to update ones mental imagery of the GI system with actual video of a person in front of you. I can now say that I have updated visual memory of the esophagus, stomach, and duodenum which is superior to the one from Costanzo. Down time was spent researching the malnourished childs mystery infection, which we narrowed down to mucocutaneous leishmaniasis or as it is known down here as espundia.
Leishmaniasis is caused by a protozoan parasite, which is transmitted by the bite of a female sand fly. The site of infection was biopsied and sent off to the lab. A picture of the kid will be sent ot a leishmaniasis expert in Quito, and hopefully th e kid will be started soon on some medication, and it will clear up. He'll be disfigured due to parts of his nasal septum being eaten away, but he'll be alive, provided if they can figure out why this kid is also malnourished.
Tomorrow we head off to the jungle to spend some quality time with the Sh'uar people. There will definitely be more posts on that, and hopefully plenty of pictures.
Un abrazo,
Matteo
Thursday, June 23, 2011
Aji (Our first two days in the clinic)
This week has been a complete blur. In addition to acclimating to the high altitude, the group has also had to immerse ourselves into the Ecuadorian culture (and the language!). Some phrases and key words have come back, but it has been a real struggle. Luckily, there is a universal language in the clinic (I´m not talking about mathematics).
Justus and I, and our new friend Jason, have spent the past two afternoons at the IESS Urgent Care clinic. The IESS is the public hospital for the city, so the lines to be seen are long, the needs of the patients run the full spectrum of care, and there isn´t enough time in the day to see everyone.
The first day in the clinic, I was very hesitant to get my hands dirty. Even after 2 full days of clinical spanish instruction, I was still not confident in my abilities to procede with a physical examination in spanish. As the day went on, and I observed how Dr. Cadena interacted with his patients, I began to get a feel on how an examen proceeded in this Urgent Care clinic. A personal breakthrough occurred during the abdominal exam of a young man and the way he described his pain and I knew right away what the organ of interest was: the pancreas! Confirmation from Dr. Cadena that what we were observing was pancreatis went a long way. However, my personal satisfaction with a correct diagnosis was quickly turned to shreds as the patient turned to me and asked, in ENGLISH, if what he had was bad. A bit stunned and chagrined, I admitted that I didn´t know, and that he had to speak with someone else. That moment definitely humbled me for the rest of the afternoon. However, with increased confidence about the next day, I felt extremely motivated to review my command verbs.
The second day was a completely different story. More confident in giving directions in spanish and going through the motions of a targeted physical exam, both Justus and myself were able to participate more in each patient encounter. From the older woman with a ventral abdominal hernia to the young man with intense pain (dolor) from kidney stones, each person taught me something new.
If the past two days have been any indication about what the future may hold, I´m very excited to see how the next 3 weeks turns out.
Un abrazo,
Matteo
Justus and I, and our new friend Jason, have spent the past two afternoons at the IESS Urgent Care clinic. The IESS is the public hospital for the city, so the lines to be seen are long, the needs of the patients run the full spectrum of care, and there isn´t enough time in the day to see everyone.
The first day in the clinic, I was very hesitant to get my hands dirty. Even after 2 full days of clinical spanish instruction, I was still not confident in my abilities to procede with a physical examination in spanish. As the day went on, and I observed how Dr. Cadena interacted with his patients, I began to get a feel on how an examen proceeded in this Urgent Care clinic. A personal breakthrough occurred during the abdominal exam of a young man and the way he described his pain and I knew right away what the organ of interest was: the pancreas! Confirmation from Dr. Cadena that what we were observing was pancreatis went a long way. However, my personal satisfaction with a correct diagnosis was quickly turned to shreds as the patient turned to me and asked, in ENGLISH, if what he had was bad. A bit stunned and chagrined, I admitted that I didn´t know, and that he had to speak with someone else. That moment definitely humbled me for the rest of the afternoon. However, with increased confidence about the next day, I felt extremely motivated to review my command verbs.
The second day was a completely different story. More confident in giving directions in spanish and going through the motions of a targeted physical exam, both Justus and myself were able to participate more in each patient encounter. From the older woman with a ventral abdominal hernia to the young man with intense pain (dolor) from kidney stones, each person taught me something new.
If the past two days have been any indication about what the future may hold, I´m very excited to see how the next 3 weeks turns out.
Un abrazo,
Matteo
Equator, Urgent Care
Just checking in!
I have more than quadrupled my Spanish vocabulary in the past few days, and I´m beginning to understand the majority of things people say, unless they talk fast or have a strong (Quechua?) accent. Sadly, most people I meet talk fast or have an accent, or both.
Today was the first day since Sunday that we didn´t have hours of Spanish class, so we visited the equator. The coolest thing there was a demonstration station where you could place a tub of water on the equator and watch it drain without forming a whirlpool. Moving the tub to one side of the equator, you could watch the water drain clockwise, and moving it to the other side of the equator it drained counterclockwise. Definitely worth the $3 admission fee.
We went by Metrobus directly from the equator to the hospital, arriving 10 minutes late for another wild day in the urgent care department in Quito´s IESS hospital.
Highlights at the IESS:
Man carried in, writhing in pain. He had been vomiting repeatedly and doubled over all day. I kept a trash can on hand just in case. When palpated, his right abdomen caused him excrutiating pain.
Diagnosis: kidney stones with possible gallstones.
Action: Pain medications and hydration stat, admitted for further evaluation
(from yesterday at the IESS)
Woman comes in complaining of unilateral neck pain. Her manner is very strange and she seems to be in no distress. During the physical exam, she fails to hold her left arm in front of her with her eyes closed. The doctor gives firmer instructions and she then succeeds. She markedly increases her respiration rate when told to breathe normally during lung auscultation.
Diagnosis: Stress-induced muscular spasm. Doctor´s actual thoughts: drug-seeking patient
Action: Precription for intramuscular injection of pain medication, referral for psychiatric evaluation
Pictures to come
I have more than quadrupled my Spanish vocabulary in the past few days, and I´m beginning to understand the majority of things people say, unless they talk fast or have a strong (Quechua?) accent. Sadly, most people I meet talk fast or have an accent, or both.
Today was the first day since Sunday that we didn´t have hours of Spanish class, so we visited the equator. The coolest thing there was a demonstration station where you could place a tub of water on the equator and watch it drain without forming a whirlpool. Moving the tub to one side of the equator, you could watch the water drain clockwise, and moving it to the other side of the equator it drained counterclockwise. Definitely worth the $3 admission fee.
We went by Metrobus directly from the equator to the hospital, arriving 10 minutes late for another wild day in the urgent care department in Quito´s IESS hospital.
Highlights at the IESS:
Man carried in, writhing in pain. He had been vomiting repeatedly and doubled over all day. I kept a trash can on hand just in case. When palpated, his right abdomen caused him excrutiating pain.
Diagnosis: kidney stones with possible gallstones.
Action: Pain medications and hydration stat, admitted for further evaluation
(from yesterday at the IESS)
Woman comes in complaining of unilateral neck pain. Her manner is very strange and she seems to be in no distress. During the physical exam, she fails to hold her left arm in front of her with her eyes closed. The doctor gives firmer instructions and she then succeeds. She markedly increases her respiration rate when told to breathe normally during lung auscultation.
Diagnosis: Stress-induced muscular spasm. Doctor´s actual thoughts: drug-seeking patient
Action: Precription for intramuscular injection of pain medication, referral for psychiatric evaluation
Pictures to come
Mitad del Mundo
Hoy Fuemos a la Mitad del Mundo! (Today we went to the "middle of the world" (AKA the Equator). We saw both the landmark equator and the real equator at 0 degrees latitude. We all took turns trying to balance an egg on the equator and enjoyed other games as well.
This afternoon (and yesterday) we are observing in the hospital. Matt and Justus are in an emergency department at a local public hospital. Kimmy and I are in a private clinic. From talking with our host family I gather that the people here do not like the private clinics (which might explain why there was only one patient yesterday). Matt and Justus shared their stories of there 9 patients over dinner last night. All of our Spanish is improving.
Adios!
This afternoon (and yesterday) we are observing in the hospital. Matt and Justus are in an emergency department at a local public hospital. Kimmy and I are in a private clinic. From talking with our host family I gather that the people here do not like the private clinics (which might explain why there was only one patient yesterday). Matt and Justus shared their stories of there 9 patients over dinner last night. All of our Spanish is improving.
Adios!
Monday, June 20, 2011
Hola Amigos!
We all have arrived in Quito. We are living with Clelia and Hugo. They have a 5 story house that is very nice (even without hot water). Yesterday we started with a Spanish test to determine our levels. Then we toured the city a bit on the trole. Kimmy and I saw the maternity hospital where we will go on Wednesday. We saw many bicyclists in downtown Quito. Here they close many of the streets on Sundays to promote bicycling and good health. The have repair stations and water stations all over the city for the bicyclists. I wish more people had been wearing helmets but it was still a great site to see. Today our 7 hours of Spanish class was exhausting.
Hasta Luego!
We all have arrived in Quito. We are living with Clelia and Hugo. They have a 5 story house that is very nice (even without hot water). Yesterday we started with a Spanish test to determine our levels. Then we toured the city a bit on the trole. Kimmy and I saw the maternity hospital where we will go on Wednesday. We saw many bicyclists in downtown Quito. Here they close many of the streets on Sundays to promote bicycling and good health. The have repair stations and water stations all over the city for the bicyclists. I wish more people had been wearing helmets but it was still a great site to see. Today our 7 hours of Spanish class was exhausting.
Hasta Luego!
Me duele la cabeza.
Saturday: fly out of Newark at 2pm, arrive in quito at 10:50pm local time. Meet host family.
Sunday: Wander around Quito by foot and bus, panting from lack of oxygen. Take in impressive cathedrals and colonial architecture, filthy children, visit language school.
Today: After 7 hours of Spanish classes at high altitude, my head hurts and I´m finding it difficult to concentrate enough to write this blog post. I have been developing a caffeine addiction over the course of this trip and I´m afraid there may be no turning back. On the bright side, I found out I´ll probably get a chance to do some surfing and go piranha fishing. Pictures to come.
Sunday: Wander around Quito by foot and bus, panting from lack of oxygen. Take in impressive cathedrals and colonial architecture, filthy children, visit language school.
Today: After 7 hours of Spanish classes at high altitude, my head hurts and I´m finding it difficult to concentrate enough to write this blog post. I have been developing a caffeine addiction over the course of this trip and I´m afraid there may be no turning back. On the bright side, I found out I´ll probably get a chance to do some surfing and go piranha fishing. Pictures to come.
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