there's no place like... ecuador.

I'm sitting in the airport now, waiting to board for my long way home. This past week has been a whirlwind. On Saturday morning, I finished up my last night of call, packed up my things, and said my goodbyes. On my way to the bus stop, a little 5 year old ran out of his mother's shop to yell "Hola Doctorita"... I had treated him for an ear infection at 2am... but his little greeting somehow softened my lack of sleep on his account.

Monday, my dear friend Sarah and I headed out for a great adventure... climbing the world's 2nd highest active volcano, Volcan Cotopaxi, sitting in splendor at 5897meters (19348feet). We hiked up to the refuge to leave our stuff, and headed up the glacier a bit for "Glacier School," the how to crash course on ice axes, crampons (like giant metal 12 point claws that strap on the bottom of the boots), and how to fall down the glacier gracefully.

We slept (or tried) for a few hours on 1.5 ft wide bunk beds stacked three high in the refuge. The guy next to me was snoring loud enough that I was grateful for the sound of the alarm at 12:30am. We got on all our gear and had some breakfast and headed out into pitch black, lit only by our headlamps, by the almost full moon, and a host of brilliant stars... between the waves of fog, wind and snow. Let's just say, I'm glad it was REALLY dark, because I couldn't see the glacier drop off for thousands of feet.
Sarah is an all star mountain climber (being from the Alps, she's a natural), and pushed our pace the whole time. We snacked on chocolate bars and gatorade throughout the night and steadily climbed in elevation. Parts were SO steep and windy, parts we had to take BIG steps over crevasses in the ice, but for the most part, I couldn't help but marvel at the grandness of it all.

The last 80 meters of elevation were the toughest. The sun had just begun to come up, it was incredibly steep, incredibly windy, and just negative 25 degrees celcius. We came over one ridge (that I thought was the top) only to have another higher ridge ahead.... but when we reached the summit, I realized once again why I love the mountains.

The sun was pouring in, the cold wind sweeping snow across the rim of the volcanic crater, several other summits (Chimborazo, the Illinizas, Cayambe) were visible above the cloud line as well. It was breathtaking. I couldn't help but praise the amazing Artist that created it all.
It took only an hour and a half to descend what had taken almost 5 hours to climb!

To see the sharp contrast of the jungle, the glacier topped volcanoes, the big city of Quito... it's pretty incredible that such a tiny country has so much variety of culture and geography. But I'm convinced once again, that what makes a place is its people... and I will miss my dear friends in Ecuador.

ciao pescado...

This afternoon I was walking home from the bus stop and a man yelled out to me from his front porch..."I'm Claude, remember me?"  He took his hat off so I could see his face better, "I was really sick, you saw me in the emergency room.  I'm all better now."  Honestly, I don't really remember him.  I vaguely remember a man named Claude, and remember thinking it wasn't a very Ecuadorian sounding name... but it was still an honor that Claude remembered me.  Probably because I'm one of the only Gringas he's ever met. 

A man came into the ER the other night.  He had gone to his girlfriend's house to ask her parents for her hand in marriage.  When he asked, the mother in law got really upset that he was taking her little girl away from her (and she had been drinking quite a bit)... she pulled out a machete and chopped his forearm.  He was asking for her hand, but he almost lost his!

I'm on call tomorrow until Saturday, then I'll leave Shell Saturday afternoon to head up north to travel for a few days...  

Sangay, El Altar, y "Coche 22"

This morning is the clearest morning I've seen yet during my time here.  From my window I can see 2 volcanoes bursting up from the horizon.  Really, they look a little out of place  The grass and trees are so green and the mountains I can usually see are lush with vegetation... but these volcanoes aren't shy... they are snow capped, brilliant, and put the rest of the mountains to shame for beauty and size.

Volcan Sangay (above) and El Altar (below).

I am nearing the end of my second to last "turno"  (aka. on-call day) here at HVO.  I had a patient come in last evening unresponsive, basically all of his organs have shut down except his heart and lungs.  I was sitting in the room with him writing on his chart when I realized I hadn't heard his gurgly breathing in a few seconds.  I quickly listened for breath sounds, ran to the hallway to elicit some help, and we called a "Coche 22".  I'm still confused as to why a "Code" (aka. code blue, harvey team, when someone's goes into cardio/pulmonary arrest) is called a coche 22... it translates to something like "22nd cart".  I intubated him and used the ambu-bag for a good 1.5 hours while the ventilator was being set up.  He's still hanging in there this morning, and thankfully his whole family has been able to come to be with him in his last hours.  They are from a very rural jungle area...His son showed up last night with indian paint masking his face.

the basilica in quito.

el tiempo esta volando

Well, it's hard to believe that I have just 1 more week left of work at Hospital Vozandes.  The first few days I was here, I thought 2 months would last forever... now I'm wishing for a few more months.  When I finish call on Saturday, I'll head back North to climb Cotopaxi (the highest active volcano in the world!), and spend a few days in the mountains before coming home to Memphis on the 22nd. 

I just got home from Quito tonight after a weekend off to experience a little more of Ecuador.  Pictures and stories to come...  I'm tired.

the problem with short term medical missions

So, I realize that I'm walking a fine line with this post, but I have to get it out there... it's just something that's been stewing in my head ever since I met little Paulo.  He's the kiddo I mentioned a few posts ago who we operated on for Congenital Pseudoarthosis.  

Paulo was born with this rare bone disorder that causes one of leg to be bowed so badly that it spontaneously fractures.  After the fracture, the circulation becomes compromised and the leg is not able to heal properly.  This leaves a mangled, deformed limb with a sort of "false" joint.  

Paulo came to Hospital Vozandes to visit his sweet grandmother who has been coming in for wound care every day for the past few weeks.  He hobbled.  I can't think of a better word for it.  It wasn't a limp, it was more like he jumped from his right foot with his left foot only barely skimming the floor.  

Paulo had surgery 3 years ago to correct his leg fracture.  So, you ask, why was he still limping?  Lack of follow up care.  A team of docs who didn't know his case well enough.  A surgeon with a "save the world in one week" mentality.  Yeah, I know, this is where I'm starting to walk a fine line.

Cuban surgeons visited his little mountain town 3 years ago, saw his leg, took an x-ray, put an intramedullary pin through the bone, and went back to Cuba.  

They didn't know, or didn't take the time to understand, that his was not a simple broken leg.  Because of the compromised circulation that comes along with the disorder he has, his bone never healed.  And they weren't around to know about the results of their surgery--which is what we had to deal with... a left leg 3 centimeters shorter than the right with a deformed "knob" of bone above the ankle.

We took out about 3 more centimeters of bone, and externally fixated it, so hopefully that segment will heal.  In the next few years, Dr. Wolff will go back in to lengthen the bone below the knee.  It may or may not work, but it's the only chance he has... otherwise they'll have to amputate below the knee.

Now don't get me wrong, I do think there's a time and place for short term international medical work.  For example, taking over for a long term doc who needs a few weeks of vacation, going into an established hospital to teach a new surgical technique or donate a new piece of equipment and show them how it works, even going to work somewhere for a few days when you work with a local doctor who can give follow up care.  But we all agreed when we got into this doctoring thing that we would "do no harm"... and sometimes fixing something, whether surgically or with a prescription, without being there to see how it results can be doing a lot more harm than if it hadn't been fixed at all.  Just something I've been pondering... what do you think?

to the hilt

Let me give you a little insight on life in international missionary medicine:  I have a very difficult time picking which amazing, crazy, breathtaking, heart wrenching, frightening, or comical event to post... there is much too much going on, too much I'm learning and seeing and experiencing to be able to summarize in a few pictures and a few paragraphs.  Please know that my experience here, my life this past 6 weeks, has been far more exciting than this blog gives it credit.

I'll try my best to give a "cliff notes" summary of my past few days:

Saturday:  Day off...glorious!  Travelled west to Banos, a little hippy mountain town with streets lined with artisan shops, internet cafes, and replicas of the Virgin de Aguas Santas (Holy water?  looked more like algae infested bath water that would likely give 

you a good case of pseudomonas otitis).

  

My dear friend Sara came along...she's a Swiss nurse who's here at Hospital Vozandes for 8 months.  She's delightful, with her 

charming attitude and constant desire for adventure and fun (she even hosted a Viva Suisa! Swiss independence day party last week).  Highlights of the day?  A huge rainstorm that hit just as we were hiking the foothills of Volcan Tungurahua above Banos, taking a break at a restaurant/ resort overlooking the mountains and the entire town, a post-hiking meal of "cuy" (aka. guinea pig) for lunch! (tastes like salty chicken, but don't worry, I've heard it has no cholesterol), and in the afternoon, when the storm cleared, watching Tungurahua (volcano above Banos that erupted last Friday) spew out ash and smoke.  Needless to say, we both slept the whole way home on the bus.

Sunday:  On call.  And it was a rough 30 hours.  But at least there's never a dull moment, and no lack of variety in the patients we see.  Por ejemplo...Man comes in complaining of a bite on his hand... pulls out a giant jelly jar with the suspect.  A very large, very alive tarantula that had chomped his hand while he was buying bananas.  He was rather offended when I asked if he wanted us to call someone to come get the tarantula (a friend of Dr. Brice is a spider expert)... the patient wanted to take it home with him! 

A man was brought in by ambulance in the evening after falling from a waterfall.  He was cascade trekking with his daughter and friends and slipped, falling about 4 meters.  Surprisingly his only injury was his upper arm.  His humerus was broken in 3 pieces...it was an impressive broken arm! We took him for emergent surgery and found the radial nerve was overlying the splintered end of the bone.  We put a plate in his arm to help it heal, but the nerve damage will hopefully partially recover with time.  Besides those, we had 2 women in labor (one delivered at 1am), and a strangulated hernia that we took for (yet another) emergency surgery.  I can't complain of being tired though-- my resident was on call all weekend and slept all of 2 hours or so the whole time.  I took over for him in the middle of stitching up post-delivery lacerations because his vision started going blurry from lack of sleep.  Someone needs to create some work hour regulations here!

when it rains it pours

There's something about the rain here.  First of all, it's inevitable.  It rains nearly every day.  It's just something you can count on.  And because most of our patients come by foot, or by bus, usually when it's raining, things slow down a bit in the ER.  Unfortunately, the rain just lasts a short while... today it rained hard...and longer than usual... and things got really really quiet in the ER.  I even went home and took a quick nap.  Then it stopped raining.

Within a matter of 2 minutes after the last rain drop, the patients started pouring in the door.  "Doctorita, me puede atender?", "Doctorita, mi hija...", "Doctorita, doctorita, doctorita"... An emergency Cesarean section among them, several "non-emergent" emergencies, then a 14-yr-old boy with a snake bite.  Crazy.  When it rains, it pours.  Then after it rains...wow.

I've posted some long overdue photos of my trip to see monkey orphans... it's 2 guys who've rescued 22 monkeys whose mom's were killed (apparently monkey is a delicacy).