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People are people wherever you go...

Shell, Ecuador 6 Agosto 2012

I'm sitting in the nurses' station at the hospital. It's a sunny mid-morning on call. The past week has seen weather in couplets - 2 days of intense rain and wind followed by 2 days of clear skies and sun. The temperature rises until the rain comes again and cools things off. On clear mornings like today's the snow-capped peaks shine like beacons over the valley - to the southwest a perfect volcanic cone and to the northwest craggy peaks that stand above the lower ranges covered in vegetation. 

The past week has also seen lots of patients! Consulta externa was full all week and the ER stayed busy too. Seems like we get an appendicitis every other day (they usually come in pairs), and had a 2 year old with a ruptured appendix and peritonitis Thursday. His parents had been taking him to other facilities for at least 4 days before they came here and finally got definitive treatment. Friday when I was on call we had 2 deliveries and 7 admissions. The most interesting admission was a little girl with a rash on her face. She came in Thursday evidently having taken some unknown pills just prior to the appearance of the rash, so we thought it must be a drug reaction and gave her steroids and antihistamines. When she came back Friday the rash had spread and the area around her mouth where the rash started had begun to form blisters and peel. Pretty soon her axillae, groin, and neck started to desquamate as well. I was still thinking it was related to the mystery drug and was worried about Stevens-Johnson, but it turns out this story was a red herring. She really has staphylococcal scalded skin syndrome, a reaction in the skin to a toxin produced by the bacteria. We gave her antibiotics, slathered her with Silvadene, and gave her pain meds. She couldn't even stand her clothes touching her. Today she is much better and we're transferring her to the hospital in Cuenca, the city she's from which is about 8 hours away. The baby with omphalitis is still here getting her IV antibiotics. The first couple of days were worrisome, and her blood cultures grew out Strep, but she improved very quickly and is stable now just finishing out her course of antibiotics. Her mom doesn't speak much Spanish, but I think she understands what's going on. She's anxious to get back to her other 5 kids at home in the jungle.

Fortunately, this past week also granted me several opportunities to get out of Shell and see a little more of the area. There are 3 Ecuadorian family medicine residents and 3 medical students from Quito on rotation here this month. All but one are female (pobre José). So on our half-day Wednesday we had a "girls' day" in Puyo - shopping, etc. Puyo is about 15-20 minutes away, the capital of the province of Pastaza, and has about 25,000 people. The nearest public hospital is there and there are plenty of shops and a supermarket. Saturday I went back with one of the residents to get our nails done, and then we met her family from Quito at a restaurant in Mera to eat fish. There were 2 buses full of people there and once they started playing some traditional music everybody started dancing. It was quite the impromptu fiesta! Her dad and in-laws and husband were super sweet and we spent the rest of the day wandering around Puyo until the bottom fell out and we had to seek shelter from the storm. It's always interesting to me to see the variety of ex-pats you encounter in places like this. There's a shawarma restaurant owned by middle eastern immigrants and the Almacen Ling-Feng (the juxtaposition of Spanish and Chinese is amusing to me) as well as several Chinese restaurants. I don't know why it surprises me, but it always calls my attention to what a small world we really live in even as I am acutely aware of just how big it is.

The people here for the most part have been incredibly friendly. I love that they call me "doctorita" and try to teach me new words and get me to try new foods. It's so interesting and enlightening to spend time with folks who are in a similar profession and stage in life, like these 3rd year family medicine residents. It definitely affords insight on the healthcare system, the culture, and the challenges here. The family I spent the weekend with are especially kind. And the resident's 1 year old daughter is adorable! She is used to hanging out with her mom and her compadres so she'll grab a stethoscope, throw it around her neck, and toddle toward the door when she's ready to go. Like her, I'm picking up alot by hanging around these folks.

Strange but True: The largest source of income in Ecuador is oil. The second is money sent from Ecuadorians living abroad, especially in Spain and the US. Then comes all the flowers and fruit and other foodstuffs. No wonder the line outside the Western Union in Puyo stretches around the block!



( 5 comments — Leave a comment )
Aug. 7th, 2012 01:28 am (UTC)
Another great travelogue. Sounds amazing. :)
Aug. 14th, 2012 01:18 am (UTC)
Thanks, dear. :-)
Aug. 7th, 2012 11:07 am (UTC)
Amazing! I knew you traveled before but how and when do you decide where you are going? Is it with a program?
Aug. 14th, 2012 01:22 am (UTC)
Mostly the opportunities arise, and I just go! No set plan or program, just a combination of wander-lust and things working out. It's weird, 'cause I can be a real homebody sometimes but I love to travel.
(Deleted comment)
Aug. 14th, 2012 01:23 am (UTC)
Will do! These are pretty cool around here 'cause some have been active very recently.
( 5 comments — Leave a comment )