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Hangin' around...

Shell, Ecuador 20 Agosto 2012

I'm sitting at the kitchen table in my casita again, watching the ants on the counter direct traffic.  Fascinating creatures.  I spent the weekend hiking and exploring, and observing all kinds of interesting creatures.  After a fairly uneventful call night on Friday (with the exception of a 3:00 AM delivery) one of the new residents (they're a good group, too), a premed student from Iowa (arrived last week and here for the next 3 months), and I headed out to a nearby waterfall.  The trip out into the Oriente was made a bit more interesting because there was a procession on the highway to the Iglesia de la Reina del Cisne in Vera Cruz. There were hundreds of people walking up the carretera and a couple of statues of the virgin, and flowers, and vendors with their carts along the roadside...and really, really slow traffic.  But eventually we made it to the other side of the church and wandered back and forth 'til we finally found the turn off.  We weren't the only ones who had the idea to visit the falls.  There were a couple of bus loads of "monos," folks from the coastal region of Ecuador.  I'm not entirely sure that's a polite title for them, but it's pretty commonly used and pretty representative of the noises this particular group made!  They were certainly a lively bunch, making animal calls and shouting, while the serranos (folks from the mountain regions) who are more reserved just quietly looked on. It was all in all a rather nice hike through the jungle to a beautiful waterfall that tumbles over the lip of the mountainside into a verdant, leafy bowl as if someone were just pouring it down.  The site was full of butterflies and spiders lying in wait for them.  The path was lined with walking palms, tropical trees with stilt roots that supposedly allow the tree to "walk" across the forest floor over the course of years.  Now, scientists debate this theory of the purpose of these roots but in any event they put me in mind of ents, so I'll happily embrace the story.  After our hike we headed back into Puyo for lunch at the riverside and a supply run.  On the way out of Puyo toward Shell there is an immensely tall tree that has these strange things hanging from it.  They're kind of teardrop shaped and the rounded base appears to be about the size of a cantaloupe and they dangle from long "stems". Turns out they're weaver bird nests, containing fruit of a different kind.

On Sunday one of the med students, the premed student, and I headed to Baños to explore.  The town of Baños is situated in a narrow basin surrounded by mountains, one of which is an active volcano, Tungurahua.  This week the rumblings of the mountain could be heard 1km away, and they offer nighttime tours to see the lava glowing and sparks flying.  There are waterfalls all over the place and the mountainsides are covered in vegetation, mostly wild but also with improbably high and steep patches of cultivated plants too.  We took a chiva tour (open-air trucks) of a few of the falls, including a hike to the bottom of one.  I thought the return trip was gonna kill me, but I made it.  We spent the rest of the afternoon wandering around town. It's a very touristy little spot, but it is lovely.  And the people watching potential is phenomenal.  There are lots of street musicians and vendors, tons of little shops and cafes, people of all stripes - Quechua folk with their ponchos and hats, dreadlocked European backpackers, middle-aged Americans with their guidebooks, and lots of other Ecuadorean families out enjoying the sunshine on a Sunday afternoon.  Needless to say, I'm a bit sore today. Surprisingly it's my arms that hurt from all the clambering up and down from the chiva yesterday! 

As for the hospital, it's been an interesting week.  We had a guy come in who had hung himself.  The police cut him down and brought him in.  Evidently, he has a long history of dramatic suicide attempts and threats - such as hurling himself and his wife into traffic - and on this occasion he threatened to kill himself if his wife left him.  He very nearly succeeded, severing his trachea - in fact, he still might. His spinal cord appears to be intact, but it's unclear the extent of his injuries and what brain damage he may have sustained.  Our team just got him stabilized overnight and transferred him to a bigger center, somewhat closer to his family who live on the coast.  It's so sad, and I only wish he could have gotten help beforehand instead of after the fact.  

We had several cases of GI issues - an older man with an acute GI bleed requiring transfusions who got scoped from both ends with no apparent source and a little old lady with what sounded like hematemesis from a gastric bleed but turned out to have an obstruction. We scoped her for the presumed bleed, but it turns out she wasn't vomiting blood, it was just whatever she put down plus bile, and her symptoms where pretty much relieved by siphoning out over a liter of stuff with the scope.  Not the standard approach for dealing with an obstruction, but it worked. Both went home after relatively brief stays.  There were a few more deliveries which went pretty well, even though one 17 year old first time mom had to go to c-section for fetal distress.  The baby needed a little extra O2 to get going, but turned out fine.  Saw him in the clinic today, and other than a little jaundice, he's good. Cute as a button, in fact, just staring me down when I held him.

Today turned out to be a very interesting one in the consulta, in fact.  I had a lady in her 50's come in with her husband and 2 daughters and she apparently has a recurrent brain tumor.  She was treated for a malignant tumor ten years ago with surgical resection and chemo and radiation and did pretty well afterward.  2 months ago she started having difficulty walking.  Turns out she's got a new growth in her cerebellum, which is responsible for your coordination.  On the scan they brought with them she had some edema, and her neurological symptoms have worsened since to include facial paralysis on the left.  There's not a whole lot we can do at our little facility here.  I gave her some steroids in an attempt to cut down on some of the swelling and encouraged them to follow up with the specialists in Quito.  They have limited resources and I think they're grasping at straws at the moment.  Evidently they went to see a group of Canadian docs who had come down to work in their community for a brief stint last week.  I think they told them the same thing.  My heart hurts for them. After that, I diagnosed a young mom with a thyroid nodule that's gonna have to be biopsied.  Then I diagnosed a gnarly Bell's Palsy in another fellow - one side of his face was wrinkled and lined while the other was perfectly smooth...and immobile.  Had a rip-roaring case of tinea capitis (head fungus) in a nine year old, covering almost the whole back of her head.  Had a hypochondriac 18 year old who had looked online to interpret her lab results (which were within perfectly acceptable limits) and convinced herself that she had some horrible gut eating fungus or something.  Finished the day with a spontaneous abortion. Sprinkle in some diabetes and insomnia and arthritis, and I'm pretty tuckered out after all that. 

This is my last week in Ecuador. I'm really bummed about that.  

Strange but True: There are over 200 varieties of snakes in Ecuador, ranging in size from a few inches to a few yards (anacondas). About half of these species are venomous, and the vast majority (I was told all but one type) have venom that acts as an anticoagulant.  A pregnant lady came in with a snake bite this weekend.  To determine if it was a venomous snake that bit her, they checked a clotting time.  Her clotting was good, so it must have been a nonvenomous snake.



( 5 comments — Leave a comment )
Aug. 21st, 2012 06:26 pm (UTC)
Snakes...uh-uh...won't be visiting Ecuador!

You seem to be able to cram such a lot into your short visits to these fabulous places. Work with some v.interesting cases and then out sightseeing. You are v.lucky! And I can't believe it's already coming to an end...so soon...

But then doing the surgical obstetric stuff and then that'll be it...trained and fully fledged and then, presumably, looking for a *proper* job!!! Tempus fugit...
Aug. 28th, 2012 08:58 am (UTC)
Tempus fugit, indeed... whether you're having a good time or not. I believe this fits firmly in the good time category, though. Thanks for following along with me. :-)
(Deleted comment)
Aug. 28th, 2012 09:02 am (UTC)
Eyes are decidedly disturbing, especially when they're all bloody and oozy and stuff. Yuck. It's kind of a train-wreck reaction...

It has gone by fast. :-(
Aug. 25th, 2012 01:52 am (UTC)
{{big hugs}} you are so amazing. i'm absolutely in awe of what you're accomplishing, and the energy and drive and joy and purpose with which you live your life and share your gifts with others. not just the gift of healing but also the gift of WORDS. you paint word pictures, so vivid, so evocative, and whenever i have the chance to read your entries, it's like i'm transported. for a moment, a precious moment, i'm somewhere else, and feeling alive and open to all the beauty and complexity in the world, as well as the tragedy, such as the poor gentleman who attempted suicide (i will keep him and his family in my thoughts and prayers)--and isn't that such a powerful reminder to be grateful for every second we have and the wonderful people who share our lives. thank you, from the bottom of my heart, for all that you do. i hope your last week is filled with joy and discovery and miracles and that you have a safe trip home. ::love::
Aug. 28th, 2012 09:05 am (UTC)
So glad to hear from you, sweetheart, and thank you so much for your kind words. I'm so glad to have the opportunity to share the journey with you. *hugs*
( 5 comments — Leave a comment )