Sala de Partos + fotos

I've been carefully carrying around my iPhone the last few days. Here are some pictures:  

-Fantastic view of Quito, from the balcony outside the room where we have our weekly meetings (9th floor):

- the view part two

This is la "Y" (pronounced "yay"). It's the crazy roundabout we live near. When we tell people or cab drivers where we live, we usually say near la "Y"

This will horrify my mother: the egg shelf in the grocery store.  The nearest refrigerator is 50-100ft away, obvi. 

Look! These eggs don't have to be sold until Harry's bday. 

The only time I've ever seen this instrument before (to listen to the baby's/fetus' heart rate) is on the PBS show "Call the Midwife," which takes place in the 1950s. 

This is where the laboring mothers are waiting and laboring until just about ready to go. Please not the large Jesus and complete lack of privacy. 

Once the baby's head is just about descended, the mothers are rushed here. 

Outside of the clinic

I'm only in the hospital or clinic for 4 hours in the morning and in Spanish class just three in the afternoon, plus with no homework, I have lots of free time! I had great intentions to read a lot here (I even bought a cheap kindle on eBay and loaded it with books from the library...I've read half of one). The day fills up so quickly with other fun, more social, and cultural activities, leaving little time to read (or blog). Here are some of the ways I have kept busy over the past week:

-Both today and last Monday a group of us went to dance class - salsa and merengue (and a little reggaeton today too)! So fun, and such a great workout. I'm starting to get the hang of the steps and movements, however I feel I will never move with the same smoothness and beauty as a Latina. Also, we've barely done any partner dancing, which will be a whole new adventure of turns and avoiding stepping on toes.

-On Tuesday, one other friend and I tried a pole dancing class. In Spanish, "el pole dance," naturally. Did you read that with a Spanish accent? We figured why not; "when in Rome," if you will. Plus, such a class in the US would cost $15-20 or more, and we payed $7.50. We also heard it was a great workout, and indeed it was. Wow! So hard. I hearby give much credit to all pole dancers around the world. We learned to walk around the pole with nice pointed toes, and we attempted two different spins around the pole. It requires more strength and grace, and less banging my shins on the pole than I was able to produce. I'll need to pick a different back up career, and we're going to stick with just salsa and merengue in the future, which are hard enough.

-On wednesday, I got a manicure ($5) and pedicure ($10). After dinner, I met up with an American girl, whom I had met during my interview in January at UCSF. During the interview day we realized we were both traveling to Ecuador, with an overlap of about 1.5weeks. We met up that night at Quito's only craft beer pub. The craft beer trend has not really made it to Quito, so the beer selection was limited, quite mediocre, and expensive, especially since I very much enjoy the cheap, national beer, Pilsener (usually $1). Regardless, we had a great evening comparing experiences, swapping travel tips, and just enjoying what a small world it is!!

- A huge and enjoyable part of my day is dinner, which lasts anywhere from 45min- 1.5 hours, depending on how long we linger to chat. I love family style dinner! She is a very good cook, but serves a lot of simple carbs, my one complaint. Soup is very popular here (I'm not sure why, they eat it at lunch, too, when it's hot out, in addition to the cool evenings...probably because they're do soup very well here), and we continue to have soup every night, with great variety, all of which I liked. Soup is just the first course. One night we had "chocho," which I think is an up and coming trend, given its health benefits like protein and fiber. It's either a grain or a legume, I'm not sure. Or we'll have beans or lentils most nights, plus rice or potatoes, and sometimes chicken, beef, shrimp, or fish. We had a delicious trout ("la troncha") tonight, it was pink like salmon. Is anyone out there familiar with pink trout, or any pink fish that isn't salmon? Regardless, it was delicious. 

-On Thursday, I went out with Ecuadorian (!!!!) friends. First I got dinner with one of the 'internos' whom I met last week in the maternity emergency room. Then his friend (who is a cardiology resident) picked us up, and we picked up two more (one I knew, a student from the maternity emergency room, the other, her friend) and we went to the resident's apartment and just hung out. Just like they would have done any other Thursday night. It was great - so much Spanish! So 'authentic.' It also has been quite an experience texting back and forth with them. My Spanish is of course just okay, but to then have to interpret their texting abbreviations is quite an adventure. On Saturday, for example, 4 of us Americans sat around trying to interpret the short hand of all the texts I had received. It was quite hilarious, moderately successful. Today in class, we had our teacher review some of the common abbreviations. Despites its challenge, I love texting with them; it's fun, it helps me learn (by being able to read how they talk), and it improves my spelling. Logistically, I try to text as much as I can while at home on wifi. I use an app on my iPhone called "whatsapp," and I set the iPhone keyboard to Spanish (helps with spelling corrections and accent use). Everyone here uses whatsapp amongst themselves anyway, because it's free texting (they don't have unlimited plans, and phone us is expensive), and it also allows free interntional texting! I actually already had the app, it's how I text with my college-friend Helaina, who currently lives in Nigeria. Anyway, that's how I text them when at home, but once I leave the house (almost always without my iphone), I have the laborious and painful task of texting on my ecua-cell circa the year 2000. Ecua-cell, get it? Ecuadorian cell phone. 

-For those wondering, Ecuadorians definitely do valentines day (el día de la amistad, or el día del San Valentin), perhaps even more fervently than we do. I actually shouldn't have been surprised by that, since Latinos are stereotypically more affectionate than us cold-hearted Americans. Pink, red, flowers (especially roses), candy, and other valentine's paraphernalia were everywhere!  They were giving roses out like they were nothing! I got two free roses, one while I was wandering around one of the malls on Friday (they were giving one out to all mall visitors) and one in the street as a token for some political campaign. Just handing them out for free! I received a third from my "secret friend," an acitivity we did through school, where we gave little valentines gift in secret each day last week to our secret friend. On the last day I both gave and received a single rose. It cost only $1, which seems cheap, but I haven no prior experience buying roses 

Here they are in their elegant vase:

-Over the weekend most of the students traveled. I stuck around to do the volunteering thing I described in the last post. I was joined by a few others including two other students who were just returning from a 10 day rural experience and wanted to stick around Quito. Three of us went to an event for singles, "solteros", on Valentines day. Supposedly it was just about friendship, not trying to find a mate. We arrived at a big function hall, and the participants (mostly in their 20s, some 30s), were divided up into about 10 groups of about 20 people - a huge turnout! We did some ice breakers, which were a lot of fun. And again, it was great to spend a night speaking Spanish. Turns out the event was sponsored by a church group, so when ice breakers turned to Jesus gospel, we took our leave. Such is the life  in a 90%+ Catholic/Christian country. 

-Sunday was awesome day. I wanted to go to a soccer (excuse me, fútbol) game, Quito vs. Guayaquil (the second biggest city in Ecuador), but I was incorrectly advised on the necessity of buying tickets in advance. :-(. However, it was fun to see all the crowds and and pre-game atmosphere at the stadium, which is just a 15min walk from where I live. I actually met up with a friend (Ecuadorian) that I met Friday night! We strolled through the big and beautiful park that is near the stadium. It was bustling with acitivity: families relaxing, pick-up and organized fútbol games, an outdoors group aerobics class, and marching band and baton twirling practice. There were also some artisan and farmers markets! I loved (as I do in America) talking to the vendors about the origins and merits of their products, and learning more food vocab. Lots of samples, too! Items included handmade goat cheese, various whole grain breads and pastries, crafts, produce, and more. I showed great restraint and only bought one thing: local Ecuadorian chocolate (yes, some for you, Dad). The park is enormous so we walked for a while end to end, and then we took the trolé (trolly, or bus, really) into Old Town (centro historicó) and met up with another American student friend of mine. We wandered through some beautiful and decadent churches in Centro Historicó. When it started to rain we popped into a little cafe (here, cafetería). We had tea and a pastry and ordered a specialty drink off the house called Ponche. They had translated their menu into English, but the drink was still writen as Ponche. Finally, about halfway through the glass, we realized we were drinking eggnog! What a good laugh we had.  We then had delicious and typical Ecuadorian dinner at one of the many restaurants off a beautiful pedestrian street called Calle La Ronda. A truly delightful day!! And all in Spanish, thanks to my Ecuadorian friend! But boy were my legs (from walking) and brain (from Spanish) tired. 

-other notes: wifi is only here in the living room and dining room - not my bedroom - and quite spotty. Major bummer. It will be a while before I upload more pictures.  On a brighter note, I've been keeping up with my mango-a-day goal. They are just soooo good and so cheap. I've also continued to try many other exotic fruits - a fun adventure!

That's all for now. Please email me with updates of your life! 

Week recap

I have certainly not kept up with my regular posting here. I'm just too busy living a life here!!

First, a clinical recap: this week I went to the emergency room of the women's hospital. It's essentially a triage for pregnant women; most are walk-ins, very few arrived by ambulance. Most women were close to or beginning labor and had labor pains, sent in for being post-dates, or a few other common pregnancy problems like bleeding. As I had mentioned before, there were "internos" there (students in there last year of school, at a level like our 4th year students and interns/first year residents) and a few 4th and 5th year students. I accomplished most of my learning by trying to mirror them, and they were very nice and helpful! One of our main tasks was to perform the fetal heart rate monitoring or NST. I have gottenmuch  better at the Leopold maneuvers, which is how you determine the position of the fetus inside the mother, thus allowing you to find the location of the heart and appropriately place the monitor! The 'internos' also take the clinical history from the patient before she goes into to see the attending physician. The internos were great at helping me nail down the correct vocabulary, both medical terms and lay vocabulary, and I even got to take the history a few times! Very helpful and useful!!! Other than that, I would sit in when the patients saw the attending physician, and would learn by listening and asking questions afterward.

Today: my precepting doctora from week 1 - a family doc - invited me to participate in today's activity. I'm not sure what best to call it - a health fair? a free clinic? It was an event put on by a church (I believe it is done yearly) for a basic physical and addressing of minor complaints for 200 niños (kids)!  There were 6 of us doctors - yes, us doctors. I was in a room on my own examining and treating children! Fortunately one doctor there is an American expat, also a family doc and missionary, who has been here for almost 30 years. He was in the room next to mine and I would consult for things like drug doses (or even, do we have this drug here?), confirmation of a murmur, etc. I was even writing and signing prescriptions myself - crazy! Before arriving in my 'consultorio' all the children had vital signs, height/weight/BMI/growth chart, vision screen, and basic blood, urine, and stool tests.  Here are some of the things I encountered: 

-everyone got a stool test, because parasites (colloquially, "bichos") are very common. The test reported normal flora too, and since this test is rarely done and results like this are not reported in the US, I had to have some coaching on what to look for. The pathological ones were Entamoeba Histolytica and Giardia. And I wrote prescriptions (several) for Tinidazole 50mg/kg (up to 2g) after the biggest meal of the day (here, lunch) for 3 days. 

-the blood test was just looking a hemoglobin and hematocrit (anemia tests), which is common here because the higher level of altitude requires more hemoglobin. However, no one today had anemia, but many had taken iron in the past

-I saw a classic case of first time oral herpes today, which i correctly (easily) diagnosed (I took a picture for those interested

-diagnosed migraines in a 13 year old (menstrual related, which is very common). They don't have the medication class "triptans" here, which is the most common and effective abortive therapy...too bad.

-a 7 year old with first time UTI

-a benign heart murmur

-lots of ear wax

-A LOT of short stature (flirting with or under 3rd percentile), howeve once their children there's not much to do other than ensure a healthy and plentiful diet...people are just short here. Thus, a lot of practice with my reassurance skills.

-a couple overweight kids, thus practice in  my nutrition counseling

-two with poor vision, one on which I discovered nystagmus ---> referrals to ophthomologist

-enlarged adenoids --> ENT referral

The record I kept of my patients:

Me in action: 

A prescription I wrote and signed:

What a great and varied day! I was a little scared the whole time with the undue responsibility of practicing on my own (even just the clinical judgment of when to ask for help and when I was confident in my conviction), but I loved that I was helping/volunteering, I loved speaking Spanish, I think I was quite successful, and I was energized and happy the whole time (830-3 in this clinc)...I really am meant to do primary care. 

I will post about the rest of the week in another post!!!

 

Friday + Weekend

Hello! So much to update! We are having internet problems here at the casa - so photos are coming verrrrrry slowly.

First, to wrap up my experience in clinic last week. Although patient volume was surprisingly quite light, I had a great time teaching Ecuadorian medical students! Medical school in Ecuador, like in many other countries, begins right after  high school. I'm still trying to understand the details, so more on that later. The students I met were in their 4th semester (knowledge level of ~1st yr med student) and 2nd semester (equivalent to our pre-med students). In my haphazard Spanish, I explained clinical principles related to the patient we had just observed, and they would help me with the vocabulary. By Friday, I was even (nicely) pimping the students! They seemed to enjoy my teaching, I of course remember being at that stage and starved for relevant clinical knowledge.  And thank goodness for all the cognates - most medical terms have Latin roots - so the students were usually able to infer what I was saying and simply correct my pronunciation to Spanish.

(In the clinic with the Doctora and the medical students)

This weekend we traveled to the city of Mindo. Mindo is only 2hr away by bus, and sits at 1200m elevation (to Quito's 2900m). Mindo's climate is "subtropical;" it's a cloud forest. Seven of us traveled there, and the weekend was packed with activities! I think my favorite was zip-lining! I had never done this before. We suited up in harnesses and zipped across 10 different cable lines, soaring high above a valley of plush green landscape. Towards the end of zip lining, and through all of our next activity - hiking to waterfalls - it was raining, first misting, then raining large fat drops of water. We didn't mind, however, because it was fairly warm there.

We went to a butterfly and hummingbird garden, so beautiful!

 

Butterflies:

Ziplining:

I must describe to you - in detail, of course - about the other highlight of the weekend: our tour of the El Quetzal chocolate factory.  They do everything there ("bean to bar") except grow the actual cacao pod. (They actually do have some cacao plants, but the pods can only ripen when grown between 0-800m, Mindo is thus too high, so they use cacao from nearby Puerto Quito). Some chocolate facts:

• The highest quality type of cacao can only be grown within 10-15degrees of the equator, which is the type of cacao they use. 
• Thousands of years ago, the cacao plant used to be eaten raw as a fruit.  A sweet pulp surrounds the beans inside the pod. 
• Cacao used to have value and was a form of currency for the Mayans and the Aztecs. 

The process of cacao to chocolate is as follows: 

1. The beans (and pulp) are fermented for 6 days.
2. Air dry for a couple of weeks. 
3. Roast for a couple of hours in the oven.
   (the roaster)
4. Grind coarsely into cacao nibs (the inside) and shell fragments (outside). 
5. Separate shell and nibs using wind (a fan).  The lightweight shells are blown to the far end of the room (and then used in compost) and the heavier nibs fall straight down. They only need to repeat this process 3-4 times to ensure there are no shells in with the nibs. So clever! 
6. The nibs are placed in a hydraulic press to separate the cocoa butter from the cocoa. The result is pure cocoa powder/paste. 
7. The pure cocoa can be finely ground into cocoa powder. Or, varying amounts of cocoa butter and sugar can be added back to the cocoa to make a chocolate mixture, which is tempered for 72 hours, and then cooled into bars.
   [Note: A chocolate bar of, for example, 72% chocolate, is 72% pure cocoa. Cocoa butter and sugar together make up the remaining 28%. Since the cocoa plant is about 30% cocoa butter, it must always be separated before being added back with sugar, to be able to make desired types of dark chocolate]

Also during the tour of El Quetzal, we saw their garden where they grow their chocolate add-ins, including chili pepper, ginger, coffee, and lemon grass. They grow other items like lettuce and herbs, which is served in the restaurant, and aloe vera, which I put on my numerous bug bites (from the zip-lining). At the end of the tour, we had a tasting of their 100% pure chocolate (as a liquid), and then with sugar, then with their ginger syrup or chili powder. My favorite was actually their boiled down syrup of the fermented liquid from the first stage, which is tangy and vinegar-y, and will make a great base for homemade salad dressing! Finally, of note *cough* Mimi and Griffin *cough*, they actually have a store in Ann Arbor, MI, called Mindo chocolate - a great place to stock up!

Overall a great weekend!

Today I started my week in the Emergency Room of the women's hospital - an emergency room for pregnant women.  I haven't been exposed to obstetrics for a year, so I have lots to brush up on. I was also still mostly in the observational role. However I think I will be able to weasel my way into doing the initial patient history (intake), which is ideal, actually, para practicar Español! I also had a great time there today because there were two "internos" (Ecuadorian medical students in their last year of school, but more like a 1st year resident in the US, ~25 years old) and two students in their 9th semester (5th year - like a 3rd or 4th year US student, ~23 yrs old).  These people were really nice and very helpful.  It was also helpful to have someone of a roughly equivalent level to mirror to become more involved (these guys do the aforementioned intakes).

Today we had went to our second salsa dance class! It was very fun, and I've convinced myself I'm making progress! I did also get to practice a bit when we went out this weekend in Mindo - it's a small town, so we recognized and danced with a lot of the guys who worked the zip line and other activities.

(en la clase de Salsa)

I've decided to begin a daily mango regimen. Mangoes here cost 50cents and they are quite delicious.... ¿como no? (why not?!).

Fun fact of the day
re, why Ecuadorian Spanish is so much easier to understand than other Spanish:
The theory goes the higher the altitude, the less oxygen, the slower, the softer, and the clearer they speak.  The Caribbean islands, with much higher oxygen content in the air, speak fast, drop syllables (and combine words), and are often perceived as practically shouting. Both the highlands of Ecuador and Mexico D.F. (the capitol, also high elevations), certainly fit this stereotype. Even within Quito, as the elevation drops (and the oxygen content increases), the people speak faster and louder. So interesting!

[More pictures in the web album, link provided in previous post]

Covered in bug bites:

I'd like to introduce you to my cell phone

Meet my cell phone, a lovely Nokia circa early 2000s, with - hard to believe - an antenna. And that's right folks, I have to press the '7' four times to type 's,' I don't even have T9.  

BUT the program loans it to us for free! And there was $15 leftover from the previous user, plus a hilarious collection of his/her (I'm not sure) old messages. And, the best of all and the best throwback - don't be too jealous - I can play snake! 

Busy busy day

So many new things happened today!

1) Last night I dreamt I made out with Tom Brady, and he was totally into me. This is, shockingly, without Malarone (the malaria prophylaxis that can cause strange dreams). Look out, Gisele.

2) First day in clinic. This week I am in a family medicine clinic.  Yay family medicine! The precepting doctora met myself and another student at our school, and we took a 30 minute taxi south to the clinic. The taxi was $1 per person, because of a set up like a ride share. Everyday taxis wait in this pre-determined location near our school and all with the same destination (the neighborhood of the clinic), and leave once full with 4 people (we were 3, one stranger joined us). Finding a taxi on the street without this arrangement would have been at least $10 for such a distance.

The clinic was fun, we saw great variety, but only in observation. We saw two patients with thyroid nodules, obesity/diabetes, bacterial tonsillitis (18y/o), upper respiratory infection (8mo), and a vaginal lesion. [For my medically inclined readers, the vaginal lesion was a 1-1.5cm painful ulcer outside/on the labia majora in a 72 year old, pain x15d, ulcer may have previously been a vesicle. The doctor suspected HSV2 and ordered IgM, which I think we never do, we would do tzanck smear or HSV PCR instead. Maybe they don't have these tests or maybe it was the 15d history (long enough for antibodies to form). Other interesting notes: they didn't have monofilaments to test diabetic feet, though I had assumed this was a cheap supply. The bacterial tonsillitis ("faringoamigdalitis") was unilateral tonsillitis (erythema and exudate), with unilateral lymphadenopathy and referred ear pain; treated with penicillin injection].

2) Class field trip to "La Mitad del Mundo" - the center of the world, aka equator. This was a fun, one hour guided tour of re-creations of the lifestyle of the indigenous people who lived at the equator and about unique properties of the equator line. This included a basin of water with a drain at the bottom, when north of the line the water drains by spinning in one direction, when south of the line, it spins in the other, and when directly on the line, it drained straight down without spinning at all. They were able to balance an egg on the head of a nail. They demonstrated the weakening of muscles directly on the equator. Finally, supposedly, we weigh 1lb less at the equator, que suerte (what good luck).

3) Dance class! I rallied a group of 7 to go to a dance class this afternoon. We started to learn Salsa and Merengue. We're hoping to go weekly and use our new skills in the "discotecas." So fun, not easy, and great exercise; I definitely need to practice!

4) We are starting to plan for the weekend. Stay tuned!

First round of pictures - posted!

I've uploaded my first round of photos! Here is a link to the photo album, to which I will continually add photos: (Quito photo album).  I did not bring my own laptop here to Quito, but I hope to upload regularly.

A few interesting notes from Quito

-The bus, the trolly-bus, and metro-bus (the last 2, which are almost like trains) cost 25cents each way
-We only drink bottled water here, but a large bottle costs less than $1. We can brush our teeth in the sink.


And now I have to give the laptop back. More tomorrow!