Wrapping it up...but not for long!

Hey everyone! I am in Tena right now, wrapping up my internship. But I´m not wrapping up the work with her for long, hopefully - I got the internship that I applied for through Grinnell, so I´ve got the funds to stay here until sometime between July 14th or the 18th (depending on plant ticket costs). But what I am doing with the internship is yet to be determined.
I've kept working with the physical therapist, Nicole, and I am loving physical therapy. It is actually something that I think I might be able to do with my future. I would like to spend the summer working with her, to continue the research on physical therapy, but I have to get my grant shifted first. See, I originally applied for the grant before I started with this work, so its funds are technically for a project in Quito, researching the effects of pesticide use in flower plantations on the workers and their children. Which still sounds interesting, but I would be sitting inside doing research on computers all day. Here, I could be working in the PT office, interviewing parents, living with my amazing host family and working with Nicole, who is a great boss. And hopefully putting together a paper good enough to get published. I have to ask Monty Roper, the head of the grant program, if I can switch. We´ll see what he says.
In other news, today I learned to eat crabs. This morning I went out with Gabi and Cecilia (the empleada) (Francisco is staying with his grandparents for a couple weeks, so he isn´t home) to the open air market (the feria) to buy live crabs, green plantains, onions, and some mandarin oranges, and two fruits we don´t have in the states, one called a chirimoya and the other called a zapote. Then we went back to the house and cleaned and prepped the crabs (I took photos), and Ceci whipped up a plantain and onion soup and then at the end threw in the crabs to boil. We each got a whole crab and a bunch of plantain pieces, and encebollada, which is onions and tomatoes chopped up, a plate of rice, and a freshly made glass of passionfruit juice. It was pretty awesome. Ceci and Gabi laughed at me because I ate with a serious expression on my face, I guess. And when they were teaching me to eat the head, I accidentally started to eat the wrong part and had to spit it out because it was so disgusting. By the end, our hands were covered in crab juice and there were ants eating at the little bits that ended up on the floor. It was a good time.
Tonight, salsa dancing. I might let you know how it goes.

Oh! Grandma - I got your Valentine´s day card in mid-March, but I was a vaga, which means lazy, and forgot to tell you I got it. Thanks so much (a month and a half late)!

Still alive and dengue-free

I wrote this about 5 days ago, so it´s a little out of date. I´ll put more new things after it:
Wednesday
Hello everyone!
I had my first overnight shift in the hospital last night. I am dead tired and ready to sleep, but I thought I would update you a little bit first on how it went. Emily, Phoebe, and I chose last night’s guardia to attend because one of our favorite doctors, a resident named Dra. Violeta Muñoz, was on duty. Luckily, with Violeta came my favorite nurses, too, so it promised to be an interesting night. We got to the hospital at about 8 pm and stayed, in the end, until 8 am. At about 11 pm, the three of us got to see the first birth of the night (which was the first birth ever that I have witnessed in person). It came so quickly that there wasn’t enough time for the doctors to get there, much less for the mother (age 27, this was her 5th child) to be taken to the delivery room. The nurses had to catch the baby right then and there! Then the doctor arrived and whisked the baby away when she came in, and it was apart from its mother for another whole hour before the mama got to see her little girl. Shortly thereafter, a bus accident happened outside of Tena and about 8 patients got taken to our hospital. I was there when they started piling into the emergency room. One of the first patients to get there was a little girl who was 8 years old and had her forehead gashed open pretty deep. She required a couple of layers of stitches, but Violeta at least waited for the anesthesia to kick in before she started sewing. And, even better, she did a really neat job of it and I think the scar won’t be that noticeable blended with the girl’s eyebrow. As those patients proceeded to come in, I whipped out my blood pressure-taking skills (thanks for the lesson, Mom!) and helped out a little in the check-in process.
After that calmed down, I stuck around in Emergency, when a pregnant woman came in fully dilated, ready to give birth. Luck was on my side I guess, because I was the only student there and they only let one extra person into the delivery room other than the doctor and nurse. So I put on scrubs, face mask, surgical hat, everything (umm, is that normal? it seemed a little excessively sterile to me) and headed in. This birth was also quick, but the baby had its umbilical cord double-wrapped around its neck and it was slow to breathe. Phoebe and Emily were going to come in for the next birth, which happened pretty much right after, but they didn´t have enough scrubs, so I (luckily? I felt kinda bad.) got to stay in the delivery room and see the next birth, too. This was a 19 year old first-time mother, and its kinda sad that the thought going through my mind was "wow, this is only her first? she waited!". Her birth was slower, and was attended by a resident who hadn´t attended to a birth for 3 years. He was guessing a little bit, and wasn´t really talking to the patient much, so I tried talking her through some things, especially after when he was sewing up her episiotomy. As for that, the episiotomy didn´t seem entirely necessary - that baby was coming out pretty well - Mom, how customary is it for an episiotomy to be cut on a first baby "just in case"? Anyway, by the time all that was over, it was about 5:30 and I wanted a nap. So I took one, until 7, then pretty much wandered around until 8 because nothing was happening, and left. It was an amazing experience. I think I´ll be doing one every week. Okay, time to sleep!

So anyway, that was a week ago. Things have actually changed quite a bit for me in the hospital since then. Us gringas were "found" by a fellow gringa who runs a free physical therapy clinic on the fourth floor. I am really interested in her work and she wanted to do a research project on the link between how births go and the occurence of cerebral palsy and other physical and mental disabilities. She said that she sees forms of CP and haven´t been seen in the US in the last 10 years, and that is really interesting to me. So, I spent Thursday and today with her in her PT office. She is teaching me to work with the kids and we are working together on this project, which right now is becoming a big patient database with information on type of birth (vaginal or cesearian), birth weight, disability, birth complications, etc... with the hopes of running statistics on it later and presenting it to the health minister in Ecuador to change birth policies. I hope it works!! That actually makes staying in Ecuador for the summer even more enticing, because I could keep working with her in my free time, presenting our information.
That is another thing I don´t think I have really mentioned on my blog yet - I think I may be staying in Ecuador until mid-July, depending on if I get a grant from Grinnell or not. There is work that I´ve been offered in Quito to research the health effects of pesticide use in flower plantation workers. But, it is a volunteer research position, so me taking the work hinges on me getting a grant from Grinnell to do it. We´ll see what happens!
A change of subject: This last weekend, clearly, was Easter weekend. All of Gabi´s (my 27 year old host mom´s) family came into town on Thursday and Friday for the baptism of Gabi´s 3 year old son, Francisco. It was really neat having everyone there, though it was a little overwhelming too.
On Friday night, I went out with Emily and Phoebe to go to a bar and we ran into the physical therapist, and then we ran into a candlelight vigil procession. It stopped for each of the stations of the cross and was a pretty amazing sight. I definitely haven´t seen anything like it before. It was tons of people and candles and rosary saying. Wow.
On Saturday the family and I went to Archidona, the city next door, to see its zoo and then we went to a spot on a nearby river that looks like a jungle paradise to swim. Seriously - sandy beach, palm trees, clear water, a little cave, some rapids down below - it was amazing. Then we went to the baptism. The mass seriously went for 2 hours before the baptism happened! There were seven readings, each with a response, before the gospel, then a crazy long homily. Mom, was that how 3 hour long Easter services happened when you were little? Luckily, Gabi and family aren´t that religious so we snuck out after the baptism to go out to eat. The food was great and we had homemade coconut-vanilla cake. Yum!
The next day (yesterday...) all of the family left except Gabi´s sister Maria (24 years old) and Gabi, Maria and I spent most of the day watching movies. For a such a Catholic country, Easter was pretty chill. I´d say that the only major thing the Ecuadorians are missing out on is the trend to eat a lot of chocolate on Easter. Because really, what is Easter without a chocolate bunny?
So that´s my life until now. I am really hungry, so I´m going to go eat some lunch. ¡Adios!

I´m in Tena, safe and sound

Oops... sorry for not writing for so long. As you can see, I´m in my internship phase right now, in Tena. It is in the tropics, so it´s about 80 degrees outside, though luckily it isn´t raining right now. For those of you who don´t know, my internship is at the Hospital José Maria Velasco Ibarra, a public hospital. I originally though I´d spend most of my time in obstetrics/gynecology, but as it turns out there isn´t a whole lot of action there during the day. So instead, two other students (Emily and Phoebe) and I wander around the hospital looking for interesting things to do. We go on rounds in pediatrics in the morning and generally end up in emergency for most of the day after that. The hospital is pretty different from anything I´ve seen before, and so are the illnesses. There´s a guy in the internal medicine unit in an isolated room who got a parasite that eats away at the cartilage in his face and causes severe enlargement of his nose and lips. His face is huge, and the skin from his now-mostly-flat nose takes up about half of his face. I don´t think this is anything I´ll ever see again in my life. Hope I don´t catch it :) Parasites are also incredibly common here. The water isn´t potable and the rivers all have parasites in them, so every day I see at least five parents come into the emergency room with kids suffering from parasites (or the parents have them themselves).
One of the most startling things to me is how young women start having babies. One 23-year-old woman in the emergency room today was on her sixth pregnancy. I´m not sure if it is lucky or not, but two of them have ended in miscarriage. It seems like every 20-year-old woman that walks through the emergency room door is pregnant with at least her second child. I cannot imagine how that would be.
I´ve decided that there are a lot of doctors in the hospital who I would not want to be seen by here. Some are really great - they care about their patients, they listen well, they treat them like they are excited to see them and are just fantastic. But, there is a group of about four young doctors from the coast, on residencies here for about 4 or 5 months, that I would never want to be my doctor. Especially if I was indigenous. They treat their patients (especially the indigenous) like they are stupid, like they don´t want to spend the time of day on them, and they don´t care if they cause their patients pain or invade their privacy. There was a woman in the ER today with a prolapsed uterus (or something like that) - the same one who is on her sixth pregnancy - and the doctor was asking her questions but not taking the time to listen to her answers, then told the woman (8 months pregnant, walked an hour to get to the hospital, has 3 kids at home) that her emergency really wasn´t and told her to come back tomorrow to see a gynecologist. Ridiculous. With a different pregnant and very embarassed patient, legs up in stirrups, the doctors in the room didn´t object at all to nurses walking in and out during the exam. And on Friday there was a little girl, 3 years old, whose brother had almost cut off her finger with a knife while chopping pieces of sugarcane. She was also indigenous. They had to sew back up the finger, and the same doctor as the one treating the pregnant woman washed the wound very brusquely, making the girl scream, and then without any warning gave her shots of anesthetic. But then, she didn´t wait for the anesthetic to kick in before she started sewing, so with every stitch the girl would writhe so badly, I could barely hold down her legs. Her mom was crying too, because she knew her poor little girl was in so much pain. I wanted to vomit from the sight.
Anyway, as if all of this wasn´t interesting enough, tomorrow I am coming in at 8 to watch some surgeries - I think a skin graft on a burn victim and maybe a C-section - and then I´m going home to sleep some because I´m coming back at 8 pm to stay for the night in the hospital so I can see some emergency surgery, some births, things like that. I´m pretty psyched about it. And, I will be following one of the doctors who I actually like very much, so I know that I won´t be bothered by the way she practices medicine. I´ll try to keep you guys updated as to how this internship turns out and everything.
¡Ciao!