Galapagos Feb 4

This was probably my favorite day of the whole trip. We had a relaxed morning which entailed me taking a two-hour nap. Being on antibiotics really takes it out of you. At 10, we went to the subcentro de salud on the island. It was fascinating, both to see it with my own eyes and see other people's reactions.

It was very similar to Puembo, same paperwork, posters, and organization. It was larger, with a special OBGYN and pediatrician and a trauma room. I was very impressed and pleased to be there, but I think many other people were not. Many pre-med students I was in a group with were surprised by how small and bare the spaces were. Additionally, they were shocked by the trauma room. Alcohol, agua oxegenada (peroxide?) and other cleaning fluids were stored in Gatorade bottles and most of the equipment was very old.

I'm really of mixed opinions about this. On one hand, yes, healthcare all over the world should be equal. The ecography machine should be less than twenty years old, records should be computerized, alcohol should come in its own bottle. On the other hand, its impressive that an island 600 miles from shore is integrated into a national health care system, that this system gives free care and medications, that there is alcohol and a trauma room to use it in. Additionally, when you think about it, most emergency room visits can be treated with a few stitches, a bandage, antibiotics, an IV for rehydration and other simple procedures. Probably 75 or 80 percent of medical care can be considered "basic." And cases that aren't basic might be just as likely to die in an excellent hospital or a basic one. It’s a matter of perspective and where to put your money. And in most cases, Ecuador has put its money where its mouth is.

Ate lunch, got on the boat to Santa Cruz. On the way there, I overheard a really interesting conversation between an unnamed student and an unnamed teacher/coordinator/guy in charge. Student was pointing at something and accidentally poked Adult's exposed belly (we were all sitting around in bathing suits)

Adult: Hey man, don't touch me

Student: sorry, it was an accident.

A: No man, I notice you, I see you touching a lot of guys.

S: We are a close group of friends. We are comfortable with each other

A: Its pretty gay.

(Silence for a long while)

S: so, you've worked with kids from K before? So you know what Crystal Ball is?

A: No, what is that?

S: Its a dance, where the guys dress up like girls, and the girls like guys and everyone just sort of goofs off about gender. So you have to understand that homophobia doesn't really exist in our culture

A: I'm not part of your culture; so don't touch me any more.

Wow. How do you respond to that, to a person in power showing such...bigotry might be too strong, but its also appropriate? And what if the Student had been gay? What if he was unsure about his sexuality? I'm proud of my friend for defending his relationship with his friends, the culture of K, his own rights. And I feel uncomfortable that the Adult went automatically to judgment and anger in a situation that started off as relaxed. Of course, its part of Ecuadorian culture drilled in early that being gay is the worst possible thing that you could be. But this Adult is hired to make international students feel comfortable. We had been speaking in English and using USA standards of behavior all day, the whole trip. Of course, in lots of parts of the USA, in places all over the world that kind of behavior is OK, but on that boat between two islands, we all felt uncomfortable.

Ok, moving on. We got to Santa Cruz and it was beautiful, island paradise style. Oh! We saw this giant solar-powered boat in the harbor that is traveling around the world-teaching people about solar power. So that was cool. We went to our hotel and it was lovely and had a pool. Of course, the guys were acting as though they were all in a giant romantic relationship so as to put off our favorite Adult. Also, because they are friends and like to make human pyramids in pools.

Highlights: Public heath and fighting homophobia where you see it: both things I think about on a daily basis.

Happenin's

Written Tuesday Night

I'm sleepy all the time. Its 10:07 and I wish I had gone to sleep hours ago. Seven thirty would have been good, or at 9 after the Big Bang Theory.

Maybe instead of talking about that semi-good sitcom, I should tell you about my life in a foreign country. Sounds good.

Saturday, I went on adventure with my friend Stewart. We took the TeleferiQuo, a big fancy gondola system up the mountain Pichincha that creats the Western wall of Quito. Pichincha is semi-active and there was a huge ash eruption maybe ten or twenty years ago. Its not dangerous, just thrilling. Anyway, we went up to the top and started looking for horses to ride through this beautiful paramo that lies at the top. After walking uphill for an hour or so, we found no horses to rent, so we kept walking another two hours. This is not a tourist activity, you're at over 4000 meters and the altitude made even Stew and I take frequent breaks so that we could "appreciate the beautiful scenery that surrounds us."

Our goal was this giant rocky crag of black volcanic stone that we were calling Nono because we thought that was the name. It's not, though, Nono is the name of a suburb to the south of Quito. So we walk along, calling out to Nono, our nononovia. Once we reach Nono, there is heavy evidence of landslides, the black rocks look even bigger and scarier than they did from far away. We say Nono more; the oxygen is thin and we are hungry. We tromp down singing every song we can remember the words to. As we near the bottom, maybe 1000 meters away, we find the horses. They look very gallant with thier saddals and woven blankets against the mountain and sky but look pretty underfead and tired. However, there are llamas that you can take unlimited pictures with if you pay 50 cents. You can also wear a cowboy hat and a poncho. Stewart takes advantage of this deal and I almost feel like I'm betraying a secret to tell you how happy he was. Not that he was embarassed to be happy, its that it was an embarassment of riches. The pictures on my camera better come out well because they really restored my faith in the natural world and the bond between man and animals.

Sunday, I mostly just slept. Acually, I watched an entire season of The Big Bang Theory, but let's not talk about that. Monday, i didn't go to work. Rather, I worked on my paper for my ICRP and took a shower at abuelas because our house did not have water because the neighbors were not paying the water bills. Good job, neighbors.

Today, I was back at work in Puembo. it was a day that really broke the routine, in a way that was not particularly pleasant. Firstly, we went to a local high school to attend to the students. The Duk and I loaded up an offical Ministry of Public Health backpack with medicine and forms and walked ten or so blocks to the school. As soon as we turned the corner, I remembered why we mark the box "Rural" when tehy ask on forms. A block away from the center of town there are fields of corn and barley and onion. Pichincha is to the West and you could see the snowy tops of Cotopaxi and Antisana if it were to be clear. The roads are grey brick with straw in the cracks. A horse passes us, then a John Deere tractor. The houses are brick and mud. Its obvious that we are in the mountains. Not very high, and quite close to a giant city, but in the Sierra without a doubt.

There are some parts of this rural world that remind you of the poverty. Its customary to dress in many, many layers of clothes, four or five shirts and sweaters, pants under pants. And people wear these without worry for stains or marks or rips. They are patched and repaired and worn forever. And that in itself is not a sign of poverty, its a choice of consumption and wardrobe, but its does effect how people view you. Before spending time up here, I would have almost automatically judged someone for wearing stained clothes. Now I think twice about it and understand that rules of looking good, looking solid, looking and feeling healthy here are different than those I am used to.

Anyway, we got to the school and it was a relajo. They had set up this giant tent for us in the middle of the basketball court with a gurney, table, and some benches. We basically had to set the whole thing up with 400 high schoolers wandering around, asking questions, touching stuff, and trying to get out of class. Originally, about 70 kids lined up, all claiming to be sick. The Odontologist and I walked around, interrogating each one "how long have you had the cough?" "Does it hurt when you swallow" "How loud is the snoring" and sending kids who were obviously not sick back to class.

After a while, the Leci showed up with the many, many things we had forgot: the sharps bottle for tounge depressors, a trashbag, thermometers, and much, much more Ibuprofen.

Because there's not much you can do when you have a cold or a fever or even the flu really. You can throw up and feel hot and drink tea and soup for a few days, and sleep a lot. I am sure people here understand that for the most part, but part of my job is interacting with the people that do not. Today, for example, I spoke to five partents who were frantic and pleading with worry about their children that had sore throats and fevers. Strep is horrible and so is tonsilitis and H1N1 is a risk, but for the majority of those fevers you just have to lie there and be miserable. Once we give out the appointments for the day, there's no fitting anybody else in unless its a heavy-bleeding emergency. On one hand, I feel horrible telling partents to take thier kids home, let them lie down, give them water and juice and tea, and wait a few days. On the other hand, I feel that its not my place to tell them how to deal with children I don't have. On my newly-created third hand, shouldn't they know how to deal with a fever already?

So there's been a lot of that lately, a lot of sick-eyed kids and parents that grab your arm and plead and beg for the appointment with the magic doctor that will give the magic pills (avialiable over the counter at ten cents a pop) that will take the evil away.

Enough judgement and poor interpretation of cultural values. Time to sleep

This! Is! RURAL HEALTH!!!!!!

Today in Puembo, everybody's expectations ran into each other. Chocarse, if you would. We were set to go out to the community to do something no one thought to call outreach. I got to the clinic at what I thought was late by 820 to find the Doc and Leci calmly treating fevers and bronquitis that every person seems to have. After three or four complete patient work ups, we gathered up our stuff: two coolers of vaccines (Hep B for the 6th graders, influenza for the old people); a sharps deposit box (really a 5-liter water bottle with the lable wripped off); some trash bags; a metal can full of cotton; and some anticeptic jel.

The Leci wanted to take a taxi because none of us really had any idea where the old folks' home was, but the Duk (that's what Leci calls the Doctor) insisted on driving her new Nissan. Within two kilometers we were on dirt road and the Duk was cursing her luck and lack of fourwheel drive. We drove around back roads for a while looking for something red, I didn't know the word. Eventually we stopped at a cross intersection and the Duk decided to turn around. Not looking behind her, reversing fast, she slammed the car into this large rock and scraped up her bumper. So then she turned hopped out of the car and put on the emergency break but didn't put the car in park, so it rolled back farther into the rock. She shrieked. Leci muttered about the taxi again. Duk tried to get into the car and drive away, but the key wouldn't turn. I thought to her "slam the break pedal and jerk the wheel to the left" but ended up articulating something like "you must be pushing the part on the floor for the breaking and flipping the tire." Obviously I was not understood and Duk kept impressing us with her lack of driving and car managmente skills.

Leci decided to walk to the nearest civilization, a high school called Colegio Israel which had everyhting plastered in Israeli flags. I tagged along as we searched for the secretary who searched for the pricipal who referered us to a teacher who knew a lot about cars. The principal, the teacher, a gardner with Down's syndrome, Leci and I all got into the principal's car and drove the 500 meteres to the stuck doctors. The teacher got in the car, slammed the break pedal, jerked the wheel, and started the car. I told you so.

With much embarassment and silent machismo, we got directions to the asilo. We got lost a few more times, and the Leci got out and ran in one direction to see if we were going the right way, but we got there.

The asilo housed about 9 old people most of whom wanted to sleep. We sat around in a room filled with exercise equiptment and fishtanks. I filled the syringes, the Duk and the Leci gave the shots, the Duk's sister who is also a Duk filled out the paper work. The dentist, who materalized as soon as we entered as the asilo talked about teh importantce of denture care.

After that completley-not-worth-the-trouble trip, we all hoped our next stop at the school would be better. We vaccinated the fourteen kids in sexto curso, me on the syringe-filling again. The Duks went to the first grade and gave a lecture about washing your hands, brushing your teeth, and "not sticking anything into any orifice of your body. It will get stuck."

The Leci went into the computer room to figure something out, so I sat by myself in high noon on a basketball court. Toasty. After about fourty minutes, she came out and told me to come with her to the fourth grade where she gave a similar health class lecture, relying heavily on the scaring power of the "filth underneath your fingernails" and its power to move all over your body. Also referenced was the love one feels for ones family, and how one could kill ones family if one does not wash ones hands.

Leci and SistaDuk seemed to think it would be cool for me to give the next lecture, to kids in about 2nd grade. I was not so in to the idea, but I was looking forward to actually speaking something. I also felt pretty good about it because in SPANISH 205 I actually did just this, talk to second graders in spanish about washing thier hands.

We pulled out around one pm, holding the giant bottle of needles behind my back so that the first graders going out for recess wouldn't be scared of gringas and doctors for the rest of ther lives. The Duks had to go to Yaruquí for a meeting, so the Leci and I walked a ways down to the Y intersection that begins the town of Puembo. The bus driver did charge us pasaje, but he did say "who's safe from AIDS today, doc?" and let us sit with our coolers in the front of the bus, which was both caring and funny.

Leci and I did paperwork for a while, then ate at Doña Marci's, where we had fried rice with hot dogs, easily the worst additon I have seen to that dish.

We walked with Doña Marci and her 10 yeah old daugher (the one I played teaching-English with) to the high school. On the way there, we commened about how the daughter is starting to grow breasts and how her nipples are visible through her shirt. Ok, honestly. The daughter responded that she didn't care. Ok, bravery.

Doña was a total jerk about the vaccines to the kids, saying this was punishment that they didn't do ther homework, brining the bottle of used needles on purpose past several classrooms "to put the fear in them." This seems to be pretty de regur, however. The teacher at the other school said that we should put the shots in thier eyes or butts. This seems unnecessarily cruel to me, and I know it would have made me cry and hyperventilate at their age, but I guess these kids are tougher.

Gimme a Shot- Puembo, day 3

Feeling soooo sick, that's why I didn't write yesterday. I was too sick. Also, I went out for Mexican food and when I came back I just went to bed. I tried to make it to Puembo on time today, but I just couldn't. I ate my breakfast, got dressed, called the Leci and went back to sleep for two hours. Sometimes, that's gotta happen. Once I got my act together I made it to ICRP and things went pretty normally.

I had missed the opening procedures: the giving of appointments, the opening cabinets and doors, the temperature check on the two vaccine freezers. All the paitents were weighted and measured and the doctors were giving out perscriptions like candy. There were far fewer adultos de tecer edad for influenza vaccines. However, four really really old people from the Mora family all came in, all claming to be each other's cousins. The second Maria Mora acredited the lack of old people coming in to the dance class going on at the old folks home that morning. We're going to the old folks' home (asilio, same word for mental asylum) tomorrow, so I hope there is not bialoterapia class then.

I really like working with the old people. They are usually very sweet, patient, and eager. Mothers have babies that cry and little kids that get restless, and people with jobs want to get back to them. But the elderly people have usually devoted their entire morning to making it to the health center and getting the shot. They are in no hurry.

They support each other. Several times a person who has already gotten the vaccine comes back with a friend or neighbor who is less self sufficient. I came into the clinic today to see a very old woman in a wheelchair. I asked if she needed help getting up the stairs. She told me that she was waiting for her daughter-in-law to get vaccinated, then asked me politely if I could vaccinate her. The daughter-in-law was 69, the mother-in-law was 87. They both had chins full of white whiskers.

Several patients come in daily or very often for blood pressure checks. Most of them don't really understand how thier blood pressure works, but they all know that smaller numbers are better. one man who comes in every day says that he will bring another person wih him each day for thier vaccination.

I had my first needle stick today. I was loading up a syringe to give to the Leci to inject, when it popped out of the bottle too fast at poked my index finger. It hurt surprisingly badly and bleed a lot too, making me feel more sympathy for all these old people whose skinny arms we are blithly plunging needles into. There was no risk of infection at all, it was a new needle. I might have given myself 100th of a flu vaccination, but I'm pretty sure I bled that out. But it was scary, to be so close to wounding myself, a medical procedure I'm not qualified to give, to contamination and all those stories about dirty needles.

After I washed it and wrapped it in cotton, I hid out in the archives room for a while, putting files back in place. It stopped bleeding quickly and I can't even see the mark now, but I remember the adrenaline, the spot of blood, putting the cover on that needle and putting it in the sharps disposal as fast as I possibly could.

However, there's a cool part to this scary story. The SCS or the Ministry of Public Health in general, I guess, has gotten these new needles for vaccinations that are one of the best public health and harm prevention measures I've ever seen. It's single-use syringes! And I don't just mean that they are thowing them away after one use, I mean that it is physically impossible to use them more than once. You pull the cap off, fill it up, push the plunger down and it is impossible to pull back up! Even if you go half way down, there's no going back. This makes it easy to give the whole shot, but it's also a failsafe way to prevent multiple needle usage.

You might think that this is wasteful, and I won't argue there. But needles are one of those things that are supposed to be wasted. Toilet paper? No. Food? No. I'm a supporter of if its yellow let it mellow and re-using plastic bags and all that. But as soon as I stick my runny nose into a medical buliding, I want it all thrown away. Gloves, masks, q-tips, and most certainly needles. And when I see track marks, which I have, and most certainly will see in pretty much any of my job options for the future, I want to focus on the addiction that caused them, not on the sickness that could result.

From an ecological prespective, single-use syringes are a bad idea. But, if you look bigger, vaccines themselves are a bad idea: they make a weaker herd, more people thowing things away and buying cars and cutting holes in the ozone layer. These elderly people shouldn't even have lived as long as they have, and they shouldn't make it past this flu season if they aren't strong enough. But from a harm-reduction persective, which is the -ology in which I find the answers closer to the meaning-of-life question, it makes perfect, beautiful sense.