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.

First Day of IRCP

Written Monday Night

I've got a huge surprise for you guys. I am currently sitting in my bed! In pajamas! Pilar and Jimmy and Natalia are watching TV! This is the most exciting thing to happen in weeks. But naw really, it's amazingly comforting to be in a safe place, not out at a bar or a restarurant or even in a livingroom. Just quiet. Under covers. I know I say that almost every day, and I certainly say it more often to myself, but being quiet, warm, little is the feeling that keeps me going.

Partially why I want that feeling right now is because I've been pretty busy the past few days. I did go paintballing on Saturday and it was so so fun. We took taxis way to the north, by the Carcelen bus station. Our taxi driver was totally sure he knew where he was going, but ended up dropping us off like two miles down a steep hill from where the paintball place actually was. At least we got our muscles all warmed up.

We got suited up in jumpsuits and masks and the goofy looking guns with thiere little super-ball pellets. The arena was basically a lot with dead grass, wooden shacks, a beat up old car, and some oil drums. All covered with neon splats of paint. We dodged and shot and hit and yelled and it was great, the team, the adrenaline, the anger, the competativeness, the threat of pain. We played five or six rounds. Around round four I tried to make it to behind this barrel and tripped and twisted my ankel really badly. Of course I was the only girl so I tried to play it off but it was one of those where it actually does really hurt and you just have to lie on the ground for a while praying people don't judge you too hard.

So during the next rounds, which we played in some nearby woods with 12 Ecuadorian bros, I either lay in some weeds and contemplated life, or I huddled in a shrub being the "sniper." Everyone was very nice to me and didn't make fun of me or make sexist comments.

I went to a bar with basically the same people and we talked about our favorite books. Ender's Game seems to be on the tip of everyone's tongue lately. Maybe its a wintertime thing? I've had like 5 separate conversations about it. Anyone else outside of Ecuador reading it?

Sunday I did nothing. Almost honestly. I talked to Ma, Emily Hanne and Tina Cava, Jon Posn and Zak Rogo. I also read a book Iggy lent me, Ironweed up on my roof and pretended I was a hobo. This was a normal Sunday.

Today was monday and I started my work! I woke up ungodly early. Well, I didn't think it was that early, but Pilar was moaning the whole time. I almost ordered her to go back to bed, but she was like "you cannot eat alone! you cannot make your own coffee!" I tried to tell her that I've been at least mostly making my breakfast for like 6 years but she was hearing none of it.

Got my buses easy, slept all the way. Maybe I do have to leave the house a little early. Once I got there, Leci already had arranged the turnos for the day and I got all the charts out of the file cabinets. We weighed and measured everybody, loud and crowded but fairly straightforward.

Today was really busy, from my limited sample of days. Everyone seemed to need things writteen twice or a clinical history opened or missing thier card or forgot waht year they were born. And people didn't stop. Normally one or two or five people will come in a morning asking for various things, but there's not usally five waiting at the door.

Part of the problem was the influenza vaccine. There are free influenza vaccines for adults over 65 which is a good public health idea but is just another program to execute. Adults need cards and we need to take thier names and make sure no one is allergic to eggs. We administered over 30 vaccines today, me filling the syrenges and forms and an aid doing the acutal shot. It was really wonderful, actually. Probably 10 or 12 very old indegenous women came in to get shots. They were freinds so they all decided to take the time to come in together. One lady, the most sentient, told each woman where to go, took and stored her card, helped her roll up her sleeve, reminded her to breathe. It was very caring. I refused one woman, though, which might not have been the right thing to do. I think she had dementia or brain damage or soemthing, because she didn't know her name and wouldn't respond to anyone. I felt like vaccinating her would be without her consent, and the Leci was too busy to argue.

Around 1 we took a break for lunch. The doctor, a woman visiting her from Canada (another doctor and a future friend), the Leci and myself crammed into this woman's tiny house which is on the clinic property. For 1.25, she fed us potatoes, rice, spicy hotdogs, soup, juice and heavens be! salad! We snarfed down our food and returned to work.

There were more emergencies today that I remember. The first was a woman who had run her finger up in an industrial sewing machine about a week ago. Today, the finger was very swollen, infected, and covered in necrotic tissue. Gross! Cool!

The second emergency was far more scary. A man, tall and pale, brought in a woman, short and dark from the flower plantation where they both work. She was swathed in cotton and rubber, booth with holes, her hand clenching her thick rubber gloved fingers. Twitching constantly, her blood pressure was low, her right side was almost paralyzed and insenstive to pain. When we got her on the table, she had a seizure. She couldn't move her eyes past the midline, her right arm was stricken with cramps that made her cry.

I don't know much about medicine, but when I smell the pesticides coming off someone as the enter the room, I'm inclined to believe that the cause of this problem might not be one hundred percent genetic. It's good she came in, good that she was wearing long sleeves and gloves and boots, but that much chemical exposure cannot be good.

The SubCentro hasn't a single anti-convulsion drug in its pharmacy, so as soon as the doctora had checked her out as best she could, after a few rounds of arm pain-attacks, her friend and I lifted her up to put her in his car to take her to the hospital in Yaruqui. I don't know what happened to her. I hope she is ok.

After that, I was a little overwhelmed, so I sat on the playground in the yard of the clinic and helped one of the little girls that lives in that tiny house with her English homework. She was learning the differnce between "a" and "an" and "the." Have you ever thought about how hard "the" would be to say? we have so many way of saying it, "da" "thee" "thuh." She got it wrong almost all the time, but she does know a bunch of words, probably more than I could read in Spanish when I was 8. she also has a barbie doll named Cynthia who is "ocho, igual que yo! Ella es mi amiga por siempre!"

At four, I cleaned up my things and walked to the bus stop. An old woman who I had seen earlier at the clinic and I sat on the steps where the bus stops, eating ice cream silently. I feel like that might become a routine.

Updates!

Not much has been going on the last few days. After my Cotopaxi Adventure and my Plaza Fosch Adventure I have chilled out a lot at home. Lots of reading, including this book about a doctor my mom gave me, that, you're right ma, is really terribly written. I've gone to abuelas and done the requisite cheek-kissing of everyone in the dynasty, slept on the couch. I walk across the street and swim 1500 meters which is very impressive because it is more than a kilometer. Are you not impressed with my athletic prowess?

After that, I go back to abuelas, drink cold coffee and eat a banana, and take the bus home.

Yesterday, we had ICRP class (surprise!) and no one knew about it so we were actually like 3 hours late. I haven't actually started my IRCP this month yet. I called the nurse on Tuesday and asked when I should come in and she was like "Monday, or Tuesday...whenever you want." So that seems pretty relaxed.

However, I'm getting really pumped up for my SIP and am going to get my ICRP work to work for that. How? The sub centro at Puembo does a great deal of work with birth control distribution and counseling. I could write my ICRP monografia (sort of like a term paper) about access to birth control in Ecuador, especially among indigenous women, and then that could be (or could be close to) my Literature Review for my SIP! Which would be about birth control among indigenous women in Ecuador! I'm not sure if this is cheating or something, but it's what really interests me and your research is supposed to further more research, right?

Not that I've started writing or anything.

The other thing that's happened lately is going out to dinner a lot and eating good food. The Bio/Ecology students went off to Tiputini deep in the jungle on the 6th to do research, so we kept going out to lavish dinners to say goodbye to them.

On the 5th, we went to this lovely asian-fusian restarurant. I had green curry so spicy and creamy it made me tear up. I've missed spicy food so much, jasmine rice, chopsticks. I am going to gorge myself on Thai food when I get back. I also had a sake bomb which I though would be really good because I always read about them. Acutally, it just tasted like rotten beer with some airfreshener in it. Also, trying to get the sake to fall into the glass, it spilled all over me and made a huge mess. This was not worth a drink that tasted like drain cleaner.

The next day we went to this Mexican restaurant that we had always made fun of because there is a guy in a huge sombrero and fake moustache outside waving a menu and yelling "hey you guys! come on in!" over and over. I ordered enchilladas and was hoping to continue my spice dream, but it was mainly a bowl of melted cheese with pieces of chicken and a single corn torilla wripped up on the top. Yum! Not!

Yesterday, I went over to Jamie's and he and Scott and I made a pimpin dinner of Macaroni and Cheese with mushrooms, a giant salad and....water. We even set the table and lit candles. Then we watched Star Wars and everybody fell asleep.

Today, I am going to eat some toast Pilar left for me, go to the store with her, hopefully go paintballing, go to Jimmy's concert, and maybe hear from my mom. You know, the regular.

Thinkin Hard

Its 10 am here in Ecuador! I am under my covers like crazy rich uncle Dana eating a banana with peanut butter, God's Gift to Food, and my head itches mercilessly. Just giving you my vital stats, you know.

As this program winds to a close, I'm thinking a whole lot about time and how it's expanding and snapping shut and shrinking in front of my eyes. For example, in late January at some point in my life, my mom and sister came to visit me in Kalamazoo. I was almost completley sure that that was one year ago, but once I really think about it, it's clear that it was two years ago when I was a freshman. They visited me in Hoben, my friends in Trow, we walked around the snowy campus and I skipped out on my caf meals to eat at Saffron and The Strutt. Last year, late January? We were cuddeled up in the sus house, trying to not turn on the heat. Zak had just gone to THAILAND. ( I tried to find your Thailand blog, Zak, and couldn't) I was taking sculputure, statistics, and beginning to gnaw my way through my independant study.

And three years ago? Slogging through twelth grade, knowing I was going to Kalamazoo, a secret warmth to get through physics.

Five years ago? I'd just started reading Cat's Cradle with Zak for the first time, and we all know how much that book means to me.

But no matter how many Januaries and Julies pass, each morning I wake up and slip on my glasses and pray that I haven't peed my pants while sleeping. It's not an issue for me, peeing my pants, it's probably happened five times since being potty trained but it remains something that I am afraid of having happened when I wake up.

With that confession over, I guess I could start actually start making sense here. What I mean to say is that no matter how time stretches and rips and gets tangled up on itself and in my mind, there are some things that stay constant. My anxiety about silly things definitely counts as something that's been there for me forever, and it's probably going to be there until my end. Sometimes, often, its no fun, it holds me back, it keeps me in my room writing furiously or imagining my death via food posioning.

However, the strength of the anxiety does help me remember parts of my life that might have faded otherwise. The churning stomach, the paralyzed brain, tight fists and though loops provide strong, clear points of recognition that might have gotten smoothed over it the physical fear wasn't so strong. And now, in a part of my life that's less riddled with anxiety, I can look back and learn from it.

For example, when I was little, I had this big thing about loosing teeth. I felt so miserable, like a part of me was dying or had abandoned me. I remember being six or seven and loosing a big tooth near the back. This seemed worse than anything, I was crying so hard. My mom, genius that she is, gave me a little potted plant from the drug store to help me feel like life was still going on even though I lost a part of myself.

Yesterday, quietly flipping out about how Ecuador is coming to an end and I'll never travel again and I don't know what I am doing with my life and have no friends, I rewound back to the lost tooth and the little plant. Its the same worry and solution all over again: loosing what is yours, the only thing you can identify and grab onto in the messy world, soothed by the reminder that the universe is larger than your bloody mouth, and that this giantness and variety can be a comfort.

So I keep losing teeth, knocking them out, they fall out while I'm sleeping or in class or at a party. And sometimes they hurt, and sometimes I don't notice until months later, but I always miss them, and I can't resist running my tongue over my bare gums.

But then in my backyard, under my bed, in my notebooks and friendships and heard in my conversations, are a million tiny trees, ferns and bonsais, dying or dead or growing strong, moments that I remember the bigger world around me, stop crying over my teeth, and just chill out and go with it.

So yesterday I lost a tooth and today I found a tree: the sounds people make when they are togehter. I heard in in my house growing up, Ma and her friend having coffee at 8 on a weekend morning. Later as I entrerd the teenager-sleep-forever phase, Ma and Lesters talking artifically loud to wake me up at 11.

"SHOULD WE HAVE FRENCH TOAST, DEAR DAUGHTER WHO DOES NOT SLEEP TILL NOON?"

"WHY PERHAPS WE SHOULD LOVING MOTHER! IF ONLY THERE WAS A THIRD PERSON HERE TO MAKE THE COFFEE!"

"ALAS, YOUR SISTER HAS JOINED THE CONVENT OF HER BEDROOM AND WILL NOT ROUSE HERSELF"

The Sus House bickering and disecting of what happened last night, or the frantic key-board and pages turned as an all-nighter winds down.

And now here, with Pilar and Jimmy, just this morning

"Ma, we have to go!"

"Ok, I just have to find my toothbrush. Did you take my toothbrush?"

"Ma, why on earth would I take your toothbrush?"

"Well, you took my hairbrush yesterday."

"That's different. We both have hair that we need to brush"

"We both have teeth my son. And I am going to brush mine before we leave this house"

My teeth make me cry and my trees make me giggle, and both of them help me remember my complicated, boring, wonderful, thrilling, scary, adventuresome life.

Bad Dana! Bad!

I didn't write today and I didn't write yesterday, I am failing at my new year's resolution. But I sitll love writing! Do not worry, I promise an entry tomorrow. A nice juice one filled with gossip, cheese, weird dreams, anxiety, way too many commas, you know, the usual

Didn't Write It, Still Like It

My Fast-Beating Immigrant Heart

On Being from a Failed Empire

by Gary Shteyngart

Past seven years I've been joking about how I was born in one failed empire (the USSR) and how someday I'm going to die in another one. Is it time to retire that joke? I came to America as a child. I studied hard, got circumcised, wrote two books, and then W. happened. I remember how excited I was to get my first U.S. passport, how happily I brandished it when going off to some ridiculous country where the ruling elite gorged itself on oil profits while enemies of the state were sent to roast in a dank tropical hell.

And then we became that country. Mr. Obama: Please make it better. All that work, all that lost foreskin, all those years of mooing the Pledge of Allegiance with one hand on my fast-beating immigrant heart—give me some pride back. Raise our taxes, if you must. We'll write even more crap for The Stranger to make up the difference. We'll do anything to redeem our butchered ideals. Let us throw off this threadbare imperial mantle. Weren't we a nation once?

From http://www.thestranger.com/seattle/here-comes-the-sun/Content?oid=757896

Everyone should read The Stranger, all the time