Mindo cloud forest

Hi friends!

This post is overdue, but I wanted to write about the weekend Amy and I spent in Mindo (two weekends ago) with three other students from the program. Mindo is a small town located in the “cloud forest” region of Ecuador. A cloud forest is a tropical evergreen forest where the clouds literally hover and float at ground level. It is a disappearing habitat, and it is beautiful.

After a two-hour bus ride winding through the mountains and down into a valley, we arrived in Mindo. I was immediately struck by the incredible flora – it looks like a temperate jungle, where the trees have huge leaves and vines and mosses are abundant. After a filling and very cheap lunch, we set out into the forest with a local guide, hiking across rocks and small rivers, uphill to the top of a waterfall. We learned the word for mud ("lodo"), which was slippery and thick in spite of this being the middle of the dry season. At the peak of the waterfall, our guide launched into a long set of instructions in Spanish, during which my anxiety and anticipation grew exponentially. We all strapped in to our harnesses – which, amusingly, were bright red with the word “mammut” and a picture of the corresponding animal printed squarely on the butt (see attached photo of Amy´s arse) – and then took turns repelling 80 meters down the waterfall to the river below. It was terrifying, exciting, cold, and magnificent. Amy was a rockstar hopping down the rocks, and I - while not quite so graceful or daring - made it down in one happy piece.

On Sunday morning, we got up at 4:30, piled into a pickup truck, and drove 20 minutes out of town to hike up another hill in the dark. By the time the sun rose, we were waiting in a little lean-to for the "gaillo de la pena," the "cock of the rock." This rare bird performs an intricate mating ritual every morning, in which the males court females by calling out, bobbing their heads, and spreading their wings. Their squawking was unique and charming, and their heads were the most brilliant red. We could hear them even before the sun came up, but over the hour or two we were watching there was a lot more waiting than seeing birds; which for me was part of the fun – anticipating the payoff when you finally catch a glimpse of such a beautiful bird.

Later that day, after a hearty breakfast, a short but necessary nap, and a very hot shower (a luxury we have experienced but few times during our month in Ecuador) I visited the butterfly farm while Amy and the other gals checked out the coffee plantation and the chocolate shop. I always enjoy the chance to wander through a place on my own, and the garden was a perfect end to my weekend. I saw caterpillars, cocoons, and countless species of butterflies, as well as the establishment´s orchid garden. My self-guided tour concluded with fifteen minutes of lounging in a brightly colored woven hammock overlooking a row of hummingbird feeders which were visited by one exquisite bird after another.

If my descriptions sound a bit over-idealized, it is because this place truly felt like paradise to me. It was hard to leave it behind, but made us excited for the upcoming visit to the Amazon rainforest… More to come!

Clinic In Ecuador

Jess or I will post about our awesome weekend in Mindo (a cloud forrest) a bit later but I had to write a quick post about the clinic I have been placed in this week.

Along with my friend Delia who is fluent in Spanish I have been assigned to shadow in a clinic called CEMOPLAF which is partnered with Planned Parenthood. The clinic is semi private which means you do have to pay to see the doctor however the rate is fairly cheap (it is $22 for a complete annual exam for a woman including labs). The physician I am shadowing in an OB-gyn who is a fire pistol. She is a very put together woman who looks around 40 but is a grandmother. She wears awesome tweed suits.

My first day of clinic she sent us to a conference hosted by Planned Parenthood that was about maternal mortality and care for patients with complications from illegal abortions. Apparently talks about abortions just seem to find me. It was so interesting to hear from all of the doctors how strongly they felt that abortion was medically necessary and how it should be legalized. We did´t get to stay for the whole conference, we really only saw a presentation on proper care for women and a powerpoint on human rights but even that was inspiring.

I was really hoping to see some crazy stuff in the OBgyn clinic but it seems like they have very similar problems to what we deal with in the US: family planning, pap smears, irregular periods and STIs (even though I haven´t actually seen any of those yet!)

I am learning lots though being in the clinic defintiely makes me wish my Spanish was better... but I´m working on it! Miss you all!

Health brigades

Over the past two weeks, we have spent four mornings doing mobile clinic work in the mountain villages outside Otavalo and in the markets of south Quito, which is generally poorer than north Quito where we are staying. In groups of two or three students, we interview patients, perform a relevant physical exam (as much as possible without violating their privacy in a large room with no divisions between patients), and conduct screenings for blood pressure, blood sugar, etc. Then, working with a volunteer doctor or nurse, we help develop an assessment and plan for the patient, which sometimes includes prescribing medication; some medications (such as amoxicillin, Bactrim, and ibuprofen) we have available in our traveling pharmacy, while others must be purchased at the pharmacy by the patient. The pictures are of our student teams from various brigades, demonstrating the crowded quarters and tiny chairs! There are, of course, more photos on Amy´s Flick´r site.

We have seen some fairly complex health problems at the health brigades: congestive heart failure, kidney infections, intestinal parasites, and a superficial tumor six inches in diameter! However, we have all been generally frustrated by our inability to do much for these types of problems. We can cure an ear infection or give someone reading glasses, but have relatively no ability to ameliorate chronic health concerns, and end up referring patients to doctors they will never see at facilities they are unable to travel to. Even with Ecuador´s recent decision to make health care more accessible – including many free procedures and services – the waiting lines are long, and not all of the service is free. For example, a hip replacement operation is free, but according to one patient the prosthetic hip itself costs $5000, which even well off folks in Quito generally cannot afford.

On the other hand, the health brigades have provided an opportunity for us to work with two organizations committed to improving the health of economically marginalized Ecuadorians. Jambi Huasi in Otavalo (where I received my “cleansing” treatment last week) is a collaboration between MD’s and traditional healers, and focuses on reaching out to indigenous populations who are often more comfortable seeking care from curanderos and shamans than from medical doctors. Two doctors, an administrative assistant, and a translator from Jambi Huasi accompanied us on our health brigades outside Otavalo. In Quito, an organization called CENIT (Centro de la Nina Trabajadora), which began as a school for girls selling goods with their families in the outdoor markets, now provides a range of services for working girls, boys, and their families, including remedial schooling, vocational training, health services, family planning and contraception, outreach to street children, and psychological assessment and counseling. Most of their staff is Ecuadorian, but they also command a small army of rotating international volunteers to aid in administration, planning, and service implementation. The people who work with Jambi Huasi and CENIT are an inspiration to me, as they continue to work toward empowerment and health for those most at risk.

So the health brigades have been a mixed experience, full of frustration, helplessness, insight, and hope. Next week we will conduct three more brigades in the rainforest of the Amazon. I think we´ll all try to keep reflecting and learning and know that we are taking away many lessons that will influence and inform my work in the future. The sense of overwhelming need seems to be ubiquitous in global health, and I guess part of the challenge is figuring out in which ways each of us will contribute to the struggle. I feel so lucky to have a group of friends to share these experiences with, each of whom is also engaged in such good work!

Con amor,
Jess (& Amy :-)

fromage!

Mostly my weekend was calm, but we did search for and find cheese! Usually, people here tell me they are getting "cheese" and they mean tofu. They call it cheese from the bean. But, there is actually cheese made here too, from cow milk. It is expensive-1 dollar for a round of it:) (the tofu cheese in this amount would cost about 30 cents). We bought some, and ate it, and it was so good! To get it, we had to drive about 30 minutes north (on a motorcycle, with my fancy new helmet), and find it on the side of the road. This isnt like everywhere else-where people sell things all along the side of the road. It was a fairly deserted road because you had to drive by the presidents house to get there and the guards only let certain people through (I think they let us through b/c they knew we wanted the cheese). I took a picture to show you all how deserted it is. And then there are these women and children just sitting there on this almost empty road, with cheese! Such a wonderful sight.

wow

you guys are doing sweet stuff! i love this blog. i thought i was done posting anything out of the ordinary, but the sweat lodge and the cool traveling kayaking snorkeling inspired me to post more.

three things to share:
1. i eat meat. i ate dog this weekend (one bite, with tears in my eyes, and i will never do it again, but i had to do it for the experience). then i was brave and ordered cordon bleu in a restaurant. ate some of the cheese out of it, saw it was still raw, sent it back, ordered a pizza, and still had to pay for the cordon bleu. i am still alive, even though it was raw pork. that was over 24 hours ago, so i think i will survive.

2. i just got really positive feedback on the work ive done this summer and i no longer feel like i am living in a beautiful place and being useless. this is great. living somewhere beautiful and doing something.

3. i sent this in an email to someone, and b/c you all are sharing these sorts of things, i am sharing it with you too:

This is how my weekend went. Its hard to explain, but worth trying. So, in the mountains, Kabiye have initiation ceremonies every year. Every 5th year, they have a special one called waaya (pronounced wa). It was this weekend. Saturday night, I went up to Kuwde, the village we visit in up there. It was CRAZY. The village has 65 households, so imagine a town spread around a ridge, of 700 or so people. For the ceremony, there were thousands of people in town. And, the homestead we stay in is a very important house, so many of the iniates were in and out all weekend. They come with gongs, horns, singing, etc. 24/7. beer 24/7. There are between 100 and 200 initiates, males around the age of 25. And all of their siblings and parents, fanning them, chasing them around, and just lots of craziness. And that’s only the beginning!

Saturday night, they dance in one of two sacred forests-one for the female clan and one for the male clan (all initiates for waaya are male, but they are assigned to a gendered clan) and we eat locust beans in oil. (think, middle of the night, woods on a mountain, dancing, loud music and singing, and a really cute child that had the most adorable laugh in the world and was really easy to make laugh. Her name was elizabeth. Everything I said made her laugh). I wore flip flops, hiking up and down this incredibly rocky mountainside, in the dark and I didn’t fall once. And it was cool because there is no electricity, but there are flashlights and gas lanterns so you could see lines of people moving up and down the mountainside in the distance by looking at the bobbing lights. We sleep in a house/hut in the homestead and people literally are banging iron gongs in the courtyard (about 10 feet away from my head) off and on all night long. By 6 in the morning, the homestead is surrounded by people, such that I can’t spit my toothpaste out the window because it will land on someone. And, I have great pictures of this, about 40 or so of the initiates’ horns were in the granary in our homestead. They are so cool! Covered in chicken feathers, ornaments, and plastic dolls. Some with santa claus. So they all come in, get them, and head out to have them tied on, dance all day, go up and down hills (it was really intense hiking, the initiates actually all wore shoes but most of the people wear flip flops) and then end the morning with a ‘race’ down a steep rock covered uncultivated side of a ridge. Except, the race was a little anticlimactic because only some of them actually raced! The rest chickened out and came down the way we did. Didn’t even go slowly down the steep way. Then they head to various homesteads and continue dancing, which they will do all week.

We, on the other hand, headed down the mountain, took a ride back to the city, and went to a 4th of July party. It was full of people in red, white, and blue, us in our sweaty hiking clothes, children with painted faces, a trampoline, hotdogs, corndogs, veggies, dessert, sparklers, and DEVILLED EGGS. Devilled eggs are one of my favorite holiday comfort foods ever. For every holiday. It was pretty wonderful.

Super Long Post Part 2

Jess- No, I definitely did not have dengue. People in the office and clinic are kind of overprotective and don’t want anything bad to happen to us while we are here.
I had some cold and just took it easy at home for a few days. By the end of the week, I was all ready for my next adventure.
Wednesday (6/30) was a holiday in Guatemala (Military Day), so Lindsey, Jana (another gringa in the office) and I decided to take a long weekend. On Friday (6/25) we took an overnight bus from Guatemala City to Flores, which is about 9 hrs northeast of here. The crazy driving made me feel like I was on a night bus from Harry Potter (maybe also because I was riding a bus at night….). Despite my fears that we were going to die- either from the driving or from people with guns taking over the bus, we made it! We got to Flores, dropped our stuff at our hostel (Hostel Casablanca) and headed to the great ruins at Tikal. Tikal was AMAZING! There were neat “templos” to explore, and we even saw monkeys. They have been doing a lot of work on uncovering the ruins there, and I got to talk to a guide who had been working there for the past 25 years. It was really humid in Tikal, but not too hot. When we got back to Flores that afternoon, the rain started. It rained A LOT. Apparently there was a tropical storm (hurricane?) in the area which we read about in the paper the following day. On Sunday, we headed out to Rio Dulce town (about a 4 hour bus ride). We were met at the docks by the owner of the hostel we were going to stay in, and took an hour boat ride to the hostel in the jungle. The hostel, Finca Tatin, is located on Rio Tatin, a small branch off Rio Dulce- a big river which runs from inland Guatemala through the jungle to the coast.
My favorite part about my trip to Rio Dulce/ Rio Tatin was our kayaking trip. We decided kayak from our hostel to Livingston (about 2.5hrs)- a Guatemalan town on the Caribbean Coast. It was soooo cool. For the most part, the water was calm, and we got to kayak through this beautiful gorge. Anyone want to go kayaking when we get home?
After the heat in the jungle, I was really looking forward to some air conditioning. I was also looking forward to staying somewhere where babies and birds did not freely use the bathroom on the floor and where I wasn’t followed by really stinky dogs. Also, since I didn’t have a flashlight with me, some electricity after 10 PM would be a plus. Getting back to the mainland however did not quite meet my expectations. We stayed in the dorm room from hell. Not only did we not have air conditioning or even a fan, we couldn’t keep one of the windows open because the bugs would get in, we didn’t really have power, and our room was guarded by some big crazy bird that wanted to get into the room. The bird sat in the sink by our door and would flap like crazy when you walked by. Did I mention that I really REALLY don’t like birds? Oh, the other thing about our hostel was the restaurant was overrun with really old, really drunk Americans who lived on boats. Very weird.
Oh well, we survived, and the next day, we took a super nice bus home (complete with AC!). Unfortunately though, when we got home a) I was locked out of my room and b) we were out of gas (which we use for cooking/ hot water/ etc). We also found lots of “anger turds” left by our roommate’s dog Lucy. At least she was happy to see us. I had a pretty uneventful week/weekend to follow my long weekend trip.
Lindsey decided to head to Antigua, but I wanted to stay in town and explore the city. I went to see two really neat museums: Museo Popol Vuh (archeology) and Museo Ixchel (Mayan textiles). I was really impressed with the styles of painting and sculpting. The hieroglyphics were rectangular and had a lot of faces. All the incense burners, jars, plates, etc seemed to have multiple layers of imagery. The textile museum talked about different weaving and embroidery techniques and displayed a lot of the different “huipiles” and “su’ts” that are traditional clothing. The color schemes and designs vary greatly depending on where you go, so it was pretty cool.
On Sunday, we headed to a 4th of July party hosted by a co-worker and I took Julia’s wonderful key lime pie. Though my pie was not nearly as good as hers and it suffered from adverse cooking/ ingredient conditions, the pie was a success! There was a (stork) piñata at the party which was a lot of fun. Seeing as how people set off fireworks all the time, I was surprised that we couldn’t find any. Rumor has it that people have been buying them for the World Cup Finals.
Tomorrow is my last official day of work (I have a feeling I will be finishing some stuff via email). I’m not sure how this month is already over. It’s been a pretty interesting and incredibly busy week. I got to shadow more in the clinic (clinic post coming soon), hear the director of the CDC talk, and tomorrow, Lindsey and I (mainly Lindsey) are giving a talk to the Ministry of Health about how to improve patient flow, data collection, etc.
Also, tomorrow, Lindsey, Ibardo (her bf) and I are packing up our stuff and heading to Honduras with a co-worker. We are going to go the Bay Islands to go snorkeling, and then we are taking a bus to Panama (which should take about 4 days). We will be stopping in Managua, Nicaragua and San Jose, Costa Rica along the way. We’ll get a couple days in Panama, and then on July 19- I fly home and Lindsey and Ibardo fly to Columbia. I would love to hear how everyone else is doing, and I definitely want to see everyone who is home when I get back! Miss you guys!
<3 e

Temascal

Emily, that was a super long post! Thanks for the update - but are you doing okay now? Please tell us you don´t have dengue...

Here is an update on Amy & my activities that I just sent to my family, along with a picture of the group after the sweat lodge ceremony:

Last night we participated in my favorite experience yet: a sweat lodge, or ¨Temascal¨ in Kechwa, the indigenous language in this region. The lodge is a small hut, a circle with a diameter of ten feet and about four feet tall. Thirty-two people in bathing suits and shorts squished into the hut, sitting on woven mats and dirt, around a pit in the middle. A tall, slender woman explained the ritual of the Temascal to us while volcanic rocks, heated in a fire for hours ahead of time, were piled into a dirt pit in the center of the lodge. The ceremony began with the passing of tobacco juice, which we snorted into our nostrils, inducing a slightly dizzy and intoxicated feeling. Then the door of the hut was closed and the only light was the glowing of the rocks. Our guide poured water and herbs into the pit, and the sweating commenced.

At first, many of the participants seemed hesitant or uncomfortable, and the guide had difficulty quieting the group as people cracked jokes or complained about the lack of leg room. I felt frustration rising in me about what I perceived to be irreverence for this spiritual space and ceremony, but also realized that we were all a bit nervous about what was to come and had different ways of dealing with it.

However, once the door was closed and we were plunged into darkness, all side conversations ceased immediately. Our guide led us in prayer and song as the temperature and humidity in the room rose, and it became impossible to think about anything besides the sensations of the Temascal. We sang traditional Andean melodies, popular Western songs like “Let It Be” and Leonard Cohen’s “Hallelujah,” and Sanskrit chants from yoga class – “Om Shanti, Guru Dei Namo.” The ritual continued through four rounds of tobacco, newly heated rocks, steam, and relief as the door was opened in between rounds and cool air allowed to flow in. In each round we gave homage to and benefited from the energy of one of the four elements: air, water, fire, and earth. The first three rounds became increasingly intense, as more stones were added to the pit; seven for the first round, nine more in the second, then thirteen for the round of fire – the round of transformation. When the guide poured water over the thirteen volcanic rocks, the temperature of the air in the room surpassed anything any of us had ever experienced. As she played the drum, she invited us to express whatever we were feeling out loud, and the tiny hut became filled with the primal yells of the normally inhibited and controlled medical students. I laughed out loud as the people on either side of me yipped and wahooed with abandon. It was exhilarating.

After the round of fire, we drank cool water and rested before one last round of seven rocks, nearly as intense as the round before, but at that point we knew we could handle anything. The whole ceremony lasted just under two hours; then the door was opened from the final round and I crawled out of the lodge to a cold, invigorating shower. Rinsed of dirt and sweat, and wrapped in soft, warm clothes, I returned to the fire where our rocks had been heated earlier that afternoon. Sipping on tea, we marveled at the experience while the owners of the lodge prepared a unique meal for us. Pachu Manka is an ancient Incan tradition of cooking food underground, buried in a pit with heated volcanic rocks. We watched the uncovering of the food, then piled our plates high with beans, corn, peas, chicken, pineapple, banana, carrots, beets, and several kinds of potatoes (salty, bitter, and sweet). Eating with my hands by the fire that had warmed both my body and my food, I felt deeply content and peaceful. After dinner, I drank a large quantity of water, slid under the wool blankets in my hostel bed, and fell quickly and happily to sleep.