My 4 months of travels have come to an end, and I´m in Quito now, trying to kill time and anxiously awaiting my flight home (I get back to MPLS Friday night, April 29th). This has been an amazing time for me.. and if you´ve been following my blog you know that I´ve had some monster adventures, some harrowing experiences, and a lot of fun and laughter --and challenges-- in between. But beyond the fun (and there has been a LOT of that), it`s also been a time for self-reflection and personal growth... a time when I could finally get my feet wet doing international medicine and learn about international public health -- something that in the past has only been ideas and hypothetical scenarios in my mind, rarely shared with anyone and certainly without much of a context to bring together the intertwined strings of ideas. This was a ´´make it or break it´´ sort of experience... a testing ground for my future. Can I handle the life abroad? Can I be comfortable living every single day in Spanish? Can I teach myself to think outside the box and focus more on innovation and creativity in the midst of limited resources and intermittent ´´essentials´´ such as internet access or phone service?? Can I go back to the basics and think about nutrition instead of MRIs, antibiotics instead of valve replacements for advanced rheumatic heart disease? Can I remain motivated by, and not overwhelmed or become depressed, by the poverty and injustice that I see? Can I adjust to the frustrations of sometimes crappy (ha!) food, long lines, inconvenient public transportation, and --when I think about a future career-- an unmotivated and apathetic government who so easily robs from the poor and gives to the wealthy? Perhaps, most importantly, what does my gut say --- is this something that feels right... is this where I can be happy? Is this my future?
Well.. to be completely honest.. I think it is!!!! Of course more training awaits and the details have yet to be dreamed, let alone wrinkled out... but it does feel right. For the experience I feel totally blessed because it certainly has changed my life. I realize how crazy spending my last 4 months of medical school abroad really is, and I know that I´ve been incredibly lucky to have the opportunity to basically construct my dream adventure while remaining supported by friends and family, and staying safe. That´s something I don´t take for granted, but I do know that this trip was worth the risk!!!!
My final couple of weeks in Ecuador in the town of Pedro Vicente Maldonado were, for lack of better words, totally awesome -- I felt so welcomed in the community and was very comfortable in the hospital and I know that the residents trusted me and at times even sought me out to ask what I think or what we do in the US during a certain situation... and that made me feel happy. :)
In my last blog I talked a lot about different cases we had that have impacted me in one way or another, so I won`t spend too much time talking about more... but there have been some interesting ones that those of you in medicine might enjoy. We had one 7 month old boy who was brought in by his mother. He was TOTALLY covered in really nasty looking bug bites --likely scabies-- and mom says that she´s seen worms coming out of his anus... we took a look and HELLO! Squiggly worms everywhere!!! Pretty nasty. And in a 7 month old... :( Parasites are real here (and in Peru).. tons of people with diarrhea and weight loss and you test their poop and sure enough they´re infected by 6 different kinds of parasites. Not too bad of a treatment -- just pills for a few days -- but they do have a tremendous impact on the patients and their families who are also likely infected. One of my favorite things to do while I was working in clinic was to ask the patients where they came from. A common response was a sigh, a hand wave signaling some far off distant land and then the words..´´pssh! a DENTRRRRRO!!!!´´ ... meaning they live in the boonies. You ask for more details and they say, for example, ´´a five hour walk down the gravel road because buses only pass by one time a week´´ or ´´follow the river and turn left after about an hour when you get past the palmitos´´ or ´´you take this bus then this bus and then this bus and then walk for like an hour´´. It´s pretty crazy. So I guess it makes sense when they come in with tons of parasites because they don´t have the resources and have to drink the river water, bathe in it, and wash their clothes in it. Which also reminds me of something else.... the hospital has hired a microbiologist to do some research about the local area, including extensive testing of the river water. The hospital has seen a dramatic increase in cases of salmonella and antibiotic resistance... the microbiologist tells me that it´s because there are some local pig and chicken farms that are totally polluting the environment and dumping into the rivers that the people depend on. The hospital is trying to build a substantial case so they can do something about it (yes!! public health!!).. but it´s taking time and in the meantime people are suffering because of it. I think that´s pretty interesting.
Que más? Ohhh we had one 3 year old boy that just broke my heart. He came in with both parents and 3 siblings (both younger and older)... they were in for parasite testing (required by schools here and need a signed doctor´s form). We took care of the 4 kids and then as the family was packing up getting ready to go the mom mentions that this 3 year old, Pablo, doesn´t really speak. His only words are mama, papa, and muchacha, but otherwise he interacts with kids, plays soccer, runs around, smiles... just doesnt really talk. Mom thinks he understands and can hear without problem, but they`ve never had him tested. Otherwise he´s a totally totally normal kid (and super super cute). His two younger siblings speak great. After talking to the family for awhile and attempting to talk to Pablo it became pretty clear that he doesn´t hear very well at all, maybe can hear something but not too much... there´s no screening tests here for infants (except in Quito), and this was the kid´s first time ever to the doctor because he was born at home... so basically he just fell through the cracks. And the family has no insurance and no money so unfortunately have very few options (and have missed a substantial part of the learning window for language and speech). SO sad, but the hospital is going to try to work with the family to see if they can come up with some sort of plan, and soon. One afternoon while I was working in the ER, two 8 year old boys were brought in... they had been riding on the same bike and crashed because the brakes went out. One had a major deep gash on his chin (that I later got to sew up!) and was freaking out but was otherwise fine... the other had no visible wounds but had a serious head injury as he kept repeating ´´where am I, what happened´´ despite telling him over and over again... plus he was in and out of consciousness... it was really bad. There´s no CT at the hospital and we wanted to send him somewhere to have one, but when the mom finally arrived she refused saying he wasn´t insured and absolutely could not afford the $20 ambulance fee plus $150 CT cost.. if they paid so he could have the CT (which may or may not affect his outcome..), the rest of the family (5 other kids plus parents and grandparents) wouldn´t be able to eat for weeks... What do you do....??? I also saw a 50 something year old woman in clinic who, after having 9 children at home throughout her life, was at her first doctor´s visit EVER. She had pelvic pain. On exam I felt a huge mass on her ovary and we referred her to the gynecologist who was coming to the hospital the following weekend... but how do you break such horrible news to such a stoic woman?
Tough cases, but I´ve learned a lot and we have had a lot of successes as well. I think I mentioned in my last blog that Andean Health and Development (AHD), the NGO that started this hospital in Pedro Vicente, has just started building a new hospital in a larger town two hours away called Santo Domingo. Dr. David Gaus, the founder of AHD and a Notre Dame grad (that´s how I got involved in the first place 5 years ago with this organization) was just recently in Minneapolis at the Notre Dame club trying to raise some money. Some people at the ND club knew of my connection to AHD and asked me to make a video talking about my experience with the NGO. I put one together one afternoon and posted it on youtube so they could use it for the fundraiser. If you´re interested it´s at http://www.youtube.com/watch?
Life for me, of course, is not all about work. For Easter weekend I was lucky to be able to meet up with a good friend of mine that I had met 5 years ago and kept in touch with through the years... and we headed to his hometown in western Ecuador and spent 3 days at the beach!! whooo!!! The sun here is HOTTT and I got a little fried my first day but then got smart and stayed in the shade and instead enjoyed the delicious cerveza that was unbelievably cheap and made occasional trips to the water to play in the waves. Awesome weekend, and the beaches in Ecuador are highly recommended!!!!!
I´m sitting here at this internet cafe in Quito and salivating as I think about eating Mexican food as soon as I get home.. yumyum. And seeing my cat. I was just thinking about my weekend at the beach... I ate either ceviche, encebollado (delicious fish soup), or shrimp for 10 straight meals. That just makes me happy.
These 4 months have been amazing... I feel like I`m a changed woman, but invigorated and totally happy. This has been a different sort of life -- a different pace and a different culture and I´ve been forced to slow down, step back, observe, and just simply enjoy the moments. What a blessing. Traveling by myself during this time has been quite interesting... I´ve gained more independence and confidence and along the way have met truly amazing and inspiring people... but I also really realize the importance of family and friends -- and think it´s always more fun to be with someone sharing the experience!! (any takers for next trip!!?!?!?!) Every experience I´ve had and every person I´ve met I think has happened for a reason and I take a little piece of each of it with me... I think back to all the random people in Honduras that warmly opened their doors to me and shared their life. Or the little kid who sat down with Harry and I as we ate lunch from a restaurant balcony overlooking Lago Atitlan in Guatemala and told us how he was shining shoes all day to earn money to bring food to his family and also buy his aunt a wedding present. Or the physician in the public clinic in Cusco who told me of his experiences working in the rural mountains of Peru and planted seeds in my mind about potential public health projects in childhood nutrition and preventative health care in those areas. Or Dr. Gaus from Ecuador and all that he has accomplished -- what a role model.
I´ll leave you with a quote I found awhile ago when I was reading some work by Che Guevara (everyone in Latin America loves him.. why can´t I too??) that I think fits what I`m feeling right now...
"What do we leave behind when we cross each frontier? Each moment seems split in two; melancholy for what was left behind and the excitement of entering a new land."
I´m coming home! And more adventures await...
See you soon,
Tarita!!!!!!!!!
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