First day in the hospital

5-30-08 – Esmeraldas, Ecuador

It’s now lunch on my first real day of work at the hospital – I’m home for the Netherlands girls’ big send-off feast. Technically I’ve got .5 days under my belt, but the five hours feel like five years. This morning started with the neo-natal floor. The director turned out to be much more receptive than when we first met – we worked together for an hour, rounding on babies, discussing different illnesses and the effects of “anti-cuerpos” (antibodies). The latter became important when we got to a newborn whose mother tested HIV+. With that diagnosis she shouldn’t be breast-feeding, but if she’s not breast-feeding, the kid won’t get his mom’s IgA - without which he’s at a greater risk to become ill. At the moment he’s on prophylactic anti-retrovirals for the potential HIV and antibiotics as a precautionary step following the Caesarian section. I intended to keep track of these drug names but someone on the bus stole my pen – and the hospital doesn’t have any extras so I’m without the notes.

After an hour he turned me over to the emergency room. Half-hour later I was seeing patients. Half-hour after that I was giving injections. This afternoon I’m told I’ll be learning to suture.

Some time mid-morning an old man came in with respiratory distress. He was poor and ill – so emaciated that his clothes were falling off. The skull beneath his face seemed only a prop to keep his skin from losing shape. A discrepancy arose over his pulse – some thought his heart was beating 64 times a minute, others up in the 80’s. The problem was that the arteries in his wrists were too weak to be palpated for more than five or six seconds at a time. When asked to weigh in I went right to the source – foregoing the wrists and putting my stethoscope directly over the patient’s heart. We are taught in medical school to maintain the seal between the stethoscope’s diaphragm and the patient’s skin – but I never learned anything about how to deal with emaciated patients whose chests suck in on themselves between the ribs. So I did the best I could, putting the stethoscope down as a bridge between two ribs and counted the sounds coming through his bones. In spite of government-subsidized free treatment, he later asked to go home and die. I think his family talked him out of it, but I’m not sure because I then left the room for the next patient.

The rest of the day went a little something like this:

33 year-old man with sudden onset of wobbly stance, slurred babbling incomprehensible speech, light-sensitivity (feels pain when he opens his eyes in a room with the lights on). Assessment: intoxication due to drug overdose.

63 year-old diabetic woman whose low blood sugar dropped her into unconsciousness. Veins no good. Started IV dextrose on her finger, given hard and fast to raise her blood glucose.

7 yo boy presenting with machete laceration to the knee whose parents waited 22 hours to see if it would get better on its own. They did not notice that the knife went through his muscles.
(At this point the Emergency Room ran out of running water)

26 yom with dangling flesh from ankle secondary to bicycle accident.

7 yom who fell from a playground, presenting with what appears to be a wrist in the middle of his forearm. Treatment: pull the arm back in place. Lots of crying. An injection of lidocaine was given as a local analgesic, but it seemed to make little difference.

9 yom with a snake bite

23 yom friend of a friend from high school (small world) with puncture wound to shin from walking along the street and falling in a hole.

-BH-

Bus to the coast

5-29-08 – Esmeraldas, Ecuador
Well I’m not in Quito anymore, Toto. No, in fact I’m far from the bubble of security provided by Yanapuma’s Spanish classroom – and the craziness started the moment I walked out the door. Late last night I flagged a taxi to the bus station, and valiantly parted my way through the sea of prostitutes who were also trying to bosom their way in. One grabbed my hand and tried putting it somewhere it shouldn’t be, but my arm jerked back only to discover another on the other side. It was a strange sensation - like going through a car wash and having those big brushes drop down from all sides.

Other than a 1AM showing of “The Animal,” the trip itself was uneventful – seven hours and pretty smooth. Esmeraldas is going to be a different place – this much was evident the moment that old bus pulled into town. For one, it is much hotter, much poorer and much more run-down. Here on the coast the blacks out-number the mixed-race mestizos, the Quichua-speaking indigenous people don’t exist, and there aren’t any whites. Although not as dirty, the streets feel like those in Congo, with big guns in the hands of police that you hope are upstanding. Even with oozies on the corners, I still get the eebie-jeebies taking money out of these ATM’s after having scuffled mid-day with a thief last year in Dar es Salaam.

This morning Maria from Yanapuma presented me to the director of the hospital, who seemed a little confused about who I was and why I was there. I’ve been told, though, that non-communication is the Ecuadorian norm, so it should be okay. The hospital itself is… interesting. In line with every stereotypical third world health care facility, its hallways are packed with patients waiting to be seen. But the new twists for me were the gates within gates within those hallways, all guarded by guys with big muscles and small shirts. Tomorrow morning I say hi to those guys, squirm my way through their gates and look for Pediatrics where I’ll be working with the director who is wondering why I am here. This realization brought on the OSP (the oh shit phase) for a couple hours this afternoon when I was restlessly walking up and down the street trying to familiarize myself with the city – but a well-placed internet café and a quick pep talk from some of you all brought me out of that.

The houses look like tornados ripped their faces off – it will be interesting to see how that manifests itself through disease-presentations over the next month. Like I said, there is a lot of poverty here – even the kids have empty in their stomachs. The hostel I’m staying in, however, is quite the fancy-pants place to be – wooden floors and hot running water. In fact, the room I’m in even has an air-conditioner and 3-pronged outlets (as opposed to the older, non-grounded two-pronged outlets most everywhere else). I’m paying out the nose, but people say it’s the closest safe location to the hospital, and I’m okay with safe. I’m also okay with balconies that overlook the Pacific Ocean, and five-minute walks to beaches where little kids run around in their underwear playing soccer.

Fortunately for me there are three other foreigners from The Netherlands who are also working in the hospital. They’ve been great today in giving me a few pointers here and there. Unfortunately they’re going back to The Netherlands tomorrow. I just got back from dinner with them. Because one doesn’t speak Spanish so well, they asked if we could all agree to speak in English for the evening, then they spoke in Dutch the rest of the night.

Oh, by the way, last week I went to a semi-final South American Cup match in Quito. Ecuadorians are fanatic about soccer – so much so that there are barbed wire fences… inside the stadium. Alright, that’s about all I got. Later.

Send me things

If anyone is interested in sending me letters in the mail, please use the following address:

Ben Huntley
Fundacion Yanapuma
E8-125 Veintimilla y 6 de Diciembre
Quito - Ecuador
Telf: 2546709

I'll be back in Quito to pick up mail during the first week of July, then again during the first week of August. It is possible someone will be able to shuttle me letters to the coast in between then, but I'm not quite sure how that would work.

On an unrelated note - today I found a BP cuff for 10 bucks... and learned the hospital in Esmeraldas doesn't have latex gloves. Hopefully I can find some somewhere.

BH

Up in the mountains

With just a week under my belt, already I can feel a difference in my ability to communicate in spanish. Whereas in the beginning conversations were more or less: "Que tal?" "Nada mucho - como estas?" "Estoy bien, y tu?", now I´m getting into much crazier business - like last night at the dinner table when my host mother was talking about liposuction, plastic surgery and boob jobs in the Americas.

Over the weekend I took a few buses to a small town, then backpacked at altitude through the Andes. We were a small group - half Ecuadorians, half students... with an Indigenous guide kwho was about the sweetest, most well-oiled machine on Earth. The dude literally made stepping stones out of the Earth, and then at another point launched around rocks the size of my torso.

The first day we climbed 1000 meters in elevation. My mind was a little week at that point... and it was at about 4200 m above sea level (mutiply by 3 to get that in feet... then laugh at Denver for thinking it´s high up on a mountain somewhere) that I realized I forgot a bag of Haribo gummy bears next to my bed back in the states. It was pretty traumatizing, but eventually I got over it.

Anyway - tomorrow I´m off to the coast, to a city in the northwest called Esmeraldas. I´ve heard the hospital is crazy and the city dangerous. It makes me feel a little nervous, and I woke up in the middle of the night thinking about it... but it will be a good experience. A challenge, of course, but I´ll try to keep my wits about me.

Welp, that´s about all I got. Continued best wishes rocking out to whatever you all up to.

Benjamin John Fullerton Huntley

ps. Yesterday I found a French bakery in the heart of Quito... boo yeah!

First email home

Hey Family-

I finally made it to Quito last night. The flights were not too bad. Dan Rather from CBS was on my last flight from Miami to Quito. Toward the end of the flight the attendants asked for a doctor - nobody volunteered, so after a short while I went back to see what was up... but they needed someone with a medical license, so I went back to my seat. When we landed, everyone remained seated so the paramedics could board the plane and attend to the patient. It was a stressful way to begin the trip - especially since it was already dark out and I wasn´t exactly sure who was picking me up, where I´d be sleeping, etc. But it all went without a hitch - I got to my host mother´s house in good shape, and the driver who took me there was friendly. My host mother cooked some food last night - we talked a little about topics beyond what I thought I was capable of commenting on (for instance, the relative strength of the dollar in the global economy... how in the world should that have been my first conversation?). This morning she rode the city bus with me to school - but I´m on my own for getting back. Thus far I really like the school - the teachers are friendly, as are the others who work here. Already I´ve made plans for the weeked for a two or three day hike up in the mountains.

Quito feels like a dangerous place and I wish I had not brought the camera with me. Hopefully, though, with good luck and God´s grace I´ll make it through these months without event. Anyway... I just wanted to write in and say I´m here safe and sound. Last night when I went to bed in a strange room in a strange city with strange noises, I wrapped myself tightly in the covers (mostly because it is freezing in the mountains) and thought of what of what you all were up to. I´m so happy for all of you and all the directions you are going. Congratulations, Lizz, on graduating from Midd in just a few days.

This afternoon I´m going to try to get a SIM card for my phone - will let you know when I have that number for you to call.

Until later...
Love,
Ben

Objectives

This post is going to be a little long, mostly because I´m pasting a proposal I wrote for a travel scholarship. In it are a few details about what I´m up to and just exactly why I´m in Ecuador as opposed to back home or somewhere else in the world. Read it, skim it, skip it... just thought I´d post it for anyone who´s interested. -BH

···

B. F. Fellowship Proposal

Proposed site: Esmeraldas, Ecuador

Applicant name: Benjamin Huntley, M1

Background [1, 2, 4, 5]

Esmeraldas is a city caught between two worlds, minutes from peaceful rain forest that starkly contrast the grunge of impoverished urban living. It was initially built on sugar plantations and mines, made possible through the importation of slaves, who have since merged cultures with native Ecuadorians to create a vibrant new environment. As capital of its own province, located in the Northwest corner of Ecuador, this busy port town of 126,000 knows few tourist dollars, but no shortage of indigenous poverty. Although locals make a living on agriculture and lumbering, the lack of wide-scale industrial development translates to economic restriction. Moving in from the shore, down dilapidated streets to the part of town that does not make the guidebooks, is a busy but under-resourced hospital that serves the community. According to NGO reports, it is not uncommon here for needles to be reused, nor for physicians to send patient families to find medical supplies needed for basic procedures. With guidance from the Yanapuma Foundation (http://www.yanapuma.org/), this environment, along with its hardworking staff, will extend my medical education through the summer.

Health Profile [3]

Perhaps in large part due to Ecuador’s economic turnaround in the mid 1990’s, its national health profile has a number of encouraging statistics, such as an average female life expectancy of over 70 years. There have been significant health advances in recent years, like a 50% reduction in mortality due to intestinal infectious diseases; however still over 27/100,000 Ecuadorians die yearly from pneumonia and about an equal number strokes. Paralleling those numbers, the Pan-American Health Organization painfully reports that, “In Ecuador, 13.2% of the population suffers from some form of disability. Given the link between disability and poor living conditions, low income, and difficult access to health services, the incidence of disabilities is greater in marginal urban areas and in rural areas”. The same authors go on to report that between 60-70% of black children in Esmeraldas are malnourished. This is where I have arranged to spend my summer months.

Rationale

The purposes of this trip are two-fold: to improve Spanish proficiency and to gain an understanding for the realities of health care in less-privileged environments. From the language standpoint, being confident in Spanish will prove useful both immediately in the Free Medical Clinic where I volunteer, and latently in the hospital, during clinical rotations in years to come. I strongly believe that investing in language skills up front will lead to better health care for future Spanish-speaking patients. From the standpoint of global awareness, understanding differences and discrepancies in health care now will challenge me to better understand the meaning of being a socially responsible physician through the remainder of my training and the career beyond.

Goals

Goal 1: Analyze illnesses common to the local community, especially malnutrition and malaria (both of which are present at high rates in Esmeralda)

1.1 Recognize common disease presentations

1.2 Use training in physical exam skills, history taking and knowledge of the disease process, coupled with self-assigned learning issues for unfamiliar illnesses, to contribute to the health of the community

1.3 Learn and practice common procedures such as suturing and pelvic examinations

Goal 2: Improve Spanish and contribute to patient education

2.1 If appropriate to my language abilities, by summer’s end I should be engaging in conversation with patients, counseling them about lifestyle modifications for healthier living. The means to this goal incorporate language development strategies through daily interactions that I will rely on to meet the overarching goal of Spanish proficiency.

Goal 3: Gain appreciation for social and cultural customs environment and their impact on health

3.1 Learn what Ecuadorians in Esmeralda believe about Western and Traditional medicine through conversations with patients, coworkers and friends.

3.2 Attend cultural and religious events to better understand forces that influence daily choices, which ultimately bear on health.

Evaluation

• Spreadsheet of common medical problems and how they are treated, along with a list of procedures performed and observed
• Journal of cultural and social experiences either via a written journal or a web log, pending internet availability
• Feedback from supervisor on performance during internship

Preparation for internship

An undergraduate degree in Biomedical Engineering coupled with training as an Emergency Medical Technician were, for me, the foundation of a powerful year spent in East Africa, just before starting medical school. I spent a few months with warriors and nomads in Kenya, and then moved to Kigali, the capital of Rwanda, to teach well-dressed university students the Physics of Medical Imaging. Between the two placements there is neither a shortage of stories nor of lessons, and as a result I know more about linking educational abundance from the US with educational scarcity abroad. I’m optimistic that a background in teaching and traveling, along with a good start in medical training, will lead to a beneficial summer for all parties. Toward that goal, I have already researched common morbidity and mortality causes in Esmeraldas, which gives me a sense of the diseases that will be encountered.

I also come into this summer with previously acquired language abilities. Throughout high school and into college, Spanish was the primary language I studied. Spending time in Spain and Mexico helped solidify my speaking, reading and writing proficiencies. Although I used to be quite adept, much of that slid when I learned Swahili last year. However, I have a sharp ear for language and look forward to re-strengthening my abilities as I immerse in Spanish again.

In closing, thank you for taking your time to consider my application and the applications of my peers. I am deeply moved by the role you play not only in our education, but also in instigating positive change in the world through these experiences. It takes more than generosity to support these endeavors; thank you for believing in the hope of effective change through cross-cultural interactions.

Sincerely,

Ben Huntley

References

1. http://www.ecuadorexplorer.com/html/esmeraldas_province.html

2. http://www.thebestofecuador.com/esmeraldas.htm

3. http://www.paho.org/english/SHA/prflecu.htm

4. Lonely Planet Guide to Ecuador

5. Personal interview with Andy Kirby, legal director of Yanapuma Foundation

Leaving home

I´m not going to get into it too much, because posting personal information on the internet is kind of freaky, but the next few months mark a big change for my fam. Obviously I´m down south of the equator - but also my pops is up sailing in Canada, my sister on her way to study for a year in Egypt, and my mom on the verge of taking a new job in Bangalore, India. So somehow the four of us are split across a couple of different continents. May in Iowa is beautiful, and the four of us had a couple lovely days together before I set off. On the eve of my departure, my dog and I went for a little walk to the corn field at the end of the road. On that short little way, a couple words kept turning themselves over and over again in my head. With a some pre-trip jitters, I returned home and wrote out the following... it´s called Leaving.

Breath to breath and head to toe
Forward, backward, to and fro
When swirled in angst I pray to thee
To grant me peace and simplicity

For a tranquil spirit in exhalation
And not the state of trepidation
For feet to see and eyes to hear
What feet and eyes want ne´er draw near

Rest me now as I prepare
To rest and rise and course through air
Through worlds and wars and woes and wonder
Arriving in whole, not torn asunder

-BH-

5-20-08 – Chicago, O’HareSomehow I blinked and then my eyes opened and not only had I been accepted to medical school but the first year was through. And now here I am, waiting to catch the second in a series of three flights that will ultimately drop me off tonight in the middle of the Andes Mountains. I have not been to Quito before – in fact, never to South America – but with optimism I tumble on. This is a spirit of I’ve long had, although it was sharpened earlier in the year by a patient who gave a lecture. The details of his story I don’t remember clearly – only that everything seemed to go downhill quickly – diabetes, hypertension, heart failure, liver damage – I’m sure it was all in there. So many bits rattled around in my head that it was difficult to keep straight. He paused at the end, and we were quiet while he was thinking. Then he continued, “I’ve been talking for a while, and I know my story is complicated, but if I could leave you with one thing to take away from this hour it would be that the best turns out for those who make the best of what turns out”. I don’t remember anything else from that day – not the foggiest idea of what we learned in Biochemistry, or even a sentence from Anatomy – but his words have stuck with me, and today they guide me. And so I’m off – to what, I don’t know, but it’ll be an interesting few months of living again. I’ll check back every now and then, and in the in between will do my best to make good of what turns out.

First week in Quito

Hey friends and family-

As some of you know, I just wrapped up the first year of medical school and am now spending "the last summer of my life," as it is affectionately referred to by my peers (from here on out it is all clincal rotations, followed by residency), in Ecuador. Short and sweet, I was not originally planning on keeping this blog - and I don´t anticipate having as much time to write as I did for last year´s blog (http://www.benhuntley.blogspot.com) - but the more I think about it, and based on some of your requests, it seems sensical to create a central location from which you all can tune into as much or as little of what I´m up to as you want.

I´m not quite sure how this will all turn out - but I´m thinking about posting letters I write to friends and family; it´s a lot easier for me to describe what I´m doing, seeing, perceiving if I have someone in mind to whom I´m writing.

That´s about all I got for now. Shoot me an email if you have suggestions, comments, concerns or generous donations to make.

Thanks for tuning in-
BH