This is what makes it all worth it!

As we were preparing for the day, we got word that Christian, the young boy with the seriously swollen leg may have Osteomylitis (an infection of the bone) No obvious fractures seen. The hospital had started antibiotics and was advising surgery to drain the infection. However the family has great distrust in doctors and was considering signing him out of the hospital against medical advice and pursue ¨traditional cleansing¨ which involves cracking eggs and sacrificing a guinea pig. Nick, Jonathan, Juan and I set off for the hospital to try and pursuad Padre to allow the hospital to treat Christian.
The rest of the team heading to San Juan to set up for the day´s clinic.

Upon arrival to the hospital - I was amazed at the different practices from the US. There is a locked steel door that blocks visitors from entering the inpatient care area. Christian´s mother was outside the door, and not being allowed in because his father was already in the room visiting. Amazingly, us 4 : Three of which are ¨Americanas¨were allowed to pass through.

As we entered Christian´s room there was obvious tension. Padre was reviewing the process of getting Christian out of the hospital with the nurse. Nick went into action. We stressed the seriousness of the infection, the possible complications of septic shock, endocarditis (Infection spreading to the heart), amputation and even death. Padre was not phased. He really couldn´t get past the distrust. He actually signed the papers in front of us and the nurses started to ready Christian for discharge.

We pleaded desperately. We forced him to look at the leg closely and we accept that couldn´t ¨make that up¨. Then we asked ¨what must we do to earn your trust?¨
Nick was a quick thinker and pulled up pictures of Darwin´s recent successful heart surgery - and offered to have Darwin´s family come to the hospital to testify to our geniune concern and intentions. I think that was the selling factor, and with a slow nod the Padre agreed to allow the doctor´s to treat Christian. The hospital had already agreed to cover the cost of the surgery. So we agreed to split the cost of the medications and supplies with the family. The final decision maker was that Nick would accompany Christian to the operating room (fortunately he knew the orthopedic surgeon who was willing to let Nick assist).

Medicine in this country is so different. The doctor prescribes medicines and supplies for the inpatient, then the family has to take the prescription downstairs to the cashier and pay for the meds/supplies and bring them back up to the patients room. So that´s what we did.

Juan, Jonathan, and I joined the rest of the team in San Juan late morning. It was a very busy day - 100 patients!! Lots of geriatric patients - 80+ years old!!
Nick showed up a little after noon with the most incredible video of the drainage of Christian´s leg. They felt confident that the bone looked OK!! Obviously the drainage is being cultured so the antibiotics can be customized to the bacteria. But the outlook is good. He´ll need one more draining and cleaning in a couple days then hopefully home on antibiotics for several weeks.

The whole day was filled with a new positive energy and I couldn´t be prouder of the team, than I am tonight!!

The lady with the goiter also was able to get a biopsy yesterday, and we should have those results by Monday. The pregnant lady from Monday did not show up for her ultrasound.

Well I may have missed some cases, I´ll try to review more tomorrow.
Thursday is our last day of Clinic and it comes with good energy.

Adios,
Terry

Pictures from Tuesday

Riding to LLalli in the back of a pickup truck
Nick and Britta, and part of Adam. There were actually 10 of us in the back of this truck on the way up.
On the ride down, we also fit in, a gas stove and 5 Villagers!!!






A typical mother and child seen in our clinic in LLalli

Amazing feat

Monday - Christian´s swollen leg

Wednesday am - Christian

pre-op

Wednesday night, post op

Christian w-Adam and Amanda

Christian w-Dad

Doing good isn´t always easy

It´s 9:40pm Tuesday night and this is my first chance to post since Sunday. We got on the road Monday intending to set up a clinic in a small village off one of the main roads about 2 hours from Riobamba. However when we arrived the village didn´t seem ready for us. There was alot of confusion about who had keys to unlock the buildings we needed. After wasting nearly 1 hour trying to settle the logistics with these indigent people. Hank, our dentist, and I tried to start seeing patients. The first patient was a young boy- Christian, who had appearantly been in a bike accident 1 week ago. He hurt his leg, but was able to walk on it immediately after the accident, however, 2 days later couldn´t walk on it or straighten it from the hip. The following days the leg began to swell. By the time I was examining him, he had tense swelling and bruising from the toes to the hip. He held his leg behind his knee and refused to straighten it. By palpating along his ischial tuberosities and comparing hips, I believe he may have a displaced hip fracture or at the least a dislocated hip with possible distal fractures. The team went to work quickly - we gave him pain meds to help make him more comfortable, and arranged transportation to the nearest hospital for diagnostics (xrays) and treatment. As of tonight, we still don´t know the outcome.
We also saw a young woman with probable basal cell cancer of the face, and are arranging follow up. Because of all the confusion with getting this clinic up and running, and the ´villagers´disinterest in actively making this work, the team made the decision to travel about 30 minutes back on the main road to a village we had passed through earlier. When the president of that community heard we were willing to set up clinic there if they so desired, word spread like wild fire and we were back to our mission!! These people were so warm in receiving us and their gratitude showed in their eyes. The team worked hard long hours, but I think we made a difference in a few people´s lives.

Highlight cases would be: a woman who stated she was 5 months pregnant with her 8th child, but was concerned because she hadn´t felt any motion from the fetus yet. On exam she felt, at best, 2 months pregnant, urine test was positive for pregnancy-- so we set her up for an ultrasound and obstetric consult. Another woman with a ¨lump¨in her neck. She had a huge goiter - so she is being refered for work up of thyroid disease. Dr Evans diagnosed 4 potentially new diabetics. By the time we tore down that clinic set up and drove back up the road to a Resturaunt that was going to host us over night it was 9pm.

They fed us a warm meal and we spread out mattresses on the floor and tried to get to sleep by 11pm. This morning there was more confusion about how we were to get to the next village. High atop the Ande´s mountains is the town of LLilla. Initial plan was for those who wanted to hike they would hike a direct trail some on foot and some on horse back, the rest of us would be driven up in an open back pick up truck with the gear. Unfortunately there are no phones or internet connections to this town so we were just about to give up on them sending us the truck they promised, when it arrived. By this time it was late morning, so we all went by truck.

Upon arrival we were welcomed like diplomats. We had Dr Evans and myself seeing medical patients and Hank and Dr Giovani were extremely busy with dental repairs and care. Again it was a very long day. We snacked on bread and nutella and animal crackers. The trip up and down the mountain was breathtaking, but dusty. We returned to our hostal around 8 pm - never so happy to see Martha, hot food, showers, and our beds....We battered but I hope not beaten! Now at 10pm bed is my main priority. I´ll try to download pictures tomorrow.
Adios Terry

Sunday night

Today the team went in different directions. It was a day to sleep in and visit places of interest and a day of reflection. Nick lead a great discussion during a brunch about why poverty exists and what we as individuals do to contribute to it. We talked about how individuals and organizations have the ability to promote change through developing systems. We compared poverty in the US and poverty in third world countries. It was sobering, but an important step towards making a difference.

Dr Lance Evans, an American who has trained, practiced and lived here for many years arrived at the hostal tonight. He´ll be joining our mission for the next 3 days of clinic. I´m looking forward to learning and sharing medical diagnostics and treatments with him.

I may not be able to journal tomorrow because we are sleeping at the clinic site tomorrow night. Tuesday night may be a late night, so it may be 2 days before I journal again. Know that we´re working and contributing all we can.

Adios for now

Terry

tourism

musical serenade during lunch in baños
group picture in front of church in Baños

Our mighty leader taking a ¨plunge¨... kids don´t try this at home!

more fun

Adam ziplining in Baños
Britta on the Zipline
Stephanie on the Zipline

Saturday continued

Sarah and her pals.
Adam and his monkey friend, who unfortunately thought Adam´s arm was a Baños!! oops. Anyone got some hand sanitizer??
Sarah becomes the Queen of Fatima!

Saturday = play day

Exotic animals of the Fatima zoo.
Sarah´s bag of fruit was a monkey magnet!!


Yes, it´s alive!!

more pictures

Jonathan, our local connection to public health (right) with the family of a young boy with a murmur. We spent a 1/2 hour at their home trying to convince them that their son needed further testing to determine if he needed surgery.

more pictures

This little guy stole our hearts, deep in the Ande´s
Adam and Juan
cruz del arenal- their community building where we set up clinic on day 2
Children waiting for their exam inside cruz de arenal.

PICTURES FROM PRIOR DAYS

Traffic Jam Ecuadorian style

80 + yr olds- married 50+ yrs w/Nick and Juan

End of the day, unpacking the Van.

Tourism Day

Today is Jen´s birthday. The Team surprised her with a cake after breakfast.

Then we crowded into the Van (14 people including the driver!) and drove out on an adventure, Ecuadorian style. Our first stop was the city of Baños (Yes, Banos means bathroom. The name comes from the ¨natural¨hot baths in the vacinity). When we first arrived the driver brought us to a deep gorge. Several of the students Zip-lined over the gorge. Quite a thrill ride to say the least. But even on our day off Medicine for the underserved was part of our day. The Zip-line operator´s son was ill with fever and headache. He appearantly has cerebral palsy and has ëpisodes¨of headache with vomitting. They had nothing to give him, so we left some tylenol.

We then ate lunch inBaños in a small cafe and were serenaded by local musicians ¨Sol De Los Andes¨. They played very authentic flute and guitar music. Then we shopped a little.

Back into the van to head over and through the Andes mountains, passing through several tunnels. We saw several beautiful waterfalls. We stopped at a roadside attraction, that turned out to be a bridge jump (similar to Bunjie jumping, but without the spring - you are harnessed and jump of the bridge and swing back and forth suspended above a gorge). A few of us, including our ¨leader¨Nick, the birthday girl Jen, and me took the jump. It was invigorating!!

Back in the van to Puyo home of the Fatima zoo in the Amazon. The zoo was really cool, we could get right in with many of the animals and touch them. Sarah brought out some fruit she had bought earlier in the day, and before we knew it we were surrounded by the cutest monkeys. They jumped right on our shoulder, and heads and took the fruit from our hands. It was awesome!! The Zoo is doing great work as an orphanage for endagered species, as well as working on educating people and students to think beyond the current ways and look for new ways to save and maintain the Rainforest and all of it´s creatures. Our Guide was quite a funny character and will not be quickly forgotten.

Back in the Van for the 3+ hour ride home. We arrived at the Hostal sometime around 9pm. Martha was ready for us with dinner. Some of the group plans to go out clubbing tonight (a repeat of their evening last night) - but I´m beat so after this post is done I´m going to bed :)
We´ll all be sleeping in tomorrow. And I would guess most will opt for walking over riding in a Van for the next 24 hours!!

Adios,
Terry

Mercedes and her niece Angela examing baby. Sarah entertaining the kids with Glove ballons













Terry w/older villager in Guamote Our second day of clinic

t
Road block as described earlier. Adam helping his grandfather, Hank, with dental exams.
Part of the team relaxing before dinner in one of our rooms at Sierra Nevada Hostal.

Guamote

It´s 6 pm Friday night and the city of Riobamba is already hopping! We returned from our clinic in Guamote about an hour ago. Today there were many more patients to see (the word must have spread quickly). Mostly adults with complaints of joint pain, headaches, and stomach problems.

We met an amazing couple that were both in their 80´s and had been married over 50 years! We found another murmur in a toddler and have arranged an echocardiogram to better evaluate. We examined a 22 yr old with hypertension. Mercedes, our Ecuadorian physician, may have found a colon tumor. Arrangements have been made to ultrasound her abdomen and pelvis. Lastly we may have identified 2 TB patients.

The team is ready for a break. They´ve earned it by their hard work during these last 5 days of our mission. Not sure what the plans are yet, but there have been discussions about visiting the valley of the active volcano near by or traveling to a rain forest.

Monday and Tuesday´s clinics are pretty remote, and we plan to sleep away from the hostal that night to best utilize our time.

Adios
Terry

Thursday

Everyone was glad for the opportunity to sleep in a little. I think our host was glad for rest too.
We only had one van to use this day, so we packed people in like sardines, maximized use of the roof rack, and the few that couldn´t fit in the van took the public bus.
We set up our clinic in a quaint mountside village. We had a local female physician accompanying us, Mercedes. She works in a local hospital and clinic. Despite our language barrier; I think we were able to learn a lot of medicine from each other. She certainly opened my eyes to more of the local healthcare issues.
It was a slow day - maybe 30 people seen. But that may be because we showed up late. We´re going back to the same village tomorrow and hope more will show up, now that the word is out.

The group that was taking the bus home had a bit of an adventure on the return trip. We got bored waiting for the bus, so Nick flagged down a pickup truck with seats in the bed and secured us an hours drive back to Riombamba for $2.50. All was well until we came to a very narrow pass, and there were 6 busses blocking the way - 2 heading in one direction, the other 4 heading in the opposite direction. It appeared we would be stuck there for quite a while. So we got out and walked past the traffic jam, and were fortunate enough to come upon a taxi. It was a tight fit with Amanda sitting on my lap. But it was dry and warm and better then waiting indefinately for the bus drivers to settle their dilemma.

I´M SORRY NO NEW PICTURES, but I´m having a lot of trouble downloading them.
I promise I´ll try tomorrow to send pictures.

Adios
Terry

wednesday

I´m writing this on Thursday night, because I was too tired last night. We had a very long day... Started at 4:30 am...
Incredible, breath taking views traveling through the Andes Mountains. A bit scarey at times. Our transportation was an ambulance, a jeep SUV, and a pick up truck with wooden rails with people sitting on a mattress in the bed of the truck. Everyone had white nuckles by the time we arrived.
This village was quite different in contrast to our previous clinics. A plush green mountainside vs. the tundra barrin of the days before. There were crops growing like a quilt pattern on the mountain side, and much more livestock.

The people were so hospitable and gracious. Every person, young and old, greet each and everyone of us, with a handshake, a smile and a Buenos Dias! They served us an Ecuadorian speciality Cuq (Roasted Guinea Pig) and potatoes.

The clinic was very busy from the moment we arrived. We saw approx. 128 patients, some with respiratory infectios, most with body aches from their laborous work, eye complaints from the wind and sand, and lastly the most common complaints of headaches, gastritis, and rashes.

The highlight of the day was picking up Darwin. Darwin is the 6 yr old that was identified by last years mission as having a serious cardiac condition requiring surgery. Darwin and his dad accompanied us throughout the day. It was amazing to see how quickly he´s recovering from the heart surgery he had only 1 week ago. Having Darwin running around smiling kept all our spirits up during the craze of the day.

We ended late and had to drive those tortuous roads in the dark and rain. Truely a death defying adventure!!

We picked up the rest of Darwin´s family on the way back to our hostal. We all had dinner together and had the opportunity to learn more about the whole family´s experience through this difficult last year. It was so moving to talk with them and see there sincere gratitude.

It was after 10pm by the time we let our heads hit our pillows. Fortunately we planned to sleep in a little later on Thursday.

Adios
Terry

Cruz del Arenal

We started our day with a few bumps in the road. (Pix to follow) Literally, there were huge mounds of dirt blocking the road. We found an alternate route but even then were faced with more mounds. Fortunately, a local had cleared enough of a passage for us to get through. Appearantly there is a major dispute going on between a large concrete company and the villagers. Including accusations of theft of valuable equipment. So the concrete company has blocked ALL roads up the mountains.

The building appeared like a humble hut upon arrival, but the inside was quite nice. Log and brick interior with running water! No electricity, but you can´t have everything.

Our team is really functioning like a team, and we were very efficeint. We saw 79 medical patients, and 40 dental exams. We found 2 new murmurs, and saw a lot headaches, rashes, and stomach aches.

Tomorrow we have a 2 1/2 hour ride on dirt rounds to the next site. It´s raining tonight, hopefully that won´t further delay our trip.

Adios
Terry

Our first day of work

Today we set up our first clinic of this trip, up in the Andes. The views of Mountains were awesome. We were greeted by a very small crowd on arrival to the site, but quickly we had lines of villagers wanting to see the doctor or the dentist.

Hank, our dentist, was busy all day. He pulled a lot of teeth. He wished he could have done restorative work on many more. The students put a lot of energy and enthusiasm into teaching proper teeth brushing techniques, and applying slouride treatments.

I saw a wide variety of patients aged from just a few months to probably late 40´s. We found a young boy with a very loud systolic heart murmur. We met with his family at their home after clinic hours, and am working on arranging an Echocardiogram to better evaluate his needs. There was a small boy with a skin condition from birth that made his skin peel and hurt. I´m still not certain what it was, but I took pictures and hope to learn more from a Dermatologist friend of mine upon return to the states. Fortunately that young boy is already tied into medical care. There was also an older women with several weeks of right lower quadrant abdominal pain, worsening in the recent days. Exam was consistent with a smoldering appendix or ovarian cause. We took her back to Riombamba with us to have a surgeon evaluate her.

Will add more pictures later, having trouble with the internet. I´ll also be sure to give you details of the name of the village and mountain we were at today - with my next posting.

Adios
Terry

Evening view of Riobamba . The ¨mountain¨ in the clouds is actually Tungurahau Volcano sprueing some smoke and ash.

Tomorrow we start our work!!
Adios for now.
Terry

pictures

On top of a vantage point in Guano
skyride in Guano
taking a rest while exploring Riombamba

Sunday May 21, 2006

Today is our first day in Riobamba. The trip here yesterday was LONG. 3 flights and a 4hour bus ride (and those coming from Maine started w-a bus ride). We got to our rooms around 2:30 am. Martha is our host. Seirra Nevada Hostile. Very lovely woman. Quaint, clean accomadations, with sporadic hot water.
Today we are getting acclaimated to our surroundings, and will develop "Teams" to deligate responsibilities during our mission trips.
Everyone is excited to start our work here and meet the people!!!
Nick and Juan have done a lot of work in the last few weeks preparing for our work.

Darwin, the yound boy found to have a serious congenital heart condition during last years mission, successfully had his surgery last week and is already home. I believe it was correction of a Patent Ductus Arterious PDA - I will send pictures and more details when we meet with him and his family on Thursday.
The altitude is not currently a problem, but we haven´t done anything too exertional yet.

Here is a list of the TEAM
Nick Ellis - Founder McGill International Development 2003, UMAINE 2006 Post BS -premed- entering Dartmouth Med School this fall
Juan Vanegas - President - student Cell Bio
Alia Whitehead - student - UMAINE 2006 -Entering UVM med school in the fall
Britta Sundquist - student- UMAINE 2006 -BS Biochem
Stefany Almendinger- Senior at UMAINE biochem major
Amanda Thibodeau- Senior at UMAINE bio major
Katie Jackson- Junior at UMAINE bio major
Sarah Dooley - Vice President- Senior at UMAINE bio major
Adam Bourgon- studen Senior at UMAINE Zoology Major
Jennifer Drouin- student Senior at UMAINE Bio Major
Tony Smart - finance advisor
Teresa Tranchemontagne, DO UNECOM Class of 1995
Hank Bourgon, DDS - retired

Well that´s all for now.
Adios, Salude y felicidad!
Terry Tranchemontagne, DO