MEDLIFE

last day in Quito

2007-06-23T16:55:00.000-07:00

We just returned frm shopping in Otovala. one of So America´s biggest markets. It was full of color, artists and great deals!!
Today is Adam´s birthday, so we´ll be going out for our last night together and try a little salsa dancing.

The week was a successs! So far only 1 PAP result is precancer and requires a biopsy. We have arranged to help a woman with a parotid tumor and assisted a bed bound man get to the hospital and care. We still have some numbers to crunch and details to review to summarize it all. A few students felt under the weather for no more than 24 hours and no serious illnesses.

smile you are on camera

2007-06-21T16:05:00.000-07:00

Sean - a med student from Georgetown - who has been helping out with MEDLIFE- and I´d saying enjoying himself!
Let´s get this Van packed and call it a day! a GOOD day! (Adam, Maureen, Sam, David, Jessica, Terry)

Maureen making fun w-the kids!
nearest the Pepsi bottle, Mercedes our Ecuadorian Doctora that is helping us, Isabella standing, and Marcos our driver behind

So you want to be a doctora! Great! This is how you use a stethoscope!
Nick, flirting with the girls :)

Adam - AKA Farmacia King!
Matt and Steph applying their skills to entertaining children while Moms are examined!

´just hanging out with the kids´ - Sam

HAPPY BIRTHDAY JUAN!!

Jessica (my right hand all week! - her interpretor skills are awesome)

2007-06-21T15:38:00.000-07:00

Hello family, friends and supporters:
Sorry it´s been a while since I wrote, but getting to the internet is not as easy as previous trips.
It´s Thursday night - and we´ve been having a great mission. We are getting PAP results in 24 hours!! Immediate feedback of our work is so refreshing.
Last night Nick led a discussion on Structural Violence and Poverty. I´m always moved by the thoughts, compassion and drive of the students that attend these trips!
It was Juan´s 20th birthday yesterday - so we surprised him with a cake at lunch and a group went out last night with him!

pictures

2007-06-18T19:14:00.001-07:00

Good brushing! Now Rinse and spit :) Pre-med student Kat
Now that´s a pretty smile ! Dartmouth Student Stephanie

Cotopaxi Volcano!

the group Monday morning!

We had a GREAT first day! Med Students doing their first after Gyn exams and OB exams.

Adios

Terry

June 17

2007-06-18T19:10:00.000-07:00

QUITO June 17, 2007 10pm

The team is almost complete. We are waiting for one last student to arrive.
We are staying at a lovely hostal that the hospital Tierra Nueva is partnered with. A bland high cement wall with a steel gate doesn’t give hint to the oasis that lies behind. A beautiful central building that doubles as the cafeteria, meeting rooms and church overlooks 4 buildings that are the dormitories.

We are in a very poor section of the city, so we have not wondered outside the commune tonight. There is another group of students from the Timmy Foundation staying here as well. One of their leaders offered to show us around tomorrow evening, if time allows.

The students all come from varying degrees of experience. I hope that they will each leave this experience a little bit enlightened and challenged. As for me, it’s hard to believe this is my third trip to Ecuador in 13 months. I am hoping that I have been a better planner and packer this time. The last two missions, we fell short on supplies (especially medications) and needed to scramble at night to ‘restock’ from local vendors.

Leaving for Quito

2007-06-16T05:16:00.000-07:00

Today I leave for Quito. I will meet Juan there, who has been busy arranging the upcoming week's mission. The "team",students from Dartmouth and NY, will be joining us tomorrow.
This week's mission is a bit different than the last few. We will stay in the Quito area and partner with Tierra Nueva, a local hospital for the indigenous people.
We have offered to help provide medical screenings in their outreach villages for a week. I will be seeing about 25 females a day for physicals and gynecological screenings, and we will have a second doctor (Lance Evans or an Ecuadorian physician that we subcontract) - and they will see an additional 30 patients (mostly children and men). We hope that this partnership will open opportunities for us to work side by side with Ecuadorian providers, and learn from each other- ways that we can grow MEDLIFE and meet our goals and their needs. They have offered their pathology lab to read our Pap smears, which will offer us quick turn around of results!

I have only met one of the students (other than Juan- President of UMAINE MEDLIFE) - so I am anxious to meet the rest of them. As I understand, some are pre-med and some are medical students - this should be a great mix. I hope to see Blanca, Martha and some of our other 'support' personel and friends. I would also hope to get caught up on how Maria ( our young, malnourished patient that was quite ill w/tuberculosis) is doing.

Well, I'm off to Boston to get a plan!

Adios
Terry

USA

2007-03-17T07:25:00.000-07:00

It's 10:30 am Saturday and I'm sitting at the Atlanta airport. Alicia, Claire and I got bumped to the next flight because I had lost my passport during the customs check in. I found it, an actually Delta was great, they had over booked the flight in the first place, so we got a $200 credit each to take the next flight! All the students and Tony made it the flight and will still have a long bus trip to Orono in the snow!

Our closing of our trip didn't lack any attention. One of the student's was very dehydrated from gastroenteritis, and fortunately Dr Lance Evans lent us some IV supplies and fluids. So we had a portable "hospital" on the bus and then in the hostel in QUITO. Fortunately the student did respond well and is much better at this point.

As it comes to the end of this mission, there is so much to reflect on. I still have a lot of work in calculating out the statistics of infant mortality and such... and then of course the list of patients that need referrals. We met a lot of young children with murmurs. Hopefully I can get that all together as soon as possible!

One of my friends Kathy is already headed for Boston to pick us up and I feel bad that she will have to wait for our delay. We hear that the snow storm in NH is bad.

It's nice to be back in the USA and we're looking forward to reuniting with our family and friends. But with out a doubt our new friends in Ecuador will remain in our thoughts and heart for a very long time. In addition to the "patients" we made new friends with some of the foriegn interpretors we worked with: Gabe, Sarah, Sarah, Mark, Marciel and Calindi - hopefully we will all stay in touch through the internet and future endeavors.

I'll post pictures in the next few days
Adios
Terry

quito

2007-03-16T14:30:00.000-07:00

Today Nick, Sarah G, Lance, and I went to Tierra Nueva to look into doing June's mission there. It a hospital especially for the poor. This would give MEDLIFE an opportunity to get involved - or at least witness the urban poor vs the mountainess indigenous. The meeting went well, and looks good for all the arrangements.
Gabe and Sarah toured us around their foundation: cenit - this is a great foundation teaching young students, as well as older woman - marketable skills.
We are currently just wrapping up our shopping in Quito, then a good meal, then a LONG TRIP HOME!!
Hope the snow falling in New England doesn't delay our return much!!
Terry

PS we brought 3 patients with us to Quito today, and they are all getting the needed treament!!

friday

2007-03-15T15:42:00.000-07:00

I have a few minutes before we catch the bus to Quito. We had a busy day today. We saw 60 patients - all between the hours of 9:30 and 2:00. Mostly children, but about 10 pap smears too. The children in this village seemed more ill, with underweight, respiratory disease and diarhea. I think we treated more people today than all week!
We are bringing Sangudo, Tupac and Maria to Quito with us - to get specialty care. There are so many others that will need follow up -especially once the pap results come in.

Adios for now
Terry

rio colorado

2007-03-14T19:39:00.000-07:00

The first really cold and wet day we´ve had. We were back up at high altitude -close to Chimborazo. These people live above tree line and live very hard lives. They have recently been introduced to greenhouse agriculture by some well meaning organizations, and this -at least- has offered them a better oppportunity to have sustainable crops.
We saw lots of free roaming alpaca and llama, they are really beautiful.
We saw Sengundo, one of the little boys from last years mission, who needs heart surgery. He and one of his parents will travel to Quito with us on Friday to have a follow up visit with the cardiac surgeons. Tupac, the other young boy w/murmur has appointment in Quito too, but fortunately he doesn´t need surgery.
We were entertained by the local men playing volleyball. They are really quite good, but given the weather conditions it turned out to be more of a mud game.
As we wind down, we are all looking forward to hot showers, fast food, our own beds and reuniting with our family and friends!
I may not get a chance to write tomorrow, because we will be having clinic most of the day, then pack and wind up things in Riobamba and then jump on a bus to Quito!
Adios for now
Terry

pictures from Saturday in Banos as promised

2007-03-13T19:11:00.000-07:00

PAIGE, SHANON, AIMEE IN BANOS
SHANON, TIM, PAIGE IN BANOS

LAURA, KERRY, ALICIA, ROUL, TERRY, JESSE, CLAIRE AT THE WATERFALL
THE BLACK CLOUD IS ASH COMING FROM THE VALCANO

THE END OF THE RAINBOW IN BANOS ALICIA, JESS, KERRY AND LAURA AT THE WATERFALL

AN ECUADORIAN BEETLE!

CRAIG, TIM AND TONY IN BANOS

Monday at Cebedas

2007-03-12T19:26:00.000-07:00

Last night some of us accompanied Martha (our host) to evening mass. Of course it was in spanish, but otherwise similar to our catholic services. The church was beautiful inside.

Today we saw 80 patients in Cebedas and will return there tomorrow. One of Alicia´s first patient was a women with a fractured forearm. the fracture was probably 2 weeks old and she tried to make a brace with ace and a branch. She was so resourceful.
I saw an 18 month old that couldn´t walk yet. Also many older patients with significant arthritis. They live such hard lives. When we suggest resting for a week to let a tendonitis ¨heal¨they simply can´t comprehend the idea of not working.
Nick met up with the team and joined us today. Talk about jumping into the fire from the fry pan. He just took 4 major exams last week, and his only week off he comes to Ecuador!
All of the students are really giving their best, despite the fact that most of them are fighting off a cough and some ¨travelers¨GI distress. There is not a whiner in the group.

Last night after dinner, I asked the students to summarize their experiences from the previous week for Nick. They were so insightful and compasionate. I feel very privileged to be working with them.

Tony has been a rock keeping us saine when needed, and helping us laugh when needed.

Anyways... back to the mission. As in many days past, the fed us lunch. It was the best fried chicken and french fries Í´ve had in a long time.

We continue to focus on women´s health and hope tomorrow will be a younger group.

well bye for now
more tomorrow
I´ll try to send pictures tomorrow
Terry

Baños

2007-03-10T17:43:00.000-08:00

Today was a great day! Started a little sad, with goodbyes to Juan and Sarah D. They are heading back to the states. Gabe (American volunteer here in Ecuador) and his friend Laura (from Cuba) joined us on our adventure to Baños. We checked out the ¨baths¨ - they were really more like public pools that are fed with the warm water that comes down from the volcano. We had a nice lunch. Then we split up for a while. One group stayed in the main city -shopping and exploring. The rest of us took the van up the road about 20 minutes and hiked down to an incredible waterfall. It was very tropical, not far from the Amazon.
Just as we were leaving Baños the volcano began ¨belching¨. We got some great views and pictures. We also saw a beautiful rainbow. I will download the pictures tomorrow.

The drive back to Riobamba we were all a little over tired and silly. Playing a game of what would you rather be.... or .... They were coming up with some rather silly options, but it was a nice release for everyone to just laugh and giggle.

Nick arrives tomorrow. It will be a day of rest. Some of us are going to go with Martha, our host, to a Catholic mass... we still are not clear if it will be in Spanish or Latin.

some pictures are up!

2007-03-10T06:52:00.000-08:00

Hi guys
I managed to post a few pictures. I interjected them into yesterdays´s post. Check it out! I´ll have more time over the next 2 days to put more pictures on. (it literally takes 3 minutes per picture)
Everyone is well, we all have a bit of congestion and sore throats, but that´s more likely the climate and the dust than real illness, because it´s not slowing any of us down.
Juan and Sarah leave today to go back to Maine and study for MCATs and work- we will MISS them greatly. Nick (our founder) will arrive tomorrow....
Off to Banos for a little R&R

Adios
Terry

getting caught up on our trip

2007-03-09T17:58:00.000-08:00

OK, so I’m sitting at Cruz de Arenal waiting for our patients to arrive. It is Day 5 of our missions. Unfortunately, after spending over an hour writing on the computer last night – the computer crashed and all was lost. So today I’m writing on my laptop and hope to just download from here.

Day 3 LICTO
We set up clinic in a monastery. We saw at least 70 people at least 25 were female exams. This mission we are fortunate enough to have 2 doctors! Alicia has been a god-send to our group.
The students are doing a great job. They rotate through the different stations: height and weight, blood pressure and temp, one student w/each doctor, they dispense the meds from the farmacia (pharmacy), they brush teeth and give fluoride treatments, and assist the dentist when he is with us.
The students witnessed a seizure today. One of our patients with known seizure disorder, seized at the clinic. She’s on anti-seizure medicine, but the mother wasn’t sure when her last blood levels were drawn. Also her mother tells us that her daughter needs surgery – a shunt- to move fluid off the brain, but they have no money for the surgery. A lot of women have expressed interest in “family planning”. One woman, when asked if she wanted anymore children, said very solemnly “No, in this life there is no rest”. She was 28 yr old w/5children. We also saw a lot of arthritis in the older population due to their hard lives.

THE STUDENT TEAM:
FROM LEFT TO RIGHT BACK: CRAIG, TIM, JUAN, PAIGE AND KERRY
FRONT : JESS, AIMEE, SHANON, SARAH

This day seemed to touch each of us differently. But there was a theme of questioning our goals and what we can accomplish. Obviously a 2 week mission, spending only a day at a time – we can’t do a lot of “real” medicine. It often feels like band-aiding the issues. But fortunately we have local support (Blanca a previous patient and now a health promoter for MEDLIFE). Blanca has been honest with us about how the indigenous people receive us, and for the most part they are grateful for the attention. When their day to day life is working to gather food and develop safe shelter, it means a lot for a medical team to travel to them and validate their human rights, especially the right to access healthcare. It makes our long term goal of building a clinic to serve them year round - more pressing than ever!

DAY 4 CALSHI
This day’s visit we had Mercedes (an Ecuadorian doctor) helping ½ a day. Alicia made a house call on a patient who was too ill to come to the clinic.

These people were incredibly gracious and generous. They served us lunch: cuy (pronounced KWEE) – in American that would be guinea pig. Almost all the team tried it. Marcial (one of our interpreters) got the head!
Most of the patients blamed the volcano ash for most of their ailments.
One patient who suffers from severe degenerative joint disease – in obvious pain. When asked about his hip, he stated it used to be so bad, he saw a doctor in town that said he needed a hip replacement, but his bones were too thin for the surgery. Then he goes on to explain that a cousin contacted an old trusted doctor (telepathically, as he was dead). The doctor changed part of the hip bone to flesh, so he no longer experiences bone against bone and then the pain is significantly better.
Another pregnant woman was asked when her baby was due, and she replied: If the baby is a girl she will come in May, if the baby is a boy, he will come in June.
DAY 5 CRUZ DE ARENAL

Today’s mission took us the highest point yet. We passed Chimbarazo. We caught a glimpse of it before it snuck behind the clouds.
There was a communication break down, and the people of this village thought we were only examining children. We saw about 50 people, but about 80% were children. They were all very small for their age, only one or two looked significantly malnourished.
Below are the names of a few patients who were awing my laptop. So I asked them to type their names, and I would store it and never forget them. They smiled, and each one (some 7yr, some in their 40s) typed in their names, and then asked me when we will be back!
Cecilia
Angel
Segundo
Segundo
BlancaAnabel

Well - all the typing on my laptop was transferrable to the blog - but still fighting to get the pictures on board. hopefully tomorrow- I´m very sorrow- I´m sure you would all love the album of pictures we are collecting but technology has a mind of its own.

We are going to Banos tomorrow ! Yeah a day off!
Adios
Terry

Mission Day 4

2007-03-08T19:06:00.000-08:00

I am just writing to let you all know - we are well. Working very hard, but trying to make a difference. The people are so grateful, and that makes it worth it.

I had just finished typing up a summary of yesterday and today, and began having troubles downloading pictures - then the connection went dead.

I had put an hour into editing that and it´s gone. It´s also past 10 and I must get to bed. so I´ll try again tomorrow with pictures as a priority!
Terry

Learning the language

2007-03-06T18:39:00.000-08:00

Today was a beautiful sunny day, with a clear picture of the active volcano (seen from a very far and safe viewpoint).

We were joined today by many new volunteers: Sarah G, Marcos and sister, and Gabe. Their assistance with transalation has been invaluable. HUVSYAL brought along a few more people as well. Initially it seemed we were going to have more volunteers than we had the need for, but it turned out to be a very productive day. We saw about 65 people, and Dr Alicia and I were head to head on our numbers of patience seen. But she´s in the lead!

A few interesting comments were are becoming accustom to are:

I have a sadness headache, the cold settled in me and caused me my ailments.

In addition to offering these indigenous people a general health screening and education, we took the time to learn more about their communities health issues - for example how many babies die before the age 5 (most likely from treatable illness)

CHILDCARE SERVICES!!

GIVE US YOUR MOUTH AND WE´LL GIVE YOU SMILE!

The flouride team, and the dentist!

SMILES ARE FREE AND UNIVERSAL

NOT TO MENTION SMILES ARE JUST GOOD

MEDICINE.... from our pharmacia

Day 1

2007-03-05T18:36:00.000-08:00

The loading and packing for today´s mission went surprisingly well this morning. It is also helpful that HUVSYAL now has a pick up truck for more of the awkward pieces of gear.

The village was so steep on the mountain that our van could not navigate the last mile, so we were shuttled in the HUVSYAL truck.

For our first day, I thought it went well. Alicia jumped right in an saw a ton of patients, probably about 55 of the 65 total. I did 23 female exams. It went fairly smooth, because the health promoters had prepared the community for our visit.

Language, as always, was a great barrier, but we were fortunate enough to have 2 young students, Colinda and Marcelle helping out and they are great interpreters.

Over dinner tonight, Jessica and Shannon commented about how they were actually able to communicate with some of the curious indigenous people. They used their basic spanish, drawing on paper and a lot of body language. This is a great experience for the students to narrow the cultural gaps.

My sister, Claire, worked as a strong link in the team, supervised by Sarah D. (VP of UMAINE´s club). In comparison to last years first day, we were so far ahead in terms of organization. SarahD. and Juan are really demonstrating their strong leadership skills.

It was pretty dark by the time we actually got onthe road back to Sierra Nevada. In part was the one car road up the hill was blocked by a truck stuck in the mud. While waiting for the van, we got to see a woman bringing her sheep in from the fields.

on a closing note, for last year´s MEDLIFErs. Thomasa had 2 babinos!

Riobamba

2007-03-04T17:29:00.000-08:00

Well we made it to Riobamba. It was a very LONG trip. The students that started in Maine got in a Van around 3:30. We all met up in Boston and headed to Quito via Atlanta. There was a delay in Boston, so we didn´t have much time in Atlanta but to run to the next plane. When we arrived in Quito it was close to 11pm then onto a bus for a 4 hour drive that was interupted by a brief stop to Dr Lance Evans WALDOS Clinic. It is a work in progress, but it is coming together beautifully! Martha, our host, greeted us at about 3am and we all passed out! We were also joined by 3 new friends that work w/a nonprofit out of Quito. Blanca (see our last year´s blog, she was the patient with thyroid cancer) has joined us for the next two weeks with her little girl!

Sunday - we got up for 10am and met w/Jonathan, a local physician, and Blanca (our former patient and newest patient advocate). We are working hard to come together and achieve HUVSYAL´s goals as well as accomplish MEDLIFE´s goals. Sarah, Mario and Gabe from Quito spent the day with us. It was awesome sharing stories and learning from each other.

After a delicious lunch by Martha we went to Guano (a small ¨leather¨town) for a little tourism.
Picture below is most of the group on the mountainside.

Then back to Martha´s for packing and organizing for tomorrow´s first village trip.
The group really worked like a team!
At supper we had Pizza and what would a pizza party be without a pizza eating contest-
Juan, Tim, and Craig ....... and the winner is CRAIG at 14 slices. Juan and Tim gave him a good fight by each eating 10 slices!

As I´m finishing this post, I had a minute to talk to Nick (our founder) who is studying excessively for his Medical School Midterms! We all sending him our ¨smart¨thoughts!!

Lots more to say tomorrow
Terry

2007-02-26T12:58:00.000-08:00

5 days to go and then we're off to Riobamba. I'm very excited to say - we have bilingual forms to use w/our patients. This way both HUVSYAL and MEDLIFE can make equal use of the information we obtain. The team of students seem like a good crew, the long trip from Boston to Ecuador will provide a lot more time to get to know each other. Jaun, UMAINE's club president and Sarah, VP are traveling w/us the first week. Nick, our founder, is busy w/exams... first year med school, ugh... I remember all too well.... BUT he'll be able to join us the second week.

I'm anxious to see how receptive the women will be to our focus on Women's health... a lot of what we will be doing may seem very foreign to them.

There have been so many generous people who have helped us put together this mission!! thank you to all of you - you know who you are.

Adios
Terry

Getting ready to go!

2007-02-13T11:19:00.000-08:00

Today is Feb 13th, 2007. We're expecting a big Nor'Easter tonight...for those not familiar- that's a huge snow storm! I'm ready for a good snow storm! better to get it out of the way now, so that the MEDLIFE team will have clear skies to fly to Ecuador in March.

We'll be leaving Boston, MA for Quito, Ecuador on March 3 to begin a 2 week mission in the villages near Riobamba.

I met w/the students on Sunday in Maine. Looks like we have a nice group going. Dr. Alicia Hilburn will be joining us - and this will be her first medical mission!! We so thrilled to have her joining us. My sister Claire Pouliot will also be joining us for her first mission.

MEDLIFE just had two very successful fundraising events!! We are eager to follow up on the medical cases (2 young boys in need of cardiac follow up) . Also this March we begin a new chapter: Women's health. We'll be screening women's health issues and developing a data base of overall health assesment of the communities.

We finally have our LOGO and a WEBPAGE!! Check them out at
www.MEDLIFEweb.org

Well - still a lot of packing and preparation to do... will write again soon

Terry

HOME SWEET HOME

2006-06-05T06:20:00.000-07:00

Well, it's Monday morning and I'm home in Francestown, NH. This will be brief because I'm having computer issues due to storms in the area. I'll write a better summary later. Just wanted to fill you all in on our last days. Friday Morning we got a late start to Quito, because some of the students were under the weather. Nick ended up getting us a private bus, so we could stop frequently if needed. We made it to Quito without much difficulty. Upon arrival however, the Hostal claimed they had no reservations and only room for 2-3 people. Nick and Juan set out on a mission, and found us a great hostal nearby. We checked in an dropped our luggage and headed into the Gringo/tourist area of Quito. Great shopping of authentic arts and crafts. We purchased items to sell at fund raisers later in the year.

We went out to dinner and ate like Kings!! We went to a buffet that served both authentic foods, including tongue and goat stew, as well as hearty pasta, grilled beef and chicken and a desert buffet which we selfishly endulged in!!

We then went to the center of Quito, where the president resides and it was beautiful. It reminded me of a Piaza in Italy. Huge cathedral, and government buildings set around a park. We were shadowed by 2 young "panhandling" children, which quickly reminded us of the poverty and reality of their lives.

We had a short night of rest and then most of us headed out early Sat. to return home to New England. Nick and Tony have stayed behind to wrap up a few things. We checked in out Christian who is doing great, and Jonathan has promised to keep us informed.

We ran into some huge speed bumps getting home, (flight delays causing us to miss connecting flights) but being a motivated group, we used our resourcefullness and ultimately got home the morning of Sunday (after driving a rental from Newark NJ)

Well as stated above I'll download more pictures and stories with in the next week. Also I plan to update the Blog from time to time to let you all follow us through our planning for 2007!!

Adios
Terry

Doctor heal thyself

2006-06-02T06:50:00.000-07:00

It´s Friday morning. The mission is officially over and we were to leave early this morning for Quito, a day of tourism. However, two of the team are quite ill with gastroenteritis. We doctoring them the best we can, and hoping no one else gets sick. Travel plans (4 hr drive to Quito) onhold for now.

Yesterday we were in a different section of San Juan. We saw about 90 patients. A little frustrating because this group of people have a bit more resources and access to medical care. Many of them are currently treated by a local doctor for hypertension or gastritis or other chronic conditions. Yet they wanted to see the American doctors. Obviously we are not in a position to treat chronic ongoing conditions that need regular follow up. Additionally, none of them seemed to know anything about the meds they are taking (ie: names, dosage etc..)
So many patients were just given a note with their vitals and a polite recommendation re: their treatment plan.

There was a very interestinganomalyy. A young boy with 6 fingers and toes on each hand and foot. His sister had a large disfiguring birth mark/defect on one of her legs. When we questioned the mom about the rest of the family (8 children) the others were Â¨normalÂApparentlytly she is married to her first cousin. I canÂ´t download pictures right now, but I will later.

There were a lot of females with vaginal complaints. We did the best we could to examine and treat mild vaginitis (unfortunately did not have the capability to diagnose sexually transmitted diseases). I think the students were a little surprised by the number of women wanting a vaginal exam. It made for a humorous moment when Nick made a little faux pas in translating. A woman came to the clinic with samples of vaginitis treatment that we had given her neighbor. She said she had the same symptoms and wanted some of the same medication. Nick misunderstood her to say that she wanted us to give her some medication for her neighbor. So in the process of trying to say that she had to bring the neighbor to the clinic for us to examine he accidentally used the word vagina instead of vecina (word for neighbor). So the translation was you need to bring the vagina here (instead of you need to bring the neighbor here). Needless to say the whole clinic broke out laughing - locals and Americans!!! (iÂ´m sure the humor may be lost in the dialogue).

One of our young ladies was showered with affection and a romantic love letter from one of the watiers at our hostal. Flattering, but stressful for her. She let him down easy!

Last night was a fiesta with Martha and the team. We drank wine and learned to salsa. It was a nice end to our stay in Riobamba.

Adios for now, Pray that the whole team doesnÂ´t get ill!!

Terry

This is what makes it all worth it!

2006-05-31T19:46:00.000-07:00

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

2006-05-31T19:38:00.000-07:00

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

2006-05-31T19:26:00.000-07:00

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

2006-05-31T19:04:00.000-07:00

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

2006-05-28T19:53:00.000-07:00

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

2006-05-28T12:39:00.000-07:00

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

2006-05-28T12:33:00.000-07:00

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

Saturday continued

2006-05-28T12:21:00.000-07:00

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

2006-05-28T12:10:00.000-07:00

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

Yes, it´s alive!!

more pictures

2006-05-28T11:53:00.000-07:00

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

2006-05-28T11:44:00.000-07:00

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

2006-05-28T11:28:00.000-07:00

Traffic Jam Ecuadorian style

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

End of the day, unpacking the Van.

Tourism Day

2006-05-27T20:26:00.000-07:00

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

2006-05-26T16:44:00.000-07:00

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

2006-05-26T16:30:00.000-07:00

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

2006-05-26T16:18:00.000-07:00

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

2006-05-25T18:45:00.000-07:00

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

2006-05-25T18:21:00.000-07:00

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

2006-05-23T16:26:00.000-07:00

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

2006-05-22T18:22:00.000-07:00

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

2006-05-21T18:43:00.000-07:00

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

2006-05-21T18:21:00.000-07:00

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

Sunday May 21, 2006

2006-05-21T09:24:00.000-07:00

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