Day One: Sunday, March 17 - Arriving in Guayaquil, Ecuador
What an awesome day so far! Since this is the first post, I'll make sure that it's detailed.
We arrived in Guayaquil around midnight. We immediately had to jump on a four-hour bus ride to Puerto Lopez, which is 20 minutes from the region we are serving in, Agua Blanca. I was probably sleeping or something, but I was told that our plane had to fly around an erupting volcano in order to avoid the ash, which I think is awesome! We were able to get a few hours of sleep before going to set up clinic. When we woke up, I spent a few minutes looking out the window. It was only then that I realized we were sleeping directly on the Pacific coast. I calmly admired the scenery as I watched locals, young and old, slowly walking up and down the red brick road.
On our way to breakfast down the road, I was stopped by a couple guys. I figured it was probably because I looked American or ugly or something, but quickly realized it was because I was wearing my scrubs, and they were yelling "Doctor! Doctor!" Me no habla no Espagnol, so I just smiled big and listened. These gentlemen explained that they were planning to visit our clinic in Agua Blanca today, and proceeded to show me different spots on their body that they needed checked out. This caught me off guard since we were 20 minutes away from the village we planned to serve, and I was in the middle of the street being asked to assess skin lesions. It was a good start to the day knowing that we would be seeing individuals from all the neighboring communities.
Upon arrival in Agua Blanca, our group was very kindly received by the local goats, pigs, roosters and dogs. And people too. But there were a lot of free-roaming animals. We set up our pharmacy/headquarters inside their beautiful, yet humble church. Seventeen bags full of medications and medical supplies! We then broke into four groups, each consisting of medical students, a doctor and a translator. Each group set up its own clinic in the neighboring huts that were opened up to us. And then patients started rolling in.
In my group, our first patient was an abuela (grandmother) with three of her grandchildren, each of them presenting with problems to be addressed. As we assessed the musculoskeletal and neurological status of the abuela, we were very sad to learn of the degree of domestic abuse in the region. Our patient's problems stemmed from physical abuse from her previous spouse, and the mother of the young grandchildren accompanying her died five years ago from physical abuse. Our translator explained to us that this is a trend across the entire country of Ecuador. Please consider praying for the individuals who suffer from these unacceptable issues.
We grabbed some lunch and continued to see patients until the end of our clinic day. My group saw another beautiful family, consisting of a mother, father and a 3-year-old girl, mucho linda (very cute). Also, we got to see something I have never seen before. A gentleman presented to us with redness and nodules on the nasal aspects of his eyes, bilaterally. Having no clue what it was, Dr. Chuang taught us that these (pterygium) are common among the people in this region. The patient also informed us that some of his friends have the same thing. Another group mentioned that they saw a patient with tabes dorsalis, a neurological complication that accompanies tertiary syphilis.
All in all, today was amazing! A few of us took a post-clinic dip in the ocean, and there was a lizard climbing the wall in our room. I think it's still there. He is more than welcome to stay. Considering our insightful debriefing session tonight, we're set to see many more patients tomorrow! Please keep our amazing group, and the patients that approach us, in your thoughts and prayers.
Day Two: Monday, March 18 - Making strides in sustainability
Our group is amazing - nine med students, four docs, three translators, one community organizer. Coolest people ever. We have all expressed our appreciation for one another, especially for the doctors accompanying us. Not only have they been incredible mentors, but we've learned so much already while treating real patients!
I wish I knew Spanish. Not that it's a problem during clinic, but it would be nice to directly communicate with the people we're here to see. Our translators have been incredible, and there are a few people in our group who are fluent. We actually discovered that two of our translators are in their final year of medical school here in Ecuador. It's very nice of them to accompany us during their break.
We were able to see 103 patients today. After just one day of experience, our workflow and patient interactions improved tremendously. There were some very interesting cases, and much opportunity for patient education. We've also made strides to ensure that our work here is sustainable in terms of continued access to well-being in the absence of formal local health care. We're hoping that the patient feedback will help us assess future need.
The population here is extremely welcoming and trustworthy of our care. This is very comforting, as we are obviously a foreign group of doctor-looking people coming into their territory hoping to help where help is needed. Also, there's nothing like being around so many cute little kids all day! They're everywhere!
At some point today, we were analyzing a urine dipstick of a little girl who presented with lower abdominal pain. We were standing over the edge of a porch, thinking deeply about the results, as a big black pig walked out from under the deck, shoved its face into a puddle of mud and decided that it was a good idea to roll around in the puddle. The girl's urine was normal.
I would say today was a great success. I thank God that everyone with us is safe and looking out for each other. Again, please keep our group and our host community in your thoughts and prayers.
Day Three: Tuesday, March 19 - A critical situation discovered
A few people in our group have gotten sick, but all are still in good spirit. We opened clinic for about 10 hours today, as patients were rolling in non-stop -- 158 patients seen and treated today!
Such a crazy day. We saw families, individuals, kids, babies, elderly, everyone. One thing we've noticed is that as the days pass, we keep seeing more families from further villages. I'm not exactly sure how the word spread so far, but it did, and we're happy. To us, it really speaks to the need of health care in the region and to the trust they have for us to provide it. We're appreciative of the groups in previous years for establishing this trust with the community. It's been interesting to recognize the beautiful mutual relationship between our medical education and the actual treatment of people in this experience. We've learned so much while helping the people who come to see us.
We had the opportunity to see some extremely interesting cases today. One of my patients presented with chronic knee pain and extreme swelling bilaterally. He wanted something to alleviate his pain, and possibly somebody to drain them. With the guidance of Dr. Chuang, I was able to do an ultrasound-guided knee tap on both knees!
A family of four came in for a check-up. The first patient of the family that we talked to was the grandmother. She complained of bad chest pain for the past three days, headache and abdominal pain. We were worried about the chest problem first, as she complained of a feeling of pressure on her chest wall. Her blood pressure was 240/110 after checking it twice, so Hieu Nguyen and I immediately consulted the doctors, gave her a regimen of aspirin, beta-blocker and told the family that she needs to get to the nearest hospital as soon as possible. Like now. The family was very resistant because they all still wanted to be seen for their own medical problems, the hospital was far and it would cost too much money. We had to convince them (via our amazing translators) that this was a medical emergency and the grandmother could die. Believe it or not, this part was very difficult. One member of the family finally decided to take her while the other two remained. We pray and hope that she made it and was able to be seen.
The two that remained, mother and son, we're just as interesting. The mother presented to us with a variety of problems, two of which were abdominal pain, mostly with exertion and constipation. We diagnosed her with the same problem that her son was diagnosed with, duodenal ulcer due to H. pylori infection, and treated her for that. Upon examination, we also found a direct hernia with a loop of bowel hanging out. Unfortunately, we had to tell her that we can treat the pain, but the hernia needs surgery because it will only elaborate her current problems. And that's when the tears started flowing. A simple solution for those with access to health care, yet such a painful and debilitating problem for those without. A lesson to be learned: These are real-world problems, never take your health for granted and compassion may sometimes be the only medicine you can offer.
Many great cases, a lot of learning, bunch of fun with goats, hectic schedule, a ton of beautiful interactions with the local population and a post-clinic dip in the ocean. I'd call that a great day.
Day 4: Wednesday, March 20 - More than 360 patients treated
Today marks our last day of clinic. It was an excellent one, but we all felt a bit sad and weird about it ending. We all reflected on how much work and preparation was needed to maybe make a difference in the life of a few people -- completely and absolutely worth every ounce of effort.
We started the day with 40 patients on our list since we only had a half day of clinic scheduled, but ended up seeing 70 because more people continued to show up for care. We hope that everyone who came through ended up receiving the care that they needed.
The community of Agua Blanca served us its homemade lunch immediately after we closed our clinic. The leader of the community expressed his gratitude to us over a hefty plate of goat, rice, soup, veggies and a glass of fresh juice.
More than 360 patients seen in only three and one-half clinic days. I just want to give a very well-deserved shout-out to our entire group for the hard work put into this mission -- Dr. Chih Chuang (big man on top), Dr. Ginger Connor, Dr. Rodrigo Rodrigues, Dr. Tracy Barbour, Jorge Vargas (organizer of affairs in Ecuador), Crystal Drayer (trusty trip leader), Mark Zekaj (sustainability), Corey Lake (drug lord), Hieu Nguyen (drug lord), Anupama Rambhatla (fundraiser), Chris McHugh (flight coordinator), Sarah Gleason (treasury), Thomas Maatman (fundraiser) and Allen Kadado (co-trip leader).
On our way back to Guayaquil, we stopped at a surfer town called Montanita. I have never been to a surfer town before, so this was very interesting. The town itself was beautiful, not to mention the gorgeous beach. We went swimming. By swimming, I mean we got destroyed by enormous waves. The town also consisted of some very unique people, which made it a ton of fun.
Now, we're in Guayaquil for the night. Flying to the Galápagos Islands in the morning!
Day 5-10: Exploring the beauty of the Galapagos Islands
Galapagos! It'd be a shame if we left Ecuador without checking this place out. There are many islands, and they are much bigger than we had assumed. The total population of the Galapagos is about 25,000, which is mostly distributed among two main islands. Most of the land is considered national park, which preserves its natural beauty.
Words cannot explain the beauty that we encountered during our stay at the islands. It was like watching "National Geographic" or "Jurassic Park" all the time, but in real life, of course. We embarked on some hiking, snorkeling, more hiking, more snorkeling, boat rides, bus rides, village life, etc. We walked and swam with sea lions, land iguanas, marine iguanas, pelicans, frigate birds, blue-footed boobies, diving birds, crabs, sharks, giant tortoises, sea turtles, sting rays and millions of fish. We had the opportunity to explore the land and sea of multiple islands, including Santa Cruz, San Cristobal, Seymour North, Baltra, Sleeping Lion/Kicker Rock and more. We hiked the edge of volcanic craters, lava tunnels and wildlife reserves. We also saw the first point at which Charles Darwin landed on the islands in 1835. Most people believe that Darwin is the reason for Galapagos' fame due to his eloquent scientific observation of the region's unique wildlife.
I haven't been to many places, but I am utterly convinced that the Galapagos is one of the most beautiful places on this earth. If you wish to see nature that has been virtually untouched by man I suggest checking it out. The Galapagos Islands are obviously a huge tourist attraction, but it does not feel this way unless you're inside a souvenir store.
This was such an incredible opportunity to appreciate creation, admire the Creator and simultaneously reflect on the scientific understanding of our existence according to the teachings of Darwin himself. We live in an amazing and beautiful world, and I am extremely thankful for the opportunity to directly experience this with such great individuals.
To conclude, our voyage to Ecuador was a great success. We hope that our hard work was beneficial to those who reside in and around Agua Blanca. We came to serve a community, but left feeling as though we were served. We learned so much, encountered many unique cases and ate their goat. We gave immediate medical care during our stay, but also made strides to instill sustainable practices in the community. We came with 17 bags full of medications, supplies and medical information, and left with zero. We made lasting relationships with our translators, organizers and the local population.
As far as our group, I love them all. I'm thankful to have experienced my first medical mission with such great peers and mentors. A big thank you to Crystal Drayer for excellent leadership and planning this trip, to the group for all the hard work before and during the mission and to World Health Student Organization as a whole for making these things possible. I came hoping to discern whether the medical mission life will play a role in my future and hoping that the trip may influence me down one medical path or another. I am leaving very influenced, and very enthusiastic about my remaining medical education. Glory to God!
Allen Kadado is a Wayne State University School of Medicine medical student volunteering in Ecuador through March 25, with the school's World Health Student Organization, a student-run organization. WHSO's medical mission trips are funded by donations. For more information about WHSO, or to donate to a future trip abroad, click here.