"Papanicolau"

Doctora: "blah blah blah, blah blah, blah papanicolau blah blah, blah?"
Me (pretending to know what's going on...my ultimate downfall): "ya ya ya, bueno!"

Dra. dons a pair of surgical gloves, motions me over to the patient bed, and hands me an ancient-looking metal clamp device. The patient, a woman in her 50s (although most women here tend to look a lot older than they are), starts unbuttoning her pants. Meanwhile, I'm holding this monster clamp in my right hand watching this woman willingly reveal her world, feeling my gracious smile beginning to twitch. What have I gotten myself into?


In Ecuador, like in most other countries in the world, high school graduates apply to universities as a medical student. In other words, there is no such thing as "pre-med." To save the confusion in trying to explain this minor discrepancy, I tell the doctors that I'm a 5th year med student (my logic being that I've had 4 years undergrad training as a pre-med, planning to start my 5th year as a medical student-here's hoping!). I'm about to find out just how much "5th year med students" in the US are perceived to know by Ecuadorian doctors...

The clinic where I've been shadowing for the past month functions under the Ministry of Public Heath in Conocoto, and provides free services to its patients who cannot otherwise afford basic health care. I would've walked right past the unlabeled building if it weren't for the locals directing me to it. It made the clinics in ghetto downtown Baltimore seem like penthouse suites. But I loved it.

Lines as long as those formed in Ohio on Nov. 4, 2008, appear every morning before it opens at 8am. The clinic has 2 nurses and 7 doctors (2 obstetricians, 1 gynecologist, 2 pediatricians, 2 general practitioners), who's showings are as predictable as Ecuadorian weather (that is, very UNpredictable). Over the course of the next couple months, I had the lucky opportunity to do clinical rotations and shadow a different doctor each week. On my first day (that is, after a few no-shows), I shadowed Dra. Espinoza, an obstetrician. She taught me the word papanicolau, which means "pap smear."

Details aside, I can now brag to the boys that I've gotten more visual action than they have since arriving in Ecuador. Not sure how jealous they are about this, but I'd like to think so.

It it weren't for the lack of liability, I think I would have been in some legal trouble. The staff just don't seem to fully grasp the meaning of "no, no todavia he aprendido eso" (no, I have not yet learned that). I've been asked to prescribe medicine, after first handedly witnessing my broken Spanish (don't worry, I didn't. Not about to build a malpractice track record that will haunt me for ages). But I did get to take patients' histories and fill out various medical forms in Spanish, fill out prescription forms (with proper assistance), and perform/record basic clinical procedures (blood pressure, weight, height, temperature). How accurate they were would be another story...seeing how I taught myself how to take blood pressure from a CVS pamphlet... But hey, the nurses seem to trust my measurements over their own. It must be the white jacket? Or being Asian?


Nonetheless, these experiences have confidently prepared me for medical school in the future, which I am immensely grateful for. I can definitely see myself, and plan to be, working long-term in a clinic that serves underprivileged citizens such as this (apart from the flakiness). However, it did, I have to admit, confirm my interests to not specialize and instead go for primary care...at least over ob-gyn. :)

SI SE PUEDE!!!!!!!!!!!!!!!!!!!

WOW. I cannot even begin to express how ridiculously ecstatic I am!!!!!!!!!! The expat/international support for our NEW PRESIDENT is extraordinary and truly inspiring. I was moved to tears tonight, along with the rest of the nation, and still feel so overwhelmed and proud of the UNITED States of America. This has definitely been one of the most exciting historical moments I have experienced in my life, and am grateful to have spent it with my wonderfully Obama-loving Manna family.

From the equator, Salud to change that we need and new hopes for tomorrow :)

Debate gatherings of expats (and reactions):


B.O. rep (debates + election day)


"Como se dice, como se llama...Obama! Obama!!!"


...and the results are in!!!








OBAMA/BIDEN 2008.

Program Update

A brief update on programs I'm currently involved in...

*Clases de ejercicios para las mujeres*

A woman’s exercise program is in the works! After coordinating a couple meetings with the community church leaders of Tena’s Evangelical Church, we have tentatively scheduled the first class to be Thursday, Oct. 16^th. It will be held on Mondays and Thursdays every week, from 7-8pm at the church, for duration of two months. Cost is $2.00/month. (How’s that for a monthly subscription!) Holly will be leading yoga, Jocelyn stretching, and me cardio/abs (thank you Billy’s boot camp!). Do keep in mind though, that MPI has absolutely no religious affiliation. Having these classes at the church has been one of our main concerns, since we run into the problem of turning away communities not affiliated with the Tena church; however, it is rare to spur immediate vibrant interest in a program in such a short time span. Their excitement feeds our passion, and we are ready for the challenge. This program will mainly serve as a pilot, and if/WHEN successfully executed, we plan to expand it and incorporate a wider range of health topics to be discussed after Christmas break. Vamos a ver. Needless to say, this is going to be a hefty but rewarding experience.

On the first day of class, we plan to measure the participants’ physical and mental well-being, which will be qualitatively assessed through surveys and quantitatively measured through the participants’ weight, blood pressure, and heart rate. These physical measurements will be taken once every two weeks.

Most importantly (and sacrificially), the girls that will be leading the class will be making an unprecedented effort to not consume one carton of ice cream and jar of peanut butter/nutella per day, and limit to one per week (unless we are PMSing).

***UPDATE as of 7th of November, 2008***

We currently have 24 women ages 16-68 years registered for the program. 14 people showed up on the first day; 21 on the 2nd; 24 on the 3rd. This has been the most successful initial turnout in any MPIE program--que buena! The women have consistently been requesting for more classes per week as well as program continuation into the next year. Starting Nov. 17th, we'll be offering 3 classes/week, one of which will be devoted to abs (the women are obsessed with ab workouts), where Dana will be taking the reins.

General class structure is as follows (varies each day):
-10 min. stretching
-25-30 min. cardio/taebo/weights/abs
-15-20 min. yoga

According to the preliminary health assessment, a significant majority of participants indicated "nutrition" as their primary health topic interest. Thus, every class, we distribute a different handout outlining a specific nutritional topic, ie, how to read a food label; how to calculate BMI; how to measure heart rate/blood pressure and what the numbers mean; basal metabolic rate; food pyramid; caloric contents; keeping a food diary, etc. Feedback has been incredibly positive so far, and we remain optimistic.

I have to admit though, the hilarity of watching the various women doing jumping jack round-house kicks is not to be underscored. With every class, however, they are improving significantly, and really get into it along with us profes.

DALE DURO SE ACABO NO SE RINDAN USTEDES PUEDEN!!!!!!!! (work it hard that's it don't quit yes you all can!!!) -consistent words that spontaneously find their way out of my mouth

*Extensión de la clínica de salud de la Fundación Aliñambi*

Mark and I are helping to incorporate the Aliñambi clinic into the public health system through the Municipio de Quito, so the clinic can be self-sustainably open to the wider communities of the valley. The long-term goal is to make Aliñambi a public, cost-independent, and sustainable clinic with a full-time Ecuadorian medical director that serves the communities of the valley. This will be reached through short-term financial assistance from US-based Foundation Healthechildren as well as our assistance in fostering these efforts. We will be responsible for constructing a 5-year contract that outlines the specific objectives and responsibilities of Aliñambi and Healthechildren, to be signed by each party. The contract will first be revised by Aliñambi and then Healthechildren before the final version is implemented. We will continue to facilitate and maintain communication between Aliñambi and Healthechildren, aid Aliñambi in any way possible with the smooth execution of its responsibilities, and physically distribute the funds provided from Healthechildren to Aliñambi. Healthechildren has also submitted a proposal in early July 2008 to generate funds for Aliñambi (up to $460,000) under the Guess application, and is one of two finalists. We will find out within the next month the status of the application. Exciting stuff!

*Apoyo escolar*

Beginning on Monday, 9/1/08, we’ve been assisting children ages 7+ with their homework and general study habits, every Monday to Thursday, from 2:30 to 4pm at la casa barial in San Francisco. So far, we have 15 kids attending regularly, which is a good turnout, since more is expected to come after Christmas break. I think I am learning just as much, if not more, by helping the children with their deberes, from discombobulated Ecuadorian math to the country’s geographical provinces, I have had my fair share. I'm unconditionally obsessed with the kids, and have developed a deeper appreciation for abrazos y besos grandes :)


*Mingas (community projects)*

Day 1: 9/20/08 (to be posted)

Before...


Day 2: 10/4/08 (to be posted)

...50+ trash bags, 100s upon 100s of cancerous bottles, toxic fumes and a dead dog corpse after:


*Clases de ingles*

La profe Jocelyn is kept busy lesson planning for the beginner English class for adults, which takes place right before woman's exercise. Dunc, Eliah and I are the "substitute" teachers, stepping in to teach the students how to sing "I am the Walrus," "Head, shoulders knees and toes" and Fuzzy Wuzzy, to name a few.

Profes Jocelyn and Eliah in la clase de ingles:


Fuzzy Wuzzy...



For a more complete summary of all our programs, please visit our webpage.

1 Gringa, 1 China, 2 Pilseners, 4 bare legs

When daylight wanes, ventas and restaurants begin to close their doors. This occurs around 7pm, give and take 15 minutes.

It was 9pm on a Saturday, 9/6/08. Jocelyn and I were wearing dresses, not caring one bit how they clashed with our beloved raincoats. 9/10 times a car drove by, piropos (flirtatious wolf whistle) ensued. Ecuadorian piropos take many shapes and forms: the common wolf whistle, the serpent hiss, the sticky lip smack, and occasionally the "chi-chi" (hint: meaning is derived from the tunnel through which we were conceived). We were used to this by now. Today, however, we were pretty much asking for it. Picture una Gringa and una China, in Cheojijon, plopped on the side of a street with bare legs, downing 40oz Pilseners, with an over-eager cow that could probably be heard 5 miles away.


Let's rewind 3 hours.

6pm: Jocelyn and I attended church in Tena to get to know some community members more personally and introduce the possibility of starting a woman's exercise and English class program. Church is a great starting point to recruit participants to programs as well as to expose yourself in a safe social environment...that is, unless you go to an Evangelical Christian Church. Two important lessons:

1) When the Evangelical pastor asks if you believe in God, you don't respond with "I'm agnostic." That doesn't work very well. Oh Dios Mio that will get you in trouble here.

2) There isn't really an Ecuadorian Spanish word for "awkward." Without giving Jos and I previous warning, the pastor, Francisco Haro, asked us to speak in front of about 80 church members on stage, under the "house of God," about ourselves, our purpose here, MPI, etc. I tried walking as slowly as possible up the stage to try and formulate some sort of elevator speech on the spot; however, Jos's 5 foot 9 stature did not allow this to happen (we call her "piernas", or legs, for a reason). This is when being un-fluent in Spanish comes in handy, because then you're not expected to talk fluidly in awkward improvisational situations such as this. I took full advantage of this, aka adding a couple words here and there as Jocelyn gave the general schpiel about our organization. Good news is, there is definite interest in a woman's exercise program as well as English classes. So that will be in the works. Stay tuned for upcoming details...

Everyone at the church did welcome us (children of God) with open arms, and really appreciated what we were trying to do.

After our arms almost fell off "levantar'ing los manos" during 20 minutes of singing songs about our love for God, we were invited to one of the community leader's homes (Bertha), and met the entire family (who also formed the band at the church). Jocelyn and I were bombarded with questions (some religious) that Bertha insisted upon us. Inevitably, I was asked if I knew kung-fu (accompanied with imitating arm movements) immediately after they found out I was Chinese. This would subsequently occur 2 more times (two of them from the same person). Before we left, Bertha kindly read us a Bible verse about how we should close our eyes and ask for Dios whenever we are feeling sad or afraid, and He will save us. I won't go into details of our conversation in that house, but I can tell you three words sum it all up: AWKWARD AS HELL (God forgive me).

The bus ride home was another story. I learned that you should trust your instincts over an Ecuadorian’s words (yes, even my spatial orientation instincts).

A bus comes.

Jos and I: “A Conocoto?” (to Conocoto?)
Bus personnel: “Si suba suba!” (Yes, come up come up)

30 minutes later (after we paid), we realize this bus is going a different route.

Me to bus personnel (in Spanish): “Uhhh, is this bus going to Conocoto?”
Bus personnel: “No, a Amaguaña.”
Me, turning to Jocelyn: "F@%#. Not again."

Bus screeches to a stop in the darkness. "Baja baja!" (get off)

Great. Pepper spray in pocket. Closes eyes and asks for Dios.

After walking about 15-20 min in complete darkness, we finally find a small venta that is opened, and ask where we can catch another bus or get a taxi. Apparently we were going the opposite direction of Conocoto. We were literally in the middle of nowhere. After a few failed attempts at calling a taxi, we finally got in contact with one, which arrives almost an hour after. That’s when we decided it was a good idea to get a couple beers to make the time go a bit faster.

Thank God for Pilseners.

la Mitad del Mundo

The closest I can get to all my loves in the Northern Hemisphere :)


las chicas

Splitting the Equator

Welcome to the center...

...OF THE EARTH!!!!!!



Bailamos

Things I wish I had known...

*1. When possible, choose the window seat on crowded buses (esp. if you are a female). You never know what to expect in this "machismo" society. Avoid standing/sitting next to men wearing gym shorts. You might end up using an entire bottle of antibacterial gel on your leg...

2. Sometimes it's better to admit you can't understand what someone is saying instead of pretending like you do. Example:
-'Planned parenthood' lady (in Spanish): "Are you on any kind of contraceptive/protection plan?"
-Me (no idea what she just asked): "No mucho." (Not much)
-'Planned parenthood' lady and Eliah: *laughing at me*
-Me: *awkward smile and chuckle*

3. Never flush ANYTHING down the toilet.

4. Always bring your camera with you (in case a cow decides to give birth in front of the classroom like Jocelyn and Dunc)

5. Avoid carrying anything over a 5 dollar bill; otherwise, you may not get change.

6. Pennies are worth saving.

7. Use "tengo calor" to say "I am hot" instead of "estoy caliente" (which is a more inappropriate meaning of "I am hot").

8. Don't rely on the internet to find information on...anything around here.

9. If you like someone, say "Me caye bien" instead of "Te gusta." (Girls will think I'm attracted to them, and guys will think dirty dirty thoughts)

*10. On Wednesdays, immediately leave Bungalow seis after 10pm when they let all the hungry Ecuadorian males in (ladies drink free 6-10pm every Wed).

*11. Do not look at an Ecuadorian man on the street in the eye for over 3 seconds. They will think you're interested.

12. Don't trust a stray dog like Diego who will use Gringos for food and then leave you and break your heart.

13. Do not tell an Ecuadorian you don't like Pilsener (an Ecuadorian beer) even though it really is gross. It will shatter their national pride and they will get defensive.

14. Don't attempt to play soccer with locals until you have had plenty of time to acclimate.

15. Always bring a rain coat with you...everywhere.

16. The Godfather is the most confusing movie ever made in the history of mankind.

17. "Chinese" restaurants are owned by Ecuadorians.

18. Bed bugs actually DO bite.

19. Try to put national pride aside if you want to conquer the world in "Risk."

20. Don't tell Ecuadorian Evangelical Christians you are agnostic, or worse, atheist.


*Disclaimer: Not trying to give off the wrong image of Ecuadorian men. Many are really genuine and respectful, and almost everyone we've met are extremely helpful and friendly.

8.10.08

Ecuador's Independence Day: the only day of the year when you will see thousands upon thousands of Ecuadorians out on the streets (mostly to visit the museums which are free that day). $1 cajita de vino durazno? por qué no?

1) Cathedral visits (not mandatory to pray)


2) "Hay mucha mucha gente"


3) Drum beats and Ecuadorian clowns


4) -"Hey Craig, a piece of the firework just fell on me!"
-"Je-Je!"
-"Smell it!"
-"Je-Je!"


5) "WOW!...MIRA!" (pyrotechnic show)


6) In good company


7) Mimers


8) Ruining the mosh pit