Life never turns out quite the way you expect it to…
This will be the final blog entry for our stay at Guadalupe, as we have returned home a little early due to a family medical issue. Just as we saw in the lives of our patients in Ecuador—and, honestly, as we see daily in the lives of our patients here at home—God's plans for us are often not the same as the plans we imagine for ourselves. We can only pray and trust that they are, by divine design, the right plans, even if we do not fully understand them at the time…
Our last week at Guadalupe was much like the previous weeks: clinic starting at 0800; lunch with the sisters at 12 noon sharp and dinner at 1800. Sunrise and sunset, as they are all year long in Ecuador, a little after 6am and 6pm, respectively. Rain nearly every day—sometimes for a few minutes, sometimes a few hours. Everything radiantly alive—green, green, green, with little sparkles of every other color you can think of scattered about here and there on plants and vines.
The patients, too, were more or less the same: people coming in for assessment in advance of the plastic surgeons coming in November and the ophthalmologists coming in January; children coming in with their parents with a request for medications to "desparacitar" (to de-parasitize); lots of gastritis; various allergies; and a random assortment of ailments familiar anywhere—diabetes, high blood pressure, headaches, etc.
Two patients stand out from the rest, however. One was an older woman, mid 70's, bent and stooped making her look more like she was 90, walking with a short stick as a cane. A son accompanied her and asked if there was anything we could do to make her better. Unfortunately, her degenerative arthritis was so advanced, there was really no easy way to reverse the damage already done, and knee and hip replacements do not appear to be realistic options in Ecuador for most people. Perhaps our emphasis should be on minimizing falls? Yes, the son replied, that would help. After demonstrating the use of a taller stick as a cane and encouraging the son to construct a homemade front-wheeled walker, using an office tray as an example and sketching them a model, they left sad but determined.
The other patient was a 19 year old woman who came in with her mother for a pre-op evaluation for the plastic surgeons. She previously had a cleft lip repair performed many years earlier, but still had a disfiguring scar that they hoped could be revised. She also had an extremely narrow palate with an extra tooth and what appeared to be a very small persistent gap. Throughout the interview and examination, the patient said nothing, as her mother provided the history and answered all questions. Concerned about cognitive issues in addition to the cleft, we asked if the patient could talk with us me directly. Speaking with a pronounced lisp, she said she could. Was there anything else she would like to talk about? After a few moments of silence during which mother and daughter simply looked at each other, we asked if the patient had thinking problems. No, they said. Can you read, we asked, probably not in the best way possible. No, the mother replied, she never went to school. Apparently, she tried a couple of times as a young girl, but the other children made fun of her deformity and her lisp, and she and her mother simply decided that she not go. In their remote rural village (a few hours from Guadalupe), no one intervened. Most likely our suggestion to try again now, as an adult, will not be possible, though we are hopeful she will return to the clinic for the repair and for more encouragement…
After years of contemplation and months of planning, our time at Guadalupe was far too short. Still, it was a blessing. Our memories of the people, of amazing nurse Amanda and the clinic staff, of the sisters, and of our Austrian and German dental colleagues and housemates will remain with us "por los siglos de los siglos" — forever and ever.
Danielle and Marc
Friday, September 2, 2016
Sunday, August 14, 2016
It was not a quiet week in Guadalupe
Which is not to say we are going to make the newspaper, but, you know, it was lively enough 🙂
Most of the week was routine, in all honesty, which was fine. Wednesday was a national holiday--though not everywhere . Apparently, different parts of Ecuador celebrate Independence Day at different times.
Anyway, Tuesday was pretty slow in the clinic. But on Wednesday, people took advantage of the day off, if they had it, and we were crazy busy. Felt like home...
My Case of the Week: a 25 yo man with partial congenital cataracts, bilaterally--nearly blind on the left. He is trying to work in a nearby city doing computer programming, but his vision is really beginning to bother him, and glasses are not helping. Never had an eye exam before, just bought glasses. Fortunately the eye doctors come in January...
Today we went to the village of San Carlos de las Minas, named after the gold mines nearby, for a "jornada" (colloquialism for "working day"). We saw 80 people over 6 hours. Many came just for "desaparasitar" -- to get treatment for parasites. Some came just for glasses: the clinic buys glasses at various strengths in bulk and we do basic eye exams and acuity checks using different size fonts for different refractions, and then we let them try different lens. Simple, but it works. Many had what I now see as local pandemic concerns--gastritis and degenerative arthritis. Kids, old folks, and entire families. Pretty fun.
Tonight Austrian dentist Andreas (Andi) is making dinner, as the sisters take the weekend off...My turn is tomorrow night. I bought achiote paste in Zamora on Thursday. We will see. Tonight, it seems the town will have music from 10 pm to 2 am. Just my style😉
Marc
Most of the week was routine, in all honesty, which was fine. Wednesday was a national holiday--though not everywhere . Apparently, different parts of Ecuador celebrate Independence Day at different times.
Anyway, Tuesday was pretty slow in the clinic. But on Wednesday, people took advantage of the day off, if they had it, and we were crazy busy. Felt like home...
My Case of the Week: a 25 yo man with partial congenital cataracts, bilaterally--nearly blind on the left. He is trying to work in a nearby city doing computer programming, but his vision is really beginning to bother him, and glasses are not helping. Never had an eye exam before, just bought glasses. Fortunately the eye doctors come in January...
Today we went to the village of San Carlos de las Minas, named after the gold mines nearby, for a "jornada" (colloquialism for "working day"). We saw 80 people over 6 hours. Many came just for "desaparasitar" -- to get treatment for parasites. Some came just for glasses: the clinic buys glasses at various strengths in bulk and we do basic eye exams and acuity checks using different size fonts for different refractions, and then we let them try different lens. Simple, but it works. Many had what I now see as local pandemic concerns--gastritis and degenerative arthritis. Kids, old folks, and entire families. Pretty fun.
Tonight Austrian dentist Andreas (Andi) is making dinner, as the sisters take the weekend off...My turn is tomorrow night. I bought achiote paste in Zamora on Thursday. We will see. Tonight, it seems the town will have music from 10 pm to 2 am. Just my style😉
Marc
Monday, August 8, 2016
Grace
Our trip yesterday was about 7.5 miles round-trip, starting along the valley floor and then up, up, up through the rainforest to a waterfall. Mud. Vines. Lots of local flora, including bananas, guava, cacoa plants, yucca, maracuya, and many others I cannot spell.
Our local hosts, Jose and Mercedes and family were gracious. Kids were terrific, especially our guides--Patricio, 19, Jinson 14, and Jonder 11-- who joined us with the dad on the hike and kept us from falling and slipping with their encouragement and a gentle hand when needed. Our medical colleagues, Austrian dentist Andreas and German dental student Oliver, were much more fit as we plodded along.
The waterfall was reached, finally, by rappelling down a short vegetation-filled embankment--maybe 25 feet--to the base of the fall, which was itself maybe 30 feet high.
A meal of empanadas and papachinas (some sort of local potato variant) and horchata tea (made from local flowers and herbs--not Mexican horchata) was waiting for us from Mercedes on our return., before we walked back home along the river.
GRACE in the water of the fall and the water from the sky. Grace in the warm and lovely people we have met. Grace for simply being here.
-Marc
Our local hosts, Jose and Mercedes and family were gracious. Kids were terrific, especially our guides--Patricio, 19, Jinson 14, and Jonder 11-- who joined us with the dad on the hike and kept us from falling and slipping with their encouragement and a gentle hand when needed. Our medical colleagues, Austrian dentist Andreas and German dental student Oliver, were much more fit as we plodded along.
The waterfall was reached, finally, by rappelling down a short vegetation-filled embankment--maybe 25 feet--to the base of the fall, which was itself maybe 30 feet high.
A meal of empanadas and papachinas (some sort of local potato variant) and horchata tea (made from local flowers and herbs--not Mexican horchata) was waiting for us from Mercedes on our return., before we walked back home along the river.
GRACE in the water of the fall and the water from the sky. Grace in the warm and lovely people we have met. Grace for simply being here.
-Marc
Our Days
We only arrived less than a week ago, but a routine has already set in. Everyone is welcoming.
Our days are spent at the clinic, which is not as busy right now. We are seeing babies, children, and a full range of adults. Many have intestinal complaints--some more likely reflux disease and gastritis, but many likely due to recurrent amebiasis or giardia. There is no lab here; everyone is treated empirically. Elderly folks with chronic joint pain, likely due to the physical nature of their everyday lives. The clinic has a supply of basic medications which we are using regularly. We are doing some pre-op evaluations for in advance of a group of Austrian plastic surgeons coming in November: scars, burns, one very large cleft palate so far. Just trying to help wherever we can.
Lunch and dinner are promptly at 12 noon and 6pm with the Sisters during the week. They are gracious and very friendly with a great sense of humor. Four sisters reside here, 3 originally from Colombia and 1 native Ecuadorean. The clinic is on a "compound" that includes the Sisters and priests residences, our house for visiting medical staff, the parish church, and an expanding retreat center that is used for both spiritual and secular gatherings. The grounds are lovely, with fountains and colorful flowers scattered among the verdant natural vegetation.
The peacefulness of the valley is present daily, invisible birds chirping at times softly and at time loudly in the trees. And today we have had the continuous pitter patter of the rain, a fairly constant phenomenon here in the Ecuadorean rainforest where temperature (highs of 75-80, lows 60-65) and daylight (sunrise and sunset both 6-6:30) are the same all year long. Clouds have been every present, drifting up and down among the hills and mountains. Music emanates from various houses in downtown Guadalupe, across the river. Lots of happy people here, it seems.
The pueblo itself is small and welcoming. Friday night, we watched 2 local futsal teams (indoor soccer) playing in the town center on a covered, cement basketball court. Lots of families on the sidelines cheering, just like home!
Already we feel the presence of Christ in the people here and their willingness to share their culture and food.
Yesterday we had the good fortune to spend time with a local farmer, Jose, his wife, Mercedes, and their family.
Mass today in the parish church was typical, we are told. Lots of lively music and both old and young singing and visiting.
Back to work tomorrow.
-Danielle
Our days are spent at the clinic, which is not as busy right now. We are seeing babies, children, and a full range of adults. Many have intestinal complaints--some more likely reflux disease and gastritis, but many likely due to recurrent amebiasis or giardia. There is no lab here; everyone is treated empirically. Elderly folks with chronic joint pain, likely due to the physical nature of their everyday lives. The clinic has a supply of basic medications which we are using regularly. We are doing some pre-op evaluations for in advance of a group of Austrian plastic surgeons coming in November: scars, burns, one very large cleft palate so far. Just trying to help wherever we can.
Lunch and dinner are promptly at 12 noon and 6pm with the Sisters during the week. They are gracious and very friendly with a great sense of humor. Four sisters reside here, 3 originally from Colombia and 1 native Ecuadorean. The clinic is on a "compound" that includes the Sisters and priests residences, our house for visiting medical staff, the parish church, and an expanding retreat center that is used for both spiritual and secular gatherings. The grounds are lovely, with fountains and colorful flowers scattered among the verdant natural vegetation.
The peacefulness of the valley is present daily, invisible birds chirping at times softly and at time loudly in the trees. And today we have had the continuous pitter patter of the rain, a fairly constant phenomenon here in the Ecuadorean rainforest where temperature (highs of 75-80, lows 60-65) and daylight (sunrise and sunset both 6-6:30) are the same all year long. Clouds have been every present, drifting up and down among the hills and mountains. Music emanates from various houses in downtown Guadalupe, across the river. Lots of happy people here, it seems.
The pueblo itself is small and welcoming. Friday night, we watched 2 local futsal teams (indoor soccer) playing in the town center on a covered, cement basketball court. Lots of families on the sidelines cheering, just like home!
Already we feel the presence of Christ in the people here and their willingness to share their culture and food.
Yesterday we had the good fortune to spend time with a local farmer, Jose, his wife, Mercedes, and their family.
Mass today in the parish church was typical, we are told. Lots of lively music and both old and young singing and visiting.
Back to work tomorrow.
-Danielle
Monday, August 1, 2016
We made it!
Then we got here and started right in.
Between us, 14 pts with a multitude of problems, some acute and
some chronic (hypertension, diabetes, GERD, mono) , old and young (5
months to 80+ years).
Some very straightforward; some a little challenging to
understand--and I don't mean language, exactly, but trying to figure out
the difference between what they are saying and what they really mean
to say. All of them very nice and happy to see us. One man came on a
bus-14 hours away; his daughter lives nearby.
We even have an EMR. Ugh.
The sisters seem like a lively group. Curious and friendly. Clearly trying to fatten us up.
Nurse Amanda is terrific:)
Hasta ...
Danielle and Marc
Thursday, July 21, 2016
It's only July, but it feels like Advent.
We are looking forward to our month in Guadalupe with great
anticipation!
As we near our departure next week, however, we are beginning to
wonder if we are going to be ready. Preparations for 5 1/2 weeks in Ecuador,
away from home and work and family are beginning to feel a little overwhelming.
What do we bring? We have reviewed the recommendations from
Padre Jorge and staff and we have communicated with Dr. Christa Balch, who is
at Guadalupe now, but we still wonder if we will have the right things. Like
enough bug spray. Thankfully, no Zika.
Is it silly to think about the right shoes?
Nurse Amanda has suggested we read up a bit about parasites. So
we have. Still, when a patients walks in with parasites, will we know them when
we see them?
And why does work (i.e. our work here at home) always
seem to become more complicated before going away. And this time, it has meant planning for our
patents here for much longer than usual.
Stressful for them and us—and our staffs.
Just leaving home is another thing. We have a house sitter.
Good. But what if something happens? How much do we worry in advance?
We have three young adult children, all with plans and projects
at work, home and school over the next couple of months. Our family has always
been our first priority. To be honest, we feel a little guilty leaving them
this long.
And yet, we are so very much looking forward to being present to
the people of Guadalupe and serving them the best we can. This has been a calling long in the making.
We pray that we will answer it well.
Advent. A time of waiting and preparation. A beginning.
Let's go!
Thursday, June 30, 2016
Saludos!
We are two 50+ year-old family physicians from Salinas, California grateful for the opportunity to
spend a month in Guadalupe, Ecuador this August. Danielle works 1/2
time for a small local private practice, caring for patients of all ages
with all kinds of problems. Marc works for our County hospital,
Natividad Medical Center, seeing patients, teaching in the family
medicine residency program, and chairing the hospital's ethics
committee. We have three adult children
who are all busy with their own lives and careers: Gabriela, a lawyer
by training who does health care policy work; Dominique, who will be
starting her first "real" job doing research work after obtaining
Masters degrees in education and social science evaluation; and Matthew,
a second-year medical student.
Outside of work, we are active parishioners at St. Joseph's Church in the town of Spreckels, just outside Salinas, where Marc grew up. Danielle is active with the student exchange organization, AFS. We have hosted students in our home five times over the years. Marc helps staff a small homeless clinic for two hours a week, and he dabbles at academia by working on projects in clinical ethics.
A very long time ago, we considered mission work…and then we had a family, worked a couple of years for the Indian Health Service here in the U.S., and put the idea of international mission and service to our common global family on hold. Until now :)
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