Jungle Doc

“The thing about rights is that in the end you can't prove what should be considered a right. So I can't show you how, exactly, healthcare is a basic human right. But what I can argue is that no one should have to die of a disease that is treatable.”

-Paul Farmer

Yet, they do. Worldwide, millions die from entirely preventable causes ranging from malnutrition to diarrhea. Some victims simply cannot afford medical care; even routine procedures or basic antibiotics can be prohibitively expensive. Others lack access to medical professionals, as is often the case in Ecuador. Although health care is free and universal in Ecuador, many remote communities lack medical facilities and trips to the nearest hospitals and health centers can be quite costly.


As a means of addressing the disparity, teams of doctors, such as the crew I accompanied to Palanda and Zumba in March, often travel to these villages and provide very low-cost health care. While these brigades are certainly needed, there short duration often severely compromises the quality of the care provided. As the doctors only visit once per year, they cannot adequately address chronic health issues plaguing their patients as there is no continuity of medical services. Yet, the doctors generally cannot visit more frequently; job and familial obligations in the United States and other countries obviously reduce their availability.


Given such limitations, the Timmy Foundation has devised a new formula for organizing medical brigades in Guatemala, Ecuador, and the Dominican Republic. In each country, they have adopted about 10 sites without access to adequate medical care. The non-profit organization, based in Indianapolis, then coordinates teams of doctors who visit the community ever two months to provide continuous care. If a physician determines that a patient needs more advanced care than can be provided in the community, the Timmy Foundation then subsidizes a trip to an advanced medical facility in a city.


Although an innovative system, it is not a panacea. As the doctors only commit to one annual visit, the attending physicians change each time. Thus, they are often unaware of the patient's history and the reasoning behind certain treatment regimens. Moreover, some treatment plans are simply too dangerous to administer with little oversight due to serious side effects. It is, therefore, too risky to prescribe psychotropic drugs even to patients in desperate need of such medication such as a twelve-year-old boy suffering from post-traumatic stress disorder after being kidnapped (and later rescued) several years ago. Doctors can only prescribe fish oil and other placebos in these situations.


Regardless, the Timmy Foundation does much good in Ecuador and around the globe. I recently joined a team of five doctors, numerous medical students, and Timmy Foundation staff to provide medical care in numerous villages buried deep in the jungle...provided that we could arrive.


And arriving was never as easy as it sounds. Some villages are only accessible via boat. Others required that we ford raging rivers in our pick-up trucks. Occasionally, we just abandoned our vehicles in the muck and trudged along on foot carrying gigantic bins of medicine and multi-vitamins in our arms.


Yet, however challenging the journey, the reception always made it clear how needed the medical brigades are in many of these communities. As we appropriated outdoor classrooms and turned them into makeshift hospitals, residents began lining up to register and receive care. Prior to the consult, all patients receive a supply of multivitamins—which is especially important considering many eat rice for three meals per day and eat few fruits and vegetables—and a new toothbrush to protect their teeth. Children also receive a free fluoride treatment, and thanks to the support of the provincial government, a free haircut.


Once in the consult, most patients report problems relatively easily treated by the doctors. Oftentimes, the greatest complications result from the language gap between doctors and patients. While many staff members are bilingual—speaking Spanish and English—patients often only speak indigenous languages such as Kichwa and Huoarani thus necessitating multiple translations. Not only is it quite time-consuming, but much is lost in translation throughout this lengthy process.


Translation problems are not, however, the saddest complications. These arise when families' have already received qustionable medical advice from others that has imperiled their health. In one particularly tragic case, an emaciated woman arrived in our clinic. She was extremely skinny but her entire left side was covered with large tumors—although they cannot be sure without more testing, doctors believe that she is in the final stages of metastatic breast cancer. When asked why she had not sought help from an earlier medical brigade, she deliriously explained that she was seeing a local shaman. He had recently recommended that she stop eating and drinking for two months to cleanse her body of all the bad causing the growths. Although only a few days into the regimen, she was already hallucinating and so desperate for nourishment that she downed two liters of pediasure in a few minutes.



While her outlook isn't particularly bright in spite of the Timmy Foundation doctors' intervention, many other severe cases should have happier endings. Children suffering from severe infections received antibiotics; a baby girl with a heart deformity will go to Quito for surgery; a man with osteomyelitis will receive medication. And, barring complications, all will be well at least medically.

Even for the endless stream of children with easily-treatable ailments such as ameobas and parasites, the outlook is better. If they aren't crouching in the outhouse with debilitating diarrhea, they can go to school and get an education. And, perhaps I'm being a bit naïve, but maybe the schooling will enable them to break the cycle of poverty and create a better world for themselves and their children. After all, according to the Arabic proverb, “He who has health has hope, and he who has hope has everything.”

And the Party Rolls On...

As discussed in my last post, the act of eating is most certainly not universal. Nor is the need to sleep.

After a week of fiestas at the high school, it seems as if Will and I are the only staff members who value sleep. Although they celebrated until the wee hours of the morning and arising at dawn for the daily programming, our co-workers never seemed to tire. I, on the other hand, definitely needed some quality time with my pillow and could barely keep my eyes open by the final days of the celebration despite my colleagues constant urging to “ponte pilas” or “put in my batteries” (a common Ecuadorian expression).

The fiestas, which celebrated the high school, officially began Monday evening with the pregon or a costume parade in which all 1300 or so students marched through the city. After passing through the central plaza, the market, and several other key landmarks, they arrived at the high school and enjoyed a musical program featuring both talented students and local “celebrity” musicians.

Daytime festivities commenced Tuesday morning. Rather than attend classes, students were encouraged to cook traditional foods with their classmates and sell them to other students. Although admittedly a bit wary of the students' cooking skills, almost everything was delicious.  And, more importantly, it provided a good introduction to entrepreneurship for many of the younger students.

For many Peace Corps volunteers in Ecuador, the overwhelming lack of business skills is often incredibly irritating. In many corner shops, vendors would rather not sell their products than use their precious coins to make change. I have been told innumerable times that I cannot buy a gatorade or a water as I do not have the correct change and the store owner does not want to give me the coins in the drawer. Given that most shop owners do not rake in enormous profits, this absurd refusal to sell product is often a bit alarming. Wouldn't it be better to give me two quarters than lose my business completely?

Moreover, store owners rarely compete with one another. Most shops sell the same products; in the Loja bus terminal, for instance, roughly ten small stands sell the exact same products. They are clearly in direct competition; yet, none of the store owners offer deals nor discounts. Nor have the added new products. As they presumably would like to maximize their profits, this continually irritates me given that they do nothing to make their stand more attractive to potential customers. They do not seek a competitive advantage.

Thus, the traditional food sales provided an interesting opportunity for students to experiment with entrepreneurship. Many had to offer better deals than their competitors since they sold the exact same products. And it worked. I patronized the stands offering me free food with another purchase as opposed to those who did not offer any incentives whatsoever.

After enjoying a relaxing afternoon in my hammock, I returned to the high school at night for the annual crowing of the “reina.” As previously noted, female beauty is highly valued in Ecuador. Thus, pretty female students are invited to compete in a competition to be named the “queen” of the high school. After visiting each class to campaign, all students cast votes and, on Tuesday evening, they crowned the winner in a long elaborate ceremony with musical acts and profuse amounts of drinking (in spite of its location in the high school).

I did not, however, stay for the majority of the party as I had to help conduct the first official spelling bee during the Wednesday morning festivities. As a means of generating more enthusiasm for English classes, the English department conducted a spelling bee pitting the brightest students in 10^th, 11^th, and 12^th grade against one another. Although initially nervous that the participants would not adequately prepare for the competition, most of them blew us away. They had memorized every word on the list and, as time rolled on, we soon realized we would not be able to crown a winner. Unfortunate. Luckily, one individual had yet to err (each competitor was allowed one mistake before being eliminated) and we could, therefore, name him champion as time had long since run out. Not only were the students quite impressive, but the competition also served a more important purpose; it increased enthusiasm about English as noted by the hoards of younger students asking me if they will have the opportunity to compete (for the monetary prize) in the future.

After the spelling bee, we once again had the afternoon to relax prior to the Noche Deportiva—or sport's night. Surprisingly, the everning did not only highlight talented students. Rather, it pitted teachers versus other public servants, alumni versus alumni from other high school, as well as students. As an avid soccer player these days, definitely enjoyed the chance to play against the Consejo Provincial with a huge fan base (most of the students). Definitely did not enjoy losing 8-1 however.

Given that Friday was a national holiday, Thursday marked the final day of celebrations in the colegio. Unlike the other days, they were a much more solemn events. The day began with the “juramiento de la bandera,” a ceremony in which all 184 students projected to graduate this year walked up to the flag, touched it, and screamed “I swear” to denote their loyalty to the Republic of Ecuador. Radical patriotism is definitely never my thing but the excruciatingly long ceremony provided interesting insight into Ecuadorian culture. Given that many students in my high school wouldn't even stand for the pledge of allegiance, the patriotic display and the students' enthusiasm for it seemed to be a completely foreign event.  

The serious tone continued into the evening with the “Solomn Session”--a three hour long display of gratitude in which school officials formally thanked local politicians for investing in the school and its infrastructure.  Although there has been some investment in the school, it seemed as if the session mostly served to further inflate their egos given that almost every speech began with a 10-15 minute greeting naming all government officers by name. After thanking the politicians, the school representatives then began asking for additional funds for future projects. Many of the potential undertakings are certainly valid, but nothing concrete was decided during the marathon session. It will be interesting to see which projects are pursued in the coming years especially given the influx of money in the province coming from the new mining concessions.

Although exhausted following the marathon session, no one left upon its conclusion. Rather, more and more people continued arriving for the inaugeration of the roof over the basketball courts. Local officials cut a ribbon and the party commenced; hundreds swirled about dancing to salsa and merengue bands until the wee hours of the morning. Admittedly, I left much more promptly, but rumor is that the party continued until sunrise when the majority tumbled into bed to rest following a long albeit enjoyable week of fiestas in “Colegio 12 de Febrero”