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”

Buen Provecho

Ten months ago, I would have scoffed if you had offered me a lukewarm cup of instant coffee. Ten months ago, I would have complained incessantly if anyone dared to make me grilled cheese with quesillo instead of good ole' cheddar cheese. Ten months ago, my local “supermarket” carried Jiff, Skippy, AND Peter Pan peanut butter instead of generic mashed peanuts. Ten months ago I could buy ready-made pasta sauce instead of chopping up vegetable and boiling them for eons. Ten months ago...

I most definitely would not snacking on an humita as I write this blog.

Food.

In the words of chef James Beard, “Food is our common ground, a universal experience.”  Across the globe, we all eat. Some eat more than others. Billions of individuals struggle to survive without enough food to eat. But, in order to live, all need a bit of nourishment each day.

Yet, this basic fundamental need for food is the only universal. What we eat and how we eat is inherently linked to our surroundings and culture. Beyond a base need to consume calories, eating is an intensely local experience.

Since moving to Zamora, the foods I ingest daily have changed as I have begun to incorporate many local treats into my diet. Favorites include humitas (ground corn and cheese with a “healthy” dose of pig fat), cevichochos (dried corn, plantains, tomatoes, and lime), empanadas (fried cheese pastries), and chocobananas (frozen bananas covered in chocolate...only 10 cents apiece!)  Beyond prepared dishes, the fruit and vegetable selection available in the chaotic Sunday market shames the selection found in most United States supermarkets. Guayabas, machete guayabas, zapotes, granadillas, uvillas, pitahayas, chontas, naranjillas, and tree tomatoes are abundant. Even fruits found throughout the United States come in more varieties; bananas can be either yellow, green, or red! 

Yet, as the variety of fruits found in my refrigerator has grown, other food have disappeared from my diet. Perhaps my favorite food in the United States—peanut butter—is hard to obtain here. I either have to buy a ground peanut substitute available in the local market or trek to SuperMaxi (a large and overpriced supermarket in Loja) and hope that they currently have either Peter Pan or Jiffy available for about $7.00 per jar. Craving Reese's Pieces? Forget about it. Want some Starbursts? Keep dreaming. Just as there are many more varieties of fruits and vegetables available here, there are many more varieties of packaged food available in the local Shaw's.

Beyond the food on my plate, the experience of eating has been transformed since moving to the southern hemisphere. Growing up, dinner was always the most important meal. Although frequently interrupted by a plethora  of sports practices, scout meetings, and the like my mother always tried to serve the family together. It was the largest meal of day after all; we groggilly ate cereal for breakfast before dawn and brought either sandwiches or yogurt to either school or work.

In Ecuador, however, lunch is the most important meal of the day. After school ends at 1:00, teachers and students alike return to their houses to eat with their families. The teachers and staff then return to the school at 2:00 under the controversial new education law requiring all public servants to work for at least 8 hours per day. Such a small window for lunch requires significant adjustment. By the time teachers arrive at home, they have barelyenough time to guzzle down the obligatory appetizer, namely a big steaming bowl of soup regardless of the soaring temperatures outside. As soon as the last drops of broth have been scraped from the bowl, all must dive into the second platter with a vengeance if they plan to return to work ontime. Not only does the plate contain a massive heap (Chimborazo if you will) of rice, but there is typically also a bit of meat or chicken and a spoonful of salad (which generally consists of only one or two vegetables maximum).  The meal isn't over after downing such a large quantity of food, however. A large glass of lukewarm “refresco” or “horchata” is still waiting as Ecuadorians almost never touch their beverage until they have devoured all of their food.

Teachers successfully returning to work on time need to eat with focus given how much food arrives with a typical lunch. Luckily, the majority of Ecuadorians do not seem to talk much once receiving their plates (which are always filled with food in the kitchen). As soon as the plate arrives—whether the others at the table have received their portion or not—an individual will typically dive into their food with admirable focus. In spite of the importance of familial meals, conversation is somewhat rare. Each person focuses on finishing their food before conversing. Although I do not know the reasoning behind this, I suspect it may stem from a desire to avoid the legions of  bugs apt to arrive whenever food is left around for more than a few seconds.

Moreover, many Ecuadorians forgo forks and knives in favor of large spoons. Thus, it is possible to eat significant quantities of food quite rapidly given how much fits into each spoonful. Anything that needs to be cut—such as meat—is simple torn with one's fingers. Quite efficient. Quite messy. Luckily, as I have somewhat recently become a vegetarian to protest the impact of the meat industry on the rainforest, by hands remain clean both literally and figuaratively.

Thus, as I sit spooning heaping spoonfuls of rice with nary a drop of water to wash it down, it is clear that the need for food may indeed be universal but the act of consuming it most certainly is not.

Ridin` Dirty

We made it. Miraculously, we made it.

Travel in Zamora-Chinchipe is always an adventure. In spite of the omnipresent “Revolución Cuidadania”--a public works program headed by President Rafael Correa that seeks to improve infrastructure throughout the country—travel in rural Ecuador remains perilous especially during the rainy season. The vast majority of roads are dirt. This is not problematic in dryer zones, but in the Amazonian provinces, for example, the roads often turn into impassable mud pits riddled with pot holes. Given that the entire province on Zamora-Chinchipe only has one paved road connecting different towns and communities (within individual cities/towns small roads are often paved), travel can be quite difficult. Some parts of the province, namely the southern counties of Chinchipe and Palanda, have no paved roads connecting towns whatsoever.

Moreover, muddy roads are not the only problem plaguing the transportation system. Given that Zamora-Chinchipe lies in the foothills of the Andes, most roads wind around mountain ridges. Landslides, therefore, are a constant threat. Roads are frequently closed, travelers stranded, and communities isolated until road crews can clear the way.  Unfortunately, landslides are not entirely avoidable; they are a natural part of the mountainous ecosystem in which I live. Yet, the problem is exacerbated by road construction, agriculture, and deforestation. Natural landslides are generally only a couple of meters wide; the landslides common throughout the province often span a dozen meters.

Why so much frusteration with the road system? A friend had invited a group of our friends to pick fruit at his farm in the countryside. Finally, after several failed attempts to visit, we ventured to his town, Numpam,he  early Saturday morning. It initially seemed like an easy trip; we needed to take the 8.45 bus to the town of Guadalupe and walk about thirty minutes to the Shuar community. Yet, our plans were immediately smashed when we discovered that the needed bus rout had been unexplicably removed the day before. Typical.

Given that the student does not have cellular phone service in his home, we could not call and cancel. We had to find another way to trek into the countryside. We eventually decided to take a bus destined for Yantzaza. We did not go all the way to Yantzaza, however. Rather we disembarked in La Saquea and began asking for a ride to Guadalupe. Luckily, a provincial fireman in the pickup truck was heading in that direction and he allowed the five of us to pile into the back of the truck. For a moment, it seemed as if we would make it after all.

Unfortunately, our plans were dashed about fifteen minutes later. A mountainside had collapsed the night before. The road was blocked. No había paso.

Once again, we were in luck. The young fireman needed to find a way to Guadalupe and he thus suggested returning to La Saquea and returning via the “bad” road on the other side of the river. Ironically, the “good” road as impassable, thus resulting in a trip along the muddy narrow track on the other side of the river. We eagerly agreed and, mud-flying, we were soon whizzing along the narrow curves until arriving in Guadalupe.

Although the fireman stayed in the town, our trip was not over. We continued on foot for another thirty minutes until reaching the Shuar community of Numpam. Although motorcycles can traverse the muddy road , the majority of residents trek on foot. It's a stunning walk and, for the majority, this is an easy, albeit time-consuming, trip. Some, however, such as the father of my friend, can no longer make such a long journey on foot due to medical problems stemming from both old-age and a lifetime of arduous agricultural work. He  is, therefore, confined to his home. It is simply too difficult to leave.

           

We would, on the other hand, be leaving in a few short hours and our hosts wasted no time in welcoming us to their community. As soon as we finished greeting what seemed to be every member of the extended family or the entire town, we were handed glasses brimming with chicha de yucca. Chicha de Yucca—fermented yucca juice—is vile and far too alcoholic to consume at 11:30 am. Moreover, traditional recipes require that the cooks or our hosts chew the yucca before allowing it to ferment. Not an appealing midmorning snack. Regardless, refusing was not an option; to refuse an offer of chicha de yucca is extremely rude and inconsiderate.

After struggling to down glass after glass of yucca de chicha, we began exploring the farm. As we roamed through the fruit trees growing amid the rainforest, we gourged ourselves on jungle treats  such as chonta, guava,  guayaba, and maracaña. We grabbed long-hanging fruits from the lowest branches as children scaled trees and tossed us fruits from above. Their agility was impressive; without fear nor caution they shimmied along  branches several meters above the ground.

Within an hour, I was not only impressed by the amount of food we had eaten and stored in giant grain sacks, but by our hosts' insights into the uses of different plants. Regardless of the plant, they seemed to know how to prepare it for human consumption. If a plant proved toxic berries, for instance, they always could provide another use. The toxic greenish-blue berries down yonder? Feed them to the fish so they die and float to the surface; then, they can easily be caught and cooked by humans (the berries consequently do not poison humans). As one woman aptly pointed out, the forest can provide plenty of food to feed impovershed communities (87% of Shuar live beneath the poverty line). Yet, they still need money—school materials, clothes, etc. don't grow on trees...even in the rainforest.

Making money, unfortunately, is not particularly easy to agricultural communities buried in the rainforest. Produce sells for shockingly low prices in the market—six pounds of potatoes only garners $1.00 in the Sunday market. Yet, there is home. Many members of the community hae recently built an organic fish farm with the help of experts at a nearby agro-pecuarian program. Moreover, others are finding jobs in nearby mining projects run by foreign conglomerates from countries ranging from China to Canada. While these projects are extraordinarily controversial given their environmental impacts, and their effects on local communities such as increased alcoholism (as demonstrated by a study conducted by Save the Children), they have already begun bringing work, albeit often low-paying and dangerous work, to remote corners of the jungle.

Will the economic situation improve in the next few years? Given that the reserves of uranium, gold, and silver are expected to value several billion dollars, one hopes that the proceeds will trickle down to area residents. After all, they will be the ones enduring the environmental damages imperiling the very jungle on which they now rely for much of their food and their livlihoods. Will the mining be for the best? For the worst? Only time will tell, but for now, the debate rages on in Ecuador and beyond.

Thirty-Three

33.

Since February 20^th, we have only had 33 days of school in a period in which were 55 weekdays. We have,  therefore, enjoyed 22 days off as well and very few of these vacation days correspond with national and provincial holidays. Rather, classes have been cancelled for nearly every reason imaginable ranging from intra-school soccer and basketball tournaments to “Día del Maestro” or Teacher's Day.

Although I've enjoyed lounging in my hammock with a book, I'm becoming increasingly concerned about the lack of classes. By cancelling school constantly, the administration inherently devalues the education it provides to students. It often appears as if soccer is more important than mathematics. Moreover, the quality of the education suffers as teachers struggle to introduce new material as the students constantly need to review after long breaks. We seemingly need to restart each unit six times before we can string together enough classes to accomplish anything.

Yet, in spite of my reservations about the lack of school, the past few months have proved quite enjoyable. At the beginning of April, we enjoyed a week-long break for Semana Santa. Even though—given that 95% of Ecuadorians identify as Roman Catholic—this is clearly a very important holy week for most, the vast majority of public institutions and schools in Ecuador only had two days of vacation (Thursday and Friday). Even fisco-misional schools, which are religious institutions funded by the state, had classes for most of the week. Yet, students attending colegio “12 de febrero” enjoyed five days off.

Although I considered travelling over the extended break, I ultimately decided to remain in Zamora for various reasons. In addition to relaxing in my hammock and devouring the first two books of the Millenium trilogy, I continued volunteering in APNELE (a center for disabled individuals), which remained open in spite of the holiday. Not only did we continue with our normal activities—training for the special Olympics, occupational therapy, etc.,--but we also cooked fonesca, a traditional Ecuadorian soup consumed during holy week. It consists of various grains as well as cheese and vegetables but no meat. Quite delicious.

Stomachs overflowing after our gourmet lunch of fried tilapia, a local specialty, and fonesca, the other staff members and I began the clean-up. As I was collecting stray soccer balls in the dirt lot behind the center, I was approached by a shy little girl hanging clothing on the line. Given that APNELE shares a building with a state-run foster home, I immediately assumed that the petite ten-year-old lived in the institution and after briefly talking with the girl discovered that I was indeed correct. Although not technically an orphan, the young lady had always lived deep in the campo in extreme poverty. She was ten-years-old and had never even been to school. Soon, I was playing soccer and tutoring the girl as well as her pseudo-siblings also living in the house and an afternoon of laughing was transformed into a semi-project in which I “mentor” the youngsters living in the home. Although I enjoy spending time with the children, my already overflowing schedule is making it difficult to make a regular commitment to them but I am hoping to have more free time come summer vacation.

Following the prolonged vacation for semana santa, I expected several full weeks of school. After all—apart from Marathon Monday—there arn't any major holidays in April. Somehow, I managed to forget Teacher's Day; after only three days of classes, students once again enjoyed two days of vacation. Meanwhile, teachers spent Thursday playing soccer and frolicking under the sun at a school-sponsored party. Good times. Bad sunburn. And no worries about exhaustion on Friday because the following day was also declared feriado and students did not go to school.

Completely rested after the long weekend, I returned to school ready for five days of classes. Students only had two days of work; due to juntas del curso, students enjoyed vacation on Wednesday, Thursday, and Friday. Teachers—not including Peace Corps volunteers-- on the other hand, had to attend sessions in which they submitted students grades for the past quimester and discuss their behavior. As I did not attend juntas, I will not comment on the utility of such meetings but three days of classes cancelled once again? Do Zamoran students EVER go to school?

Miraculously, we had a full week of school following the juntas del curso. This week also marked the beginning of the annual sports tournament between the staff of  all public institutions in Zamora ranging from the hospital to the high schools. Given the emphasis on appearance in Ecuadorian culture, all teams had to march in a parade through town in their full uniforms prior to the tournament. This was the fifth parade in which I have marched since arriving in Zamora less than a year ago. Insane. The tournament has been quite enjoyable though; I'm playing soccer and basketball which has been a completely different experience than in the US of A given that I tower over almost every other Ecuadorian in this Amazonian town.

And so life rolls on in my jungle paradise. Even with all the vacation from school, there is little time fo boredom. Other projects, dirt roads open for running, rainforest hikes, and my hammock call my attention. Eleven months have gone by since I arrived in the southern hemisphere, but it's passing in a blink.

Everybody Poops

It's true. As stated by the title of this blog post and a delightful children's book, everybody poops.

And some poop more than others.

For the past week, I haven't had many adventures outside of work because I have been hiding in the bathroom. I was recently struck by a bout of severe diarrhea lasting several days. Although I have not been sick often since arriving in Quito ten months ago, it wasn't completely surprising. Gastrointestinal problems (AKA diarrhea) is the most common health problem besetting Peace Corps volunteers in Ecuador and worldwide.

Why so much gastrointestinal distress? Some can be attributed to new, albeit relatively harmless, bacteria unknown to volunteers' bodies before going to another country. The majority, however, comes from more sinister sources: harmful bacteria, parasites, worms, and amoebas. Due to unsafe water supplies and subpar food handling in markets and restaurants, the “culprits” enter volunteers' digestive tracts and they are soon racing to the bathroom far too often. Whether inadvertently consuming juice made from tap water when visiting a friend or buying a pincho (a shish kabob made of beef, sausage, peppers, potatoes, and plantains available on most street corners) from a vendor who forgot to wash his hands after handling raw meat, there are dozens of ways to contract these pests even if the volunteer consciously boils all water and thoroughly cooks all meat at home.

As volunteers, however, we are lucky to have numerous resources available to counteract bacteria, parasites, worms, amoebas, etc. We are counseled by Peace Corps medical staff in Quito as to how to do stool samples and, depending on the result, which medicines will have us back to normal as soon as possible. In the meantime, our medical kits are equipped with large supplies of rehydration salts so we can avoid dehydration. Mixed with Gatorade, the salts don't even taste too bad.

Many others plagued by these pests and the consequential diarrhea are not so lucky. Across the world, diarrhea is the second leading cause of death amongst children under the age of five; generally, it is not the poop that kills them but the resulting dehydration. Unfortunately, oftentimes, the very dirty water than made them sick in the first place is the only liquid available to quench their first and they become even sicker.

Death from diarrhea is entirely preventable--access to clean water, access to resources to rehydrate, knowledge. It should be easy. It should be prevented today.

After all, everybody poops. The lucky ones, like me, spend a few days gulping Gatorade spiked with rehydration salts. The unlucky, on the other hand, don´t have the opportunity to tell (or blog) their tale.

Where There Is No Doctor

In spite of universal free healthcare, the impoverished Ecuadorians often lack access to adequate medical care. Statistically, there are 15,866 doctors in Ecuador who serve a population of roughly fourteen million. These numbers are not particularly alarming; they are, in fact, similar to those in most other Latin American countries. Yet, they are not indicative of the realities found in many Ecuadorian communities. Citizens living in poorer and more rural regions, such as the Cantón of Chinchipe, face a far bleaker situation in terms of their health. Often there are no doctors within hours of some communities.

Ultimately, although medical care is guaranteed under the 2008 Constitution, those living in the mountainous jungles of Chinchipe and other widely impoverished and rural zones do not have access to adequate healthcare. Fortunately, there are efforts underway to remedy the problem...no pun intended. A group of American doctors, for instance, recently conducted a health brigade in underserved communities throughout the county including Vallalodid, Porvenir, Palanda, San Fransisco, Zumba, Chito, and San Andres. As a local Peace Corps volunteer, I was asked to accompany the group and provide cultural insights while helping in any way possible (mainly by providing basic information on the importance of boiling drinking water, adequate hydration, and sun protection). Throughout the week, I had the opportunity to observe many of the obstacles hindering universal access to adequate healthcare as well as the impact basic medical care can have on an entire town.

Why do many Ecuadorians lack access to healthcare? In some communities, such as Chito, there is simply no healthcare facility. The town's sub-centro de salud closed more than seven years ago and has yet to reopen. Given that Chito lies more than three hours from the nearest “sizeable” community—Zumba-- along twisting dirt roads prone to landslides (I should know...our medical team's bus was almost pushed off a precipice by a river of mud streaming across the road), residents cannot easily trek to the doctor. One town, San Andres, is so remote that there is significant in-breeding and incest, which has resulted in many severely disabled residents. Thus, many forgo medical care in spite of the obvious need. One woman, for instance, had broken her arm years ago and never received car. The bone was never set; thus, it now protrudes from her arm and she cannot use the arm without enduring agonizing pain. In another, more disturbing case, a man had cut his leg while using a machete several years ago. The wound had since become infected and bacteria had consumed much of his lower leg. Our doctors prescribed an antibiotic that may kill the bacteria, but without the possibility of a skin graft, he will most likely never have a usable leg again. Had he visited a doctor in a timely manner, perhaps this disabling wound on his leg could have been avoided.



Yet, simple access to a hospital, sub-centro de salud, or a pharmacy does not guarantee access to quality healthcare. In one of the most alarming cases seen throughout the week, a twelve-year-old girl visited the clinic with her mother. The young girl—who had already dropped out of school to work on the family's farm—had a bacterial infection in her lungs complicated by an untreated case of asthma. Her mother, recognizing the severity of her daughter's illness, had brought her to a local pharmacist who sold her a large supply of medications including codeine. In many patients, this would not be problematic, but codeine is contraindicated for those with restricted airways (asthmatics for example). Such medicines could, therefore, severely harm the girl. Yet, the untrained pharmacist did not recognize the problem and sold the drugs; had the mother not sought out one of the few sources of medical aid in the community, her daughter may, in fact, have been better off. Yet, not knowing, the mother purchased the drugs. Luckily, the mother then brought the girl to our clinic and the doctors purchased the dangerous drugs before giving the child a more appropriate drug regimen to heal her lungs. A happy ending—except for the sad reality that the asthma is a chronic condition and the girl's mother admitted that it is unlikely she will be able to refill the medication when the girl's new inhaler when it runs out of abuterol in a few short weeks.

The absence of enduring medical care highlights a major problem facing the medical brigade. We are only in each community for a few short days at most; yet, many common conditions require on-going care. For instance, one major healthcare issue is high blood pressure. Although this cannot be cured, it can be regulated by various medications provided the patient follows the same regimen for the rest of their life. If they stop taking the pills, perhaps because they run out, then they blood pressure will spike. It is, therefore, better to never medicate than to begin the drug regimen and stop. Given that follow-up is impossible, our doctors thus needed to decide whether the patient would even be able to refill the medication before deciding whether to give it in the first place. Moreover, some conditions cannot even be addressed as it is far too dangerous to do so without ongoing care. Perhaps one the most delightful patients was 74-year-old Rosa. Always smiling and giving unsolicited advice on marriage, the elderly women lives far in the countryside caring for her severely disabled daughter alone. She has thrived under difficult conditions since the loss of her husband nearly two decades ago. Yet, it is becoming increasingly difficult as she suffers from a severe case of Parkinson's disease. She trembles constantly; she can no longer walk for long periods without toppling over. Medication would help her; unfortunately, the powerful drug regimen must be overseen by a doctor and, as this is impossible, the best remedy available was a relatively benign sleeping pill to help her sleep and calm her nerves.


Not only are many of our patient's conditions untreatable due to their living conditions, but these same living conditions also create many of the conditions. The most common complaints—“machete” elbow and parasites—are virtually unavoidable for the majority of the patients. “Machete” elbow is our nickname for pains caused by farm work; a shocking percentage of the patients arrived with chronic pain stemming from farm work. Logically, to address these pains stemming from repetitive motions, the farmers should avoid using their machetes, milking cows, etc. This is not, however, an option in agricultural communities in which there are few jobs other than farm work and the complete lack of income make retirement utterly impossible. Moreover, many of the patient's conditions stem from the environment in which they live. Amoebas and parasites, for example, proved endemic as many tap water is far from clean and many families get their water from nearby brooks and streams. While boiling water can certainly help, it is not a certain cure as dirty water is often unavoidable; after all how many can refuse a nice cool juice offered by a neighbor who does not boil their water when temperatures soar? Thus, as one mother aptly pointed out, her children have parasites simply because of where they live. They don't do anything and it certainly isn't their fault. It just happens.

A lack of infrastructure capable of supplying impoverished families with clean water is only one of many structural problems hindering the Ecuadorian healthcare system. As a teacher, one of the most bothersome related to education—often the patients lacked the knowledge necessary to protect their health. From not boiling water to eating diets consisting solely of rice and yucca while discarding fruits, the lack of knowledge was constantly imperiling their health. Moreover, many did not have the skills necessary to follow complex drug regimens. No one can be expected to remember how to administer a handful of medications; yet, we often could not write out instructions given our patients never learned to read which is not particularly surprising given that many eleven and twelve-year-old patients had already dropped out of school.

Not only did local structural problems hinder the brigade's ability to help its patients, but the structure of the brigade itself often compromised its success. Many of its problems were, however, unavoidable. For example, the brigade often worked in churches with several doctors crammed into one room. Thus, there was very little privacy for patients reporting their health problems, which proved particularly uncomfortable for many women reporting gynecological problems (unsurprising given that the average women probably had at least ten children). Thus, many seemed reluctant to provide relevant details and, I suspect, some refused to acknowledge such problems at all which is to be expected as their neighbors were often peering through the open windows or crowding around nearby tables eager to hear their complaints.

Moreover, the doctors in the brigade only spent a day in each community; thus, they were often unaware of other resources available to patients. For example, a fourteen-year-old girl arrived with a baby. Both appeared healthy; the girl just had a lengthy list of somatic complaints. The doctor soon began peppering her with questions, trying to find why she seemed to unhappy and reported so many complaints. He soon learned that her significantly-older husband was abusive; yet, she felt she could not leave nor return home. She needed counseling and help, yet apart from some advice, there was little that could be done. No one on our team was familiar with any support available in Palanda for women in abusive homes or even if such resources exist.



In spite of it all, the brigade made a difference. Given the lack of follow-up care, we will never know how many of our patients thrived. Yet, their gratitude, smiles, and the endless stream of “Dios le pagará” (literally, God will pay you) indicated that many will awake feeling better tomorrow, even if its only a bit of a placebo effect. One middle-aged man, who walked for hours to the clinic with his elderly mother, even returned the following day to give us a trash bag stuffed with machete guayabas (a delicious fruit) as a means of saying thank you. Others offered us a place at their table even though they can only feed their children white rice a few times per day. Their generosity was often overwhelming; without a doubt, whether cured or not, their reactions suggested that even the mere attention of a doctor truly mattered.

And, for some, the doctor's advice did cure. Last year, many of the doctor's had treated a three-year-old boy about to die of pneumonia. While they provided the best care possible given the circumstances, they had to leave before it was certain he would survive. Imagine their delight, therefore, when the same four-year-old boy with and enormous smile bounded into the clinic to say hi and thank the doctors who likely saved his life.