Foresight

(With less than two months to go in our wild South American adventure, harassment of the roommates for more guest blogs has officially commenced. Serena is up first, and she has some exciting things to share! Enjoy.)

"A visit to a public hospital ran by the Ecuador Ministry of Health:
-Cost of receiving vitamins and micronutrients for all children ages 3 and under: Free
-Cost of an x-ray: Free
-Cost of a C-section: Free
-Cost of a TB vaccination: Free
-Cost of getting your eyes checked: Free
-Cost of anti-diabetic meds: Free
-Cost of an emergency service: Free

In the US?
-Contact your insurance company. aka, get out your pocketbook.

Of course, I'm not saying the health care system in Ecuador is superior in any way. All health care systems are internally flawed. But here I am, living in a relatively impoverished country that is considered "developing" by Western standards, and getting a free physical check-up without having to fill out any forms about who my provider is. In the same situation in the US, without insurance, I'd be paying close to triple digits. I don't get it.

But unfortunately, free services do come with a price. There are not enough medical personnel working for the MoH to service all patients who are in need of care. Many clinical physicians find themselves multitasking at both the micro- and macro- levels and end up running entire clinics completely on their own. Although Rafael Correa (the Ecuadorian president) is increasing spending on health care, the patient to physician ratio is over-saturated, so patients will only be seen if they are showing physical symptoms, thus diverting the attention away from the important aspect of prevention.

This is where we come in.

Along with summer volunteers Mari and Priya as well as our new Country Director Bibi, we have been working tirelessly on finalizing a promising health proposal in hopes of turning the 4th floor of the building that hosts the MPI library/teen center into a full-fledged, no BS, locally-owned Preventative Health Center (PHC). So far, we have held the first of many successful focus groups with 20+ women from the Exercise and Nutrition Program and attended various meetings with the Ministry of Health to obtain insight on local/national health issues as well as how to get this moving. We're currently in the process of contacting local health promoters and prospective community health workers (our aim is 10), connecting them with the Municipio (town) to provide professional and certified health promotion training, and then finally, in the long-run, hiring them to work at the PHC to create local ownership and sustainability.

We hope our surrounding communities will frequently utilize the health resources provided by the center, learn to properly care for their health before getting (and while being) sick, and in the long-term lower the national cost burdens spent on preventable illnesses.

Empowering individuals: Check
Strengthening institutions: Check
Building networks: Check

With the help of Healthechildren, we have high hopes of turning our idea into reality that is nothing short of extraordinary. Oye, that's how the library started, right?

-Serena"

(If you're interested in learning more about this program or how to donate directly to it, please email either serenazhou1@gmail.com or bibi.alebrahim@gmail.com)

Interview a PD: Serena Zhou

And...a week later, Serena's interview is finally finished! Her responses were definitely worth the wait, though :)

The sound is a little funky, gets pretty quite in certain parts and slightly loud in others (although that's probably because I have zero volume control over my laugh), but it wasn't worth delaying it more for me to watch more tutorials on apple.com.

Happy Sunday!
Holly

Week 3: Iowa med students summary

Today's post is Serena Zhou's recollection of our third and final week of Spring Breakers for which she and Seth Harlan were the leaders. It's posted here to give you all an idea of the wide variety of programs and activities Manna spring breakers actually participate in any given week.

Later today I will be putting up more pictures of the library in action, as many of you have requested.

Sunday 3/15

Less than 12 hours after Iowa set foot upon Ecuadorian soil, we learned how to massacre live chickens. And as bloody and unappetizing the process might have been (eg, squeezing out the contents of large chicken intestines), the end result was vale la pena (worth the pain). Pepita, Mayra, Francisco, and Julio (one of our favorite Ecuadorian families) were experts in this field. Needless to say, this was a perfect skill to learn with med students! I wish I did this before anatomy class... Details aside, I think these pictures will be sufficient.

(Taj tries his hand...may have to work on this a little. Next time...?)

(Anatomy lesson!)

(Pobrecito gallinos)

(Iowa + Pepita, Mayra, Francisco, Julio and family)

Iowa, Holly and I then got "opendhandsdirtyfeet" by cleaning up the cancha from the previous night's library/teen center inauguration, before enjoying a local soccer game from the patio of our new space.

We ended the day with a conspicuous visit to Sangolqui markets, haggling with success to some extent (it's harder to fool the Ecuadorians with 11 Gringos flashing hi-fi photos in their faces). So far so good. Everyone is alive and kicking.

Monday and Tuesday 3/16-17

Iowa split up into 3 different groups in the morning, with each group going to:
-Alinambi (to measure kids for our Positive Deviance-based nutrition pilot- more to come on this!)
-Waldos clinic/Sangolqui hospital
-Ministry of Public Health of Conocoto

Some highlights:
-Julie and Brett watching a woman get her tubes tied.
-Spontaneously turning the MoH emergency room into a full-out salsa/reggaeton dance club with patients and doctors alike.
-Dan screwing up his feces sample. Rosanna the nurse at Waldos laughing at his liquid-soaked sample.
-Amanda, Taj, Ryan, and Brett basically running the ER at Sangolqui hospital (via body language and me translating) due to shortage of doctors... including suturing a very drunk old man's head (yes, during the middle of the day), building a "nose bridge" for a man with a broken nose (who doesn't remember breaking it bc, surprisingly, he got drunk during lunch last Sunday), stabilizing two teenagers who just got into a near-fatal motorcycle accident, etc.

(University of Iowa med students and their 133 boxes of gloves they generously donated!!
(From left to right): Matt, Serena (MPI co-leader), Alex, Brett, Julie, Collin, Dan, Amanda, Taj, Anna, Ryan, Seth (MPI co-leader))

Wednesday 3/18

Spent the day doing touristy stuff, including climbing the breathtaking Basilica, walking through Quito's Old Town, and visiting la Capilla del Hombre- the museum of Guayasamin. I think we Program Directors need to keep reminding ourselves just how amazing this country is, as we have lived here long enough to feel relatively desensitized. Watching the reactions of Iowa and the other spring break groups- served as a constant reality check, telling us not to take this place for granted.

(Iowa at the top of the Basilica)

Thursday 3/19

Summited Pichincha- the 3rd highest mountain in Ecuador (4600m). Our lungs definitely got their workout today. Lesson of the day: EAT FOOD before attempting to ascend a 300m. Waterproof gloves are also nice.

Friday and Saturday 3/20-21

Weekend excursion to Banos! I don't think any of us could ever get sick of Banos. Rejuvenating massages, hot springs, majestic waterfalls, exotic birds... we could get used to this.

Iowa went on the infamous bike ride to the waterfalls, which is always an exhilarating experience, despite some mishaps on the way (Amanda's flat tire, dogs chasing after us). By the end of the trip, despite the exhaustion, we were all regretful the trip was coming to an end.

Sunday 3/22

Thanks Iowa for picking the earliest possible time to leave Quito (6:40am) ha. Ryan, Brett, Anna and I strutted it out and kept our lids up till 3:30am, spending a romantic night together by the fire roasting cinnamon-chocolate-bananas, and watching Aladdin.

Miss you Iowa. Vengan a Ecuador prontisimo!!!!!!!

Lucky

(Today's guest blog is from Serena Zhou, MPIE's tri-lingual, pre-med rockstar. Enjoy!)

This is my lucky year: the year of the Ox (牛), my birth year.
一九八六年, 一月十九日.
I am lucky to have three homes: one in Ecuador, another in the United States, and the last in China. No matter which home I'm in, the other two eventually venture their way to my front door.

I am lucky to have my beloved Manna family along with a handful of chevere ("cool", "sweet") Ecuadorian friends celebrate my 23rd birthday with me, and to have a successful joint bbq birthday bash with Mark, packing the Manna house with colorful bilingual nationalities, sinfully delicious pork loin, carrot cake, chocolate cookie cake, and Mississippi mud cake (thanks girls).

I am lucky to receive presents that every kid dreams about: A KIDDIE POOL + sour patched kids (thanks Holly) + a stuffed duckling named "Patita" as in "little foot" (thanks Seth). (Given the fact that I accidentally failed to properly care for the real duckling(s) we had for less than 24 hours). Monday morning meetings have now been officially moved up to the roof, rain or shine.

I am lucky to have Andres ("the only male belly-dancer in Ecuador") perform for me and the girls plus Dunquito a jaw-dropping private show. And, might I add, I am lucky to have gone on a heavenly trip to Maui, my birthday present from mi amor Ryan, which I still daydream about and wonder if it really did happen...

I am lucky to have a local Chinese family take me in on New Years day, invite me to their home in Caracunga, personally expense my trip, and feed me the most amazing home-made, authentic Chinese food I've craved ever since landing in Ecuador. I am lucky to witness a modest Ecuadorian apartment miraculously transform into the hottest Asian techno nightclub in town, forgetting for a moment that I was actually in a Latin American country.

I am lucky to be accepted into my respective communities, and to not only having three homes, but also three inter-being families as well.

2009 Year of the Ox. It's going to be a lucky year...

Papanicolau

(Today's guest blog comes from Serena Zhou, who has recently begun teaching us all words in Chinese while lounging on the couch in the kitchen.)

"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!"



La Doctora (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. To be honest, it made the clinics in ghetto downtown Baltimore seem like penthouse suites. But I love 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 past few months, I have 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" and subsequently set me to work. If 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 despite my broken Spanish (don't worry, I didn't. Not about to build a malpractice track record that will haunt me for years). But I do 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 are might 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, for which I am immensely grateful. I can definitely see myself, and hope 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.

:) Serena."

(Jocelyn gets her blood pressure taken by Serena. And tries not to laugh.)