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Photos and interviews by Rachel Hoffman
Silvia Huafatoca came to a MEDLIFE Mobile Clinic in Tena, Ecuador last December with her 2-year old daughter, Janice. The clinic took place in a schoolhouse just down the street from the small house she shares with her husband, daughter, parents, and three siblings. Having never heard of MEDLIFE before, Silvia approached the clinic cautiously, and was relieved to find out that doctors and medications would be provided free of charge.
"My daughter has a cough right now," she told us. "I'm glad the doctors came here, close to my house, because sometimes we can't get to the clinic." She said the cost of transportation (40 cents each way for a two-hour bus ride) and time spent waiting at the closest health clinic often prevent her from going. When Janice was just one year old, Silvia took her there for a bad cough, and she was diagnosed with pneumonia and given antibiotics. Between the ride and the wait times, going to the doctor took a full day, and sometimes Silvia didn't have time or money for treatment. "This was a better experience, it's a lot closer," she said of the Mobile Clinic. "You just go to the doctor here, and the pharmacy's right over there!"
Last week, students from universities all over the United States traveled to Tena, in the Ecuadorian Amazon, to participate in a Mobile Clinic! Check out some photo highlights below:
Photos by Luis Herrera
"I'm 37," Holanda Marquez tells me, without any intention of lying about her age. She easily lifts a bucket full of rocks that even the strongest and most agile members of the group have trouble carrying all the way to the top of the project site. Holanda told us that she struggles with lapses in her memory; just moments later her daughter, Martha, assured us that her mother is no younger than 60. Yet, with her 60 years, 10 children, and various grandchildren, Holanda still has the strength of the 37-year-old she claims to be. I thought for a moment that this must be a product of years working in the field, but I was wrong. "I work as a homemaker," Holanda explained, making me wonder if hard work runs in the blood of the people here in Esmeraldas.
Holanda's husband leaves every morning to head to his job in the heat and rain, without a car, without air conditioning, and without any options of speeding up his travel. "If he walks quickly, he can get to work in 45 minutes," Martha tells me. Martha is the youngest of the couples' children; she dreams of moving to Guayaquil to study to become a flight attendant.
"We have 20 hectares," the family tells me, as if it's no great thing. The work together to grow corn and cocoa, saving one part for the home and sending the rest to a small store located below their fields. Unable to depend on any fixed income, they sells what they can, depending on the weather, land, and market to determine their small income.
The MEDLIFE team in Ecuador is off to a great start with our first-ever Mobile Clinic in Esmeraldas, Ecuador. Although we are just starting to build a presence in Esmeraldas, staff members on the ground noted that attendance at the clinic has been very high so far, with some patients walking an hour or more to arrive at the clinic sites. According to MEDLIFE Director Martha Chicaiza, the clinic on Tuesday was one of the busiest that she's ever seen in all of Ecuador.
Students are also completing a staircase construction project at a site a bit outside of the city center. As we see in Lima, many of the communities surrounding Esmeraldas have also been built on steep inclines. Navigating the terrain is further complicated by the weather in Esmeraldas; the region experiences year-round tropical showers and flooding. In some cases, residents' entire feet sink deep into the mud as they attempt the climb up to their homes.
Esmeraldas was considerably affected by the El Niño events of the late 1990s, when mudslides caused explosions, fatalities, and environment damage due to ruptured pipe lines. Communities rebuilt slowly, and the tourism industry – once an important part of the economy – is still recovering.
MEDLIFE's first staircase in this area is large, yet work began with a slow start on Monday due to heavy rains. On Tuesday, with ample sunshine, students and community members were able to make much greater progress mixing and setting the cement. We hope that the weather will allow us to continue to move forward, and complete the project by the end of the week.
Esmeraldas is a port city located on the northwest coast of Ecuador. The city is home to the majority of the Afro-Ecuadorian population; the province is the most ethnically-diverse in the nation. The main exports are wood and agricultural resources, yet the establishment of Esmeraldas as Ecuador's largest oil refinery has also turned it into an important commercial center. In a meeting with MEDLIFE staff members in November of 2012, residents of Esmeraldas reported drug abuse, pregnancy at a young age, and lack of access to medical care as issues that desperately need to be addressed.
For more information on the community of Esmeraldas, please read the blog from our first visit here.
The MEDLIFE McGill student group will be instagramming their experiences during the week here.
In November of 2012, we wrote an in-depth profile on one of our patients in Ecuador, Jose Francisco, who has been living with a condition called cryptorchidism (undescended testicles). Without surgery, this condition puts him at risk for infertility and, most importantly, raises his chances for developing testicular cancer.
Jose received the first of two necessary surgeries in early November at the Hospital Provincial General Docente in Riobamba, Ecuador. As Jose's medical condition affected both testicles, his treatment called for two surgeries to be performed separately. Although the surgeon originally recommended a resting period of six months in between each operation, Jose recovered extremely quickly from the first, making it possible to operate again just three months later.
On Wednesday, January 30, 2013, Jose returned to the same hospital to receive the second of his two surgeries. Accompanied by MEDLIFE Field Nurse Maria Chavez, he entered the hospital early in the morning to take the required preliminary exams. Although Jose had recently been sick with flu symptoms, doctors verified that he was well and able to receive the operation, which was scheduled for 6 pm that night.
On Thursday morning, MEDLIFE Ecuador staff members went to visit Jose in his room. "It was amazing to see him, happy and content, as if nothing had happened," said MEDLIFE Director of Ecuador Martha Chicaiza. "It's always incredible to see a patient attended to and treated in time, especially when it's a child."
Doctors and MEDLIFE staff will continue to monitor Jose's development post-surgery. If the operations were successful, his testicles will continue to develop normally as he grows. Doctors explained that because of Jose's age, 11 years, he faces greater risks of complications.
"If we had found him when he was younger, we could have helped him better," says Martha. "Many times this happens in Ecuador – patients don't get the help they need in time because of the lack of education, or because they are scared of certain treatments or surgeries."
As Jose recuperates at home, MEDLIFE will continue to monitor and support his full recovery.
As the February 17th presidential election approaches in Ecuador, many are taking a longer, reflective glance at what President Rafael Correa has achieved since he took office in early 2007.
A recent Reuters article reports, "Correa has won broad popular support by expanding access to healthcare, doubling state spending on education and turning rough dirt paths into proper paved roads." It also notes that, according to the government, Correa has "built 18 hospitals and 250 health centers across the nation."
Indeed, Correa – who describes himself as "left-wing" – has made it a top priority to increase spending on social projects. Many believe Correa is on track to winning the upcoming election.
Yet, implementation of Correa's health care plans has been slow. Like many other countries in Latin America, Ecuador's health care system is taxed by overwhelming demand and a lack of resources. Since the country began providing free public health services in 2007, it has struggled to keep up with a growing body of patients; MEDLIFE staff members in Ecuador have often seen residents begin lining up hours before dawn in order to seek medical treatment.
The health system in Ecuador is comprised of a private and public sector, with the public sector guaranteeing, as stated in the revised 2008 Constitution, "permanent and timely access, without exception, to all comprehensive health care programs and services" for all citizens. However, overall, this covers the health care of only 51 percent of the Ecuadorian population, according to a June 2011 paper by the Ministry of Social Development in Quito, the nation's capital.
The government funds 47 percent of outpatient and hospital services in the nation, in addition to the nation's largest hospitals for referrals. But according to World Health Organization (WHO) standards, there should be between 8 and 10 hospital beds available per thousand people. The number of available beds in the Ecuadorian hospital system in 2011 was only 1.7 per thousand; many hospitals remain at full capacity.
MEDLIFE's work in Ecuador has also changed under Correa. On the one hand, better government coverage of medical costs helps lift the financial burden on low-income families, as well as on MEDLIFE as an organization. On the other, quality is often poor and waits may be extremely long. A 2011 Wall Street Journal article said there were, at that time, "4,500 people on waiting lists for surgery."
These problems are evident in this excerpt from a recent blog post written about a current MEDLIFE patient in Ecuador:
Jose's first consultation for his condition was the entire family's first visit to a hospital. It then took three months to schedule a surgery for him.
A nurse walks by and says the doctor has arrived at the hospital. He is the only pediatric surgeon, working four days a week, and it is obvious. Dozens of families rise to their feet at the news, standing around the exam room door, silently hovering in a semi-circle of anticipation. Eventually, people grow tired and sit back down.
When patients are referred within the public system for treatment, many times they still fail to receive the treatments they need due to lack of resources, lack of confidence, cultural insensitivity, or a lack of understanding about how to navigate the system. For all of these reasons, MEDLIFE's role of advocating on behalf of our patients has become even more important.
You can read more about MEDLIFE's patient follow-up process here.
Post republished from the MEDLIFE McGill blog.
Today was our first day as a group working together. For some of us arriving into Ecuador at around 3:00 a.m. this morning, getting up to go on the bus seemed like a pretty strenuous task. However, our eyes were opened when we made our way to the rural town where we would participate in our first Mobile Clinic.
As we were split up in groups and set up our tents and specific areas, we couldn’t help but notice the beautiful agricultural landscape we were in. As time went by, small children with their parents started to arrive. At first, it was a bit surprising to see their faces. Most of the children had scars from heat and wind exposure, and their parents suffered from poor oral hygiene. It became evident how serious of a health problem dental hygiene was in this area, and it was up to us to help the children learn proper techniques to maintain good oral health, which they can apply in the future.
At first, it was a bit difficult to communicate with the children and elders – who spoke Spanish – when most of the MEDLIFE students could not. However, it became easier when we used simple phrases and using hand gestures to communicate tasks, to the children especially.
I think every member of MEDLIFE learned a great deal from both the children and the elders of the community today, who sacrifice a great deal to support their families through farming while also taking the time to come into the clinic for medical care.
The group that was involved in the development project also reinforced how important it was for the area to create working washrooms in order to promote better hygiene. Everyone working together and putting their efforts today went a long way. When they thanked us before leaving, we could only say thank you back; little did they know, their smiles from receiving proper treatments and toothbrushes was probably the highlight of our day and the best thanks we could have received. We can only hope that they will cherish the information we gave them in the future, and continue to work on developing the washroom in their community. Now we are off to explore more of Riobamba as a group. Ciao for now!
The road goes from pavement, to cobble stone, to dirt. Small tin-roofed houses reveal themselves, hidden high in the hills. They can only be found by following the the trail of concrete steps coated in a fine veil of green moss from the street to their doors.
Luis, PJ and I wind our ways into the countryside of Colta, Ecuador in a white pick up truck. We’ve come to check on a bathroom construction project at a rural school called Columbe Lote 1 y 2, situated in a deep valley near a snaking river.
Dr. Antonio Tayupanda, director of Columbe Lote 1 y 2 greets us in front.
He leads us to four young male volunteers energetically sloshing together cement in a wheelbarrow and hammering apart the adjoining wall of the old, insufficient bathrooms. Currently, there are five bathroom stalls for the 170 students who attend the school. A long basin of dirtied pink and while tile with brass faucets serves as a sink. They are constructing three more bathroom stalls through funding by MEDLIFE Ecuador.
Dr. Tayupanda surveys the work proudly. This new project will serve his students well, who range from ages four to 16 years old. He is stocky and his posture is straight. Brown eyes framed by crinkles of smile lines nestle into his round face. For a 48-year-old man, his hair is youthful. A thick black curl falls in the center of his forehead.
After snapping photos of troweling out thick cement mixtures and aligning cinderblock bathroom walls, the director insists on feeding us. He whisks us away to a small classroom where we squeeze into wooden chairs better suited for five-year-olds. Dr. Tayupanda leans in the doorway, pressing us to finish our plates like a worried mother. He is bundled in a white corduroy coat with a faux-sheepskin collar, though the weather is warm. Small children in thick, red wool sweaters danced about his feet, excited by visitors and the day’s construction. He playfully pats them all on the head.
Our next stop is a bare classroom. A thick red curtain serves as a separating wall for the long room. It hangs limply and unevenly on a wire strung across the ceiling. Dr. Tayupanda speaks of the dire need for more schoolhouses, gesturing out of a dirtied window lined with small potted plants.
Outside was a circle of painted wooden stumps that served as the student’s seats. They conduct class here when they run out of room indoors. The strong winds turn the pages of Quichua instruction books, and teachers, of which there are 12 in the school, have to compete with the loud moo's of cows grazing in the distance. The lack of space is a thorn in his side as principal.
This is one of only three stark classrooms they have at the school. But smoke hangs in the air. Why?
The director answers our questioning with a gesture toward the back of the classroom. There lies a narrow room the size of a closet. Three young women in traditional dress cluster around a fire, heating a large metal pot of potatoes. They peel potatoes with small knives, chatter, and lean toward the one open window for fresh air. They were making lunch for the students, and the principal is proud that no one goes hungry here.
Dr. Tayupanda excitedly leads us to the back of the school’s property. It appears that lunch was not only provided for each student, for the cost of one U.S. dollar per month, but it was home-grown.
We slip through a narrow, muddy passage way between a school house and a small set of three cages formerly used to raise guinea pigs. Here lays his pet project to improve the school -- a cinderblock foundation of what will be a new, larger pen for guinea pig farming.
Though not what one assumes of school lunch, guinea pig is a common dietary supplement in the rural communities of Ecuador. According to the Telegraph, these small rodents can have “more protein and less cholesterol than beef, pork, lamb or chicken.” They’re also quite easy to raise, needing a few servings of commonly grown vegetables a day, such as dark greens, radishes and celery.
Around the corner from the pen are steep hills of fertile, black earth. Dr. Tayupanda points to our feet where a springy lettuce plant grows.
“In three months, it’s ready to be harvested,” he says, beaming.
The hills surrounding the school are draped with rectangular plots of vegetables. Blackberry vines curl along the thin wooden fence surrounding the farm plots. Crops like potatoes, onions, cilantro, turnips, and peppers are grown by the parents of the children on these hills. They volunteer once a week, and the harvest feeds the children and teachers lunch throughout the year.
“How long have you worked here?” I then ask.
“Twenty three years,” he replies without a blink. “And you, you’re what? Twenty-two?” he asks smiling.
“Yes, twenty-two, how did you know?”
He let out a deep laugh. “Twenty three years working [with young people] and I know a twenty-two-year-old.”
He thanks us for visiting, shaking our hands with both of his.
I really hope that you return and come see us,” he says sincerely, as if inviting us back for a family dinner.
Rachel Hoffman is a MEDLIFE media intern based in Riobamba, Ecuador
On a visit to a small school compound in Valle Alto, a poor rural community in the humid hills of Cumandá, Ecuador, Maria, PJ, and I met with a new patient named Alex Javier Chafla.
Cumandá was overcast and hot. We walked on gray dusty roads surrounded by thick clusters of palms and ferns to the community school. There were two buildings, the older one L-shaped and strung together with orange and yellow painted bamboo, and topped with thick sheets of corrugated tin for a ceiling. The newer building was constructed by MEDLIFE Ecuador in February 2012, and is one long room of thick concrete walls with wide windows. Currently, we are working on building another school house for the over 70 children between four and twelve years old who attend.
When we arrive, it’s recess. Children suck on packets of light-pink colored yogurt and scrabble in the dirt to win soccer games without any distinct goal posts. Then they line up for a turn to cool their faces and quench their thirst from a spigot of potable water next to the one bathroom stall. The line is long and children push up against one another in excitement. A young girl gets squeezed out of line and falls into a muddy puddle. A young teacher helps her up and hugs her, reprimanding the unruly line.
After the students rush off to their classrooms, Maria, PJ, and I greet Alex in a small room with a plastic table and a few chairs serving as the principal’s office.
Alex is 18 years old, and slight in build. He is wearing a bright red and white striped t-shirt, with golden yellow embroidered logos and numbers across the chest. His hair is long, gelled upward on the top and buzzed on the sides. Alex sits a bit slumped in his seat with his hands clasped together. He has a hard time making eye contact when he speaks. Essentially, he’s a normal teenager.
And typically, his condition is considered a normal side effect of puberty for young men. Alex has the beginnings of gynecomastia, or the “development of abnormally large breasts in men.” Currently, he has a small lump beneath his left nipple.
Though more than half of boys develop the condition during puberty, which can range between 10 and 20 years of age, it usually disappears over a few months. Alex is toward the end of puberty, and his condition has persisted. The possible causes for gynecomastia other than typical hormone changes can be serious health threats. Chronic liver disease, kidney failure, and testosterone deficiency are some of the more common reasons. Genetic defects, an overactive thyroid, and tumors are more rare.
Alex speaks in a soft whisper as he answers our questions. His long lips barely part. At first, he said that he was not nervous to be treated. He later adds with uneasiness that it would be his first time getting medical care, especially in a hospital. “I am a little nervous but I have to confront my sickness,” he says resolutely.
Alex found MEDLIFE Ecuador after a Mobile Clinic came to his high school, Colegio General Antono, in Valle Alto. After seeing a clinic doctor, MEDLIFE was able to assess his family’s financial needs. Currently, they are bringing in less than $80.00 per month to support a family of eight people.
The family was verified to receive aid. When Alex found out, he says, “I felt good, sure that I would see a doctor.”
There have been additional financial constraints as well. Alex’s father, Segundo Alejandro Parapi Chafla, 42, has not been able to work driving his taxi for about four months due to hemorrhoid surgery. Alex admits that it has “affected the family a lot.” His mother, Maria Cenada Chaflas, 35, works at home taking care of Alex’s five younger brothers. They also care for a mentally disabled uncle.
However, unlike many poor rural families in the Valle Alto community of Cumandá, Ecuador, the family owns their own house. They do have electricity, though more than three people sleep in each room.
Currently, Alex is slated to see a doctor next week. It is a three hour bus ride to Riobamba from his community. For now, the doctor ordered an x-ray of his left breast and a series of laboratory tests for when he arrives at the hospital.
Rachel Hoffman is a MEDLIFE media intern working out of Riobamba, Ecuador
Luis and I took a short bus ride from Riobamba. The rhythmic rocking of the behemoths they call buses here was still enough to induce both of us into a brief slumber. After thirty minutes and a brisk walk through a few uneven cobblestone streets, we reached a tall iron gate that sat guarding a small school. On the side of the school facing the street it read “Escuela Mariana Borja” in black, capital letters.
We had arrived. To look at a bathroom.
It wasn't yet a bathroom per se -- it was a patch of grass and a pile of rubble from which we were going to begin building one. Sanitation projects for MEDLIFE Ecuador are some of the most important community projects for providing sustained health care. This school sits in the Cajabamba community in Colta, a primarily indigenous and rural population. Rural and lower-class regions like these have the worst access to proper sanitation facilities in the country. Without hygienic separation from fecal matter, it can often lead to infections and diarrhea that is life-threatening, especially for younger children.
Escuela Mariana Borja is overflowing with children between first and sixth grade. Once you’re inside, dark orange and ochre walls form semi-outdoor hallways. Children duck and giggle behind pillars. A cement rectangle forms a small soccer field in the center of the compound, where young boys scrabble over a well-worn ball.
The need for the bathroom project was obvious. The current situation involves three stalls for boys and three for girls. There are over 200 students. When we spoke with the principal and some school children, they told us that often the smaller children get pushed out of the long lines for the bathroom during recesses by the older students. They hardly get to wash their hands, let alone relieve themselves.
But the school day must go on. Children in a fourth grade science class were excitedly slapping bright red paint onto papier mâché volcanoes in makeshift streams of lava. First graders were practicing their letters in small marble notebooks in an impressive concentrated silence.
On November 7th, the bathroom construction site was a pile of cinderblocks, a few scattered indigenous women volunteers from the community, and the skeleton of an old metal swing-set. By November 16th, a frame of the new stalls was erected in gray cinderblock, and a volunteer group was busily installing piping and supports on the roof. The project is slated for completion by November 26th.
Rachel Hoffman is a MEDLIFE media intern based in Riobamba, Ecuador