Why Yes, I Am Alive and Doing Things...

My first full week (January 30^th) in PVM started with shadowing a medical resident…for over SEVENTEEN HOURS.  He was working in the emergency room; I began shadowing him at 8:30am and returned to my room at 2:20am.  He stayed at the hospital with the other resident on duty that night, to sleep while waiting for the next patient in need of aid to arrive at the 24-hour emergency room.  And no, I did not attend the medical residents’ 6:30am class the next day.

The emergency room has five beds, and for most of the morning they were all full.  Most patients came with severe abdominal pain, which often ended up being a result of their diet and were sent home with instructions to lay off the fried or acidic foods.  However, one small boy did have dysentery.  Other noteworthy experiences were an allergic reaction to shellfish and an elderly campesino (rural farmer) couple who came in around 11-11:30pm seeking treatment for a machete slash in the man’s knee.  I watched the medical resident clean and stitch up the deep cut.  I was worried I might pass out (there was a lot of blood…and I’ve never seen someone sew skin…), but I was more weak from not eating for nine hours than from the blood and needle.  I asked the wife if they lived close and she said they lived two hours away.  I think they walked to the hospital.

The best part of the day was interviewing an elderly main who had been hospitalized a few days prior due to his symptoms of nausea and abdominal pain…and blood glucose of 520!!!!!!!!!  (Anything over 126 without having eating, called fasting plasma glucose, is diagnosed as diabetes.)  We asked him questions about his physical and mental status, as well as the foods he usually eats.  Next, we looked up the caloric values and glycemic loads of these foods, then calculated the calories for the man’s diet.  It was very interesting to observe and be a part of this process.  I didn’t offer “my expertise” (the medical residents have called me an expert on nutrition and diabetes…hardly the case) because I wanted to observe how the medical resident goes through this whole process.  I unfortunately was not at the hospital when the resident talked with the patient about dietary recommendations for his diabetes, but I hope to do much more observing of this diabetes diet process to learn more about the diet prescribed to diabetic patients.

Well, that was just one day.  I had already done quite a bit of exploring the food market, to get an idea of the types of food available and most common here.  So, I spent a lot of time working on questions for surveys.  The American doctor who founded the Hospital and Andean Health and Development (AHD—which is a Non-Governmental Organization (NGO)—check out the Hospital PVM tab) was here, so I met with him and the doctor from PVM, who are two of the advisors for my project.  I realized how unprepared I was with the survey questions I had been working on.  With the help of a hospital employee who is well-known in the town, I met and briefly talked with providers of alternative medicine, as well as a couple pharmacies.  This helped me realize the many various options of healthcare treatment that are available and often used here.  The treatments ranged from insulin and other Western-medicine medications to insulin water (like an herb juice), protein powder, herb supplement (like a cough syrup), herbs used to make an infusion, herb supplement pills, and massage of the pancreas.

Might seem a bit odd, but this is the whole point of my project: to articulate the contextual, cultural understanding of diabetes here in Pedro Vicente Maldonado.  And why articulate this understanding?  Well on the Stateside, the goal of my final report is to introduce doctors to the many alternative medicine options their patients may practice and to encourage acknowledgement of this type of medicine as a legitimate alternative.  Here, in Pedro Vicente Maldonado, my final report will also have this goal for the doctors in the hospital.  However, a couple residents have expressed to me their interest in my project because they’ve noted that diabetes is becoming a greater health concern and they are interested in knowing how to treat it more effectively with diet.  To this end, I’ve been thinking about a new part to add to my project: develop nutrition-related resources (such as a guide to a diabetes diet) that doctors can use when working with diabetic patients.  Of course, these resources would be within the context of the diet, health, lifestyle specific to rural Ecuador.

Goals for the upcoming week:

*Develop questions for healthcare provider surveys

*Complete the official ethics application to conduct research

*Observe more interactions between doctors and diabetic patients

*Speak more Spanish

*Go dancing J