Another [Attempted] Adventure

Picking up from where I left off...

After the great experience in Latacunga, I returned to Pedro Thursday (March 22) night.  I had left the workshop in Latacunga with tentative plans to attend a smaller workshop the following Monday in a small town near Latacunga.  I wasn't too psyched about another seven our trek, but I was also interested in observing a small workshop.  Back in Pedro, I had a short weekend of catching up on homework for my online class, conducting one practice-interview (testing interview questions) with a diabetic patient, and then attending the Friday night psychology discussion and humanities class with the medical residents.  Saturday I left for Quito again--a friend, Victor, who is working in Pedro invited me to his home, where he lives with his mom and sister.  He also has family in Latacunga, so he suggested he accompany me to Latacunga for the smaller workshop and he could also visit his family.  Staying with his mom in Quito was absolutely wonderful--she, and also Victor's sister, Liss, were immediately welcoming and so nice.  We celebrated his mom's birthday with cake and jello that night and then went to a movie Sunday morning before leaving for Latacunga.  As it turned out, Victor was sick and also had to work the next day, so Liss traveled with me.  We stayed at their uncle's apartment in Latacunga.

Despite a late Sunday night of finishing my homework, I got up early Monday morning and set out to find the office where I was going to meet the group leaving for the smaller workshop.  Unfortunately, all I remembered was that the office was on the same street as the hospital.  But I didn't remember which street...or what the office looked like...so I just wandered around for awhile.  My contact in the group did not answer his phone, so I was unsuccessful in finding the office.  A little bummed and annoyed, I headed back to the apartment where Liss and I were staying.  On my way back, I called Liss to ask for the name of the apartment complex, so I could tell a taxi driver where I wanted to go.  My phone died mid-call.  So I just started walking...I had a relatively good idea of where it was, remembering a few buildings that we had passed along the way the day before.  After a half an hour of wandering in the general direction and getting turned around the entire way, I hopped in a cab and explained to him where I wanted to go.  All I knew was that it was a new apartment complex near the airport (and we were sitting in the taxi across from the airport).  He looked at me like I was crazy and suggested a few new apartment complexes in the area.  I asked him to take me to the first one he suggested, hoping that I would recognize it as we approached.  Luckily, it was the right place...I had only been 10 minutes away when I hopped in the cab.  I had been so close...definitely gave my intuitive direction skills a boost of confidence!

Liss and I met up with some of her friends who attend the university in Latacunga and spent the rest of the morning walking around, finding touristy places for me to take pictures.  (There weren't many.)  After lunch we returned to the apartment, where I then took a three-hour nap!  That evening, we went over to one of Liss' friend's apartment and played cards and ate pizza.  It was a nice fun break from Pedro, hanging out with 19-year-olds who have a different demeanor and vocabulary than the older crowd of doctors at the hospital.

Pizza place named after me, hahaha!

New friends...at a slimey paddle boat pond.

The next day, Tuesday, we made a quick visit to Liss and Victor's grandparents' home.  We ate haba, a type of bean that is typical of the Sierra (each bean is a little bigger than a quarter!).  Liss' grandmother made some popcorn that we took for the journey back to Quito (and then Pedro, for me) and we were off for another long bus ride.  Even though this second adventure to Latacunga didn't quite work out as planned, I found it all very comical and still very fun.  I finally made it back to Pedro and decided that I would not be traveling for at least a week or two, I was exhausted!

A Turning Point

On March 19 I had a meeting with the Regional Director of Latin America at University Research Corporation.  The director was a former colleague of one of my project advisers, who is also a respected mentor.  Following an email introduction, I had expressed my interest to the director about learning more about a maternal and child health project they were leading in the province of Cotopaxi, which is south of Quito.  The meeting was absolutely great!  I learned a lot about the role of URC in implementing evidence-based practices in many areas of public health.  I did not previously understand the link between research and practice, so it was wonderful to meet with URC and develop a vision of the type of work I want to do in public health.  I learned a lot about the maternal and child health project they are leading, too.

This four-year project works with traditional birthing attendants (parteros) in small villages.  The goals are to improve the healthcare of the parteros without changing cultural traditions (such as vertical birth), and also improve the services in formal hospitals.  The overarching theme is also to create networks of healthcare providers and community leaders that work together to reduce neonatal mortality.  It's important that the parteros still deliver babies how they have delivered babies for years, but the project teaches them practices that improve the sanitation of delivery or the feeding of newborns, for example.  There are many levels of people involved in the project, from towns to townships, counties, and finally the entire province.  At each of these levels, project facilitators lead workshops for parteros, teaching and reinforcing the main points of neonatal health.

I'm really interested in this type of project that implements evidence-based practices to improve community health, specifically in the area of maternal and child health.  I asked the nurse who leads the project (who was at the meeting on March 19) if I could accompany her to one of the workshops.  She said "of course, I'm leaving tomorrow for a county-level workshop the following day."  I was quite taken aback and not expecting this idea of mine to materialize so quickly!  The workshop would be in Latacunga, a city south of Quito.  I was not prepared to stay another night in Quito and accompany the nurse the next day, so I left the meeting with her phone number and the possibility of finding my way to Latacunga on my own.  I returned to Pedro extremely excited and hopeful that I could go!  (Who was I kidding, I have no real schedule and was at a standstill with the diabetes project...of course I could go!)

The next morning in Pedro I quickly contributed to my online class discussion, packed, and reserved a room at a hostel in Latacunga.  I was off on my adventure.  After the three hour bus to Quito (which ends at the north bus terminal), I had to get to the south bus terminal, where buses leave for Latacunga.  It took me over an hour and a half (but only 50 cents!) to get through the long city, using public buses (well, actually three different public buses).  Once in Quitumbe, the south bus terminal, I quickly boarded a bus to Latacunga and was proud of myself for navigating the busy city.  There was a march of indigenous people in the highway just outside of Quito, so our bus driver turned off the bus as we waited half an hour for the march to pass.  Unexpected but interesting.  Finally in Latacunga after two hours, I found my $5-a-night-but-still-clean-and-accommodating-hostel then wandered a bit through the streets to find a bite to eat.  The next morning I wandered around again then called the nurse, informing her that I would meet her in 10 minutes at her hotel!  She was shocked yet thrilled.

Pretty building on my morning walk

One of the lovely plazas

I joined the nurse and two other members of the project team and we were driven (by a local driver who works for the project) out to an old country monastery where the workshop would be held.  Many parteros had arrived the night before and were staying at the old monastery.  It was a beautiful setting for the workshop.  After breakfast and introductions, the parteros broke into groups for the training sessions.  I observed a group led by a nurse from Latacunga and woman who works with the Intercultural Health division within the Ministry of Health, a native to the area who speaks Quechua, the indigenous language.

View from outside the old monastery.

It was so exciting to see so many parteros, there were over 50 of them from all over the county, all wearing the traditional garb.  During the small-group training session, the main points that were taught/reinforced were hand washing; preparing the maletin (the bag that parteros bring with them to a birthing mother's home); delivery practices (such as cutting the umbilical cord and immediately putting the baby with the mother); and warning signs for pregnancy, postpartum mothers, and neonates.  The parteros observed demonstrations, practiced different procedures, did role plays, drew pictures of warning signals, and participated in question/answer with the facilitators--there were many methods of reinforcing the same principles.  Everyone was engaged and eager to learn.  It was a long day at the workshop, but we were all fed breakfast, 2 snacks, lunch, and dinner.  The workshop continued the next day until the mid-afternoon snack.  Then the parteros rushed off to catch various buses back to their villages.  I also rushed off, knowing that I must get back to the north bus terminal in Quito by 6pm when the last bus to Pedro leaves.

Attending the workshop was an incredible experience--I was able to observe methods for implementing community projects that, through previous courses or experiences, I had learned were effective, sustainable, and contextually-sensitive.  Projects like this maternal and child health project are what I want my career to be.  Getting excited and learning about URC and what they do has helped me realize that what I'm doing in Pedro with the diabetes project is a stepping stone to reaching my career goals.  Just the motivation I've been needing!

Setting up for demonstrations. 

Partera demonstrating the hand washing technique she learned.

Game/exercise break after lunch.

Drawing out various warning signals.

This cute child accompanied our small-group session and was very fearful of me!

Inside the church.

Recap: Beginning of March

It's been a month now since I've posted, so I thought it is bout time that I update you all!  The weekend before my birthday (which is February 28), the group of medical residents at the hospital switched.  They spend eight weeks in Pedro then eight weeks in Quito.  The U.S. American medical student also left on the 29th.  Because of these changes, the first couple weeks of March were rather boring and lonely!  I was readjusting to making new friends in the new group of residents--who are busy and don't necessarily have time to hang out and make new friends.  I mean really, they're doctors.  They work at least 12 hours a day.  I also kicked off March with a large grasshopper chirping and flying around my room as I tried to fall asleep with the sheet over my head.  It landed next to my pillow, and I promptly got it out of my room using a broom.  When I first saw this creature in my room I thought it was an alien.

As far as my project, things were also moving slowly.  I'd been practicing interview questions with diabetic patients.  However, the method for doing this was waiting in the consultation waiting room for hours; if a doctor had a diabetic patient that came in that day, they would introduce the patient to me and I would interview them.  Some days there would be no patients.  Thankfully I had a book to read (I recommend Half the Sky by Nicholas Kristof and Sheryl WuDunn for anyone interested in global women's issues).  Needless to say, this waiting around got to be rather demotivating and frustrating, especially thinking that I was simply testing questions...I hadn't even begun officially conducting interviews and collecting data.  Unfortunately my on-site supervisor had also been on vacation, so I was also waiting around to get feedback from him.  It was a long first two weeks of March!

Where I hang out at the hospital, the cafeteria.

The waiting room.  Entrance to the right, consultation rooms straight ahead, reception to the left.

On the bright side, my free time and lack of friends allowed me to do some cooking (always a stress-reliever) and go to the gym more often.  The gym has an odd variety of weight machines and non-electrically-powered treadmill and elliptical (one of each).  I use the weights a bit, but the main reason I go is for the aerobic dance class.  The first class I went to was a mix of aerobics and salsa/merengue.  Now we mostly dance to salsa, merengue, cumbia, and little reggaeton and other traditional Ecuadorian songs.  It's not very organized and I can't say the workouts are consistent or targeting specific muscle groups or flexibility, etc...but my salsa dancing has definitely improved!

A few other highlights:
*I had an "admirer" who works at a little grocery store in town.  He asked me to dinner one day and I said no, so now he no longer gives me roses when he sees me.

*On March 5th I went to Quito to visit a friend in the previous group of residents.  I accompanied him to the doctors' class at Pontificia Universidad Catolica del Ecuador (PUCE).  It was interesting sitting in on the class and even more awesome to wander around campus a bit!  It had been a long time since I'd seen so many students my own age; it would be very fun to be a part of the ambiance of the undergrad campus and student body.  After the class, my friend and I drove up the panecillo (which means cupcake), the man-made hill in the center of the city, atop which is a statue of the Virgin of Guadalupe.  We climbed up the statue and had some great views of both north and south Quito.  I didn't bring my camera, not expecting a touristy excursion.  Bummer.  (The background of this blog is actually the panecillo, though, a picture I took in June, 2011 from a huge cathedral in the historic part of Quito.)

*The following weekend, March 11, one of the residents asked me if I wanted to go with her to visit her family in Santo Domingo.  (I think she overheard me telling the dentist that the next time he goes dancing with the women who work in the lab, he needs to invite me because I'm so bored in Pedro.)  It was really nice to do something different and I really enjoyed meeting her family--they were so friendly and generous.  Sunday at her home was definitely "family time," so I spent a lot of time playing with a little cousin (or nephew, I'm sure how they were all related...).  We also visited the farm where her parents now live.  Her 15-year-old niece showed me around, not knowing that I grew up on a farm as she pointed out things like: "this is where the cows eat," "this is where the cows poop," "we put the poop in the fields because it's good for the soil."  I thought of all those summers our farm/the countryside smelled like turkey shit.  But the niece and her father also pointed out things that were very new to me, like: "these are coffee trees," "the red seed pods are the ripe ones," "this is a pepper plant, you harvest the seeds and grind them to make black pepper."  It was borderline torrential down pour as we walked around the farm, so no pictures taken!

*I finally went dancing with the medical residents (the second and third years) and also met some other hospital staff that joined us at the discoteca.  It was a fun night!