ER in Quito - By Robin Fillner - SALUD Program Guest blogger traveling in Quito.
...Please be aware that the following blog contains graphic descriptions of scenes witnessed in an operating room. Reader discretion is advices.
Yesterday was pretty interesting. First, I attended rounds with the students. The patients we studied were in an observation room adjacent to the ER. The patients go there for a couple of days before actually being admitted, if necessary. We talked about different clotting times when taking warfarin, a blood thinner and different medication interaction when taking warfarin. The students participated in writing orders... and me too; I added cardiac diets to the cardiac patients. Most of the patients had pyelonephritis, a kidney infection.
Today, I hung out in the ortho room. We examined about 100 x-rays and discussed fractures and dislocations, etc., in between patients with broken bones. The students are so quick; it was hard to find the fractures before them.
After rounds yesterday, (don't read this if you have a queasy stomach but definitely read the end!) I hung out in the trauma room and there was a patient that was driven from La Costa, the coast, about 5 or 6 or maybe more hours away... that had been in a fight with another man regarding a land dispute. The angry man attempted to cut his head off with a machete or a hatchet; I couldn't understand which. But the patient had two cuts from the middle right ear all the way around to below his left ear. By the time I got there the patient already had a central line ( a main IV,) and was bandaged up. He had an ET tube and was being ventialated and had a midazolam drip running for sedation.
There was no cardiac monitor in sight and I really don't think anyone had taken his vital signs. He was moving all his extremities which was impressive and we had to hold him down because there were no restraints, or side rails. I got to go up to surgery with him. When they removed the bandages, arteries instantaneously started pulsing with blood. I was so impressed that the patient was so stable! The doctors immediately clamped off maybe 10 or so sites to decrease the bleeding. Inside the wound, you could see that his cranium had been severed, and so you could see his brain. I had never ever seen anything like this before. Also, part of his cervical vertebrates were cut as well. My Spanish teacher said it is common for injuries like this (although more likely on extremities) to happen in the coast because machetes are the only source of weapons there. There was an anesthesiologist, a plastic surgeon, a vascular surgeon, neurosurgeon, and about 5 other people there to watch. I was so impressed with the nurses and the sterility of the room. However, I had to hold the patient for a while because he was on his side and the only method they had to keep his legs on the table was with tape. A little precarious, the doctors in the room took pictures of the wounds with their cell phones, which I thought was a little weird.
Sorry if I ruined any appetites. The whole experience is really eye opening. There are a lot of differences in medicine here vs. the US. I will discuss some of them in the next blog.
By Kayla Allen
The Amalfi Coast is known worldwide for it beauty. Famous for its views, its food, its walking tours and the diversity of its towns, it's got a little something for everyone.
Nature
Amalfi's oceanic views will turned even the most stalwart city dwellers into nature lovers with its bright blue water and villas built into the hillside, you simply can't help falling in love.
For the already seasoned nature lovers there is Ferriere Nature Reserve which hosts a variety of plants and wildlife including salamander, badger, fox and many birds like the kestrel and the red woodpecker. Due to the reserve's position in a valley it is protected by the cold winter wind and has a pretty consistent temperature of about 59F degrees with high humidity. These characteristics help the reserve to act as a nursery keeping plants that would find it very difficult or impossible to grow anywhere else on the coast.
Food
Italian food with some of the freshest fruits and vegetables, seafood, cheeses, and sumptuous pasta dishes how could you go wrong. Not to mention the wonderful world of Campania wines.
Lemons are always used in the local cuisine in the preparation of main courses, sweets, ice cream and simple refreshing drinks, such as lemonade. Lemon liqueur is one of the most famous foodstuffs on the coast, offered after meals and always served cold.
A mainstay of every lunch on the Amalfi coast and in Neapolotan cuisine in general is strong black coffee.
History
Amalfi has no shortage of museums owing to its long and interesting history.
Il Museo della Ceramica
A Museum dedicated to local ceramics with pieces dating back to XV century and votive ceramic of the XVII century.
Il Museo della Collegiata Chiesa di S.Maria a Mare
This church was built during the XII century and was turned into a museum a few years ago. It contains many objects thought to be holy, Spanish sculpture from the XVI century and its most treasured piece from that period, an ivory casket.
Sources:
www.amalficoast.com
www.amalfilife.com/tours_culinary_06.html
Vaqueria and the Pyramid Across the Street - By Jeremy Carter - Guest blogger traveling in Merida, Mexico.
Last night, I headed down to Merida's main square for the weekly performance of the vaqueria, a dance native to Yucatan. In this dance, couples dressed in traditional attire (white suits and white dresses, all with intricate embroidery) do a spirited dance where their torsos remain nearly motionless and their legs and feet move. (Think a Mexican version of Riverdance, only a lot more graceful.) To further demonstrate their skill, the performers dance with a glass of water balanced on their head…then they up the ante and dance while balancing a platter of five or more glasses of water. As if that weren't enough, they next dance with the platter on their heads while standing on a small box that's no more than a square foot in size.
Today, Armando – the archaeologist who doubles as our Mayan culture instructor – took our class to Izamal, a town about 45 minutes east of Merida. We were expecting an archaeological site with perhaps a few homes and small tiendas, so we were shocked to find a rather large and very beautiful colonial town where all of the buildings are painted yellow with white accents, and the streets are paved with cobblestone. The town square is lined with shops and vendors, and today was quite a busy day…although compared to the hustle and bustle of Mérida, Izamal seemed to be a sleepy town.
The focal point of the town square is the Franciscan convent, an enormous structure built in the 16 century on the site of a Mayan pyramid which the Spanish conquistadors dismantled. The convent still contains many of the original murals showing the Spanish settlers, while the cathedral contains elegantly dressed statues of various saints and the Virgin Mary.
Then of course there are the ruins of Izamal. What makes these ruins so different from the others we've visited is the fact that they're scattered throughout the town. So from a back staircase at the convent you have a view of a pyramid being restored, and a nearby residential street divides a row of houses from another pyramid. I can't imagine what it must be like to look out your front door and see a pyramid that's more than 1,400 years old, but the people living in Izamal likely don't think anything of it. We climbed one of the pyramids, which has been restored about halfway up, but the second half of the stairs leading up to the top were extremely rocky and even. However, the view from the top -- with the convent and matching yellow stores and homes in the foreground and a 360-degree view of the flat, green Mexican countryside -- made the climb up (and the even more harrowing descent) well worth it.
Service Learning Visit at Hospital of Quito - By Robin Fillner - SALUD Program Guest blogger traveling in Quito.
Buenes Dias! Como estan? Well, this week we started volunteering in the hospital. So, now our days are pretty full with volunteering in the morning around 8 until 12. At 1:00pm we have lunch at school and then study Spanish from 2:00 until 6:30pm. and we always have homework... The hospital is a teaching hospital and since 8 in our group are med students, the doctors that they follow give them homework such as presentations about certain diseases (yes, in Spanish!). And 2 people in our group have to be there at 7:00. The others in the group are in the areas of OB-GYN, surgery, oncology, infectious diseases, and pediatrics.
I went into Urgencia, or Emergency. I was assigned to a nurse but she has me doing things like taking 1000 blood pressures, so I have been just observing the trauma cases that come in or attending the rounds or the med students. I haven't practiced too many skills as of yet just because of the language barrier. But, I am pretty satisfied with learning the Spanish medical lingo and observing the way things are done in Ecuador.
There are so many med students in the hospital that there really isn't that much to do for me. Which I was a little disappointed with in the beginning but with the language barrier, it's really ok. The first day I was there, I met 2 med students from Colombia that showed me around the ER and talked with me for about 2 hours! Isabel, my house mom, is convinced they are into drugs somehow, but I keep telling her that no, they're really med students. How they had time to talk with me, I have no idea. They talked really fast but I was able to keep up. There are also a lot of residents there that are also extremely friendly and eager to show me equipment and introduce me to their instructors and other doctors. I am so amazed at how incredibly friendly all the staff is: nurses, doctors, and students.
By Jeremy Carter - Guest blogger traveling in Merida, Mexico.
Skulls, Monkeys and Flamingoes (oh my!)
The school hosting the Yucatan Spanish Institute, the program I'm participating in, has done a phenomenal job of planning excursions for those of us studying there. On Wednesday, we went to the Museo de Antropologia e Historia, which is operated by the Instituto Nacional de Antropologia e Historia that I blogged about earlier. The museum, which is housed in a restored mansion on Merida's historic Paseo de Montejo, is filled with artifacts about the people who have occupied the Yucatan peninsula for the past 4,000 years or more. The first floor of the museum is devoted to the history of the Mayan people, in particular from the Pre-Classic (2,000 BC-250 AD), Classic (250-900 AD) and Post-Classic (900-1500AD) periods. (I hope I got those dates right.)
One of the most fascinating exhibits was the one showing skulls of ancient Mayan people. Mayan people used to believe that a sloped forehead leading to a nose of about the same angle was the ultimate in beauty and a sign of nobility. As a result, they would often force this slope by tying boards and other objects to the foreheads of babies. At the museum, we saw skulls of adults and children who had this slope, either naturally or by force, and the shape was indeed striking.
Also interesting was an exhibiting showing the various materials Mayans used as "canvases" for their artwork. Jade, pottery and stone were the most common mediums, but they were even known to carve intricate carvings in bones from deceased people and animals. (As a side note, we learned from Armando, our Mayan culture instructor, that no ovens for firing pottery have been found at ancient Mayan sites, so anthropologists aren't sure if ancient Mayans fired their own pottery or imported it from nearby cultures/countries.)
On Thursday, we took a trip to the city zoo, which is located just outside downtown and, due to the fact that it's government-funded, admission is free. Since there's no direct public funding for the zoo, it's not as expansive as many zoos in the states, but we got to see many animals native the Yucatan peninsula that you wouldn't otherwise get to see.
Today, however, was a definite highlight of my two weeks here. This morning we boarded a bus and went to Celestun, a town and neighboring nature preserve that serve as home to North America's only mainland population of pink flamingoes. Here we took motorboats out into the water to see these beautiful birds, which number in the tens of thousands during the winter months, but there are still a few thousand of them this time of year. We also stopped at an "ojo de agua," or freshwater spring, for a quick swim. After that, it was off to the town – a quaint, sleepy pueblo fronting the gulf – for dinner. This evening I'm so tired I can barely stand up, but with only two weeks left, there's much more to see, so tomorrow I'm planning a trip to the nearby beach at Progresso.
By Robin Fillner - SALUD Program Guest blogger traveling in Quito.
Some people in my family were wondering about where I live and the food we eat in Ecuador so I thought I'd write a blog about it. I live in a really neat little apartment in kind of the older part of town. There is just me and the mother of four older children who all live and work around Quito. She has family dinners with them on random nights and every weekend.
One of the sons, Jose Luis, works out of the bottom floor of the apartment. He deals in exports/imports. Another son, Freddie is a lawyer; her daughter Tanya is a social worker, and the other daughter, Christina, is studying to work with computers. Isabel, the mother, has three grandchildren who are all extremely cute and a lot of fun. Nickolas is the son of Tanya; he is 11 and swims most nights of the week. He is very serious about his swimming and eats a special diet. He speaks a little "Ingles". Sometimes Isabel has him interpret. He loves to play video games and watch TV, but works very hard on his studies and sports. I am usually gone on the weekends. While I am gone, Isabel usually has the whole family over for dinners and while Ecuador was in the World Cup, the family came over to watch the games.
Isabel makes breakfast and dinner for me every day. I try extremely hard to help her but she always says "manana, manana," you can help me tomorrow. I try to sneak in washing or drying some dishes, but she tells me to sit down. She puts out butter, jam, cream cheese, coffee, hot chocolate, and so many other little jars on the table every morning - so I sneak those back in the cabinets to help her clear the table. Every morning she makes fresh juice of some sort.
There are so many delicious fruits, they are so different than in the US. There is one called a narajanita - a tomato looking like thingo that grows on trees like an orange. It tastes like sunny delight but is completely natural. She makes these little empanadas - fried tortillas with cheese and usually meat inside. I am bypassing the whole vegetarian deal right now b/c it's just to hard to explain and a big deal to make a special meal just for me. But I think she knows now and she is cutting down on the meat.
We had scrambled eggs this morning, but also breads, fruit salad... pretty much the same as in the US. For dinner, we've had rice, empanadas, beef, pork chops, always a bowl of soup with potatoes, or cream of mushroom. She makes veggie salads with cucumbers and tomatoes. We had some little yucca balls that were white and floury with cheese in the middle, extremely delicious. Sometimes she cuts of pieces of corn but not just the kernels but the whole cob part as well and throws it in the soup. It's really good. We had some little fried broccoli with cheese thingos that were really tasty.
On the street I had some fried plantains with cheese in the middle that was incredible. My friend calls the street vendors 'diarrhea markets'... but I haven't had any problem with that in the least. There are also a lot of restaurants - mexican, chinese, tex mex, ice cream (mmm....)... and a lot of specialty shops. I went to a cafe called 'xocoa' and there was the most impressive selection of delicious chocolate. I had an Irish chocolate with a little bit of liquor and super thick chocolate; so thick I had to almost chew it with a deliciously thick blob of whip cream.
Overall, I think they eat a lot of potatoes, yucca, beans (lentils, garbanzos), and meat with most meals. But everywhere there is fresh fruit juice to be had... it's really inexpensive as well. You can also buy a dozen roses for a dollar! We always have fresh roses in the house. A lot of businesses have fresh roses as well.
Well, time to get with the group!
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