Anecdotes from the Amazon: Final Thoughts

The Amazon Community and Indigenous Health program through CFHI opened unimaginable horizons for me. I learned so much about what it is like to work in health care in a hands-on way I would have never imagined to be possible. At the same time, I gained an immense sense of culture and learned so much about myself and who I want to be.

I plan on applying to medical school after I graduate from UCSC this fall. I plan to pursue a Masters in Public Health as well as my M.D. and I hope to work in Latin America in the future or in Latino communities in the United States. The variety of clinical and public health experiences I gained while on my program will undoubtedly influence my choices in the future and I feel that I have gained a unique type of knowledge that few others will ever obtain.

Something in me has felt unsettled since I returned from Ecuador. I am not lonely because I am back home where I can see my girlfriend, best friends, and family.  I am not lacking in learning because I am taking my final classes at UCSC and continuing my research in the neuroscience lab. Lastly, I am not without reminders of my trip because not a day seems to go by where I don’t reflect on an experience, gaze at a photo, or tell a story about it.

What seems to have me so unsettled is the fact that my time in Ecuador, at least for the time being, is over like a dream that passed in a 4 week sleep. In a sense, I became settled in Ecuador and to leave is like pulling a new tree up from its young roots. However, I feel more like a South American Socratea exorrhiza or the walking tree, which is believed to be able to move itself slowly through the jungle by extending new stilt-like roots. While I may have laid roots in Ecuador, I must continue my journey through the jungle of life in search of new patches of sunlight.

I am overwhelmingly grateful to have my experiences in Ecuador to inspire me for the rest of my life, both in my academic and personal lives. I would like to thank the people at CFHI headquarters in San Francisco for adequately preparing me for the program. I would like to thank Rosita Tomayo for being so helpful in Quito at the language school and in the first week of adjusting to a new place. Thanks to Dr. Torres who made the effort to ensure that everything was going great during my program despite being so busy with his own amazing work. Thank you to every doctor in every clinic that I worked in for including me in your work and educating me in priceless ways. Tii yuminsajme (muchas gracias) to the entire community of Uwijint for your hospitality and sharing of your beautiful culture. Waraji amikiurt (cheers friends). A special thanks to all of the CFHI students who I consider to be amazing friends. It was a pleasure to get to know each and every one of you and I wish you all the best of luck in your futures. Finally, my deepest gratitude to my host families in Quito and Puyo. Kelly and Hugo, if I am ever again in Quito, you are the first people on my list to see. Hugo, you taught me so much what it means to be a physician who cares about his patients and I hope to follow in your path of caring for people even if they have no way to pay. Kelly, you are one of the sweetest people I have ever met and I am so glad that I was able to spend a week in your home. Nancy and Henry, you both took care of me when I was sick in Puyo, for which I could never repay you. You both were amazing. Henry, I hope to climb Cotopaxi with you someday and Nancy I will dearly miss the amazing meals you prepared every day. To all the above, I am forever indebted.

Arum (adios).

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Anecdotes from the Amazon, pt. 5: Arajuno, Puyo, and Quito

The final week of my program began in another small clinic called Subcentro de Salud de Arajuno, which is a two hour bus ride over mostly a bumpy, unpaved road that winds through the jungle hills. The clinic was  bigger than the Pitirishca clinic, but it still only provided primary level care and was much smaller than Hospital Vozandes.

At the Arajuno clinic, I again had an opportunity to do some hands on work by assisting the physicians in taking patient weights and heights. Again many of the patients were children who were trying to get their vaccine certification in order to enroll in the upcoming school year. I also had the opportunity to calculate the amount of medicine that one doctor was prescribing, which was an important job to ensure that the patient received the correct dosage. I also learned how to give an intramuscular injection, which was performed on an older man who received a vitamin B12 IM injection in the gluteal muscles.

The final clinic that I worked at was the El Dorado clinic in Puyo. This was again a smaller clinic and my experience here was very short because I only spent a single day working there. However, I was allowed to continue practicing my patient interview skills and calculating prescriptions.

On my final day in Puyo I went and said goodbye to Dr. Torres, who was such a great coordinator and teacher throughout the entire experience. I also treated my host family to dinner at a nice Italian restaurant to say thanks for their impeccable hospitality.

I made my way back to Quito for the reunion of all the students in the program. We were treated to dinner by Rosita, the program coordinator in Quito, after we had our final meeting at the language school to discuss how everyone’s program went. After dinner we took a ride on a chiva party bus, which includes riding around the historic part of Quito and the Mariscal district. A band played on top of the bus while we rode around, drank a warm alcoholic drink, and blew whistles. We probably seemed quite obnoxious to the locals, but it was a chance for all of us to have a lot of fun before we all went our separate ways. The departing of the group was sad for all but it was great to see that every single person had a positive experience and had come away with a renewed outlook on life.

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Anecdotes from the Amazon, pt. 4: Uwijint

Possibly the most significantly impacting part of my trip, my experience in the Shuar community of Uwijint is one that I know I will always look back on for inspiration.

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While visiting this small community that is a four to five hour walk into the jungle from Pitirishca (three hours for the Shuar, who make the trip regularly), I not only discovered a great deal about the indigenous community but also about myself. The community of Uwijint is an amalgamation of traditional indigenous life and minimalist modernity. While the Shuar of Uwijint dress in modern clothing and sometimes use rifles to hunt for food, they still use a variety of plants from the jungle for everything from snake bites to soap.

What amazed me most about the Shuar is their inherent familiarity with their environment. Dr. Torres summed it up perfectly when he told me that “if a Shuar were to try to live where you live, he/she would die.” I felt the same was true of myself in this beautiful yet dangerous jungle. From the time Shuar are little, they are constantly being educated about the dangers and uses of the jungle. The children play by swinging on vines above a river and when they happen to lose their grip and fall onto the rocks below, the expected tears are replaced by laughter and determination to do a better job next time. Walking through the jungle with my guide Hope, an 18 year old man of quiet yet friendly disposition and already a plethora of wisdom, I could see how even the way he walked through the dense foliage was a testament to his knowledge of the place he lived. While I had to look down at all times to avoid tripping over branches, he calmly strode with his head up listening for sounds that could be clues to what else was taking a walk through the jungle.

Upon our arrival and our leaving, we were treated to a traditional dance by Gustavo’s children who consisted of three young boys and two teenage girls. We were also served traditional food and slept in a traditional hut. I made every effort to learn as much of the Shuar language as possible during the three days/two nights of my stay and in return I helped Hope learn some English. Sitting by candlelight at the table in the family’s dining room hut, with the pelts from Gustavo’s successful hunts hanging on the walls, Hope and I exchanged words and phrases using Spanish as our common ground. This exchange of both culture and language gave me an incredible appreciation for my entire time spent in Uwijint.

I had the opportunity to meet Hope’s father Gustavo, who is more talkative due to his experience hosting CFHI students. Gustavo is content with his one wife while other Shuar men are polygamous and he is an excellent host, making sure that everything was going well during my visit. I was also fortunate to play a game of fútbol with Hope and his younger brothers and sisters.

One of the highlights of the trip was walking on a tour of the jungle with Hope while he showed me several plants in the jungle and described each of their uses thoroughly. On the same tour, we also stopped at an amazing mirador (lookout) where Hope bestowed me with the Shuar nickname nanki, which translates to spear and signifies strength. After I was given my Shuar name, my face was painted with achote by Hope. We walked a little more and then came to a sacred waterfall, which Hope said we were allowed to swim in after completing the ritual, which in addition to the face painting and naming included washing myself with jabon natural (natural soap) and sniffing liquid tobacco. The jabon was a root that Hope had dug out of the ground and that when it was smashed and wet produced suds. The liquid tobacco was a steamed tobacco leaf that Hope squeezed into my hand and told me to sniff up my nose.

The tobacco instantly burned as if I had put hot sauce up my nose, but I was rewarded with a pleasant, light-headed feeling as the tobacco quickly entered my blood stream through the nasal membrane. The pain was worth it to be able to swim in the pool below the waterfall, which Hope explained had been used by the Shuar for thousands of years for a variety of ceremonies.

The most significant revelation I had came during the nature tour with Hope, when while describing one of the plants on the jungle he told me “la selva es nuestra farmacia” (the jungle is our pharmacy). I remember feeling the weight of this comment as soon as it left his mouth, it traveled from him to me and has resonated in me ever since. I realized that in order to be a good physician someday, I would have to know my urban jungle like he knows his and to know my pharmacy equally. I felt that there was nothing in my life that I knew as well as Hope and the Shuar know their home, and while this at first was disappointing to me, I soon found inspiration in this. I realized that I must always continue to educate myself, both in medicine and in life.

Anecdotes from the Amazon, pt. 3: Pitirishca, Servicios de Control de Malaria

After working in Puyo and Shell, my next clinic assignment was at the Subcentro de Salud de Pitirishca. Pitirishca is a small community about an hour and a half by bus outside of Puyo, with the majority of its residents being from the Shuar indigenous group. The clinic serves the members of the community as well as the people who live in the surrounding jungle.

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Dr. Ramón Moncayo met us at the clinic and showed us around, which didn’t take long considering the clinic consists of two small buildings. The clinical facility features a small waiting room, a reception room, and two patient rooms while the resident building is essentially two small studio sized apartments joined together. Since this was my first experience at one of the smaller, less funded subcentros, I was very surprised at first by the intense contrast to the larger hospitals which I had worked at previously. I was quick to ask questions about the difficulties of working with so few resources, to which the doctor responded that although it is difficult to treat some cases they are still able to treat many others. Many of the patients were children who had come to get their required vaccinations for the upcoming beginning to the school year.

The above video again highlights the importance of effective communication between doctor and patient. A older woman patient who complained of pain in her extremities and back came in to the clinic and did not speak Spanish, speaking in Shuar instead. Fortunately one of the medical assistants was a local high school student who was interning at the clinic as well and was a Shuar. The doctor we were working with at the time encouraged us to perform basic physical examinations and patient interviews, so one student volunteered to exam this particular patient. She used the moderate amount of Spanish that she knew to ask questions to the medical assistant and then the medical assistant would translate to the patient. The situation was somewhat comical because the patient continually changed her story, making the translation and potential diagnosis more difficult. However, the patient was eventually given a proper diagnosis and treatment. The video also gives an idea about how students might interact with a patient during their program.

In general, the Pitirishca clinic gave me a very good sense of what working in a small community clinic is like. While the clinic was only capable of seeing a single patient at a time and did not have a huge diversity of medicines available, the doctors did whatever they could to treat their patients. I felt that the lack of resources was a major problem despite the hard work of the doctors. One problem with the public health system in Ecuador is the distance many of the indigenous communities live from accessible services. While some of these communities rely on their traditional practices of medicine, others are unable to access these services when they want them unless they walk or ride by boat, sometimes for several days. I feel it is important that the government works toward a system that delivers care to the people who have slipped through the cracks of the current system, especially because of the abundance of indigenous communities within the country. This also translates to American health care and I believe that I would be interested in working in public health in order to provide access to services for under-served communities based on my experience in Pitirishca.

My work continued back in Puyo at the Centro de Servicios de Control de la Malaria, where I had the privilege of working directly with Dr. Torres. At the malaria control center, a team of physicians, virologists, entomologists, and volunteers work to eliminate the threat of tropical diseases such as malaria, chagas, dengue, and leishmaniasis. I was assigned to a team that went directly into the community to eliminate mosquito larvae from water reservoirs. The other volunteers and I would go door to door and inspect water tanks and other reservoirs of water ranging from tires to cups. If we found mosquito larvae, we would take a sample, identify the species, and treat the reservoir with a chemical called abate that kills the larvae but does not harm humans.

Working directly in the community was very excited and gave me a sense of public health work. The work at the malaria center was also a nice break from the clinics to learn something different, and Dr. Torres was an excellent person to work with. He and his team did a great job of making me feel included and taught me a great deal even before we went into the community. Meeting with the entomologist allowed me to learn about the different types of larvae and which diseases they could carry. Dr. Torres provided sufficient information about the prevalence of each disease, its distribution throughout the country, and the symptoms associated with each. I feel very fortunate to have participated in the control efforts and worked with such a great team.

Anecdotes from the Amazon, pt.2: Puyo

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After a fun filled weekend with the entrie CFHI group in Baños that included a chiva bus tour of several waterfalls, canyoning, and rafting on class III rapids, it was back to work. Two students and I had to say a sad goodbye to the group as we prepared to leave for Puyo to participate in our clinics there while the rest returned to Quito for their respective internships. One thing I will always remember about the group is how quickly we all bonded and felt that we were part of something special. I believe this is an important revelation because I have heard too many stories about physicians who place themselves above the rest of their team and it creates a hostile dynamic. I feel that this program taught me a lot about working in a team, accepting and appreciating the differences each person brings to the table.

Puyo was a much smaller city than Quito and thus provided a much better perspective of Ecuadorian culture. We met our program coordinator Dr. Wilfredo Torres the first day we were there and he drove us to the first clinic we would be working at while in Puyo. We arrived at the American-owned missionary Hospital Vozandes del Oriente in time to sit-in on the daily morning meeting. I found this to be a part of health care that I was never aware of but that made complete sense. The doctors would discuss the status of each of the patients in the hospital and the proposed treatment plans.

The resident doctors and the foreign doctors spoke to each other and to patients exclusively in Spanish, which I found very impressive considering most of the foreign doctors’ first language was English. I was proud to be able to follow the discussions and I realized the importance of knowing more than one language in the health care field.  For example, in the United States, where the primary language is English, a Spanish speaking patient might feel pressured to communicate outside of a language with which they are comfortable and may therefore be misdiagnosed, feel misinformed, or neglect treatment altogether. At this hospital, I saw proof of the effectiveness of communicating with somebody in their most fluent language and I know that as a future health care worker, I must always be improving my Spanish speaking and if possible learning other languages in order to communicate with my patients.

I was fortunate to have the opportunity to observe several different doctors at Vozandes, which yielded a variety of interesting clinical experiences. With a Swedish surgeon I had the opportunity to scrub-in on an orthopedic surgery. A woman had fractured her tibia as a result of crossing a river and required surgery to put a plate on the bone. I was allowed to observe the surgery and was fortunate to have another visiting orthopedic surgeon explain the entire process to me while the Swedish doctor performed it. I felt that this unique opportunity was one that I may not have had in the United States unless I was interning with an orthopedic surgeon. The great part about my CFHI program was that I got to experience a variety of procedures.

I was also fortunate to see an endoscopy performed on a man who had severe gastritis. Watching the peristalsis of the stomach in real time was a truly unique experience, as was the taking of small biopsies from the lining of the stomach using a device inserted through the endoscope.

The most interesting case was one which I felt I was able to appreciate due to my experience studying neuroscience. While shadowing Dr. Matt Kappen, woman who had received medical attention for pain in her eyes returned complaining of pain in her neck. An x-ray revealed a fusion of cervical vertebrae V and VI as well as scoliosis. The woman also complained of a loss of sensation in her face. Upon testing of the cranial nerves, the doctor discovered that the woman was unresponsive to temperature sensation on one side of her body as well as diminished pressure sensation on the same side. The doctor had never seen a case like this and decided to refer the woman to a neurologist for proper diagnosis.

These examples are only a handful of the many different cases that I saw at Vozandes, and I appreciate each one as a learning experience. I can easily say that I learned more than I ever would have expected at Vozandes and during my CFHI program in general. Not only was I exposed to an incredible variety of medical procedures in an educational setting but I also learned a great deal about myself.

On my last day at Hospital Vozandes, I had the opportunity to visit the Fundación Casa de Fe which is an orphanage in the oil town of Shell. I arrived without any idea about what I might be doing at the orphanage and that feeling seemed slightly reciprocated by the volunteers that worked there, who are known as tias/tios (aunt/uncle) to the kids. The Casa de Fe was a two story home with several rooms dividing the children into appropriate age groups, ranging from babies as young as a few months to teenagers. I asked one of the tias how I could help and she said that most of the kids just need someone to spend time with them, so for about 4 hours that is what I did. I came to realize that many of the kids living at the orphanage had been there since they were very young. I spent my time with the youngest group, which included kids who had been left there because their parents could not afford to take care of them or because the physical and mental disabilities some of the children suffered from were too much of a burden for the parents to handle.

I felt that my experience at Casa de Fe was truly eye opening and it made me realize that in the future I need to find more time to volunteer in my community wherever possible. I feel that my concept of service to my community was completely changed by the children at the orphanage. I now realize how much of an impact a person can have by simply taking a few hours of their time to visit a person in need of companionship or assistance. I hope to do more volunteering back home within the same context because the thought of potentially making a positive difference in the lives of children who have started their lives off in a disadvantaged position is worth more to me than any amount of money in the world.

Anecdotes from the Amazon, pt. 1: Quito

When I arrived in Quito around midnight after a 16 hour journey from San Francisco, I was exhausted to say the least. However, I couldn’t help but feel amazed by the immensity of the city of Quito, which stretches north to south like an illuminated blanket across the Guayllabamba river basin. Flying into the city at night, I became lost in the sea of lights below and wondered if I had caught the wrong flight and ended up in Los Angeles. When the pilot announced “Bienvenidos a Quito”, I knew I was in the right place. My first night began with a comical miscommunication, when after sitting in the airport for about an hour and not finding my host mom to pick me up, I used a phone to call the local coordinator Rosita Tomayo. She was surprised to hear from me at 1AM because she thought my flight was arriving later that day, but she directed a taxi to her house and I stayed with her the first night.

The next morning I went to met with my host family, who were an older couple who lived a few doors down from Rosita. Kelly and Hugo would be my host family for the week that I was staying in Quito. After the first week I would leave for Puyo to stay with another host family there. Having arrived in Quito ahead of the program start date, I had a few extra days to explore Quito. Hugo gave me a map of Quito and showed me how to use the public transit system in Quito. I spent my first two days in Quito walking as far as I could and exploring the parks and shopping centers. I visited the Vivarium in the largest park in New Town Quito, Parque Carolina. I also visited the Plaza Grande in Old Town Quito and saw the changing of the guards at the Palacio del Gobierno.

The Vivarium in Parque Carolina, Quito, Ecuador

Palacio del Gobierno, Plaza Grande, Quito, Ecuador

 

My first week of the program in Quito began at the Amazing Andes language school run by Rosita. I met the rest of the students in the program and we took Spanish placement exams. To my surprise most of the other students spoke very little, if any, Spanish. This placed me in the position of being the most fluent in the language, and with that position came the responsibility of translating for many of the students when we went around Quito. However, this really didn’t bother me at all and in fact it gave me even more opportunities to practice and improve my fluency. We began our Spanish language classes and by the end of the week we all were assigned to our first clinical rotations. I was placed at the Centro de Salud Numero 1.

Centro de Salud no. 1, Quito, Ecuador

My time volunteering at this clinic gave me my first insight into the health care system in Ecuador. I spent the first day shadowing Dr. Paez in the emergency room. The emergency room had only 3 beds in it, and patients were not allowed to wait within the clinic but rather had to wait outside. The emergency room had a desk where the doctor would interview the patient, a cabinet full of basic medical supplies, a sink for washing hands, and the bed area which had an old vital sign monitor that the doctor told me “sometimes doesn’t work”. I saw a variety of cases in the emergency room that ranged from complications caused by one of the most common problems in Latin American, hypertension, to teenage pregnancies and a suspected H1N1 patient. My experience at Centro no.1 was a very good way to transition into the program because although the facility lacked some of the common features of American clinics, the physicians were engaging and made me feel like I was there to learn rather than be an obstacle in the tiny E.R.

Personal introduction

My name is Brian Sumstine. I am a senior at the University of California, Santa Cruz. I am studying Neuroscience and Health Science, for both of which I am pursuing a Bachelor of Sciences degree. In August, 2011 I participated in the Amazon Community and Indigenous Health program in Ecuador with the organization Child Family Health International. I chose this program because, as a requirement for my Health Science degree, I was required to perform an internship in a health care setting. Not being one to follow the traditional mold, I asked my internship coordinator if there was a way that I could do my internship abroad, particularly in a Latin American country. My coordinator advised me that CFHI is one of the best organizations for the type of internship I was looking for and that students in the past who had participated in other CFHI programs always had positive things to say about the organization. With this advice in hand, I began conduction personal research into the programs that CFHI has to offer. I quickly realized that the programs that CFHI was offering me were exactly what I was looking for, so I settled on the Amazon Community and Indigenous Health program for its mix of clinical experience, cultural immersion, and excellent location in Ecuador.

One initial concern about my participation in the program was how I would afford the cost of the program. As a full-time student and part-time worker, I realized it would be very difficult for me to raise enough money to pay for the program, let alone have sufficient funds for when I was actually in the host country. I again did some research and began applying for several scholarships offered through my university, but soon realized that even this might not be enough. I was fortunate to find out that CFHI was offering scholarships for the Fall internships in 2011 and that I could be awarded up to $1000. With this opportunity in sight, I sat down and began trying to prove that I was deserving of the scholarship. It is a difficult thing to do, trying to convince others that you are more deserving of something like that when surely each candidate has legitimate reasons for applying for it. However, I focused my writing and was honored to be a recipient of the CFHI scholarship.

Receiving the scholarship provided the financial support that I needed to take part in this great experience, and the CFHI program provided me the opportunity to see health care in a whole different light. Prior to receiving the CFHI scholarship, I had never applied for a scholarship before. Being my first time, I did not have high expectations of my chances of being awarded the scholarship because I felt I lacked experience in writing a convincing scholarship essay. However, I tried to respond to the questions and prompts in a way that set me aside from other applicants, and I also attempted to reflect my personality onto my writing. I wanted my essay to stand out and show that I would put the funds to the best use and that I would get the most out of my program as possible, pushing myself every day to learn and appreciate the experience. When I learned that I had been awarded the scholarship, I immediately called my parents and told them. When they told me that they were proud of me, I realized that I too was proud of myself. I was ready to invest all my energy in this experience and make it worth the investment in me by CFHI.

In order to really ready myself, I would have to go through a bit of a makeover in order to present myself in a manner more conducive to the health care environment, so…

Cutting off my four year old dreadlocks to make way for my more professional look