Hosp. Militar Parte Dos

Friday was my best and final day shadowing Dr. Vargas and staff at Hospital Militar. Finally, I felt that I had achieved a level of confidence and improved comprehension of the medical cases we were handling. By the end of this week I made significant progress in breaking through my language barrier, & I was able to converse freely & comfortably with the med students part of "las rondas." Today was especially exciting because I got to "scrub-in" on a laparscopic surgery performed by Dr. Vargas. It was a gall-bladder removal that was deemed necessary due to several gallstones detected in the patient´s gall-bladder. Mona and I stood back and actively observed the 2-hour long surgery. We watched as Vargas fed sterile gauze through the apparati down into the cavity of her (the patient) liver and gallbladder. He used Kelly forceps, scissors and sterile plastic clamps to manipulate the gallbladder and cut it out. He also used a cauterizer to burn ligaments of the gallbladder, as well and stop bleeding. Mid-surgery he accidentally made an abrasion on the woman´s liver and it began to bleed profusely. This caused a slow in the surgical process, as Dr. Vargas had to use the cauterizer and suction to slow bleeding and remove excess fluid caused by the blood. For a quick minute I worried that the liver´s bleeding couldn´t be quelled. Surely enough, it slowed and Dr. Vargas placed a wire "mesh" over the abrasion which helped clot the source. In the end, the surgery was successful and, once removed, I got to see the gallbladder up close. It looked like a tiny slab of raw chicken breast, and the stones look like tiny marbles below the flesh. Super fascinating! My classmate Mona got to handle it for a solid 5 minutes with sterile gloves. I was slightly jealous.

Here are some pics to accompany the story.....I also got several video clips but don´t have enough space on my flashdrive to get them posted on here. Sad to say I won´t be returning to Hopsital Militar next week------but what an incredible experience while it lasted.



Pre-surgery requirements:
Emerson and Mona washing up to elbows x 5 minutes.



Carolina, Emerson and Dr. Vargas.

Dr. Vargas is a multi-tasking pro

 clamping and cutting gall-bladder

close-up gauze being applied to gallbladder. liver surrounds it.



Mona and me- enthusiastic observers!




the final product: gallbladder glory



Hospital Militar

This week I've attended rotations in the surgery ward at Hospital Militar. In the recent past it was exclusively a hospital for military men/women and their families; but I learned yesterday that this hospital has expanded its services to all civilians, but still charges it's private fee prices. I have been under the advisement and teaching of Dr. Rene Vargas, a hip, kooky brilliant doctor with a passion for all sugeries gastro-intestinal. Each day begins with ¨"las rondas" which means a group of med students makes  "rounds" to each room to check in on the status of each patient whose case we are following. After we make the rounds, there is a group discussion of the "plan" (what´s next?.) Our group is comprised of 4 doctors,  1 nurse and 10-12 students of varying skill levels/accomplishments. In Ecuador, students who pursue medicine begin at an early age, during the U.S equivalent of high school. They basically get their undergrad out of the way by age 19 or 20 and are in residency by age 24- 25. It depends on each student´s area of focus/specialty, but it never fails to shock me when a 4th year med student tells me they are 24 years old. Today a student asked me my age and when I replied with " ¿Que piensas?", he guessed I was 25. I proudly declared that I was 29-almost 30- but somewhere deep inside me I questioned myself and my academic progress in this field. Here we are discussing case studies of people who are suffering from grave conditions, have needed endoscopic biopsies, drains, stents, and who are still suffering from fistulas, inflammation, infections etc. and all of the jargon used used is heavily drenched in anatomy and physiology (and discussed in Spanish.)  Half of my time is spent straining to understand the gist of what´s being said and the other half of my time is spent piecing together the patient cases.
Here is where Dr. Vargas comes in. Luckily he thrives off of the inquisitive student, and since it´s in my nature to ask questions and clarify, I get good results in the form of a doctor who engages my every curiosity. He loves to explain the form of posing questions, drawing pictures and gesticulating wildly to act out a function of the body. Pretty genious, he teaches at a private university here in Quito. Also because of him, I´ve had the opportunity to work with the head doctors in Sonography/Radiology and spent one full day watching Dra. Paez turn over 6 patients per hour while working in a  white lab coat, white skirt and spiked heels adorned with rhinestones. She is whip-smart and my current inspiration to further pursue my Ultrasound tech dream.
Here are some examples of Dr. Vargas in action and the rest of our crew this week only.
Next week I´m off to a different clinic, north of Quito, called Carcalen Alto. Stay tuned.......

The zany Dr. Vargas pretending to use a suture gun as pistol

his famous illustrations

students w/ Doc, notice how the boys on my left look like they´re 15

the day we got to watch a endoscopy of the esophagus and stomach, they found metaplasic cells in the fundus of the stomach

Mona, my CFHI partner and friend, holding a biopsy vial from the endoscopic procedure. next up: send it topathology

This tagger mixed politics with STD´s in this anti-Ecuadorian prez statement. shout-out to the PP crew!

Banos

Francia & me in her living room

Last weekend, the CFHI crew and I hopped on a bus & headed south of Quito to the quaint town of Banos. It's  at a much lower elevation than Quito but still has lush green mountains, waterfalls, & thermal springs heated by Volcan Tungurahua. There is plenty of charm, beauty and fresh air to be consumed and get lost in. Our group couldn't get enough of the action so we pursued a range of activities, including horseback riding, quad-runner buggy racing, mountain biking, salsatecas at night and---a personal choice--- a 70-minute massage including free facial. It was simply divine and suprisingly relaxing, despite the active pace we maintained. This town has the best espresso and coffee yet! sure isn't Nescafe. the food was pretty delicious too, the highlight being our dinner at Cafe Mariane, where I ate baked macaroni n' cheese con jamon (with ham.) For dessert, crepes and mochas followed. That meal was TO DIE FOR, and to be truthful it helped soak up some of the liquor in my system before 3 hours of hot sweaty dancing ensued. Here are some pics to explain the story, the first being one of my host mom before I said goodbye for the weekend. :-)

an adorable indigenous (Andean) child about to nap on the mountain.

The amazing dinner & my enthusiastic flexing of muscles

Nightlife at the salsateca! Cumbia, reggaton, electronic and old school hip hop.

Gerrardo, our guide whilst riding horses

A gorgeous view of the mountains engulfing Banos, and our horses on the left

Us ladies

my horse Champingon, and me!

The horse ranch

Our sweet hostel in Banos

Cuy (guinea pig) before being BBQ'd. No i haven't tried it yet :-)

a day in the life of........jkb

La Basilica, the oldest church in Old town Quito-

                                                  l

Nuns on the street by their monastery

                                              

ceiling of the La Compañia iglesia.... plated in incan gold

Ben taking  pic of me taking a pic of La Ronda by day

                                           
                                         

example of a standard almuerzo: YUM!

the CFHI student crew at lunch, on our tour de Quito OLD TOWN

                                              
                                             

 Ben & I playing horseshoes on the sidewalk. I´m turning away from his stale coffee breath         

                      

the marriage of 2 great professions

a celebration on "La Ronda" Oct 9th the anniversary of Guayaquil´s independence

 me in front of the La Virgen de Quito

                                              

tomfoolery in a bar on La Ronda

                                                

 Club-- the  poor students´s cerveza of choice

                                                 

 the ascent begins:  trail to Pichincha

                                                   

 about halfway up to the peak, right around 12´000 ft

                                        

 beautiful Quito in the background

                                              

climbing up the northwest flnk of Pichincha. 14,900 ft. I can´t breathe.

                                            

 I reached the very top and here is a hawk

                                        

a sweet view from the top, Quito behind me

                                         

 I climbed this volcano in my Chacos. Word!

                                       

 top of the world, it seemed

                                             

sunset illuminating the path back to the gondola

Mirador= the vista point.

                                            
                                                                    
                                                       the walk back down. can´t feel my legs

Volcan Chimborazo behind me

                                            

the descent, super fun! skiing down ash at 50% grade.

                                          



a vulture, waiting for us to expire



 where we began our ascent: at 4300 meters

                                             

my partner in coffee, riddles and climb! Ben!

                                           

 Me and Sarah in Parque Alameda

                                          

         CFHI students playing soccer with Quiteño kids

                                 

Buenas tardes~
Ahorita estoy en un cafe de internet, in a mall, listening to Michael Bolton´s hits projected over a loud speaker. it´s quite hilarious. and i´ve found it to be true that in every new city i visit outside the U.S., the most common american music played is late 80´s/early 90´s hits, and the 1 ever famous Eagles hit "Hotel California." Dios mio! the things that bring me amusement.

So today began as every day has since I arrived: desayuno (breakfast) composed of a bowl of mixed fruit, toasted cheese sandwich, & Nescafé prepared by the lovely Francia. (Side topic: She and I watched every possible minute of the Chilean miner rescue coverage over the past 48 hours. hooray for the successful extraction of 33 miners trapped underground for 70+ days. truly a miracle. )
After breakfast I paid my 25 cent dues to ride the trollebus to La Maternidad, the hospital I am doing rotations in this week. we have only one more day in the Emergency ward, and next week I begin observing at the Hospital Militar, a privately funded hospital providing services for military families. Yesterday, La Maternidad Hospital ran out of rooms to admit patients for urgent surgeries; this was particularly unfortunate timing, as yesterday turned out to be the busiest and most critical day for the patients we saw. Out of 5 pregnant women needing surgery (4 pre-eclampsia and 1 ectopic preg) these 5 patients were turned awaty and referred to a hospital down south.

By "down south" I am unclear as to how far away this place is and how long it takes to get to this hospital; no matter what the situation, I watched 5 women leave La Maternidad in severe discomfort without a clear plan as to how they would secure a ride to this southern hospital, and once there, how they would obtain a surgery. I imagine it´s difficult to serve every patient´s needs when operating as a public hospital. Anyway, I am curious to follow-up on the outcome of these women´s situations, in particular the woman with an Ectopic pregnancy, but I may never know because La Maternidad does not do f/up care once they refer out. 2 exciting things also happened yesterday: I got to watch an abdominal ultrasound performed for a woman 36 weeks pregnant who was having severe pain in what they thought was her kidneys; turned out she was diagnosed with appendicitis and had to get surgery right away. The 2nd exciting event for me was that the doctor gave me the chance to do an ultrasound on a woman 37 weeks pregnant. I was terribly nervous because I have never performed an ultrasound on a pregnancy that far-developed; i took a few minutes searching for the head so that I could perform measurements, but i had no luck and handed the probe back to the doc. Turns out , the fetus´ head was quite low in her belly, and i never thought to scan the probe over that area. No me importa ahora (its no matter to me now), but in the moment I was rather flustered that i couldn´t locate the head or the femur. Dr. Gomez didn´t seem to have expectations either way, and was very calm and patient with me. he completed the u/s and it was determined that her gestational age was 37 weeks. I thanked him for the opportunity and am hoping to be given another chance to get hands-on experience at future rotations/hospitals here.

I am free to roam as I please this afternoon, as I have completed y 30 hours of spanish class already. After La Maternidad, I explored the Mariscal district which is considered "New Town." It is the hustling, bustling business district blended with hip shops, eateries, and cafe nooks. I was a little overwhelmed because I hit the center of Mariscal at lunch time and I was repeatedly almost hit by cars and plowed over by women in heels for the duration of my walk, so I decided to head the safe internet cafe on the 3rd floor of this mall.

Tonight I´m considering watching Resident Evil:2 en 3D & español. could be cool....? and this weekend I am heading to Baños, a small town south of Quito where there are natural thermal baths, waterfalls, and amazing discoteques. Stay tuned for the Baños post!

Love yous........... Jessica