DukeEngage | Duke Center for Civic Engagement

This week, I was in the jungle, or “dentro” as it’s known here. Our journey began early Tuesday morning with a 2 hour bus ride to Tsraku, a small Shuar community. There, we met up with our guide, Delphina, and some other gringos and began our hike to Awajin, an even smaller Shuar community tucked back in the jungle. The hike didn’t seem too bad at first, just a trudge through mud that was at least ankle deep, if not knee deep. However, after 4 ½ hour of trudging through that, along with intermittent rain, we were pretty exhausted. When we finally crossed the river and arrived at the community, we were met by Gustavo, who showed us to our living quarters.
The house we would be living in was about 10 feet off the ground, accessible by a ladder, which led to a landing that was stable enough to support only one of us at a time. In the hut, we began walking across the floor, only to realize that it was flexing under our feet. It was made of bamboo and there were only a few beams for support. There were 6 beds (3 bunks) for the 7 of us, and we quickly realized how uncomfortable sleeping would be. We headed down for a quick meal, which consisted of rice, noodles, and some vegetables, but not many. We were then given some free time to relax before the welcome dance. Some went down to bathe in the river, but since I’d forgotten my swimsuit, I decided to set up my bed. This involved getting my sleeping bag out and trying to figure out a way to hang my mosquito net, not an easy task. I then laid down and took a quick nap, before we all assembled and made the trek over to Gustavo’s house for the welcome dance.
At first, it seemed like a very authentic experience. Gustavo began by explaining that these dances were done whenever there were visitors to a Shuar community. However, it quickly became less of a traditional Shuar experience and more of an act. The group was composed mostly of children who didn’t know the dance very well. The group was named (making it seem even less authentic) “Hijo de la cascada [son of the waterfall],” and performed several of their traditional welcome dances. For the second half of the dance, we were invited to participate, and though we had no idea what we were supposed to do, we tried our best. After this dance, we headed back to our accommodations in the dark. Getting into bed and getting to sleep was no easy task, but eventually we managed.
Wednesday was probably one of the most informative days I’ve had here. First, we hiked for 2 hours to a sacred waterfall of the Shuar. Before we could approach the waterfall, we had to have our faces painted. Upon arriving, Gustavo explained the significance of the waterfall to the Shuar. He talked about the power the waterfall possessed – it could reveal cures to ailments and future lovers after a day of fasting and the eating of a hallucinogenic plant (which he said he’d show us later). After this talk, we were allowed to bathe in the waterfall, which after 2 days of hiking through mud, felt pretty awesome.
Once we returned to the village, we ate lunch and returned to Gustavo’s house for an explanation of the medicinal plants around the village. He was not nearly as dismissive of western medicine as others have been, and constantly emphasized the link between traditional and western medicine. It seemed as though everything he showed us was good for a stomach ache, but many were things we hadn’t heard of before. After the talk, we sat down with Gustavo and discussed the conservation of the jungle. The government and many oil companies want to come and explore in their part of the jungle. Many indigenous tribes in the area have allowed this to happen with the allure of jobs, roads, and other projects. However, the jungle was destroyed and would never return to the way it was. Technically, the Shuar own the land, but the government retains the mineral rights. Both sides have lawyers working for them, but the Shuar want to know what they can do to increase awareness of their situation. They are trying to maintain their way of life while at the same time making themselves visible to the world – definitely not an easy task.
After dinner, we went to our farewell dance. This dance was very similar to the first one, but this one included “chicha”. I’m not going to fully explain how chicha is made here, but it consists of yucca, alcohol, and water. (It was only later, when we were all very ill, that we were told it was made with river water.) It was a traditional farewell drink for the Shuar, and we were forced to drink or appear rude. They brought it around in bowls several times, and each time we were told to drink.
The next day was our walk out of the jungle. This time there was no rain, which made the mud somewhat less formidable, but still not easy. It took us only 4 hours to hike out, and when we reached Tsraku, we couldn’t wait to head to the store and get a water. Unfortunately, the bus was rolling down the road, and since it comes very sporadically, we had no choice but to get on and head back to Puyo.
 

Last night I was at a movie with my entire group. Though I wouldn’t have chosen to go to a movie on any other night, I decided it was necessary because our group was beginning to disband, and it was the last time we’d be together. Most are only staying one month here in Ecuador, and that month was coming to an end. While at the movie, one of the girls who isn’t leaving until tomorrow mentioned that she was going to work at a soup kitchen today. One of the other Americans staying at her homestay had worked at this soup kitchen, “Pan de Vida [Bread of Life],” in the past, and he mentioned that they would be needing help with their health fair. This fair was to be held all day for the local community. They would be gathering basic information and providing recommendations for needed doctor visits and nutrition.

When I arrived this morning, I wasn’t really sure what I’d be doing or where I’d be needed. We had a meeting before we got started to let everyone know where they’d be working, but since they didn’t know that a bunch of us were coming, we had to wait for our assignments. The patients would begin by walking in the front gate, where they would fill out a registration card. From there, everyone in their family would have their blood glucose taken and would be served breakfast (the BLG must be taken fasting). They would then have their height and weight taken, and be photographed for future reference. Then they would come over to my table where I would take a blood pressure. From there, they proceeded to the vaccination table, where they would discuss with specialists whether or not their children had been vaccinated and why. They then proceeded upstairs to have a consult with a physician and a nutritionist.

This was one of the best experiences I’ve had here so far. We’ve been following doctors around and learning about traditional medicine and public health here in Ecuador for a month now, but I never really felt like I was doing anything. Today, I was a part of a team that actually needed me (not many people there knew how to take blood pressures), and I was doing this service for the community. Seeing all the families coming through with all their children to get information about how they could improve their health despite their impoverished backgrounds was really inspiring. It also got me thinking about healthcare in the US. I don’t think I’ve ever heard of an event like this which sought to inform the poor about how to improve their health before they need expensive medical treatment they cannot afford.
 

It is now the end of my second week in Ecuador.  I've had some really amazing experiences so far, and expect many more amazing experiences in the future weeks.
          I arrived on Friday, May 31, to the Quito airport. My host brother, Annibal, was waiting for me, and somewhat to my relief, he spoke fairly good English. I had time to drop my things off in my bedroom before he took me out to a party with a bunch of his friends. The next morning, I awoke and headed off to explore Quito with two other Americans, Tim and Laura, staying in the house. We went to the TeleferiQo, which is a gondola that took us up about 1,000 feet to one of the mountains around Quito, which is already at about 9,000 feet. At the top, I defied pretty much everyone’s orders and hiked around, albeit slowly, for a few hours.
          Sunday was the beginning of our program. Our host mom was fairly adamant about us being on time, and she made sure Tim was there by 8 am and I was there by 9 am. Unfortunately, I was supposed to be there at 8 and Tim was supposed to be there at 9. I missed the ice breakers but got there just in time to introduce myself to the group before a presentation by our medical director, Dr. Wilfrido Torres. He told us some of what we would be doing when we got to Puyo and gave us our rotation schedules. We then left the Amazing Andes Language School and headed for a walking tour of Quito. The group dynamic seemed great – no one knew anyone before coming which prevented clique formation, and everyone seemed to get along. That night, I went out again with Annibal, this time to a barbeque at a friend’s house. We arrived at about 8, and after eating a ton of meat (not knowing what a lot of it was), we left around 1 am.
          Monday began with an orientation. Unfortunately, much of the orientation revolved around Quito, where my group would be spending one short week. It was a painful 4 hour orientation, and we were all very eager to leave. At noon, we headed to a little café close to the school for a 3-course, $3 lunch. Monday also was the first day of language classes. I was placed in the most advanced class of our group, which surprised me because we were supposed to be at least conversant. Evidently I had no reason to be too nervous about not knowing enough Spanish. Our classes consisted of 2 hours of grammar review and 2 hours of conversation/medical Spanish. The classes made me very excited about Spanish, but unfortunately few in my group felt the same way.
          Tuesday started with Spanish classes, but few were very focused. We also headed to Old Town and saw some beautiful churches, but we were all pretty impatient. That night, most of our group was going to the semi-final of the South American Football Cup between Liga de Quito and America de Mexico. Despite having to pile our way into the bus and one of our group getting robbed along the way, we were all very excited when we got to the stadium. While we were standing in line, I was almost pick-pocketed, but felt the Cliff Bar in my pocket move, thereby preventing what would’ve been a devastating loss. The game itself was quite a spectacle. We raced to find a seat, but we were only 2 hours early, and therefore couldn’t find one. I ended up standing behind a ledge at the very top of the stadium. When Liga took the field, there were fireworks, confetti, and toilet paper rolls everywhere – all coming from the crowd. The game itself was fairly uneventful, and though Liga hit the post twice, no one found the back of the net and the game ended in a 0-0 tie. Which, of course, meant that Liga won. (It’s far too complicated for me to explain here.) The crowd went nuts and there were more fireworks and chanting and jumping. It was an amazing experience, and one that must be had while in South America.
          The rest of the week was fairly routine: we had classes in the morning and a tourist activity in Quito for the afternoon. Since we were only there for the week, they wanted to make sure we saw everything. We really had no down time, which was a little frustrating, but it also made sense. Friday, instead of our activity in Quito, we headed out to Otavalo after classes. Otavalo, about 2 hours north of Quito, has the largest indigenous market in South America, and on Saturday morning, it was in full force. We stopped by the animal market to see all sorts of livestock being exchanged. Then we spent the rest of the morning looking around the town. On Saturdays, the entire town becomes the market, and it took us a good 3 or 4 hours to make it through it all. Then it was back to Quito to prepare for our trip to Puyo.
          Sunday morning, we packed up and headed off to Puyo. The drive was about 4 or 5 hours and was really beautiful. Arriving in Puyo, we met with our homestay family here and went off to a meeting with Dr. Torres to figure out exactly what we’d be doing here.
          Monday began our rotations. I went with two others to the Servicio de la Erradicacion de Malaria, which is where Dr. Torres works. In the morning, we learned about the different types of mosquitoes and which diseases they cause. After a frightening couple of hours, we went around to different places in Puyo that have standing water – mainly tire stores. They have big piles of tires outside and seeing as it rains every day here in Puyo (not kidding – every single day), there was a lot of water in the tires. At the first store, we didn’t find any mosquito larvae because they used a chemical that killed the larvae. However, at the second store, we found a couple larvae of the mosquito that can cause Dengue fever. Thanks to the work of Dr. Torres and his staff, there are actually very few mosquitoes in the town of Puyo, a remarkable feat.
          Tuesday I was at the Hospital Vos Andes, which is an American missionary hospital in the town of Shell, a 20 minute bus ride from Puyo. We spent the morning helping with endoscopies and trying to understand what each patient had. The doctor noted one very interesting thing to us: people in this part of Ecuador are starting to believe that an IV will heal anything. Most people do not drink enough water and suffer from dehydration. When they come to the clinic and get an IV and feel better, they believe that their mysterious disease was cured by the IV. Many times patients will come in and demand an IV, even when it won’t do them any good. It’s similar in the United States to patients coming in and demanding a medication they just saw on television, even though the doctor knows it won’t do any good.
          The afternoon was spent seeing patients in the clinic. The doctors were all family practice doctors and saw everything from pregnancies, to pediatric pneumonia, to twenty-somethings with scabies. There was also an incredibly diverse group of patients in terms of background and socioeconomic status: some were middle class families while others were indigenous people who grew their own food. The doctor we were with was fluent in both English and Spanish (he had grown up in Venezuela), and this made communication markedly easier. He had us do little assignments like looking up the symptomology of a disease to make sure he wasn’t missing it and filling little bags with medication. It was very interesting to see how organized this clinic was, despite the lack of resources available to them.
          Wednesday and Thursday were both spent away from Puyo. We traveled by bus three hours east to a tiny “town” called Arajuno in the jungle. On our way, we were delayed because a bus was tipped over in the road, but once they got that straightened out, we were on our way. We arrived at the tiny “Subcentro de Salud” in Arajuno and were introduced to the head nurse. She led two other students into the room where the doctor was seeing patients – mostly Kichwa families from the surrounding area – while I was taken into the receiving room. I took blood pressures and pulses and filled out some paper work (which is more difficult in Spanish) – I even got to fill out a birth certificate! Once again, I was impressed by the organization and efficiency of the clinic, despite them having very few resources. Every patient had a chart, and every baby had their vaccination records on file. The nurses chastised parents who had let their children fall behind the vaccination schedule and made sure everyone was aware of their own health.
          Thursday we went to a Kichwa village about 30 minutes away by pickup truck. We piled all the equipment and personnel in the back and headed off. When we arrived, the dentist set up a little office off in the corner while the nurse, doctor, and the three gringo students headed over to the nursery. There were about 40 kids that the doctor wanted to see, and the nursery had all their charts ready to go. We weighed the children then passed them off to the nurse, who made sure everything was in order before passing them off to the doctor. We moved then to the school-aged kids, many of whom needed vaccinations. They all willingly submitted to the vaccinations, which was somewhat surprising to the three of us. For people to willingly submit themselves and their children to vaccinations takes a significant amount of education and continued focus on public health. This emphasis could be felt by the nurse (the only permanent member of this team), as she made sure the teachers and caregivers all knew about the signs of diseases like TB and passed out literature on what the people needed to do if they saw these signs.
Friday, we were back at Hospital Voz Andes for the morning. We sat in the emergency room for a while but there were apparently no emergencies, so we went back to the clinics. We saw many patients that probably weren’t that sick and one woman who had a lot of lung congestion but no TB.