Taxis

I’m getting to know the taxi cab community here in Santo Domingo pretty well. Every morning I flag someone down on the busy corner of Latacunga and Guayaquil. After I tell them that I want to go to the barrio of Carlos Ruiz Burneo, a pretty rough place, they almost always hesitate a moment and look at me briefly, as if to ask, “why would anyone want to go there, particularly an aging gringo like yourself?”

Since this has been going on for over a year now, I’m now regularly flagging down taxi drivers who I’ve had before and they greet me like an old friend. Sometimes, if they spot me walking to the market, they honk and wave, though they have yet to stop and offer me a ride. Rita came out to the clinic last week for a little birthday celebration for Mercedes and got into a little fight with the driver. He was going to charge four dollars and she complained that I only pay three, to which the taxista replied “Your husband is an amigo mio and I give him a deal.” They finally agreed to $3.50, but she had to throw in one of the brownies that she was bringing to the birthday party.

Honking is important here. It’s a friendly place and the drivers are forever tooting at someone they know on the street or in another cab. Honks can also be a declaration of intent, like “I’m coming through this impossibly small space at a rapid rate of speed despite all this chaotic traffic, so you better watch out, because if I hit you, since I was the first one to honk, it won’t be my fault.” These sound like this: beep-beep, short and in quick succession. Also there are lots of angry honks directed at anyone doing something hasty, nasty or stupid. Because this happens pretty frequently there is always a background of angry honks wherever one goes, night or day. Angry honks are louder and sound like this: Beeep. Beeeeep. For a group of people who are so warm and welcoming face to face, they are incredibly rude on the road.

The taxistas favor seat covers made up of that deep pile shag carpeting that was really popular maybe 30 years ago in the US; carpeting over the dashboard, too, for some reason, but not much in the way of personal safety protection. Seat belts are for sissies and their use is thought to reflect a lack of confidence in the driver. It took me more than a week to figure out why I was arriving at work each morning with this big swatch of dirt running from my right shoulder to my left hip. With all the pollution, dust and grime in the air, seat belts tend to get pretty dirty when not used and since I apparently was the only one in town using a seatbelt, I was getting pretty dirty. I decided in favor of clean over safe but am prepared to admit that this might not be the best decision, especially in Santo Domingo.

Something

Who said: “I can't do everything but I can do something.”?* Whoever it was, it’s how we steer our star down here in Santo Domingo, Ecuador.

I met Rene, a little boy 6 years of age, a couple of months ago. He has spina bifida, a birth defect involving the spine, which has left him paralyzed below the waist. He can’t use his legs and can’t control his bowels or his bladder. In addition Rene has hydrocephalus, which occurs frequently with spina bifida. In the US, he would have had an operation for it by now, a “shunt”. Here in Ecuador, the family couldn’t afford it--about one year of dad's salary--so it hasn’t been done and his head is therefore bigger than you’d expect. He’s an engaging, bright-eyed little guy who loves attention.

Spina bifida is certainly a tough go for families, even in the US, and much more so down here. Mom, dad, Rene and his older brother Diego live in a little apartment behind dad’s automobile repair shop in a neighborhood near the clinic. He was getting around in the apartment by rolling around on the floor. While we were talking with his folks about his problem that first time at their place, his mom began to cry quietly and Rene looked confused, not understanding why the fuss.

Jamie Strawser, a friend and physical therapist, brought Rene his first wheelchair last month. She was here as part of a brigade made up mostly of faculty and students from UK. It was quite an event, and a little crowd formed in front of the clinic as Jamie adjusted the chair, passing on instructions and tools to dad, mom crying in the background—she wasn’t the only one—and Rene, he was smiling, happy and excited about his new wheels. It wasn’t everything he needed, but it was something.

*Frederic William Farrar (1831-1903), canon of Westminster and later dean of Canterbury. The complete quote is : “I am only one, but I am one. I cannot do everything, but I can do something. What I can do, I ought to do. And what I ought to do, by the grace of God, I will do.” This quote has also been attributed to the American Everett Hale (1822-1909), religious thinker and writer from Massachusetts, who also said (my favorite): “If you have accomplished all that you have planned for yourself, you have not planned enough.”

Nieve in Ecuador - Rich Letter #2

If you turn right out the front gate of our clinic, right again where the sidewalk ends, and walk carefully four blocks on the muddy road lined by hibiscus bushes up the hill, after a turn or two, you’ll come to Nieve’s house. The first time Mercedes and I visited her, Nieve couldn’t get out of her bed. She could hardly move.

I love doing these house calls with Mercedes, our community nurse. She’s in her element out there and everyone seems to know her and love her. Your patient list has a way of growing when you’re out visiting homes with Mercedes. Recently she recruited me to visit a little girl badly burned on her leg but when we finished with her, 2 or 3 more folks needed a visit. Knowing you are in the neighborhood, people will flag you down and off you go.

Anyway, Nieve is better now, on medication for her severe rheumatoid arthritis, provided through the help of our generous benefactors back home. She now limps on her walker the four blocks to the clinic every week to get her methotrexate shot and have her blood pressure checked. She’s a very positive person, doesn’t complain much about her lot in life. We aren’t able to solve all of her problems, but she’s grateful she can walk again, and so are we. Thanks for making it possible!

Letter from Ecuador #1 (Rich)

June 22, 2008

We got caught in a torrential rain the other day while Cristian, my colleague at the clinic, was driving us home. He’s our young, excellent and hard-working Ecuadorean doctor who sees the adult patients while I see the children. Driving through the rain, he observed good-naturedly that we really weren’t supposed to get rain like this now that summer, theoretically the dry season, had arrived. The passage of the (two) seasons here at the equator, however, is a pretty nebulous concept. Winter and summer are pretty much interchangeable. Winter is warm, humid and rainy, and summer is warm, humid and slightly less rainy. I joked that really the only two seasons in Ecuador were mud and dust and everyone laughed in the usual Ecuadorean way. There is so much here to laugh at, they get pretty good at it; the weather, the water supply, the economy, the crime rate, the corruption and the many unpaved roads being only a few of the possibilities.

Despite it all, or maybe because of it all, Ecuadoreans are hopeful people and our days at the clinic are filled with hope. Rocio, our nurse, and I were talking last week about the unacceptable number of children we are seeing with malnutrition—24 children just in the month of May. We have a supplemental feeding program which keeps most of the kids 6 months to 3 years of age reasonably well-nourished, but still some are falling through the cracks. She thought that organizing group meetings to provide education and support for the families with malnourished children would be a good idea. We’ll also be doing monthly weight and infection checks. Mercedes, our new community outreach nurse, will be visiting the families at home, checking to see whether the family needs food and how the feeding is going. We also have a little money to buy food in emergencies when families are going through rough spots. Hopefully—there’s that hope again—we can start getting these kids back on track nutritionally. Thank you, friends and family back home, for helping to make our hope possible.

Marcelo and Maria

Marcelo, who is four months old and blind, went home on Friday. He and his sixteen-year-old mother Maria came to CRN five weeks ago, following his two week hospitalization to recover from malnutrition. I don't know the cause of his blindness; local doctors are saying he needs an operation within the next few months in order to save his right eye, and that the left eye is a lost cause. Hoping for a miracle if not a possible mis-diagnosis, I have sent pictures to an ophthalmologist friend in Lexington, hoping that she might have a suggestion or lend some insight into why the medical advice has so far been very inconsistent. Marcelo is a real peach -- good natured and pretty straightforward in communicating his needs: a real stroke of luck, since his mom required some major on-the-job training. Thankfully, Maria rose to the task, learning a lot from being with other mothers and the CRN staff. She and her son are a disarming pair, and I'm looking forward to seeing them both at his first check-up (today!)

Laura and Friends

Last Thursday Laura Grabau, a UK student who is studying in Quito for the semester, came to Santo Domingo with three other US college students to volunteer at the clinic and CRN during their spring break. The Hombro clinic was closed for Good Friday, so the six of us gave the reception and waiting area a new coat of paint and some of the girls got started on setting up a better filing system for patient charts. By the time the students leave tomorrow this latter job will be complete - a huge accomplishment which would have taken the staff weeks or months to get done. The picture shows Rich and the workers after the painting was finished, all holding their "good patient" award stickers. Laura is furthest on the left.

We took the group out to the Tsachila festival (previous post) and to the Easter vigil service at the Agnus Dei monastic community, a liturgy beginning with the traditional fire at 3:30 a.m.(!) None of the girls is Catholic, but they will never forget this Easter, I am sure.

Tsachila Indians

The Tsachilas, a community of Colorado Indians (from whom Santo Domingo de los Colorados got its name), had their annual festival this past weekend in Chiguilpe, a pueblo on the outskirts of the city. The Hombro clinic may start sending a medical team out to the community, whose people are among the poorest of the poor here. Rich and I took the bus out with our four house guests and spent a few hours sampling the food (we took a pass on the grilled grubs, though a couple of the college girls tried them), looking at handicrafts made from seeds and wood and cotton, and watching the entertainment - music and dancing and a drama about global warming....a sad irony that this society which has left no footprint at all on the earth should have to be concerned about this travesty. The pictures above are of two Tsachila girls, two American men (Rich and Trent Blair, a Peace Corps volunteer from South Dakota who has been working with the Tsachilas) and a group competing for "best dressed Tsachila". Their red hats are actually their hair, which they coat with a substance made from the red achiote seed.

Follow ups

Here's a new picture of Luis, taken last week, a little more than two weeks after the picture I posted last week. He has made great progress, though he still has a ways to go. This week, due to school matriculation for the older kids and the Holy Week holiday, Lucia is not at the Center.

Rich and Corrinne requested a follow-up on Daisy. I'm sorry to say that I don't have any recent info about her. We went back to the family home several weeks ago to check on her; she had gotten bigger and looked very different, but we didn't have a scale so I don't know what she weighed, and the mother has not brought her back to the clinic to be re-weighed. In spite of the social worker's threatening to remove the child from the home if the mother didn't bring the baby in, the fact is that it's a terrible burden on this mother to come back with any regularity--more than a two-hour bus ride each way at a total cost of $5, which the family can ill afford, plus five other children at home. One of these days the social worker will go back out.

Lucia y Luis

For the last two weeks I have been helping out with Luis, a now three-month-old baby who weighed about four pounds when he was born and hardly gained a thing in his first month at home. So he spent 3 weeks in the hospital and then came to CRN. When I first met his mother she was sitting on the edge of the bed with tears running down her cheeks, despondent over her situation - missing her other children who were at home, the house she shares with a sister and brother-in-law and their children. She said that her sister doesn't love her (Lucia's) children, and the father of the baby "se fue" (is gone, presumably for good); she obviously was feeling hopeless. I took a picture during the first week. You might be able to see Luis's fuzzy forehead. This black fuzz is a common sign of malnutrition. (Sorry about the orientation; I should have posted it vertically but I can't change it.)

Now the fuzz has almost disappeared. Luis is still terribly floppy, but his eyes are bright and he's begun to make baby sounds and follow my keys when I move them across his field of vision. And he's got a smile like a jack-o-lantern!! His mother's spirits have changed completely, so much so that it's obvious she was suffering from severe depression. I'm working on a follow-up picture to post.

Leap Day

The strangeness of February 29 makes it a good time, I suppose, for me to return to the work of reporting on our activities here in Ecuador. Our return to the US for the Christmas holidays proved to be something of an obstacle to my developing sense of belonging here, I'm afraid. It set back the Spanish somewhat. (Of course we COULD have spoken Spanish every day for an hour or so with Danny and Cristina Oviedo, who visited us from their temporary home in Florida, but we were charitable and helped them with their English.) And since at least for me, communicating with people is paramount to feeling at home, the month away slowed me down.

But in the last few days I have realized that I'm understanding the mothers at CRN better than I ever have (still not completely), so I feel that I'm back in the saddle. And it only took six weeks!

Three things from today are worth commenting on. Those of you who were in 4-H will doubtless remember "demonstrations", those little presentations each member did to show how to make something in the kitchen (I remember doing humble stuff like tuna salad, but Carroll and Alice Holder did some kind of amazing cupcake-decorating thing that involved mirrors and palindromic names like Sis and Otto). In a little conversation this afternoon a few of the mothers expressed enthusiasm for being shown how to prepare nutritious food. (One would think that such sessions would already be a part of a program such as CRN's, but they're not). So starting next week we're going to begin demonstrations.

I accompanied the CRN social workers on a visit to check the progress of a child who came to the Center for a period of time a while back. The home is in a neighborhood of mostly stick houses that have been built on top of a former dump site. The baby is still "hinchado" (swollen, a sign of excess water retention and malnutrition) and will be coming back to the Center with the mom and a couple of siblings starting Monday. They (family of 8, I believe) live in a place with an uneven dirt floor, one large room with two double beds and a stovetop/dish area, and a curtained-off space where a very decrepit-looking grandfather was lying flat on his back, asleep & wheezing, on a wooden bench with no cushioning or bedding of any sort. There was one other room: the "store". Like way too many of their neighbors in this little forsaken neighborhood, they had a few bagged snacks for sale, maybe 10 or 20 items. I am really curious what force is at work making such families invest their scarcest of resources in trying to sell stuff to other people. It seems impossible to me that these enterprises produce income, and I am planning to look into the matter and see what's going on.

I finished up the day hanging out laundry upstairs on the terrace. This is the warm rainy season in Santo Domingo, and oftentimes it's impossible to get clothes truly dry. But today there was a nice breeze, so we're in luck. In these days of worrying about global warming and sustainable lifestyles, it's a wonderful and simple thing to hang clothes on a line.

Building Houses

During the week of January 27 - February 3 I had a chance to do a little re-bar work and some hole digging with a Habitat for Humanity group from Lexington! The delegation from Christ the King cathedral excavated and did foundation work for a house a few kilometers from where Rich and I are living. The twelve or so workers were an inspiration - working from 7:30 a.m. until 5:00 p.m. for five days straight, performing some really heavy-duty labor while dealing with rain, mud, bugs and stomach issues. Four members of the team were medical professionals, and on Friday afternoon I took them on a brief tour of the Hombro-a-Hombro clinic, for which the cathedral parish has been providing significant financial support.

A different building effort, in the neighborhoods served by the Hombro clinic, took place the following week, sponsored by a university in Quito. About 50 Ecuadorean college students camped out in the Julio Jaramillo high school (high schoolers were on vacation), and worked for six days putting up four houses. These houses probably won't last as long as the Habitat-built concrete block house; construction materials consisted of cane posts and underpinnings with a thin concrete overlay. The Oviedos' son Andres was a part of this team, and we went to visit the site with Leonardo and Marcita, who were clearly proud of their son's efforts; this type of project was unheard of when they were his age.

Jemina the dentist; Rich lectures en español

Last week Rich took some photos of Gemina the dentist and her patients to send to Lilian Ranseen, who is doing a toothbrush-collecting project with Veterans Park elementary school. Part of Jemina's work is being supported by Jubileo. In examining the students at four schools in the Hombro clinic service area, staff have found a terribly high level of dental caries and/or need for extractions (more than 65%). Jemina spent six years living in Israel; that's where she met her Ecuadorean husband Jaime! She is very devoted to her patients and her work, and looking forward to implementing a prophylactic program using dental sealants which are being purchased by Jubileo and Hombro jointly.

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Rich has spoken at lots of pediatrics conferences, but on January 30th, his two talks at Voz Andes hospital in Quito represented a big first: he gave both "charlas" in Spanish!! In retrospect, maybe this challenge was a bit premature for the level of fluency he has attained, but he took it on, and due to intense effort, he did himself proud. He basically read the papers, which he had written first in English, then translated, then corrected with the input of several native speakers, then rehearsed many times. His preparation paid off in a polished performance. The only sign that he wasn't totally at ease was the amount of movement in the laser pointer; rather than hitting a particular point on the projected image, it would just sort of wander around the intended area. (I don't know if anybody but me knew that the instability was due to trembling!) He fielded questions from the audience well enough that he received the ultimate compliment from a participant who approached him afterward to discuss something - the person thought Rich was a doctor from Brazil!! (i.e., not a gringo).