Buenos días again...

Good morning. I wanted to post some photos I took from the rooftop terrace a little while ago. The volcanoes are covered in fog, which is typical; but, the Quito panarama is beautiful.

I was blessed with a wonderful hot shower this morning and it looks like it'll be a perfect day for shopping -- neither too hot nor too cold.

I hope you all have a wonderful day.

I'll be home sometime tomorrow.

Did you say HOT water?

Tuesday, July 27, 2010

We left our hotel at 6:30 am this morning after a wonderful buffet breakfast. We were headed to the airport to fly back to Quito (a 30 minute flight -- as opposed to the 10 or so hour drive back up the mountain.) As it turns out, our last screening had to be cancelled because of a communication gap we don't fully understand. Of course we were a little disappointed, but I think it was a blessing, given that we're so tired and we haven't had much leisure time for renewal and rest.

We had already planned to visit the Termas de Papallacta (Papallacta Thermals)located in the quiet little town of Papallacta about 40 miles east of Quito, Ecuador's capital. So as a result of the cancelled screening, we got to stay a little longer at the hot springs and not be rushed.


The thermal baths are right on the banks of the Papallacta River in a unique natural environment accommodating nine hot thermal pools and three cold water pools. The hydrothermal value of Termas de Papallacta's Hot Springs is thanks to Papallacta's location between two volcanoes, Volcano Cayambe and Volcano Antisana.


Though the ambient temperature was cold at the springs, it felt wonderful once we got into the pools. The water was very hot and the temperature varied according to which pool you were in. It was raining a heavy mist the entire time we were there with heavy cloud covering, so photographs were a challenge -- the lens kept getting water droplets on it. Some of us sat and soaked in the healing warmth of the waters; others, including Dr. Moss, jumped from pool to pool so they could say they tried them all.


We ate lunch at the restaurant directly adjacent to the pools, then drove back to Quito to find our lodgings. We're spending our final night in Ecuador at a large hostel -- 2 people to a room with an en suite bathroom. There is hot running water and I have great expectations for a hot shower tomorrow morning.

For dinner tonight, we scooted downtown to the Terraza del Tartaro rooftop restaurant for a lovely meal. They had a warm fire glowing in the fireplace and blessed me with delicious iced tea, served with fresh limes. This was definitely a night to remember.

After breakfast tomorrow, we're planning to drive over to the Middle of the World Monument for shopping. We'll go to a restaurant for lunch and dinner and squeeze in a debriefing meeting with Mike, our Extreme Response host. At around 8:30 pm, we'll board the bus one last time for a short ride to the airport, then take a late flight to the states tomorrow night.

I have such mixed emotions...

Riding back into Quito earlier today, I realized Ecuador is growing on me. I've warmed up to the style of the houses and the city and no longer think they're as shabby as I once did. After getting to know some of the Ecuadorian people, I'm able to see the way of life here for what it is and am not so eager to compare it to what we know in the states.

and I wonder...

Did I meet the goal?
Did I impact community health in Ecuador in some small way?
Did I make a difference?

Combing the beach for rocks...

Monday, July 26, 2010

We hopped on the bus this morning after breakfast and drove to Manta, which is on the coast. We were scheduled to conduct a health screening at the dump. We worked in conjunction with a mission and there was a doctor to write prescriptions and follow up with the patients on site. There were only 50 people and I was able to take blood pressure and pulses again. We worked more efficiently than ever, since we're staying at the Howard Johnson's ocean-front hotel (5 star) and we were eager to hit the beach!

It was chilly down by the water and there was hardly any beach to speak of – mostly rocks. Not a soul was on the beach except us – apparently it's not safe here. The security guard from the hotel didn't take his eyes off us as we stayed near the hotel, combing the beach for shells. Well, mostly combing the beach for rocks.

Here I am -- looking over at the beach from the railing of our hotel...



The best part of going down to the beach was coming back to our room and taking a hot shower -- with all the water pressure you could ever want. We also had ice in our drinks for lunch and dinner -- Thank you Howard Johnson!!

We have internet access in the rooms and I'm a little crazy trying to catch up on blog posts and homework. We can't believe it's almost time to return to the states. It seems like we just got here and we have to fly home Wednesday night. Where did the time go???

Tomorrow we fly back to Quito first thing in the morning and conduct our final screening in the early afternoon. Wednesday has been reserved for shopping and touring.

A little bit of Heaven...

Sunday, July 25. 2010

This morning's church service was wonderful. We attended Pastor Noberto's church and made up half the congregation.

Here is Pastor Noberto...



The worship service was refreshing. We sang "Shout to the Lord" and "Lord, I Lift Your Name on High" with them – us in English and the congregation in Spanish – and I thought of how big God is and how lifting our voices in praise together was a glimpse of what Heaven will be like.

Here is the outside of the church...



The pastor called us up to the front of the church and prayed for us, asking God's blessings and protection over us. Then, as the service ended, he asked us to stay in the front of the church and allow the members of the congregation to greet us and show their gratitude. Of course this was done in the traditional Ecuadorian way – with hugs, kisses, and "Dios le bendigas." (God bless yous) -- all in Spanish.

Their gratitude brought tears to our eyes. We have learned to love the people so much and their contentment is so refreshing. There are no words to describe the love and connection we feel and it's impossible to express the oneness we have with them.

With renewed vision, we reluctantly said our good-byes and headed back to the hotel.

As quickly as possible, we lunched, changed clothes and headed 45 minutes toward the coast to Bahia de Caráquez (Bay of Caracas) for a look at the beach, a little shopping and dinner out. The town seemed shabby, the water dirty and the non-existent beach rocky, so no one wanted to swim. But it was nice having some time to walk around, take photos by the water and relax.

Here I am, fooling around by the sea...





We went to a really great pizza place for dinner and had a taste of home, then it was back to Tosagua and homework for the rest of the evening.

Augustina's hospitality...

Saturday, July 24, 2010

This morning we headed to a nearby community called La Madera, where Noberto, the pastor of Dios Con Nosotros church in Tosagua, and a few church members have been trying to plant a church. Up to this point, they've not been able to make much progress. Their hope is that by having a health screening and providing follow-up for the needs of the people, this will help open doors to enable them to build relationships and thus progress toward their goal.

To access the community, we had to walk across a long swinging footbridge over a river.



The screening was to be in Escuela Enrique-Gilbert, the local school. Here is the wall around the school with typical painting on it.



We used two open air classrooms for our stations. The weather is always mild here and keeping things open helps to ensure breezes. In the corner of both classrooms was a standing basin of water with soap, and a towel hanging on a nail for handwashing when school is in session.


The school desks and chairs were ancient and, though there was a standing white board, the furnishings and supplies were sparse and primitive.



The toilets didn't flush unless you poured water into the tank first. Water buckets are kept full outside the bathroom stalls and there's a converted milk jug scoop for carrying and pouring water.

I found a little frog when I lifted the tank lid to fill with water so I could flush...



Our new Centrifuge broke yesterday, so there will be no more hemoglobin checking station for our screenings. I was able to check blood pressures and take pulses all day and we screened approximately 140 people. With that kind of practice, my skills are quickly improving and the environment among the students is supportive. In fact, we've grown more cohesive each day. It helps that we're not so crowded in the Tosagua hotel.

The screening was like all the rest, with the people showing great love, affection, and appreciation to us with hugs, kisses and kind words. My Spanish is improving and I can greet people in their native language comfortably now.

The highlight of the day was eating lunch at the home of Augustina, one of the residents of the La Madera community and a church member of Dios Con Nosotros. We washed our hands in the same way as last Friday, because these homes don't have running water. We sat at a large table on her open, covered porch and had fried plantain chips, an unidentified soup, chicken drumsticks, white rice and a kind of cabbage salad which Dr. Moss told us not to eat. Three students have come down with traveler's diarrhea and had to be taken back to the hotel as soon as we got to La Madera this morning – so that's taken some of the fun out of meals for me, but I loved being in Augustina's home, seeing her open kitchen and getting a close up look at the way things were arranged and built within her home.

Here are photos showing Augustina's open kitchen leading to the covered porch...




We've been shown such hospitality by the Ecuadorians -- This is just one more example...

...and they will be my people.

Friday, July 24, 2010

I photographed a handmade banner hanging on the wall of the church where we worked today. In English, it reads, "Thus saith the Lord, I will be the God of all the families of Tosagua and they will be my people."

We headed over to Dios Con Nosotros (God With Us), a local church this morning to conduct a screening for some of the people of Tosagua. The children were more timid than we've seen and less cooperative; so many didn't get their hemoglobin checked. (The hemoglobin station involves a quick finger stick and taking a tiny amount of blood from the fingertip to rule out anemia.) Still more children pouted as they moved from station to station and several refused to allow me to check their pulse or blood pressure! This is quite a change from before, where the children were eager to see what our station was all about and willing to allow us to do most anything as long as we smiled at them and patted them lovingly.

The children, in fact some adults, are a little suspicious of us. I can see mistrust in their eyes. Still others – especially the abuelas (grandmothers) – are very loving, hugging and kissing us over and over and thanking us and repeating, "Dios le bendiga." (God bless you.)

The pastor, Noberto and his wife, Belen (Bethlehem) were very gracious, bringing us fresh mandarin oranges & papaya, freshly baked bread & cake still warm from the oven and drinks throughout the day.


We saw a little over 90 patients and learned how to flush a toilet without running water by pouring water into the tank before flushing. Before lunch, we washed our hands by wetting them in a bowl of water, lathering up well with soap, then rubbing our hands to rinse as someone poured "clean" water slowly over them into a basin. What servant hearts the people of Tosagua have! I really felt humbled having someone assist me to wash my hands.

During a delicious lunch prepared for us by the hotel staff, (fried rice with peas and carrots, chicken, fried plantains, and a warm potato salad with cabbage) the water truck came to fill up the cistern. After that, thanks to gravity, we had running water in the sinks and toilets!

A photo of me with Bella, a lovely lady with high blood pressure...



Following dinner at the hotel, we headed to the open air arena, one block away, to watch what we thought was a soccer game. Pastor Noberto promised to save a spot for us if we would agree to come and we were under the impression he was going to play. We arrived at 8:00 pm and it seemed as though they were never going to get started. We finally left at 10:00 pm without ever having watched a soccer game! We never did figure out what they were doing – it may have been a kick-off for the soccer season or some kind of exhibition – who knows, it was all in Spanish!!

A photo of Noberto, the pastor of Dios Con Nosotros Church in a soccor uniform!

We travel to Tosagua...

Thursday, July 22, 2010
What a journey! Today we traveled from metropolitan Quito, 9,500 feet above sea level, to Tosagua, a rural town near the coast. We bumped and careened our way down inferior roads for hours, as we soaked up the novelty of Ecuadorian culture. At one point, we followed behind some cowboys driving cattle down the middle of the road!


Riding on the edge of a cliff much of the way, we arrived at Tosagua around 5:00 pm. God is good.

Most of what we passed was farmland with cattle, goats, donkeys, horses, chickens, geese, corn, sugar cane, tomatoes and a few empty rice wetlands. Growing (apparently) wild, cultivated in fields and planted in the tiniest yards, banana and papaya trees were abundant. Hammocks hung under houses, on tiny front porches and between trees.

All along the road were houses. Scores of them were built on stilts, even when water was nowhere in site – perhaps to discourage bugs or supply shade and storage for people or animals. Nearly every house we passed was in deplorable condition, many with no windows or doors. A few had beads or a curtain hanging where a front door should have been and curtains in glass-less windows. Countless homes had bars over the windows, glassed or otherwise, as security is an issue even in rural Ecuador. It is noteworthy that the houses lack uniformity – they might be roofed or sided with several different materials, as if they ran out of one thing and were forced to make do with something else. Even brick houses are often not uniform – being part brick, part cinder block and part something else. Incidentally, it was impossible not to notice Ecuadorians don't use a level to lay cinder block or brick. This is true in Quito as well.

Almost every house had clothes hanging outside, sometimes on a clothesline, sometimes over a fence or porch railing. (This was also common in Quito, even with the nicer homes.) One family was outside washing laundry in tubs, as we passed by.


Many times I would spy a ramshackle shed or barn and focus my camera on it, only to find out, as we approached, a family was living there. I have never seen such abject poverty. Indeed it is impossible to convey or comprehend

and yet these families live…

I don't know what I expected upon arrival in Tosagua. I know my expectations were decreasing by the minute as we drove along. Reading the Bienvenidos a Tosagua sign prominently displayed at the edge of town, I seriously began to consider our lodgings.


My relief was palpable when our bus driver slowed to a stop in front of a lovely hotel right in the middle of town. We're staying at the Hotel Punta de Oro and the rooms are quaint and charming. In most cases, we are 2 to a room, with en suite bathrooms. Ashley and I each have our own bed, covered in old white linens with embroidered pillowcases and lacey white mosquito nets hanging overhead.


The walls are a charming periwinkle blue, as are the tiles in the bathroom. Our rusty shower head is equipped with a widow maker, a way to harness electricity in the water pipe to heat water; but it isn't hooked up and doesn't heat water… I know this because I can see the loose wires hanging out above the shower head.


Needless to say, I won't be considering the implications of mixing water with electricity in the morning as I hurry through a cold shower and thank God for running water.

We were given free time before dinner to walk around town in groups of 3 or more. A few of us headed to the open market to look at picturesque fresh produce and the Faramacia to buy some anti-itch cream for somebody's mosquito bites. We endeavored to absorb the sights, sounds, and smells of a town that in many ways seems as if it's living in another century.

Here's a view of a major intersection from our patio-furniture-ready rooftop terrace...


A view of the open market from our roof-top terrace...



At 7:00, we enjoyed white rice and grilled chicken for dinner with peach juice in the hotel restaurant, then spent several hours packing supplies for the next few days of screenings. After that, I headed upstairs to my room to do homework and, with no internet access in the hotel, went to bed earlier than I have since we arrived in Ecuador.

Buenos Días...

Good morning,
I wanted to share another view of Volcán Cayambe I was able to capture this morning just after sunrise. We are busy getting ready to travel and vacate the guest house. When we return to Quito on Monday night, we will stay in another location. Pray for safe travels and happy hearts. Muchos Gracias.

Splendor...

Volcán Cayambe-- the only place in the world where you can find snow on the equator


Volcán Cotopaxi (w/ the black hole)


Volcán Antisana (the shy one, because she can rarely be seen)


Wednesday, July 21, 2010

We have a beautiful view of the landscape from the guest house. Our living area is wall-to-wall windows on one side. This morning, we woke to a rare sight -- three volcanoes showing their faces. Usually they are covered in clouds or fog and you can't see them clearly, if at all.

Today, they were spectacular and we felt the rarity of it. I took these photos from our rooftop terrace.

First thing after breakfast this morning we toured the Hospital Vozandes, which is run by hcjb global, a prominent evangelical mission organization here in Ecuador. I was impressed with how nice it was, if not exactly modern. It is a 76-bed private hospital with an 8-bed ICU. They told us their mission is to share the good news of Christ with everyone who walks through the doors.


Hospital Vozandes, Quito

Later in the afternoon, we traveled by bus to the south side of Quito, the poorest district, to conduct a screening at Iglesia Cristiana Remanso de Amor (Haven of Love Christian Church), a community mission and Christian school.



When we arrived, the people were already waiting. I loved the place immediately. It was not beautiful, but the children were waving to us and interacting with us before we even got off the bus. I loved the people instantly. The mothers were very young, but they managed their children in a quiet way that I rarely see. Even the toddlers were impeccably well behaved. They were loving to each other and to us – hugging and kissing us and taking our hands for a squeeze. When they saw my camera, they all wanted to have their picture taken, and there were so many…

This screening was our favorite. There was just something special about it, and we had the strong impression that the Christian school and ministry has had a huge impact on the community. We were able to see 92 patients and will be making a number of referrals for dental work (I worked the oral health/hygiene station again today). There is a dentist who comes regularly to the school, but the people can only afford to pay to have teeth pulled when the pain becomes unbearable. They just are not believers in good dental hygiene. Nevertheless, I enjoyed myself immensely and am improving in both my clinical skills and my Spanish.


One pregnant lady who came to the screening had her prenatal paperwork with her. Ecuadorians traditionally don't think prenatal care is important, so this is unusual. Anyway, she had an order for a hematocrit (to check her hemoglobin) from a doctor, but she had not yet been able to afford to get it done. We were already set up for hematocrit checks and were happy to provide this for her at no charge. To us, this was a small miracle. And we were so proud of her for taking charge of her healthcare and coming to the screening prepared.

An elderly lady, Luz (Spanish for light), who had hardly any teeth, came to my station and allowed me to check her mouth. Noting the trash can full of used gloves on the floor, Luz asked me in Spanish if she could have a glove to do some washing or something. She indicated the bag full of purple gloves at my side. (I happen to know the verb for 'wash' because it's similar to the French word.) Before this trip I didn't speak a word of Spanish, but anyone who heard her gentle request would have understood her meaning. Of course I pulled out the gloves and asked her in Spanish, "Uno or dos?" "Dos," she replied. Tears came to my eyes as I realized I wanted to give her so much more, but all I had that she needed were 2 disposable gloves. I had been wearing the gloves for about a minute, then tossing them in the trash; but I suspect she'll keep hers a little longer. I'm praying they'll last a long time.


Luz

Please pray for these people. Their pastor, Ramiro Maldonado, has made great progress in helping the community, especially through the Christian school and assistance with health care…

but the real difference in their lives is Jesus.



Tomorrow morning, we leave Quito and travel by bus to Tosagua and Manta, near the coast. We will have only intermittent access to the internet, as these areas are very rural. If we have access to an internet cafe -- I'll post an update.

The least of these...

Quito City Dump (and Extreme Response Daycare)


Tuesday, July 20, 2010

Today, my birthday, we spent all day at the dump!!!

Poor people in Quito are desperate for survival. Some of them are so desperate they sort through trash at the Quito landfill, then sell anything that can be recycled. Even though the city benefits from having less trash to bury, the workers don't get paid anything for their work. They simply work for what they can make selling recyclables. The city limits the number of individuals who can do this and even hires people to supervise them. The work continues 24 hours a day with two 12-hour shifts. Most workers can make between $30-$40 a week -- up to $70-$80 in a good week (if they are young and can get around fast).

In many cases, both husband and wife work together so they can make more money. Extreme Response has built a day care for children of the workers, so there is a place for them to go while their parents work. The daycare building is where we spent our day -- screening folks that can't even think about making health care a priority -- until something hurts so badly they can't stand it.

We screened all the children and the workers who wanted to participate. Extreme Response didn't really expect a good turnout. If the workers chose to come to the health screening, they would have to factor in what my son refers to as "opportunity costs" -- when they're getting screened, they're not making money. But, amazingly, we completed 150 sceenings! I worked at the oral health station doing assessments on dental hygeine/overall oral health and could hardly believe the amount of dental decay I saw in the mouths of these individuals -- even the preschoolers. Nearly every patient will be referred for extensive dental work. In fact, as a result of our screening, Extreme Response is now aware of the need and will get a dentist to come out and take care of these people on a small fee scale basis -- $1.00 per visit. I'd never realized until today how much I take flouridated water, toothbrushes and toothpaste for granted. We live in such a blessed country...

I can't describe the smell of a city dump -- you just have to experience it. At first, I thought I'd not be able to adjust. Then little by little the smell seemed to be turned down in my brain. That is... until the workers walked into the screening room. The stench was beyond description. It was only the grace of God that helped me get through those first few patients. But they were such ordinary people, so much like me. They were so grateful and greeted us so warmly. Who could help but be drawn to them? Still, God had to do a great work in all of us to get through that morning's screening,

and the smell lingered.

We thought the screening would never end. We were so tired and the people kept coming. It wasn't fun. Even the children had terrible dental decay -- many complained of pain.

In late afternoon, we left the dump and went to a Chinese restaurant for an early dinner. Dr. Moss informed us we were going to return to screen the second shift workers. I can't say the mood on the bus was light -- we were just so tired. But the Lord did a mighty thing... As we returned to the dump, we didn't realize the mood of the entire group had lifted. It wasn't until half-way through the evening screening we realized we were having fun. We were actually laughing and enjoying screening the workers! And the smell wsn't so difficult to tolerate as we reached out and cared for them. I saw them through different eyes as I touched their faces, their skin. And the night was just beginning.

Later, we learned the plan was for us to fix 100 sandwiches and feed the workers that night at 9:00 for what Extreme Response refers to as an outreach night. Hosea, the fellow who ministers to the workers thanked us for being willing to open our hearts to the workers, for being willing to touch them and provide health screenings to them. He told us that most of the workers cannot read or write, that they consider their job the least desirable job in the world and that they are shunned by the community, that many times they offer their fist for a handshake, forcing you to take their arm, which is (a little) cleaner than their hamd. With hardly a dry eye in the room, Dr. Moss asked us to form a line and shake the hands of the workers or hug them and greet them lovingly one more time as they came for a brief meal. She said we could opt out if we wanted, but not a single student would make that choice...

At a little after 9:00, the workers began arriving. With eagerness, all of us formed a long line and, though their hands were filthy, we shook them and greeted the folks warmly once again and acknowledged them with dignity and respect. After they were seated, we served the workers ham & cheese sandwiches with a napkin, bananas, and hot chocolate (it was 55 degrees) and Hosea offered a long prayer of thanksgiving. After we handed out the food, we watched them carefully eat their sandwiches and bananas. They used the napkins and banana peel to hold the food while they ate it, never touching the food with their hands.

We went to the dump this morning to bless these people and in the end, we were the ones who were blessed. As Hosea said, "After all, God gave us skin that can be washed..."

...a good lesson for novice nurses.




Here are some of the children at the day care...



Here we are with sandwiches waiting for the workers to come...



Bananas and hot chocolate ready to serve...



Here's a photo of me with some of the workers. I'm in the back...

The Healing Power of Touch...

My good friend, Ashley, holding hands with Carla, a resident of Hogar Betania


Monday, July 19, 2010
This morning we headed to Hogar Betania (Bethany Old Folks' Home) here in Quito to provide screenings and, as Dr. Moss would say, "love on the people". Dr. Moss' husband helped build some of the buildings at Hogar Betania when they lived and worked here as missionaries several years ago. We were all prepared for decrepit conditions and for the residents to be pitiful and smelly; but we were pleasantly surprised! The place was beautiful, with well-tended flowers and lawn and carefully laid out paths. It moved our chaperones to tears when they saw how lovely and well-kept the place was.

The residents were clean and well-cared for and the staff was attentive. The fact that the residents were receiving good care was obvious in everything we saw today. They were relatively healthy (for old folks) and Dr. Moss will need to make only 1 referral for follow-up! Praise the Lord for blessing this home so richly with excellent staff and people who care enough to give.

After we completied the screenings, Dr. Moss had a teaching session with the staff to help them understand the importance of hand washing and proper dental hygeine techniques when caring for the clients. Then we had the opportunity to give back rubs, manicures, and hand and foot massages to grateful recipients. The people were so dear -- serving them was a joy for all of us. We left feeling incredibly blessed...

This is me with Maria. I hugged her close, gave her a back rub, held her hand and she laughed with joy...





Later tonight, we headed to an upscale shopping mall for dinner in the food court. We could have chosen KFC, Pizza Hut, Taco Bell, Sbarro, McDonald's or Burger King, but we wanted something more traditional. On Dr. Moss' reccomendation, many of us chose a popular Spanish dish called Ceviche. It consists of shrimp with onions and cilantro in a soup served with white rice on the side-- mucho delicioso! Popcorn and corn nuts were also on the tray alongside banana chips. They were intended to be put into the soup, but I didn't care for soggy popcorn. The banana chips were good.

There was little time for shopping, but it gave us an opportunity to glimpse the upper class of Ecuador. In this country, there has traditionally been a large gap between the upper and lower classes. A mddle class has recently emerged and is growing.

After returning to the guest house, we counted out the rest of the vitamins and put them in packages of 30. Whew! At about 10:00pm, we got started on our homework...





We have a long day ahead tomorrow -- we're completing a screening at a daycare that a mission has built at the local dump! After the children go home, we are planning to stay until 11:00 pm "doing whatever needs to be done..."