Sara: busy week in Otavalo

I figured I would update everyone on whats going on in life right now, it seems like its been awhile! I am still at my internship in Otavalo in the Hospital, I have been observing doctors and nurses in Emergency, Surgery, Gynecology, and the Birthing Center and I will be going to Internal Medicine and Pediatrics in the next 2 weeks then I head back to Quito for a week then off to Bolivia! Time is sure flying by!

This week was crazy, a friend and I did tons of things! On Tuesday we went to an indigenous healing center where we got “cleaned with an egg.”  The egg is used in indigenous medicine to diagnose illnesses, my cleaning said that I have a little pain, but other than that I was a very healthy person. We also hiked up to an exposition building that is shaped like a hummingbird (the national bird), but we got to see a lot of original artwork by an artist from Otavalo.

This weekend though a friend and I stayed in Otavalo instead of traveling to see all that we could here. On Friday we went out to dinner and then to my host dad’s birthday party where we sat and talked forever with my host family and friends. Then we woke up at the crack of dawn (6a) to go the animal market.  Here all the people come from all around the city and country to sell their animals, there were tons of pigs, bunnies, puppies, chickens, roosters, cows, calfs, bulls, guinea pigs, cats, ducks, llamas, alpacas, goats… everything! I have a few pictures attached. Then after that we went to the food market and the artisan market where we got some more souvenirs and did a little people watching. It was a great time!

On Sunday Shelby and I went to a laguna, which a lake formed by a volcanic crater.  We even took a boat ride around the lake and learned all about it. It was really beautiful to see, we hiked to the top of one of the nearby hills to get a great view of the lake.  To get there we took a camioneta, which is a pick-up truck taxi where we sat in the bed of the truck. It was fun! After that we went to this little house on the outskirts of Otavalo where we got full body massages, it was amazing.

This coming week I am only in Otavalo for 2 days, I head back to Quito on Tuesday night for a workshop at my school and then I am heading to Cuenca, a little artisan city in Ecuador for Thanksgiving. I am super excited, it is the last place I wanted to travel to while I am here! 

               

Sara: The Internship

So I just finished my first week at my internship at el Hospital San Luis de Otavalo, which is like 2 hours north of Quito. I live with a different family here, they are really cool though and have had tons of international students so they know the drill. I have a host mom (Alba), a host brother who’s 9 (Andres), and a host sister who’s 12 (Domenica), and my host dad works during the week so I haven’t met him quite yet, but from what I have heard he is a great cook and an awesome guy.

I spent this week in the ER in the hospital shadowing a doctor and investigating the situation of patient privacy in the hospital. It’s kind of a hard subject to study, but I am super motivated because I also will be writing a 20 page paper on it at the end of my internship.  But I have seen quite a few different things, I cannot believe how many people have appendicitis in the ER. It has been a really interesting experience for me though and I will be doing rounds in the entire hospital, so I wonder what the coming weeks will have in store for me!

Although next week I will be going to the Galapagos Islands for 4 days which I cannot wait for right now! I am so super excited, I will be heading back to Quito on Monday night and then to the Galapagos by plane on Tuesday morning!

Attached are a few pictures of my new house and the emergency room at the hospital,

     

Shawnda: Nothing that is worth knowing can be taught

“Nothing that is worth knowing can be taught.” –Oscar Wilde

Another day, another experience. 

Yet again I found myself in Extension 2.  This day I took advantage of the slow morning and asked as many questions as I could.  I’m finally getting to know people and they are getting comfortable enough to talk in English around me, which is a relief.  I asked Agnes, the nurse from Princess Marina Hospital, about the workers strike and why so many nurses from PMH have come to E2.  She explained how the recession affected Botswana’s economy and how the mining industry was shut down for a length of time because no countries could afford to buy diamonds.  In 2009, I believe, it started up again and Botswana slowly got back to developing, but the work force was still at a standstill. 

During this time, about 3 years, workers received no pay raises, yet inflation was raising prices everywhere. Employees were working just as much as they used to, but were not being paid to compensate for the higher prices.  How are they expected to get by even with lower prices when they make almost nothing?  Doctors only make P30,000 a month, about $4,500 compared to the >$100,000 US doctors make.  Also, the majority of Botswana’s doctors are not private practice, but are government employees.  So they finally went on strike.

What was supposed to be a 14 day strike turned into a 7 day strike and a court case.  The court was in favor of the government, and ordered the employees to return to work.  Many of them, angered in the meager 3% raise offer (when they were asking for 16%), did not return to work and were laid off.  Little did the government know, when you fire the majority of your health care workers, you then have no one to work in the clinics and hospitals.  So with a shortage of workers, many of the nurses were relocated, still with no raise.  There is obviously much more to the story that I know little else about, but I am trying to keep learning as I go.

It is unfortunate that people are not getting paid for being overworked and for providing vital services to the public.  How can a nation develop when it isn’t healthy?  I think this is one of the lessons you don’t want to learn after you see the bad end of it, which I think Botswana may be reaching with its high rates of chronic disease and STIs. 

I also learned about why many of the doctors are not from Botswana.  The government pays its citizens to go to school, so many doctors went abroad for medical training.  However, most of them did not return, which led to a net loss for the government.  Also, for reasons I’m not sure of, foreigners receive more benefits than the citizens.  I don’t understand the specifics, but foreign doctors are paid more and receive better accommodations than people who have lived in the country their whole life.  Why should non-citizens reap the benefits?  I’ll have to look into this more.

The exciting parts of the day consisted of seeing a man’s head wound get sutured and going to PMH in an ambulance.  The head wound was about 3 inches long and maybe 1cm deep.  It was odd to see how tough the skin on your head is, but somewhat relieving to know you have that protection.  Going to the hospital was very interesting to say the least.  The woman unfortunately had a “missed abortion,” which in our terms is a miscarriage.  Reading her records, which were written with poor penmanship, I believe she had a previous ectopic pregnancy.  She was given an IV at the clinic and we transported her to PMH.  On the way there and back the ambulance driver and male nurse, Stan (his middle name, I couldn’t pronounce his first), taught me some Setswana terms. 

I toured the hospital and it was surprisingly much more accommodating than I had expected.  The hospital is mainly one level, and consists of multiple buildings that are connected by an outside path that is covered by ‘canopy roofs’ for a lack of a better term.  One thing I noticed was the lack of technology.  When you walk into a hospital in the US, it is buzzing with heart rate monitors, telephones, computers, ambulances, and simultaneous beeping noises; and it just has that “hospital” smell.  It was rather calm in the ER, with many nurses and ‘blocks’ divided by curtains for each patient; no particular sterile smell.  The waiting room was insufficient with no chairs; beds were brought in when needed.  They call their OR’s “theaters”, but also had many of the wards that you would find in the states.  They only just recently got a cardiac surgeon, and for most other larger surgeries, patients are referred out of the country. 

By the end of the trip I saw most of the hospital, learned how to formally refer to an adult, and got hit on by Stan.  I also met an oncologist who referred to me as his wife; I don’t think monogamy is possible here with so many marriage proposals. 

Kelly: Field study to Otavalo & Cotacachi

Our program is divided into 4 tracks, one of them being a Public Health group, which I am in. Last Wednesday–Thursday we took a trip to Otavalo and Cotocachi to observe indigenous medicine practices (un parto vertical y práctica curativa por Yachac) and to observe the interrelations of health systems (medicina occidental y indígena).

Our first visit was to Hospital San Luis in Otavalo. This hospital is the only intercultural hospital in the area and has been making an attempt to integrate/co-opt/absorb/accept (the word choice depends on your viewpoint) indigenous medicine into/with the Western medicine system.  A unique part of this is the presence of a sala de parto, which is a room that mimics the house of a partera (midwife/doctor) where a woman would go to give birth. We were fortunate enough to be able to enter the sala while a young woman was in the process of giving birth. The traditional way of giving birth is for the woman to be kneeling and kept warm by layers of blankets around her, and usually to be surrounded by her family. The partera present explained the different herbs used and we saw how she used massage, touch, and her voice to aid the mother. She said, several times in different ways, “Da ayuda de un montón a la mujer, nuestras compañera.”

After we left the hospital, we went to a health center with a focus on indigenous practices called Jambi Huasi (Casa de Salud). We visited with a Yachac (medicine man) who told us that his grandmother lived past 110 years old and started teaching him how to heal when he was three. His children don’t know his secrets and he doesn’t use or promote plantas sagradas (like Shamans do). In his candle-lit room filled with animal skins, bones, shelves of dried plants, some christian relics, crystal pyramids, and other assorted “sources of power and energy,” he explained that his knowledge is not studied, that it is knowledge of his ancestors and wisdom from nature.

Next we filed into the fregador, where we met the experienced fregadora Mamá Juanita (who our chauffeur later described as poca expresionante). She demonstrated two forms of body cleaning for us—one with an egg, the other with cuy (yep- a guinea pig). I volunteered to be cleaned by egg. Mamá Juanita had me sit in a chair and proceeded to rub an egg all over my body, softly chanting the entire time. She paused on my palms and the top of my head to tap the egg against me, saying “Chunga, chunga, chunga.” When she had finished, she cracked the egg into a metal dish and examined the contents. She proclaimed there was nothing to be seen and that I was healthy. If the yoke is runny or has odd colors, it signifies that the egg has absorbed bad energy from some part of your body. My yoke was golden and perky. Chévere.

And now for el limpia con cuy… Adriana was the only one interested in volunteering. Before I explain the process, I feel the need to give a cultural disclaimer so that this practice isn’t misunderstood. So, in a cleaning with cuy, the cuy is viewed as a sacrifice for the health of the individual. The cuy dies in the process of the cleaning and is cut opened afterward to reveal what bad energies it had absorbed from the person.  To start: Adriana stood in the center of the room as Mamá Juanita pulled the cuy from the burlap sack it which it had been silently stationed. Mamá Juanita grabbed two legs in each hand and began vigorously shaking it up and down Adriana’s body. It was a bit difficult to watch as I remembered my former pet piggies Patches and Oreo. During the cleaning, we could hear the sloshing of the cuy’s insides; later, Adriana told us it was making little vocal noises as well. Mamá Juanita checked a couple of times to see if  the cuy had died, and after the third time she decided it had passed and let Adriana take a seat as she began to skin the cuy. Turns out Mamá Juanita had judged wrong because once she had removed most of the skin, we heard noises from the cuy and saw his back legs contract; Mamá Juanita looked up at us with a surprised laughsmile and said, “He’s not dead yet!”

Once she had examined all of the organs and musculature, Mamá Juanita told us that Adriana was pretty healthy, but had a bit of lower back pain (the cuy had had black area in his lower back). She added that Adriana’s heart is “muy fuerte!” Claro. We collectively decided that if our group is faced with an armed robber at any point, Adriana gets to protect us since she has a heart that will never perish.

Once we arrived at our rather lavish hotel, ate lunch, and took a little siesta, we had a conference titled Cosmovisión andina y la salud with Enrique Cachinguango. He talked with us about how the idea of an intercultural health system is lovely, but there are still many limitations and ways in which it is not being realized. I found much of what he told us profound—it was a life lessons, ways of living talk with Grandpa. He told us, “Viva fuerte y con amor, con mucho amor.” He stressed that, “No somos parte de la naturaleza. Somos naturaleza.” We took a walk to la cascada Peguche afterwards to take part in a what our syllabus called a “ritual ceremony.” What this ceremony consisted of was standing together in a circle, lighting our neighbor’s candle, telling Peguche our name, why we were here, and te amo. It was lightly raining, Peguche was continuing to fall, and I felt a deep sense of peace.

(Due to the title of this part of our day and religion, there was one individual who chose not to participate. This individual also read her bible the two hours from Quito to Otavalo. She explained later that she didn’t know what to expect and didn’t want it to conflict with her own religious beliefs. This seemed strange to me as Enrique had earlier explained the importance of putting all cultures/beliefs on the same level and not being scared of what is different.)

On Thursday our easily-confused driver got us to Cotocachi where we saw a simulación de parto vertical ancestral. Three women and a blushing man acted out how a traditional indigenous birthing process would happen. This partera told us as well, “We always help the mama.” Maybe I’ll elaborate on the whole process in another post.

Thursday night, two friends and I stayed with our couchsurfing friend Julio. We went out to a bar where I got a free, strong fruity drink topped with two cherries. In the Plaza de Ponchos, we got empanadas and walked back to the flat drinking beers. His two cousins and their two friends came over before we went out to dance the night away. At some point during the night a flaming shot was put in front of me. I almost drank the whole thing I’d say we brought my birthday in right.

Friday, the actual anniversary of the day of my birth, I returned to Quito, took a shower, and went with a friend to the museum and house of Guyasamín. SUPER CHÉVERE! Then we went to La Ronda with my parents, had dinner, and drank boiled wine. There was a live band that said, “To the cumpleañera!” after every song, thanks to my dad’s note to them. It was a very enjoyable evening.

Tiana: Joal—the final stretch

Where has the time gone? I’ll tell you right now that it seems way too soon for me to be leaving Joal. I’ve just begun establishing friendships that I swear could last a lifetime, and now it’s time to go home? It just isn’t quite sitting well.

Anyhow, buckle your seatbelts, folks! I have a whole bunch of information to share with you from the past few weeks. First, let’s begin with current events:
Joal was hit with a heat wave at the end of April. Everyone was sweating bullets, and there was virtually no way to escape the heat. The day at work was rather dull. I was mistakenly called “Doc” by one of the mothers accompanying her ill child, and I really like the sound of it! After leaving work and eating lunch with my family, I drank a mixture of bouye and bissap juice to rid myself of some lethargy and headed to the beach that afternoon to cool off. As I was walking along the shore looking for shells, I heard a chorus of children shouting, “Tiana! Tiana! Tiana!” I looked up and saw some of the neighbors swimming just down the coast, Fatou, Papi, and Ami among them, and strolled over to join them. Taking pictures and shell-searching for the afternoon was so much more enjoyable with people to laugh with and pass the time with. Fatou helped me collect shells, and we all headed home at the same time, together. The kids and I made shadow puppets for practically the entirety of the evening, and voila, another day in Joal was finished.

Thursday afternoon, my host aunt (but more like an older sister) Agnes invited me to the beach with her and her English-speaking friend Lamine. We all camped out under a palm tree with some delicious lait caillé, or sugared milk, and spent the afternoon chatting, taking short walks, and looking through an English grammar. Once I got home, I learned that nine-month old baby Aissatou, a neighbor of mine, is now nicknamed after me! Her mother now calls her Aissatou Tiana! I was blown away by the compliment, and had a nice Wolof conversation with the mother in the process. After dinner that evening, I headed to the center across the street. My friend El Hadj and his friend Alioune tutor middle school children every evening. Mamadou instructs English, as he has his diploma from the university at Dakar in English language, and Alioune tutors math. I went and helped out with the English class a bit and have been going every night since! If I didn’t want to be a pediatrician, I think I would want to become a teacher!

Friday was rather uneventful, but with one particular note. I somehow forgot to wear earrings to work on Friday, and for some reason, literally everybody noticed! “Tiana, where are your earrings?” “Tiana, you look different. You’re not wearing earrings!” It seems that jewelry is absolutely integral to female culture here, something I didn’t notice until that very moment because it’s a normalcy for me to wear it!

The weekend was a lot of fun! I had previously planned to go to Mar Lodj, a small, paradisiacal island in the Sine-Saloum delta, but decided instead to rest with the family for my final full weekend in Joal. (Of note: when I come back here, I am definitely going to Mar Lodj! It’s supposed to be incredible!) I began my 20+ page internship report on Saturday, but quickly tired of it and decided to go to the beach and soak up some sun before lunch. Then after lunch, I went back to the beach, but this time with friends! El Hadj, Amadou, Alioune, and I all camped out under a palm tree for a couple of hours and made tea! One thing that I love about being here is that I have Senegalese friends, more specifically Senegalese guy friends—y’all back home know that I’m really shy, so this is a welcome departure from the norm.
When I got home that afternoon, my host dad’s friend, Madia, brought an American Peace Corps member by our house to introduce us. I had heard that there was another American girl working in Joal, but had never met her before. Alexis has been here for around two years with the Peace Corps working in environmental education. She speaks practically fluent Wolof and has spent a lot of time here, so it was fun to hear her perspective on the city, on Senegalese life, etc. I ended up going to dinner with Alexis, Mike, Brian, and Jacob (Mike and Brian are also Peace Corps members here in Senegal) at the Taverne du Pecheur. It was so nice to have a break from the daily grind of French and Wolof!

Sunday was as low key as ever. I hit the beach twice. Played with the neighborhood kids outside of the social center across the street. Learned to make baignets with the instruction of Mam Clo. Went to help out at English class. Went to sleep…

The following week came and went in record time. Monday, we took a good number of pictures at work, because it wasn’t only my final week, it was that of Dr. Bangura and two other interns also. I went on a walk through Joal with some colleagues from the clinic. We tried to go to the museum that used to be Senghor’s home, but it was closed, so we went to the bridge of Samba Dia. We made a heart in the sand, lined it with shells, and took pictures of each of our initials within the heart. Dorky? Sure. But it was really nice to spend time with them outside of work. On the way home, we did just fun random things—found a stray bill for 10,000 FCFA (the equivalent of about $20), stopped by a sand art shop, picked flowers that were growing from cactus, walked along the beach, and then parted ways. After dinner I went to English class and then helped Mama out with her homework! She has a penpal that wrote her a letter and drew her a picture, and she was to respond in kind. It was so sweet; she kept asking me what she should say, what she should draw, if her French was spelled correctly, etc. I loved it!

Tuesday, I intentionally woke up before sunrise so that I could run over to the middle school and photograph it. I do not regret getting up early whatsoever! It was stunning. The sun rises just over the basketball courts and behind a layer of palm trees. Once you pass through the school grounds, there’s a door that opens to the bras de mer, the arm of the sea, and you see the sun rising over a forest of baobabs, Fadiouth, and the cemetery. WOW! Before work, I stopped by the neighbor’s house to greet Massif, the sweet puppy there. The work day was short, and I ended up going home early because work was so slow, giving me the opportunity to help Agnes cook lunch! She showed me how to make the traditional plate, ceeb-u-jen, and allowed me to pound the spices, pick through and cook the rice, peel and clean the vegetables, and even help with the dishes! This was monumental, as I have wanted to help in that capacity since I got here, but haven’t really felt comfortable doing so. After lunch was ready, I climbed up to the roof to wave to the kids as they came down the long road from Fadiouth, then we all ate together and passed a peaceful afternoon and evening.

Have you ever had a day when your alarm goes off, you hit the snooze, and then sleep way too late because the snooze doesn’t work for some reason? Welcome to my Wednesday morning! I slept in until 8:45, the time that I usually leave for work, and had both Agnes’s in the family calling to me through my closed door to see if I was alright. It was an eye-opening experience for me, and here’s why: Typically, in such a situation, I would be completely panicked (heightened heart rate, irritable disposition, grumbly, etc.) as I really dislike being late. I believe I can safely say that Senegal has changed that in me quite a bit. The general mentality here is founded in patience and the practice of taking things in stride, two things I never quite realized I needed so badly to learn. At work that day, I took weights and temperatures for the incoming children, one of my absolute favorite tasks, despite its simplicity. I love being able to interact directly with the kids in Wolof, and I’ve found that their reactions to toubab presence at the clinic typically fall into one of three categories: You’ve got the kids who just stare at you, as if you were an extraterrestrial being; then you’ve got the ones who wail, as if you were there to hurt them in as many ways possible; and then there are the ones who fall in love with you at first sight, come to shake your hand, laugh and play around, etc.

Tiana: Toubacouta part 2

Peeking out the bus windows while approaching central Toubacouta, we saw a large circle of chairs and a giant group of people.  The center of the circle was lit with two bright outdoor lights and nothing else, so faces were cast in shadow.  Stepping from the bus, the children of the village reached for our hands, offering a warm welcome and the invitation to “viens, assis-toi!” or “come, sit down!” We were lead to a chair and several children quickly surrounded us, introduced themselves, asked our names, and promised to teach us to dance mbalax, a traditional African dance, by the time the evening ended.  Then, the drumming began.

The next three hours were filled with traditional African music, including drumming sequences infinitely more elaborate than anything I’ve ever seen before, and dance, which all of us toubabs attempted in good spirits, making quite a spectacle of ourselves.  One guy took a flaming torch and rubbed it over the soles of his feet and his stomach without charring his skin at all, and later swallowed fire!  The mbalax dancers moved their feet so quickly and in such calculated steps, it seemed as if they were never really touching the ground.  So there we were, stars above us and joyous, energetic people all around, having a jolly good time, and getting yet another true taste of culture in Africa.  Three different groups performed, each with a different style of entertainment and a unique flair.  The people of that village seriously know how to have fun.  Something tells me that that is true of this entire country.

Unfortunately, all the sand and dust that was kicked up during the dance took it’s toll on my lungs.  Just as we were leaving the show, my coughing, sneezing, drowsy fit began. Despite feeling miserable by the end, that Saturday had been one of the coolest days of my life.

Children of Keur Ousseynou Dieng

Sunday was a doozy.  And when I say doozy, I mean that every fiber of my being wished that I could have stayed in bed all day.  Wheezing and sneezing like crazy, I joined the group for another delicious breakfast and a bus ride to another local village, Keur Ousseynou Dieng. We received a similar welcome as we had in the previous village and were quickly ushered into the case de santé, a small, village-based medical facility.  It was an insightful visit, but I ended up getting very frustrated.  I don’t even know quite what I was frustrated with, but I think it was a compilation of things.  As an aspiring medical professional, it was difficult to see such a basic facility.  Sure, it is very convenient to have a close area where villagers can go for a free verbal consultation, to give birth etc., but the case lacked even the most fundamental necessities for an efficient practice (aside from the caring and well-trained personnel who run the space as volunteers).  Kleenex for runny noses, band-aids for wounds, malaria medication or antibiotics: all things that they need to out-sourced and that take time and a great deal of money to acquire.  Further, the case is not equipped for medical emergencies, and such urgent cases need to be evacuated to the nearest poste de santé or the nearest hospital, requiring even more time and money that may not be available.  This is, of course, from my outsider’s perspective, and I know that the case is an incredible blessing and a step in the right direction in terms of health care.  Still, it broke my heart.

The remainder of the afternoon was spent in parlance with a local women’s group that is in the process of forming an agricultural market in which women can cultivate and sell crops.  The project is outstanding, but also presented another frustration.  The idea, the dream, and the prospect of the end goal that these women have are all beautiful, but it’s the execution of the plan that seems slightly behind.  These women work and work and work in such admirable fashion and with such heart, and it seems still that all possible roadblocks between them and success spring up.  One foreign government helped them plan an irrigation system for their massive cultivation space, a plan that has not been carried out.  Transport of goods to a larger city is extremely expensive, and there is no middle-man or mediator to help the process along.