Montanita

There were two other students staying in my house who I didn't meet right away because we had different schedules. On an afternoon before class I heard them in the courtyard, Chispas' territory, while lying down, typing away on the laptop. M stuck her head in my bedroom window and asked where I was from. This question is sometimes confusing to me, and without looking up I answered, the U.S. Then she asked what school: Touro- CA. When I finished typing and sat up to engage in a conversation, they were gone.
Such is the suavity of my first impressions.
When we did talk, it was over lunch, the big meal of the day, always prepared by the maid around 1:30pm. Our host Sonia, her daughter Sonita, and the maid, Rosalita were always there, and I made an effort to be home at that time for a few days before favoring remaining at the hospital until closer to my evening class time.
They were from Florida, had been here one week and let me in on the details they had discovered since their arrival. Breakfast was on your own, usually some toast, bananas and juice. Coffee was always made, cold, and could be reheated to a watery resemblance of the caffeinated beverage you may enjoy any time of the day. Supper was mostly a resurrection of the maid's lunch, with perhaps de novo additions. Ice cream and snacks were a big hit in lieu of their evening meal. This was J's first time out of the country and there was a bit of homesickness; missing the family and boyfriends.
They were going into Surgery and Anesthesia, and had been in the public hospital, VCM, but  found it difficult with limited Spanish ability, so switched to meeting Dr. V and traveling with 4th and 5th year students to nearby villages, el campo.
We started talking about weekend plans, and as the other group had mentioned the beach, I thought I would ask our Spanish teacher about travel recommendations.
My Spanish teacher was great. Patricia. She had a degree in Espanol and taught primarily foreign university students. I was paired with one of the OSU students, so we had a lot of face time which was mostly spontaneous. We would go over different tenses and work them in to our conversation. She had pictures cut from magazines of celebrities and would have us make up stories about them. I had a problem recognizing a lot of them, which highlighted how out of touch I am with pop culture, but I could always invent a scenario.
In one scene we had Brad Pitt and Angelina Jolie sitting in a restaurant ordering huevos rancheros for their anniversary dinner when Jennifer Aniston is suddenly seated next to them and has a custody argument over one of their adopted babies and then orders youth restoring skin products from some famous Swiss dermatologist to be delivered to their table while she intercepts the eggs and leaves with the baby. Fun, right?
When we told her that we were thinking about heading to Montanita for the weekend, she said, "oh, great, marijuana, drugs, surfing, gringos, it's perfect!" After laughing a bit and discussing other beaches, she agreed it was a beautiful beach, inexpensive, and although the water was too rough for swimming, it was good for surfing and going for a dip.
It rained nearly every day, and the evenings were chilly, so the beach sounded like a good idea. The girls wanted me to go because they got cat-called and whistled at by any male on the street, including cops and especially the guys in the brake shop across the street who began accumulating in their knee-high yellow rubber boots and plaid button-downs at six am waiting for business to begin. Apparently marriage proposals had been made just in passing.
My only other offer for weekend plans was from Diego, one of the surgery students, who was having a party about two hours out of town that would last from Friday through Saturday.
After the hospital on Friday we met Dr. V at Cinterandes office and made plans for the next week. I would start surgery at VCM, the others with doctors in their specialties, Family Practice and Peds. We had a mobile surgery day in el campo on Thursday, and would meet the following day, when Dr. R returned, to plan the next week.
We finished just before the lunch meal and decided to go to a museum.
Afterwards, there was no class, so I had time to pack for the 6 am trip to the beach, 8 hours away on the west coast.

cathedral nueva

san alfonsa

In el centro the ministry of health decorated the trees with water-proofed photos from different provinces highlighting the lack of health care in these regions. One of the most highly represented areas was Provincia del Oro, where the mobile surgery unit would be in two weeks.

san sebastian

santo domingo

Universidad de Azuay - del Rio

For some time I have considered my Spanish ability as passing. After we met the chief of surgery, the director of medical education and the chief medical officer of the hospital on our way to dividing into groups for the week, it was clear that getting by should be a temporary solution. I fell in with the surgery students, 5th years mostly, and we began with a tour of the OR and then the surgical floor. This is a very new hospital, two years old, and is not yet full of patients. The new operating rooms are well equipped and spotless, the floor staffed with attendant nursing staff and numerous residents populate the nursing stations.
There were some obvious differences from the U.S. becoming apparent already. Students and residents answered nursing calls from the rooms, and performed many of the tasks we reserve for nurses here. I had heard about the unusual structure of medical education but hadn't understood it before. They spend 6 years in medical school immediately following high school, and residencies are shorter. Fifth years are externs and sixth years are interns. However, there are more similarities than differences. There wasn't much on the board for today, so the students made a copy of some 60 questions they were given to answer, all in English, reading suspiciously like ABSITE (U.S. residency board questions) material, and we retreated to the library to search for the answers. On the way there we stopped in the cafe for coffee and saw this doctor enjoying his morning puff and sip, which made me think of Camel ads from the 50s:

Since the questions were in my language, and this was my field of choice there was some expectation that I would naturally know all of the answers, which I quickly dispelled. I did help them with the English. 
The days went quickly here - brief rounds, morning report/lecture, occasional actual case to scrub, small group surgery lecture with the chief, question sets and Spanish classes in the evening. It felt almost like a regular U.S. surgery rotation with the twist of a foreign language instead of pimping, although pimping in a foreign language was bonus-bonus . The first case I scrubbed was a thoracotomy for removal of a mass, pleural adhesions and drainage. The surgeon was French, who told me that his Spanish was not that good, and his English worse, so if we had trouble he would just hand sign me. This actually works best for me when everybody does speak English, so I felt quite at home. Notably, the fifth year scrubbed in as the nurse tech and the surgeon attended to a lot of details that ancillary staff would perform here, regarding the equipment and patient handling, which made it seem more like a team performance.
I actually felt like my comprehension was coming along. It helps that the morning reports had powerpoints and medical language is very similar everywhere, so that when I was asked if I understood I could honestly answer: more or less.
In the evenings I would leave Spanish class, which was taught at a church on the southwest side of town, and start walking home. I'd try to catch a bus if one actually came down the street, or if it was raining, but often they didn't come that way, despite numerous stops. So, mostly I walked the 45 min home.
I usually got off the bus at the center anyway, about half-way home, so I didn't mind.

catedral vieja

catedral vieja

catedral nueva

 

municipal bank

Why am I here?

First I had to grab a cab to my meeting. I had the name of the building and some cross streets. This was my second Cuencan navigation adventure, and I had already learned that you and the cabby were in this together.

I am accustomed to not knowing what I'm doing until I have begun. I think it is part of the physician's training.

It's definitely part of life's training. So I wasn't surprised to arrive at the office of Cinterandes Foundation for a morning meeting and then wait until after noon for the doctor. I was greeted warmly by the secretary who buzzed me in, wearing her midriff and slacks with a jean jacket. She has worn a version of this every time I've seen her and is always professional and pleasant. She answers the phone, does the books, buzzes the gate for guests three floors below and listens to 80's soft rock on jam.
My back definitely felt better, but I still preferred to stand, which is what I was doing when three of the other students arrived. None of us knew what to expect, only what we had found on the website.
http://www.cinterandes.org/
Dr. V arrived and began to clear things up. She was an anesthesiologist and family physician who was one of the backbones of the foundation. She traveled into the countryside almost daily with students to visit patients who wouldn't otherwise make it to a clinic or hospital. She spoke clearly, and almost slowly enough for me to understand everything.
We had some options until the founder, Dr. R, got back from the states. We were to begin in Hospital Del Rio, associated with the Universidad de Azuay, meet the students there and figure out who we would work/study with. The other students, three girls from OSU, were into different specialties - two Family, one Pediatrics - and I was into Surgery. We would be in the Hospital for a week and meet up to go over plans on Friday.
One of the students had been to Ecuador for a semester before and spoke nearly flawless Spanish, seeming to understand everything. Between the four of us we were a spectrum of abilities. I was in the middle, which is not a bad place.
They were taking lessons in the evenings and I decided to join them. I hadn't had Spanish classes for about 7 years, and considering that we were the only people we were likely to encounter that spoke much English, it seemed like a good idea.
We got a packet of information from the Foundation, and there was a map inside. After thanking Dr. V and the secretary and making our plans, I walked back to 1-55 through the city center.

Depues de la entrada

Home sweet home. My first taste of Ecuadorian food was a bag of popcorn and some candy roasted peanuts in the Guayaquil bus station. Now my host mom offered some food, but I really wanted to lie down. I think it was just an offer anyhow. She had only woken up for the doorbell because the neighbor had been pounding for an hour. She showed me three open beds in the apartment behind the main house, I picked the best feeling mattress and made it home.

But I had to make it across this enclosure. Chispas territory.

I slept like death. The odd type of sleep that is so intensely relaxing yet with a wakeful sensitivity to each sound. My window and door were open; I prefer to sleep that way if it's not too cold at night.
I had never met the little girl that I was staying with. I didn't know that cute, 9 year-old Sonita sat down before school every morning at six fifteen in a seat at the breakfast table facing an open window directly across from mine and opened up her vocal chords at full throttle to dispute the necessity of breakfast. Sonia isn't much more subtle. This is a routine.
Somewhere there was an accordion playing, with guitar and spanish singing straining the speakers to their raspy, rattling limit. And somebody was moving around: a head in the window of a short, stout, black haired woman, pushing about, turning on machines, then disappearing. I could sleep some more....
"Arnold? Buenas dias. Tiene que encontrar...."
8:30am. Felt like noon. Must be time to go to work.

In the beginning...

There was Chispas.....


Well, not really. But I have to start somewhere, and I don't have a picture of el vecino borracho pounding on the door next to my new homestay at one in the morning following a 20 hour journey that only involved two planes, a bus and a cab.
I do have the culprits that helped put me to sleep from San Salvador to Guayaquil.

However, they were too busy for comment.
The problem was that I had a horrible backache. It started after my car ride from SLT, CA to Houston, TX.
Although, the section from Pasadena to Houston, following a ghost encounter at this house of ill repute, really did me in.

Or it may have been the accident with the farmer that left hay and cow manure covering the Volvo inside and out...
At any rate, it was pain. I tried jogging with the pups the day after getting in to Houston, and a half mile into feeling swell I took a step and it was no bueno. One of my bestest friends calls me the machine when I make trips like these, thirty hours nonstop, but this time I was really feeling the aftermath.

So I was up most of the night packing and could barely get out of bed and stand straight the morning of my 5 am flight to El Salvador. I was so relieved on the bus ride to Cuenca, through heaving rain and turn after endless turn, that the night bus was mostly empty, and I could sprawl out and relieve my back, only moving a handful of times for the roadside pickup who disputed the requested fare from the moment he dripped aboard until I left the bus with my bag to grab a cab.
And there we were, windshield wipers unable to keep up with the water rushing down, headlights failing to identify street signs, lack of signs at all, street names unfamiliar to the one am cabby, my awful spanish and poor handwriting, a call to the cab director in desperation and finally identification of an address written in marker on the wall by the gate. I asked the driver if she might wait; it was so late, and I hadn't called to explain. It was still pouring and there was the neighbor, pounding on the door beside me, slurring something about 'open the door', 'my love', 'please' and 'wet' that made me wonder if the doorbell would be answered at all.