El Guabo

We arrived to the local health center in el Guabo, not far outside of Machala, and spent the first part of the afternoon in patient interviews, pre-op and unscheduled patients. There was also a television interview with Dr. R, Dr. G who arrived from the states and the local health center administrators. A candidate running for mayor was campaigning there as well.

We strolled down to a local hotel and diner which would be our meal source during the stay. I forced myself to eat a bit and we returned to our headquarters to begin the first cases.
We only had three procedures scheduled, but we didn't begin until 6 pm and the start was a bit slow.

We took a break for dinner at 9pm, by which time my stomach and appetite had completely recovered, and finished the last case at 11:30pm. We were staying in Machala, so it was close to midnight before we arrived in our rooms at the Hotel Ejecutivo, located one block from the city center, where there was a bit of construction taking place.

We were off for the health center in Guabo at 7 am and back in the quirofano movil, beginning the days cases.

There was a big south american soccer game that the local surgeons wanted to see, so we took a long break after two to watch the match. And J3 showed up, feeling much recovered.

We finished earlier than the first day, which was nice to have a relaxing evening before the next day. I jogged around a bit before we left. Machala is right on the coast, so with the high humidity I was sweating for almost an hour afterward, which makes jogging before work a tough call.

 We post-oped patients from the previous days. Again, the larger procedures stayed with a nurse over night, but most were home as soon as they felt able. Patients were very grateful, and there were a lot of photos.

 The television crew appeared again.

walking back from lunch. our presence was, well, a presence in this small town

 We had a couple of interesting cases, including this parotid mass.

 I also assisted Dr. S in a bedside lesion removal during which we fashioned mini-retractors, like a senn but smaller, from needles because the only pair was in the OR.
At the end of the trip, we had more photos.

And then, when we thought we were having dinner, the town hosts threw a party for us! It was also a health promotion meeting, so a group of 30 or so participants followed their leader in step aerobics for half an hour. They invited us to join, but before long the humidity was taking over. Afterward a dance troupe performed traditional dances and local songs from Guabo.

 

This was a wonderful end to a fantastic and inspiring trip.
We had one more night before a final post-op session in the morning and then the long climb back up to Cuenca.

roadside church

 Back in Cuenca I was homeless and found a hostal close to the center for my last night.

 Then I did some shopping, viewing some of the sights, before the rain began.

las conceptas

san francisco

la catedral nueva, in the rain

And found a brew pub - only one in Cuenca!

 I needed a five am bus to Guayaquil to make my flight.

dawn in cuenca

descending into the clouds

Guayaquil

la provincia del oro

When we stopped for gas and bathrooms, the girls were miserable. Retching in the bus' bathroom, stomach cramps, and nausea combined with bad seat partners and our rocky departure was mixing poorly for our journey home.
I was glad I felt fine. We were not far away, and when we pulled into the familiar Cuencan station there were abbreviated farewells.
The house was in disarray. Sonita and her cousin were baptised this Easter, and Sonya hosted the celebration. It had rained all weekend and as a result ants migrated into the house in droves. Previously my room had been inundated, but the kitchen was the target this time, and again acrid spray fumes lingered in the heavy, though cool, humid air. While the Florida girls went for bed, J3 and I were hungry and made quick plates from what remained of the left-overs.
Rosalita hadn't gotten to my laundry, and I started the wash immediately. Half way through the first cycle, as I packed for the week's surgery trip and to move out of 1-55, my stomach began to flip, and I started to realize what the others may have been experiencing. Normally I believe myself to possess one of those legendary steel stomachs, but I've experienced a rare gastroenteritis, and this is it.
I was making trips to the john every twenty minutes and wondered when it would end. I was exhausted, and despite my preparations for the morning, sleep seemed unlikely. I didn't want to think about being without a bathroom in the middle of the mountains.
There was little sleep to be had by morning. J3 was up but dragging around due to some bathroom issues early this morning and wasn't sure she would make it. We grabbed a cab to the office and met up with the crew. She explained her problem to Dr. R who gave her directions to meet us later on.
I helped haul baggage and supplies to our trucks and felt satisfied that I hadn't eaten and could minimize my difficulties.
The scenery was amazing, weaving our way past Area de Salud #3 and over a dirt pass-way high above Cuenca to descend down to sea level on the shore of Provincia del Oro.

   

el domingo de resurreccion

After a lunch that was much better than a sandwich, our guide led us on a jungle tour.

bird nests

bunny ear fern

water reservoir that collects ants. they taste like lemon and stave off thirst

mud facial

ants carrying leaves that are cultivated into mushrooms for their food

walking tree - can move several cm per year

fan palms used in roofs

termites. taste like mint

termite mounds can be burned for fuel

rubbed all over the body, termites ward off insects

river spider hunts minnows

It is said that Virgin Mary was seen bathing in a waterfall in this town. Look closely.

Next we went to meet a Quechan tribe. I'm not too keen on this facade of insight into native life, but our guide explained their current existence depended heavily on tourism.
They were ready for us.

It had been a nice long tour. Thank goodness the tribe was not naked, but I was disappointed that there were no alligators.
It was Easter in Banos and time to head back to Cuenca again.
I had time for a jog up the side of Tungurahua, the active volcano adjacent to Banos, which is named for its thermal springs.
But first, I had to go to church.

Church was busy. Semana Santa is one of the busiest weeks of the year, and people travel from all over to worship here.

This was at 7am

Shortly after viewing this showdown, I was attacked by a loose dog across the street in a park.
I saw the owner walking him yesterday, and now he was standing some distance away with a leash in his hands as I jogged by. I could see that he was calling to the dog, who wasn't acquiescing, but I didn't expect him to take a swipe at my left thigh and nearly tear a hole in my shorts.
After trying to kick the dog I yelled for his owner to get his dog, in english, and still fuming, fumbled  in spanish for the first thing that came to mind - mantenga...control..su perro - maintain control your dog. Perfect.
It didn't work, but he didn't make a second pass, and it was a pretty good cardio warm up. Thankfully, no skin was broken, so I took my bad attitude up the hill.

Besides, just looking at this guy cheered me up.

This is the most I saw of the volcano, although our guide said he saw sparks last night, and there had been an eruption in December. It was comforting to see the giant green arrows painted on the streets pointing in the direction of evacuation. They all seem to simply point away from the volcano, which sounds reasonable.
The city was evacuated in 1999 for a couple of weeks. Locals said that when they returned most of their houses had been looted and they blame the government and the police for the looting.

Hot springs.

Apparently it was animal encounter day. You would have laughed to watch how gingerly I skirted behind these two.

Stretching taffy, for which the town is also well known.

cuy

look like little pigs?

guinea pigs!

chainsaw carving contest

The others were heading back on a different route, so I headed off to the station on my own, determined that  my route was shorter.
Twenty minutes later, four of the five climbed aboard the same bus and we were off to Riobamba. J3 had stayed to get some spa treatment and was following later on.

The next bus for Cuenca was full. We had a two and a half hour layover. I thought there must be another way,  but there was only one company operating out of this small terminal, so I stepped out to ask around.
The girls were already frustrated because one of their host families advised them not to ride on this company's bus, and they wanted to go another route, so when I returned they had vanished. I tried to haggle for a spot on the last bus, but it was the end of a holiday week and it wasn't working. I decided to try another company on the other side of town, and when I stepped out of the cab the girls were walking out of a restaurant right in front of me.
As a group, they were fairly discriminating in the cleanliness department, so despite the shabby looks of the place, I followed suit and dove into a plate of something greasy.

After a prolonged wait for our late bus, we were relieved when it finally pulled up, with J3 sitting in the front seat! This bus was arriving from Ambato, the same distance from Banos as Riobamba, but in the other direction, so she had been on the bus for four hours already, which made us feel better about our wait.
The bus was packed, however, and our seats were full. Fortunately the companies here sell specific seats, so after some discussion we jammed in. I was sitting next to a mother and her son, who was basically sitting on my lap. Five hours, here we come again Cuenca.