Surgeries

Today's dispatch is a little late. Melanie Wood and I have returned to the states, and now we're telling the stories we didn't have time to tell from Quito, because we were just too busy. This is the story about the surgeries performed in cooperation with Hands For Humanity, "a nonprofit charitable foundation reaching out to meet the needs of underserved children and families primarily from Ecuador." (See their home page at http://handsforhumanity.com/wordpress/.)

As a retired Air Force physician's assistant, this is Melanie's second visit to Ecuador to offer her skills. She not only helped, she photo-documented the gift of a visiting orthopedic surgeon and anesthesiologist to help children in Ecuador.

That's Melanie, below, with a girl about 11 years old, who underwent a second surgery to fix her club foot.

Melanie Wood of Portland, OR, a retired Air Force physician's assistant, and my side-kick on the Ecuador trip, with a child who underwent a second operation to fix a club foot.

Hands for Humanity provided the clean, sterile operating room, shown below, where local and visiting doctors perform surgeries. Kate Whelp, a Minnesota resident and founder of Hands for Humanity, raised funds for the facility.

The three x-rays below show the kind of issues the surgeons dealt with.

 Immediately below, an x-ray shows the displacement of a young boy's hand. The radius (the arm bone on the thumb side of the hand) sustained a break that became infected, and the bone's growth plate died. As the ulna (bone on the pinkie finger side) continued to grow, the hand was tipped to the side.

In the next image, the opaque object on the right shows pins in the thigh bone (femur) of a young patient. The pins were placed to correct dysplasia, a condition that can occur as the infant passes through the birth canal, resulting in dislocation of the joint. Doctors routinely look for this condition at birth in the United States, and it is easily corrected. However, in third world countries the condition can go undetected. If it is not fixed,children cannot walk well.

The x-ray below shows screws placed in a hip socket to correct for dysplasia.

In the photo below, a youngster scheduled for surgery demonstrates how he cannot bend his left arm. There was a fracture within the elbow joint that happened after birth. Doctors performed a long surgery that will allow him to bend the left arm up to 90 degrees. He was recovering when Melanie left Portoviejo for Quito, where she joined me for Spanish language classes at Simon Bolivar, a language school.

Not all defects require surgery; The infant's foot shown below had some toes fused together, a condition that is not uncommon. Web toes are easy to fix, but the surgeons decided to wait until the child is older. The child does not need the surgery at this time and it may prove to not be essential, Melanie explained.

Teenagers were allowed into the operating room, where anasthesiologist Matt Ulrich explained about blood gases. Among the teenagers was Ecuador-born Maya, the adopted daughter of Hands for Humanity founder Kate Whelp, and two other teenagers--the son of the orthopedic surgeon and his friend from the states.

Graduates from medical school in Ecuador are expected to work as general practitioners for a year before their residency. Below, the newly-minted doctor on the left wants to become an orthopedic surgeon, and he assisted the American doctor, Tony Stans, during the operation to repair the displaced wrist, displayed in the x-ray above.

This close-up below shows just how badly the wrist was displaced. The ulna has reached beyond the radius to form a virtual "shelf" beside the hand.

Matt Ulrich, anesthesiologist, smiles after surgery with the guardian of a child from the Casa Hogar de Belen orphanage, who underwent an operation to repair a club foot. Not all orphans are without parents. Some children are given up by their families. In this case, the child was removed from her home by social services because her parents were allowing her to starve.

The little girl below was described as a "lazy breather."  Ten minutes out of surgery, she was crying very slowly. Then her crying became more and more  slow and her oxygen saturation numbers fell. Matt put an oxygen mask over her face to create positive pressure that pushed oxygen into her lungs to restore normal breathing. In this photo he's checking her out after that crisis was over.

During a break in the procedures, an American nurse takes a salsa lesson from a local.

There's so much more to be shared about what these volunteers were doing for the Ecuadorean children, but you get the picture.

Love,
Robert, Melanie
And Wilson

Culture Shock, and a trip to Middle Earth

Dispatch by Robert Smith; photos by Robert Smith and Melanie Wood
(Note: We're home now. We were having too much fun and there was no time to blog. But there's still stories to tell about Ecuador, so we'll send out a few more dispatches before we calla it quits.)

Where, when you need her?

I've already mentioned that, in Ecuador, the coin of the realm is the U.S. dollar coin that bears the image of Sacajawea. This young Native American female was Lewis and Clark's ambassador to the tribes they encountered as they took the measure of the land known as the Louisiana Purchase. The coin depicts Sacajawea bearing her papoose and looking backward over her shoulder with a gentle smile as if she’s leading the way and encouraging us to follow.




Last Wednesday I was wishing I had a guide like Sacajawea. I have become painfully reacquainted with how difficult it can be to operate on unfamiliar turf while trying to communicate in a foreign language. Our guides to the pueblito did not speak English. As I reflect on this experience, I’m reminded of the title of Mark Twain’s book, The Innocents Abroad.

 But before we get into that, let’s first share some photos of some young children who were having their first encounter with the One World Futbol:

Melanie with youngsters at the soccer field

That’s Melanie in the photo above, being mobbed by a group of youngsters at a soccer field where we walked to get the kids acquainted with the balls we had brought them. They loved them. And they loved Melanie, too. One or two of the kids played with her fine, blond hair, which apparently seemed quite exotic. One little girl examined it as if she were looking for nits, and tried to create a pony tail. Melanie came away feeling well groomed This was the highlight of the day.

Melanie after a few minutes with the youngsters at the soccer field

Despite the excitement the indestructibles brought to the children, much of the experience gave me an appreciation of just how enormous the challenge is when addressing the needs for communities such as the pueblitos of Valle Chota. One World Play Project has distributed more than a million balls around the globe. However, the world is a big place, and, understandably, only one shipment so far had reached Ecuador. (Ours was the second, I think.)

First meeting with the village representatives

As Melanie and I engaged some village leaders of the impoverished pueblito we visited, we became aware that it wasn’t enough to create a ball that was perfectly suited for such communities—it was also complicated to understand how to present and distribute them in a way that fits the cultural norms of the community. Two days earlier we had visited Quechua-speaking pueblitos with a guide who had an anthropologist’s world view. But in Valle Chota, I came to realize the people who brought us to this remote outpost were more like chauffeurs, than guides. How that situation developed is too complicated a story to tell here.

The stunningly beautiful Valle Chota

Valle Chota is a visually striking locale, situated roughly 150 kilometers North of Quito, and just a few kilometers from Highway 35--the Pan American highway. It is the place where the descendants of African slaves made their home.

Yes, there were black slaves in Ecuador, and I was surprised to find that their owners were Jesuits, who employed this human resource on their sugar plantations and in their mines. (You ask yourself, did Jesuits whip their resentful slaves? There must have been some.)

Against the majestic backdrop of the mountain the homes reveal a hard scrabble life.

Today, much more than a century later, the wealth that flows along the Pan American highway seems to enrich the Highway 35 corridor and perhaps major cities, but it looks like that wealth barely trickles down to Valle Chota.

This home was just outside the gate of the soccer field

This photo suggests development will arrive. The street isn't paved, but the sidewalks are in.

On the other hand, “seven out of the 23 players in Ecuador’s groundbreaking 2002 World Cup squad came from here,” reports The Rough Guide to Ecuador. With that kind of history, and the extreme poverty of the area, this seemed like a good place to share the magic of the One World Futbol.

However, when we distributed the balls, we became aware almost immediately that this was just the gleam on the drop in the bucket. The need is enormous.

After some introductory confusion over how to share the largess, the elders opted to have us take the balls to the soccer field for initial presentation to the children. As an adult led us and some youngsters to the field, our chauffeurs drove off, apparently unaware that they were expected to return us to our pickup point in Quito, 150 kilometers away.

The youngsters gain acquaintance with two of the indestructibles -- Ganador, and José.

A few hours later we would be returning to ask the pueblito fathers what became of our ride. One of them accompanied us to a bus stop. The good news was that bus rides are very inexpensive in Ecuador. It was a 2.5 hour ride out by car, and a 4.5 hour ride home, and we arrived in the middle of a torrential downpour.

At the bus station, a pedestrian rushes across the street being pounded by torrential rain, while others stand under shelter, anticipating arrivals of taxis.

 At the Quito bus station we braved a cats-and-dogs downpour to pile into a cab just long enough to discover the ride was going to cost $20. Then we piled out again, back into the downpour. The next driver charged us $8 and we were back at our home stay by 9 p.m., about 10 hours after we set out.

The next day, at Middle Earth, we came across a potentially better resource for bringing the indestructibles to Ecuador.

The visit to Middle Earth

Well, OK, it’s not middle earth. Mitad del Mundo actually translates to “Half of the world.” But Middle Earth is so much more colorful. It’s soft of Tolkeinesque.

At Mitad del Mundo, abroad promenade leads to the monument to the equator.

Ecuador is named for the equator, which runs right through the country, including through Quito, or at least one of its “burbs.” Buses transport tourists to Mitad del Mundo, where they line up on a yellow strip about as wide as their shoes for the obligatory misleading photo – the actual equatorial zone is about five kilometers wide, covering the equatorial valley called Lulubamba. Nevertheless tourists (like Melanie, pictured below) like to do the toe-to-heel high-wire gesture to demonstrate -- misleadingly -- that they are precisely on the equator.

Melanie atop Mother Earth's hemisphere tatoo.

The location of the equator was actually delineated by the French Geodesic Mission in the 1730’s, to determine whether the world was rounder at the poles or the equator. By the time their work was complete, another team had already determined that the earth is flatter at the poles.

Not to be outdone, the French left this monument to their research and opened a gift shop. That’s the gift shop in the photo immediately below. It’s held up well over the past two and a half centuries. (Well, OK, maybe I'm stretching the truth a little on this point.)

From atop the tower, a view of the gift shop bestowed on Ecuadoreans by the French whose scientific acumen told them the best place to situate a future tourist trap. Note the thin yellow line leading right up to the door. Those guys thought of everything.

At 8146.325 feet above sea level, most tourists choose to reach the top of this tower via elevator, and then just take the staircase down.

Wlson paused to read the information in this fancy-schmancy kiosk.

Oblivious to the tall gringo almost pictured next to her, this security guard struck a pose with Wilson. Note the truncheon in her right hand. No-one messes with her.

But just to be sure, a military helicoptor flew circles overhead, keeping an eye on me and Melanie.

Atop the tower, Wilson took in the view of mountains and volcanoes. To the northeast of this tower lies Pululahua Crater, one of only two inhabited volcano craters on earth.

This emblem carved on into the north side of the monument represents a Toesa, an antique French measurement instrument used by the Geodesic Mission. 

Regarding that cultural clash...

At the gift shop, we made a phenomenal introduction. Standing at the door, providing guidance, was a gentleman named Manolo Perez. (Sorry, no photo. We had totally exhausted our batteries.) I commented on Monolo's excellent English. Well, it should be excellent. He moved from Quito to Indiana when he was 15 years old, spent his work life in Florida, and retired back to Quito six months ago to pursue work as a photographer.

And Manolo loved Wilson.

Enroute to Mitad del Mundo we passed a distributorship for Chevrolets. Remember that Chevrolet is the prime sponsor for One World Futbols? And Manolo, as a U.S. citizen had the phone number for the U.S. Ambassador, because he is in the process of arranging his social security payments.

And One World Futbol Project has distributed 45,000 of those futbols via U.S. embassies.

Hmmmm. The worst thing that can happen is that we don't at least try. Where there's a will...

Next dispatch: The surgeons of Portoviejo.

Love,
Robert, Melanie
and Wilson

Quechuans engage the One World Futbol

Dispatch by Robert Smith; photos (most of them) by Melanie Wood

At Iglesia Emanuel, an evangelical church, Quechuan-speaking youngsters share and chase after the first One World Futbol they have ever seen.

On Sunday, Melanie Wood and I rode into Quechua country, courtesy of Enrique Tasiquando, a gentleman well connected with the indigenous comunities adjacent to Quito.. Our trip involved distributing One World Futbols to "pueblitos" that represent pockets of poverty around Ecuador's capital city. Today's story represents my understand of what "poverty" can be Ecuador, and how it is expressed. It was different than I imagined.

Germanico Carrion Torres, operator of Jerry's a kind-of coffee shop down the street from the Simon Bolivar language school we attended. Jerry fell in love with the One World Futbol.

The day began with a stop at Jerry's, a coffee shop near our language school. Germanico Torres speaks passable English, having lived in New York for several years. We showed up carrying four gift futbols and Wilson, and waited for Enrique. After a while, Jerry asked about the futbols, and I explained their indestructible nature by slipping a knife into Wilson. That required  no further explanation. Jerry wanted to know how he could obtain these.

Jerry seems to be a shrewd business operator, and on reflection, I realized he was thinking of resale. He clearly saw the value in these balls.Unfortunately for him, I think this isn't going to work for him, because the One World Futbol is donated, not wholesaled. But the conversation was a reaffirmation of the value of this product in the third world.

In Quito, homes often perch aside the abyss.

On the way out of town, Melanie, I and Enrique stopped at a bridge over the deep chasm carved by the Rio Machangara. Then we looked back at the hillside behind us. Atop that almost sheer cliff, homes nestled. It gives you shivers to realize that an earthquake fault runs right under Quito.

In this elementary school, classes are taught in Quechua.

It's only a 30-minute drive from the Simon Bolivar language school in the heart of Quito to Quechua country. It's sort of like heading into the "burbs." One of the first sites we saw that told us things were different was the elementary school pictured above, where classes are taught in the language of the indigenous folk -- the Quechua speakers.

The boundary between the dominant culture and the indigenous culture is not clearly demarcated to the foreigner's eye, but it is there. As Enrique later explained, the difference isn't  expressed in abject poverty. In fact, we came across one pocket of what qualified in my mind as affluence.

However, the difference can be expressed in services. In Quito, there are doctors and optometrists and pharmacies. In the Quechuan "burbs," you don't find these services, Enrique explained.

Laying in the shade (of a kind old tree?) a hog quietly contemplates our arrival.

Once we reached Quechua country, the next step was to locate some local representatives. Enrique stopped at various homes, asking where he might find the president of Cocotog, the first community we visited.

At one home several pigs were lounging around the yard adjacent to the house. Even at 9,000 feet altitude the day was warm, and they were doing what pigs do--rolling in the dust and avoiding getting overheated. After knocking on a few more doors we located Miguel Angel Tipan, the vice president of Cocotog, and Enrique explained our mission. Off we headed for the soccer stadium.

A well-loved sign shows us the way.

The first group of players we found were members of a woman's soccer team.

To our pleasant surprise, the first group of soccer players we found were in a women's soccer team. (In the past I've received comments from readers that the One World Futbol only seems to be reaching male players. But in Cocotog, that's clearly not the case.

The community's vice president receives the One World Futbol on behalf of the team.

Enrique smiles as one team member slips a knife into Wilson.

It's time for Melanie to get into a photo. Along with us are coaches, a player, and Wilson, who I am trying unsuccessfully to crush. The indestructible will flatten, but bounces right back.

As we went in search of the next pueblito, Enrique took a brief side trip to introduce us to a native drink, which is extracted from plants like the ones shown below. They call the drink "dulce de cabuyo," but between his poor English and my poor Spanish I finally gathered the notion that this is the black agave.

A small grove of black agave plants.

Hack one open and hollow out the trunk, and you have a perfect collection vessel for the liquid from the succulent leaves.

Enrique stopped at a home for directions and the man of the house brought out two large plastic soft drink containers filled with the sweet liquid. In the photo below, Melanie and I wrap arms and taste the liquid, with me wondering whether I was going to regret this in the morning. (I didn't.)

Are we, including the retired physician's assistant at my right, really drinking this straight-from-the-used plastic container unknown liquid?

Another plant we were introduced to was growing like a weed in one of those patches of corn that you can find anywhere. It was black amaranth, a highly nutritious food item not unlike quinoa. According to some sources, this food of the Incas is not a grain.

The black amaranth plant was flowering in a corn field.

Look closely. Those tiny, shiny black beads are the food source from this flower. It takes a lot of amaranth to make a meal.

Once Enrique located our next community leader, Mariono Guañuno, the president of the Oyacoto community , we walked some dusty streets to the next soccer field. Along the way, we caught sight of a worker whose job description would give the Department of  Labor the willies. The rungs on his ladder are nailed to the two rails; the ladder is leaning against a utility pole that is being held in place by a man holding a rope and a woman leaning against the pole. Well, you get the picture.

"I am the line man for the county . . ."

Oyacoto President Mariono Guañuno in the red shirt; a soccer player far left; and Enrique

As we presented the ball for the Oyacoto soccer field, we learned something surprising -- we thought there would be a small group to receive the One World Futbol. And we were right, but there are actually 28 teams that use the field. As the photo below illustrates, the players showed a lot of interest, but they would like a lot more futbols like this one, and One World Play Project doesn't yet have a regular pipeline for delivering the balls to the Quito area. Demand clearly outstrips supply.

Oyacoto players give the ball a workout.

Although this community might qualify as poor, it is not extremely poor. There is a soccer field, and there are sponsorships for the  teams, hence the uniforms. Not so for our next destination.

Near Mariono Guañuno's home, a solitary bus makes its inter-pueblo run through lands that are largely undeveloped, except for farming.

Our next stop brought us to Emmanuel Methodist church of Llano Grande, an evangelical church. (Non-Catholic churches are called "evangelical" in Ecuador.) In the photo below, the youngsters discover the wonders of a ball that cannot be deflated. Young people from the church chase the ball in the photo at the top of this dispatch.

One youngster slips a knife into Wilson while the rest watch intently.

It's hard to believe delivering a soccer ball is a big event for a community, but I was invited inside the church during its service, and the next thing I knew I was shaking hands with the pastor and then giving a speech which was translated by a Lisa Renz, an Oregon native who moved to Ecuador after raising several children in Mexico.

Oh, and passing out business cards that contained this blog address and the home page for the One World Play Project.

It's kind of stunning to find out how little it takes to be a rock star in these small communities.

The final location we visited turned out to be a conundrum. In this backwater stretch of country a 30-minute drive from the heart of Quito, with scrub land criss-crossed by an inter-pueblo bus and  lesser bus traffic to the city, there was Tinko Plaza. This is a private school, funded by a community of 3,000. It's as modern looking as anything inside Quito--maybe more so. The young men we met speak a little English as well as Quechua and Spanish.

Freshly washed soccer uniforms dry on the grass near the play field.

The boys get acquainted with Wilson with the help of a jack knife.

Freshly harvested, an avocado tree yields up some remaining fruit to Enrique.

Melanie and I were served up a gracious meal of chicken and fries in a cafeteria as clean and attractive as any in Quito.

A clean, sparkling cooking area behind the service counter.

Right now there's a thunderstorm outside as I write this. But if the weather turns favorable, Melanie and I will visit a different sort of village tomorrow. Its inhabitants are the descendants of slaves who were brought to Ecuador to farm and mine for the Jesuits.

It's not what I was expecting to discover -- that part of Ecuador's history includes slave-driving men of God, but there it is. All I know at this writing is that Valle Chota is a location with many poor communities and it's a 2.5 hour ride to get there. Melanie and I leave Quito on Friday, so we hope to have this dispatch to you before then.


Afterthought--getting in shape: There are 42 steps up the stairway to our classroom, and after two weeks I can climb them without breathing hard. So if you are planning a trip to the Andes, that's an indicator of how long it takes to get "normal."

Thanks for following along.

Love,

Robert, Melanie
and Wilson