It is now Saturday afternoon almost evening and the work portion of our Ecuador trip is more or less over and I can reflect on how the week went.
As I mentioned in my previous post, we arrived at our hotel, the magnificent Inca Real and walked to the hospital from there. The main purpose of Saturday afternoon was to unpack our bags which had now arrived and also to unpack the equipment we had left behind in storage the year before. While we did this the surgeons had a follow-up clinic where they saw patients who had been operated on in years past. Some of these patients would be having surgery on the other side this year. We ate our first of many excellent dinners at the hotel in the evening. Our group has over fifty people in it between adult surgery, pediatric surgery, dental and camp followers. Dinner is a large social event where we meet at the end of the day and each individual "team" will give a report on how their day went. Depending on who gives the report, these can be wordy and long. This being the first day, there was not much to report.
On Sunday after breakfast Mary, I and several others in the group attended Mass at the huge cathedral two blocks from our hotel. After Mass I met my resident Riley who had arrived from Quito that morning.
After lunch at the hotel we went back to the hospital for pre-assessment clinic where we select patients who will have surgery the following week. This is the one part of the mission I find daunting if somewhat rewarding. Every year there is a huge crush of patients and family waiting to see if they or their relative will get surgery this year. They block the halls and spill outside. We were set up in part of the hospital's emergency department which was stifling hot. There were only three closed exam areas which were taken up by adult and pediatric surgery as well as the dental team. The Dental team's work is quite important as we want to clear all the rotten teeth from people who are going to be getting hip and knee implants. This of course relegated Anesthesia to seeing patients out in the open on chairs. While we target 40 surgeries, for various reasons we see many more patients. During the afternoon, there is tremendous competition for space, interpreters and oxygen but at the end of the afternoon we have 40-50 patients screened and awaiting surgery the following week. We were also able to move some our equipment into the operating room so that we could get a quick start on Monday.
Sunday was also Super Bowl Sunday and the hotel was nice enough to serve those who wanted, dinner in the bar where we watched the game on the big screen.
Weekdays on this mission follow a predictable pattern. Between 0630 and 0730 people straggle into the large dinning room for breakfast which is a buffet with eggs, bread, pancakes, ham or bacon, slices of fruit and some type of fruit juice. This is in addition to strong coffee which we usually mix half and half with hot milk. Soon people start the walk to the hospital, the ward nurses and OR nurses leaving first, followed by anaesthesia and just like at home the surgeons eventually make their leisurely way to the hospital.
The hospital Santa Innes is a 15 minute walk thru the colonial streets of Cuenca, crossing the river and then on to the hospital. Even early in the morning Cuenca is bustling with people getting their day started. The walk to the hospital in the morning is one of the best parts of the day for me. The dental team literally "head for the hills" going out to isolated mountain hamlets to treat the children.
Monday is a slightly different day as we have to set up for the rest of the week. The first eight patients who aren't yet in hospital have to arrive and be processed. Meanwhile equipment has to be moved from the store rooms to the two vacant operating rooms that the hospital allows us to use. This year both the floor nurses and OR nurses worked extremely hard and efficiently and quite soon we had our first patient down, IV already started. Traditionally the rookie on the anaesthetic team does the first case and so my resident Riley did the first spinal. The second patient to be done in the other room arrived soon after. Being the first day, there were glitches but we were able to get eight patients done and I was able to head for the hotel where a cold cerveza grande awaiting some time after 1700 hours.
At 1900 we ate another spectacular dinner, had the usual long winded reports, laughed a lot and were in bed by 2200, ready to do it again the next day.
Saturday, February 9, 2013
Thursday, February 7, 2013
Ecuador Mission Getting There
While I had good intentions of blogging about my seventh trip to Ecuador, I have been a little busy and in between internet connections so I am just getting around to posting now on “hump day” which marks the middle of our mission in Cuenca.
The trip started out at 0330 when Mary and I arrived at the airport for our scheduled 0630 departure toting 2 hockey bags each of (mostly) medical supplies and some personal items. This was in addition to the rolling carry-on bag of personal items and a small backpack. Even 3 hours in advance of our departure the line-up at the United counter was already snaking back a bit, mostly with our group. The United counter opened a little early and we were able to check in and it was off to customs. We were able to dump off our hockey bags before going thru security and then to the friendly happy US customs agents. Ours actually smiled at us. The advantage of being so early was that we were able to negotiate customs and security quickly, those who arrived later took a lot longer.
After eating breakfast and coffee in the departures area we boarded our flight to Houston. When about 40 people with carry-on luggage descend on a plane there is always a little tension over the overhead compartment space something that would be repeated later in the day. We left a little late due to de-icing. I alternately slept or read on the way to Houston; I had my iPod playing Jimmy Buffet which made for some interesting dreams. Arriving in Houston most of us headed off the Pappadeau's a Louisiana style seafood restaurant where we usually have the lunch buffet. This is usually busy but we were able to get tables fairly quickly and had the buffet and a beer. We had a 5 hour stopover in Houston. The Houston airport is a little like a shopping mall but we mostly just wandered around. Some of the people from Calgary and Vancouver who were joining us in Houston met us there. We more or less boarded our flight on time with another fight for overhead space and some of our group had to check their carry-on. There were two other missions on the plane with us.
It was a five hour flight to Quito but finally the plane descended over the mountains into Quito. Quito is said by some to be the mostly difficult airport in the world to land in. It seemed like we had to go around a mountain which seemed uncomfortably close before flying down the valley where Quito is, flying low over houses landed roughly and braking hard. We deplaned, got thru customs in short order and went to get our bags. It was in the baggage area that a man approached me and asked in quite good English whether I was from Edmonton, and on replying, yes, explained that about 32 of our bags had been left behind in the Houston because of weight restrictions. This is something that has happened in the past; this time however they actually had a list of exactly what bags had been left behind, had the lost baggage claims already filled out and photocopied our passports so that the bags could be sent to our hotel without having to return to the airport. All in all pretty good service. After X-raying those bags that had arrived we were spat out into the crowded Quito arrival area where Manuel Avila the local physician who arranges our trip was waiting for us.
Because in the thin air of Quito planes cannot take off heavily laden, our hockey bags are transported over the mountains from Quito to Cuenca in a truck, so we loaded the bags on the truck and took a bus to the Savoy hotel. It was now getting towards midnight. The Savoy where we stay in Quito is near the airport. Judging from the decor it was built in the 60s or 70s. It has been renovated over the last few years and the rooms are now cleaner and more comfortable with showers where you actually feel cleaner rather than dirtier after using them.
Despite the noise of planes landing and taking off, dogs and car alarms we slept fairly soundly. Breakfast was at 0800 served in the basement which backs out onto a garden where you can see hummingbirds flying around. We had our first cup of thick Ecuadorian coffee with hot milk and ate fruit, pastries and huevos. It was a beautiful sunny day.
After 0900 most of us left on a small bus for Otovalo, via the Equator monument. The after winding its way thru the streets of Quito and the suburbs, we got onto a substantial highway and were at the Equator museum fairly quickly. The Equator monument we visited is about 200 metres south of the “official” monument measured in the late 19th century. The museum we visited which is where the indigenous people believed the Equator actually was, was proven by GPS to the be the correct site. We had a tour demonstrating the Coriolis effect and learned something about the indigenous people of Ecuador including a demonstration of shrunken heads.
Leaving the monument, it was off to the fabulous Otovalo market. The Otovalo market is a place where one can buy all sorts of local merchandise such as sweaters, ponchos, table clothes and scarves, made of alpaca and other fibres. Having been there several times we have bought most of the popular items but we did pick up a few other items; first buying a cloth bag to carry our purchases. From there we took a short bus ride to Cotacachi (Catch a Coatie), otherwise known as Leather Town. The main street of this town has leather stores on both sides of the street stretching for several blocks. Unfortunately because we were late, we only had 40 minutes. Leather Town is somewhat overwhelming with the selection of coats, purses and hats and 40 minutes was probably not enough but we did it justice. Finally rounding up all our group we headed back to Quito which was 2 hours away.
While most of the group went our for Chinese food (in Quito go figure), Mary and I were tired and I had a bit of cold so we ate at the hotel which was actually not bad including beer brewed at the hotel. Then to bed and we slept thru the planes, dogs and car alarms.
Manuel and Dr. Greidanus went to the airport the next evening to pick up the rest of our bags. We were able to get most of them but there were still 7 outstanding.
We had a 1200 flight to Cuenca the next day which made for a more relaxing morning with another breakfast at the hotel, time to pack and the bus picked us up at 1000 to go to the airport. Air travel in Ecuador is always interesting even when we have tickets as we did this year. Arriving at the LAN desk the staff didn't seem to believe we had reservations. Apparently you are supposed to check in online. Eventually after some negotiation we were able to check in and go through security. Joining us at the airport was Mitch Giffin the other anaesthesiologist who had flown in from Vancouver the night before with his wife and 16 year old daughter. This is my fifth mission with Mitch so it was nice to see him again and catch up on things.
After a short one hour flight we arrived in Cuenca. We picked up our luggage and left the luggage area where we were met by the local Rotarians who presented us all with a rose and a chocolate bar. Then we piled into a bus and off to our hotel in Cuenca.
Every year that we have stayed in Cuenca since I started, we have stayed at the Inca Real Hotel which has really become a second home for me. This is a beautiful hacienda style hotel with a covered courtyard. The staff seemed genuinely happy to see us all again. Mary and I checked into our room and then out to the courtyard for a bag lunch and a chance to talk things over before heading over to the hospital to unpack our bags.
The trip started out at 0330 when Mary and I arrived at the airport for our scheduled 0630 departure toting 2 hockey bags each of (mostly) medical supplies and some personal items. This was in addition to the rolling carry-on bag of personal items and a small backpack. Even 3 hours in advance of our departure the line-up at the United counter was already snaking back a bit, mostly with our group. The United counter opened a little early and we were able to check in and it was off to customs. We were able to dump off our hockey bags before going thru security and then to the friendly happy US customs agents. Ours actually smiled at us. The advantage of being so early was that we were able to negotiate customs and security quickly, those who arrived later took a lot longer.
After eating breakfast and coffee in the departures area we boarded our flight to Houston. When about 40 people with carry-on luggage descend on a plane there is always a little tension over the overhead compartment space something that would be repeated later in the day. We left a little late due to de-icing. I alternately slept or read on the way to Houston; I had my iPod playing Jimmy Buffet which made for some interesting dreams. Arriving in Houston most of us headed off the Pappadeau's a Louisiana style seafood restaurant where we usually have the lunch buffet. This is usually busy but we were able to get tables fairly quickly and had the buffet and a beer. We had a 5 hour stopover in Houston. The Houston airport is a little like a shopping mall but we mostly just wandered around. Some of the people from Calgary and Vancouver who were joining us in Houston met us there. We more or less boarded our flight on time with another fight for overhead space and some of our group had to check their carry-on. There were two other missions on the plane with us.
It was a five hour flight to Quito but finally the plane descended over the mountains into Quito. Quito is said by some to be the mostly difficult airport in the world to land in. It seemed like we had to go around a mountain which seemed uncomfortably close before flying down the valley where Quito is, flying low over houses landed roughly and braking hard. We deplaned, got thru customs in short order and went to get our bags. It was in the baggage area that a man approached me and asked in quite good English whether I was from Edmonton, and on replying, yes, explained that about 32 of our bags had been left behind in the Houston because of weight restrictions. This is something that has happened in the past; this time however they actually had a list of exactly what bags had been left behind, had the lost baggage claims already filled out and photocopied our passports so that the bags could be sent to our hotel without having to return to the airport. All in all pretty good service. After X-raying those bags that had arrived we were spat out into the crowded Quito arrival area where Manuel Avila the local physician who arranges our trip was waiting for us.
Because in the thin air of Quito planes cannot take off heavily laden, our hockey bags are transported over the mountains from Quito to Cuenca in a truck, so we loaded the bags on the truck and took a bus to the Savoy hotel. It was now getting towards midnight. The Savoy where we stay in Quito is near the airport. Judging from the decor it was built in the 60s or 70s. It has been renovated over the last few years and the rooms are now cleaner and more comfortable with showers where you actually feel cleaner rather than dirtier after using them.
Despite the noise of planes landing and taking off, dogs and car alarms we slept fairly soundly. Breakfast was at 0800 served in the basement which backs out onto a garden where you can see hummingbirds flying around. We had our first cup of thick Ecuadorian coffee with hot milk and ate fruit, pastries and huevos. It was a beautiful sunny day.
After 0900 most of us left on a small bus for Otovalo, via the Equator monument. The after winding its way thru the streets of Quito and the suburbs, we got onto a substantial highway and were at the Equator museum fairly quickly. The Equator monument we visited is about 200 metres south of the “official” monument measured in the late 19th century. The museum we visited which is where the indigenous people believed the Equator actually was, was proven by GPS to the be the correct site. We had a tour demonstrating the Coriolis effect and learned something about the indigenous people of Ecuador including a demonstration of shrunken heads.
Leaving the monument, it was off to the fabulous Otovalo market. The Otovalo market is a place where one can buy all sorts of local merchandise such as sweaters, ponchos, table clothes and scarves, made of alpaca and other fibres. Having been there several times we have bought most of the popular items but we did pick up a few other items; first buying a cloth bag to carry our purchases. From there we took a short bus ride to Cotacachi (Catch a Coatie), otherwise known as Leather Town. The main street of this town has leather stores on both sides of the street stretching for several blocks. Unfortunately because we were late, we only had 40 minutes. Leather Town is somewhat overwhelming with the selection of coats, purses and hats and 40 minutes was probably not enough but we did it justice. Finally rounding up all our group we headed back to Quito which was 2 hours away.
While most of the group went our for Chinese food (in Quito go figure), Mary and I were tired and I had a bit of cold so we ate at the hotel which was actually not bad including beer brewed at the hotel. Then to bed and we slept thru the planes, dogs and car alarms.
Manuel and Dr. Greidanus went to the airport the next evening to pick up the rest of our bags. We were able to get most of them but there were still 7 outstanding.
We had a 1200 flight to Cuenca the next day which made for a more relaxing morning with another breakfast at the hotel, time to pack and the bus picked us up at 1000 to go to the airport. Air travel in Ecuador is always interesting even when we have tickets as we did this year. Arriving at the LAN desk the staff didn't seem to believe we had reservations. Apparently you are supposed to check in online. Eventually after some negotiation we were able to check in and go through security. Joining us at the airport was Mitch Giffin the other anaesthesiologist who had flown in from Vancouver the night before with his wife and 16 year old daughter. This is my fifth mission with Mitch so it was nice to see him again and catch up on things.
After a short one hour flight we arrived in Cuenca. We picked up our luggage and left the luggage area where we were met by the local Rotarians who presented us all with a rose and a chocolate bar. Then we piled into a bus and off to our hotel in Cuenca.
Every year that we have stayed in Cuenca since I started, we have stayed at the Inca Real Hotel which has really become a second home for me. This is a beautiful hacienda style hotel with a covered courtyard. The staff seemed genuinely happy to see us all again. Mary and I checked into our room and then out to the courtyard for a bag lunch and a chance to talk things over before heading over to the hospital to unpack our bags.
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