Guayaquil and Cartagena

Many years we take a little trip after the mission.  This year we decided to visit Columbia, specifically

Cartagena.  We did consider other options in Columbia most of which involved a lot of travelling which means a lot of packing and unpacking and time in airports.  Going to Cartagena gave us the option of staying in one place and taking day trips.

To get there we have to go to Guayquil first.  We have never visited there before so it was a place we had to check off.

We finished our surgeries on Friday but Mary had to go in to the hospital for a couple of hours to look after the post-ops before we transferred those still in hospital to the local staff.  Many of the mission left earlier in the morning for Quito to spend some time there before flying home on the red-eye.

Many years leaving Ceunca has been a frantic adventure with late buses, large groups and crowded airports.  With just 3 of us this year and a 1430 departure we felt we had things in hand.  Unfortunately in Cuenca it was Carnivale a yearly festival perhaps corresponding to Mardi Gras.  Because of parades on Saturday, no taxi was able to get to our hotel.  The hotel staff were very helpful and helped us carry our bags a few blocks away, and flag a taxi that would take us to the airport.  We ended up arriving way to early and had to wait about an hour to check in but were eventually on our way to Guayquil. 

Cuenca while near the Equator is at 8000 feet and is quite temperate.  Guayaquil is at sea level and we were warned to expect hot and muggy conditions, which we found when we landed after a one hour flight.  We got our bags and tried to get a taxi to our airport.   In what seems to be an increasingly common event,  the taxi driver did not know where our hotel was but I now expect this and had the address which also didn't seem to help him but he radioed and somebody gave him directions and so about 10 minutes later we were at the Marriott Courtyard.   Some people may like authentic local hotels.   I do too but we had an early flight out in a day and besides I knew that without air conditioning we wouldn't sleep much.  

It was later in the afternoon when we arrived.  In the humidity we were content to just chill in our room. I did go up to the pool on the roof which was quite small, fairly warm and had a couple making out at one end so I didn't stay long.

The hotel directed us to a Peruvian restaurant at an adjacent large shopping mall which was really good for supper.

We had a day to explore Guayaquil before flying to Cartagena.  Based on advice from people who had been there before, we took a taxi to the Iguana Park.   This is square adjacent to the Cathedral with... Iguanas.  Lots of them.  Walking around, climbing trees, sunning themselves.  We spent a little time there then went off to look in the Cathedral which being Sunday was actually being used as a church, not as tourist attraction.  Not as nice as the Cathedral in Cuenca.

We then walked a couple of blocks over to the Maracon which is a long walkway adjacent to the river.  The river is in itself interesting just for the amount of vegetation floating slowly down it.  The Maracon itself was a bit of a disappointment.  Lots of fast food joints.  A parade came by on the adjacent street which we watched for about 15 minutes. 

We walked along it a km or so to Las Penas and then climbed the 400 steps getting a nice view of Guayquil from the top.  We walked down, stopping for a cerveza on the way down before catching a taxi at the bottom back to our hotel.

Sunday was Super Bowl Sunday and so we just had pizza in our room and watched the somewhat dull game.  We had an early flight the next day.

Monday morning we took the hotel shuttle to the airport.  We found out that our flight to Cartagena was not direct but rather that we changed planes in Panama City.  Confusing things was that both flights had the same number.  The airport was not that busy with none of the bustle and confusion of many South American airports.  We had an uneventful flight to Panama and after a brief stop flew to Cartagena.  

Arriving in Cartagena we learned that Canadians have to pay what is called a reciprocity fee.  That is a fee equivalent to what it costs for a Columbian to get a visa for Canada.  The US also requires a visa for Columbians but their citizens don't have to pay this fee.  Because we came from Panama they weren't expecting any Canadians and so had to get somebody from his siesta or lunch to process our payment. 

We were met at the airport by Brian our guide.  I have never met another Brian in Latin America.  He and the driver drove us to the walled old city and then through the busy, crowded streets to our hotel.

The Ananda Boutique Hotel is one of those Died-and-went-to-heaven places.  It is a hacienda style hotel with a courtyard pool at which I could have spent the entire visit and a rooftop patio with a refreshingly cool jacuzzi tub.  Our room came with a rain-fall shower and a large tub as well as its own small balcony.  The restaurant in the hotel is considered the best in Cartagena which is both good and bad.  Good because it is close and bad because you need to make reservations.  We couldn't get a reservation for the first night but the concierge got as one at a nearby restaurant.

We got out and walked the walls of Cartagena before venturing into the crowded streets.  Like Cuenca Cartagena is a Spanish Colonial town only the architecture is slightly different.  It is also quite flat.  Finding our hotel again we had a dip in both pools before heading out to Alma a nearby restaurant for the first of several excellent dinners in Cartagena.

Ecuador mission the rest.

Every year I vow to keep up on my blog however I never do and I am home now.  There are a number of factors. Firstly this year we were really busy, often not getting home until the evening and after dinner I just didn't have the energy to type.  I also blame Skype.  Whereas when I first went to Ecuador we used to make long distance calls from a call centre for a ridiculously low price; now many people on the mission communicate with their families by Skype which means that in the late afternoon and early evening, the Wifi in the hotel slows to a crawl.  

I normally don't like to criticize my hosts when doing missions in the developing world but it is hard this time not to.  Five years ago we moved to Santa Ines from Monte Sinai at the invitation of Santa Ines.  We did this because we were offered the use of 2 operating rooms which were larger than the one OR we had at Monte Sinai.  We felt that this would enable us to do more surgery and maybe finish earlier in the afternoon.  We met with the medical director and got the usual Latin American welcome, Mi Casa, su Casa.  This worked well for the past 5 missions.  A couple of years ago they took the monitors out of the rooms which meant scrambling to make sure we had monitors of our own but even that hadn't been a problem for the last two missions.

In December we got a letter from the medical director telling us we could only have the operating rooms from 1300 on.  This meant in order to have 8 hours of OR time we were really looking at 2100 hour finishes.  Keep in mind that the recovery room and floor nurses would stay 1-2 hours after the end of surgery.  Now you could say, okay you have the morning off but again the floor nurses have to be there in the morning and doctors have to round etc.  Makes for a long day.

We were able to get a compromise that maybe we could start one room a little earlier.  

It ended up however being a frustrating week, waiting around in the am to be able to start as soon as a room was ready and late days.  We also worked Sunday in order to get a few extra cases.  We ended up doing 34 or so total joints including 2 bilateral and one revision, which is only a little less than the 40 we normally get done but with a lot more time spent at the hospital much of it just sitting around.  

The hospital we work at is a for profit hospital like most in Ecuador.  In 10 years I haven't quite figured out the medical system which is a mixed public private system that right wing politicians would like for Canada.  There are public hospitals but a lot of public work gets contracted to private hospitals.  I often wondered how I would have reacted if our hospital told me that a surgical team from another country were taking over 2 ORs at my hospital for a week.   Probably with enough notice we would have just taken vacation as we do when the surgeons or the hospital close rooms for other reasons.  Anyway just saying that maybe with enough notice we could have accepted doing fewer patients or staffed differently to accommodate longer days.

The whole issue of voluntourism and should teams from the developed world even be doing surgery in the developing world is of course another topic.

I can't say enough about our team because as I say we worked some fairly long and irregular hours in order to accomplish what we did.  We do come down to help people but we also come down because we enjoy each other's company before, during and after hour and because we love hanging out in Cuenca.

Ecuador Mission 2016, getting there.

I am right now almost half way through my 10th mission to Ecuador.

This year our son Bill came down with us. I went down to Canmore a couple of days early to mostly chill but also to nag him about packing, making sure he had found his passport etc.  We left Canmore about 1700 on Wednesday to go to the Delta Airpot hotel.  Our plane was to leave at 0640 the next morning and quite frankly being able to just walk across to the airport is priceless.  We of course had the ubiquitous mission hockey bags 4 in total plus our own stuff.  In Calgary I was able to find long term parking quite close to the terminal.  There didn't seem to be a shuttle but there were luggage carts so we wheeled our bags about a km to our hotel.   Mary was coming down by Red Arrow and arrived just after 7.  We had an expensive meal in the hotel restaurant after which we tried to sleep.  We all awoke shortly after 3 am, got dressed,  drank some coffee and then checked out picking up our bags and rolled across the street to the departures.

Even just after 4 am there was a huge line to check.  Fortunately I had managed to get Prestige status which meant we all got to go the head of the line.  This didn't help much as it was a long slog through customs and security.  One wonders how much productivity is lost through the long process of crossing borders, especially having travelled in Europe.  The US departures area in Calgary is much inferior to that in Edmonton in terms of places to eat.  We had pastries of indeterminate age from Starbucks and sat down to wait for our flight.  Gradually other mission members trickled in including my work colleague John Soong from Edmonton, the Pediatric team from Calgary and a few members of our adult team who were flying through Calgary.

After finally boarding, it was a 3.5 hour flight to Houston which I spent trying to sleep or read.  In Houston we went to our usual go to place, Pappadeux for a feed of fish and of course a beer.  We had a 5 hour stopover in Houston so this only killed about an hour, the rest of the time we spend wandering around, reading etc.   It was a 5 hour flight to Quito which was long if uneventful.  We cleared customs in Quito in an acceptable time, picked up our bags without event and were outside.  We had to wait a bit for the bus to our hotel and also for the bus which would take our bags to Cuenca (they are too heavy for  the plane to take off).  We stayed at beautiful and comfortable Hacienda style hotel about 20 minutes from the airport and were in bed by shortly after 2 am.  

We got to "sleep in" as our flight wasn't until 1230 which meant leaving the hotel around 1030 so we awoke around 8 am got dressed, had a nice buffet breakfast before loading ourselves back on the bus to go back to the airport.  Our flight to Cuenca was a short hour flight.  Unfortunately it was cloudy and we couldn't see much until we approached Cuenca.  We landed, got our bags and were greeted by the Rotarians who help us out every year.  We went in two buses through the crowded streets of Cuenca to our hotel the Inca Real.  It sounds hackneyed but after 9 years I find Cuenca and the Inca Real to be a second home.