Surgical Camp in the Inland Coastal Region

Earlier this month the Cinterandes crew worked for 4 days in the coastal lowland region in the town of Vinces, a 5 hour drive northwest of here.  There are huge banana plantations in the area, also pleasant rolling hills with dry forests and small subsistence farms.  The town of Vinces initially reminded me of a Southeast Asian city because the streets are filled with motorcycles and three-wheeled bicycle taxis.  But salsa music filling the streets until late at night and street soccer games bring one back around to Latin America.

On the day we arrived, we did surgery until midnight.  The following day, we started around 8am, operated until 8pm, then went to a late night dinner party at a local doctor's home on the banks of the large river that runs through town.  I have been honored to work in the OR as first assistant on about half of the surgeries.  The rest of the time, I have been able to roam around taking photos and find people to make small talk with until the next case. In the end, we did 30 surgeries over the 3 days in Vinces:  hernias, phimosis/circumcisions, tubal ligations, gallbladders, and  lipomas.  The Cinterandes crew works very hard, taking advantage of the long trip with lots of equipment to do as many surgeries as possible.  And usually the host city welcoming party makes sure after work is over that everyone plays in the evening just as hard as they worked during the day.

From the team of local volunteers, working as late as everyone else.

The third day was a more mellow schedule of surgery, interspersed with a tour of a cocoa/chocolate factory and a mandatory break to watch the Ecuadorean national soccer team play Peru in a World Cup qualifying match.  And in the evening, we took a short field trip to a nature reserve where we were able to see monkeys and sloths, then had another late night dinner party, this time with salsa dancing past midnight.  I am embarrassed to admit that not only did I shock the crowd with my Gringo style salsa dancing, but I was also forced to sing Hey Jude in a Karaoke performance!  Luckily, there’s no footage of that behavior.

To the Beach

A few  weeks ago, the kids had several days off from school for Azogues Independence Day, so we drove a few hours down to the coast for the first time.  On the way, we spent the night and following day in Guayaquil, the largest city in Ecuador with 3 million people.  This is a port city, situated at the mouth of a huge river that drains the streams and rivers of half of the entire western portion of the country.   It is a lively city with salsa music filling the streets, great seafood, and a pleasant 2 mile long waterfront park.

The pigeons at this city park have formidable competition for food hand outs.

The next few days we spent along the central coastline.  We stayed at one beach that was as busy as Waikiki nearly all of the night, then spent a couple days on a 3 mile stretch of beach further north where we saw only a handful of other people all day long.  I had my first surfing lesson, getting up on the board and falling off shortly thereafter about a hundred times (so I was pretty sore the next day).  We ate seafood 2-3 times a day, played in the sand, ran on the beach.  When we returned back home in the mountains, we felt like we had been in a different country for the past week.

Hanging out in the hotel lobby.

Cinterandes Mobile Surgical Program

Small primary care health clinics are found throughout rural Ecuador, giving reasonably good access to clinic medicine services.  But if someone needs surgery, they often do without for "elective" surgical problems like hernias or gallbladder problems.   For emergency surgical problems, patients often have to travel hours to the nearest hospital, and obviously sometimes they don't make it in time. 

Cinterandes is an organization founded in 1992 which travels to rural communities throughout Southern Ecuador with a mobile operating room in a retrofitted produce-delivery truck to provide surgical services to the underserved.  The staff members include 2 general surgeons, a family physician, a couple of medical students, 4 full-time support staff, and a cadre of volunteers.  They do incredible work, often operating on very advanced/complex surgery patients, because as you can imagine, people in rural areas do not often consult with a doctor about health issues until their hand is forced.

On the day these photos were taken, we did a large inguinal hernia operation, removal of a lipoma growing between a patient’s legs that was the size of a pineapple, and a laprascopic tubal ligation.  Cinterandes usually sets up the mobile surgical truck in the parking lot of a rural health center, working together with local health workers, and using clinic beds for post-op recovery.  The work has been particularly gratifying to me because we see the patients throughout the day before/during/after surgery, meeting their families, and seeing them return to their homes after a surgery that they would likely have never considered if it weren’t made available so close to their home and free of charge.

In 1994, I worked with Cinterandes for an elective rotation during my last year of residency.  The founder of the organization, Dr. Edgar Rodas, put me up in his house back then and continues to be the primary surgeon for the organization now.  He has a remarkable commitment to the underserved people of Ecuador and runs an amazingly efficient program, performing surgeries that would cost many thousands of dollars in the US.

At this time, I am working with Cinterandes 2-4 days/week.  Patricia is working a similar schedule at the local hospital in Azogues.  Patricia will follow with an entry on her work soon.

Fall School Festival

In a gracious gesture from their classmates, Hans and Annalise were chosen to be class representatives in the annual fall school festival.   The event is an entertaining mixture of school carnival, Halloween, and beauty pageant.

Hans’ school soccer team, playing the part of a rock and roll band posing for their debut album cover.

Hans had the privilege of escorting the class pageant girl. 

Annalise’s escort was a sweet, attentive date for the event.

The girls on display for the judging panel, and spectators.

Our Little Miss Sunshine, without the burlesque dance.