The last two weeks have been busy. This was due in large part to the prep time involved in making and giving a 50 minute talk (all in Spanish) on all I had done and learned here to a group of colleagues, Fulbright people, and random individuals I’d never met (it was open to the public). I was rather nervous having never presented anything over 20 minutes in the past and never in Spanish but it turned out well and even though presenting was not a requirement I was very glad to have done it on a personal satisfaction level – the experience tied it all together for me.
After the presentation it was time to say goodbye to everyone I have come to care for here. Sleep took a big hit the past week but the price was gladly paid.
(Me being nostalgic and taking pictures inside the Fulbright building.)
(The amazing FB team. Their dedication and compassion helped make my time here truly great.)
(Lab friends before saying goodbye.)
(At Theo’s house with his family after dinner.)
(Quito and surrounding mountains this morning. The tallest peak in the background is the one I have blogged about hiking to the top twice before. I went running around my neighborhood at 6:45am this morning taking pics; it is so beautiful and quiet on Sunday mornings.)
Today I spent mostly with my EC-family and packing. The highlight was teaching them all how to make play-doh and then us playing with it like little kids! What an amazing family I have been able to live with these past 10 months. I will miss them a lot.
And now it’s over.
But in some ways I feel things have only just begun. I leave tomorrow, this is true, but the friendships I have formed remain, the possibilities to return and continue working in a similar vein are abundant, and the new life-avenues that have opened during my time here leave me very excited for the future.
On Sunday the 1st of June after my 15K race (9.32 miles) - which went well - I finished without vomiting, ran the whole way and my time of 1 hr 14 min sounded good to me! I caught the bus to Shell in the upper Amazonian rainforest of Ecuador with two hiking packs stuffed to the gills with equipment for our joint research and treatment project. My mission was to shadow at the hospital in Shell for a couple of days while finalizing plans with personnel there and then communicating all this back to the docs in Quito before we all entered later in the week.
(Theo and I at the Hospital Vozandes Oriente (HVO) in Shell a few months back.)
I got into Shell about 6pm and went in search of Dr. Mark Nelson, my principal contact with HVO for the project. He was on call and after attending to a few patients he gave me a tour of the hospital before we got some dinner at a highly regarded local eatery. After dinner he suggested I visit the interns (final year medical students) and residents who lived on the hospital grounds, so I did! One can’t help but feel a bit awkward entering a house at 9pm at night into a room of people you’ve never met and have no idea you are coming, but they were a welcoming group and after a “who the heck are you” moment we chatted for an hour or so until I had to head back to my hostel. Before leaving they invited me to bunk there the following night! I thought this sounded great but we had to check with an administrator the next day. Instead of paying $10 a night to be alone if I could pay $3 and hang out with some awesome folks there was no way I was going to turn that down!
The following day started at 7:30am for chapel followed by rounds (without actually walking around). The interns/residents got grilled a bit but not too harsh. After the meetings I spent the morning with Mark in the outpatient clinic. Some things I learned: Even though the local diet is super high in fat + salt and low in fiber (the recipe in the US for colon cancer) said cancer is extremely low here. In turn they have very high levels of stomach cancer. Mark informed me the diet results in high constipation levels and this was bore out in the patients we saw, almost every one complained of some type of intestinal ailment. To head off the cancer they schedule lots of endoscopies (which I would spend the next morning watching). In the afternoon I met Miriam, a nurse with around 30 years working in the rural communities of the Ecuadorian Amazon basin, and we packed up the supplies I had brought, tested equipment, and planned out the final details of how the next three days would hopefully go.
During the day everything had been cleared for me to stay in my own room at the student building and that night we cooked up a big communal dinner and hung out, I love doing those but hadn’t had the chance yet in Ecuador, it was great!
(Enjoying a delicious dinner with my new friends in the medical student/resident’s housing quarters.)
Wednesday morning we gathered our gear and headed for the airstrip. The initial flight in consisted of myself, Veronica Redín (our team doctor from HVO), and Miriam. Each person and all the gear was weighed and calculated to make sure we didn’t overload the plane. The little Cessna we were to fly in could take a total of 850 lbs of people/equipment and I think in the end we went 9 lbs over!
(Dr. Veronica Redín in the weigh-in station with our pile of equipment.)
(Our Cessna plane getting loaded up!)
As we were strapping ourselves into the seats I wrote a small note that said, “If I die tell my family I love them. - Michael Wauters 10:41am 6/4/08” and stuck it in my zipper pocket. Luckily it wasn’t needed. As soon as we took off I was in awe of the views and completely forgot about crashing, it was exquisitely beautiful.
(One of many incredible views I would get to see on our numerous short flights.)
The flight to Yuwientsa (YUW - our first destination) normally takes about 30 minutes. Or, one could bus 5 hours over rough roads to Macas, from there another hour plus bus ride to a random spot in the road and it would then be 9 hours hard walking through the jungle to reach YUW. However, we didn’t make it to YUW right off the bat as low lying clouds and rain rushed in as we approached and as all flights/landings (checking for clear runways etc.) are done visually we couldn’t proceed safely. The pilot decided to land us at the nearest community, Katsutka, and try and wait out the weather. As we landed it seemed the whole town was out on the runway… and they pretty much were, as it turns out we visited during a day when the whole village was conducting a communal workday to improve the runway! When the plane stopped we were at once surrounded by inquisitive faces. I felt more out of place than usual, my height, hair, and skin at odds with stockier, darker, raven-haired individuals gazing at me. “You’ve come to help us, this is great! We have many sick people.” a spokesman said.
We weren’t actually supposed to be there at all but we couldn’t fly and there were people that needed our help. So, we did the obvious. We were taken to the community church/meeting building and people started pouring in! I think we attended to over 30 individuals in just a few hours, from stomach parasites to fever to fungal infections. My job was to help prepare the patients for the doctor, taking temperatures, weighing people, and getting a basic history to speed things up. The weather cleared up and we stayed an extra half an hour to see more people. We still left with many unattended to but with the weather able to go bad again at any moment we had to take advantage of our exit window.
To take off on the short runway the pilot gunned the engine while holding on the breaks, allowing us to rocket off and get airborne far more rapidly. We flew for about 10 minutes (3 hour walk) before descending to land in YUW (population ~230). The landing was a rush in itself; it appears you are going to crash into the jungle until the very last moment when you come bursting onto the runway, awesome!
(Video of landing at Yuwientsa!)
From the airplane we were whisked to a meeting building without walls and a steep roof made from local plant materials. Once seated, chunks of sugar cane, slices of papaya, and sugar cane juice were provided. We were all located on one side of a big circle and a number of community members faced us. From the setup I thought we had to give some kind of speech to them but we ended up having more of a relaxed conversation. Miriam knew almost everyone there, my admiration of her in the care and dedication she brings to so many people would only continue to grow throughout the trip. After the refreshments we were taken to our working location.
(The building we both housed and worked in. Nicer than most of what the community had; it was constructed by an outside NGO a number of years back and had running water and a solar powered light! But just one☺)
We then started working, similar to what we had done in Katsutka, providing general medical attention. In the meantime our plane had picked up two individuals, the Daniels, from the town we would travel to next, Makuma, to supplement our efforts. Daniel Chu is a well-respected pastor in the area and a good friend of Miriam’s, he was brought in give a visual reminder of his/the church’s backing and to provide counsel to any who needed it. Daniel number 2, Daniel Kashihin (sp), is a government employed health technician from Makuma who came in to vaccinate all the children of YUW.
Everyone there assumed I was a doctor and used the title as such. I gave up correcting them pretty quick; it was hopeless. My role in YUW was different. I was in the same room as Dr. Redín and played the part of pharmacist more or less. The doc would see a patient, scribble out meds and dosage instructions, then hand me the card from where I would count out pills, mix up powders into drinkable formulas and do whatever else was needed to prepare the medications before then explaining how the people were to take them. This saved her a lot of time and allowed us to attend to a many more people. The people we saw were almost exclusively Shuar, with their own unique language and customs. Many of the women and kids didn’t know Spanish very well and at times we had to have the village health promoter Felipe translate for us. I tried learning a few basic greetings but with limited success; the language is so different that many of the sounds required me to move my mouth and tongue in ways I had never tried. Only one picture this day as I was warned photos can be less than appreciated and I didn’t want to offend anyone. Later on the community grew used to us and I got the go ahead to take a few pics of us at work.
(Me in the “pharmacy.”)
We worked till 10pm and then went right to bed exhausted. I didn’t sleep that well, as it was much colder than I expected and I just had a sheet. YUW is in the rainforest, but still in the foothills of the Andes and at night it can get a bit chilling. The cold combined with my bed of wood and just a thin camping pad (firm to say the least) made it a rather long night.
(I finally got to use my own mosquito net! We’ll see how it worked, if I did get malaria it should show two weeks to a month after initial infection. There is malaria in YUW but at rather low levels.)
The bonus of being rather uncomfortable was that I had no problem getting up early in the morning. Just in time to catch the sun rising over the jungle, withering away the night’s mist. It was a special moment for me; our world can be so beautiful.
(Yuwientsa in the morning.)
(A shot down the runway we arrived on, morning as well.)
One of doctors I work with, Manuel Calvopiña, was supposed to get in around 9am that morning to screen potential leishmaniasis patients and distribute treatment provided by the government for positive cases. The problem was he didn’t arrive till 4:30pm due to a scheduling mishap. The company we were flying with, Mission Aviation Fellowship (MAF), used to be comprised of all foreign missionaries but the new government decreed they had to include half Ecuadorian pilots and mechanics or they would be shut down. A new Ecuadorian pilot was in charge of the schedule that week and he basically did whatever he wanted, screwing us over in the process. Until Manuel arrived we continued to see patients reaching over 105 combining the two days and communities we worked in. This obviously wasn’t an ideal time per patient ratio but with so many you just have to try and do your best. Dr. Veronica Redín headed back to Shell on the flight that Manuel came in on as she was on call the following day.
At this point we switched over to taking blood samples for our study on Chagas disease with Manuel seeing Leishmaniasis patients. It got dark quick (6:30pm like always!) but the people were still there and we kept going. My job was to take the already drawn blood samples, centrifuge them for 8 minutes to separate the various components, and then transfer the serum into a labeled tube for storage in the coolers with icepacks Manuel had brought in. The serum contains all the antibodies we would be looking for while the RBCs, WBCs, platelets etc. just contaminate the delicate ELISA procedure. We had to run the centrifuge off a small generator, as the solar-powered electricity they had wasn’t powerful enough. We got through 37 samples before the people stopped coming at about 8:30pm.
(At work processing the blood samples.)
(Miriam using her headlamp to keep working into night for the blood draws.)
Manuel saw a great number of patients with various types of lesions and thought 4 looked very suggestive of leishmaniasis. He took samples from all of them, 3 per person, and stained them for later microscopic review. You can’t leave samples like that out overnight, as cockroaches will eat the biological material.
(Typical leishmaniasis lesions in the process of scarring over. The bigger risk in the Amazon region is that in 10% of all cutaneous cases (the most common leishmania form) the parasites will migrate to the nose/mouth causing the more dangerous mucocutaneous (MCL) form of the disease which can result in severe disfiguration and even death.)
(Healed lesion and the typical scar left behind. One can see that a lesion on the face would be traumatizing.)
Upon review the next morning one man who looked to be in the beginning stages of MCL was confirmed as positive from his slide. It can be difficult to find the parasites in MCL cases as the body mounts such an intense immune response (which is what actually causes all the tissue destruction) that not many parasites exist at any one time. Manuel was almost 100% sure about his diagnosis from a clinical standpoint but the slide confirmation left no doubt. We gave the man a full regimen of a new oral leishmaniasis treatment called miltefosine, which has about a 70% chance of curing him. We caught his MCL rather early and have hopes he recovers without suffering any further damage. Using the center’s microscope we were able to confirm one more case as positive (cutaneous) and glucantime was left for treatment. The remaining two suspect cases we will be reviewing in the lab in Quito.
We were hoping to see a few more leishmaniasis patients as other community members said they knew of more, but with communication and travel so difficult in the region we were glad that we were able to help at least some.
We worked taking/processing blood samples with Manuel seeing leishmaniasis potentials using my headlamp until 8:30pm. From there we ate a bit and pretty much went straight to bed, exhausted. That night I slept like a rock.
The plane taking us to our next work site, Makuma, was supposed to arrive sometime early that morning and due to the flights putting us behind the day before we worked like maniacs to get as many samples as possible with our limited time. I started off the day doing a number of blood draws, and they all went well! It was nice to take a skill I had only practiced in the lab and employ it effectively in a real situation. However, Miriam wasn’t up to taking over my blood-processing job so I had to switch back after a while so we didn’t get too behind. In just a few hours (working from 7am till 10:30am) we took and processed 58 more samples bringing our YUW total to 95. As this approaches almost half of the community we are confident that if Chagas disease exists in this region we will detect it (there are no existing studies on Chagas in the province of Morona Santiago). When Manuel ran out of leishmaniasis patients he took out the education materials we had brought (a picture of the vector and several real samples of said insect) and spent time educating all those assembled how the disease works, how it is spread, and how to avoid getting it. A number of people commented they had seen the insects in their houses and some even recalled being bitten as well.
(Manuel teaching community members of YUW about the vector for Chagas disease.)
From there we pretty much ran to the plane, whose pilot had been waiting 15 minutes for us to finish up processing our last blood samples. The flight to Makuma was a mere hop of around 10 minutes but would have been 3+ hours walking.
(Health center in Makuma, a village of 400-500.)
Dr. Angel Guevara had joined us in Makuma, coming in on a different flight from Shell. The problem was our already short time allotment in Makuma had been cut down by staying on in YUW to finish (which we had to do as Manuel’s late flight had put us way behind). We worked as fast as possible but only got 44 blood samples and because we were there such a short time (really just an afternoon) only one leishmaniasis patient came in (who was obviously positive and we gave a regimen of the oral treatment miltefosine). The explained reason why many of the leishmania infected people didn’t show up is because they live an hour or two away in the jungle and don’t want to make the walk into town for nothing and unless they hear from a reliable source that yes indeed, the doctors are actually there, they won’t come. This requires us spending more time in a location, like we did in YUW, but in Makuma we just couldn’t, as it was Friday, MAF won’t fly weekends, and the docs had to be teaching classes early Monday morning. We agreed to come back to Makuma to “do it right,” when we have the time. I probably won’t be on that trip but the fact that it gets done is the most important consideration.
(The end team before flying back to Shell. L-R, Miriam, Manuel, Angel, and me. The flight back was gorgeous, weaving in-between huge cloud formations as the sun was getting ready to set. Sadly no photos.)
Conclusions: As I mentioned before the nature of the working environment, namely the difficulty of communication and the spread out living situation make a project such as ours a challenge to carry out. That being said, in YUW we brought much needed general medical attention to a large number of people, vaccinated numerous children, identified and started treatment for several individuals with leishmaniasis, and collected a sufficient number of blood samples to get an idea about Chagas disease in the area. Concerning Makuma we just didn’t have enough time, trying to do two communities like we did with the flight problems just proved to be too much, but plans are already being made to return to Makuma and finish what was started. Now comes the laboratory portion, examining the rest of the leishmania lesion scrapings and testing all the serum samples for Chagas disease. Whether we find more positives or not we already need to procure the medication(s) used in Chagas treatment (benznidazole or nifurtimox) for the positives we previously identified in Arajuno. If we find more people infected from YUW or Makuma this only becomes more important.
In all honesty I had my doubts as to whether the project would ever happen but after months of planning and delays not only did it come to together, it was judged as a success by all involved – the communities, the hospital’s personnel, and ourselves. I feel fortunate indeed to have been a part of this experience. In my eyes it has been the culmination of my time here in Ecuador.
Russell sent me some photos of our adventures that I did not have, figured I'd post them here. You may want to review my entry already describing our adventures to place them better in context.
(A cow in the middle of the city. We encountered this one on a bike ride into South Quito. I don't recall this phenomenon from the states.)
(Walking up to Ruccu Pichincha on a rare clear day. The mountain almost always clouds over after 8am even on sunny days in Quito so we really lucked out!)
(A plant with our goal in the background. It was a good walk to say the least, about 4 hours there and back.)
(At the top, 15,500 ft baby!)
(Just after exiting a 400m long pitch-black tunnel where large buses almost ran us over! Nice!)
(Russell and I with the impressive Pilón del Diablo waterfall in the background.)
Quito is a long city, to say the least. Hemmed in by steep valley sides it has had to grow almost exclusively longitudinally, making it incredibly long compared to wide. I live in the center section and have almost never ventured south of Panecillo (“little bread” in Spanish) with its giant angel statue towering over the city from its hilltop perch. Almost every guard, taxi driver, or housemaid I have ever talked to has told me they live “in the south.” It is the district of Quito’s working class, nothing touristy to be found, a place where ordinary people live and work. And it was high time I went to explore.
But why go alone when I had an offer to visit Douglas (one of my guard friends I’ve known virtually my entire time here) and his family? So, last Saturday I met him at 6:30am and we caught the bus for the hour commute south.
After breakfast they took me up to an overlook near the house to get a view of their part of the city.
(Douglas on the right with his two daughters (he has three older sons too), two grandsons, and a nephew with South Quito spreading out behind them.)
(We next headed to a local park and after playing on the big toys I busted out my Frisbee. Like every other time it was a big hit☺)
(Back at the house we decided to do a group pic. I don’t have all the names, especially of the little guys, but everyone was related to some extent. Douglas’ wife is on the left. I’m awful with names but her kindness and instant welcome will stay with me for a very long.)
(After this I taught them how to play spoons and although we used lego blocks it didn’t matter. I think they would have kept playing till nightfall but Douglas and I had to leave at 3:30 (for him to work his next shift and me to get home) so we had stop, to many calls of “one more game!” After we had already played 3 “last games.” ☺)
I have been bombarded since my arrival with descriptions of how filthy and dangerous the south is; “you don’t want to go there” was a comment I frequently heard. However, after my recent visit, I couldn’t disagree more. It may not have the high-rises of the central districts and it is more rundown, but the people make the place for me, and I’ve been fortunate to meet some amazing ones.
For the first part of this month my good friend Russell Carroll was in Ecuador (on vacation from Nicaragua where he is working for a year) and we had the chance to go on a number of adventures. I’ve known Russell since 6th grade (11 years now!) and having him here in Ecuador was great fun.
We started off with some time in Quito; my family let him stay at our place for a small fee and even though it was cramped (we shared my bed for example) it was much better than if he’d been at a hostel. One highlight for me was finally having someone who could share in my urban bike adventuring. Most Ecuadorians seem to think I’m a bit crazy biking around the city but I’ve found some sweet lines and having someone to share in these delights was priceless:) We also spent some time in the children’s hospital I have been volunteering at, which as Russell speaks Spanish very well he fit right in with the kids. I was a little worried we’d have trouble entering as it was getting on in the evening but like every other time they didn’t even ask a single question. Somehow I think if I were dark-skinned this wouldn’t be the case. Racism here can be subtle but it is ever-present.
Next up we headed for Baños, a perennial favorite destination of mine. We rented some bikes and ventured out along the valley road. This all sounds pretty tranquil, but throw in almost all uphill for the return, huge muddy swaths, pouring rain, and the necessity to share a 300m + long, pitch-black tunnel with speeding buses and it quickly turned into a venture we won’t soon forget! The tunnel was especially hairy, we got off to run our bikes (have you ever tried riding a bike in a dark tunnel? It’s hard to say the least) and would have to jump into the water-filled ditch ever 30 seconds or so to avoid vehicles speeding by. The next day we both participated in a cayoning tour, which basically consists of rappelling down waterfalls.
(Me descending the warm-up fall.)
(Russell on the same one.)
(Me in the middle of the finale, a 46-meter descent.)
From Baños we bused down to Tena, a 4-hour trip down into the beginnings of the rainforest. The bus we hopped on was packed full and so we spent the first 1.5 hours standing until a few seats opened up. Not getting a seat in buses is actually pretty common here but until that voyage I had been pretty lucky in avoiding standing for long periods of time. The next day we signed on for a rafting tour with an agency run by British ex-pats (a shock at first, I asked a white guy I thought was going on the tour who we needed to pay and he replied “me, I work here”!). The tour itself was great, good rapids, beautiful day, fun side trips, and arguably the greatest lunch I’ve ever had on a trip of this nature (make your own burritos with tons of ingredients, fresh fruits, and homemade chocolate cake for dessert!).
(A view back towards the mountains where we started at.)
(Russell with a small monkey-like creature we were introduced to at lunch by a local boy.)
(Me with said creature and boy to boot!)
(Russell exiting a narrow ravine we walked up a ways to find special mud they use for facials. Seemed just like mud to me. Cool lighting for the pic though.)
(Our boat at the day’s end: Russell, myself, two British girls, and our guide – who was quite the jokester if the picture doesn’t give it away☺)
We took a night bus from Tena to Quito, amazing how in a few hours one can go from lush tropical rainforest surroundings to the arid mountains of the sierra. At about the midway point the bus stopped. This is actually quite common and I often never figure out why. This time though things were more obvious. A policeman boarded and ordered everyone off the bus. We lined up to present our identification and have our belongings checked (for drugs). Russell had his real passport and got right through the check while I only had a copy (I never carry the real thing). This normally is fine but this particular officer seemed to have it in for me. He asked for more ID so I pulled out my bankcard and a worthless international student ID card I paid for at the Fulbright’s urging. Still not enough. He called over his supervisor who began interrogating me, what was I doing in this area, where was I from etc.
Officer: “The USA huh, I hear you guys have lots of hot girls, right?” Me: “Umm, yeah, that's right.” Officer: “Man, I’d like to meet some American girls; what do you think of the Ecuadorian gals?” Me: “They seem nice…” Officer: “What color do you like ‘em?” Me: “That really isn’t a factor for me.”
My “interrogation” continued in this vein for another few minutes with several of the other nearby officers leaning in to hear. At the conversation’s end I left with their best wishes, my lack of documents and the search of my possessions well forgotten:) Times such as this make me glad I can speak Spanish.
Next up was a day trip to the famous Papallacta thermal baths with my lab compatriot Yosselin, her sister, and one of their friends.
(A view of the valley in which the springs enter.)
(We took a small hike before hitting the pools. This is a picture of one of the unique plants we found.)
(An old couple crossing a field.)
(Relaxing in the pools. L-R Russell, Yosselin, her sister Karla, and their friend Javier. The place had hot 10 pools feed by nearby hotsprings (several of them huge, as in 50 people could fit in easily!), 2 cold ones and even a small freezing river could be accessed for the brave. As we went on a Wednesday there may have been 10 other people in total. We pretty much had the place to ourselves!)
Only a little over 1.5 months left and so much I want to fit in. Just have to do my best:) Hope you’re all well.
Judging by the number of blog entries I have dedicated to what I am doing in the lab one would think I really never do anything there. This would be what we call, “incorrect.” It is true that recently much of my time previously devoted to pure technical work has been taken over by helping plan and coordinate our upcoming project on Chagas/leishmaniasis in the oriente but we have still been progressing in the lab. One of the main reasons I haven’t posted as much is that in the monthly Fulbright updates I write to my program coordinators I discuss in-depth all things concerning the lab – however, I’ve been writing them in Spanish since month 3 and this wouldn’t help out the majority of people who actually read this thing. So, this entry is an attempt balance things out.
We recently procured a live Trypanosoma cruzi culture; this is the parasite responsible for Chagas disease for those of you who didn’t know. We have been growing it for several weeks know and boy have all those little parasites been asexually reproducing like mad!
(Parasite video, 40X power with zoom from my camera added in. Watch ‘em squirm! This is a good sign, growing well.)
Every couple of days we withdraw 80% of the medium (and parasites), which we spin out with a centrifuge and store the resultant pellet. The remaining sample has more medium added (medium is basically a super parasite food) and is placed back in the incubator at 28-30°C to continue growing. Now, why are we building up a huge stock of parasite bodies? So we can later use (after a series of more complicated steps that I won’t go into here) key T. cruzi surface proteins in an in-house ELISA procedure to test for the antibodies against the parasite (thus determining if a person is infected – although confirmatory tests are always carried out). This in-house ELISA, when dialed in, can be more effective and cost waaaay less than buying commercial kits.
(Manuel withdrawing parasites for examination under the microscope. Based on their shape and motility we can determine which phase of growth they are in and if it is the right time to harvest them. Note the small alcohol burner; everything must be passed through the flame to avoid contamination.)
Another in-house test we are preparing (once again using the parasites) is involves a process known as immunofluorescence. The test is actually quite straightforward and involves putting a known quantity (I will explain in a bit how we determined this) of parasites in a small well of a modified microscope slide. They are allowed to dry on the slide overnight and stored until use at -20°C. To run the test a small quantity of an individual’s serum is placed on the well and left for a time. If they have been infected with T. cruzi they will have antibodies to the parasite, which will bind to specific proteins on the parasites previously bound to the slide. A specific conjugate is then added which binds to the other end of the antibody and the slides are then washed, removing excess conjugate. The conjugate contains a compound that fluoresces under UV light and this can be observed with a fluorescence microscope. Thus, if fluorescence is observed it indicates T. cruzi infection. At this point we have only reached the prepared slide step; I will explain how we determined the parasite concentration.
(This tiny device, known as a Chamber of Neubauer, lets us count parasites. A drop of medium filled with parasites is placed in the middle of one of the metal looking middle sections and a cover slip is applied. The contraption is then placed under the microscope.)
(This is what you see at 20X, we used 40X to count. Zoom in to see the parasites. Each square surrounded by 3 lines is counted, there are 25 in total (a 5x5 square), which are all screened and then totaled. This box of 25 squares corresponds to a volume of 1mm x 1mm x 0.1mm and using this volume and the number of parasites we can calculate our parasite concentration per milliliter. One wants around 1-2 million/milliliter in order to have a sufficient number to make a useful slide for the immunofluorescence test.)
(Me counting parasites, oh yeah!)
During free time Theo (a lab compatriot) and I like practicing various techniques useful for working with infectious diseases. We’ve done a fair amount of blood draws after which we’ve centrifuged our own blood to get the serum, which we have used as negative controls in several Chagas tests in the lab! We’ve also learned how to do a finger prick and use the drop of blood to make a blood smear on a glass slide and then stain it. This may sound easy, and it is pretty easy, but there is a great trick Manuel showed us for getting just the right thickness. Too thin and you don’t have enough to examine, too thick and the red blood cells (RBCs) pile up making it easy to miss anything abnormal. This basic test can detect acute stage Chagas disease and malaria among others.
(Some of our blood (stained). The numerous cells are RBCs and the big purple guy is a white blood cell or WBC. This one happens to be an eosinophil, which if detected in elevated levels can indicate a parasitic worm infection, such as gnathostomiasis. The really purple part is a multi-lobed nucleus while the little reddish granules contain powerful enzymes.)
I have an intense dislike of being bored. Thus, as the lab work has slowed during our current planning/contacting/equipment acquiring phase, I’ve sought out new opportunities. These include tutoring a good friend in English and volunteering at the local state-run children’s hospital, which is just a 15-minute walk from my house.
I’d actually approached Hospital Baca Ortiz (HBO) about volunteering before but didn’t get a favorable response. I wandered around, directed from one person to another, until a lady finally told me I had to write a letter to the hospital’s director stating my reasons for wanting to volunteer. Why the heck would the director care why a gringo wanted to volunteer? I felt like the request was an easy way to get me out of her face; so, I didn’t write it and started looking for another way in.
Karla’s extended family is large, at least 30+ people in Quito alone, and they probably know a good 50% of the city’s residents. OK, a slight exaggeration, but they know a lot of people. I talked to Karla about my desire to volunteer in HBO, “Oh, I know someone in the Volunteer Lady’s organization there, I’ll give them a call for you.” – Great!
My first day I met Karla’s friend Laura and then got introduced to a bunch of other ladies who give their time as part of the “Damas Voluntarias” (Volunteer Ladies). The organization is unlike anything I have encountered in the states. They coordinate student volunteers like myself (who give out diapers/stickers/drawing supplies to hospitalized kids and play with them), have meal vouchers for poor/out of province parents staying with their kids, help parents locate resources (pharmacies, transport, anything really), run a free-clothing bank for those who don’t have a change of clothes, and provide general information. HBO is recognized throughout Ecuador as the top children’s hospital (age 0-12) for those with minimal resources and thus many patients arrive from every province, often over a days travel away. As medical emergencies rarely give time to prepare they often arrive with the clothes on their backs, a little cash, and not much else. In this context the services the Damas provide are vital indeed.
When I go in weekday mornings I help with the standard diaper/sticker/paper/crayons dispersal but it doesn’t leave too much time to spend with any particular kids. Thus, my favorite times have come to be afternoons and weekends – no other volunteers seem to come in but the kids are still there, lonely/bored/in pain. I’ll admit, it is hard to see kids suffering but the majority are getting better and if I can take their minds off the reality of their situations, get them to smile, maybe even laugh, I consider my investment a success.
I’ve just started taking in a few of Julian’s children’s books to read to the kids. I’ll pull up a chair in a room and roll the kids’ beds closer to me so they can see the pictures better and then launch in. It’s been a big hit! And, surprising to me, has been that the parents get into the stories just as much as the kids! Makes me think they never had anyone read to them in their childhood. I also play a drawing game where the child and I take turns drawing something and the other person has to guess what it is. Another highlight has been “Marco” my hand puppet cat.
(Me with Marco. Some kids like to talk and pet him while one young lad enjoyed playing catch with Marco!)
A recent idea I just tried out to great success is a special balloon that races around the room bumping off walls before heading in a new direction. The balloons also make a loud shrieking noise but no nurses have reprimanded me yet. The kids laugh and scream, then beg me to make it fly again.
(Balloon ready to go – this is in my house.)
(Flying balloon!)
I’ve also brought in my camera and let kids learn how to take pictures. They always like seeing pictures of themselves too. Some of the children I’ve spent time with follow:
(A big Marco fan with pictures we drew. I met this boy one day while giving out stickers in the room next to his – he pressed up against the glass dividing the rooms, gesturing wildly for me to come visit him next☺ He was all alone, no other kids in his room and the mom was gone. It is actually quite common that the parents have to leave (for food, to buy medicine, take a breather, etc. and the kids or babies get left alone.)
(A little boy I played the drawing game with. His parents were gone.)
(A man and his daughter – he really wanted a copy of the picture so I brought him one today.)
(A young boy who I hung out with and read a story to.)
(The cutest little girl – she liked playing with my camera☺.)
My time in HBO has been a blessing, sometimes I wonder who gets more out of it, the kids or me! I can go in whenever I have time (which has been a good deal lately) and make kids who are in pain or lonely stop crying, smile, maybe even laugh – you can’t beat that!
In other news, I’ve just decided to do a 15K. Dimas convinced me it is THE race to do in Quito, a classic that has been going on for 48 years. As I’ve lost the running shape I had for my 10K in the fall (more biking as of late) it will be a good challenge to get ready in the 34 days I have till the gun goes off.
Only a little over 2 months left, time sure is flying…
