Semana Santa

This past week has been a special one for Ecuador. This is because 95% of Ecuadorians are Catholic and thus these past few days marking Jesus’ death and resurrection have been a pretty big deal here.

Friday I attended the “procession” commemorating Jesus’ death and the events leading up to it. This gigantic march took place in the historical center of the city and was quite a sight to behold. There were lots of folks in purple KKK looking outfits (I’m told the KKK copied from this), men dragging crosses, people with chains around their feet, whipping themselves, painted on blood, and the grand finale, a huge Jesus statue pushed by people in business suits. After the statue passed, all the watchers joined in behind, many with umbrellas to block the fierce sun. See pics below.




(The original KKK. Not really of course, but striking similarity in dress.)




(Dragging the cross. This was a small one, some guys had medium sized trees! I saw one guy collapse from exhaustion. Then there were little children dressed as Jesus dragging mini-crosses.)




(The Jesus statue.)


Then on Sunday, that would be today – Easter, I traveled with Fernando (guard friend) and his family to visit Quinche, a famous church out in his neck of the woods. First though, we stopped at his house so he could shower and we could eat some breakfast. During this time I met Cliotilda’s father. He is 75-years-old and it was a pleasure to talk with him; older people often have perspectives on life that can’t be reached by a mere babe such as myself and this man was no exception:) Five months back he lost his left leg due to complications arising from diabetes. He hadn’t received treatment for his condition before his surgery (even though it had been diagnosed when he was 70) and isn’t taking any medication or insulin now either. He worries he will loose his other leg soon and confided to me if that happens he mind as well die. He had me touch his foot and said he couldn’t really feel it; very limited toe movement as well. Sometimes I feel so frustrated and helpless here. He did have a brand new wheelchair, gifted from a humanitarian organization.




(Me with 3 generations of Fernando/Cliotilda's family.)


From there we headed on to Quinche, 30+ minutes standing up in a packed bus from Fernando’s house. The church was impressive and there were lots of people everywhere, inside, outside, holding candles, singing, praying, begging, you name it. I saw a new food too, small water snails sucked out of their shells and eaten with lime-juice. I tried one and got a bad aftertaste.




(Quinche's famous church.)


We exited a side door and came face to face with a line of people begging for money to help their sick children. The people were out in the hot son, sick kids lying comatose at their feet. One had what looked like bad burns all over a lower leg, others with bad coughs, one just a year or so old. I asked them what had happened to their children (they seemed surprised at my approach), gave a quarter to each, and felt helpless again. I have trouble reconciling a just and all-powerful God with sick children.




(Poor people with sick children.)

Supplemental Project Information

For those of you who don’t know where Ecuador is, well, shame on you:) Situated in the upper northeastern corner of South America inbetween Colombia (north) and Peru (South). The country is split by the Andes mountains into three distinct regions, coast, sierra, and “oriente” or amazon rainforest. It is in this last area where we are planning our project, in the far reaches of Pastaza province. See below:


(Map of Ecuador. Project planned in the far reaches of Pastaza Province)


Huge tracts of pristine rainforest make this area very difficult to access, indeed, a number of communities can only be accessed by days of walking or via small planes termed avionetas in Spanish.




(Rain-forest shot from Pastaza.)


A typical house from Arajuno, the second largest town in the province. Our project aims at communities further inside the province.




(House.)


Two main ethnic indigenous groups inhabit the area we plan to visit, the Shuar and the Achuar, each with a distinct language and myriad customs.


(Girl from Arajuno holding a local mammal.)


The medication most commonly used to treat leishmaniasis is called glucantime. It comes in a small liquid filled vial and the recommended treatment regimen for maximum results is 4 vials/day for a total of 2 weeks. At $5-6/vial this comes out to around $300/patient! The good news is the government has glucantime on their “free drug list” but the bad news is they will normally only provide ¼ the recommended dose per patient saying more is overkill. I work with the top leishmaniasis expert in Ecuador (Manuel Calvopiña) and according to him treating with a ¼ dose is more about saving bureaucrats money than with helping patients.

The disease normally starts off as skin lesions, some self-healing in a matter of months, but that can leave horrific scars even if they do heal. The real danger is that the cutaneous form can progress to the severe mucocutaneous version (this progression noted in 2-10% of all cases but only in the Amazon-side rain forests of Ecuador. MCL not found in the mountains or along the coast).

We have a great deal of evidence to suggest there is a significant amount of leishmaniasis in the area we will enter and thus the more money we can raise the more people we can treat. Please see pictures below:




(Mucocutaneous leishmaniasis (MCL) case from Amazon lowlands of Ecuador. Note complete destruction of nasal septum. MCL attacks the mouth and nose of sufferers, and while rarely fatal can disfigure a person leading to ostracization and other social problems. Image from M. Calvopina)




(Advanced MCL patient from the Napo province of Ecuador. Napo is similar to Pastaza in both geography and populace, bordering Pastaza to the north. Image from M. Calvopina)


For more information concerning leishmaniasis please see: http://www.who.int/tdr/diseases/leish/lifecycle.htm


In comparison with leishmaniasis, Chagas disease is a much more subtle affliction but decidedly more lethal. The disease usually presents symptoms decades after the initial infection, destroying heart and gastrointestinal tissues and resulting in high levels of morbidity and mortality among infected individuals. Treatment in the late stage chronic condition has debatable results but for those people more recently infected Rochagan (benznidazol) has been proven a very effective chemotherapeutic agent. It is thus imperative to diagnose this disease as early as possible as well as educating those living in endemic areas in order to help prevent transmission. Rochagan is a cheaper drug and we are not as worried about paying for it as with glucantime. Several studies (one listed at the end of the letter) have pointed to Chagas being a problem in the Ecuadorian amazon but no one has of yet conducted testing in the area we plan to visit.




(Youth infected with T. cruzi via the mucosal membrane of the eye. Image from http://www.vif.se/Mallar/publicent.aspx?SidID=10123)




(Electron micrograph image of trypanosoma cruzi next to red blood cells. Image from: http://www.rsc.org/Publishing/Journals/OB/News/B707772F_Hot.asp)


For information concerning Chagas disease please see: http://www.who.int/tdr/diseases/chagas/default.htm

In summary, our plan is to enter the two communities via plane, diagnose leishmaniasis on site and provide instructions and medicine for its treatment, while also taking venous blood samples (from all who will participate) to be analyzed at the lab using a proven commercial ELISA kit to look for the presence of T. cruzi infection (in brief, we look for antibodies produced by the body’s immune system which are present if the person has ever encountered the parasite). Education on these two afflictions will be imparted to both communities through their respective community health promoters. If we encounter individuals positive for Chagas disease they will be given a clinical screening and, if this confirms the lab results, treated with Rochagan.

If you read all this congratulations! And don’t hesitate to email me with more questions: wautersm@gmail.com

Best,

Mike

A day in the city

Today was full and I feel inspired to relate.

It all started off with a practicum in the lab to learn how to take blood through venipuncture. This was the second time we had done this, and after each stick (all successful so far!) I feel a little more confident. Blood is an incredibly useful substance in the testing of a whole number of tropical infectious diseases, and not being able to acquire it is a huge detriment; thus, we practice on each other to not mess up when the real deal comes! Today we also practiced how to do a finger prick and use the resulting drop of blood to make a smear that we later stained and examined under the microscope. The stain has to be made thin enough so the RBCs don’t pile up more than one thick, but too thin makes checking for infections tough – a happy medium is best. The stain we used picks up nuclei, thus clearly showing the WBCs as well as any parasites present (such as those in malaria or chagas disease). Our basic self-check showed no parasites, nice!




(Our happy team – you know you work with good people when they let you stick needles in them!)




(Looking for parasites.)


After the practicum I headed out to meet up with Molly, the sister of my good friend Russell. Molly was in Ecuador on a spring break trip to assist in the delivery of medical care in underserved areas near Otavalo and had a few days free afterward to explore Quito. As she had already done most of the normal touristy activities I decided to show her parts of my life in the city. This included a tour of the lab, walking (a lot) around parts of Quito she hadn’t seen, exploring Parque Metropolitano (where I go mountain biking), and returning to her hotel via the Ecovia (a double-long bus on a set route – fortunately it was packed to the point that almost everyone had to stand and hug each other to fit on; an experience I think shouldn’t be missed when in Quito:)




(Inside the Ecovia on a not so full day. Take this pic and add in about 10-15 more people just in the area pictured!)


After dropping off Molly I headed for home, stopping briefly to watch one of the live street comedy acts so popular in the historical center. I am always wary at these as the actors like to involve the audience, and a tall gringo is a ripe target indeed! Later on, waiting for the Ecovia, I felt a nudge at my elbow and looked down, an older man grinned up at me.

“How tall are you?” he asked.

“1.9m”

“Nah, you gotta be at least 2m.”

“I assure you, just 1.9m”

This was my introduction to Juan. He seemed like a friendly fellow and so as we boarded I took a seat next to him and continued to chat. He told me he is outgoing and likes meeting new people; I told him this seemed clear. We chatted about his life and mine, and I found out he was 79, amazing as I would have pegged him around 60. I asked for the secret to his youthful appearance and he replied sleeping with much younger women. Then he winked at me. I’m still not sure if this was some kind of manly connection wink or if the wink implied the whole thing was a big joke. We chatted some more but my stop came up all too soon. As the Ecovia passed me by Juan gave an enthusiastic wave and a big smile. Man, I love people Juan. I just hope he was joking about the multiple much younger partner advice:)

Tonight the adventures continued with Julian and I venturing out into the dark garden to look for animals. We were on the lookout for lions, tigers, and cows, but found slugs and pill bugs instead – a great success.

Shell

You might think Shell means the thing one finds at the beach and you’d be right, but it also is the name of a town in the Ecuadorian rainforest. This is where I was the past few days. The name Shell actually comes from the oil company Shell, as they set up the first settlement on the present day site years and years ago.

I was in town to attend a tropical disease conference being given by two of the professors I work with and to then get to know the Hospital Vozandes Shell (run by HCJB – a missionary group that started in Ecuador in the 30’s and is now all over the world, I have an earlier blog with more info on them a ways back).




(Theo and I in front of the Hospital Vozandes-Shell)


The conference was great, a far larger turnout than expected but everyone managed to cram in. Dr. Guevara talked about Chagas disease in Pastaza province while Dr. Calvopina discussed Leishmaniasis in all of Ecuador – focusing on the more rare but severe subtype known as mucocutaneous leishmaniasis (aka MCL, and is only found in the non-coastal rainforests of Ecuador). There was even a patient with MCL on hand to come forward (I felt horrible for the poor guy, it was like a zoo exhibit) to show the docs what to look for and afterward how to properly take a sample from the dermis to look for the amastigote form of Leshmania under a microscope.




(A view from the back of the packed conference room.)


After the talks the two doctors headed out while Theo (lab compatriot), Jessica (fellow fulbrighter doing a bio project who joined us for the trip) and I remained behind to check out the hospital and town in more detail the next day. The morning started with a hunt for breakfast. We wandered into one small panaderia just in time to see a mountain of fresh bread being pulled out of the oven. Our decision of where to eat was a no contest; I think I ate 5 of the utterly delicious “pancitos.”




(Minutes fresh bread for breakfast, yum!)


From there we headed up to meet a doctor Theo knows well in order to get to know the hospital better. Unfortunately, he hadn’t arrived back from a Quito trip yet so we didn’t spend long there. Theo took us on an excursion to find the old hospital site, which was successful, but the real excitement came on the trip back. Walking along the road, I heard someone call out to us in English and wheeled around in surprise. Across the road a middle age man beckoned us over. After a bit of chatting we found out he was semi-retired missionary by the name of Richard Michael (my father’s and my first names combined) who now flies people into remote villages in the rainforest. He showed us his plane sitting behind the house, with a strip of pavement directly connecting him to the airstrip. We ate fresh citrus and chatted about our individual paths leading to all meeting up in that sunny afternoon. One of those experiences that demonstrate you can never expect the next turn in the road, especially in Ecuador:)




(Ricardo's plane and a backside view of his house)


From there we wandered through the town, eventually finding the local soccer field with a game in action. The approaching rain clouds that had failed to chase off the sun made for a striking image. The contrast of the well lit field and the dark sky was amazing.




(The soccer field, mere minutes before a downpour. )


After the rain we explored some of the rainforest around the cabins we were staying in. We worked our way down to a stream where Theo found a vine for swinging out over the water! Good fun:)




(Me swinging!)


So, not the trip I had pictured in my mind but still a great experience!

Ecuadorian Citizen #23098417 – Alberto Bohorguez

Ok, I admit it, I made that number up. But that isn’t really the point, the point is I want to tell you about someone I met recently.

Last Saturday I was heading for home after a little walk and decided to drop by Carlos’ guard post. Approaching the door I could see someone inside and made some weird noise to announce myself; out stepped someone who was most definitely not Carlos!

And thus I met Alberto, filling in for Carlos while he was on his one vacation of the year. I found out he was from the Coast and in Quito by mistake really. He had contacted a man to help him gain entrance into the United States where the individual promised Alberto that a $15/hr job awaited him. Alberto and three other hopefuls met in Quito and after going over the plans paid the man $1,200 each. They met at the appointed time and place… and the man never showed. Tricked by a coyote.

No money, no plan, no family in Quito, Alberto lived for a time in a cardboard box and ate bread. Going three days without food became the norm and he went from a self-described pudgy to stick-thin.

After this tale I had to head for home but I promised him to stop by again. That time ended up being today. Biking home under gray skies and an intermittent rain all I could think about was getting inside, warming up, and finding something to eat. As I passed the guard station I called out hi, continuing to ride. A boisterous “HEY!” responded and Alberto burst out to greet me. He seemed positively pumped to see me and I knew the warmth and food would have to wait a bit.

After some banter he told me so many people in Ecuador treat guards like servants, not fellow human beings, and he was grateful I wasn’t taking that approach. His story continued.

After wandering the streets for a while he was eventually able to find employment as a guard. I asked him how that was going as he was obviously still with it. Long hours, little pay, and dangerous was the reply. He told me one time he was attacked from behind, something was smashed against his head, and he awoke bloodied and confused to be interrogated by police as a possible accomplice to the crime. Alberto’s shift that night was normally staffed by two guards but that evening his compatriot hadn’t showed up. The guard company employing him has refused to pay for an X-ray even though he still feels the effects of the injury 5 months later. Alberto cannot afford it by himself.

After this he called out someone who was inside the guardhouse, and introduced me to his 16-year-old cousin who has come to Quito in hopes of finding work. His cousin doesn’t have a place to stay so he overnights it with Alberto for the moment. There isn’t enough room for even one person to lay down in the little shack they call a guard station, but two?





(Alberto and his cousin.)

By this point I was positively freezing and saying goodbye I headed for home. As soon as I got inside, I started thinking about Alberto and his cousin sitting out there in an un-insulated hut, shivering and with nothing to eat for dinner.

Grabbing two bananas and my camera I headed back outside.

I returned an hour later, after having chatted with Alberto and his cousin on topics ranging from being careful not to marry too early to the economic disparities between our two countries. We had all crammed into the little guardhouse to avoid the cold; it was cozy to say the least!

And here I am, inside, warm, belly full, and writing you all. I posed a question a while back, that being - why was I so lucky? I didn’t have an answer then, I don’t now, and I imagine I won’t ever really figure it out, but I am starting to see maybe I’m asking the wrong question. It seems a better way to look at this conundrum is: what can I do for those who weren’t as lucky as me?

Hope you’re well.