Day 5 – January 11, 2025
Day 5
Day 5 – January 11, 2025
After a good night’s sleep, I felt refreshed and ready to meet the day. Jane, Claudia and I are the only ones here for the weekend. Jane needed to go into town to purchase some food for next week so we planned to go with her and see the local market that is up and running every Saturday. We decided to go to the market around 7 am as Jane said a lot of the vegetables would be sold out by mid morning generally. Plus, she needed to be back at the clinic by 9 to attend the board meeting for her mission. The board consists of all Americans plus one Ecuadorian. They meet virtually and Jane joins in to give updates and answer questions, but she is not a voting member of the board. The meeting would run for about two hours.
At the market we saw large displays of many different kinds of vegetables that were locally grown and were freshly harvested. There was an abundance of produce at various vendors on displays stretching about two city blocks of distance on both sides of the street. There was also a rather large meat market on one side. The meat market included a lot of fish for sale that included various salt water fish and shrimp of various sizes, prawns, live crabs, and clams. This section was rather smelly because of the fish being out in the warm air with no refrigeration. One man had several huge red snappers that were all at least 25 to 30” in length. I looked at them and tried to imagine the thrill and work involved in reeling one of them in to the boat. Catching fish is a lot of fun when you are working with fish like that.
Other meat was available, whole chickens that had been dressed. These chickens were huge in size. there were stands with fresh beef and pork that had been butchered. At one stand a man was hanging up strips of cow innards and cuttings to be sold as well as large chunks of beef harvested from a cow that was butchered. Lying on the street next to this display was the cow’s head. What a sight! Jane had told us before we got out of the car to be discreet in taking pictures with our iPhones as we could have them suddenly jerked out of our hands and be gone before we could react. This limited my use of getting pictures of some of the sights.
What is difficult for us to understand is the apparent filth and squalor that is present in this community. To us, seeing so much dirt, poor housing, bugs, stray dogs running around, and all the food out with no refrigeration or some sort of barriers to keep the food fresh and uncontaminated is hard to accept. Yet, the local people live this way all the time and to them this is totally normal. And the people seem to thrive and remain fairly healthy without infections and other diseases. It seems that Jane sees many people who have diabetes and I wonder if that is more prevalent because of the diet and the lack of regular medical care, especially the active management of diabetes.
She sees patients with skin ulcers, many of which come from pressure induced skin breakdown and then healing is very slow or even absent. She will give wound care and help these people to heal up and return to some level of wholeness. Having been here 15 times before this trip and seeing essentially minimal changes in the living conditions is still somewhat shocking to me. In the States we are so protected by all the health codes and practices that seeing conditions where none of that is exercised is hard to get used to. The people here seem happy and content with their present living conditions and life and they don’t complain. They are used to waiting and do not mind waiting a long time to see the doctor. They teach me to live with what I have and make the best of it and to not complain.
This afternoon I was given a special treat. Back in 2010, on September 11, I did the first and only delivery at Jane’s clinic. The mother was Angelita’s daughter and she wanted me to deliver her baby. I remember she came in on a weekend in labor and Jane and I took her back to the operating room and set up the table for a vaginal birth. She successfully delivered a healthy baby girl.
I saw her a year later when Angelita’s daughter brought her in to see me. That reunion, I remember, ended up in the little girl crying because she was scared of this strange man. A couple years later in 2016 she came in again giving me some follow-up on her growth into a young girl.
She came in this afternoon, now at age 14, to see me again. We met outside on the bench by the clinic door and I pulled up the pictures of her birth and then a couple more as I saw her a year later and then a few years after that. I love this kind of follow-up, something that rarely happened in my practice. Only in Ecuador would it be special days like this that make this place have a special place in my heart.
For dinner Jane took us out to eat at a small corner eatery where we have been able to get good meals. They had a main menu of grilled beef, pork, or chicken served with beans, rice, slaw, and a potato. We each got the pork which consisted of two grilled pork chops that were quite tasty. I didn’t eat the entire meal but brought a good part of it home with me for later consumption.
After returning to the clinic we all retired to our rooms for the night. I am tired even though I didn’t do much of anything today. I am looking forward to another good night’’s sleep.
Medical Missions 