A day in the life

We have been in Guadalupe for about 3 weeks, and so we are settling into a routine a little bit.  Since some of you might wonder what a "normal" day is like for us, I will give you a sense of what we are up to.

We have to get up early, because school starts early here -- Emmett and Annalise have to be at school at 7:30am.  Ecuadorean schools don't really have the resources or infrastructure to feed kids at school, so they start early and finish early so the kids can go home to eat lunch (they are home by 1pm).  So we are up at 6-6:30am to have breakfast and get ready for the day.  The kids are in charge of getting dressed, putting on their sunblock (good old SPF 50 is part of our every day routine, like brushing teeth), washing their breakfast dishes, and getting their school stuff together.

Once they are out the door, I get ready to start my work at the clinic at 8am.  My commute is about 2 minutes, walking across the river on the foot bridge, and up the hill to the mission.  There is a crowd of people waiting outside the clinic when it opens.  People come to see me ("general medicine"), the dentist (there is a steady stream of dentists that come for a month at a time, mostly from Austria and Germany), to buy medicine at the pharmacy, or to buy eye glasses.

I step into my "consultorio" and get ready for the day.  The patients have to stand in line at the pharmacy to register to see me and/or the dentist, so it takes a few minutes to get them signed up.  There is a simple electronic health record, which is basically just a list of SOAP notes.  The patients pop up on the electronic system when they are signed up and ready to be seen, and I call them into my room in the order that they were signed up.  I believe they have to pay $1 to see me or the dentist, and sometimes up to $5-6 more depending on the treatment plan.  I believe it costs $5 for the dentist to fill or pull a tooth.  For me, if I do a minor office procedure like a skin bump removal that requires a sterile tray, the patient has to pay $5 for a sterilization fee.  If we decide to do a cortisone injection in a knee or shoulder, they have to pay $6 for the steroid that I then inject into their joint that day.  The pharmacy is reasonably well stocked, and medications are sold at low prices.

We have a very limited number of point-of -care tests that we can do -- a urine pregnancy test costs $2, and we can do a urine dip, a spun hematocrit, or a blood sugar for $1 each.  I could do a wet mount free of charge.  That is it for office diagnostics.  A small handful of times I have sent someone out to a lab to get some blood work done (mostly at their urging) -- but they then have to return to the lab a couple of days later to get their results, and then bring them back to me.  I have not yet had anyone return with their lab results.  I am really relying heavily on my clinical experience to make treatment plans, and I am trying to just do the best I can.

The size of the crowd in the morning is highly variable -- this past Monday there was a bus that had come from a town about 3 hours away, so it was busy and I saw 18 or 19 people that day.  For the rest of the week I saw 3 to 5 people per day.  I would say the average so far has been about 8-10 patients per day.  The goal is for me to be done by 3pm, though often I am done well before that.  When I finish, I can go home and hang out -- and they will call me if more patients show up.

While I am at the clinic, John is normally at home -- studying Spanish, exercising, reading, etc.  The clinic closes at lunch time, from 12-1pm, so I come home for lunch.  There is a lovely local woman whom we pay to cook us lunch, help clean our apartment and do our laundry (until recently the washing machine was broken, so it all had to be washed by hand).  So there is a yummy a hot lunch waiting for us every day -- which is a nice luxury.

In the afternoons, the kids do their homework, whatever they may have from school that day and also a couple of pages of their math books from Tacoma Public Schools.  Then they relax and play with friends.  Emmett and his buddies play soccer, or to go the river to to swimming.  Two days per week at 3pm, Annalise and I have beadwork lessons from a local artisan who makes really beautiful work.  It's fun to be learning a new skill and doing something creative.

John is teaching a conversational English class to some people from the town two evenings a week, and Emmett usually goes to help him out.  The people in the class are really appreciative of their time, and John and Emmett seem to really enjoy teaching them.  John may well start helping teach some English in the kids' school as well.

I have been doing my best to make tasty and healthy dinners from our local resources -- I can usually get fresh chicken (with the feet still on -- it seems that people eat them here), carrots, potatoes, onions, rice, plantains, tomatoes, cucumbers.  The variety is OK but not awesome, and I have to get kind of creative to not make it seem like we are eating the same thing over and over.  I have been baking some good banana bread and apple bread, and we even managed to bake some brownies from scratch.

So, we are slowly settling in to a new pace of life, with different demands and different blessings from what we experience back in the U.S.  While we miss the variety of foods and a good glass of wine, we are also really happy to have a more relaxed existence with less focus on "stuff" and "productivity."

That said, we are headed back to Quito tomorrow, to stay a week and to work on converting our tourist visas to "missionary" visas -- an important task if we want to stay for the year.  Stay tuned!