Wednesday, July 24, 2013


The last few weeks have been jam packed with work, fun, and travel. I've really gotten to feel at home - or as much as is possible considering that my stay has an expiration date - mostly thanks to making some more friends in Quito and getting busy with work. 

One particularly exciting thing is that I've been able to pick up a lot of skills simply by watching Dave and others in the lab. Much of the credit goes to Dave, who is a fantastic teacher - super encouraging, and he doesn't dumb things down for me just because I'm not a master in the field. I'm not sure I've ever met someone who can be so much fun and so goofy and yet still get things done extremely well and efficiently. 

So, this is to say that it was really cool when Dave told me to get a trans-tibial (below knee) prosthesis ready for a patient and I was able to complete all the steps: filling the mold, pulling the plastic, cutting and grinding the plastic, and putting the leg and foot together. And what's better -- I got to help deliver the prosthesis to the patient - a guy named Marco - and watch him test it out. 

A little about Marco:
Some years ago he was diagnosed with osteosarcoma, a form of cancer that is typically found in the legs and often requires amputation. After the operation, Marco decided he wanted to study medicine and work with cancer patients. Right now he's in the middle of his studies -- the tragic thing is that doctors have found osteosarcoma tumors in his lungs. This diagnosis is pretty bleak, meaning Marco will likely die before he can become a doctor. Despite all of this (or perhaps because of it), Marco was absolutely beside himself with the new leg. In 15 minutes he was jumping around and kicking me a soccer ball that we have in the kids toy box in the fitting room. Just this week he invited Dave to a potato-picking party at his family's house as thanks. 

With this situation, it's hard to forget that Marco is dying. When he left Proteus, I didn't know what to say, really. I said something like, "It's my pleasure. Good luck with everything!" I think Dave did it better, saying "See you next time." I suppose it's a reminder that you can have a success story hand in hand with sadness. It's an amazing thing to be able to give someone their mobility back, but it doesn't beat having an actual limb or not having cancer. 


Part of the reality of being here is that there are a lot of people passing through my life. Growing up, you get accustomed to people being permanent fixtures your day-to-day. And then, you go off to college and some of those fixtures change and now you have some new permanent people. But as a traveler, friendships can be 2 weeks, 2 months, 2 days. It feels easy to open up, often, because fellow travelers are like unlikely comets crashing into each other and then going on their merry way -- the probability that you met this person, here, is so preposterous that you might as well just be yourself. 

In many ways, I'm also passing through the lives of the patients I work with. I'm getting a little glimpse into their world and then sending them off with some pretty cool new hardware. I wonder what that means to them, or if they'll remember the blue-eyed American volunteer that spoke broken Spanish to them and handed them their new leg. Just some thoughts and questions I guess... not as many answers, but that's ok. 

Wednesday, July 17, 2013

Mindo, the Cloud Forest!

I haven't had a travel post in a while, so here it is. My friend Andrew and I went to Mindo a couple weekends ago, and it was the bomb-dot-com. First off, the bus ride there was, shall we say, unique. The bus was full when we got to the station so we sad on the floor in the aisle between the seats... it was one of those moments where I knew I could appreciate the youthful experience at the time but wasn't sure if I'd be doing this at 40. Luckily some people got off so we did end up with seats for most of the ride. 

So, without further ado, we arrived in Mindo. All I can say to sum up the place is: beautiful, tropical, friendly people, tranquil. Mindo is in the cloud forest and at a lower elevation than Quito. It's got a cute little river running through it, which was refreshingly familiar to Upstate NY. The first thing we did upon getting there was get settled at this cute hostel on the river with a nice host named Henry, who had worked for a time in London in fancy shmancy hotels and the like. Then we checked out the chocolate factory, El Quetzel, and had a brownie and some ice cream. We didn't end up getting to do the factory tour, alas, but maybe some time in the future. 

Andrew Crosses the River to Retrieve the Forgotten Sunscreen

The next adventure was ziplining! We walked pretty far up this hill and then fortunately caught a shuttle the rest of the way up. Hilariously, there were two stoic cows at the entrance of the ziplining that were just staring us down, as pictured. 

Judging Cows

Alright, so there were 13 ziplines that crossed 2 valleys and varied in speeds. Overall, super fun. But nothing topped the last line I did wherein the zipline guide went with me and flipped me upside down (still safely strapped in), so I flew across the valley mariposoa(butterfly) style. 

The town in general had a great vibe -- really laid back with very friendly people. We saw two boys on the road trying to fix a bike, and we did our best to help them out but the chain was too big. They were super cute and said "Have a long life!" or something like that to us when we left.

At night we went to a fun bar/club with some good salsa dancing. Andrew and I worked on our moves amidst the crowd of other dancers, and I think we did respectably. We looked for another place to go out, but all we found was a Quincinera that was blasting techno music. At first we thought it was the lamest club in the world, but the 15 year olds in dresses kinda gave it away. The next day, we heard a couple Americans saying they mistakenly went in there to party and were awkwardly rocking out amidst the family/friends of the birthday girl = so funny. 

The next morning we had a 6 am bird watching tour planned, and in classic fashion we woke up an hour late but we still got to go with Irman, our guide. At first, things were a bit dull BUT THEN we started seeing the toucans  There are 4 species of toucan native to Mindo and we saw... wait for it... all four. Boo ya. We got to look through a sweet bird telescope to see them up close. Overall, I'm not sure I have the patience to be a bird enthusiast, but this was pretty cool. 

Toucan Action

Afterward, we went tubing on the river, which really mean bumping around in big black inner tubes, scooting over rocks and avoiding branches. But it was a good time, and a short little excursion. 

It was an adventure filled weekend, and we had a nice ride back to Quito. I really loved Mindo because of the great community feel and the beauty and tropical forest feel. Highly recommended if anyone ever gets to Ecuador.  

Good Times with the Military.

Working at ISSFA (Instituto de Seguridad Social de las Fuerzas Armadas - Institute of Social Security for the Armed Forces) has allowed me a glimpse into the corporate/military world in Ecuador. The work environment is much different at Proteus, where it's such a small group of us joking around and such (and getting work done!). 

Here's how it goes at ISSFA. I catch the bus for about 10 minutes and it drops me right off at the door. I've taken to liking the bus, perhaps more as a cultural insight than anything else, because there's always some form of entertainment. The other day there was a rapper (I think the same guy as before), an opera singer, and a guy playing guitar and panflute who performed on the various legs of the commute. So, once at ISSFA, I have to get a special pass to go the the 2nd floor where my boss, Armando, is. Then I get in my cubicle and start plugging away at the database, while listening to music or an audiobook. It brings me back to that "traditional" engineering job, the one where you sit at a computer from 9 to 5 every day. I'm excited about setting up the database and what it means for military amputees, so that keeps me chugging along through the day. But I am certainly reminded that I'm not the cubicle type, or not all the time at least. 

There are some fun norms and quirks at ISSFA. For example, everyone wears the same uniform every day. I noticed that Armando and another worker were both wearing salmon and grey suits and then he pointed out that everyone was wearing them - it goes beyond a dress code even... the clothes are bought by ISSFA and supplied in the correct sizes to the workers, kind of like a school uniform. Hm, what else? Well, in Ecuador in general saying hello and goodbye to people is very important and polite. At Proteus it's easy because we just say hey to the few people who work there. But at ISSFA the norm is to announce "Buenos Dias" to a whole room of people when you walk in, and they all respond back. 

The different floors play different music. My floor is salsa, which I like. But the 3rd floor, which is the tech people, plays heavy metal (hilarious). The guy who was trying to set up wifi for me had a screensaver of a band called "SouldBurn". Not my style, so I'm thankful to be with the salsa crew. For lunch, we go up to the 7th floor to eat an in-house almuerzo, and afterward everyone walks around outside to digest. I have to say, I really love the food culture here. Lunch is the biggest meal of the day, and everyone, without fail, takes about and hour to eat with coworkers and take a break from the day. I'm very convinced that this contributes to a better work environment here and would greatly improve the work experience in America. 

So I work with Armando, a cheery guy who's quick to laugh and talk really slowly for me when I'm having trouble understanding something. There's also Gustavo, who asked me if I was single 2 minutes after meeting me. He's a nice guy though - a 25 year old marine with a kind of boyish look and voice... I think that's enhanced by the marine uniform he wears which looks like a little boy's sailor halloween costume (in an adorable way). He's actually really good at English, so it's nice to be able to communicate a little less haltingly. 

Even in the corporate environment, people are very jovial here. It's rare to go a moment without someone cracking a joke or teasing a friend. People love to tell me that their coworkers are "loco" (crazy) and things like that; they think it's pretty hilarious to embarrass their buds in front of a gringo. 

Friday, July 12, 2013

A Day in the Life

I've been doing a lot of storytelling in this blog, but I want this post to be about the little day to day things that happen and might get lost in the hustle and bustle otherwise. In many ways I still feel like a fly on the wall here, observing this place from an outsider's perspective and cocking my head at some of the perceived oddities.

Walking to work:
So I go uphill about 20 mins to get to work, and I walk faster than essentially everyone here. I don't know if that's because I'm used to it from the states or because I just know where I'm going and don't really meander much. There's a lady who sells madura (sweet plantain) with cheese in the same spot on the street every day... I've been meaning to buy one from her but haven't yet. Most of the stores here are these weird little things that sell a small amount of a bunch of random stuff, almost like a flea market. I don't know how that type of business model works out, but I suppose it does. Though I've heard from Americans who are in business here that the Ecuadorian business model isn't very competitive- as in, they have a lax way of approaching cost/profit. Crossing the road here is either a complete science or no science at all, I'm not sure yet. All I know is that most people are constantly flirting with disaster. To go along with the weird shops here there are street vendors selling the most random stuff - crocs being one of the highlights. 

There's one store that I pass that only plays Adele... literally, it is the only music I have ever heard coming from that place. 

Goofin' around in the Lab

Taking the bus:
Only been doing this for a little bit because I use the bus to get to ISSFA, where I'm working on the government database. Today there were a couple amateur rappers serenading the bus. I caught that they said the word "casa" (house) and that's about it but  it was cool anyway. They were followed by a guy with a stomach tumor who showed it to everyone and was asking for money. Part of me was glad that in America there is enough of a culture of detachment/personal space that something like this wouldn't generally happen, but then I thought maybe it was sad that most people in America wouldn't show their stomach tumors because they know no one would care that much. Well, that, and we are generally healthier, at least in visible ways. But you're probably not gonna run into a diabetic in America who'll ask you for money for their insulin. The motorcycles here don't really follow any sort of road rules. Today I saw a guy drive about 100 metres on the sidewalk when traffic was slow. 

I went into a market today and there were entire roasted pigs on in, everything from head to tail in almost one piece (it was already dead though, phew). The ladies at the stands were trying to get everyone to try a little sample of some part of the pig kind of like Chinese fast food in American shopping malls. 

Last week when I had a cold/fever, my roommate's dad suggested a mix of rum, lemon juice, and coca cola as a cure. That one cracked me up... I kind of feel like it would work. Or it'd be so disgusting you'd forget you're sick. 

Now almost 6 weeks in, I also feel myself adjusting in some ways to Ecuadorian life. The first time I tried Almuerzo (the 4 course, $2.50 lunch that is proliferous here) I was underwhelmed. Now, however, I'm verging on obsessed. For one, the amount of variety they serve day to day is incredible and the food is always fresh. There's a great balance between veggies, meat, and carbs. And it's such a good deal too. I've really gotten to like the understated, homey flavor of these dishes. I've been wondering if the restaurants actually turn a profit serving almuerzos - they must, but I doubt it's very much. I think school lunch programs in the states should adopt these, for real.

Tuesday, July 2, 2013

New Projects

Something that has always challenged me is creating new momentum for a project or experience. I've always been quite good at exceeding expectations when they are laid out for me, but I sometimes struggle with creating my own expectations and goals. At the halfway mark of this experience, I found myself looking for small projects to keep me on my toes and to go beyond the learning experience I've had in the lab. 

For a short time, this meant that I was looking around the lab and trying to invent a design problem to create a solution to. This is not necessarily a bad thing, but it left me staring off into the lab with not much to do. That's when I realized that this impulse stemmed from my desire to connect, in a very literal way, this experience to my engineering design background. However, as good as design challenges can be when they do present themselves, I've decided that I shouldn't waste time trying to fabricate them to the exclusion of simpler, less tangible goals. 

There are many small tasks I can take on at work that will bring more meaning to my experience and yet have nothing to do with engineering. For example, I have often been in the room with families, alone, while Dave has to go make a quick adjustment to a prosthesis. Though my spanish is improving, I am often left with a lack of proper grammar/vocabulary to address the patients and ask them about their day, their lives, likes and dislikes, etc. So, a very valuable and extremely simple goal I've set for myself is to improve my conversation with patients at times like these. This means more actively getting on top of my spanish and even memorizing certain phrases with correct grammar, etc. 

Fortunately, I've recently come into two new projects that will keep me busy until I head home. On top of the work I do at the lab, I'm going to be creating a database for military amputees that makes it easy to see who needs prostheses updates and when they need them. This will allow the government to propose all of the prosthetics work for their amputees, in any given year, all at once. This makes the whole process streamlined because the entire year's schedule can be figured out at once which cuts down on the possibility that a patient's prosthesis gets delayed due to organizational inefficiency. 

The second project that I'm working on is designing a new rack to hold the large sheets of plastic we use in the lab. Right now, the plastic is leaning on a wall and wedged behind the oven which makes it super difficult to get at and even more so to put back. One of the best things about having Dave as a boss is that he is ridiculously supportive of any and every idea that I throw at him. I mentioned that the plastic was difficult to work with and we immediately started going back and forth with ideas for a solution. He basically said, Design it and we'll have it custom built. So, there's my engineering design project. And it came to me more after understanding how the lab worked than by arbitrarily looking around and picking something to change. I've got a few ideas sketched up which I'll talk to Dave about tomorrow, but I'm very excited by the independence this project gives me as well as the fact that it will become a tangible reality. I also love bouncing ideas off of Dave, and together we both start nerding out on the concepts. 

The work in the lab continues to be rewarding, and I get great satisfaction out of improving at any particular task. If I were to go into this field, though, it would be as the prosthetist (or maybe an engineer designing the parts) as opposed to a technician because I need the intellectual challenge that the human physiology brings to the table. The combination of biological problem solving (determining how to fix someone's current physiology) and technical problem solving (figuring out how to actually fabricate a prosthesis/part that accomplishes that) is the best of both worlds. 

All of this has certainly made me think about getting a master's degree in prosthetics. At this point, it seems to make sense to work for a bit out of college to get industry experience and get a better sense of how I fit into industry and what my specific likes/dislikes are. And then, after, to look towards a masters... I'm still pondering neuroscience and product design as two other options as well. 

Sunday, June 30, 2013

A Little Rambling is Good for the Soul.

Currently relaxing back at in my apartment after an exhausting but awesome day of mountain biking at Cotopaxi, Ecuador's largest active volcano and one of the largest in the world. The tour took us up to the base of Cotopaxi and we started by riding down the winding road to the bottom. The road was really bumpy and all the vibration was a little tough on the hands. With me were four others - a threesome from the states on vacation and a British guy doing a 10 month exploration of South America. After that little bit we went off road across the beautiful valley below the volcano. It reminded me a lot of the scenes in Lord of the Rings where the fellowship is crossing those yellow fields to get to the Mines. Anywho, this is was by far the best section and we were literally the only ones riding it which made the whole thing more serene. We got to check out some Incan ruins (an old fort of theirs) which was c00l. Jan, the Dutchman of the Biking Dutchman company that hosted the tour, gave us a fantastic lunch complete with brownies made from cocoa plants grown in Ecuador - yummmm. 


This weekend got me reflecting a bit on the experience of traveling solo here in Ecuador. Despite the fact that I am down here by myself, I very much rely on others for weekend travels and such. This weekend my plans to go for a long trip fell through, and I was pretty bummed but also began thinking maybe I would travel to this particular place alone. Safety, of course, held me back and it made me a bit frustrated for a few reasons. At some level, I attach a sense of complete independence to the ability to take on that solo voyage and meet people along the way and have that quintessential backpacker experience. Also, I sometimes feel that I am too afraid of the world and the possible risks associated with whatever and it worries me that I might hold back from a truly great experience because of it. In truth, I questioned coming down here due to safety concerns, and that would have been a real mistake. Finally, it really bothers me the reality of having to take much greater precautions as a woman traveling alone than as a man. I don't think it's a fabrication to think that I would have traveled alone, no doubt, by now if I was a man, but have not partially because of being a woman and the dangers associated with it. 

All those points made, I have realized (definitely with the help of talking to others) that independence is what you make of it and I actually have a great deal of it and have cultivated more by coming down here alone. It's been a good learning experience to be forced into a new culture/language/location alone and to make friends and acquaintances on my own. It can get lonely, for sure, but working through that has been essential to the experience. At this point, I have a solid little base of people I call friends and I've realized how solo travel brings up countless opportunities to meet super interesting people. 

There's Austin and Aliya, two kickass freelance journalists who traveled here from Egypt to follow the Assange case and now Snowden as well. They're two of the most knowledgeable people I've ever met about world events (I suppose that's necessary for a journalist) and even in the short time I've known them they have caused me to reflect on the importance of having a stance on things, formulating an opinion, and being open to talking about it. They're also fantastic at questioning the status quo in a way that makes me think about my own role in, dare I say it, changing the world. 

Richard and Andrew are two chill guys I traveled to Banos with - it seems that we're all in a similar boat about trying to figure things out and hoping maybe Ecuador is a place to facilitate that. Andrew is studying for a law degree and working for an environmental lawsuit here and Richard came to work for a hostel pretty much out of the blue. In all honesty, it seems that most people here - foreigners at least - are looking for something. Or maybe we're just more honest about not having it figured out. There's a great amount of camaraderie in being in a new place together. I'll also add Justin, a paramedic here, to the list of we're-figuring-it-out.

There was a cool Australian guy who was traveling around the world. And Simon, a British guy I went biking with for the day, was doing something similar. He had a very interesting perspective on travel - I don't know whether it was a getaway for him or if it was simply taking advantage of being young. In terms of how long travel disrupts your "career" (or just career depending on how much weight you put into the whole idea), he said: Is there really any risk? At worst you work a bar job or whatever until you can get another job you want. Ok, so that didn't sound as philosophical as when he said it, but it does make me question the illusion I often fall prey to about the linearity of life. When in a place like this, maybe it's that you appreciate the figures that pop in and out of your life. Though I'd say there's a statistical likeliness that people who ship out to Ecuador on a whim are more interesting or have more to say than the average person. 

Quito has been a good reminder that I can't try too hard to prescribe a certain experience for myself. There's a lot of imagery out there that makes me feel that I have to have certain stories to tell at the end of this trip but there's no way to live up to them. I do believe that some of the best things in our lives happen when we aren't looking for them. So, here's to not looking too hard and having four more weeks to explore!

Wednesday, June 26, 2013

Banos 'n Stuff

Week 3 has come and gone, but not without the usual excitement and adventure. At work we had some great patients:

There was a young guy completely funded by the non-profit who got a below knee prosthesis. He was the most adorable 18 year old guy, and absolutely dominated his first day of walking. He had the biggest smile on his face while he practiced his gait with his dad cheering him on. It was awesome to think that this prosthesis cost him nothing and could totally change his life. I only say could because a lot of the effectiveness is up to the patient - whether they are actually using the prosthesis and practicing with it. But on our side of things, the process is completely sustainable. What's great about David's non-profit is that he has hired local Ecuadorians to work for him and he himself lives in Quito. Many other prosthetics non-profits aren't long-term because they provide an expensive prosthesis but don't stick around to make adjustments when the fit is off or when the patient's limb shrinks over time. With ROMP, the patient simply has to come back to the permanent clinic to get tuned up. 

Another guy we had was nicknamed Nacho, and he allowed me my first in-person look at cheetah blades (curved prostheses used by runners in the olympics, etc). 

So, Nacho had an awesome cheetah blade on his left side -- it was a great opportunity to see the difference in gait that occurs with the blades. He was really comfortable with his, so the difference was almost imperceptible. The biggest deviance was that he didn't bend his knee on the left side nearly as much as the right, and that's simply because without calf/lower-leg muscle on that side there is no process by which to push off the ground. The real benefit of the blade is that it is much lighter than a day-to-day prosthesis and the carbon fiber material is springy and allows a higher energy return as well. 


As the days go by I get more and more into the swing of things here in Quito. What I like most is being surrounded by Spanish, new foods, good people, and my work of course. I'm not so keen on the smoggy-ness/car infestation that there is here. Sometimes when I'm walking to work it is almost hard to breath because of the exhaust fumes from cars and busses. I think it would be tough to live with that for a long time. Quito is a great location, however, to have weekend excursions to places with tons of fresh air and nature. 

This past weekend I went to an adventure sports town in the direction of the jungle (the Amazon that is) called Banos. I went with a couple of friends - an American and a British guy - who I know through my roommate. We headed out on Saturday and had a 4 hour haul to get there... we got a bit of a late start and arrived around 1 pm. But we wasted no time in going to a spa - Banos is known for waterfalls, chocolate, and spas - called el Refugio. There, we all got something called "Banos de Cajon" which were wooden boxes that you sit in (your head sticks out) that fill with eucalyptus infused steam. You get all toasty in the steam and then they pour cold water over you... it felt great! In addition they give you some awesome tea-juice stuff to rehydrate with and the boxes are located in front of a huge glass window overlooking the mountains and river. 

After getting loosened up in the BdC we all got massages... it was the first time I've had a massage with hot rocks. At one point the masseuse left the rocks resting on my back and in my hands = immediate sleep. 

Needless to say, that was awesome. However, it was totally topped by the whitewater rafting we did the next day. We went to sign up for the rafting and the dude asked us if we'd ever done rafting before. Worried that we wouldn't be allowed to go we said yes of course. I think the last time I rafted I was 8 and mostly just sat there. Lucky for us, everyone going on the trip was a newbie and there wasn't really any prior experience necessary. They took us in a fun wagon-car thing, blasting music, as we drove to the river entrance. There they split us up and instructed us about how to paddle together and what to do if someone were to fall out. Everyone in my boat was from the US, Canada, or Britain so our team name was the Allied Powers - woohoo! The rafting was a level 3+, meaning mostly 3 with some 4 sections (the scale goes 1 to 5). It was a rollicking  good time with just the right balance of excitement - ahh, almost fell out! - and relaxation. The leader we had on our raft was a definite pro and seemed to be the alpha male of the raft leaders because he was always yelling at them to do things. He had a very urgent way of yelling "Forward! Paddle! Faster!" that made the whole thing more life-or-death seeming (in the best of ways). At one point we got a bit turned around and he yelled at us to row backward very fast... we didn't quite catch on fast enough and went directly into a huge rapid while facing backwards. It was awesome. 

The Allied Powers. Spoiler alert: We Win WWII.

If I happen to have the time, I'd definitely go back to Banos because there's so much to do there and everything is so cheap compared to the states... rafting for a half day plus lunch was only $30. 

Tuesday, June 18, 2013

Work and Play (aka Trying New Foods)

This past week marked 2 weeks in country, meaning I'm 1/4 of the way through the project. That really blows my mind, especially because I know the rest of it is gonna go so fast. 

So, what's new? This past week was mostly about exploring Quito more (especially the food) and getting really comfortable with my surroundings. A safety checkup in case anyone's curious -- I feel really safe now that I know Quito and my area very well. I know what precautions to take, common sense stuff really, and I know how to flag a legit cab and can even communicate my needs in Spanish. So, on that front, all is well. And that realization has allowed me to enjoy things much more :)

There were some great personal and team successes this past week at the clinic. One of the best was fabricating and testing a prosthesis for a hemipelvectomy patient (the entire leg and half of the pelvis is removed). For this guy, the cause was cancer - osteosarcoma to be precise. Unlike clinics in the states, here we see a lot of young people, under 40. The two major causes for amputation that I've seen are motor vehicle accidents and cancer. But the cool thing about it is that these young people are rarin' to go on their new limbs so it's particularly fun to watch them walk and even run/do sports again. 

The man himself!

 Taking the first few steps. 
This guy was the definition of determination. 

The steps to get this guy back on his feet (one real, one mechanical!) were to:

1) Take a cast of the residual limb. This means using fiberglass cloth to wrap around the limb that has been amputated (once it's healed of course) and get a cast of the area. While doing this, David applies more or less pressure in certain areas that he wants to hold more or less of the individual's weight. He'll also draw out critical anatomy that helps to determine where to give more or less room in the socket.

2) The cast is then put in our sand box (brings be back a few years) and filled with plaster. This gives us the mold - in other words, we now have plaster shaped in the same way as the patient's residual limb. I can do this step!

Carlos (one of the other prosthetists) adjusting a plaster mold.

3) We then heat up sheets of plastic (there are different types for different sockets). For a test socket, that will need to be adjusted to get the right fit initially, we use a clear plastic, and otherwise there are various thicknesses of more permanent opaque plastics. After the plastic is heated up we quickly drape it over the plaster mold and force it to conform exactly to the mold with a vacuum. 

A little plastic action.

4) Once dry, we cut the plastic socket off the mold and grind down the edges until it's the exact shape we want. Then we buff the edges to make sure they're nice and smooth. 

Back to the old grind (ah, puns).

5) Finally, we attach the pylon (the metal rod that basically replaces the leg), the knee joint (if necessary), and the foot. Voila, we have a custom made prosthesis!

One of the greatest things about this experience is that all of the results of my work are so tangible. One day I may work on fabricating a socket and the next I'll see someone using that socket to take their first steps. Watching this particular young man learn to use his new leg with such determination was total validation. As hard as I work, I know it's nothing compared to the physical, emotional, and mental rehab that our patients do. And yet, they always leave the room with a smile. I can't wait to see this guy in a couple weeks to see how much he's progressed. What makes the story even better is that while he was in the hospital with osteosarcoma he met another young man with the same disease who had had a prosthesis already made for him. The other man was terminal, and before he died he gave our patient his prosthesis. Incredibly, all of the measurements were almost exactly the same -- it ended up saving our patient over $12,000 which is an astounding amount of money here (most Ecuadorians make about $400 a month). 


Besides all of this excitement at work, the week was spent mostly exploring new foods and seeing more of Quito. Here are some of the things I got to try this week:

Pan de Yuca - little balls of starchy yuca dough, often served with cold, fruity yogurt.

Exotic fruits - tuna (watermelon-like texture, light sweetness) and taxo (very sour, seeds much like a pomegranate).

Ceviche - consists, normally, of fish or seafood cured in a citrus soup (basically). Here it's eaten with popcorn and plantain chips (chifles). 

Cevichochos - chochos (white beans), chifles, popcorn, and tomatoes in a ceviche sauce. This dish is EXTREMELY popular here in quito and a pretty big portion runs you about $1. I wasn't a huge fan because it was pretty watery with the ceviche sauce and didn't have enough spice/flavor for me. 

"Executive lunch" (Almuerzo) - this is a full meal that costs $2.50 and you get a soup, a main dish, a juice, and a small dessert. The main dish is always a meat (probably chicken) and the soup varies. When I went with David it was a chicken broth soup and actually had a chicken foot in it which surprised me to say the least. 

Emborrajados - a much egg-ier version of fried dough, topped with condensed milk, honey, or sugar. 

Dylan, my roomate, and I walked around Quito on Saturday. We saw the Mariscal area which is considered "gringoland" and has most of the travel offices in Quito. We also checked out the super nice mall "Quicentro" which is, quite truly, far nicer than the malls near me in the US. On Sunday, I took the Teleferico to the base of the active volcano Pinchicha which overlooks the city. It was a beautiful view of Quito and the surrounding mountains, and it was nice to get out of the smog of the city for a bit. The Teleferico could be called touristy, but is mostly frequented by locals because the cost for Ecuadorians is about half that as for foreigners. I met two really nice ladies, Terry and Teri (hilarious, I know), who were on a program called "Road Scholars" that was taking them to the Galapagos for a week. It's pretty funny how much gringos stick out in Quito - I spotted these ladies in no time flat. At the top of the Teleferico I also bought some grilled chicken and vegetables that were being sold, and they were pretty delish. 

Can't really go wrong with that view.

I finished off Sunday by taking Lucky, the dog, for a walk in the park. On Sundays, Quito really emphasizes family time so there's a huge fair that happens every weekend in el Parque Carolina right near me. The place is flooded with food vendors, jewelry makers, game areas, and families. There are also tons, and I mean tons, of young couples sprawled out on the lawn, PDA in full force. It's not something that's as common to see in the states, so pretty interesting to see that intermixed with families. 

Thursday, June 13, 2013

Horses, Waterfalls, Volcanos, Oh My!

First, apologies for the horrible reference/joke title of this post. But you're probably over it already, so onward with the tale of Black Sheep Inn and the first weekend adventure. 

Day dos (2) began with another nom-licious meal - some muesli, bangin' eggs, and fresh juice with a base of tomate de arbol (this is a tomato-like fruit that can be used in everything from hot sauce to jam to juice). Then we set out on a horse-back adventure up higher into the mountains above the cloud forest. My horse was Estrella (meaning star... all the horses were named after astronomical features) and she was essentially the Khaleesi of the horses: a very sure-footed lady who liked to lead and would rarely let another horse out-gallop her. Sol, Pat's horse, was the alpha male and he and Estrella essentially led the pack. Ok, horse hierarchy aside, we set out from the town and took the roads up and up into the mountains. The horses much preferred walking on grass which was conveniently located on the very edge of the road/cliff so I had to trust the desire of the horses to not go tumbling off the side. 

The views were really stunning, as I'd gotten used to in the mtns, and we had a good bit of fun hyah!ing and vamos!ing the horses so they would gallop a bit. Like I said, I really didn't have to do anything because Estrella was dead-set on staying in front of the other horses. Most of the time I just told her how pretty and important she was. 

Yea, Estrella had a mohawk. Be jealous. 
Also, sick POV shot, no?

At our first stop there was a cheese-making factory, which was essentially just a big room with some guys pouring cheese curds into a big bucket. From what I gathered, the little cheese pieces get squished into a bigger block of mozzarella. They let us try some young and aged cheese, and the aged was much much better. They both had a really squeaky feel to them, but the aged had more salt/flavor. 

So from there we rode a bit farther, and had a bit of a horse pile up. Well what actually happened was that Sol kinda slid Pat off because he didn't like the other horses tryna pass him. But all was well. We stopped at this gorgeous little grassy hill - it was one of those places you think no one has ever found before (well, obvs not true in this case, but here's to dreaming) and had a beautiful view over the cloud forest. The CF occurs at certain elevations where the clouds sit low, below the hilltops and when you look down from above it's just a blanket of white. There was a wild horse on one of the peaks across from us, so that was rad. 

Cloud forest!

Wild horse, nuff said.

From there we walked to a small waterfall and Greg, the adventure-instigator, was in for a "swim" in 0.6 seconds. He convinced us all to join in and then climb the tiny waterfall to the second pool area. Climbing a waterfall: check. Humbertos (sp?), our really awesome nature-man/guide, took pics but didn't get in due to being commando (we found this claim debatable). After the 'fall, we once again mounted our steeds and rode back into town. It was probably my favorite single activity at BSI.


The next day we hit up Quilotoa, an inactive volcano-turned lake, for a hike. We hiked the entire rim of the crater, with magnificent views of the lake, and it took about 5 hours. The distance was somewhere north of 10 miles, and with all the ups and downs we did it was probably more like 13. It seems that people in Ecuador constantly live on the edge (literally), because the trail was edge-tastic. There was this adorable dog that walked with us the ENTIRE way around the crater. I gave him some popcorn so hopefully he thinks it was worth it. By the end of the hike I was basically lifting my legs with my arms to keep going - nothing like a huge hike at 12,000 ft! But it felt so good afterward to relax and read back at BSI. 

Also, props to BSI for serving us some bomb pancakes with, get this, cinnamon syrup. 

Mind = blown. 

The next morning we all chilled out, read, and did the super-short but super-fun zipline they have on the property. It was a pretty janky setup and the line went right through a tree top (pro tip: wear shoes) but I dug it (past tense of I dig it). 

In the early afternoon we made our way back to Quito and gathered at Dave's place for an epic Game of Thrones finale watching party. No spoilers, I promise. Fun fact: Dave's a huge GoT nerd, and for his recent birthday he had his friend make an iron throne cake that was actually edible. 

I gotta say, it's gonna be hard to top this trip, but there's plenty of time and plenty of places yet to explore. Over and out. 

Wednesday, June 12, 2013

Black Sheep Inn

This past weekend I had an amazing 4 day trip to the mountains, specifically to an eco-lodge called the Black Sheep Inn. Eco-lodges are basically super environmentally friendly getaways. BSI had special no-water toilets, efficient heating systems, vegetarian food made from locally grown products, and tons more. It was ranked as one of the 50 best eco-lodges in the world by Nat Geo, and it only costs $29/night. 

We (me, Greg, Emily, Sarah, and Pat, who had just flown in from the states) headed out early Friday morning. We caught our bus at this huge bus terminal in southern Quito. As far as I can tell, the buses in Ecuador are used for everything and anything. On our first bus there were three boxes of chicks (as in, baby chickens) aboard. It was a bit of a culture shock to see live animals on a passenger bus. The first bus took us to Latacunga, which is really just a transfer station and not much of a city. But we got some food on the streets - bread, sausage, and "chochos" (an Ecuadorian white bean). Then we found this little grassy area by a river running through the city and sat down to eat. 

Lunchtime scenery

There were some city workers there who were cutting grass, but not in any way you'd see in the states. They used machetes to hand cut the grass and then put it into large grain sacks which they carried on their backs to dump out. 

From Latacunga we caught the bus that took us all the way to Chugchilan, the rural town where BSI is. Despite all the English that was spoken this weekend, owing to the fact that we're all American, there was no forgetting that I was still in South America. Vendors of all sorts of things - kebabs, nuts, popsicles, gum, you name it - would walk up and down the bus aisle trying to sell things to passengers. It's actually not a bad deal... as long as you avoid anything that could have been sitting out in the sun the goodies actually make for good (and cheap - usually 50 cents a pop) snacks. As we rode along toward more and more rural Ecuador I got to see, for the first time, the Andes Mtns. The landscape wasn't rolling hills or anything like I've seen in the states. It was more like interlaced hills and ridges, kind of like fingers that fit between each other while holding hands, and almost looked like something Gaudi - the famous architect from Barcelona - would have designed. The tops of the hills and mountains were lined with skinny trees that sat darkly against the cloudy sky. The road we were taking was literally along the cliff edges, and yet there was somehow still room for schoolchildren to be walking to or from school. The uniforms identified them as belonging to one school or another (or one grade or another?) and looked a bit like American track suits. It makes sense, though, because they seem to walk very long distances from home to school. Once you get into the mountains, all you see is farmland. The farms are grown on incredible slopes... There is almost no flat land to be found. I was excited to see that all the animals are grass-fed and allowed to lounge outdoors as they please (though they are kept in within a certain radius by a rope). There were all sorts of animals to be seen, from llamas to donkeys to pigs. There were also tons of dogs and puppies around, and they all seem to be of a similar breed - something like a small golden retriever. Some of the buildings along the road were painted with voting signs/information, such as "Vote for ___" and the date of the vote. 

View from the bus. Pinch me. 

When we finally arrived to BSI, we took a look at the place and all its amenities. There was a yoga room, a gym with workout devices made from simple materials (ie, pipes and plaster), a zipline, a sauna/"hot tub" (disclaimer: not actually very hot), and a frisbee golf course. In fact, THE HIGHEST frisbee golf course in THE WORLD. So, naturally, we played a round. It was the first game of FG I've ever played, and probably will be the coolest ever. We had an insane view of the sunset over the andes as we wove the discs between trees, farms, fields, errthing. I didn't exactly kill it, but I kept it respectable yo. 

How can you concentrate on FG with this 
staring you in the face?

After that intensity we had our first dinner, communal style. Every night they had a soup, a main dish, and a dessert = nummy (yummy + nom). With some nice food babies we hit the sauna for a, dare I say it, dangerously long time and I might have had a spiritual awakening in there. But, in reality, the sauna was totally awesome. After that, it was time to hit the sack and prepare for our epic horseback adventure the following day (to be continued... dun dun dun).

The Bunkhouse where the cool kids at.

Thursday, June 6, 2013


So it's been two days of work now and a total of 3 days in country. Yesterday, day 1 at work, was fantastic - David and the crew showed me how to consult with a patient and take a temporary cast of the residual limb (the part that remains after amputation), create a plaster mold for the cast, vacuum form a carbon fiber socket, and tons of other things. I am constantly surrounded by Spanish. Only David and I speak English, so I think I will learn very fast. I have already learned a few key phrases and words. Some of the ones I hear around the clinic the most are 

pero - but
mejor - better (important for determining whether a patient's prosthetic is more comfortable after an adjustment)
presion - pressure (on a certain part of the leg)

Well, there are tons more but that gives you an idea. I got to watch David with a lot of patients yesterday and they all took well to me being in the room. He explained that I'm a student from Duke/the US and they all seemed very pleased to meet me. 

It was so fascinating to see the countless odd jobs that David does as a prosthetist, everything from sewing a strap to drawing out anatomy on someone's leg. It really does seem to be a jack of all trades profession. And it's insanely active - I was up and down grabbing tools and sitting next to patients, grinding prosthetics and covering molds in plastic. It was exhausting but in a very satisfying and exciting way.

Some of the specific scenarios we had on day 1 were a trans-tibial (below knee), a trans-femoral (above knee), and complete leg (through the hip) amputation. It was a good variety of situations to see on the first day. Some of the time David was making adjustments of the prosthetic and others he was taking measurements to cast a completely new prosthetic. At first, I thought I might be grossed out by the residual limb, but there wasn't anything that shocking about it. There was an older woman with a bit of a sore on her residual limb, but even that didn't really bother me. 


Day 2 at work was a bit more sedentary... I was doing a literature review for a presentation that David will be giving next Friday. We're looking at tips for prosthetic users on maintaining their setup and getting into more demanding sports activity. 

The day was made more exciting, though, by a visit from Greg Krupa, who runs a sports/prosthetic medical gear company with David. He's also, if you didn't guess, David's brother. Anyway, he came by to do a delivery and is insanely awesome, just like David. We went to lunch together at a nearby taco place (I had a pollo y carne burrito with delish hot sauce) and he invited me that evening to hang out at his place with his two roommates from the states. So he met me after work at my place and we took the Ecovia, which is basically a bus-metro hybrid, to Centro Historico which is where he lives. The area was really nice, and quiet when we got there. There were a lot of sombrero (which actually just means any kind of hat) shops open -- it's in southern Quito and more where the touristy shopping is. His apartment was super nice, much more than mine, and not much more expensive. I live in north Quito so I guess the prices skyrocket in that area, though I'm not really paying that much regardless. 

The view from Greg's apt

I met his roommates, Emily and Sarah, who were awesome and we all nerded out about Game of Thrones for a while before hitting the town. We went to this cool New Orleans themed bar started by a guy who lived in San Fran and moved down to Quito a while ago. It's called Dios No Mueres, which means God Never Dies. The reason is because there was a President of Ecuador who was killed near that area (a long time ago) and apparently his last words were those. Furthermore, he is apparently buried in a tomb that abuts the bar. At the bar they were also having this art gallery presentation of jewelry made by indigenous persons. It was funny because there were photographers there for the opening and any time I'd look closely at a piece of jewelry they would take like 500 pictures of me. I started cracking up a few times, because they weren't doing that with any of the non-gringos (non-Americans). That must be what paparazzi is like. 

After the bar we went to a street called La Ronda, which the government apparently cleaned up significantly and which is now a tourist destination. We found a nice place to eat with some live music (we taught the maraca player how to politely ask for money in English). I had an Ecuadorian specialty, cuy (pronounce kwee) which is... wait for it... guinea pig! It was interesting enough, pretty tasty actually, and has been a staple of indigenous cuisine for a long, long time. I also got to try some tamales and some cornbread thing who's name I've forgotten. The walk between places was so nice, because Centro Historico is where all the old Spanish influence can be seen, and there's a lot of European looking streets and buildings. 

Down a street in C. Historico

It was great to see Quito by night, and with Greg and friends, who are very familiar with the area. I was not nervous at all about safety -- there were lots of police everywhere, on street corners and such, just watching out for everybody. This weekend I'll be going with Greg and the girls to an eco-lodge in the mountains... it's apparently ranked by nat geo as one of the 50 best eco-lodges in the world, and it only costs $29 per day with all food included. I'm so excited, and I'll be there from Friday (tomorrow) until Monday. I'm so glad I'll be going with those folks because 1) they're really awesome, and 2) it's always good to travel in groups. 

In other brief news, we got a new roommate today! A nice Italian guy named Dillon. He knows Quito fairly well so that will be muy bueno for me -- I'll make him tag along to various places. 

Tuesday, June 4, 2013

First Impressions

First, a brief overview of my project:

So, there's this program at Duke called DukeEngage and it funds students to travel abroad (or domestically) for either pre-determined group projects or student-proposed individual projects. I am doing the latter. As a mechanical engineer I really wanted to bust out of the 9-5 desk internship that I'd already experienced and get hands-on and interactive with other people. After a little research, I thought prosthetics might be a good fit. I followed some leads at Duke and ended up connecting with David Krupa, an American prosthetist who moved down to Quito, Ecuador to start both a private practice and a non-profit. So I proposed a 2 month long project to DukeEngage where I'd station in Quito and volunteer with David to make prosthetics. 

Modern Day: 

It's day two and a little bit here in Quito, but I wanted to go back to the beginning to talk about my first few hours and first day here. Day one began in typical Brucato fashion, hectic and dramatic. Literally as I was walking out the door to go to the airport at 3 am, my grandpa had a tumble down the stairs; it was a furious race between the two Brucato cars to see who could reach their destination first - the airport and the hospital. Luckily, Papa Pete - hearty old guy - was totally fine... just a few bumps and bruises. 

The rest of the trip was much less eventful. I had smooth flights from Albany --> DC --> Miami --> Quito. My thoughts before and during the trip were all over the place. For one, I didn't feel prepared because I hadn't really packed that much, and didn't have a great idea of what I would need. Or rather, I knew what David had told me to bring and it wasn't too much. The other major concern on my mind was safety. I had heard varying reports about Quito being a dangerous city, and I sort of psyched myself out the night before by reading up on some of the crime there. I debated how much I would write about the dangers of being here in this blog, but I have decided to be open about it because it is an important part of the experience. Anyway, the night before leaving I was trying to figure out exactly how to get from the airport to the city center, about 45 minutes away. My homestay host, a young woman named Janne, said I could take a bus from the new airport to the old airport and then a taxi from the new airport to my homestay. But David had offered to give me a ride, so I was trying to nail that down instead. 

View of Andes Mtns from the plane

So, here's the deal with safety. Quito is certainly not the safest city in the world. It is much more dangerous than my hometown. Of special concern are taxis -- if you take an unofficial taxi there is a possibility that you could get held up or robbed. Women should not walk alone at night, etc. As I said, I spent some of the night reading these stories to understand the situation in which I would find myself... which I do not regret, but it definitely freaked me out to say the least. I was SO relieved when David said he could pick me up from the airport. As we drove to the city center, he echoed what others had said - always take an official taxi marked by orange license plates and other identifiers. And I will not stray from that. That being said, Janne takes a taxi every morning and night to school and has lived in Quito for 13 years and has never had a problem. So the key is follow people's advice, be smart, and pay attention to your gut. On top of that I am in good contact with everyone I know here in Quito and my parents/DukeEngage at home. 

That all being said, I had the day off on Monday and David suggested walking around, exploring, and maybe doing a hop on hop off bus tour. Truth be told, I was rather terrified to go outside. I had built up an image in my mind that I would be jumped as soon as I left the confines of my home. I finally forced myself to venture out, and walk to the nearby mall. The sun was shining brightly and there were many people, and especially many women alone, walking around. I immediately felt better. I walked fast and with purpose to the mall, and then walked around to look at all the shops. The mall was nicer than the one close to me at home. The locals did look at me a bit funny - a blue eyed gringo girl walking around Quito - but not in a threatening way. I bought some staples at the local Supermaxi (grocery store) and carried them home. Excursion 1 = successful. Hilariously, because of the altitude (~9300 ft), carrying the few groceries back was a workout! 

I went out again a bit later to walk around the park - a nice place. Guys ride around on these ice cream carts and you can buy various yummies from them. Later at night, Janne and I went back to the mall to get some dinner. My initial reaction was ruh roh because I had convinced myself that going out at night was idiotic, but Janne says it's very safe around our area. I felt totally fine with her -- it was nice to be with someone who really knows the place. We ate in sort of the food court area of the mall; I got "pollo negro" (black chicken) for 3.25. 

Things that are cheap here:
-gas ($2.50/gallon)
-food ($2/lunch)
-coke (as cheap as water)

At night we posted up like an old married couple and watched a Spanish soap opera (Amores Verdidades). I'm guessing soaps must be the biggest consumers of waterproof mascara... too many tears (by about 100 litres) for me. Janne's ADORABLE dog Lucky watched with us. Today I checked my camera and 5 of my 6 total photos of Quito so far are of Lucky. On the camera topic, I decided not to bring my nice Cannon because I thought it might get stolen... but I'm sort of regretting that. I can use my iphone, yes, but I won't be able to zoom very well. I might just buy a little disposable camera and have some fun developing all those random photos in the future. 

Lucky, who's actually ghostwriting my blog

Well, that's all for now. I'll try to be less verbose, but I like giving details so no guarantees :)