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.