A Typical Day at the Ecuadorian ER

Hello All!

How is everyone back home??

Things are still extremely busy here.  Looking forward to the weekend!

This morning I woke up at my usual 5:30am, took my cold shower and ate breakfast with Veronica, my host mother.

My host mother (middle) and the program directors

My alarm clock.
Too bad he doesn't have a snooze button or
know what a Saturday is.

I made myself a lunch with whatever I could find, (today: fried rice with ham and cactus fruit), and embarked on my usual 20-minute, uphill trek to el Centro de Salud.

Today was a typical day in the ER.  I had to wait outside the door for 10 minutes until the rest of the staff arrived, (typical Ecuadorian time). (Only here am I ever early to stuff).

With only one doctor, one nurse and myself, it didn't take long for a line to form outside the door.  But we work at a steady pace and see a lot of returning patients in need of fresh dressings.

One kid came in with an obvious broken arm.  You can tell he had been crying, but he was tough.  I asked him for his name. 

"(Sniff, sniff)... Miguel."

"Hola, Miguel.  Me llamo Estefy.  Cuantos anos tiene?"

(Sniff).  "Siete (7 years old)."

"Wow. Tu estas muy macho, Miguel! Nosotros vamos a cuidarse bien."


He sat and waited patiently as la doctura examined his arm.  Then I watched as she went to the supply cabinet and dumped out the contents of one of the boxes.  She then took the scissors we use for bandaging and started cutting the different flaps off the box.  I really didn't know what she was doing until she began fitting the box flaps to Miguel's arm, which involved a lot of manipulation and discomfort for the patient.

Sigh.  Add "slings" to my list of stuff to send here once I return home.

Later in the day I walked with two physicians to a school nearby.  They explained that as part of their job they have to do a brief physical examination of every single student in the schools of Conocoto... and there are over 50 schools.  Quite a task, indeed.

We spent a couple hours measuring, weighing and examining some 80 fifth-grade girls.  It wasn't anything special until they noticed how slowly I read off the numbers in Spanish.  At first they just thought I was really bad with numbers, until one of them asked my name.  When I told her I was Stephanie and from los Estados Unidos, her eyes got reeeaally big.  Then she ran off to discuss this with her friends.

Next thing I know, I am surrounded by fifth-graders everywhere, pushing in to ask me my name, how old I am, if I'm married, what my favorite band is, if I've seen snow...  I felt like quite the celebrity!  They're favorite part was when I read aloud their Ingles homework.  If only I had had that kind of effect on the fifth-graders I used to work with in the U.S.

Schoolyard complete with stray dog

FIfth graders

After my hour of fame, I walked to lunch with my two best buds at work: Marcia and Gladys.  These women are so funny.  Between their different personalities and my language barrier, we've had plenty of laughable moments.  For example, when ordering I tried to ask the waitress for some ice cream, which is helado.  Instead, and to the surprise of my colleagues, I ordered hígado... which is liver.

...

Good thing laughter is a universal language.

Marcia & Gladys

 When 3:30pm rolled around, I hopped on a bus to Quito for my Spanish lessons.  Until recently, I used to walk roughly 45 minutes between bus stops, but los doctores spoke with the Medical Center's bus driver for me and hooked me up with a ride straight to my school. Woop! My calves are thankful and my zeal renewed to learn Spanish in order to ask these questions without interpreters...

My Spanish school downtown. Adorable, no?

After two hours of lessons with the ever-patient Veronica, I made for the hour-long walk and bus ride back home.

And that's a typical day for me in Ecuador.

...But my weekends are far from typical, and I can't wait to share about them in blogs to come!

-Steph :)



Spending Christmas a little closer to Bethlehem

It's strange being so far away from home on Christmas.


But honestly, I'm kind of thankful for the opportunity to celebrate the birth of my Savior apart from the lights and presents and everything else that makes it "feel" like Christmas...


It's funny how I've learned to equate this day to those things anyway.


Like the first Christmas over 2000 years ago, it's going to be a silent, but oh so holy, night for me.

I can almost hear those angels singing...


(Click to listen to a song that I heard at my church here in Ecuador and has really captured my heart.)

The toll booth my bus passes through every day to and from mis clases de espanol in the city

La Ambulancia

Today we transported a patient to a hospital in Quito.

It's about a 40 minute drive from mountain terrain to crowded streets.

___

We were going about our regular routine in la emergencia in my small clinic when a woman came in presenting with chest pain.  I may not have understood her Spanish, but I knew enough from my experience in the States to know that she was suffering from a myocardial infarction.  She was sweating and clutching her chest...  She was in bad shape.

We radioed in an ambulance from somewhere in town. 

And by ambulance I mean a van with sirens.

Our ambulance in the city hospital

There was hardly an equipment in the back of the rig

We loaded Rosa in the back and were on our way with nothing but an empty oxygen tank and a BP cuff.  Most of my patient care involved keeping Rosa from flying off the cot during the sharp turns.  If you've ever driven in Quito, you'd know how crazy the cars on the road can be.  It was a bumpy ride and scarier than a taxi in downtown Chicago.

As we were pulling out, a woman on the street flagged us down.  She jumped in and got a free ride to Quito.  I think she was the driver's girlfriend, but still...  Only in Ecuador does an ambulance double as a taxi.

Halfway to the hospital Rosa coded on me, and I thought we'd lost her.  All I could think about is how she would make it if she were in the States.  But she came back quickly and was stable the rest of the way.  I felt terrible that there was nothing we could give her for pain, or that I didn't have enough Spanish to comfort her pregnant daughter riding in the front.

We eventually got her to the city hospital, and she was talking when we left her.  I have no idea how she's doing now, but I think she'll be okay.

All the same, it would be neat if you could say a prayer for her and her family.  She may be worlds apart, but prayer can go a long way, and luckily we have a God that isn't constrained to only the Western part of the world, as some would think.

Thank goodness we serve a God that is so much bigger than that!

Operation Enduring Freedom

I hope all is well back in the states! I cannot begin to explain how much your love and support mean to me. Your letters are encouraging and a blessing!

It seems like just yesterday I was leaving family and friends for Officer Candidate School. I remember feeling nervous, yet excited about the possibility of being a Marine, an Officer, and in the infantry. It all seemed like a far off dream though. Now just over a year later I'm actually in Afghanistan as a TRAP  Platoon Commander.

I officially left California on November 9th. It was hard saying good bye on such short notice, but Steph's support really helped. I definitely could not do this with out her! After a short lay over in Alaska we departed on a long flight to Kyrgyzstan. We stayed there for two nights before departing for Afghanistan.

It's hard to explain how I was feeling as all this was happening. I had heard rumors and stories of Platoon Commanders graduating the Infantry Officer Course (IOC) and meeting their platoons on the plane to Operation Enduring Freedom. I did not think it would happen to me. Basically, my first conversation with my platoon sounded like this: "Hi my name is Lieutenant Moxley and I'm your new Platoon Commander. I'll be leading you in combat in a few days." Talk about a baptism by fire.

The first few weeks were hectic to say the least. There was so much to get done and just not enough time in a day. This is my office.
 

This is where I live.
 

Home sweet home!
 

 

So let's talk TRAP. TRAP stands for Tactical Recovery of Aircraft and/or Personnel. Essentially I command a force similar to SWAT, but in combat. We are a quick reaction force (QRF) that respond to a multitude of situations across the battlefield including mass casualty evacuations, recovery of downed aircraft and personnel, and/or providing reinforcements or more firepower. Unfortunately, I can't talk specifics due to operational security, but I can give you a glimpse into some of the opportunities I've had. I worked with:

• the Brits and Danish who are fun and light hearted
• the Jordanians who speak Arabic so an interpreter is necessary
• local nationals that speak Pashtu and serve as our interpreters
• Afghan Uniform Police (AUP) who think Marines are GI JOES
• Special Forces units who are relatively normal guys

 



Practicing combat life saving

 

So we still need some work...

 

Maybe Steph could give us some lessons!

 

As time goes on, I am relating more and more with my Marines. I find myself playing many roles- from Commander, to counselor, to coach and teacher, to mentor, and older brother. Recently, I had the opportunity to pray with one of my Marines. It was an encouraging and rewarding experience.

 

Chapel. "Finding Hope in the Desert"

 

I recently finished the book Desiring God by John Piper. I highly recommend reading it as he challenges believers to seek Christ as our supreme joy in all things to the point of forsaking our freedoms, comforts, even our very lives. Some key verses I would like to share are:

• "For whoever wants to save his life will lose it, but whoever loses his life for me will find it. For what does it profit a man if he gains the whole world, yet forfeits his soul? Or what can a man give in exchange for his soul?" Matthew 16:25-26
• "So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal." 2 Corinthians 4:18
• "I count everything as loss because of the surpassing worth of knowing Christ Jesus my Lord. For his sake I have suffered the loss of all things and count them as rubbish, in order that I may gain Christ." Philippians 3:8
• "The man who loves his life will lose it, while the man who hates his life in this world will keep it for eternal life." John 12:25



An armored vehicle that was struck by an Improvised Explosive Device

 

It may seem far away, but it is very real to those of us here and the families of the Hero's sent home bearing our flag. There are people laying down their lives everyday for something they believe strongly in. Please earnestly pray for us and realize that everyday you too have an opportunity to make a difference in someone else's life.



¡Feliz Cumpleaños!

So...

What better way to immerse oneself in a new culture than to attend a birthday party? :)

It was this little niña's birthday today:

Meet Raffaella

What a cutie!

The party was in the yard behind my house, because it was my host family's niece. Admittedly, it was a bit awkward for me at first when your conversations with people only go so far, due to my limited vocabulary... But Ecuadorian parties are a bit different than American ones in that, in addition to the cake and piñata, there's a time called hora loca, or crazy hour!

It didn't take long for me to get dancing, playing musical chairs, and sack jump racing!  I also don't intend to brag...but you happen to be reading the blog of the winning three-legged race team... (Haha). What fun!
 

   

 

Feliz Cumpleaños, Raffaella.  :)

 





 

First Week at la Clínica

Hola mis amigos y familia.

So I am nearly finished with week one of six at the medical center.  Wow, do I have some interesting things to share.

First off, I am exhausted.  My days are long.  I wake up at 5:30 every morning to take a freezing cold shower and eat breakfast with my host mother.  It's a 15-20 minute walk to the clinic, but it's all uphill.  I like to think of it as my morning work out.

The clinic is called the Ministerio de Salud Publica Médico Center, and it is a tiny, three-story building in the middle of el Valle.  It is my new home.

Hill. x 20 minutes
(Those are dogs on the roof...)

Clinic

Streetview from Doorway

I work in La sala de Emergencias, or the Emergency Room.  In the U.S., we use the terms "Emergency Room" and the "Emergency Department" interchangeably.  Well, this "Emergency Room" is literally a "room."  One small room with one bed, two desks, and few supply cabinets... 

The stock room at my last job was bigger than this room.

La solamente camilla

Wound Supplies

(Yes, those are written labels taped onto empty windex bottles).

(No, I'm sure they cleaned the bottles of windex before putting wound cleanser in them).

 



Other than cleaning and bandaging a couple burn wounds and administering a few nebulizer treatments, I mostly obsereved for my first week.  While observing, I noticed a few notable differences in my Ecuadorian patients from the patients I've worked with in the U.S...

For example, Ecuadorians are no wimps.  I've watched the enfermeras (nurses) scrub at painful skin abrasions or drain very infected wounds*, and these people just bite the bullet with zero complaining.  Even the kids are very compliant. 
Also, there are no complaints about the wait time.  People stand in line for sometimes hours to get their hand stitched up or have their sick child checked out.  (And when I say "stand," I mean stand.  The "waiting room" is the line right outside the door. This includes mothers holding babies or elderly with canes, etc...)  I think they are just happy to be receiving care.

There was this one older kid who split open his index finger.  We had to stitch him up, as well as remove some of his nail, but we were out of Lidocaine, (local anesthetic).  So I watched la doctora write down the name of the drug and hand it to him with some money.  Twenty minutes later, he's back with a bag from the pharmacy down the street.  The kid had to go buy his own Lidocaine!  That would never fly in the U.S. 

Lots of things here would never fly in the U.S.


Save the seriously ill, Ecuadorians are enjoyable patients to work with.  They smile easily and are very respectful of health care workers.  They lack the sense of entitlement that most North Americans have about, well, everything.

We don't even know how good we've got it in the U.S.  I treated a 9 or 10 year old child today with special needs.  She wasn't verbal, and she wasn't able to walk.  Her mother literally carried her over her shoulder, everywhere.  It was a strange sight to see since the child was over half her mother's height.  But I guess wheel chairs aren't easily accessible here.

I think when I return home I'm going to send a few medical supplies.  A mother shouldn't have to carry her special-needs daughter over her shoulder for the rest of her life.  And a baby shouldn't have to have her head stitches removed with a pair of dull scissors.

Yep, we've got it good, my friends.  If you're reading this from the U.S., take a moment to thank God for your local E.R.  We are very, very blessed.

 

*Nasty skin infections appear to be very common here. My guess is that regular flesh wounds that would normally heal up fine with a band-aid in the U.S., get infected here by the contaminated water.

¡Saludos desde Ecuador!

¡Hola! Greetings from Ecuador!

I write to you from a Cabinero (internet "cafe" without the coffee) in downtown Quito, Ecuador! It's still kind of surreal to me, but let me share with you my arrival of less than 18 hours ago...

I left early Thursday morning from San Francisco Airport.  My parents  kindly saw me off...



Still a Daddy's Girl

My flight arrived in Quito on-time, but it took awhile to get through immigración and customs. I held my breath as I exited the terminal and scanned the dozens of people holding white name signs... until I saw Freddie front and center with a sign that read "Moxly." He was very nice and spoke great English, (something I didn't know to appreciate until later...) We chatted the whole 45-minute drive to la casa de mi host familia en Valle de Los Chillos. I couldn't see much of the city since it was nighttime, but there were bus loads of people on the streets... Turns out I flew in on a huge national holiday, (Ecuador was founded on December 6th of 1542).

Freddie dropped me off with my host mother, Victoria. She seems very nice, although we had a two minute "conversation" of hand gestures and head nodding. The poor woman has un Norte Americano living in her house that doesn't understand a thing she says! Although I did pick up that she is a teacher... ("Yo trabajo mañana en la escuela.") And  that her husband is in the military, also.  Phew, I'm quickly realizing that I have a LOT to learn!

I woke up the next morning to the sound of roosters and dogs barking outside my window, but at least with the daylight I was able to see where the heck I was. I have a nice little room and bathroom in a sort of guesthouse in their back yard. They live in a little courtyard type thing with four houses, all family. The house looks pretty sad on the outside (all rough cement, large cement walls around the courtyard with crude iron bars at the top and some graffiti...) but the inside is very quaint.  It reminds me so much of the Philippines.  The scents and smells are exactly the same.

 Home Sweet Home

 

 

 

Outside view of my new crib from inside the courtyard

 

 

I had breakfast (hot milk and sweet bread with guava marmelade) prepared by the house helper. She's my favorite so far. She's already taught me half the words I know. (One such word is indoro, or toilet. This is because after a game of charades, she showed me how to fix it when it doesn't flush properly...)

Maria, the program director, met up with me and went through the project details. I asked a million questions. She drew me a couple maps, explained how the bus system works (definitely different than the US!) and how to get around downtown Quito.

After getting a key to the gate from Mariam (the helper), I walked the several blocks to the closest bus stop and rode the 30 minutes to downtown Quito. Holy culture shock. Things are so different here! Of course I expected things to be different, but there are so many cultural "norms" that I am devastatingly unaware of. And hardly anybody speaks English, so I'm really coming to realize how badly I need to learn Spanish. I walked several blocks to the Spanish school that was recommended through the program, (an adorable little nook above a barber shop). I love it! And it's so nice to be around a bunch of Europeans and Ecuadorians that speak Inglés!

I had two hours before my first lesson, so I found a vintage, little bookstore and bought a Spanish-English dictionary. I had lunch at a tiny cafe (verrrry difficult to order, pay, and tip with the language barrier!) And now I'm here writing to you!
Phew, I wish I could describe in more detail the sights and sounds of everything. For example, the "cafe" was a little kitchen counter and register where I can see him cook my chicken. And the city is very big and teeming with people, mopeds and taxis, and colorful houses crammed together on the mountains.

Downtown Quito

BUT, I gotta run to my lesson. Miss you all and will write again soon!

-Steph :)

What Lies Ahead...

This year has been quite the adventure.

As brand new military folk, we loaded up a U-Haul in January and drove the 14 hours to our new home in Washington, D.C.  After baptism by fire into the Marine Corps way of life, it didn't take long for us to fall in love with our first apartment, new church home, and incredible friendships.  Jason stayed very busy studying what it means to be a 2nd Lt in the Marine Corps.  I took some time figuring out what a military wife does; it was certainly different than working my previous three jobs.  After waking up to the reality that I wasn't going to grad school or that military wives have trouble getting hired (due to the fluid nature of their husband's line of work), I embraced the new.  I crash-learned the art of meal making, (poor Jason ate many a lousy meal--what a good sport), practiced my time-management skills of housework (so easy to let everything slide when you don't punch-in in the morning), and turned into the Budget Finances Queen.  I also took a biochem class, took gym classes with other wives, and learned a ton about what ministry in the military looks like.  Because there is often close-knit community among the wives whose husbands are busy training, ministering to other women is like a cake walk.  In the 9 months we were there, God blessed me with the opportunity to disciple 3 young women, lead 4 Bible studies, be discipled myself, and give a Gospel presentation to about six women.  Amazing!  God was Good was in showing me that my time there--without a job or a career goal--was purposeful and life-giving...right at a season of my life when I was really struggling with purpose.  Can I get an Amen!  We also grew a TON in our marriage, fellowship, and walks with God.

 

 

We wrapped up our time in Virginia with Jason finishing Infantry training, (Like a rockstar, I might add. For a small idea of what an incredible achievement that is, take a look at this NY Times journalist's slideshow and associated article.)  Shortly after, we got word that Jason was to deploy within the month, so we packed up our stuff into government storage and headed up home to say hello & goodbye to friends and family before making the trek to southern California.

And I had thought that was all an amazing adventure. Until God showed us where He wanted us next.


Two days before departure, we find out that Jason is deploying to Afghanistan as a Platoon Commander.

And I find myself on plane to do 5 months of medical missions in South America.


And here we are!  The purpose of this blog is to keep everyone (including each other) updated on what's happening in our parts of the world.  As bummed as we are to not be home with friends and family during the holidays, we're excited to see what God has planned for us on this next adventure.

Thank you so much for all your prayers and support.

Will write again soon!