Update on the Water Filters

Mary Rose Day (she participated two years ago) and her husband, Brian Day, are in Riobamba for the September 2011 program.  Their main objectives are to follow up on the water filters and plan the next steps:

Update

We met with Carmen (President of Fecaipac), Juan (representing el Consejo Provincial), and Dr. Maritza last friday and proposed an expansion of the pilot program in Puchara Quinche which appears to be a huge success after just 8-12 months.  Dr. Maritza gave her powerpoint presentation showing initial data from water samples taken in 2008 in Cacha.  We all spoke with Carmen and Juan about our mutual belief that the next feasible step in expanding this project would be to place filters in all public facilities, such as clinics, schools, guarderias, and colegios in Cacha.  27 filters would be needed for this proposed expansion, costing $25 per filter.  ($675 initially and $405 every 2-3 years for replacement ceramic parts)

Carmen and Juan seemed very interested in the project and found the intervention to be simple and economical.  They expressed interest in eventually expanding this availability of filters to ALL communities in Cacha.  I mentioned our 2 current ideas for payment from the public:  1) direct payment with cash vs. 2) payment via Mingas.

The public opinion seems to be that $25 for a filter is very expensive, although the estimated average annual income for a family in Cacha is $2400 (estimated by Dr. Maritza).  The public is VERY interested in the idea of mingas as a payment alternative.  I mentioned my idea of having the Consejo and Fecaipac fund the filters in return for TRASH REMOVAL services provided by mingas.  Everyone seemed interested in that proposal.

Today, we are waiting for a phone call from Carmen.  She and Juan were going to speak with local leaders yesterday at a big meeting in Machangara and ask for their support to fund the expansion to schools.  They were very confident they would get the money.

Today, Brian and I are going to make an instructional video (2-3 minutes long) about how to use the filter and how to clean it.  We’re making the video in english (for future students), spanish, and kichwa (with help from Segundo).  Once it’s edited and fixed, we’ll take the projector up to Cacha next week and start showing the video and passing out handouts in some of the larger communities.  That’s the plan for now.

I’ll write again as soon as I get news from Carmen.

Preventing mountain sickness

Participants ask about what should they bring or do before going to Riobamba,Ecuador. We usually tell them to throw sunglasses, sunscreen lotion and hat in their bags, the sun in the Equator line is vicious. Yes, it is nice in the morning, but once it gets up there-right on top of you-it might still be nice,but the rays are very strong for the skin, eyes and head. Another thing we usually tell participants, is about high altitude sickness. Riobamba and Cacha are between 3,000 and 3,500 above sea level, we tell them to take it easy the first days, do not eat much at night, drink nice herbal tea and sleep early, by the fourth day it is okay.

Dr. Jorge has asked me to post an article that tells more about how to prevent this mountian sickness, believe me, the symptoms feels like Atahualpa’s revenge!

Article on Preventing Mountain Sickness

Who is CACHAMSI’s Founder?

Cachamsi was at the AAFP National Conference of Family Medicine Residents and Medical Students. It was held in Kansas City, Missouri during July 28 through July 31,2011. This is Cachamsi’s third year attending the conference. Dr. Duchicela was the exhibitor and was very satisfied meeting and engaging with family medicine residents and medical students. Dr. Duchicela  has been working in rural family medicine for almost 22 years and almost as long serving as a faculty preceptor and associate professor for the University of Texas Medical Branch in Galveston.

 

He and his wife Juanita chose to live in Weimar,Texas, where he was offered a position at the Youens Clinic.  After becoming a partner about twenty years ago the name changed to Youens and Duchicela Clinic. His experience as one of the town’s doctor has been enriching, treating a diverse set of population including patients from German/Czech, Black and Hispanic descent. After many years of practicing as a rural family physician and teaching hundreds of medical students, residents, nursing and physician assistant  students, he realized the urgent need for medical students, residents, and other healthcare professionals to communicate well with the Hispanic patient.

 

 

These experiences helped him decide to offer an immersion language program.  He noticed that medical students and residents tried very hard to learn Spanish within the medical context, but they very seldom succeeded in acquiring the language skills to adequately communicate with their Hispanic patients.  They were too busy and there was no available structured program that could offer an effective methodology.  He saw the need to create an institute specialized in teaching medical Spanish.  This facility would be built and developed in Ecuador.  This small South American country is  safe, diverse and friendly.  It is also Dr. Duchicela’s birth place, a region where one can find areas where English is not spoken at all. The Central Ecuadorean highlands provided great language professors, a multitude of health centers, and a special indigenous community close to Dr. Duchicela’s heart.  He felt this institute would not only help the Hispanic patient in the U.S. but would also help the indigenous people of central Ecuador.  

 

In 2000, Dr. Jorge (as he is known in Weimar to differentiate him from his younger sister, partner, family physician Dr. Olga), began the tedious and slow work of meeting and establishing relationships with physicians, hospitals, government leaders, families, and potential members of the new institute in Riobamba, Ecuador.  Why Riobamba?A quaint, small, colonial city surrounded by majestic volcanoes and drenched in history and its indigenous culture, Riobamba (from the Kichwa word ricbamba which means the walking plane) became the place where the Cacha Medical Spanish Institute was going to be built.  The name Cachamsi came later as medical students would call the institute and program by its acronysm, Cacha MSI (Medical Spanish Institute).  By 2004, he had all the major components ready to offer an integrated, focused, immersion experience to participants of the institute.  He saw this school as a way to bring United States health professionals, community members, and Ecuadorean health professionals together to accomplish the missions of Cachamsi:  To improve the health of the Latino patient in the United States and enhance the health and education of the indigenous people of central Andean Ecuador.

Information on Travel Grants for Health Professionals and Medical Students

Recently we have been receiving applications for long term participation, from 7 weeks to 8 months. Usually the students obtain their own financing, which is commendable. We have been searching possible alternatives of funding sources for potential Cachamsi participants, here is an interesting link:

http://www.fic.nih.gov/Funding/NonNIH/Pages/default.aspx

Water Usage Patterns in Cacha

Water is a very valuable commodity in every part of the world. For the people of Cacha,Ecuador, water represents the soul of the livelihood, along with the soil (Pachamama).For years,these 23 Indigenous communities conglomerated in one Parrish in central Ecuador, have worked and fought for their right to use water. Currently, two of the 23 communities are served by a central water system referred as Huangopud. The water is stored in six central cement tanks filtered through sand before it is piped to the community. The people access the water from outdoor spigots feeding into large cement storage tank. Since water delivery is unreliable, inhabitants use plastic containers to store the water in their houses. Two communities that do not receive filtered water are PUCARA QUINCHE and CAUÑAG, in other words they do not have a purifying treatment.

For three years, medical Students from the University of Rochester Medical School have researched and assisted these two communities to find a better point of use intervention treatment for their water. In 2010, water filters were delivered to the community, Cachamsi financed 50% of the filters, the other 50% of the cost of the water filters was paid by the people of Pucara Quinche. See filter below. There was training and education to use the filters adequately, also a control was set in place. Although Cauñag is getting ready to obtain their filters, we need to collect data from the monitoring system.

The ceramic is made of mud and other filtering substances.

The outside part is plastic. Below, the same filter with a top.

Health Camps – 3rd and Final Week

Medical students from Boston University and Dartmouth College ventured to lead and deliver three weeks worth of lesson plans to children from Cacha, an indigenous parrish twenty minutes away from Riobamba (central highlands in Ecuador). Eleven first year students had prepared for three months previous their start date on July 4, 2011, some had arrived to take medical Spanish classes and attended hospitals and clinics shadowing local doctors. In addition, the majority had an acceptable proficiency of Spanish. But nothing could have prepared them for the cross-cultural impact of 250 children. Yes, children are children anywhere, they are curious and silly,running close to mischievous and exploring the boundaries.Cacha children learn to do household activities very young, they take care of animals and crops during their summer vacation.Most of them walk to the city of Riobamba and help their parents in the markets;others just work in stores or in households.The ages range from 7 to 14 years old. In all, their life is not easy, they experience discrimination and lack of opportunities in education and health. Although the health camps will not solve their problems, Cacha children will be redirected to other topics and people for three weeks.Probably will maintain their faces clean and shiny for some weeks, and treasure their school supplies and toothbrushes brought by these medical students.

The last week has been to wrap – up and to have assessments on the learning. A group has shared with us the kind of assessments they did their last week.

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Health Camp – Week 2

    Definitely our second week had more success. Children learned the names of the bones and body parts, some organs and how they function. It was very attractive for many kids to have their own white shirt to draw the heart and lungs. It turned out really well. In our nutrition lesson, we drew a big plate of 4 categories of food which are fruits, vegetables, meat (protein) and carbohydrates. They drew pictures of plates which they like the most in each category. They enjoyed these activities a lot, using all these materials to draw, brought huge smiles to their faces!

    In Cacha, they do not have an access to pure water. They drink from tap water which is still unsanitary and filled with bacteria. There is a report that over 50 % of children in one school have bacteria in their stomachs, maybe stools(?) They do not know how to access clean water. So, the medical students told them to boil the water before they drink it, which is really important. Maybe, there are other reasons that explain why they keep drinking the untreated water, moreover, maybe they are doing other unsanitary activities that increases the exposure to bacteria. For example, not cleaning the kitchen utensils or not washing their hands after using the toilet.

    The community is very poor, and they do not have enough amount of health education. Yet, the children are learning to take better care of themselves and their families, and also how important to keep themselves healthy. We have noticed that they have started washing their hands before they eat, which is becoming a habit. But, then, I question myself, when does this become a habit or a practice? How long will it take? So ,many questions so little time. Slowly but surely, the community and the attitude of the children are changing. The next post includes some pictures of our second week!

Health Camp – Photos – Week 2

Head,shoulders,knees and toes! Our Body!

First, listening to our hearts.

Then, drawing body parts!

On paper:

On white board:

On sweatshirts:

Awesome!!

Later, knowing the 4 categories of food and drawing food we like!

“This is the way we brush our teeth,brush our teeth, brush our teeth, early in the morning….and at night, tooooo”

They learned to wash hands before eating, so they went to wash their hands before getting snacks.

 

 

    They just learned how to count from one to ten in English. Then they are counting one to ten in English while they are stretching.

 

 

They are learning about the five senses.

After they learned names of the body parts in English, they played “Head, shoulders, knees and toes” with using the vocabulary they just learned.

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They are so happy to have their own toothbrushes

 

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They are getting washed their faces and hands.

 

Health Camp – Children are learning! –

    It’s been a while since the last update. I would like to declare that the camp is amazing. We started teaching the basic hygiene practice through the games. The children learned to protect themselves from germs by washing hands, face, feet, brushing teeth and covering when they cough or sneeze. They seemed really enjoying playing the hygiene games. We also started teaching English such as basic greetings, numbers, colors and some body parts. We used those words when we play activities or so. Overall, the medical students are providing really practical lessons.

    The children are learning. They have been experiencing what is better to do for their hygiene. The Cacha people do not take a good care of their hygiene. They do not have a custom of washing hands, face, or brushing teeth. Regarding that, it is one of our biggest challenge to provide the community basic hygiene.

    One day, the children were provided a toothbrush and toothpaste, and they had a lesson of brushing teeth. Their blackish teeth became so clean. After that, a student washed their hands and faces with soap. We could see how their faces and hands became cleaner. Every child felt better after getting their faces and hands washed. The children are learning what is better. The following day, they came to camp and it was obvious that they washed themselves that morning. Their face had beautiful SHINE!

    We are so happy to see that the children are learning the importance of keeping themselves away from sickness and how to prevent

themselves from it. It is not a common idea for the Cacha people to keep themselves clean. That is going to be a big challenge for us that how to make

them as custom and make the people to keep practicing it.