Timmy Foundation Brigade Report

Brigade
Report
University of Notre Dame –
Quito, Ecuador
October 2010
Timmy Foundation
Building Healthy Futures
Brigade Report – University of Notre Dame: Quito, Ecuador, October 16-23, 2010
The following report summarizes the Timmy Foundation’s October 2010 brigade to
Quito, Ecuador with the University of Notre Dame chapter and medical professionals.
A special thanks to all of the volunteers—both students and medical professionals—
who made the brigade possible.
Volunteer Specifics
For 2010, the University of Notre Dame chapter selected 18 students to travel on the brigade—8 men, and
10 women. They were joined by their faculty advisor. Seven total medical professionals were recruited by
the Notre Dame chapter, including one Family Medicine Physician, one Emergency Medicine Physician, and
one Cardiologist, two ER nurses, and two pharmacists. The Timmy Foundation’s Program Coordinator and
the Medical Brigade Coordinator in Ecuador were also present. The total number of trip participants totaled
28. For a complete brigade roster, please refer to Appendix I.
Though facets of the trip are summarized below, please refer to Appendix II for a complete hourly schedule,
revised according to the group’s actual movement.
Travel
Flights
Twenty-three of the total participants were scheduled to depart Indianapolis, Indiana on a group flight,
contracted through Delta Airlines. One physician along with the two pharmacists arrived on a separate
American Airlines flight through Miami. The Timmy Foundation’s Medical Brigade Coordinator met the
group in country. The group arrived safely and on schedule in Quito at 11:00pm on Saturday night.
Ground Transportation
Transportation throughout the week was organized by Quito Eterno, a local organization assisting all Timmy
brigades to Ecuador. For the duration of the week, a 33-passenger bus was contracted from Girasoltour and
driven by Don Alberto. The bus found itself in a tight squeeze on a dirt road on Thursday while attempting to
arrive at a rural work site via a detour but, other than that, there were no notable transportation issues.
Clinic
Full days of clinic were scheduled for all work days, Monday-Friday. Wednesday has traditionally been an
educational and cultural day in Quito. All clinic days the group split into two teams and traveled to different
communities except for Thursday when the group traveled to a rural work site and worked as one team. In
total, the Notre Dame Timmy team treated 787 patients during the clinic week.
Monday –Garrochal & Venecia
On Monday, the Notre Dame chapter and medical professionals attended to 82 patients in Garrochal and 87
patients in Venecia. Both communities are newer to the Timmy Foundation and were adopted in March
2010. They are visited on a regular basis. Garrochal has 31 patients identified as chronic, with diabetes,
hypertension, or degenerative arthritis. Of the 82 patients in Garrochal, 9 were on the chronic list; 24 were
males, 58 females; 13 were young children (ages 0-5); 12 were children/adolescents (ages 6-17); and 57
were adults (ages 18 and older). A total of 6 patients were referred to the Tierra Nueva hospital for more
intensive examinations, treatment, or follow-up. For more specific information regarding the morbidity
statistics in Garrhochal (and all other communities and age-groups), please refer to the brigade data in
subsequent pages.
Of the 87 patients in Venecia, 5 were chronic (of a total 34 previously identified in the community); 25 were
males, 62 females; 11 were young children (ages 0-5); 24 were children/adolescents (ages 6-17); and 52
were adults (ages 18 and older). A total of 5 patients were referred to the Tierra Nueva hospital.
Tuesday – San Blas I & Musculos y Rieles
On Tuesday, the Notre Dame chapter and medical professionals attended to 92 patients in San Blas I and,
over two clinic days, Tuesday and Wednesday, a total of 160 patients in Musculos y Rieles. These
communities were recently adopted in March 2010 and May 2010 respectively and are visited on a regular
basis. Of the 92 patients in San Blas I, 15 were chronic (of a total 50 previously identified in the community);
27 were males, 65 females; 15 were young children (ages 0-5); 16 were children/adolescents (ages 6-17);
and 61 were adults (ages 18 and older). A total of 4 patients were referred to the Tierra Nueva hospital.
Of the 160 patients in Musculos y Rieles, 10 were chronic (of a total 26 previously identified in the
community); 66 were males, 94 females; 48 were young children (ages 0-5); 34 were children/adolescents
(ages 6-17); and 78 were adults (ages 18 and older). A total of 9 patients were referred to the Tierra Nueva
hospital.
San Blas I was adopted in March 2010. (For more information on how this and other new communities are
selected in Quito, please refer to the article on the Timmy Foundation blog on the website.) It has strong
leadership from several men in the community, including the president. They were offered an expanded two
clinic day for the May brigade and October brigades with the capacity to attend to 160 total patients.
However, they were unable to sell more than one day’s worth of tickets in advance and we were forced to
attend to a different community the second day, Virgen del Quinche.
Wednesday –Virgen del Quinche & Musculos y Rieles (continued from Tuesday)
On Wednesday, the Notre Dame Timmy team attended to 85 patients in Virgen del Quinche and the second
half of a total 160 patients in Muculos y Rieles (data listed above under Tuesday). Virgen del Quinche is not
one of the Timmy Foundation’s officially adopted communities because it receives weekly visits by the Tierra
Nueva mobile medical unit. However, we chose this community to fill in at the last minute for the second
day originally planned for San Blas I. This community has been visited several times in the past, but never on
a regular basis. Of the 85 patients in Virgen del Quinche, 1 was chronic (of a total 1 previously identified in
the community); 27 were males, 58 females; 37 young children (ages 0-5); 8 children/adolescents (ages 617); and 40 adults (ages 18 and older). A total of 5 patients were referred to the Tierra Nueva hospital.
Thursday –Cuturivi Chico (Latacunga)
On Thursday, the Notre Dame chapter and medical professionals traveled two hours outside of Quito to an
area called Latacunga to attend to 122 patients in Cuturivi Chico, a rural, primarly Kichwa community that
receives little medical attention. Of the 122 patients in Cuturivi Chico; 34 were males, 88 females; 12 were
young children (ages 0-5); 23 were children/adolescents (ages 6-17); and 87 were adults (ages 18 and older).
A total of 11 patients were referred to the Tierra Nueva hospital.
Friday –Loreto & San Francisco
On Friday, the Notre Dame chapter and medical professionals attended to 79 patients in Loreto and 80
patients in San Francisco. Both are brand new communities recruited by Timmy during the latest community
search. They are located in Valle de los Chillos, an area outside of Quito that serves a different patient
population than the usual Tierra Nueva outreach. This brigade was the first clinic at the site and it remains to
be seen if we will continue to include them in our regular clinic visits. Of the 79 patients in Loreto; 40 were
males, 39 females; 13 were young children (ages 0-5); 14 were children/adolescents (ages 6-17); and 52
were adults (ages 18 and older). A total of 11 patients were referred to the Tierra Nueva hospital.
Of the 80 patients in San Francisco; 25 were males, 55 females; 14 were young children (ages 0-5); 25 were
children/adolescents (ages 6-17); and 41 were adults (ages 18 and older). A total of 3 patients were referred
to the Tierra Nueva hospital.
Following clinic, all medicines and supplies were dropped at the Tierra Nueva hospital for later inventory and
storage until the January brigade.
Referral System
A total of 54 patients were referred to the Tierra Nueva hospital throughout the week. An incentive program
is used to encourage patient follow-up that consists of a $3 transportation rebate given in two parts. The
rebate is valid through the entire month after the brigade, in this case November, and the disbursement is a
$1 cash allowance upon the first appearance at the hospital to make the initial appointment. The other $2
cash is awarded after attendance at the medical consultation. Referral follow-up under this system usually
hovers around 60-70%.
Activities
There were several planned cultural activities throughout the week beginning on the Notre Dame
participants’ first full day in Ecuador.
Tierra Nueva (our International Partner Organization)
After arriving at the airport late Saturday night, the Notre Dame Timmy team was up bright and early on
Sunday morning for mass at Tierra Nueva. After the mass and a brigade orientation at the old hospital, we
had the opportunity to get to know the new hospital, including the Emergency Room, now fully operational,
the inpatient wards, and the Neonatal ward. Much of the student chapter fundraising over the last several
years contributed to the construction of the new hospital, a dream of Tierra Nueva’s founder, Padre Jose
Carollo.
Exploring Quito
On Sunday afternoon the group visited a new museum in the historical downtown of Quito called Casa de
Alabado. It houses the most extensive private collection of Ecuadorian pre-Columbian ceramics in the
country. After a stroll through the Historical downtown, the group explored the Basilica of Quito, often
thought an eyesore by the locals but a fabulous opportunity for views of the city as well as a precarious and
frightening climb to the tower on a questionable looking, exterior staircase.
Cuarenta Tournament
On Monday night the group had some time to relax and socialize as they learned Ecuador’s most popular
card game, Cuarenta. One of our local translators along with the MBC taught the group the basic rules of
play and later helped to referee a tournament. We had eight different teams of two playing for the coveted
prize of two decks of Quito themed playing cards and the final title was hard won by Emma and Nathan A., a
team that remained relatively quiet through all of their victories to come out on top.
Quito Eterno Ruta de Leyenda
On Tuesday night the group was led around the Historical Downtown, including the San Agustín convent, by
none other than the Devil himself. Hosted by Quito Eterno, a local nonprofit whose aim is to increase
awareness of Quito’s history among its own people, the tour is called a “Route of Legends” and is always led
by an important historical character. The Devil explained stories behind historical monuments and artifacts
with the use of fact and fiction intertwined. To conclude the tour, the group ascended Panecillo, an iconic
hill in the city with the Virgen of Quito as its hallmark feature. On top they enjoyed naranjillaso, a traditional
warm beverage to temper the windy and chilly night.
Humanisarte Andean Folklore Dance
On Wednesday evening, the group dined out at a local restaurant called La Frutería on the lower floor of a
historical building in the downtown and later attended an Andean folklore dance performance by a local
dance troupe, Humanisarte, off of a famous street called La Ronda. All types of dance and costuming
representative of the different regions of Ecuador were presented including La Sierra, La Costa, and La
Amazonia.
Salsa Dancing Lessons
On Thursday evening, Notre Dame students and medical professionals had the opportunity to attend free
salsa dancing lessons at the Centro led by a professional instructor. Many people showed off their inner latin
rhythm while others danced like gringos with pride! Overall, I think we can all take away that Salsa is more
difficult than it looks.
Supermaxi
On Friday evening there was a stop at the local supermarket, Supermaxi, for a chance to purchase
Ecuadorian food specialties such as ají, chifles, chocolate, and coconut cookies.
Cena Especial
On Friday night, the group was joined for a special dinner by the directors of the Tierra Nueva Foundation
including Dr. Patricia Jarrín, Coordinator of Brigades, and Beatriz Rivadeneira, Director of Outpatient Care, as
well as the two volunteer policemen who assisted the group throughout the week. Ms. Rivadeneira made a
heartfelt speech to thank the members of the group for their hard work and each trip member was
presented with a personalized certificate and small gift from Tierra Nueva.
Exploration in Imbabura
On Saturday the group spent the day outside of Quito in the Imbabura province. En route, we stopped at the
Sun Dial, marking the exact equator, where we posed for photo-ops and stood in both hemispheres at once.
We were also presented with information about the scientific research project about the equator and
astronomy taking place at that site called Quitsato.
Lunch was at a restaurant in a town two and a half hours north of Quito known for its leather goods called
Cotacachi. After lunch, free time was given to shop the small stores with local leather goods ranging from
jackets and shoes to purses and belts.
From there we traveled the fifteen minutes to Otavalo, Ecuador’s, and supposedly South America’s, largest
outdoor marketplace. The Saturday market, the area’s most popular and crowed, offers textiles, jewelry,
and many other handicrafts. Trip members did their best to bargain down prices, as this is the local game
and expected business transaction. Within two hours we had a bus full of smiles, plenty of Ecuadorian
goods, and more than a few empty pockets.
Dinner was American style with a twist; pizza at a local pizzeria called El Hornero. We enjoyed the familiar
such as pepperoni but ventured to try Ecuadorian variations such as the fresh tomato and the “criollo” with
bacon and choclo (a large, white corn). From there the group was taken to the airport to await the return
flight home.
Wellness
Brigades to Quito rarely experience trip member health issues but one physician fell ill on Thursday evening
with extreme nausea and vomiting. By Thursday night she was seen by one of the other doctors and placed
on IV fluids and Phenergan for the duration of the night. She was still under the weather on Friday and was
unable to participate in clinic. By Friday evening she was feeling much better and was able to participate on
Saturday as well as travel home without any problems. A student also felt ill on Friday but did not miss any
activities. All other trip participants were able to successfully participate in all clinic days and activities and
there were limited complaints of altitude sickness or diarrhea throughout the week.
Appendix I
Trip Participant Roster
Notre Dame Quito 10.2010
#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Last Name
First Name
Role
Nalezny
Emma
Student
Benson
Elizabeth
Student
Morris
Stephen
Student
Lam
Janna
Student
Hussey
Kristen
Student
Dozois
Adeline
Student
Anhut
Jennifer
Student
Albertson
Nathan
Student
Nasca
Brian
Student
Ensslin
Courtney
Student
Clifford
John
Student
Lin
Nathan
Student
McCaskey
Conor
Student
Polcari
Ann
Student
Matthews
Shawn
Student
Moriel
Gabriela
Student
Rodriguez-Homs
Miguel
Student
Kang
Julia
Student
Schierling
Sharon
Advisor
Clifford
Robert
RN
McHugh
Emily
RN
Deurinck
Mark
MD
Cole
Donald
MD
Dowell
Elizabeth
MD
Billotti
Jamie
Pharm
Carson
Sarah
Pharm
Morris
Kathy
Timmy Staff
Gilman
Alana
Timmy Staff
Appendix II
Hourly Itinerary (Revised)
Saturday, October 16th
11:00 pm
Group Arrives at Airport
Sunday, October 17th
7:30 AM
Breakfast at Centro
7:50 AM
Leave for Mass at Tierra Nueva
8:15 AM
Mass at Tierra Nueva (optional)
8:30 AM
Breakfast at Centro (for non-church goers)
9:10 AM
Leave for Tierra Nueva (for non-church goers)
9:30 AM
Tour of Tierra Nueva Medical Institute
9:45 AM
Brigade Orientation
11:15 PM
Tour of Un Canto a La Vida
12:00 PM
Lunch at El Centro
2:00 PM
Casa de Alabado Museum
4:00 PM
Tour of La Basilica
5:30 PM
Depart for Centro
6:00 PM
Dinner at Centro
7:00 PM
Organize Medicines/Count Vitamins/Med Professional Mtg.
Monday, October 18th
7:00 AM
Breakfast at Centro
8:30 AM
Leave Hospital for Work Site
 Venecia
 Garrochal
4:00 PM
Leave Work Site for Centro
5:00 PM
Internet & Phones/Nap
6:00 PM
Dinner at Centro
7:00 PM
Reflection (led by Trip Leaders)
7:30 PM
Medicine packing
8:30 PM
Cuarenta Tournament
Tuesday, October 19th
7:00 AM
Breakfast in Centro
7:30 AM
Leave Centro for Work Sites
 San Blas I
 Musculos y Rieles
5:30 PM
Dinner at Centro
6:15 PM
Leave Centro for tour
7:00 PM
Tour with Quito Eterno
10:00 PM
Medicine Packing
Wednesday, October 20th
7:00 AM
Breakfast in Centro
7:30 AM
Leave Centro for Work Sites
 Virgen del Quinche
 Musculos y Rieles
5:00 PM
Leave Work Sites for Centro
6:30 PM
Dinner at Frutería
8:00 PM
Andean Folklore Dance “Humanisarte”
10:30 PM
Medicine Packing
Thursday, October 21st
6:30 AM
Breakfast at Centro
7:00 AM
Leave Centro for Latacunga work site (2 hours away)
9:30 AM
Arrive at work site
 Cuturivi Chico (Latacunga)
4:00 PM
Leave Worksites for Centro
7:00 PM
Dinner at Centro
7:30 PM
Medicine Packing
8:30 PM
Salsa Lessons
Friday, October 22nd
7:00 AM
Breakfast at Centro
7:30 AM
Leave Centro for work site
 San Francisco
 Loreto
4:00 PM
Leave Work Site for Centro
5:00 PM
Supermaxi
6:30 PM
Drop off remaining meds at Instituto Medico
7:00 PM
Cena Especial at Centro
8:00 PM
Final Reflection (led by Timmy Staff/Trip Leaders)
Saturday, October 23rd
8:00 AM
Breakfast at Centro
8:45 AM
Leave for sun dial on equator
11:00 AM
Sun Dial
12:15 PM
Lunch at Cotacachi
1:00 PM
Shopping at Cotacachi leather market
2:00 PM
Leave for Otavalo
2:15 PM
Otavalo: indigenous market shopping
4:45 PM
Leave Otavalo
6:30 PM
Pizza Dinner at El Hornero
8:30 PM
Airport
Timmy Foundation Brigade Report
Notre Dame - Quito, Ecuador
October 16-23, 2010
The following report summarizes the October 2010 Timmy Foundation medical brigade to Quito, Ecuador.
Patient and referral data was collected during the brigade clinics and is shown below.
PATIENT PROFILE
TOTAL Patients
787
Young Children(age 0-5)
Children/Adolescents(age 6-17)
Adults (age 18 and older)
163
156
466
Young Children
21%
Children
20%
Adults
59%
Males
34%
Females
66%
Males
Females
268
514
OVERALL MORBIDITY
Parasites
General Pain
Other musculoskeletal
Gastritis/GERD
Hypertension
Other
Headache (non-specific)
Well Check
Tonsilitis
Cold/Cough
Osteoarthritis
Abdominal Pain
Other derm.
Allergy
Other ophth.
Other Cardiac
Urinary Tract Infection (UTI)
Dry Eyes
Other gyn.
URI Non-specific
Fungus
Conjunctivitis
Diarrhea
Dermatitis
Other neuro.
Exema
Osteoporosis
Malnutrition
Anemia
Other laryngo/pulm.
Cataracts
Caries
Pharyngitis
Vaginitis
Menstrual/Menopause
Hearing Loss
Rhematoid Arthritis
Other gastro.
Diabetes Mellitus
Asthma
Prenatal visit/pregnant
Stress
Anxiety/Depression
Ear Infection
Migraine
Yeast Infection
Constipation
Murmur
Other psych.
Lice
Scabies
279
122
82
62
55
50
50
48
45
41
40
40
27
25
22
21
20
19
18
16
15
14
14
13
12
12
11
11
10
10
8
8
7
7
7
6
6
6
5
5
5
3
3
3
3
3
3
3
2
2
2
0
50
100
150
200
250
300
Young Children Morbidity (age 0-5)
Parasites
75
Well Check
32
Tonsilitis
17
Cold/Cough
16
Other
9
Malnutrition
8
Diarrhea
8
Allergy
7
Fungus
7
URI Non-specific
6
Conjunctivitis
5
Abdominal Pain
5
Other derm.
5
Caries
4
Anemia
3
Other ophth.
3
Other musculoskeletal
3
Dermatitis
3
Exema
3
General Pain
2
Lice
2
Urinary Tract Infection (UTI)
1
Osteoarthritis
1
Other laryngo/pulm.
1
Pneumonia
1
Asthma
1
Pharyngitis
1
Gastritis/GERD
1
Scabies
1
Impetigo
1
Hypertension
1
0
10
20
30
40
50
60
70
80
Child/Adolescent Morbidity (age 6-17)
Parasites
80
Tonsilitis
14
Well Check
13
Headache (non-specific)
13
Cold/Cough
12
Abdominal Pain
12
Other
11
Other derm.
11
Other musculoskeletal
10
General Pain
10
URI Non-specific
8
Allergy
6
Other neuro.
6
Dermatitis
6
Anemia
5
Other laryngo/pulm.
4
Exema
4
Other ophth.
3
Malnutrition
3
Gastritis/GERD
3
Diarrhea
3
Fungus
3
Other Cardiac
3
Dry Eyes
2
Caries
2
Pharyngitis
2
Injury/Lesion
1
Anxiety/Depression
1
Hearing Loss
1
Ear Infection
1
Conjunctivitis
1
Asthma
1
Other gyn.
1
Vaginitis
1
Menstrual/Menopause
1
Constipation
1
Murmur
1
0
10
20
30
40
50
60
70
80
90
Adult Morbidity (age 18+)
Parasites
General Pain
Other musculoskeletal
Gastritis/GERD
Hypertension
Osteoarthritis
Headache (non-specific)
Other
Abdominal Pain
Urinary Tract Infection (UTI)
Dry Eyes
Other gyn.
Other Cardiac
Other ophth.
Tonsilitis
Cold/Cough
Allergy
Osteoporosis
Other derm.
Cataracts
Conjunctivitis
Other neuro.
Rhematoid Arthritis
Vaginitis
Menstrual/Menopause
Other gastro.
Diabetes Mellitus
Hearing Loss
Other laryngo/pulm.
Prenatal visit/pregnant
Fungus
Exema
Pharyngitis
Dermatitis
Well Check
Stress
Migraine
Asthma
Yeast Infection
Diarrhea
Anemia
Other psych.
Anxiety/Depression
Ear Infection
Caries
URI Non-specific
Constipation
Murmur
124
109
69
58
53
39
37
30
23
19
17
17
17
16
14
13
12
11
11
8
8
6
6
6
6
6
5
5
5
5
5
5
4
4
3
3
3
3
3
3
2
2
2
2
2
2
2
2
0
20
40
60
80
100
120
140
MORBIDITY TOP 10
Garrochal (Monday)
General Pain
Other musculoskeletal
Osteoarthritis
Hypertension
Other neuro.
Abdominal Pain
Other laryngo/pulm.
Parasites
Gastritis/GERD
Other Cardiac
13
7
6
6
5
5
4
4
4
4
0
2
4
6
8
10
12
14
Venecia (Monday)
Parasites
32
Other musculoskeletal
18
Tonsilitis
14
Hypertension
10
Gastritis/GERD
8
Other
7
Osteoporosis
5
Cold/Cough
5
Abdominal Pain
5
Other Cardiac
5
0
5
10
15
20
25
30
35
San Blas I (Tuesday)
Parasites
37
Other musculoskeletal
16
Gastritis/GERD
14
General Pain
12
Tonsilitis
10
Hypertension
9
Urinary Tract Infection (UTI)
8
Headache (non-specific)
8
Well Check
5
Other
4
0
5
10
15
20
25
30
35
40
Musculos y Rieles (Tuesday & Wednesday)
Parasites
23
General Pain
18
Hypertension
18
Other
17
Other musculoskeletal
17
Cold/Cough
14
URI Non-specific
13
Well Check
11
Headache (non-specific)
10
Osteoarthritis
8
0
5
10
15
20
25
Virgen del Quinche (Wednesday)
Parasites
44
Tonsilitis
12
Well Check
11
Headache (non-specific)
9
Gastritis/GERD
7
Allergy
6
Other musculoskeletal
6
Osteoarthritis
6
Cold/Cough
5
Abdominal Pain
4
0
5
10
15
20
25
30
35
40
45
50
Cuturivi Chico (Thursday)
Parasites
56
General Pain
32
Abdominal Pain
17
Gastritis/GERD
11
Other musculoskeletal
10
Other ophth.
6
Conjunctivitis
6
Other derm.
6
Exema
6
Other
5
0
10
20
30
40
50
60
Loreto (Friday)
Parasites
52
General Pain
22
Well Check
9
Gastritis/GERD
8
Headache (non-specific)
6
Osteoarthritis
6
Other
4
Dry Eyes
4
Other musculoskeletal
4
Tonsilitis
4
0
10
20
30
40
50
60
San Francisco (Friday)
Parasites
31
General Pain
22
Other
11
Cold/Cough
8
Well Check
7
Headache (non-specific)
7
Urinary Tract Infection (UTI)
4
Other musculoskeletal
4
Osteoarthritis
4
Tonsilitis
4
0
5
10
15
20
25
30
35
REFERRALS
Gastrointerology, 1
Physical Therapy, 0
Internal Medicine,
1
Pediatrics,
1
Psychology, 1
Audiology, 2
Family Medicine, 2
Ophthalmology/Op
tometry, 9
Urology, 2
Dermatology, 3
Cardiology, 6
ORL/ENT, 3
Other, 4
Neurology, 4
Dentist, 4
General
Surgery, 4
Gynecology/Obstet
rics, 4
Traumatology/Orth
opedics, 3