Climbing Cotopaxi

One of the best experiences that I have had here in Ecuador was a weekend climbing trip to the summit of Mt. Cotopaxi.  It is one of the highest active volcanoes in the world at 19,347 ft.  and on a clear day, its dramatic cone-shape can be seen from Quito.  Due to its location near the equator, the weather is more moderate and predictable than other high peaks.  This plus the relatively non-technical nature of the climb make it a very popular first mountain for people interested in high altitude ascents. 

Our trip started on Saturday morning with a gear check and a two-hour car ride to Cotopaxi National Park.  On the way we stopped for a large lunch and all ate too much.  This would be the theme for the rest of the day as our guides made it clear that we needed as much energy as possible for our climb.  After navigating some washed out roads we arrived at the parking lot for the climbing refuge.  From the parking lot it is about an hour-long hike over very loose gravel up to the refuge.  With all of our gear this was not the most pleasant of hikes, but the views from the refuge are stunning and many tourists make the hike as part of day trips to Cotopaxi.  Once at the refuge, we claimed our bunks upstairs, unpacked our gear, and most importantly ate again.  The meal consisted of hot chocolate, sandwiches, soap, and other snacks and despite still being full I packed away quite a bit.  We spent the rest of the afternoon taking pictures from the refuge, talking to other climbers, and getting nervous for our attempt. 

At around 6 PM, we had another meal and then retired to our bunks to try and get a bit of sleep before waking up at 12:30 AM to start our ascent.  Being completely bloated from the all of the eating, excited, and nervous did not lend itself to very good sleep but at some point around 9 PM or so I must have dozed off.

I awoke to the scurrying of everyone at the refuge getting themselves ready for their ascents.  I pulled on my layers of clothes as quickly as possible, laced up my heavy plastic boots carefully, and ran through my gear to make sure I had everything.  After a quick breakfast and bathroom stop, we were ready to go.

The first hour of the climb is more loose dirt and gravel, always a pain, and our cumbersome boots did not make things any better.  So it was a welcome sight when we got to the glacier, strapped on our crampons, and felt the clean crunch of the snow beneath our feet.  The guides told us to walk slow and with a rhythm: step, step, ice-axe, step, step, ice-axe, etc.  I was thankful for the nice weather, clear skies and low wind and between watching my foot placements I could appreciate the nearly full moon and abundant stars.  We took frequent breaks for chocolate and water and before I knew it we had already been climbing for 4 hours.

After this things got quite a bit harder: steeper grade, narrower path, more need of the ice-axe, and more wind.  We were still on pace to summit shortly after sun-rise (the sun heats up the snow during the day creating dangerous conditions so descents need to begin by 8 AM or 8:30 AM at the latest) and even though fatigue was beginning to set in our sprits were high.  For the next couple hours it felt like we were moving really slowly but the guides said we were doing fine and soon they were telling us that we had approached the final 200 meter push.  This is the hardest part of the climb, but as long as were not feeling sick we had ample time to make it to the summit.  This final section was the steepest yet and we were frequently on all fours crawling up the mountain with our ice-axes.  It was starting to get light our and after was seemed like an eternity of crawling up-hill in the snow we reached the summit!

The view from the top was breathtaking and the elation from having just summited a 19,347 ft mountain is indescribable.  At the summit we took lots of pictures, exchanged congratulations, ate more chocolate, and tried to take it all in.  It seemed so short but after about 20 minutes it was time to start our descent before the sun heated up the snow too much.

The descent was much shorter than the ascent, only about 2 hours compared to the 7 hour ascent, but it was much harder.  The altitude was starting to give me a headache, I was feeling disoriented, and the adrenaline rush of reaching the summit was starting to wear off.  As we plodded along, I could not believe that I had climbed this high up.  My energy level was dropping faster than we were and by the end I was nearly delirious with exhaustion.  Upon returning to the refuge, I ate to try and regain some of my strength and rested.  My body was very disoriented after 9 hours of exertion, little sleep, and being at such a high altitude.  I somehow managed to pack up my things, tromp down with the group to the parking lot, and plop down in the back of the truck.  As we drove away from the refuge my head started to clear a bit.  Looking out the window at Mt. Cotopaxi, I couldn’t believe that only a few hours earlier I had been at the top.  Climbing Cotopaxi was one of the hardest things that I’ve ever done, but it is something I will never forget.

Southern Quito Neighborhood

I’ve been living this summer in a shared house with about twenty other students and doctors working with The Quito Project.  The house is located in the southern part of Quito, near “el Puente de Guajalo” in “la ciudad de Pleibol” which is all of the direction that I’m able to muster.  Fortunately, it’s sufficient for taking a taxi and once I’m in the area, I know my way around.  Life in this neighborhood has been a great experience thus far although it is markedly different than any of the neighborhoods that I’m used to.

What was most initially surprising to me is the lack of zoning in these neighborhoods.  As a result, on our block is a school, a health clinic, a warehouse, tons of little bodegas, a salon, and a mechanics workshop.  This is in addition the construction zone, plywood factory, and gas truck parking that one passes upon entering our neighborhood.  Needless to say, there’s a good deal of dust, noise, and stray dogs in our neighborhood that accompany the community of families that have their homes here.

An interesting note about the houses here is that they are all made of concrete, reinforcement rod and bricks.  Furthermore, they are constant works in progress as owners add on to their homes when they have the resources or need to do so.  As such, the reinforcement rod extends past the current concrete structure in order to add another floor on to the house later.  Even if it does not make for the most polished looking home, I appreciate the optimism it represents to build a better future.  I like to think this is the same optimism I see in workers’ faces as they go about their work whether it be at the hospital, repairing roads, driving buses, or cutting hair.

City beauty and Transport

Here are a few thoughts about life in Quito, Ecuador.  Clouds and mountains, I cannot say enough about how beautiful it is here.  It still baffles me that people built a city up here in the mountains as it looks more like a national park than an appropriate place for a city.  This is never more clear to me than when daydreaming out the window while stuck in traffic.

Transportation here is hectic.  There are three primary ways to get around town: the ecovia/trole formal buses, the informal buses, and taxis. 

The ecovia/trole formal buses are similar to what I’ve experienced in most other cities I’ve lived in.  They have a set route with fixed stops and the buses by-in-large all look the same. 

The numerous informal buses on the other hand offer a very different experience.  Firstly, especially for young men, they don’t really stop.  Rather they just slow down so that you can hop on.  Despite a number of bus entrances in this fashion, it never ceases to raise my heart rate a bit as I hope to time my jump at the right time.  My favorite part of these buses though is the personalization that goes into decorating the bus’s interior.  Furry coverings, tassels, curtains, speakers and stickers are a few of the ways  that these bus drivers/owners express themselves so the rides are never dull.

Taxis are surprisingly plentiful here, and people from all walks of life seem to utilize them.  During the day, meters (which start at $0.35 and count by the penny) are in use but at night its best to negotiate fares in advance.  However convenient the taxis are, they are not always faster than the ecovia/trole which have the benefit of a dedicated lane, and a ride from our place in the south of the city up to the La Mariscal frequently takes 40 minutes or so.  Like the informal buses, there is a great deal of creativity expressed in decorating the cabs.  Aftermarket LED lights, furry coverings and fringe abound; so every ride has a slightly different character.

Overall, considering that Quito very narrow and long, it takes awhile to get from point to point, but at least one can travel in style.

Surveys and Paper-based medical records

Our survey work is going well as we are nearing our goal of 180 patients enrolled.  Having been exposed to some of the workings of the health system here for a few weeks now, I can understand the urgency expressed at the eHealth conference for South American countries to better utilize technology to improve efficiency.   Healthcare workers here in Ecuador work hard to provide the best care possible, but they are limited by still having to rely on paper based medical records.  This makes it very difficult to access patient information quickly.  Moreover, only one person can access a medical record at a time.  Information is transmitted to multiple departments for tracking purposes with handwriting (which if it is anything like mine is far from reliable) and carbon copies.  It’s impressive that so much gets done as well as reminds me how much we take for granted when using electronic medical record systems. 

However, switching to electronic medical records requires significant resources and coordination.  While the centralized public health model here provides order and consistency, it is hard to imagine the resources appearing for such an investment.  The need for low cost electronic medical records solution here is great and hopefully as electronic medical records become standard throughout more developed areas, lower cost solutions will emerge to make this possible in lower resource areas.  It would certainly make life a bit easier here in the hospitals of Quito, Ecuador.

Telesalud in Quito, Ecuador

Greetings from the middle of the world: Quito, Ecuador.  By way of background, I’m spending my summer with The Quito Project, a group of medical students and public health students that are working on projects ranging from chronic disease research to depression screening.  I’m working on Proyecto Telesalud (Telesalud), a mobile device intervention that seeks to improve follow-up care for new mothers and their babies.  My role is to help enroll patients in our randomized control trial as well as develop a cost/benefit analysis for the intervention.

Thus far, we’ve have been busy getting our the logistics of the survey organized, training Ecuadorian medical students in the enrollment process, and coordinating with the appropriate administrators for health center and hospital access.  Additionally, the University of Michigan organized a great conference on eHealth and Chronic Disease Conference at Pontificia Universidad Católica del Ecuador (more on that in another post).  The passion that the presenters and attendees exhibited for global health was inspiring.  Furthermore it was interesting to see how presenters from various countries in the Americas were tackling similar problems in different ways.

All of The Quito Project members are living in a rented house in Southern Quito, I’ll post more later on some of the quirks to life in Southern Quito but thus far its been a blast.  I look forward to reading more about the adventures of the other WDI fellows and keeping everyone abreast on the notable goings on here in Quito.