Sunday, January 24, 2016

My Turn at Hospital Vicente Moscosco

Today was my turn at becoming a patient at our ever ready and available Emergency Room at the free public hospital, Hospital Vicente Moscosco here in Cuenca, Ecuador.  I got out of the shower as usual and dried myself off, then stepped out as usual to dry my lower extremities - lower legs and feet - and *then* it happened.  

At first I thought I needed to get some object off of the top of my left foot, but then I realized I had hit a gusher of blood!  I had popped a vein right at the skin's surface on the top of that foot, and it was gushing out with a great deal of force, to the point it was hitting the floor and wall area in the bathroom two feet away!  Every time I changed my foot's position, it merely sprayed its red product to a new part of the floor, soiling even more of the room.  

I realized then that I was going to end up in medical shock if I didn't get this thing compressed somehow.  Carolyn Anne had been resting and sleeping in bed up until that moment, and I called out to her that I needed her help now.  She immediately came, and saw what I saw.  She ran to the wired house telephone, and called 9-1-1 (Ecuador has the ECU 911 system in place here, and has for several years).  At first she got a Spanish speaking dispatcher, but then they got an English speaking dispatcher to assist in the call.  Carolyn Anne animatedly but decently enough gave them the needed information on how to get here - it helped that we are located next to a major well known landmark here in town, too.  

Meanwhile, the condo's security phone was ringing repeatedly for some reason.  Once Carolyn Anne applied a tourniquet to my leg and wrapped a towel around my foot, I moved myself to the security phone to find out what was going on in the midst of our own medical emergency.  Some female was saying mostly in Spanish but with some broken English they knew us from our church, and wanted 20 dollars.  I told them we were in the midst of our own emergency, and would not be able to help.  Geesh!  We still don't know who that was. . . or how they knew where we were or what the name of our church was.  A few crazies are here in Cuenca, and a good number of them are typically drunk, we have since learned.  

The Bomberos (EMT Firefighters) were quick to come with their ambulance and came up to our floor with a stretcher and three strong men to assist me.  I was ambulatory at that point, and walked myself down to the building's entrance with them, along with my ID and my water bottle. . . I knew where I was going and had seen it before.  I told Carolyn Anne "I love you!" one last time before going out to the entrance.  We had the good sense to supply me and her with cell phones (including our new smartphone) for this event.  

Once underway to the hospital, I was asked if I was covered under IESS insurance.  "We applied for coverage this month," I replied in Spanish.  "When?" they asked.  "The fifteenth of the month," I told them.  "Oh," they sighed.  They checked with dispatch to see if I was listed in the IESS computerized database yet, and no. . . I wasn't.  Off to Hospital Vicente Moscosco I went.  (Both the IESS hospitals are next to each other and near Hospital Moscosco, by the way).  

I entered a familiar parking circle at the ER - sure enough, it was Moscosco, I soon learned - and I ended up in the same bed location Carolyn Anne had used during her last visit to Hospital Moscosco.  What are the odds of that?  The usual things then took place: getting patient record data, blood type, and so on.  Remember here in Ecuador the patient is the repository of medical records, not the doctor or hospital (or insurance company).  Not like the USA at all.  My foot was cleaned up, bandaged, and once the result of my blood tests were known, I was released to go.  All of that took four hours.  

Carolyn Anne took a taxi a bit later than when I got loaded into the ambulance.  She showered and took her meds before getting into a taxi and getting a call from me to advise her which hospital I was at.  She arrived a half hour later than I did.  One of her friends, a retired nurse like Carolyn Anne, also came to visit for an hour or so.  It's good to have friends while in the hospital.  Here in Ecuador, the nurses don't look after you as comprehensively as they do in the United States.  Family members and friends do that job here, and their presence is valued all the more.  The biggest task they did was refill my water bottle with water, which nurses don't do here believe it or not.  

While we were here, we met two ER staffers, one a female intern in residency, the other a male student from the University of Cuenca who were bilingual in English.  Though they spoke in English to me, it wasn't necessary. . . I understood them and could communicate in Spanish well enough for the occasion as it presented itself.  In fact, my patient intake was done completely in Spanish.  Their bilingual abilities were a comfort to Carolyn Anne, of course, who doesn't yet have the capabilities in the language I have.  

During our visit, we saw a man that tried to get up out of his bed, and he almost fell down in the process.  As it turned out, he was drunk according to the male medical student, and it was a good thing I was observant enough to see what was going on while the student and I were making a bit of small talk.  I alerted the student to the fact this man had gotten out of bed, which probably helped save him from cracking his skull or something as bad.  He thanked me later, of course.  Here in Ecuador, there are no detox centers for alcoholics.  There are a very few rehabilitation facilities for alcoholics - even to the point of using a friend's house for the rehab services rendered - but not a single detox facility exists here.  May God help that unnamed man who almost fell down out of his bed!  I'd never seen that before at Hospital Moscosco, and this was our third visit there in the last two years.  

Currently I am resting comfortably in recovery and will be seeing the cardiologist doc I have been seeing before here in Cuenca to evaluate my foot on Tuesday.  If everything goes well, I will be on my feet and back to a normal schedule - knock on wood - in two week's time give or take.  I'm getting older, and my body's just not as together as it used to be.  

We're making progress though.  We enrolled in the Ecuadorian government's IESS health insurance program, which seems to be well regarded by the indigeneous Ecuadorians as well as expats, and now have a working smartphone (still working on the Skype Voice and Whatsapp apps, though.  Takes time to learn how to use them and so forth).  Two steps forward, and I suppose a step backward for the moment.  Your prayers for my healing and strength for all that needs to be done by Carolyn Anne will be appreciated!

Wednesday, January 13, 2016

A Short Recounting of Iglesia Verbo's Story in Cuenca

Carolyn Anne and I attended our first ever "Iglesia en Hogar" or "Home Church" small group meeting for those of us who speak English as our home language here in Cuenca, Ecuador.  It met at our church here, Iglesia Verbo Cristiana in Cuenca, in the cafeteria in order to provide a familiar and reasonably central location, as well as allow enough space and time saving access by the pastors who are involved with this new group.  

Verbo, which means "Word" in the action (verb) sense versus "Palabra," which means "Word" in the subject (noun) sense (and is analogous to the Greek word Logos), was named from its first bookstore in Guatamala decades ago.  The bookstore was called Verbo, ergo the people who met next to the bookstore were referred to by the local people by the same name.  A name was born.  

Verbo actually got started in Ukiah, California according to my own research on the Internet in the mid to late 1970's. . . contemporary with what was going on in Southern California and the "Jesus People" and beach/hippie culture with the Calvary Chapel movement.  By the 1980's Verbo was in Central America, Guatamala in particular.  

Verbo's entry into Ecuador was in Quito at first, where difficulty in establishing the church was encountered.  Several trying years were spent getting the congregation started there, but they are still there in Quito, and today in fact have several congregations in that city.  Cuenca came later, 27 years ago according to one of the founders, and began as a home church of just a few families. . . nothing big.  For years certain founding members, originally from the United States, learned to adapt to a new culture, a new language, and a new country.  Things stayed small and the church stayed within home churches meeting in various locations in Cuenca.  There was no central "church" facility or meeting place in those early years in the late 1980's.

Later on, as Verbo got to about 350 members give or take, a couple of leaders attended a theater showing of "Titanic" (which dates the event to circa 1997) in the downtown El Centro area and said to themselves, "I think this place would be a good place to have a church!"  They investigated, and procured the venue for a meeting place for Verbo.  That rather dated theater is still in existence today, though not well used as far as I know.  I walk by it on a regular basis still.  

Without realizing the future consequences for ministry in a strategic way, falling into the opportunity as it presented itself, Verbo performed probably a stroke of genius: the highly Roman Catholic culture of Ecuador and Cuenca looks down on its members attending a church other than the Roman Catholic church.  By renting a theater, one could say they were not "in church" while attending Verbo.  They would say they were visiting friends at a well known theater.  And they were!  Verbo grew in an exponential way at this point, and though the set up and tear down of sound systems, etc. took a toll on the volunteer members, it was all well worth it.  The populace could hear the worship going on inside the theater, and the curious could come on in and experience what was going on.  More people told more people about what this Verbo was doing in this rented theater space.  And the attendance grew, to the Glory of God.  

It took two years to build just the sanctuary (established circa 2002) on the land Verbo now uses as its church campus at 10 de Agosto y Loja.  The rest of the building - cafeteria, offices, classroom meeting space upstairs - was built as funds were raised over the years.  Nothing ever given to the congregation from outsiders or the city or any other source, everything came from the resources of the congregation's giving.

A couple of events has helped Verbo become better known to the Cuenca community over the years.  The previous Roman Catholic archbishop would get on the radio in Cuenca on a regular basis and denounce Verbo and what they were doing.  He had a real antipathy towards any religious group that wasn't Roman Catholic, apparently.  The net effect was that Verbo's name was on everybody's mind, and the brave and curious would inquire of Verbo.

The second development was really so very complementary and humble.  The current archbishop, which is in Guayaquil currently, but started out in Cuenca back then, would refer people in the Roman Catholic church to Verbo for counseling and/or instruction on marriage issues, for example.  "We don't have what you need. . . Verbo does.  Go there!" he would say.  Truly humble and amazing.  These referrals would come from the reputation Verbo was getting in terms of restoring the family, and providing real answers from God's Word in ministering to them.   

Once, the Roman Catholics came to Verbo and asked for help in observing a particular event in the life of the community.  "What would you like us to do for you?" Verbo's leaders asked.  "Preach the sermon, lead the worship of God in song," they replied.  "What will you be doing?" the Verbo leaders inquired.  "We'll give the closing prayer," they allowed.  Talk about open doors in a Roman Catholic venue. . . and there it was!  This story in my mind exemplifies Verbo's attitude towards others who claim a faith.  Work with what you have and seek common ground, versus finding ways to not work together and stay separate. . . and have no open doors to do ministry that could bring Glory to God and truly be a blessing to people.  In a country such as Ecuador in a region such as Latin America, I find that this approach has much merit.  

All the while as Verbo was growing in its former downtown theater location, as well as its current one, all kinds of people were drawn to what God was doing in Verbo.  It had a kind of "rock star" quality to the community for a time as people would hear the church's name and remark, "Oh, my doctor goes to that church!"  Or, "Isn't that the church that my neighbors go to?"  To this day the name of Verbo is well known in the community, especially for the outreach ministries it continues to do, such as Clinica Hogar which ministers to the poor providing needed medical treatments and services.  

I don't know that this information is out there on the Internet in one place, so as a courtesy I thought I'd provide it here.    Soli Deo Gloria!       

Sunday, January 10, 2016

Taking Heed. . . Lest You Fall

While taking care of a couple of errands Thursday, and doing them *together,* Carolyn Anne had yet another fall to the ground.  She was walking right behind me - two steps back, in fact - as she took yet another tumble.  This time, we were in front of Hospital Monte Sinai here in Cuenca in the very modern and up to date Ave. Solano neighborhood, with its wide boulevard, flat streets and sidewalks, and modern buildings all around.  

There are a number of curb cuts to access points by car to the hospital, including a parking garage, as one walks the sidewalk in front of the medical complex on the other side of the street from the hospital that houses medical offices and the farmacia.  The curb cut closest to the street for the parking garage might be two inches deep as one is closest to the street walking along the sidewalk.  One inch deep as one is further away, and the same depth as one gets the furthest away from the street along the sidewalk walking past the parking garage driveway entrance.  Well, Carolyn Anne didn't judge the depth of the sidewalk ahead to be any kind of a depression at all, apparently and took a tumble, causing a deep cut to the left eyebrow area at the edge of her eyebrow (which ended up getting four stitches).  She was walking where the change in depth to the sidewalk was about one inch difference.

Three to four Cuencano/as came to immediately assist her before I could even turn around and see what had happened.  There's that many people using the sidewalk in front of this hospital here in Cuenca, and in Cuenca generally this is the case.  Sidewalks are full of people walking as it is customary and expected.  Many don't even own cars.  Blood was spurting out of her face above her eye, and Carolyn Anne was furiously trying to wipe it up with her brown hankerchief to no avail. . . the blood kept on pumping out, and the ensuing mess on her Grace Chapel light green 2015 Community Day of Service tee shirt and pants was spread all over her clothes, drying eventually.  

I raised her up as a fellow Cuencano rushed to obtain a wheelchair located in the parking garage.  Now seated on the wheelchair, we wheeled her across the street to the Emergency Room, and took care of business. . . again.  This was all too familiar, but at a different hospital this time.  No X Rays or anything this time, though thank God!  Just clean up of the wound and four stitches.  

Since Monte Sinai is a private hospital, we had to pay upon leaving - and we had a guard escort to ensure we did so (that's the system here in Ecuador for private hospitals, btw).  The damages were $68.36 in total, and we were able to pay the cashier in the business office immediately upon discharge.  

The lesson here?  Certainly was one.  Obviously, when we are walking together, hold hands (which we have not been doing. . . long story there - but not a bad one.  Don't read anything into it that isn't there, folks).  Be very diligent to know about every step that you take.  Lessee. . . I remember a song lyric from "Every Breath You Take" by The Police which states "Every move you make/every step you take/I'll be watching you."  Those particular words fit.  

Spiritually speaking too we are reminded of the words from the Apostle Paul in 1 Corinthians 10:12 which say "take heed where you stand lest you fall."  Actually, the ESV text reads "Therefore let anyone who thinks that he stands take heed lest he fall."  And that's the problem and challenge in a nutshell: thinking that one stands when actually. . . one is on the precipice of falling.  We must constantly take heed!  Especially in places that might seem familiar.  Checking things out, testing, proving. . . all that wonderful counsel from God's Word through the writings of the Apostle Paul, among others, is the key in a world where things appear to be, seem, are one thing on the surface when, in fact. . . danger is lurking just around the corner.  

We have been warned once again, haven't we?

As Carolyn Anne heals up, her left eye area has turned violet due to bruising, as has an area past her hip - both these places got bruised, obviously.  Ribs are sore and likely bruised on one side, too.  Her glass frames got bent on one side, and have been fashioned back into place good as new!  Her stitches come out Monday.  We really need your continued prayers for her (and me as well) as both of our coordination and balance functions are not exactly normal, nor strong at our age.  Falling down here in Cuenca or in Ecuador by foreign expatriates is not uncommon, but we all need to be aware of the dangers and take appropriate heed to how we all move through space here while walking.  

Turning a page. . . 

The new teaching schedule for Arco Language Institute is out, and we teachers have six month terms, new terms starting every three months.  As a smaller language school, we can offer the beginning and intermediate levels of conversational English language classes, but doing a pre TOEFL or TOEFL preparation class isn't doable given the level of classroom space Iglesia Verbo Cristiana makes available to us.  So Arco's focus is on beginning to intermediate level of English conversation skills, which allow for local nationals to converse with the foreigners amongst them in jobs in hotels, restaurants, travel, hospitals, phamacies, retail, and the like.  

My contribution at present is to teach when the regular teachers aren't available to be there.  There looks to be definite need in March when a couple of teachers plan to be away, and I hope to be able to contribute that way at that time.  Thanks for praying for my preparations in advance!  

We've ordered a Smartphone from that should allow us to make international calls to the States once we get an Ecuador SIM card for it and get service on it.  It will have portals to Skype Voice and Whatsapp, which I understand is both voice and text communication.  We aren't texters, btw and will be sticking to voice calling.  The Whatsapp app will be very helpful in circumventing the excessively high prices the Ecuadorian telecoms want to charge for voice calls, and we look forward to getting used to using these ways of calling.  

Our landlady happens to be on a trip to the States at the moment and has agreed to "mule" the phone to us in her luggage.  Ecuador protects its telecom industry by confisticating internationally supplied new cell phones via the Aduanas - Customs enforcement.  Commercial shipment isn't allowed, but bringing in a personal amount on a commercial flight is.  New smartphones here in Ecuador will run you in the high $500 range at minimum, and can go to over $700 or even more.  Not paying those prices if we can help it!  We are grateful to God for our landlady and her helpfulness to us.  

I am at my lowest weight since my mid forties.  I'm now about ten pounds less than I was when last visiting the United States a few months ago.  Walking daily - sometimes for up to two kilometers or more - and not eating a whole lot compared to how it's done in the States are two good reasons why.  The more healthful food here in Ecuador is another.  Very grateful to God for the lost weight and for looking more normal sized day by day.  

Meanwhile on the health insurance front, we are working with friends at Iglesia Verbo to assist us in enrolling in the IESS health insurance program Ecuador offers its citizens - and since the start of 2015, foreign resident nationals (expats) like us.  I had to obtain earlier last month a RUC tax account number due to my teaching employment at the SRI (Ecuador's IRS) office here in Cuenca, and I could do so using my Spanish skills.  I am less certain of those communicational abilities when it comes to enrolling for a government health insurance program.  I could be wrong, and can do it myself, but I'd rather not make mistakes or get ourselves into needless complications due to communicational errors.  So just to be sure, we'll go with a friend from our Verbo church to the IESS office.  We hear we can enroll on the Internet, but given our status as foreign resident nationals, I believe seeing the official eye to eye is the best means of communication.  Looking forward to seeing how that goes, and having the insurance coverages allowed which will reduce our health care expenditures in a significant way.  

I keep reading in sources such as Gringo Post on the Internet of fellow expats who charge for this sort of assistance - actually, it's more common to see notices from Ecuadorian nationals to offer these services for a charge.  That's the whole "Facilitator" gambit going on here in Ecuador among the expats.  Hire someone for a communicational task that you are not familiar or comfortable with.  I can understand some doing this, but probably the majority of expats with some Spanish speaking ability can do a lot for themselves without having to hire out for this sort of thing. . . and all the other tasks one might want to do living here.  It's part of the adventure of living in Ecuador if you ask me!

As an example of Gringos feeding off of Gringos, in today's Gringo Post there's an individual charging $40 a person (limit six individuals for this class) to learn how to use their smartphone or tablet to take photographs/videos.  Doing some quick arithmetic, that's a likely $240 going to the poster/teacher.  Easy money if you ask me, and while it may be the going rate in Ecuador, strikes me as something that could be offered for free, if the person really wanted to share the knowledge they have with the expat community.  Your mileage may vary.  

Another example from Gringo Post: a Samsung Galaxy 6 smartphone 32 gigabyte is advertised for sale for $400.  Two of 'em, in fact.  Memory is cheap, even in Ecuador and this phone likely in the States went for $200 give or take.  Easy profit to the poster. . . if PT Barnum's famous adage of "there's a sucker born every minute" holds.  

And here's another from an EC national: Ecuadorian cooking classes offered to unsuspecting Gringos for $20 a (two hour) lesson or $150 for the 16 hours of courses.  Limit eight students per class.  Again, doing the math, this works out to be $1200 for the teacher for the four week period involved.  From an expat perspective, that $20 or $150 sounds reasonable coming from a place like the United States. . . but this is Ecuador, where the average family monthly income is a bit more than $600 a month.  That $1200 is double that, of course.  Ka-ching!

As you can see, here in Ecuador, land of the Wild Wild West, anything can and does go.  Regulation and "fairness?"  Out the window.  Caveat Emptor - buyer beware.  And that was for items with stated prices.  All manner of classes, workshops, and such are offered on English language Internet sites here in Ecuador all the time. . . some of them having to do with frankly Gnostic religious "knowledge" that claims to be what everybody's looking for.  All for a price, of course.  

There are those in the expat community that are willing to assist for free, like us, or at a nominal cost that is appropriate to the situation.  You can see both kinds of expats out in the Cuenca community everyday, as well as on the Gringo Post notices.