COVID Story #1: Abuelo

A few friends have asked about the impact of COVID on rural Ecuador. My perspective here is limited to that of a listener. Unlike home, I am not practicing medicine and do not have front line experience caring for COVID patients. To capture pandemic's effects on this community, I will share a series of COVID stories people have graciously shared with me. I filled in details where some were missing, and you will see my own reflections sprinkled throughout the stories. This is the first of these stories.

Don Feliciano Cuchipe (Abuelo) Don Feliciano was 97 1/2 when he contracted COVID in early January of 2021. At the time, there was a nationwide ban on gatherings of all sizes; Christmas and New Year's parties were forbidden, but people were tired of being told what not to do and increasingly less obedient to what felt like arbitrary edicts. Holiday town gatherings are cherished rituals in small rural communities and up until this point in the pandemic, there had been very little experience with severe COVID disease in La Josefina. Don Feliciano himself had lived through multiple bouts of malaria, as well as diphtheria, typhoid, measles, even prostate cancer, and he wasn't particularly scared of COVID. Don Feliciano was born in 1924 in a rural pueblo on the outskirts of a small town named Insilivi in the high paramo of the Andes Mountains. At a very young age -- maybe as young as 16, no one is quite sure-- he married a young girl named Maria Pastora and, like many young enterprising folk in the late 1930s, he trekked down the Andes Mountains in search of land and opportunity. At the time, the Ecuadorian government was incentivizing development of these lands (not unlike governmental land grant opportunities by in the late 1800s in the Western United States). At the foot of the Andes, a rugged outpost called Pucayacu was taking shape. There were a few wooden houses not far from the large river, several mercantile/stores where one could find basic supplies, a bar, and a weekly Thursday market, in which farmers from the Sierra began to bring their products (potatoes, greens, onions) down the mountain to trade with more tropical/coastal farmers, who offered bananas, oranges, and yuca, guava in return. Don Feliciano staked out land --- 7 miles west of Pucayacu -- in what is now the town of La Josefina, a rugged hilly area at the bottom of the cloud forest, banked by two small rivers. Using his machete, a single burro, brute strength and some serious vision, he and his young wife cleared the land of the dense tropical forest and began to plant grass seed for cattle (ganado). Over the next forty years, they grew their homestead, constructing a sturdy house made of wood they harvested, first cooking outside, then later adding an indoor kitchen, slowly turning wild undeveloped land into cultivatable farmland and then a township. They ultimately deeded part of that same land to build a small rural school, another piece of land to build a small Catholic chapel, another to build the Seguro Social Campesino (the local health center for farm workers). Don Feliciano went to the fields seven days a week to milk and tend his cattle into his 90s, baseball cap, black gum boots and a walking stick in hand. And each afternoon, after a morning's hard labor in the fields, he sat on a chair in his wooden house, eating a late lunch of rice and meat, while listening to the radio play "banda music" -- classic big-band style Ecuadorian music, and reminisced about times passed. Don Feliciano was, in essence, a founding father of La Josefina and Abuelo to now many many descendants who call this place home. His five living children each married and raised a total of twenty-two children in this same town. He continued to bequeath his time and land both to his children, grandchildren, and to the town itself until his passing. And so, Don Feliciano attended a medium-sized town fiesta on January 7, 2021 -- in honor of Dia de los Reyes (King's Day). He loved banda music, and he loved fiestas. He wasn't alone; many people attended, and even though all events occurred outside (as is the tradition of such gatherings in these tropical parts), it is likely that he contracted COVID at this event. The timing of Don Feliciano's COVID corresponds almost exactly with our delta surge in the United States. During this same period, we were seeing record numbers of patients dying in our ICUs, and while we were never over capacity in Santa Rosa, we got close. Healthcare is extremely limited in rural Ecuador. Small health clinics tend to people's most acute needs: suturing lacerations, basic prenatal care, treating ear infections and minor respiratory infections. When it became clear that Don Feliciano was severely ill, the family was torn. Hospitals don't always feel like the safest places to take a sick relative; people were going to the hospital to die, and by this time, hospitals in Ecuador were beyond maximum capacity. Several other family members were also quite ill with COVID at the same time, including Feliciano's oldest son (age 72) and an adult grandson (aged 47). The family managed to get their hands on a pulse oximeter and eventually even an oxygen tank. They made Feliciano freshly squeezed orange juice and brewed natural remedies from homemade high proof sugar cane alcohol mixed with local herbs and barks. Then one daughter who lives in the Sierra, where it is generally believed that healthcare is better, offered to take him to Latacunga to get him to a physician. He preferred to stay home in La Josefina, but was clearly getting weaker. And sicker. Unfortunately (or perhaps fortunately), there was no place for Don Feliciano at any surrounding hospital. And so, his family tended to him themselves at home. Taking shifts. Fearing less for their own well-being than for his survival. They paid for a medical consultation, one doctor even came to the house, and had an IV pole, fluids, steroids going, as well as all the home remedies. He was delirious during a large portion of this time, but at times, he seemed to show improvement, taking some occasional soup in, speaking clearly about his wants and desires. His family maintained hope. And they were by his side throughout. Don Feliciano died peacefully on February 7, 2021, exactly one month after contracting COVID. He was surrounded by his familia. Thankfully, his son and grandson -- both hospitalized for COVID -- had full recoveries. His children and grandchildren shake their heads mournfully when they talk of those weeks; they wonder if there was anything they could have done differently to keep Abuelo alive. His memory and his legacy live on.