Ecuadorian Health Care

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We came to this little coastal surf town to surf, learn some Spanish, and volunteer at a near-by hospital.

We stayed in this amazing little apartment. It felt like we were in a remote beach house and had the ocean all to ourselves. The crashing waves blocked the sound of everything else. We spent most of our time hanging out on our balcony with our Swiss friend Patrick who we had met in Matapalo.

One morning as we were sitting and enjoying our morning coffee on the balcony I saw a pod of 50 dolphins swim by. As we watched them pass they turned around and went by again.. and again.. and 20 more times, swimming right in front of our place. Dana and Patrick ran out with their snorkels and surfboards and the dolphins swam right up to them to check them out. Dana said that when his head was above water he could hear them surfacing and clearing their blow holes and underneath he could hear them all eeekkking to each other. One swam under him while another swam in front of him. As I watched from the balcony Simona (from Germany) and I decided we had to go too, so we ran down. Devastatingly, by the time I swam out there they were gone and since it was a way out I was almost drowning! I recovered on Patrick’s surf board and then we all headed back in. Too bad, but Dana had an amazing experience with them.

The Hostpital:

I spent 2 weeks at the Manglaralto hospital, a small rural coastal town in Ecuador.

What a gong-show!

I spent the majority of my time in the 3 bed emergency room. The hospital is pretty well off for Ecuador: they have running water, a pharmacy, 1-2 doctors on working in the emeg at the same time and electricity for most of the day. There is a rolling blackout in Ecuador so the power unexpectedly goes off for 4 hours/day.

There was no organization or triage, the patients wandered in and stood listening to another patient’s problem or even interrupted the doctor to relay their problem (most commonly their baby had a cold). Confidentiality also non-existent: one doctor was draining a breast abscess by roughly shoving forceps into the wound to make a drainage hole, while the other 10 patients in the emerg were crowded around to watch as the poor 50 year old woman lying exposed on the table was screaming in pain.

Ecuadorians value their doctors, thus wait until the last possible moment to visit the doctor so that they don’t waste the doctors' time. The exception is for their children, which they bring in if the slightest change occurs. Thus the majority of what I saw was sick (or not-so-sick) babies and traumatic injuries.

I don't think they have heard of sanitation (bloody rags on the floor, no sink to wash your hands in, and the medical equipment is just rinsed before reusing). One day I looked up to see a dog strolled through (from the hospital entrance, not even from outside) the emergency.

Everyone gets a prescription, no matter what the problem was. And that is usually the only thing they get. No other recommendations or guidance.

Sympathy/Concern for the patient: nope - they are very rough, scrubbing wounds unnecessarily hard while the nurse is pinning down the screaming child. Hardly ever using anesthetic and never asking how the patient is feeling.

My experieinces with Labour and Delivery:
1. Natural- The doctor walked in, pushed down hard on the abdomen and POOF out popped the baby - magic
In addition, the baby was then taken away to another room and the poor mom wasn’t allowed to have anyone in the room with her. (No wonder most women opt for a home birth)

2. Caesarian - Similar to procedure to Canada, but sanitation less of a concern (no scrubbing in - just rinsing hands with iodine, blood on the floor and the room isn’t cleaned between patients (the blood on the operating table wasn’t even wiped off, and the anestisiologist’s equipment was lying on a dirty table). The procedure itself took 2.5 hours and the power cut out 2 minutes after they finished. Lucky! They had a generator, but it took a few minutes before they were started up and the power was back on. That’s a few minutes during a surgery where the monitors are off and the respirator isn’t working.

Top Clinical Presentations:
Sting-ray sting to hand
Motorcycle vs Dog
Motorcycle vs Little Girl (yes this is as bad as it sounds)
Dengue Fever

Moral: never get sick in Ecuador!

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Photos

Morning coffee
This was a routine, every morning, checking the waves and having a freash cup of coffee.

Dana and the dolphins!
I took this photograph from our balcony

The office
Dana is doing a online class.

Comments

[dylanw]

hospital
Next time you go you should check this site for travel health info: http://www.mdtravelhealth.com/destinations/samerica/ecuador.php They have a recent outbreak section too - it seems like things happen there with food preparation and such.

[tom]

resident looking to do same
hey, where and how did you get that sweet apt? im an ER resident in DC and some of my other medical friends are trying to set up a similar elective in october, and are trying to find basically yer same experience... apt steps from surfing, and ER to work in nearby... Would love to hear yer input and if you have any doctor contacts that could set us up at the hospital for our residency program forms, thanks! tom, janie, payal

[carriemcq]

Sorry I haven't chekced my blog in awhile, it sounds like I'm too late, but I was in Montanita, Ecuador, which is a surf town (all the appartments are on the beach, but ours (Brisa de las Mar or something similar) was away from all the horribly loud disco music. I heard about the volunteering through the Spanish School (which was terrible and I wouldn't recommend that part, or the accommodation they provide). I did lessons for a week and then just did the volunteering after that. Plus if you have Spanish lessons for 4 hours and volunteer for 4 you have no time to surf! Most importantly the experience would only be valuable if you spoke Spanish. Also it is not hands on. Most International work you do as a resident/student isn't so make sure you ask before you plan and elective! Here is the link to the school: http://www.montanitaspanishschool.com/medical-spanish I also think you should read this article before you go, as it is better to know before hand to avoid disappointment and/or regret: http://www.guardian.co.uk/commentisfree/2010/nov/14/orphans-cambodia-aids-holidays-madonna