Rotations, Health Systems, and Politics

Blog 2. Chone, Ecuador.

We finished with rotations for the day and all I can say is Huh. Huh? you ask. Well, lemme tell ya about Huh. The hospital we rotated at today is called the Hospital IESS de Chone. It is a small, public hospital, run by the Ecuadorian Social Services, called IESS (think of it like Social Security in the United States). In this way, it is a government-run hospital, and the government mandates that doctors work at least six hours a day in the hospital, usually from 7 am to 1 pm. The hospital is a small, provincial (rural) one, with only 35 beds in the entire building. This morning, we went with Dr. Javier, the director of the hospital and the son of our homestay family, to the hospital. He is the nicest man ever!! Always willing to help random students out, and he does it with grace and dignity. He specialized in dermatology, and apparently trained in France! A quick aside on specializations in Chone: Rare. Apparently, according to Dr. Carlos Munoz, the ER director I met today, there are very few doctors who are specialized in the rural hospitals of Chone. That’s because of a slew of issues, including economic and personnel (more on all this later). There are only five specialists in the Hospital IESS de Chone, and no ENT doctors, no urologists, no neurologists, and if patients need to see any of these doctors; i.e., a patient might have brain trauma, they are sent to the nearest better-resourced public hospital, which is usually the one in Puerto Viejo. Unfortunately, that’s at least a three-hour round trip — one hour to get to the hospital, one hour to fill out paperwork, and one hour to come back — and it’s quite a hassle for the staff at the hospital as well. Apparently, there hasn't been a neurosurgeon resident in the past 10 years in all of Ecuador. At the hospital, I rotated in the emergency room. Chone’s emergency room is not like those in the States. In the US, our ER rooms are bustling with doctors scrambling back and forth, transporting people with serious trauma in beds with IVs and heart monitors dripping after them. Here in Chone, that’s not the case. We saw zero surgeries in the hospital, and the ER doctor was either usually charting, having patient consultations, or talking. (Ecuadorians love to talk and share, and our doctor was very warm in sharing what he knew about the health system in Chone). After talking to our host mom, the mother of Dr. Javier, the Director of the hospital, I found out that this is normal: emergency rooms in hospitals here only do consultations and small surgeries. Huh. Una cultura muy diferente que la de EEUU, no? Dr. Carlos Munoz, the Director of the ER, proceeded to tell us more about the health system of Chone. An aside about the health system of Chone: Very resource-strapped compared to other parts of the country. First, there is not enough personnel to support a huge hospital. One reason why doctors and specialists are scarce here is due to economic incentives: the pay is very low compared to other parts of Ecuador. From what I understand (my spanish numbers are a little rusty, so take this with a grain of salprieta) general practice doctors here are paid about $6,500 for a year of work. Just FYI, the general practice doctors are paid about $120,000 a year in the States. A HUGE disparity. Second, there is difficulty obtaining enough technology in these areas, again for economic reasons: the IESS hospital has only one ultrasound to use, from 9 am - 5 pm, three days a week. It also has two CT scanners, but nothing else. There are also around 55 strategically-placed municipal health centers around Chone, staffed with health professionals. These are meant to promote preventative health measures in the city of Chone, dispersing information like why it’s important to wash your hands before eating, why you should wash, sanitize, or cook your food thoroughly before eating, why it’s important to fumigate your house (to prevent mosquito bites, which can carry malaria, dengue fever, or chikungunya (pronounced chicken-goon-yeah), the cousin of dengue), and why it’s important to exercise and eat foods with less sugar/salt (prevent diabetes). Thousands of dollars are put into these centers and the preventative health campaign; however, the doctor expressed frustration because he says that it hasn’t helped much — the Ecuadorian diet and lifestyle are contrary to these health measures, and it’s nearly impossible to change Ecuadorian culture. A quick aside about the prevalent diseases in Chone: The most common ones in Chone and along the coastal regions of Ecuador include: Diabetes (although not as common as in the US) Hypertension Hyperthyroidism Anemia Other diseases that are generally encountered include: Dengue - symptoms include pain in the muscles Chikunguya - a cousin to dengue; symptoms include pain in the joints (los articulos), especially the elbows (los codos) and the knees (los rodillos). Patients can be seen limping around bent over due to the pain. Malaria - easily preventable as a traveler if you eat your anti-malarial pills. We saw a patient with a case of chikunguya in the ER, a woman in her forties with thick brown hair who appeared healthy except for the way she limped into the emergency room. Dr. Carlos Munoz told us that common cases in the ER include reptile wounds and dengue/chikunguya cases. A quick aside about the set-up of the ER: 8 beds. 1 room. 1 small glass cupboard for medicines and bandages in the ER. None of the doctors or nurses wore gloves when putting in IVs or handling patients. All patients who occupied a bed were hooked up to an IV with a saline pouch. No other technology, no heart monitors, nothing. The room was kept spotlessly clean, however, and a security guard showed people in for consultations or a bed space. After the ER, Amida (one of the awesome girls in my CFHI program) and I went to shadow a family practitioner. We saw four patients: a woman who had stomach pains and vomiting, a routine check-up for a nine-month baby boy, a girl who had allergies, and a woman who had colon/stomach pain and problems seeing and holding things. The doctor proscribed and prescribed, respectively: dehydration; eat less fried foods, rice, and meat, eat more vegetables for a healthier diet; allergy medication; and bad diet and stress from working as a secretary, so eating at consistent hours and resting after work. I noticed that the doctors here tend to speak longer with their patients, and generally consider their home life and other family and social factors and try to fix poor behaviors that cause the symptoms, rather than just prescribing pills, as we commonly do in the US. The family doctor we shadowed was particularly good with this. Finally, when our family practice doctor told us, “Tengo hambre (I’m hungry)” we were dismissed and we all decided to grab lunch ourselves. An(other) quick aside on lunch: For $3.00, we had almuerzo, which is not “lunch” in Ecuador but the name of an actual course of food. Lunch is the Ecuadorian’s biggest meal, in general. Almuerzo included: Salprietas - the Ecuadorian version of peanut butter 2.0, which is salt and corn ground up and mixed with peanut butter and served with platanos. You can literally put this in ANYTHING and it will taste yummy Sopa con queso y harina - A soup with cheese and flour dumplings (this was absolutely delicious!! One of my favorites by far!! It had bits of what looked like sage in it too, you’ll love it if you’re a cheese lover like me) Almuerzo - a plate of rice, potatoes in a delicious yellow sauce, and a side of either fish, pork, beef, or chicken. Jugo de maracuya - passion fruit juice. My favorite, so fresh and delicious!!! I would recommend trying the soup and the maracuya juice if you’re ever here. The BOMB. And a quick aside on politics: Uprising. The people of the oriente are traveling to Quito, the political seat of the country, to stage a protest and a riot for their working conditions (I believe this is true; I will double check to make certain). They are scheduled to arrive in Quito August 13, the day before we return to Quito. Depending on the length of the riots and the protests, we may be able to see it as it happens. Why the protest? I learned today that the people of Ecuador are very anti-government. Although their culture is one that highly prioritizes group mentalities, respect for hierarchies, and observance of traditions, apparently this only applies within the family. Ecuadorians do not, apparently, like taking orders from the government, which is perhaps another reason why preventative health campaigns have failed to do their job so far. They have an extreme distrust of the government.

Update: since then, I've learned that the Ecuadorian people tend to be more externally influenced, rather than "anti-government." See my other blog posts. Thanks for reading; keep tuned for more! I’ll post up some more pictures soon! Hasta luego, :) DizzleD

#Chone #Rotations #Health #systems #politics #HospitalIESS #specializiations #prevalent #diseases #lunch #almuerzo