3 Tiers, 2 Surgeries, 7 Bites
- DizzleD
- Aug 11, 2015
- 4 min read
Blog 5. Chone, Ecuador.
Morning surgery.
Today has been a very…itchy day.
I am not even kidding. After our jaunt in Puerto Lopez, I have returned with no less than seven bug bites. SEVEN. It might be my fault; there was a moment Sunday evening when I was too engrossed in the conversation to reapply my OFF! I was probably 2 hours without repellent. And I was so smug; I was certain I'd finish the trip without mosquito bites completely. Sigh.
Although my friends not only have OFF! lotion, they also have anti-mosquito spray, and nearly take a bath in it twice a day. So I guess my repellent game still isn’t strong enough. Really, it’s super worth it to invest in good mosquito repellent here, anywhere you’re traveling abroad. I have my fingers, toes, and eyes crossed that I won’t get chikungunya.
Anyways, for all those premeds out there, here’s what I learned today:
Rotated in surgery and saw a cyst (quiste) removal and a laparoscopy (also known as keyhole surgery) which resulted in the removal of the gall bladder (vesicula). The surgeons were a bit rough in how they broke the skin, but it was obvious that the surgeons were very skilled; both surgeries were very routine and no complications occurred.
An aside on health systems in Ecuador:
Fascinating, and pretty extensive, from what I've seen. What was the most fascinating to me today was how the Ecuadorian health system is set up. While we were waiting in between the surgeries, my friends and I fell into a discussion on Obamacare in the US (we’re all not a fan of it, though we agreed that it had good intentions). But she said something really interesting: she felt that the Ecuadorian health system would actually probably work in America.
The Ecuadorian health system has two sectors - one that’s private and one that’s public. The private sector entails private practices and clinics, and generally cater to those who can pay, much like in the US. However, the government has capped private consultation fees at $20 per consultation to help make private clinics more affordable. The public health system is meant to provide free healthcare to all the citizens of Ecuador. It it a three-tiered system.
At the first tier, there are community clinics, which are stationed with health officials and which patients are supposed to go to get general health information, advice, and guidance on things like nutrition and small, common illnesses like the flu. If the staff at the small community clinics see a more severe case, the patient is sent to the second tier. The second tier includes hospitals with beds that can admit patients for care. I’m fairly certain that the hospital we are shadowing at is a second tier hospital. If patients are truly, truly ill, then they’re sent to a third tier hospital, which has specialists and are supposed to provide the best quality care. All of the Ecuadorian public health system is completely paid for by the government, although its people do pay taxes. It seems like the public hospitals are managed by a social security of some sort; I’m guessing that there’s a general social security system in Ecuador that people pay into, which then goes to help fund their healthcare.
Sounds pretty sweet, right? In theory, yes. But reality is always more complicated. The problem with this system is that the Ecuadorians don’t have enough qualified individuals to serve at each level of care. Doctors are in perpetually high demand because the government is unable to pay Ecuadorians well enough for them to stay and practice. That’s why the practice of importing Cuban doctors to Ecuador is very common; they’re willing to work for much less, although they’re less skilled and less trained than their Ecuadorian counterparts. Therefore, patients are often sent up the tiers or stay at a tier indefinitely, due to lack of personnel and attention, creating clogs in the system. Another common thing is that patients will try to stay as long as possible at the third-tier hospital because they feel that it’s the best care they can receive.
My friend does have a point — it seems like the Ecuadorian system, with more personnel and funding, could accomplish everything it sets out to do. I wouldn’t be certain that it would work in the US, but it seems like if we at least considered the Ecuadorian systems, we could at least better see the flaws in our own. You might be asking, well, if the problem is personnel who won’t stay because of lack of economic incentive, why don’t we just up the economic incentive? Because, apparently, Ecuador is broke. In terms of economy, after the giant economic depression in the 1990s, Ecuador switched to US dollars with the idea that it would be a more stable form of currency. As a result of this change, people became broke overnight. The exchange rate is something outrageous like 5,200 Ecuadorian dollars to 1 US dollar. Ecuador’s current GDP is also only $8,500 annually, or something similar, because it doesn’t really export or import anything — indeed, I don’t think Ecuador could import anything successfully even if it wanted to, because it would be mind-glowingly expensive. That’s why the Ecuadorian government is working on exportation of oil to the world and exporting more goods (incidentally, we met an international working in Quito on Ecuador’s import-export matrix in Puerto Lopez two days ago).
The Nordic countries, especially Denmark, have very good healthcare. But their citizens pay about fifty percent of their income to taxes to the government. I think politicians would be laughed offstage if they suggested that (and in the upcoming GOP election, there are already plenty of political gaffes to laugh about). So perhaps America can take a closer look at the Ecuadorian system instead.
I am now going to nap and scratch my bug bites.
xoxo,
Diana Z.
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