The Secret Life of Public Health

Blog 6. Chone, Ecuador.

Fascinating. Today was fascinating — we conducted home visits (visita domicilios) again, only today, we went with Dr. Fabricio and David, his accompanying nurse, the two men who started the domicilio project at the Chone hospital.

Dr. Fabricio was, as expected, an amazing doctor — over the week, it’s begun to become obvious that you have to be a certain kind of physician to choose to work with Chone’s more rural population and less equipped hospital, when your services as a doctor is in high demand everywhere else.

We caught him right as he was leaving the office (Dr. Javier is in Quito at the moment) and Dr. Fabricio easily let us hop onto the car with him. He’s a general practitioner and family physician, so we headed around town on consultations; we seemed to have all new patients today. When he was seeing patients, I noticed that he didn’t use gloves or make a big show of sanitizing his hands before and after touching the patients (which is something American physicians usually do, in order to show that they take sanitation very seriously). When I asked him why, his answer was, “I want to build a stronger connection with the patients; if I wear gloves or act like I’m hesitant to touch them, sometimes I scare the patient. And that’s the last thing I want to do.” It was so humbling to hear that, because Dr. Fabricio’s answer truly demonstrates what it means to provide attention and concern to the patients.

A quick aside on the patients we visited today:

A range on the spectrum. The patients we visited lived in such different living situations:

The first patient's house

Patient one: An old lady living way way way outta town; she lived in el campo, or the fields. Her front and backyard literally housed two parrots, a gorgeous white turkey, a furry pink pig, and lots and lots of greenery. She had light edema around her feet, and cystic sores on her skin (not sure what they were called, but they were large and round and protruded into a crusty open sore on her skin; no pus). Her living situation was simple and small; their house, like many houses in the countryside, had lots of openings and square holes in the wall with no glass for windows. The nurses and doctors and the chauffeur had a lot of fun with the parrots in the house.

Patient two: an old man who introduced himself as having hypertension (very common in Ecuador and in Chone, based on their diets) and who we later found out from the nurse was also bipolar. Interesting…this was my first time encountering bipolarity in Ecuador.

Patient three: apparently the daughter of the old man; she had had a miscarriage over a year ago and was having complications and pain in her stomach. The doctor thought she might have a urinary tract infection and prescribed her an x-ray at the hospital. Note: both patient two and three lived in very, very nicely furnished homes.

Patient four: an old man living at home; he was very thin and his muscles seemed to be deteriorating from lying in bed for so long. He was on dialysis, and seemed well-cared for by his family. He also had an enlarged heart, and when we listened to it, it made a whooshing sound instead of the regular thumping heard in normal hearts.

Patient five: a very old lady in her 80s, who was so thin that her muscles appeared to be atrophying away, and who could not move her limbs for pain. She had an infection on her left foot and her knees were hot and had chronic inflammation. The doctor prescribed her admittance into a hospital and offered ambulance services if necessary. Their home was very, very simple; they had a toilet joined to what looked like the shower, but there were no walls or curtains around them and the woman’s bed had posts that looked like wood tied together, with a mosquito net thrown over it.

We then returned to the hospital and Dr. Fabricio thanked us for being a good group of students; he seemed very impressed and he commended our thoughtfulness during rotation, and how we continued to participate and ask questions and make connections with the doctors here. (Note to self: this is what makes doctors happy with rotating students) Then, we were taken under the wing of David, the nurse, who proceeded to explain the domicilio system to us.

An aside on the public health system of Ecuador:

A diagram of Ecuador's public health system.

Following this diagram, there are four levels of healthcare in Ecuador’s public healthcare system.* They are all specific to address different levels of health need, and the domicilio visits have four pillars: integration, prevention, curative, and rehabilitation. There seems to be a greater emphasis on including those who are usually excluded from hospital access in Ecuador, including those who are too old, those who are senile, demented, or have some other mental disorder, and those who are disabled.

I promise to do a more comprehensive overview of the health system and domicilios, but for now, just somethings that I found interesting:

The hospital IESS is 1st level to 2nd level care

The domicilo visits only exist in the hospital at Chone and some hospitals in Quito, as far as David, the nurse, knows.

There is also significant promotion of indigenous health here in Ecuador (a famous clinic in Otavalo is known for receiving travelers all around Ecuador and other Latin American countries)

RED: makes all the different organizations in the health system work together.

More to come, I promise.

xoxo,

Diana