CEPI and Private Hospitals

Blog 14. Quito, Ecuador.

Today was my first day of rotations at a private dermatology clinic in Ecuador, La Clinica del Piel, also called CEPI. The comparison between private and public health in Quito is astonishing — CEPI is a private clinic for patients who can pay, although the government has capped consultations at $20 for all private clinics so that they can’t aggressively overcharge (another example of how Ecuadorian healthcare has been trying to look out for its people). And here’s the law into action:

Anyways, Dr. Palacio, the head dermatologist we’re shadowing, is really nice, as all the physicians we’ve met here are, but he has such a thing for slang words — every five minutes he’ll say something, everybody will laugh, and then he’ll look at us (it’s me and Justin rotating here) expectantly and ask, “Entienden? Entienden?”(Do you understand?) The answer is always no, it feels like, but he’ll explain it anyways and then joke around for another five minutes and then move on. There are also four fifth-year medical students from Catolica here (What’s Catolica?) who are all very smart and know quite a bit of English as well. I noticed that there’s only one woman in this group, but there are two female dermatologists and two male dermatologists running the clinic. I’ve been pretty impressed by the representation of physicians so far.

I was a little bit hesitant about this derm rotation because I had heard a few things from people who hadn’t had a good time in the clinic. Because the clientele is generally better off, they felt like patients came in without “real” life-threatening problems, only little things like acne or sunburn. I settled myself down for a real bummer.

But, thank goodness, it was totally the opposite. True, we did have two patients who came in about small problems, like discoloration on their face or slight lesions, but personally, I found those fascinating, because skin pathology can indicate so many things about the body’s inner pathology. We also had a really interesting case that confounded the dermatologists. Take a look:

Patient 1. One of the routine skin cases I was talking about above. The patient was in her forties, divorced, and worked as a janitor for a large company. She started seeing discoloration on her face after she had taken some medication to alleviate the burns that occurred after some cleaning chemicals had spilled on her neck about a year ago. Interestingly, she didn’t have much exposure to sunlight until a year ago, after the company moved her to work outside after the chemical spill accident.

Patient had melasma, which causes brownish/grayish patches, usually on the face, although they can also get it on other parts of their body. Sun exposure tends to trigger melasma. The patient also had solar lentigo, which are small, sharply circumscribed pigmented macules surrounded by normal skin, which can also be an indication of severe sunburn in the past. The doctor prescribed some creams and applied a bit of nitrogen topically on her spots.

melasma - especially common in women & during pregnancy

solar lentigo

Patient 2. Had dermatitis, a general term for inflammation of skin, and what looked like dyshidrosis, which is an uncommon eczema-like skin condition in which small, fluid-filled blisters appear on the palms of your hands and the sides of your fingers, and sometimes the soles of your feet. The patients’ skin appeared scaly because apparently the blisters had dried before. Super, super interesting to watch.

Patient 3. This patient had something that absolutely confounded the physicians. He was an eleven-year old child, absolutely adorable and lively, but with a series of bluish and grayish and reddish spots all along his legs. (Aw I love kids!) He had had a terrible fever about six months before, which caused the spots to flare up, but he had always had these macules on his legs. The doctors threw around a few things:

pupura - red/purple discolorations or scabby rash on skin due to bleeding under the skin usually caused by deficiency of vitamin C or vasculitis. Generally an indication of platelet, vascular, or coagulation disorders in the body. However, patient’s skin was smooth and did not appear rashy. Does tend to occur on lower limbs.

Livedo reticularis - common skin finding that appears as a lace-like purplish discoloration of the skin. Can indicate congenital conditions, systemic vascular disorders, autoimmune conditions, obstruction of capillaries, drug-related side effects, or connective tissue disorders. However, the patient did not have the characteristic lace-like pattern normally seen:

The doctors also speculated that it was Erythema (eritma) Ab Igne - EAI, also known as hot water bottle rash, laptop thigh, toasted skin syndrome, or granny’s tartan (flattering, right?) is a skin condition caused by long-term exposure to heat. The pathogenesis of EAI is largely unknown, although it’s believed that thermal radiation exposure can lead to epidermal damage to superficial blood vessels that then leads to vascular dilation.

None of these quite fit the kiddo we were looking at, whose legs appeared different, and he himself was so eager and excited and in obviously good health that it was confounding. I couldn’t help smiling at the beautiful little boy and asking him stupid questions (I am such a sucker for children). The doctors eventually gave him some pills to alleviate the coloration and scheduled some lab tests and follow-ups. He headed out with his family, but they came back a second later because they had forgotten something in the office. After grabbing what they came for, they walked out, only to find that their boy wasn’t with them — he had come up next to me and grabbed my arm in a hug. I nearly died right there, it was so cute. And then everybody laughed and the family grabbed the kiddo and walked off. That was probably my favorite part of the day. Did I mention I love kids?

Patient 4. The last patient, a forty-year old female, had melasma as well, although hers was grayish-black and curiously shaped like a mustache around her upper lip. Quite routine check-up and prescription.

Overall, a great first day introduction to dermatology. We had a lot going on and I learned loads about skin pathology. More to come.

xoxo,

Diana

#Skin #Clinic #private #hospital #quito #dermatology #CEPI