Health Stuff

I know I didn't come here to just to eat, learn Spanish and read American books. I came to learn about the health care system here. And even with just 2 days of clincial experience in an Ecuadorian community clinic, I have seen a little bit of everything.

This week, I rotated in a clinic in Toriculo on the southwest side of Quito. It takes about 20-30 minutes to get there in a car, during morning rush hour from la escuela and and about 45 minutes to get back (by Trole and bus). Dra. Guaman and her husband pick us up at la escuela at 8:30. I'd just like to pause here and say that everyone here is on Ecuadorian time, which is equivalent to CPT. So 8:30 really means 8:45. On Thursday and Friday she has her 4 year old daughter in the car with her. She's absolutely gorgeous and very sweet. After leaving the school, we maneuver through the insane Quito traffic, try not to hit pedestrians or other cars and make our way through the city. We climb up the steep mountainside in a stick shift car passing at least ten stray dogs, indigenous looking grandmothers selling fruits and vegetables, little boys sitting on the side of the road, and young girls carrying their little siblings (or children) in their arms or on their backs. When we arrive at the clinic, it is spilling over with children and mothers waiting to be seen by the doctor. This is the point where I wish my camera's batteries hadn't died. I wish I could describe the building. It was very small, probably smaller than my house in America, except for no attic, basement, carpet or heat. The paint and plaster is chipping off of the walls and its pretty dark as far as clinics go. There is one small tv in the lobby area that is playing some gameshow in Spanish, and people are everywhere. I mean, everywhere. And they are staring at me and the other person that I am rotating with (we're both Black, if that tells you anything). Babies are crying, kids are yelling, screaming and playing, and there seems to be little to no organization.

Dra. Guaman checks in with the nurses as to how many patients she has, puts her purse in her locker, puts on her scrub top (labeled with her name and specialty) and grabs her first patient. Doctors here usually see an average of five patients in a four hour timespan. To condense, I will just briefly list all the patients that we saw in 2 days.

Thursday

• An 80 year old woman came in complaining of a headache, pain in her waist and neck. She never had a mammogram and had a history of blood clots. She recently had blood work done, and everything was normal, except her WBC (white blood cell) count and her blood sugar was slightly elevated. She was also classified as obese. Dra. Guaman diagosed her with a UTI, prescibed aspirin everyday, exercise and diet shift (for her obesity and high sugar) and antibiotic for her UTI.
• A 30 yr old woman came in, but I don't remember what her inital complaint was. She had a lot of other emotional problems to deal with, however. She had two children 3 and 17. Her 17 year old refused to work or go to school (even though he was smart). Her husband worked 7 days a week and she was unemployed and trying to find work. Dra. Guaman spent an hour listening to her discuss her problems and finally just diagnosed her with chronic depression. She told her to exercise 30 minutes a day (exercise releases endorphins), improve her diet, go to church and talk to a priest and take ibuprofen for pain.
• A little boy came in next, maybe about 11 or 12 years old with a huge burn on his arm. Dra. Guaman examined the wound, redressed it and told him to come back the next day for another look.
• A teenage boy came in last and he was EXTREMELY sick. I saw him in the lobby before, curled up in a fetal ball, with his head on his mother's lap. He complained of having a headache and stomachache that got worse and worse as the week went on. When Dra. Guaman examined his throat with a tounge depressor, it looked like it was about to swell completely shut. She precribed penicillin, lots of rest and liquids and ibuprofen.

Friday

• An 11 month old boy was rushed in. He was ceasing, lethargic, breathing heavily, crying uncontrollably and had a fever. He was severely malnurished, probably dehydrated (he gave us a nice stinky diaper to remember him by) and needed nutrients fast. His little body was giving up on him. I couldn't help but to get angry at the mother who was standing there as calm as ever, with seemingly no emotion. If my little boy was ceasing and crying uncontrollably, I would have been a mess. There should be no reason why her child was underfed. The Ecuadorian government takes care of their pregnant and post-partum women by giving them pre-natal vitamins (Babilla) and formula (Papilla) at no cost. All the mother has to do is go to the clinic and ask for it. The only thing I kept thinking about was my little cousin Lindsey. At 6 months old, she is already 25 pounds and all over everything. This baby boy was almost twice her age and she practically had him beat in weight. He was only 35 pounds. Dra. Guaman gave the little boy an anal suppository of Infantil to try to put nutrients back into his body. He seemed to calm down and relax. He eventually fell asleep. Everything on his body was underdeveloped, including his genitalia. He eventually just needed to be taken straight to the hospital to be given food through an IV.
• Another baby boy came in with a fever and a wet cough. His mother seemed extremely young (13?) and didn't have anyone else to help her take care of her baby. Dra. Guaman seemed to be asking her the most simple questions, like did you have the baby at home or in the hospital, but the mom didn't seem to understand her questions. Everything she said, she said it in a timid small voice. She hadn't been going to the clinic for well baby check ups either. when we examined the litle boy, he had an irregular heart beat. Dra. Guaman finally diagnosed the baby with a respiratory infection and gave the mother some amoxicillin to administer to the boy everyday. It was a long list of instructions, that she wrote down, said loudly and asked the mother if she understood. For the little boy's sake, I hope she did.
• A 78 year old man came in next, complaining of inconstinence. He was in absolutely excellent shape; I got to listen to his breathing and heart sounds. After a prostate exam, she discovered that his prostate was slightly enlarged. She sent him for blood and urine tests as well as a thourough prostate exam.
• The little boy with the burn came back. Dra. Guaman examined him to make sure no infection was setting in, changed his bandage and sent him and his big sister their way.
• A gorgeous 4 month little girl came in with her grandmother for her well baby check up. She was absolutely gorgeous! She looked like a little Buddha with big puffy cheeks, slanted eyes and the fattest legs you could imagine. Everything about her was in great shape: breathing, heart sounds, organs and responses to touch. She could hold her head up when she was placed on her stomach and had a nice tight grip on my finger when I touched her hand. She was a wonderful way to end my day.