Part of my program was focused on rural health. We spent three weeks in Chone, a rural town in the costal region of Ecuador. Although the town of Chone itself has a bigger population than Corvallis, it felt much more rural and isolated because it was so spread out. The town has two hospitals- one social security hospital and one general hospital. We spent our time at the general hospital with a pediatrician. The doctor was great and we probably learned more in this hospital and connected more with the doctors here than in Quito just because it was smaller and more close-knit. Some days we shadowed the pediatrician all day, which started with rounds on the pediatrics floor in the morning. Most of the kids we saw had respiratory problems or diarrhea. There were lots of colds, flues, fevers, pneumonia, a few suspected (but not confirmed) Dengue fever cases, bronchiolitis, and viral/bacterial/parasitic diarrhea. After rounds we went with the doctor to the external consult area of the hospital where she saw patients for the rest of the morning, many who were coming for follow up appointments after having been hospitalized. The afternoons consisted of more external consults and trying not to fall asleep in a post-lunch afternoon food coma. The external consults were interesting in that the doctor let us do physical exams and tell her what we found and she would confirm our “diagnosis.” When there weren’t very many patients, or as the doctor would say when there was “an epidemic of health,” she would take us to the ER to see if there was anything interesting there. It was a little awkward to walk into the ER just to see if we could see anything interesting and then leave but the gesture was appreciated because she definitely tried her best to show us as much as she could and provide us with many learning moments.
On some days the doctor would call down to other floors and let us shadow doctors there. Some of the best days I had were in surgery and neonatology. I already talked a little about my experience in neonatology and seeing some C-sections but on our last day we also got to see two live births. One didn’t go so smoothly and the girl (she was younger than me) needed immediate attention so I held her hands and tried to calm her down, although I can’t even begin to comprehend the amount of pain/terror she was feeling. I accompanied the doctor and patient into the OR and got to assist in the process of stopping the bleeding and tried to keep her calm when she woke up again. The adrenalin rush lasted the rest of the day and there were moments where I was seriously concerned for the life of the baby and mother. It didn’t help that the mother kept screaming that she was going to die, which at first I’m pretty sure was just the drama of labor, but then I got worried because I had never seen that much blood in my entire life. What I remember the most from it all was the smell of the blood. It’s has a very distinct smell, which I had never realized until then. I’m glad I was there to comfort her because all the doctors were too busy trying to stop the bleeding and no one else was there to calm her fears. I’m not sure I was much help but the least I could do was hold her hands, tell her to keep breathing, and let her know her son was healthy and safe. It was an intense afternoon and I left the hospital a little shaken but thankful that both mother and child were stable at the end of the ordeal.
Another highlight from the Chone hospital was seeing a reconstructive surgery of a machete wound. We were told that we would likely see machete wounds in the hospital in Chone because they are common in rural areas. This poor patient had accidently cut his fingers off with a machete while trying to chop something. One of the figures had been completely amputated and they were able to reattach it but it will never regain function. The other two had only been partially amputated and were salvageable, so we got to watch as the plastic surgeon reattached the tendons. It was a very interesting surgery and I’m glad I got to experience that because I don’t think it’s something I would see in the States but it’s very unfortunate that I got to see this surgery because someone had a traumatic accident. It’s a weird feeling to be excited about seeing medicine like that but also knowing that someone is suffering because of it. I think a lot of doctors (surgeons especially, at least from what I’ve seen) forget that there is a person there and this is their life. I think since I’m new to the world of medicine I haven’t become as jaded yet but I also hope that I never, ever forget that there is a human side to medicine because my purpose first and foremost is to serve people. I think the medical world in general would be a better place if more doctors were focused on the patient as a person rather than just another interesting medical case. But I digress…
For a small hospital, there are an awful lot of surgeries in Chone. Of course, the more complicated ones have to be referred to a hospital in a bigger city because Chone has far fewer resources than the bigger cities. Some of the other surgeons I enjoyed shadowing were the orthopedic surgeon and the plastic surgeon because I haven’t seen anything like that before in Quito. Orthopedic surgery is unique. It requires a lot of brute force and physical strength, unlike other surgeries that require more precision. It was interesting watching the surgeon just push and pull bones back into place and hear them crunching and snapping. It really makes you realize how strong the human body can be. Plastic surgery was interesting because it was the complete opposite of orthopedic surgery. In the public hospitals they obviously don’t do any elective plastic surgeries (because I know most people think nose job when they hear plastic surgery). The plastic surgeon in this hospital does reconstructive surgeries for patients that have had some sort of traumatic injury. Apart from the machete wound, we also saw a skin graft on a patient who had been in a motorcycle accident. This type of work requires a lot of patience and focus on the fine details. It was interesting to be able to see the two types of surgeries and see their differences.
As far as the contrast between rural and urban health in Ecuador there are definitely some differences but it mainly all comes down to resources. It’s not surprising that the rural areas just don’t have the same capabilities as the urban ones and that’s true everywhere, not just in Ecuador. However there were some regionally specific issues that I noticed in Chone that weren’t quite as prevalent in Quito and vice versa. For example, since Chone is in the costal region and Quito is in the Andes, people from Chone and the surrounding areas are more at risk for tropical ailments, such as Dengue fever. The cuisine in Chone is also a little different than in Quito. There were basically 4 or 5 ingredients in all the meals but in different forms: plantains, bananas, rice, peanuts, and some sort of meat or fish. It was all delicious but as you can see the diet isn’t very varied, which causes some health problems. I would venture to say about 80% of the children we saw in pediatrics had anemia (not as their main problem but as a problem nonetheless). Young children usually don’t have anemia unless there is a dietary issue and the doctor contributes the high rates of anemia to the costal diet. Plantains and bananas are the main childhood staples for many families but they don’t provide any iron, hence the high rates of childhood anemia in Chone but not as much in Quito. Another interesting difference was the poor air quality that causes health problems in the two different cities but for different reasons. In Quito there are a ton of city buses that spew out black smog as they drive by and there doesn’t seem to be much, if any, air quality regulation in the city. I’ve seen this manifest itself into respiratory problems, such as a taxi driver who came into clinic for COPD. In Chone we also saw patients for respiratory problems due to air contamination but instead of bus fumes, it was dust that was the culprit. Most of the roads in Chone are still made of dirt and they kick up a lot of dust when cars drive by. Children in particular seem to suffer the most, either because their lungs are more sensitive or because they are more likely to be playing in the dirt (or both), but we saw many patients with respiratory issues that the doctor contributed to dust. It was interesting to see the same health problem but different causes based on rural vs. urban environment.
As for life outside of the hospital, Chone didn’t have quite as much to offer as Quito. There was actually not much to do in the town itself. Luckily it was about an hour from the coast so we made a few weekend trips to the beach to go surfing and lay in the sand. People from Chone (Choneros) are very prideful of their hometown and everywhere around the town had signs and stickers that said 100% Chone Lindo (beautiful). It was a little ironic because it was probably the least beautiful place in Ecuador that I’ve seen but maybe it’s a coping mechanism. At least the people were nice, although we attracted a lot of attention. Not a lot of foreigners have a reason to go to Chone (except for CFHI students), so the site of English speaking gringos was very exciting for the kids/creepy men/taxi drivers/and everyone else. Basically everyone that saw us walking down the street felt the need to call out to us from their homes or cars or as they walked pass and use the few English words they knew. There were a lot of “hellos,” some calls of “what your name!?,” a few “I love you’s,” and even a “good morning teacher” one evening as we walked home. At first we felt harassed by all this, especially when the calls came from men even though we knew they do not view it as harassment. We got more comfortable figuring out which ones to respond to and determining which greetings were truly friendly and which were creepy and ill intentioned. For the most part people were just trying to be friendly so I tried to wave or say hello back to the kids and old people/women but tried to ignore the men who were professing their love to us, flattering as it may have been.
This was our host family in Chone, they were so sweet! They had a little birthday celebration for Ricky and Oresta and we wore our 100% Chone Lindo shirts that we had made. The group before us had stickers made so we had to one up them. Our host family kept us well fed and Pepe, our 80 year old host dad even took us out to the Chone festival one night and drank canelazo with us (Ecuadorian national drink) and danced salsa with us, it was awesome!
With Dra. Diaz on the pediatrics floor in the hospital. She was a great teacher!
In front of the Chone hospital.
The street we lived on in Chone. As you can see the dirt roads have the potential to kick up a lot of dust. A lot of people water down the road outside their houses in the afternoon to make it less dusty, mud seems to be preferable.