My third week in Quito I was in a family clinic called Cochapamba Sur, which is a public healthcare center that serves the communities surrounding it. It was a tiny clinic that consisted of a small waiting room, a primary care exam room, a dentist room, a tiny pharmacy, and an obstetrician exam room. I was surprised at how many services they were able to offer in such a tiny space. The waiting room was pretty empty when I showed up to the clinic at 8am but within 30 minutes all the chairs and benches where full of crying kids and their parents, elderly people and their adult children, and generally unwell patients wearing masks. The TV in the waiting room was also always on at full blast which added to the general atmosphere of chaos. Once the doctor started seeing patients she went nonstop, one after another, for the whole four hours that I was there. I was very impressed that she could keep that pace up as we saw one patient every 10-15 minutes. With the amount of people waiting in the waiting room and outside the clinic, there’s a sense of urgency and efficiency in order to get through everyone that day. When she was done with one patient she would tell that patient to call for the next patient and the next patient would come in right away. At first I was trying to get my questions in really fast in the few seconds between patients but I soon realized that wasn’t going to work and started asking my questions in front of the patients. At first I felt awkward about talking about the patient in front of the patient but the doctor was pretty receptive and enthusiastic towards my questions and the patients didn’t seem to mind so it worked out in the end. I really enjoyed shadowing this doctor because she made sure to explain things to me even though she was incredibly busy and she let me listen to all the patients’ hearts and lungs and assist in the exams. I will admit that the medicine itself was rather boring. Most of her patients had minor aliments such as a cough or cold that probably didn’t need the attention of a doctor and there were a lot of other patients that were there for checkups. She mostly listened to their hearts and lungs, palpitated their abdomens and lymph nodes and then prescribed them antiparasitics and whatever else they needed for their issue. I was confused why everyone, especially the children, were getting antiparasitic drugs because not everyone’s symptoms pointed to a parasitic infection. However the doctor told me that everyone is deparasitized every 6 months to a year, depending where they live. The area around this clinic had better water so her patients were deparasitized every year. I did see some exciting cases, such as a young man that may have had Guillain Barre, which is an autoimmune infection that’s triggered by a virus and causes paralysis. However we had to refer him to the hospital so we never got to follow up on that diagnosis, which was kind of sad because it would have been interesting to know what he had.
Family medicine is essential when it comes to healthcare. Family doctors are the gatekeepers of medicine and are the first people patients see when they need to be referred to a specialist. I understand the importance of family medicine and the need for more doctors and I want to contribute but based on what I’ve experienced so far in Quito and also back in the States it seems sort of monotonous. I’m not sure it would be stimulating enough as a career but it’s definitely an area I would like to explore more in the future.