Friday I woke up early as usual and took the bus to Shell, the next town down from Puyo. My first scheduled visit was to Hospital Voz Andes, a Christian missionary hospital. I arrived where I found myself entering a morning meeting amoungst the doctors. This is typical in hospitals. They will talk about a set amount of cases and at Voz Andes, although I am not exactly sure about how they do it in the States, the residents will go through each case file. On top of being a group discussion, it is suppossed to help the residents learn and adjust their practices. After the meeting I tagged along with a Dr. Martin from Texas who was on-call(not seeing patients) and therefore passed me on to another Dr. Dueñas. Since it was a Friday, he was only had patient consults in the morning. We saw about six or seven patients. Dr. Dueñas focused in family medicine, so he sees a variety of patients with all sorts of different illnesses and needs.
To list a few, we saw a patient with hyperthyroidism(?I think that is what it is called) who had been on vacation for a weeks and hadn't taken her pills and as a result here situation worsened. We also saw a patient who had come in to get stitches removed from her big toe on he right foot. An older man who was having problems with weight loss, but hadn't been diagnosed with anything, had a prostate exam. I watched the doctor put a gloved finger up an older man's bottom. I was a little shocked, but I guess I need to get used to it, as I am going to have to do it atleast once in med school.
On a side note, I talked to some of the other members of my program and they were telling me that it was common for gay male doctors to volunteer for the position in med school. Apparetnly in med school students practice on other doctors, because only a doctor really knows how to properly perform one, and as so it is the best way for students to learn.
Anyways...the in patient process is different here in Ecuador. I do not know about everyone, but when I go to see my personal doctor, he has his a handful of rooms, where each patient will meet separately. The doctor will then come to your room and each room should be cleaned afterwards before another patient comes in. Here, the doctor's office is the appointment room. The sheets are never changed, I assume because it is impractical and costly, but I am not sure why. So an old man with a prostate exam wipes his butt on the bed sheet and then a kid lays on it and puts her hands all over it and such. I guess they haven't had any problems with it, but it just doesn't seem sanitary enough to me.
I was also able to participate (observe) the doctor perform two ultrasounds that day. One was on a patient who was determined to have appendicitis and was set to be operated on. I had never seen an ultrasound done before and I was able to gain some insight into how the technology works and how it is applied. A probe is placed on the skin where waves are sent through the skin and down into the core of the body. A grainy, black-and-white image appears on the screen and it takes a little bit, atleast for me, to get oriented to the fact that as you move down the screen, you aren't moving down the patients body, but further into the core. After seeing the appendicitis patient, Dr. Dueñas told me that he would probably be scheduled for surgery and so I made sure to find out when as I am extremely interested in surgery and had never seen an appendectomy before. I then found the surgeon, Dr. Eckehart Wolff, a German trained surgeon who had been working at the hospital with his wife for some 20-or-so years. He was very numb to the experience, as he had done it a million times, and chatted about various topics. He told me that appendicitis was a recently new illness to this part of Ecuador and that cases were higher in Quito and more developed cities as there was more fast food and greasy food available to the population. He also told me that he was at the hospital when the first case of appendicitis occurred in Arajuno. Arajuno is considered the final frontier before the jungle and has only recently had a road built to access the town (a stone and pebble road however). Before if you wanted to get in or out, you have to spend over ten hours just hiking or be able to afford a plane ride in. Also present was an American anasthesiologist from Texas who told me step by step about what his role was and what he was doing and so on. The surgeon was incredibly fast in performing the surgery, it only took him thirty minutes and towards the end the anasthesiologist noted that he was a little behind in the drug regimen he was delivering to the patient becasue he didn't expect the surgeon to finish that quickly. The surgeon then left and I stayed with the anasthesiologist to watch the wake-up session. The patient would wake up for a minute wiggle around in pain and then pass back out for a few minutes. This went on for a little but and I left before he was fully awake, but I am pretty sure it was all under control.
After surgery I grabbed a quick lunch and then headed over to Casa de Fe´ an orphanage located in Shell. Kids are there for two main reasons, either their parents can't be finacially responsible for the children or in the sadder case, the kid was born with some deformity. In indigenous communities, it is a common practice to dispose of a deformed child as he/she will most likely hinder the rest of the family/community. I arrived just in time to head off to the park with the older and more capable kids. I chased them around, played on the jungle gym, went down all the slides and pushed one kid on the swing. They were all adorable children and even in the light of their situation were full of love, energy, and hope. You might not think so, but these kids were just as happy or happier than a kid with his parents might be. After the park, it was movie time and so all the kids sat down under the covered area where they watched Sleeping Beauty in spanish.
I took this time to head off to the little kids room, where a dozen or so kids were just hanging out with the other girls. Alot of the children here had birth defects or developmental problems. The little girl in the pink, was out to get me from the start and spent the whole time I was there giving me hugs, lots and lots of hugs. Another girl, who had two club feet (one which had been amputated) and who couldn't speak, but understood everything kept asking me to comb her hair and then would mess it up and ask me to come it again. It was truly powerful experience, mainly because they are children and I hate to see children be treated as such from the beginning of their lives. However, it is nice to know that someone is there to take care of them.
There I met up with two other girls from my group who had been there all day.
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