La Clinica

Is that pus coming out of his ear? The answer to this is yes. But lets not jump ahead. I figured that rotating in Ecuador at a community clinics was going to be full of surprises and I would be thrown into it the thick of it, and today I came to find that I was absolutely correct. And what better way to start a new rotation than getting lost am I right? After going to where I assumed to be the correct meeting place I started to question my logic after almost an hour or so. I guess I might as well head over to the clinic and find a call center close by.

After spending my twenty five cents on the bus ride I walked up to the El Centro de Salud, which having been open only about fifteen minutes was already full of patients hoping to see a physician for their many different complaints. I began wading through the groups of people trying to find someone official looking in a white coat and after having found several I quickly realized something; no one knows I’m suppose to be here. Which led me to plan B: to the call center! Fortunately I was able to get a hold of Maria Agusta, the main coordinator for the international program, and we had a plan; I was to wait at the clinica and do what I could until she arrived.

El Centro de Salud in Tumbaco I later came to find is the busiest clinic for this area, spanning several different small cities, towns, and neighborhoods. Once the doors open there is no end to the number of patients waiting to see a doctor until you finally have to start turning people away and ask them to come back the next day. Fortunately my time as a Spanish speaking missionary and Spanish medical interpreter prepared me well for this experience. The medicine wasn’t the hard part. Learning how it is practiced here was the true challenge.

In the United States we have vast amounts of medical resources, research, education and specialists. If you have a problem, chances are you can find someone to treat you and they can give you several different options for treatments, often in the form of medication. I quickly learned that this was not going to be the case. Resources are limited so conservative therapy is often the treatment of choice. Fortunately most of the complaints some form or other of gastroenteritis of unknown origin or a upper respiratory infection. But then you get others who are really sick or have an acute injury. In walks a patient with a venous stasis ulcer that needs to be debrided and have his dressings changed; however there are no scalpels left in the clinic or Kerlex (dressing used to wrap around wounds) and you’re just going to have to use the back of scissors and just tape a bunch of gauze over the now clean wound. Sir you seem to be bleeding profusely from laceration on your finger. Lets stitch you up! However we have run out of 4.0 and 5.0 suture kits so lets just use on of the big 3.0 suture and hope everything comes together well. And is that pus coming out of that child’s ear? (see, we’re al caught up now) Ah so this is what happens when infectious otitis media is left untreated and it actually causes the tympanic membrane to rupture and now there is pus leaking out of your ear hole (technical term). Despite all of this the clinic moves forward, you help out in everything, and practically everyone leaves humble and very grateful for your service.

One great lesson I have gained from all of this is that the administration of healthcare has no perfect system. It must adapt to each situation and patient. Students here get trained in so many ways because there is a good chance that they are going to see anything and everything, so they must be prepared. I have no doubt that when I serve as a physician in a deployed setting I must be able to adapt the each unique situation and my time here will leave me more than trained for those moments.

Well time to rest up now. Who know’s whose ear is going to be leaking pus tomorrow.