A Long Week

Well, it has been quite the week. A lot happened, but I’ll see if I can break it down.

Amoebas

So, I was pretty sick all of last week with traveler’s diarrhea. I spent much of the week in bed, unable to keep anything in me. After 5 days and a course of cipro, I actually seemed to be getting worse, so I had to go see a doctor here.

At this point I was tachycardic lying down and just feeling terrible. All I really wanted was suero (an IV). But, the doctor who was a friend of a friend and who was an allopathic and bioenergetic doctor (I’m still trying to figure out what that is), had some other ideas. He prescribed me no less than 5 medications, only one of which was an antibiotic. (And the antibiotic was a sulfa one. I’m still trying to figure out what organisms he was trying to cover that cipro didn’t cover.)

Most of the other medications were probiotics, he also prescribed me some antiemetics and anti-diarrheal medications.

On top of that, he ordered me to not drink anything for another 3 hours, even though I was dehydrated and tachycardic. I think he was thinking that it would help me stop vomiting, but he also wouldn’t give me an IV unless I did vomit more.

You probably all know this, but, if someone is dehydrated, you generally want to hydrate them. So, luckily I was with a bunch of people, the program coordinator, my Spanish teacher, my host mom and my friend who’s a US doctor, and they were all for me trying to drink some Gatorade.

I also found out that here you don’t even need a doctor to diagnose yourself, you actually can just walk into a laboratorio and say you want to do an análisis de heces. Anyhow, the test came back positive for amoebas.

Though apparently to be sure that I have pathogenic Entamoeba histolytica and not its non-disease-causing relatives, I also need more tests that I can’t get done here. But I started a course of flagyl and am now getting better. Never have I been so excited to have a solid bowel movement. Yay!

Hospital Andino

I was able to make it to a couple days of clinic. I was at a hospital called Hospital Andino, which has 3 sections to it. A regular medicine section, an Alternative medicine side and an Andean medicine side. I mostly saw the latter 2.

Please note, the following pictures are courtesy of Bo Cuevas.

Homeopathic/Alternative medicine mostly relies on various “natural” medications to treat illness and they in general say they like to treat the whole person instead of just the disease. I think there are definitely merits to the homeopathic approach, and the patients I saw really felt that they were better treated by this kind of medicine. However, what kept irritating me was that the doctor couldn’t explain how many of his cures worked and said it was very American of me to want to know how (which is true.)

The Andean medicine clinic was a very interesting experience. I watched a bunch of limpias (cleansings).

They involved running a candle and a wooden stick over your body and lighting them and then reading the flames to diagnose your disease. Then there was lots of calisthenics type exercises. There was also hitting you with plants all over your body (some of which cause extreme urticaria, kinda like poison ivy), and then the yachuk (medicine man), would spit on you with some sort clear liquid. There was this pot that kept fuming incense that he would run over your body.

He also breathed fire at one point by blowing lighter fluid onto your candle/stick of wood.

He also used “natural medications.” (As I side note, I really dislike it when people use the word “natural” to imply that something can only benefit and cannot harm. Many “natural” compounds can be incredibly potent and dangerous.)

The most interesting thing to me was the prescription for the next limpia (you have to keep coming back). So, he prescribed about 7 different types of plants and then you have to bring with you 2 more candles and 1 cuy (guinea pig), of solid color. I asked why it had to be solid color- the yachuk said the multi-color ones didn’t work.

Solid color only, please.

Though I did not personally see this, at the second limpia the cuy is waved over your body, then dissected open and its innards reveal your disease.

Certainly an interesting experience.

Carnival

The other big thing going on this week was Carnival. Time to go a little crazy before Lent happens. Here that crazy manifests as water fights in the streets, as well as egging, talc-ing and spraying people with foam canisters.

It sounds like fun, until you’re walking down the street and someone pours a bucket of questionably clean water on you. I didn’t mind being sprayed by little kids so much, but it was not fun getting the foam spray in your mouth and eyes…

Baños

I was feeling better by the weekend and really wanted to head to this town called Baños (Baths) which is famous for natural hot water springs, waterfalls, hiking, rafting, etc. I opted to do canyoning (which was awesome!) and involves repelling off waterfalls!

The hardest part was the hike to the waterfalls, which though not very long was really steep, and at that point I was still only subsisting off of Gatorade and the occasional cracker.

wild orchid

Lots of people at the hot springs

On the way back to Riobamba, we stopped in Ambato, which is famous for its flowers and plants

Awesome park bench

Mural made from seeds and flowers

I can’t believe I’m already starting my last week here! Time really flies.

Last days in Hospital IESS

It’s hard not to compare my experiences here in Riobamba with other experiences in other countries I’ve worked in. Often, I think of Peru, after all they are adjacent Andean countries. But weirdly I get reminded of China quite a bit. It’s probably because it’s fresher in my mind, and I spent a lot more time there.

For example, what it’s like for patients to see a doctor in the Emergency Department is pretty similar in both countries. First you have to wait in a line to get a ticket.

A nurse checks your vital signs. Eventually your number is called and you get to see the doctor. Other patients are often crowding around you, listening to your personal information (this was way worse in China, here, it’s not too bad.)

The doctor does a brief history, he’s seated at a desk; then there’s the physical exam where the patient steps onto the bed/table (though in China we didn’t always have a bed/table). In total, the H+P is usually less than 5 min, in China it seemed more like 3 min or less…

This gentleman had a volvulus, where the intestines twist and cause an obstruction. You can actually see the twisted loop of bowel.

Then the doctor may order labs or x-rays. You get another ticket, in China it was printed out, here it’s handwritten, and you then take yourself to the laboratory window or rayos x window. Then you give your sample or get your films and you wait again. Sometimes to get all your lab work can take 6 hours or more, even just a U/A with micro.

This gentleman had an accident with a moladora or a rotating saw. Most of the bones in his hand and all his tendons were cut. He waited 2 days to come in.

So you kind of hang out in the hospital or you leave, run your errands and come back. If the doctor determines you need a specialty service, he gives you the name of the doctor and sends you on your way. If it’s a more serious case, you skip a lot of the waiting and do get a bed in the ER and observation and monitoring.

A more serious case.

In some ways it’s super efficient in that the doctors are always seeing new patients, and no patients are taking up rooms in the ER that don’t absolutely need them. Each ER doctor here can see 60 patients a day. I guess to sum up the model, there’s a lot more emphasis on patient leg work. The doctors and nurses and labs and etc are all stationary while the patient hurries from one to the other to get their diagnosis and treatment.

Still, I've heard stories here where some patients just don't get seen at all by doctors, no matter how long they wait. There's simply not enough staff and resources. My Spanish teacher here actually told me several stories of people simply being sent away and told to come back in 20 days, which essentially was a nice way of telling them to leave.

The waiting room to get into the waiting room.

It’s all very different in the U.S. The typical model used in the U.S. ER is patients sign in and wait to be seen. They are screened by a triage nurse, to make sure they aren’t in critical condition. Then they are taken back to their own room in the ER where doctors do an H+P, then they occupy that room until all their labs and x rays and what not are done. Any specialty consults come down to the ER to see the patient if needed urgently. In other words, the doctors and nurses and specimen collection and x-rays kind of move around, while the patient stays put in one place.

Still the U.S. ER model is changing. As you all know, ER wait times can be horrendous. In some county hospitals it can be 10 hours or more in the waiting room. No one wants that. So a lot of hospitals are starting to employ a fast-track system. A patient is seen by the nurse, she can order all his labs and xrays up front by protocol. The patient goes to a room and gets their labs drawn and their x-rays done and then goes back to the waiting room. By the time the patient gets to an ER bed and sees the doctor, all his or her lab work or films are back and the doctor can make a diagnosis. In some ways, it’s a little like the system here in Ecuador or in China, where the patient does a bit more moving around.

Weekend in Salinas

I headed out from the central highlands of Riobamba to the western coast of Ecuador this weekend. I went to a beach town called Salinas for a nice relaxing beach weekend and a visit to the Pacific Ocean. The 10 hour bus ride, descending 2500m was a bit extreme, but all in all a nice weekend.

Chilled coconut juice! Yum.

Lots of people.

Porta, a cellular company, is everywhere in Salinas, even in the ocean!

That’s one way to make sure your kid doesn’t wander off. Put him in a hamster ball.

This was an awesome triptych of ads in the Guayaquil bus station...

Bathrooms Before

Change you can feel!

Bathrooms After

This week I’m working with Alternative Medicine and Andean Medicine doctors in Hospital Andino. It should be an interesting change of pace from the ER…

Margaret

El Fin de Semana #1 (Weekend #1)

Hola!

I just finished my first week in Ecuador, and while I have a lot more interesting stories to share about patients I’ve seen at Hospital IESS, this post is dedicated to my viajes (trips) over the weekend!

El Naríz del Diablo

We headed over to Alausí to visit El Naríz del Diablo (The Devil’s nose), which is a mountain range through which Ecuador’s first major trans-country train ran. It was called the Devil’s nose because it was super dangerous, with many deaths during the construction of the railroad in the late 1800s.

Here’s some pictures on the road from Riobamba to Alausí.

This is one of my favorites.

The town of Alausí also has a giant statue of San Pedro (Saint Peter) over looking the town.

San Pedro close view

The train was pretty nice. It’s not really the important transportation lifeline it used to be; now it’s mostly for tourism. Some sad facts about the train… the labor used to build the train was mostly from Jamaica, where they tricked workers from Jamaica into coming to Ecuador with promises of good pay and a nice life, and then essentially forced them into slavery. Also the Naríz del Diablo area used to be home to condors, but the construction destroyed their nests and forced them to move.

The naríz, it’s the big mountain. You have to use your imagination.

We took some group photos, but all these Ecuadorian tourists wanted to take pictures with us too (like the dude crouching down.)

Chimborazo Volcano

The one place I really wanted to visit was Chimborazo Volcano.

View of Chimborazo from Riobamba, Parque 21 de Abril

It’s technically the highest mountain in the world if you measure from the center of the earth (Everest wins for height from sea level).

It’s an extinct volcano topped with a glacier, and I see it almost everyday on my walk to the bus. So I was super excited to get to climb on it.

Riding in the back of a truck on the way to Chimborazo

On the way, we passed this lady who was taking her llamas (2), pigs (2) and cows (2), by leash into town.

Chimborazo at its peak is 6310m (over 20,000ft).

To climb to the top you need ice picks and rope and real climbing gear, but we managed to climb up to 5000m (16,400ft) where the last refugio (retreat/cabin) before the summit is located.

While Riobamba is already at a pretty high elevation (2750m), I could definitely feel the altitude and was getting super dizzy and having problems breathing. Gotta love altitude sickness.

Chimborazo is also located in a National Park, which is a refuge for lots of wildlife including the vicuña, which almost went extinct here, but was repopulated using animals from Peru.

Yes, I am looking at you.

All in all, a pretty action packed weekend!

Chau!

Margaret

Hospital del IESS

Monday was my first day at Hospital del IESS or (Instituto Ecuadoriano de Seguro Social). I’ll be working there for 2 weeks until rotating to some different clinics/hospitals. It’s a pretty big hospital with 21 departments.

I was down in the emergency room working with a bunch of 1^st year interns and an attending. Here they do med school straight out of high school (as most other countries do), I think it’s 6 or 7 years, but the final year is intern year, and they do 30 hour shifts the whole year. Eek.

The patients we saw were kind of a mixed bag. The hospital is the equivalent of a Level 2 trauma center, but we still manage to see some trauma. Some interesting cases I saw:

Here's a lady who unfortunately sustained 2^nd degree burns to her hands and face during a gas explosion of her stove (this happens quite frequently here).

I saw a man with lung cancer (who did not know he had lung cancer, as the family had decided not to tell him.) with new onset dyspnea. Here’s his x-ray.

That’s bad.

There was this other man with a ridiculous amount of earwax (that ball floating in the tray is only part of what we got out…)

And then there was a metal worker who came in with a corneal abrasion. But they don't use fluorescence here, and we did not have a slit lamp, and we didn’t CT him to make sure there were no metal fragments in the eye. But I think we referred him to an ophthalmologist (oftalmólogo- I like that word). Otherwise we did a lot of wound examinations, lots of skin infections and burns, and of course saw lots of broken bones.

In the afternoon I headed to my first day of Spanish class, little did I know that it was going to be one of the heaviest rainstorms Riobamba has seen in years!

The streets literally looked like rushing rivers and most of the taxis refused to take any passengers while the buses attempted to ford the rivers. My host sister’s boyfriend’s car actually was lifted from the ground and sustained water damage to the point where it wouldn’t start. Craziness!

I was soaked despite my rain jacket and umbrella by the time we finally got a fake cab to take us. Afterwards, I ended up at El Restaurante de San Valentín because it was el Día de San Valentín with some friends, it just seemed appropriate.

The next day it cleared up a bit.

One thing I love about Riobamba is that whatever direction you look, you can see mountains.

Here’s some random graffiti, which I thought was pretty awesome...

Until Next Time!
Margaret