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Put the Rain in Rainforest...

Shell, Ecuador, 31 Julio 2012

I'm sitting at the kitchen table with all the windows open listening to the night noises - insects, frogs, the wind...and oddly enough the occasional rooster.  I just got back from the Sala de Emergencia where an 8 year old little girl came in with anaphylaxis after eating fish her dad gave her.  She'd reacted to fish before, but that was saltwater fish, and this was something he caught in the Rio Pestaza in Mera.  And it tasted good, she said.  She is cute as a button, even with her eyes swollen shut.  When I got there and hunted her down in a corner (they really need to work on their idea of triage around here), she'd just begun to have some respiratory issues - stridor and wheezing - so I herded her into a room, onto a monitor, and shot her up with some epi.  She was chatting the whole time.  When her dad got there, he was pretty upset about giving her the fish and I'm pretty sure he's got a vendetta against all aquatic creatures now. She turned around pretty quick, opening her eyes enough to comment on the color of mine, and I gave instructions let her go home after a few hours of observation with meds and a follow up appointment.  Unfortunately, epipens aren't readily available here. They're going to ask a cousin in the States to send some.  Her dad gave me a big bottle of water when we said our goodbyes.

It's been raining off and on the past few days, which seems to be more typical than the relatively dry weather we were having last week.  I was on call all weekend, but managed to get away to do some exploring.  On Saturday I went into Shell, which I hadn't really seen much of in daylight since it gets dark around 6:30 this close to the equator. It's not a very big town, not all that busy, but still lively enough.  One of the missionary nurses and I ducked into a comedor for a traditional lunch: always sopa (a brothy soup with some potato, maybe carrots, and some bones and/or organ meat of some variety in it), rice, salad, and some meat (typically chicken). Everybody eats this every day for lunch.  Soup is often served with every meal, including breakfast. Kids who don't eat their soup won't grow up to be big and strong.  After some fortifying soup, we got some ice-cream and did some grocery shopping at the market and walked down to the dique, a little damn on the river where they've built a park complete with a water-slide.  In spite of the overcast weather I managed to get a sunburn (forgot about that whole equator thing), but it was a nice excursion.  

Sunday I hung out with a couple of the residents and we went to the military base where they have a nature park.  You drive through the base, literally across the airstrip that runs the length of the town, to a dirt road that leads to a hut where you pay a fee to go into the park.  There's a very nice trail into the jungle, winding along a stream, with examples of the various styles of shelters used by the different Amazonian peoples alongside it. We stumbled across a brilliantly colored, 8 or 9 inch centipede, black with yellow stripes and almost neon red feet and antennae, on the trail. It's so green, thick with moss and ferns and bromeliads all over the trees.  Eventually you get to an open spot that drops down to the Pestaza River and houses a small animal rescue park.  The monkeys, parrots, and other birds run loose (and are not shy); but the pumas and ocelots and marmosets and coatis, etc. are kept in enclosures.  The soldiers in their uniforms take you around and point out the animals.  The whole thing was so beautiful, and kinda surreal.  

The hospital wasn't too bad over the weekend, but busy enough.  Saturday we admitted a man with a new diagnosis of AIDS. One of the nurses here described it as the modern day leprosy of Ecuador.  Folks are cast out of their community when they get the diagnosis of HIV. Results in a lot of denial, it seems.  At least that's what must have been going on with this fellow.  By the time he sought medical attention, his disease is well advanced and he is wasting away.  We're transferring him to a public hospital so he can get plugged in to the national HIV program and get his meds for free.  Sunday there was a lady from the jungle who came in with a pretty impressive periorbital cellulitis.  The right side of her face was all puffed up and the eyelid incredibly swollen and tense.  Since we didn't have access to CT over the weekend (it's in the neighboring town, anyway) we were lucky to have a visiting ophthalmologist to reassure us that the infection wasn't actually in the orbit.  She's improving with antibiotics, but difficult to communicate with because Spanish isn't her first language.  Delivered another baby early Monday morning and that afternoon I took a nap to the sounds of the rain!  

On call again today, but only for OB and peds while the gastroenterologist who's visiting from North Carolina covers adults.  It's already been a busy night with the anaphylaxis girl and a tiny 5 day old baby who was born in the jungle presenting with fever.  Has a pretty nasty belly button, so where calling it omphalitis and treating with IV antibiotics. So little but has so much hair!

One thing I love about coming to places like this is meeting all the folks who come from all over the world to work in these remote areas.  I had dinner with a German couple who have been serving in Ecuador for over 20 years, a family from Cuba, and a guy from Seattle.  Tomorrow I have plans to head into the nearby city with a group of the Ecuadorian residents. It's started to rain again, so I'd better get to bed and let it lull me to sleep.  Won't take much.  

Strange but True:  A patient's medical information in Ecuador can be withheld from them by a physician, hospital, social security/ministry of health.  An individual may have to get a lawyer to write a letter to the government agency to release biopsy results to a patient.  Coming from the land of HIPPA, I find this mind-boggling.  



( 12 comments — Leave a comment )
Aug. 1st, 2012 06:23 am (UTC)
Fascinating! :)
Aug. 6th, 2012 11:28 pm (UTC)
Thanks for reading, and for taking the time to comment. :-)
Aug. 1st, 2012 07:20 am (UTC)
You're doing good work, m'dear. Kudos and keep well yourself. I agree with hardboiledbaby, it's really interesting to hear about other places and differences and people's experiences, especially non-touristy stuff.

Is this an official "exchange" programme, something you fixed up yourself, or what?

Sorry, I probably missed your post explaining.
Aug. 6th, 2012 11:32 pm (UTC)
Thank you! :-)

It's kind of an exchange program... The director of the fellowship I'll be starting when I get back has a relationship with the folks who run the hospital here, and I think he'd like to send fellows down for rotations on a regular basis. This is the first year, though, and I'm the second fellow to come. They just asked me if I'd be interested in going to Ecuador, I said sure, and here I am!
Aug. 1st, 2012 07:30 am (UTC)
oh wow! i am in awe of anyone like you! and hope you have a good time in the city tomorrow!

one of my best friends is from Ecuador so i've heard a lot about the country, but only from her point of view.
Aug. 6th, 2012 11:33 pm (UTC)
Thanks! :-)
It's a beautiful country.
Aug. 1st, 2012 04:49 pm (UTC)
As someone who has been in the business of making patients active partners in their care, and developing interactive EHRs...BLUH that *IS* mind-boggling.

Gosh I love your globetrotting posts, and only envy you your experience-wrangling the tiniest bit. (and your talent for expressing the idyllic beauty and yet the poignant troubles of the country).

That little girls sounds adorable - what colour *are* your eyes, btw? :)
Aug. 6th, 2012 11:41 pm (UTC)
I know, right? Conversely, there are patients who tote big file folders of their medical records with them.

Thanks so much for reading, and taking the time to comment. It's fun to share the experience.

She is! And that's a hard question. My passport says gray, but it really depends on the ambient light and the color of my shirt and the phase of the moon. She thought they looked green with black around the edge (they do have a really dark ring around the iris) and black in the middle!
Aug. 7th, 2012 01:45 pm (UTC)
Aw, they sound very pretty. Mine are equally hard to describe, but I think the grey-blue-green colour is pretty common. I was very excited when I recently discovered the term 'glasz' to describe them. :)
Aug. 1st, 2012 10:47 pm (UTC)
Wow, I adore your travelogues. You have a real gift for writing, so vivid. From the father giving you water to sadness at the HIV positive gentleman to practically tasting that soup and seeing that nature park.

A patient's medical information in Ecuador can be withheld from them by a physician, hospital, social security/ministry of health. An individual may have to get a lawyer to write a letter to the government agency to release biopsy results to a patient.

Wow. Okay. But why would a doctor want to withhold a patient's results?
Aug. 6th, 2012 11:43 pm (UTC)
Aww, thanks! I appreciate your reading and sharing the trip with me. :-)

I don't know why anybody would withhold results. Is it a power thing? A money thing? I have no clue. As frustrating as the US system can be, at least I feel like my medical records are mine.
(Deleted comment)
Aug. 6th, 2012 11:43 pm (UTC)
Well thank you for traveling with me virtually! I appreciate the company!
( 12 comments — Leave a comment )