First, a little background on Ecuador's healthcare system:
It is actually a combination of public, Social Security, and private. The public system is a four-tiered system, starting in the community and working towards Quito, the capital and largest city.
1) Subcentros de salud (SCS) - local community based clinics that deal with everyday problems and act as a triage for anyone needing to see a specialist or get further testing. But oh are they so much more.
2) Hospital - where patients go for any testing, to see any specialists, or for any emergencies that cannot be handled in the SCS.
3) Specialty hospital - Children's, oncologic, etc. Any specialty that might require its own space.
4) Regional hospitals - located in Quito and Guayaquil.
This structure has changed in many different ways over the years, and I haven't had exposure to anything except level 1, el subcentro. Anyone who knows more than me, I apologize if I write anything in error. I'm just reporting my knowledge and experiences.
Un subcentro de salud (subcenter of health) is rural/family/general medicine at its finest, at least in my opinion. Every patient in the respective region is known and accounted for. The doctors care about their patients but are also stern with them when they need to be serious about their health. They use the resources they have and are much more capable than many other doctors who might rely on tests and imaging too often. However, they known when tests and imaging are necessary and are more than happy to send a patient to the hospital when it is warranted. Vaccinations, prescriptions, and nutritional support are all found and administered on site. If a patient hasn't been showing up to their appointments, the doctors take time out of their clinic hours to show up at the patient's door and ask what is going on. The best part about all of this, it's FREE.
There is obviously a lot more going on behind the scenes, but the doctors are committed to their patients and providing them the best care possible. The other parts of their jobs are just par for the course. And they aren't really those that you see in the United States. Some of these responsibilities include:
-- Holding monthly "clubs" for patients with hypertension, diabetes, and those who are pregnant in order to perform check-ups, give nutritional and lifestyle advice, and get everyone together to deal with any issues (like a rude EKG tech and incompetent cardiologist at the local hospital).
-- Going to all the schools in the region to perform check-ups on all the students including height, weight, age, vision, and general well-being.
-- Keeping tabs on all pregnant patients, particularly those at some sort of risk.
-- Completing monthly statistical reports, detailing the health of the patients in the region and what services were performed at the SCS.
-- Performing home visits for any patients that cannot make it to the SCS, whether they be elderly, pregnant, or disabled.
All of this on top of clinic hours at a place that is open Monday through Saturday, 8 am to 5 pm (with a 1 hour lunch break). Did I mention that there are only 2 doctors?
The doctors at SCS San Pedro are lucky that right now they have a Family Medicine resident as well as a medical student in her final year of study helping them. They both truly appreciate this assistance because they have a lot on their plate. The other staff of the center include una licenciadora (meaning she has achieved a Master's), 3 nursing interns, and the constant ebb and flow of foreign students passing through to learn and assist however possible.
I fit into this final category. I am at the SCS in a shadowing/volunteering/educational capacity. However, my role is very flexible. As my program told me, I will get out what I put in. So far, I have already learned a lot and although I know that right now I may not be very helpful, I know that as I get my bearings and get used to how the clinic runs, I will become a more useful part of this well oiled machine.
Some of the amazing and striking things I have seen so far include:
A 42 year old 1st time mom holding her 10 month old son, both she and the husband/father so overjoyed that he is progressing well.
The same day, an 18 year old going into labor and being sent to the hospital, and hearing her mother respond "soltera" (single) when asked about her marital status.
Patients coming in to request birth control implants so that their husbands don't know they are on birth control.
Discovering a likely pulmonic heart murmor on the day I listened to at least 30 hearts.
Osteomyelitis still persisting 1 year after hip surgery, being treated in the home.
I am going to post shorter thoughts throughout the week, but won't be posting them to Facebook just because I don't need to spam all of my friends' News Feeds. So if you like what you read, come back and check things out more often.
It is actually a combination of public, Social Security, and private. The public system is a four-tiered system, starting in the community and working towards Quito, the capital and largest city.
1) Subcentros de salud (SCS) - local community based clinics that deal with everyday problems and act as a triage for anyone needing to see a specialist or get further testing. But oh are they so much more.
2) Hospital - where patients go for any testing, to see any specialists, or for any emergencies that cannot be handled in the SCS.
3) Specialty hospital - Children's, oncologic, etc. Any specialty that might require its own space.
4) Regional hospitals - located in Quito and Guayaquil.
This structure has changed in many different ways over the years, and I haven't had exposure to anything except level 1, el subcentro. Anyone who knows more than me, I apologize if I write anything in error. I'm just reporting my knowledge and experiences.
Un subcentro de salud (subcenter of health) is rural/family/general medicine at its finest, at least in my opinion. Every patient in the respective region is known and accounted for. The doctors care about their patients but are also stern with them when they need to be serious about their health. They use the resources they have and are much more capable than many other doctors who might rely on tests and imaging too often. However, they known when tests and imaging are necessary and are more than happy to send a patient to the hospital when it is warranted. Vaccinations, prescriptions, and nutritional support are all found and administered on site. If a patient hasn't been showing up to their appointments, the doctors take time out of their clinic hours to show up at the patient's door and ask what is going on. The best part about all of this, it's FREE.
There is obviously a lot more going on behind the scenes, but the doctors are committed to their patients and providing them the best care possible. The other parts of their jobs are just par for the course. And they aren't really those that you see in the United States. Some of these responsibilities include:
-- Holding monthly "clubs" for patients with hypertension, diabetes, and those who are pregnant in order to perform check-ups, give nutritional and lifestyle advice, and get everyone together to deal with any issues (like a rude EKG tech and incompetent cardiologist at the local hospital).
-- Going to all the schools in the region to perform check-ups on all the students including height, weight, age, vision, and general well-being.
-- Keeping tabs on all pregnant patients, particularly those at some sort of risk.
-- Completing monthly statistical reports, detailing the health of the patients in the region and what services were performed at the SCS.
-- Performing home visits for any patients that cannot make it to the SCS, whether they be elderly, pregnant, or disabled.
All of this on top of clinic hours at a place that is open Monday through Saturday, 8 am to 5 pm (with a 1 hour lunch break). Did I mention that there are only 2 doctors?
The doctors at SCS San Pedro are lucky that right now they have a Family Medicine resident as well as a medical student in her final year of study helping them. They both truly appreciate this assistance because they have a lot on their plate. The other staff of the center include una licenciadora (meaning she has achieved a Master's), 3 nursing interns, and the constant ebb and flow of foreign students passing through to learn and assist however possible.
I fit into this final category. I am at the SCS in a shadowing/volunteering/educational capacity. However, my role is very flexible. As my program told me, I will get out what I put in. So far, I have already learned a lot and although I know that right now I may not be very helpful, I know that as I get my bearings and get used to how the clinic runs, I will become a more useful part of this well oiled machine.
Some of the amazing and striking things I have seen so far include:
A 42 year old 1st time mom holding her 10 month old son, both she and the husband/father so overjoyed that he is progressing well.
The same day, an 18 year old going into labor and being sent to the hospital, and hearing her mother respond "soltera" (single) when asked about her marital status.
Patients coming in to request birth control implants so that their husbands don't know they are on birth control.
Discovering a likely pulmonic heart murmor on the day I listened to at least 30 hearts.
Osteomyelitis still persisting 1 year after hip surgery, being treated in the home.
I am going to post shorter thoughts throughout the week, but won't be posting them to Facebook just because I don't need to spam all of my friends' News Feeds. So if you like what you read, come back and check things out more often.
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