I don't know whether it will surprise you or not to know that the standards of hygiene and sterile precautions here in Cuenca are much different than in the United States. I think it is due to many different factors, such as the lack of resources, a government run system, and I believe it is both caused by and causes the people here to have much better immune systems. Obviously they get sick just like Americans, but the lack of constant hand sanitizer use has not exactly impacted them detrimentally that I can see.
Here are a few examples:
The only time the doctor puts on surgical level gloves is to deal with an open wound.
The only other times the doctor puts on gloves at all are to perform Pap smears and other vaginal examinations, to check the genital area of growing boys, and to check on a wound that is healing.
Washing of hands usually occurs only once gloves have been removed.
The other doctor does use hand sanitizer occasionally but not nearly to the extent that it is used in the US; it is more to replace occasional hand washing.
All patients sit on the same bed, with no paper covering or changing of sheets (because there are none).
All patients who have to wear a gown put on the same gown that lives in the bathroom connected to the office.
Many items in the office are wrapped in brown paper to keep them sterile, however these items are wrapped by nursing and medical students (like myself) without any extra precautions.
There are also still standard precautions for equipment that needs to be sterile of course. Instruments for Pap smears and other vaginal examinations come in sealed plastic containers. Sutures and syringes are in the same peel open container seen in the US. Wound cleaning and suture kits are sterilized and stored properly. I don't want to misconstrue the system and make anyone thing that sterilization is just willy-nilly. They have a very good program and process in place.
I don't see too much wrong with the system that they use. Mostly because it makes sense with the resources they have access too. Also, with all of the hype about the "hygiene hypothesis" it is interesting to experience a medical system that, if this hypothesis is true, is not perpetuating it. The biggest problem I have found with this system is that if the doctor wants surgical level gloves, sutures, or a syringe, she has to write a prescription and send the patient to the pharmacy (in the same building) to get it. These things are not on hand. Even though I know this is their protocol and a method to maintain inventory, it seems like an unnecessary impediment to efficient medical care. However, overall I have enjoyed experiencing a completely different approach to hygiene and medical cleanliness.
Here are a few examples:
The only time the doctor puts on surgical level gloves is to deal with an open wound.
The only other times the doctor puts on gloves at all are to perform Pap smears and other vaginal examinations, to check the genital area of growing boys, and to check on a wound that is healing.
Washing of hands usually occurs only once gloves have been removed.
The other doctor does use hand sanitizer occasionally but not nearly to the extent that it is used in the US; it is more to replace occasional hand washing.
All patients sit on the same bed, with no paper covering or changing of sheets (because there are none).
All patients who have to wear a gown put on the same gown that lives in the bathroom connected to the office.
Many items in the office are wrapped in brown paper to keep them sterile, however these items are wrapped by nursing and medical students (like myself) without any extra precautions.
There are also still standard precautions for equipment that needs to be sterile of course. Instruments for Pap smears and other vaginal examinations come in sealed plastic containers. Sutures and syringes are in the same peel open container seen in the US. Wound cleaning and suture kits are sterilized and stored properly. I don't want to misconstrue the system and make anyone thing that sterilization is just willy-nilly. They have a very good program and process in place.
I don't see too much wrong with the system that they use. Mostly because it makes sense with the resources they have access too. Also, with all of the hype about the "hygiene hypothesis" it is interesting to experience a medical system that, if this hypothesis is true, is not perpetuating it. The biggest problem I have found with this system is that if the doctor wants surgical level gloves, sutures, or a syringe, she has to write a prescription and send the patient to the pharmacy (in the same building) to get it. These things are not on hand. Even though I know this is their protocol and a method to maintain inventory, it seems like an unnecessary impediment to efficient medical care. However, overall I have enjoyed experiencing a completely different approach to hygiene and medical cleanliness.
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