Semana 9

For my 9^th week, I worked with Dr. Barrera at the Centro de Salud #4. There are a bunch of Centros de Salud around the city. They're mostly located in the poorer areas of Quito, and provide free medical care when they can and at the lowest price possible when they can't. Dr. Barrera mainly sees patients with diabetes and/or high blood pressure. Every morning he would pick me up on a corner about a 10 minute trole ride from my house, and we drove up to the clinic. During the drive we talked about various things like current events, healthcare in our countries, sports, etc (we both agree that baseball is boring and golf is an activity, not a sport). Two things that happened around that time that made big news were the immigrant massacre in Mexico and a terrible bus crash South of Quito where 38 people died when the bus driver fell asleep and drove off a cliff. There were a few Ecuadorians among the 72 killed in Mexico, and the only survivor was an Ecuadorian man. That got us talking about the anti-immigration laws in Arizona and the proposal in Florida, and Dr. Barrera wasn't the first person I talked about it to, but the general view on it is that it's racism and the whole country is in agreement with it. I was pretty embarrased to hear that my country has earned itself a racist reputation, and all because of two states.

There were two other Ecuadorian medical students in their last year working with Dr. Barrera. They would see patients while he went off for smoke breaks. Smoking and drinking are pretty common activities among doctors there, from what I hear. I took the blood pressures of a few patients and listened to some hearts, nothing too exciting after spending a week in surgery and what I saw in Chone. On Tuesday there was a group of 6 first-year medical students in the consult with us. The room was packed. Despite the blinding white light from the wall of lab coats, the patients didn't seem to find it unusual. They were all 20 years old; almost 2 years younger than me and already on their way to being doctors. In South America, you go into med school right after high school, but med school is 6 years instead of 4. The highlight of that day was seeing Dr. Barrera drain A LOT of pus out of the hand of a woman, caused by her diabetes. There was also a 101 year old woman that came in to have her glucose checked.

Almost everyday I heard people drive by our house yelling something into a loudspeaker. Finally I asked Cristina, my host mom, what it was. They're two guys that drive around the neighborhoods taking anything old and unwanted from people. Anything: furniture, electronics, clothes, pets... whatever they can turn around and sell. Everyone seems to find them a nuisance. That day was Cristina's birthday, and also the day that Andrés, my host sister's boyfriend, graduated from medical school. He was the top student in his class of 80 or so. For dinner, we brought out the bottle of Rex Hill wine, made just a few minutes from my house in Newberg, that I gave to them the first week. It was very good, and the Oregon marionberry jam we had a few months earlier was a hit, so they must think that everything we eat and drink is absolutely delicious.

On Wednesday, Dr. Barrera couldn't pick me up because of the new Pico y Placa law. It restricts cars with license plates that end in certain numbers from driving one day a week. I took a taxi, and he decided to take a “shortcut” through the mountains on the west side of town, even though the clinic is on the east side. We ended up getting stuck in traffic and spent probably 15 minutes in a tunnel. I could tell he was pretty embarrased by his intuition. Because of that I showed up late to the diabetes presentation Dr. Barrera puts on every Tuesday for his patients. There were about 60-70 people in folding chairs in front of a projector screen showing a powerpoint in what looked like a large storage room. One of the two medical students went over the basics of diabetes and tips on how to stay healthy. Some of the things they talked about was getting support from your family, eating small meals five times a day to keep glucose levels steady, and putting blocks underneath the posts on the foot of your bed to incline it and keep blood from pooling in the legs. My favorite bit was when Dr. Barrera described circulation to them. At first some people weren't following him, then he used the example of what happens when you cut the neck of a chicken and suddenly everyone knew exactly what he was talking about. He told them he was working on getting them free laser treatment for diabetic foot fungus at Hospital Metropolitano. Everyone cheered and said ¡Gracias, doctor, gracias! After the talk was over we measured the blood glucose of everyone there. I must have pricked the fingers of at least 40 people. That was the first time I had done fingerpricks before, and there's nothing like taking something new and doing it again and again on flinching, cringing people to get decent at it. Later, in the consult, a patient gave us each a bag of apples as gifts. I saw quite a few people give gifts to the doctors there. My second week in Hospital IESS, the husband of a patient gave Dr. Salazar a bottle of expensive whiskey. Quite a difference from the US where doctors are more likely to be sued than given gifts. We taught the daughter of a recently diagnosed diabetic how to measure her blood glucose. They were given a glucose meter to use for free. I asked Dr. Barrera how they can afford to give meters out, and he said they don't give them out, they borrow them out. When a patient is having high levels and needs to keep a closer watch on it, they give them one until they work it down to the point where they can get it checked just when they come in to the clinic. Almost all of his 200+ patients with diabetes don't have ways of checking their glucose at home.

The front entrance

Tuberculosis information