Only in Ecuador

Last night a drunk man came in with a ruptured anal sphincter. He had been bored by a bull in the anus.

I haven't talked a lot about what I've been doing clinically lately, because up until last week I wasn't doing anything. Ecuador has 4 tier health care system, and for the first week I was in the first tier which they call the subcentros. The town I was in was called Pifo which is about an hour away from Quito by bus. The subcentros are where people living in rural areas go for the non emergent things, like common colds and lab tests. And the doctors there weren't super friendly either because my Spanish really is not up to par, and they didn't seem to like to teach a lot. It was nice to be able to see patients in a rural setting but at the same time I wasn't learning anything.

Fast forward 2 weeks, and I changed to the second level in the system, to a hospital in Yaroqui. I should have done it so much sooner. I'm currently working in the emergency room, and I get to be so much more hands on. I've learned how to clean wounds, stitch, do EKGs on an ancient machine, and the next adult that needs an IV line is mine. Also so many babies are born at the hospital, so I've gotten to see one and hopefully I can help in the next one.

Although I'm having such an amazing experience, at the same time the hospital just breaks your heart. They're constantly running out of equipment or supplies, and there is always a shortage of workers. You can also see how the public health care system screws over many of their patients. This one middle aged man was recently diagnosed with precancerous gastritis after being bounced around from specialist to specialist for 14 years. And it is unlikely that any specialist will see him now that he's been through them all, and he is most likely going to die. I've also seen so many teenage pregnancies in Ecuador due in part to the lack of reproductive knowledge. Most of the girls that are pregnant for the first time are in their teens or early twenties. And in one tragic case that Alissa and Jordana saw, a 13 year old girl was raped and impregnanted by her step-grandfather. Stuff like that just breaks your heart.

Tomorrow I do my first overnight shift, hopefully I have a lot more to report back.