Rural Ecuadorian populations face a menagerie of health care issues rooted
in social, economic and political problems. The established health care
system is inadequate to effectively manage these issues. A major issue
for rural populations is inaccessibility of quality secondary (hospital-based)
health care; many people live hours away from the nearest facility. Others
with better access do not utilize available facilities due to poor quality
of care, limited availability of personnel in an emergency, and maltreatment
of patients. This is compounded by political issues including financial
mismanagement, lack of strong governmental leadership, and an inefficient
social security system.
All these barriers create an inefficient system where only 50% of the population
utilizes free services offered by the Ecuadorian Ministry of Health (MOH).
The other half is willing do pay out-of-pocket, despite extremely limited
resources, for private providers. Below is an interview with one patient:
Birth of premature, very low birth weight twins! Fabiola had 3 prenatal visits elsewhere, but no Ultrasound. She came to the hospital one night wanting to push, but was 5 weeks early. Out came one baby, followed by another 3 minutes later.
Each of the twins weighed about 3 pounds. Miraculously, they had no problems with lungs. The mother and family had heard “bad things” about taking babies to Quito, and insisted that we take care of them or they were going home, where the twins would have surely died. After 6 weeks, antibiotics, intravenous lines, phototherapy, aggressive feeding, and lots of TLC, the twins are going strong and will soon “graduate.”
This is an example of where rural hospitals sometimes are forced to care
for patients who really should be in a major hospital, which we find ourselves
doing frequently.
Meningitis is an example of a childhood infectious disease that takes the lives of many children in the developing world. Vaccines have drastically reduced this problem in the US, but they are not yet readily available here in Ecuador.
Elena is a 5-year-old girl who lives far from the hospital. She was brought
in with 2 days of symptoms of meningitis. We successfully diagnosed and
treated her. She is now in kindergarten learning with all the other kids
in her little community. Timely diagnosis and the right antibiotics are
critical.
Pre-eclampsia (toxemia) is one of the leading killers of pregnant women in developing countries. 18 year- old Natalia unfortunately received no prenatal care, and came into the hospital in labor with all the signs and symptoms of this disease. Her fetus showed distress on the monitor, and we immediately performed a cesarean section which saved both mom and baby. Both are doing well. Surgical support is crucial in our hospital for our high risk maternity care.
Two young women, both of whom suffered from muscular dystrophy, lived in a remote village with heroic parents who took care of them all their lives. Their condition deteriorated significantly in recent months form immobility, poor feeding, and difficulty breathing. Their father and brother brought them in with infected beds sores, pneumonia, dehydration, and severe malnutrition.
They were at the end of life, requiring comfort measures and a lot of “care” in the very human sense of the word, including the family. After 1 week one passed away, and a week later, the other sister died. It was a wonderful, albeit difficult, experience for the hospital staff who were unaccustomed to dealing with end of life issues.
The family was very grateful for our help at a time of need, and for not insisting on heroic, nonsensical medical interventions. We all grew from the experience, and the two daughters are most certainly in a better place now.
Carmen is a 22 year old woman who came into the hospital extremely pale, lightheaded, with lower abdominal pain. She was approximately 6 weeks pregnant at the time. Her blood pressure was extremely low (70/40) and her belly was tender. She was immediately diagnosed with an ectopic pregnancy, rushed to the O.R., and fortunately was saved. From presentation to the O.R. was 15 minutes, which is quite impressive for a rural hospital in the developing world. That speed is what saved her life.
A bus rolled off a ridge and dropped 90ft. into a ravine in the early morning hours in October about ½ hour from the hospital. 20 patients were brought to the hospital for emergency care. All 20 were successfully triaged, treated, and fortunately all survived. When asked where the other victims were taken, the police officers looked at us with a funny expression on their face and simply said, “Doctor, THIS is the only place where we bring emergencies, because all the patients want to come here!”
Camilo is a 43 year old gentleman who moved to the area from another part of the country where prolonged drought made farming nearly impossible. Arriving at the hospital one day, his request was simple and entirely legitimate. I have two children, my wife, who already miscarried once before, was again pregnant. I have very little money, but what little I have, I am willing to spend some of it to make sure my unborn child comes into this world healthy. How can I do this? Who can help me? Whom can I trust? Camilo bought a prepaid healthcare package for $30 that included maternal care and his wife delivered their baby son without complications. He was elated and so were we.
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