Hospital in Quito

ER in Quito - By Robin Fillner - SALUD Program Guest blogger traveling in Quito. Hi again. Just got back from the hospital today... here are some things I've noticed. I think it's important to keep in mind though that the people in Ecuador are amazing: the patients and the staff. They do so much with so little. I am impressed. Even sick patients are incredibly strong, and don't complain very much about anything. I have seen a lot of equipment that looks like it was down the hatch in the television program "Lost". I saw a thermometer shaker for glass thermometers and plaster casts. And the EKG machine was very perplexing. There are 6 bulb suctions and 4 clamps. The bulbs suction and ¨electrode´ onto the chest, with the help of alcohol, and the clamps go around the wrists and feet. The print out looks very similar to our 12-lead EKG. At the same time, I've only seen one ventilator, an Oxylog 2000, it was very small and had lots of dials. I think these manual machines are pretty cool, and the concept behind them is easy to understand. I have noticed that the med students-residents-and doctors do a lot of the work of nurses in the US. But, I've never worked in a teaching hospital so it may be similar in the US. I have assisted doctors and students with putting in Foley catheters (urinary tubes), naso-gastric tubes, and flushing clogged renal-biliary tubes. Any nurse from the US knows that this is their responsibility and to have assistance doing it is a godsend. I think it is mostly because there is a surplus of med students-doctors at this hospital, but I am not certain. The nurse that I was following was mainly stocking, but also documenting her observations in charts. I have also seen nurses drawing blood, putting in IVs, but not really ever giving medicine. The patients are definitely not on as many medications here as they are in the US, but, the meds are pretty similar. The only people I have seen wearing protective equipment - such as gloves, gowns, and masks - are surgeons and the cleaning people. In the ER I haven't really seen anyone wearing gloves while drawing blood, changing dressings, etc. They don't have retractable needles and there are needles lying around a lot. Not that the in-hospital infection rate is really good in the US, but here it must be pretty high. Unfortunately, there is not a lot of money to spend on research into in-hospital infections or money to spend on protective equipment. The sterile field is compromised a lot. Some people put un-sterile and sterile supplies together, or moisten their gauze over the sterile field... But, they also don't have as much packaging as we do in the US. For example, they have a sterile container full of gauze and use sterile hemostats to pull it out. That saves on so much waste. Usually, people here have to buy medicine and food from outside the hospital and bring it in to take. They depend strongly on their family for this assistance. Without family, the patients don't do well. I think also because the focus is on getting the patient better, privacy doesn't take on to much importance. Many patients are examined in full view of everyone. I saw a man getting a prostate exam, a women getting a urinary catheter inserted, and even a woman giving birth while people were passing by checking it out. I think they were just happy they were getting help. It is interesting too that the sickest patients, unless they are really young, are assisted to and made comfortable, but they are not given resources that others could use because they have a chance to survive. This is sad but I think it is very practical. There is no existence of 'code status'. The doctors in my hospital think it's crazy that we put patients through so much trauma when they are very old. I followed the neuro rounds today and I saw a lady today with cerebral lesions due to uncooked pork. In Ecuador this is very common, also with strawberries. The lesions are from parasites. I always wondered why Isabelle cooks the meat to the point of not being able to cut it, or chew it. I couldn't understand if the woman needed surgery, but she is on anti-convulsant medication as well as steroids due to the increased intercranial pressure. This is my last week and then it's off to the jungle for a week for some piranha fishing!! Tomorrow I'm getting a yellow fever vaccination and buying malaria pills to prepare. Take care!!