Hola! Once again I have failed to update this blog as regularly as I had originally planned on, but I think this makes the posts more concise and interesting. Hopefully you feel the same!
As I enter into the last week of my internship, I can’t even begin to describe what a valuable experience it has been to work in the hospital here. As the weeks have passed I have learned a tremendous amount about the process and practice of emergency medicine. I’ve also become more confident in my abilities as a healthcare provider. I see the pain in the eyes of the patients as they wait to be examined, and the peace they feel once they’ve been treated. For me this has been a lesson in compassion because when a patient comes into the ER, they are usually at their most vulnerable point, and it’s more important than ever to care about them.
During the past two weeks I have taken a more active role in the ER. I now routinely (and confidently!) give EKG’s and clean wounds. And although I have only done it twice, I am very proud to say that I have given two people stitches! Both times the patient had a head wound. Stitching is surprisingly easy, but of course it takes a lot of practice. I also take vital signs and help out with other procedures as needed. I am very fortunate to work with doctors and interns that are willing to take the time to explain to me what they’re doing and teach me how to do it.
There is one other American student that is working in the ER for the same time period as I am. Her name is Michelle and she is a Physician Assistant student at George Washington University. I love having her there with me because she’s able to explain to me (in English) the medical things that I haven’t learned yet. I also get to ask her questions about PA school (since that’s what I will be doing after I graduate) and she’s offered me some good advice. In a lot of ways I feel like a younger version of her (although she is only a few years older than me) and it’s pretty cool.
Along with working almost full-time at the hospital I have started to write my monograph, a 20-25 page final paper that is required by my program. I am writing about how the public health system works in Ecuador, and about socio-economic discrimination that exists within the system. It’s a topic that I find very interesting and I enjoy learning about it. However, it is incredibly time-consuming especially because I find myself completely unmotivated to do anything academic. I know what you’re thinking, “Lindsey, you have had the easiest semester of your life. Suck it up and work!” and I tell myself the same thing every day. But somehow that doesn’t motivate me! ;) My biggest struggles have been organizing the mountain of information that I looked at, and figuring out the format of the paper. I’ve never written in this format before, so it’s helpful that I have a tutor (as is required by CIMAS) to guide me along. Hopefully I will have it finished by the end of the week, and then I will be done with the hardest part of my semester. All I’ll have left is a reflection paper and a few forms to fill out!
I should also mention that alongside working and writing, I manage to find some time for fun! Two weekends ago I went to the Cloud Forest in Mindo, which is a small town about two hours north of Quito, right next to San Miguel de los Bancos (where I went with my group our first weekend here). I really liked the small-town charm of Mindo. There are a lot of sporty and adventurous things to do there such as rafting, hiking, repelling down a waterfall, canyoning (ziplining through the forest) and much much more. I went canyoning which didn’t give me the adrenaline rush that I’d hoped it might, but nonetheless I enjoyed “flying” through and above the forest. We also went on a hike to get to the waterfall, but we were given bad directions so we ended up hiking almost straight up and then straight down the mountain without even realizing it until we got back to the bottom. That part was a little frustrating, but at least it was a nice hike. On this trip I also got to try Fanesca, which is a dish that’s only served during Holy Week. It’s a hearty soup that’s made with twelve different ingredients, to represent the 12 apostles. (I will admit here that I didn’t know this fact until I looked it up on Wikipedia). Every place will make fanesca a little differently, but generally it includes fish, quinua (an Andean grain that is actually a super-food), corn, and a bunch of other things. It’s served with boiled egg, fried banana, and empanadas. This may seem like a strange combination, and a lot of people don’t like it, but I absolutely loved it!
As my stay in Ecuador dwindles down, I find myself thinking about the things I will miss the most. Like the street vendors that come onto the bus and try to sell you everything from gum to CDs to sewing kits. And the bakeries that serve freshly-baked cheese empanadas for only $0.19. And the way that the people interact with each other here, always cordial and polite. But I am also thinking about what I’ll be coming back to in the US. I miss my friends and family very much, because as much as I love getting to know new people, they could never replace the people that already know and love me. I am increasingly excited to live in Minneapolis this summer and work at ACR Homes again with the wonderful residents and staff, and to live with one of my best friends. I also look forward to eating American food, as greasy and unappetizing as it may sound sometimes. I think about these things more and more every day, and so I am determined to live-it-up during my last 3 weeks in Ecuador and do as much as I can. I hope to go to the beach one more time, to the jungle, and spend time with the people I’ve grown closest too. I should also mention that I will be buying souvenirs soon, so if anyone has a specific request, SPEAK NOW or forever hold your peace.
I hope you all have a wonderful week! If you don’t hear from me, it’s because I’m working on my paper. I suppose that tonight it would have been a wiser choice to write that instead of this blog, but I think they’re both important.
Sunday, April 26, 2009
Sunday, April 5, 2009
Hospital Pablo Arturo Suárez
What a busy two weeks this has been for me! I have mostly been working at the hospital, and I can't even describe how much I love it. I am more sure than ever that medicine is what I'm meant to do! I am learning so much from the doctors and interns and I am so grateful for this experience. My biggest struggle so far has been the language. I am thrown off by the medical terminology, which I know in English but not in Spanish. Fortunately, though, a lot of the terms have the same latin root so I am able to deduce a lot of the words. I work Monday through Friday from 8am to 4pm. This means that I have to get up at 6am so that I can leave by 7am. That has certainly been an adjustment but it's not too bad. At 8am I go on rotations with Dr. Mario Pancho and the rest of the doctors and interns, and we go to each patient in the Cuarto Critico (ICU) and Observacion to discuss their case and make a plan for the day on how we can continue their treatment. For the rest of the day I accompany the doctors and interns as they perform patient exams, and assist them in any treatments. For example, I have helped with multiple sutures, wound cleanings, and the like. I think that next week they are actually going to teach me how to suture!
I have never worked in a hospital before, let alone a public hospital, meaning it is funded by the government. They have very little resources to work with, but I think they do a good job. They have talented doctors and bright students. The ER consists of three exam rooms, two observation rooms (one for men and one for women, but usually there are patients of both genders in the same room), and the cuarto critico, or ICU, which as two beds. It's a very small space, especially when there are a lot of people. When a patient arrives, they check in at a small window and fill out a form with basic information. After that, they are admitted into the ER and the doctors and interns examine them. Ideally each patient would be examined in one of the exam rooms for privacy reasons, but the rooms are usually full, so they do the exam wherever they can, including on the waiting bench. It's also common to have two patients in one room. Each exam room consists of a bed, IV stands, a tray for the doctors to use, and a supply cart, which contains 4 bottles of solution used for cleaning wounds, gauze, tongue depressors, and a bottle of anesthesia. Notice that it does not include hand sanitizer or gloves. There is one box of gloves in the nurse’s station, and hand sanitizer (apart from the travel-sized bottle that I carry with me) is non-existent. It was obvious from the beginning that this hospital does not use the same standards of hygiene that we use in the United States.
Another thing worth noting is that for the first twenty days of April, the operating room in the hospital is closed for remodeling. This has a big impact on the ER because we can examine and diagnose a patient, but if they need an operation of any sort we have to transfer them elsewhere. For this reason, we have seen a drop in the number of patients that come in. My first week the ER was absolutely full, but for the last couple of days we have had about 50% of our beds free.
The hospital is not free, as I had previously thought, but it is much cheaper than a private hospital. Generally once a patient has been examined, the doctor gives a prescription to the patient's family members with a list of supplies, medications, and orders for lab tests, x-rays, etc. that need to be done so that they can treat the patient. If the medication can be found in the hospital's pharmacy, it is free of charge. If not, there are at least six pharmacies directly across the street where they can buy it. The patients that come in to our hospital are generally of the lower class. I think this makes sense, not only because of financial reasons, but also because people of the lower class tend to be more at-risk. This could be because they don't take good care of their health, because they have more dangerous jobs, or any number of things.
Now on to the exciting part...cases! As you could expect, we get a huge variety of cases that come in. Interestingly enough, about 50% of the patients come in reporting abdominal pain. It usually turns out to be appendicitis or gastroenteritis. We also have people come in reporting chest pain, headaches, and other things of that sort. And of course, we get trauma patients. Here are a few memorable cases that I’ve had so far:
- I helped a doctor suture up the head of a guy who had been shot by a robber that entered his home. The skin on the top of his head was ripped open all the way down to the skull, but fortunately it didn’t go into the bone. It took us three hours to stitch him up.
-We had a 16 year-old patient with tuberculosis and HIV. The doc told me that he probably won’t live for more than 6 months.
-Multiple patients have fallen from heights of one or two stories, mostly construction workers. Their injuries include broken hands and fingers, swelling of the brain, and more.
-This week we had two patients brought in (within 24 hours of each other) by airport police for trafficking drugs. I was there for one of them. He had swallowed about one kilo of cocaine in capsules. He was ok, but they had x-rays done and everything. This guy was from Amsterdam and doesn’t speak Spanish, but he spoke English, so I helped translate for the doctors, and later for the police.
-The other day there were two burn victims in the ER at the same time. One had been burned by fire at work, and the other had been electrocuted. Obviously both were in a lot of pain, but I think the electric burn was probably worse because it’s on the inside.
-One day I came in and all the doctors were in one room crowded around a patient that was unconscious. They were using a hand-held breathing device to breathe for him. We have ventilators, but only in the ICU and both of the beds were already full. So I took over for one of the doctors and started breathing for this guy, who had an aneurysm. As I was standing there, just me and him, it occurred to me that I was the only reason this guy was still alive, and that scared me. But, I did my job and he was put on a ventilator shortly after that.
These are just a few of the cases that I thought you would find interesting. I’m sure that in the coming weeks I will have a lot more to tell you!
I have never worked in a hospital before, let alone a public hospital, meaning it is funded by the government. They have very little resources to work with, but I think they do a good job. They have talented doctors and bright students. The ER consists of three exam rooms, two observation rooms (one for men and one for women, but usually there are patients of both genders in the same room), and the cuarto critico, or ICU, which as two beds. It's a very small space, especially when there are a lot of people. When a patient arrives, they check in at a small window and fill out a form with basic information. After that, they are admitted into the ER and the doctors and interns examine them. Ideally each patient would be examined in one of the exam rooms for privacy reasons, but the rooms are usually full, so they do the exam wherever they can, including on the waiting bench. It's also common to have two patients in one room. Each exam room consists of a bed, IV stands, a tray for the doctors to use, and a supply cart, which contains 4 bottles of solution used for cleaning wounds, gauze, tongue depressors, and a bottle of anesthesia. Notice that it does not include hand sanitizer or gloves. There is one box of gloves in the nurse’s station, and hand sanitizer (apart from the travel-sized bottle that I carry with me) is non-existent. It was obvious from the beginning that this hospital does not use the same standards of hygiene that we use in the United States.
Another thing worth noting is that for the first twenty days of April, the operating room in the hospital is closed for remodeling. This has a big impact on the ER because we can examine and diagnose a patient, but if they need an operation of any sort we have to transfer them elsewhere. For this reason, we have seen a drop in the number of patients that come in. My first week the ER was absolutely full, but for the last couple of days we have had about 50% of our beds free.
The hospital is not free, as I had previously thought, but it is much cheaper than a private hospital. Generally once a patient has been examined, the doctor gives a prescription to the patient's family members with a list of supplies, medications, and orders for lab tests, x-rays, etc. that need to be done so that they can treat the patient. If the medication can be found in the hospital's pharmacy, it is free of charge. If not, there are at least six pharmacies directly across the street where they can buy it. The patients that come in to our hospital are generally of the lower class. I think this makes sense, not only because of financial reasons, but also because people of the lower class tend to be more at-risk. This could be because they don't take good care of their health, because they have more dangerous jobs, or any number of things.
Now on to the exciting part...cases! As you could expect, we get a huge variety of cases that come in. Interestingly enough, about 50% of the patients come in reporting abdominal pain. It usually turns out to be appendicitis or gastroenteritis. We also have people come in reporting chest pain, headaches, and other things of that sort. And of course, we get trauma patients. Here are a few memorable cases that I’ve had so far:
- I helped a doctor suture up the head of a guy who had been shot by a robber that entered his home. The skin on the top of his head was ripped open all the way down to the skull, but fortunately it didn’t go into the bone. It took us three hours to stitch him up.
-We had a 16 year-old patient with tuberculosis and HIV. The doc told me that he probably won’t live for more than 6 months.
-Multiple patients have fallen from heights of one or two stories, mostly construction workers. Their injuries include broken hands and fingers, swelling of the brain, and more.
-This week we had two patients brought in (within 24 hours of each other) by airport police for trafficking drugs. I was there for one of them. He had swallowed about one kilo of cocaine in capsules. He was ok, but they had x-rays done and everything. This guy was from Amsterdam and doesn’t speak Spanish, but he spoke English, so I helped translate for the doctors, and later for the police.
-The other day there were two burn victims in the ER at the same time. One had been burned by fire at work, and the other had been electrocuted. Obviously both were in a lot of pain, but I think the electric burn was probably worse because it’s on the inside.
-One day I came in and all the doctors were in one room crowded around a patient that was unconscious. They were using a hand-held breathing device to breathe for him. We have ventilators, but only in the ICU and both of the beds were already full. So I took over for one of the doctors and started breathing for this guy, who had an aneurysm. As I was standing there, just me and him, it occurred to me that I was the only reason this guy was still alive, and that scared me. But, I did my job and he was put on a ventilator shortly after that.
These are just a few of the cases that I thought you would find interesting. I’m sure that in the coming weeks I will have a lot more to tell you!
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