Experiences in Ecuador
Never one to do something the normal way, when my nurse practitioner residency started, I opted to expand my horizons and venture to the southern hemisphere in Quito, Ecuador. Doing my residency in the Ecuadorian health care system was one of the most profound and life changing experiences I ever had.
The first week was rough. My luggage did not arrive for 4 days, it was cold and wet, I was battling the high altitude at 10,000 feet, and to make matters even worse, I had a gnawing, stabbing pain in my ribs that made it difficult to sleep, breath, and move. Within my first week of being in Ecuador, I found myself experiencing the health care system first hand. I had to go to a local hospital and get chest x-rays, purchase an unknown medication that I was given a prescription for from a local doctor whom I hardly knew, and place my trust in the hands of a health care system that I did not yet trust. In fact, trusting in the health care system was a challenge in and of itself. Although I have spent some time volunteering as a nurse internationally before, I found myself completely unprepared to deal with what I would soon experience both personally and as a nurse practitioner.
My perspective of global health completely changed in "Sala de Partos," the labor and delivery unit at a public hospital in Ecuador. "Sala de Partos" was a basic operating room that had several stretchers lying side by side. Women were admitted here for various reasons: they were in active labor, they had problems with their pregnancy, they miscarried, or they had a fetal demise. They had no privacy and the environment certainly did not give them a sense of dignity. They were young, scared, and alone in this process. Taped on the wall, as if it were an afterthought, but definitely not a practice honored at this facility, was a journal article citing that there were less birthing complications in women who had the support of their family during the labor process and furthermore, that it was the right of a woman to have the support of her family during this time.
Each woman was assigned a stretcher, where she would lay on her back with only the package of maxi pads she had brought with her to serve as a pillow. If she were lucky, she had a sheet to cover her. There were no pain meds, no epidurals, and their IV poles served as the one thing they could grasp onto when the intensity of labor struck them. They would arch their backs and cry out saying "No puedo! No puedo!" ("I cannot! I cannot!") This was a task that they would have to complete alone.
It was in this place that I met Ana. Ana was a 29 year old G1 P0 who had ruptured her membranes almost 24 hours prior and was now facing the sting of intense contractions as her baby desperately tried to enter this world. She grabbed hold of the IV pole and her face turned beet red as she cried out in pain. She lay on her back, sitting in a pool of blood, urine, and feces, her thin blue gown had been pulled up revealing her perineum to the group of first year students who stood around talking about her case as if she wasn't there. I, too, was among that group. This was rounds after all. I had to analyze the case and try to answer the questions right. Yet, something in me hesitated.
I walked up to her; she looked at me, sweat was dripping down her face and her eyes were full of fear as if to tell me she could not go on anymore. I grabbed hold of her hand. It was as if in that instant it didn't matter that I was a white woman from a strange country who has never experienced child birth; I was a presence to her, a comfort in a time when comfort simply did not exist. For a moment, I had set aside my note taking and question asking role and became her source of support. She held onto my hand tightly and I coached her through labor all the way until the delivery of her son. She had never let go of my hand and she turned to me with a smile on her face and simply said, "Gracias" with tears streaming down her cheeks.
Ana's lesson to me was that often it is the simple things that make the difference in the lives of our patients. Sometimes, we get caught up in all the data and facts and forget that we are dealing with a human being who isn't as concerned about data as much as whether they are going to live to see the next day. They are not as interested in our medical rounds as they are in keeping their dignity and being respected. We are here there for them; they are not here for us. Sometimes all they are asking for is a hand to hold and a comforting presence.
Ecuador was a place that many times, challenged my educational foundation and personal values. There were a times that things were said and done that I didn't understand. It was so easy for judgment to creep up into my heart. It became very evident that I was dealing with a system that faced severe challenges: lack of resources, widespread poverty, infectious diseases, and poor sanitary conditions. Perhaps some of things I saw could have been handled differently, or perhaps everyone was just doing the best they could given the circumstances.
Studying in Ecuador was more than just learning clinical practice, it was about learning the culture and expectations of this population and the relationship they have with their doctors. It was about learning that our ways are not the only ways; they are just different ways, like how to care for people when you don't have the luxury of diagnostic testing and monitoring. It was sometimes about setting aside my opinions and being open to learning and understanding their ways. My time in Ecuador was an experience that I will recall for years and that will forever influence the way I practice health care.Last edit by Joe V on Jan 8, '15
QuitoGal has '14' year(s) of experience and specializes in 'OB-GYN, Med-Surg, Rehab'. From 'Ecuador'; Joined Feb '09; Posts: 10; Likes: 16.
Must Read Topics0Feb 19, '09 by QuitoGalCFHI is a particularly costly program. I did it during grad school so applied a school loan towards it; however, there are lots of other international nursing opportunities available. I read on a thread somewhere that under the specialty tab on this website, select nursing specialities, you can scroll down and there is a section devoted to volunteer nursing opportunities. Perhaps you can find something more reasonable. There are also short term trips available with different programs that enable you to go for 1 -2 weeks which cuts the price down significantly.0Mar 1, '09 by califalconLatin America hasl always been a third-world environment when it comes to medical care, not medicine. It is the cultural attitude that allows the apparent lack of caring or lack of cleanliness. But also is the lack of rural health care, education and resources.
As an international educator in an area that in the US is considered the Elite....flight medicine, I have seen many changes in the last 15 years of traveling to Central and South America. Health care is improving mainly because people do have alternatives or perhaps, can afford to pay for hose basic needs like a stretcher with sheets, a bedside commode and curtains for privacy.
I am sure a few hospitals in he US are also struggling to provide those simple items. But I will share a recent experience observed during a trip to Argentina to certify flight physicians.
As I am being shown the beautiful sites of La Plata, the capital of the Province of Buenos Aires, we pass by he "General Hospital"; there is a line of people waiting outside, many sitting on he 10 steps leading up to he reception area. Food vendors all around and people holding bags with food and linen.......still waiting to be seen.
Here is a country with advanced medicine, with surgeons who staff the UCLA and Stanford medical centers, yet still can not manage their local needs.
If I were to be given the challenge to change something there, it would be to re-educate both care givers and patients...and show them how local free or sponsored clinics, would alleviate the problem of immediate health care.
Those agencies offering such exposure to Lain American health care, do so not to improve the care, but to profit from he many souls who believe in giving while learning.
I would love to hear comments and suggestions. You may visit our website as posted on our profile.
Last edit by califalcon on Mar 1, '090Mar 1, '09 by QuitoGalWhen I went to Ecuador, I actually met my husband there and have been living in this country now for 2 years. I have gotten involved in the health care system here. I find it is very diverse. You have clinics and hospitals that are public run and are struggling with resources and funding and then we have others that are top notch, follow EBM, and I feel comfortable getting my medical care there.
Unfortunately, the role of a nurse here is likened unto "maids work" and pays full time at about $400 a month!! The role of a nurse practitioner does not exist. I volunteer at one of the clinics with a doctor who understands what a NP is and does and allows to function in that role. I volunteer with a local foundation running a public health program for the poor, and do a variety of other work, currently exploring teaching at one of the univ here in their school of nursing where the dean, who is US trained, has a goal to raise the bar of nursing and care provided in this country. Change will only come slowly.
There is a severe shortage of nurses in this country as almost everyone interested in health care goes into medicine. They have hundreds of medical students, so many in fact, that many are unemployed! On the other hand, nurses are undertrained, come from low socioeconomic status, aren't paid well, have little voice, and are not allowed to function in so many of the ways that nurses function in the U.S.
Every medical and nursing student in Ecuador must complete a rural rotation. They are assigned by the ministry of health to a rural location anywhere in Ecuador to serve for one year. This is the only way they can staff their rural clinics as the bulk of doctors are located in the urban cities and very few in the rural areas. Unfortunately, that means the ones going out to the rural areas are green. If nurses could raise their standard here and be trained, they could help fill the gaps in the rural areas, but this requires a major shift in thinking!
It seems that somethings are coming together so that in the future we may see nurses have a better status in the country - I hope anyway!0Mar 1, '09 by califalconIndeed!!! I am quite aware of such nurse./doctor imbalance. I believe that changes occur when examples are set.......such as our aeromedical certification program. But we are in the midst of creating an academy in Florida that will fundamentally serve the EMS and prehospital care needs of our Latinamerican counterparts bu we can also take those programs abroad and offer the incentive of a US certificate which could open some doors to change.
I applaud your stamina and dedication to a profession that is so mistaken for maids or worse, Doctor's maids. New doctors should play nurse...and see what it really means.
Let me know how we can help. I do know some major players in Ecuador........perhaps it's time to make such attitude change0Feb 7, '10 by jreeveshHi there,
I enjoyed reading your post so much and was glad to know that there are opportunities in Quito for extranjeros
I am a nursing student moving to Quito in June after I take the boards. I would love to find nursing work there and am nervous about how to go about it, but reading your post was a little reassuring. Would you have any advice for me? My spanish is decent, and I think if I brush up on medical terminology that would be helpful. My clinical experience has been heavy in cardiology, but I have also done rotations on a neurology floor, pediatric medical surgical unit, labor and delivery, and a psychiatric rotation.
I am so excited about moving to Quito and would love to hear more about your experiences!