Week 2 Clinics - Maternidad and Jambi Huasi

"Maternidad"

Maternidad Isidro Ayora, Quito

Ecuador has public healthcare for those who can't afford it, and Maternidad is the largest public OB/GYN Hospital in Quito.  Also, all elective abortions are illegal in Ecuador, and the unintended and teenage pregnancy rates are high.  I was told that this hospital is largely funded by the medical schools in Quito, who send their students there for training.  I assume this to be true, because of the number of students that cram into the Salas de Partos (Delivery Rooms).  

Initially the biggest difference between this hospital and those in the US was that there were so many patients in one room, all of them laboring together.  One morning I counted 13 patients packed into the main room!  The patients would stay in this room until just before they were ready to deliver, and then be hurried to a delivery room that was basically an operating room.  These rooms were sterile, contained no comforts and the patients were not able to have any family present during labor or delivery.  Often, there would be 8 or more students lining the walls of the room trying to see what was happening as the residents delivered the baby.  

Most patients are not on continuous monitors, but they are available when needed and used intermittently.  Residents and students often stood at the patient's bedside with one hand on the patients abdoment to feel the contractions, and the other setting the timer on their cellphone to measure the frequency of contractions.  The most interesting intsrument that I was able to try was a coroneta de Pinard (Pinard stethescope).  This is used to listen to the fetal heart beat.  Hand-held dopplers were also available, but not very commonly used.  

Pinard Stethescope
http://www.mumstuff.co.uk/acatalog/pinard.jpg

Another large difference was that at this hospital, epidurals are virtually non-existent because they do not have the anesthesiologists available to give them, even when a patient could really benefit from it.  Following the delivery, they would just get some local lidocaine if they needed a few stitches.  Other commonly used drugs were oxytocin (given IV only for significantly prolonged labor and given as a IM injection to all women immediately following birth), misoprostil, and magnesium sulfate.  Amazingly, the women on IV magnesium sulfate were not on cardiac monitors!  I was assured that they checked reflexes regularly, and since loss of reflexes occurs at lower concentrations than arrhythmias, this was safe.  

I spoke with several students, and they informed me that at the private hospitals, each patient has their own room for labor and delivery, and that the family is usually present, which is similar to the US.  

Jambi Huasi

On Friday, October 14, we had the privilege of going to the indigenous clinic in Otavalo called Jambi Huasi.  Otavalo is a town about two hours north of Quito that is home to many indigenous people, and a famous market where the sell their goods (check out my next post!).  The desire to preserve traditions in this community and the need for adequate health care for the town lead to the opening of this clinic, which combines Western medicine with the ancient traditions.  We watched as one of the traditional doctors treated several patients.  It was interesting to watch the techniques used by the doctor, but it was also challenging because she and the patients often spoke in Quichua (indigenous language mixed with some spanish) and it was very difficult to understand.  

Jambi Huasi Clinic

View from inside the clinic's courtyard

The most well known procedure practiced in this clinic, and in only a few remaining places, was a diagnostic procedure that uses a cuy (guinea pig) as a medium.  We had one patient who came to the clinic because he was having back pain, and he wished for the doctora to diagnose the problem.  She rubbed they cuy vigorously all over the patient's back, chest, abdomen, arms and head.  (Apparently, at this point, the guinea pig is either dead from suffocation or comatose from severe cerebral edema.)  Then she skinned it and opened its abdomen to analyze its organs.  After much analysis, she stated that there wasn't anything seriously wrong and she recommended that he get massages for his back pain!  I understand the importance of preserving this type of traditional medicine, but it seemed unfortunate that an animal was killed for what seemed like a very simple problem with a simple solution.  

In addition to the "Cuy X-ray," the clinic offered colonoscopies, EGDs, tuberculosis treatment, family planning, massages, mainstream medicines and many herbal remedies.  We were able to walk into the herbal medicine room and take pictures, but unfortunately the "pharmacist" wasn't to interested in teaching us about his craft. 

Traditional medicinal herbs

Guide to herb identification plastered to the wall

More herbs on the wall, as well as quite a few animal skins

Overall, it was a week full of new experiences.  I learned a lot about the differences between healthcare in private and public hospitals in Quito and hospitals in the US, as well as some of the forms of traditional medicine practiced by indigenous people in Ecuador.