Centro de Salud Part 2

Hello to all those tuning in to read up on our adventures in Cuenca, Ecuador! My name is Margaret Meyer and I'm a junior pre-med biology student minoring in Spanish. This is the second blog post about the first week of shadowing in the Centro de Salud Número 4 (Health Center #4). Look for the previous post about our time in this clinic written by Joy!

When we first arrived at the free clinic on Monday, January 5th, the entire outdoor waiting area, along with the indoor waiting area, was overflowing with people. In Ecuador, both January 1st and 2nd are observed national holidays and this year they fell on Thursday and Friday of the previous week which meant that the clinic had been closed for the previous 4 days. The director of the clinic told us that she had her entire staff in the clinic that day because they knew it would be a very busy day. When I asked her how long patients normally wait to be seen at the clinic she said on a normal (busy) day it is normal for a patient to wait up to 5-6 hours just to be seen by a doctor! This baffled me because I know that as an American who has grown up trying to fit a million and one things into my daily schedule I cannot even fathom having to sit and wait 5 hours just to see a doctor. But, if there's one thing I've learned here in Ecuador in the last 2 weeks it's that not everyone, or everywhere, moves nearly as fast as Americans do.

The clinic has several departments: family medicine, pediatrics, gynecology, psychology, early childhood development, disabilities and emergency.. I'm sure I'm forgetting some and for this I'm sorry! The patients must check in with administration so that their paper files may be given to the doctor (I only saw one doctor who used any type of computer system for records). They must then proceed to the nursing station to be weighed, have their blood pressure checked, etc before they can be seen. The patients then move to the respective waiting room for whichever area they are trying to get to. Patients may wait here for hours depending on the day. The patients are responsible for bringing their personal "health booklet" to their appointments. (I am calling it a "health booklet" because I'm sure there's a more official name that I don't know but it is basically a small laminated book of medical records that the patient presents to the doctor, the doctor fills out, and then returns to the patient.) I like to think of myself as a pretty well organized person but I have some doubts about whether or not I'd be able to keep track of my booklet, as well as the booklets of any children I might have! The free health clinic system here fascinates me because it relies so heavily on the patients.

The two areas of the clinic that I'm writing about are vaccinations and emergency.

From what we were able to see, the vaccination area serves mostly to administer vaccinations to infants and children (up to age 5 after which they receive their vaccinations at school) as well as flu shots to the general population. There were a few things that struck me as different than anything I've experienced in the U.S. First, the nurse called the next patient into the room even before the previous patient had finished. As a country, I think the value the U.S. places on privacy and space discourages this from taking place. Another thing that I observed was that the windows were open and the vaccinations were kept in coolers similar to those one would use to take lunch to the beach. Every science lab class I have taken at Luther has drilled the importance of sterile technique into my head so seeing the windows open and the vaccinations in a potentially hazardous environment made me question the sterility and safety of some of these vaccinations a little bit.  I am interested to see how things will function at the private hospital we visit next week to see if this in an "Ecuadorian thing" or a "free clinic thing." All in all, the atmosphere and pace of the vaccination room was very different from anything I've experienced in the U.S. as a patient or as a shadowing premed student.

The next area we visited was the emergency room. I have to admit, when I learned our shadowing time was 8-10 am I thought "We're probably not going to see very much in the ER because that's so early!" Wow was I wrong! I was in the ER on Wednesday morning and I probably saw more action in those 2 hours than I've seen in the 30+ hours I've spent shadowing in the ER in my hometown. Things worked almost the same in this ER as in the one I've been in too many times, both as a patient (sorry Mom and Dad), and as a shadowing student. Patients wait to be seen, outside in the waiting area, and are called into a smaller waiting room to be seen by the nurse before entering the doctors "office." Depending on the severity of the problem patients are then moved to 1 of 2 rooms with beds and medical equipment or are written a prescription and sent on their way. There is also another area of the ER that has 3 birthing rooms, the ER's most frequently used area. For the most part the ER at this clinic was almost exactly like the American ERs I'm familiar with, besides the fact that most births (among women who use this clinic) occur here instead of at a birthing center or a hospital.

I have attached a few photos of my favorite area- the ER! I hope you enjoyed reading about our shadowing in the Centro de Salud Número 4, as well as the rest of our trip. Stay tuned for more posts about all of our adventures, inside and outside of the classroom!

One of the "habitaciones" in the ER.
Jenna and Austin approaching the nurse's station to get their doctor assignment in the ER.
Our group (minus a few students) on the last day of our rotations at the Centro de Salud.