Ecuador: Week 2
I remember her bright blue eye shadow perfectly matched the shade of the sky that day, contrasted sharply by her warm brown eyes. Her bright orange lipstick curled into a friendly smile as I walked through the door of the consultation room for El Centro de Salud Cochapamba. In less than a minute, I knew shadowing Dra. Sancho in family medicine that week would be an enjoyable experience.
Although over the course of the week I only got to spend about 20 hours in the health center, I saw more diverse medicine than I ever had before. To give you an idea, some of the most notable ailments, diagnoses, and treatments I observed included:
- Ocular pruritis
- Acute pharyngitis
- Abdominal aortic aneurysm
- Muscular pain
- Rashes
- A dog bite
- Chronic gastritis
- Ear irrigation
- Physicals
- Treatment for hypothyroidism
Here's how a typical doctor - patient interaction would go:
The doctor would input the patient's identification number into the computer and bring up their file with their health information, including height, weight, and personal/family health history. She would then typically go through the motions of asking what brought them in that day, and documented on her computer everything the patient was complaining of. A physical exam of the patient would then usually take place, which differed only slightly depending on what each patient was presenting with. For instance, she felt their lymph nodes, checked their throat, listened to their heart rate and lungs, etc.
El Centro de Salud is a single building with two consult rooms, as well as rooms for obstetrics, dentistry, a pharmacy, and a break room for the staff.
Dra. Sancho kept me actively engaged by speaking slowly enough for me to understand her interactions with her patients, and she made sure I was seeing, hearing, and feeling what she was. Knowing I was not yet trained in the medical field, she made every effort to make my week an ethical learning experience. For every patient that complained of a sore throat, Dra. Sancho encouraged me to stand over her shoulder as she examined their throat to see acute pharyngitis for myself. With the patient's permission, she guided my hand so I could feel the pulsating mass of an abdominal aortic aneurysm on the abdomen of an elderly man. Never have I felt closer to medicine; never have I known more what I want to do the rest of my life.
What I loved about family medicine was the diversity. Dra. Sancho's patients ranged in age from 8 months to 84 years; they came to her for help with everything from the common cold to mysterious rashes, dog bites to ear lavage's. Every day was fresh and exciting, and I found myself eager to get to the clinic early and stay until the last possible minute.
Amazing view of Quito
from the door of the health center
I didn't love everything though. For one, there was a LOT of sitting, which really started to take its toll on my body. Since Dra. Sancho has her own consultation room, patients come to her one after the other without her needing to get up. Of course, she got up to examine each patient, but I noticed most of her time was spent sitting across from patients at her desk on her computer. This seems to be the new reality of medicine/consultation with technology. I found this to be the same (to a slightly lesser extent) with my shadowing experience the week prior in the emergency maternity consultation with Dr. Gomez. Before these experiences, the only doctor I had shadowed was a dermatologist named Dr. Glick in the United States, whose running from room to room resulted in a much needed break to catch my breath as he talked with his patients. It was therefore automatic for me to make a mental note of this contrast, and I realized with astonishment that I much preferred being out of breath to sitting in one room all day.
On Tuesday, Dra. Sancho, a nurse and I packed up and drove to Unidad Educativa Liceo Policial, a school in Quito, where we saw about 80 schoolchildren aged four to six. I helped the nurse by directing each child to the scale to be weighed, and helped them stand nice and tall while she took their height. We then sent them over to Dra. Sancho for a quick physical. It was overwhelming to see that many kids, but Dra. Sancho handled the chaos with grace.
One of the patient experiences I found most interesting was the ear lavage. I think the reason it stands out the most to me is not because it looked painful - honestly the dog bitten woman looked to be in more pain - and it wasn't because it was a kinda gross procedure... it was because it was the only time I had seen a patient arrive in pain and leave feeling better. The ear lavage had an immediate result. Physicians usually see improvement in their patients over time, depending on the specialty. For instance, in dermatology, a patient and their dermatologist may spend months or even years clearing acne or controlling eczema - the progress is slow, and therefore it's difficult when shadowing a physician like this to see those results, as shadowing is typically only done over a relatively short period of time. Other physicians may not see improvement at all - in other words, there isn't much follow-up, like when Dra. Sancho had patients with the common cold.
This patient was different though. He came in with some sort of previous inner ear injury of which he was healing from. The healing process had created some debris (dead skin/dried blood) which made it very difficult and uncomfortable for the gentleman to hear. Clearly miserable, he slumped into a chair in Dra. Sancho's office and waited. Briskly, she left the room and came back with a metal basin full of tepid water. A menacingly large metal syringe was in her other hand. I watched, puzzled, as she filled the syringe with the lukewarm water. It only dawned on me what she was about to do as she began lifting the syringe to his afflicted ear, as the man held an empty basin below it. I'll spare you the details, as the syringe was filled many times and more debris came out of his ear than I thought possible (in the end, with the help of a pair of tweezers), but something remarkable happened when she was done. The gentleman's face lit up with the most genuine warmth and relief as he experienced the simple joy of hearing clearly again. And in that moment, I felt something I hadn't gotten to experience before: the contagious joy and relief of a patient feeling better because of their doctor.
