Health brigades

Over the past two weeks, we have spent four mornings doing mobile clinic work in the mountain villages outside Otavalo and in the markets of south Quito, which is generally poorer than north Quito where we are staying. In groups of two or three students, we interview patients, perform a relevant physical exam (as much as possible without violating their privacy in a large room with no divisions between patients), and conduct screenings for blood pressure, blood sugar, etc. Then, working with a volunteer doctor or nurse, we help develop an assessment and plan for the patient, which sometimes includes prescribing medication; some medications (such as amoxicillin, Bactrim, and ibuprofen) we have available in our traveling pharmacy, while others must be purchased at the pharmacy by the patient. The pictures are of me and my team from various brigades, as well as one of the other students that shows the crowded quarters and tiny chairs! You can saee more photos on my friend Amy´s Flick´r site: http://www.flickr.com/photos/amysparks/sets/ The first three sets are of us in Ecuador.

We have seen some fairly complex health problems at the health brigades: congestive heart failure, kidney infections, intestinal parasites, and a superficial tumor six inches in diameter! However, we have all been generally frustrated by our inability to do much for these types of problems. We can cure an ear infection or give someone reading glasses, but have relatively no ability to ameliorate chronic health concerns, and end up referring patients to doctors they will never see at facilities they are unable to travel to. Even with Ecuador´s recent decision to make health care more accessible – including many free procedures and services – the waiting lines are long, and not all of the service is free. For example, a hip replacement operation is free, but according to one patient the prosthetic hip itself costs $5000, which even well off folks in Quito generally cannot afford.

On the other hand, the health brigades have provided an opportunity for us to work with two organizations committed to improving the health of economically marginalized Ecuadorians. Jambi Huasi in Otavalo (where I received my “cleansing” treatment last week) is a collaboration between MD’s and traditional healers, and focuses on reaching out to indigenous populations who are often more comfortable seeking care from curanderos and shamans than from medical doctors. Two doctors, an administrative assistant, and a translator from Jambi Huasi accompanied us on our health brigades outside Otavalo. In Quito, an organization called CENIT (Centro de la Nina Trabajadora), which began as a school for girls selling goods with their families in the outdoor markets, now provides a range of services for working girls, boys, and their families, including remedial schooling, vocational training, health services, family planning and contraception, outreach to street children, and psychological assessment and counseling. Most of their staff is Ecuadorian, but they also command a small army of rotating international volunteers to aid in administration, planning, and service implementation. The people who work with Jambi Huasi and CENIT are an inspiration to me, as they continue to work toward empowerment and health for those most at risk.

So the health brigades have been a mixed experience, full of frustration, helplessness, insight, and hope. Next week we will conduct three more brigades in the rainforest of the Amazon. I will try to keep reflecting and learning and, as with my time in Kosovo, know that I am taking away many lessons that will influence and inform my work in the future. The sense of overwhelming need seems to be ubiquitous in global health, and part of the challenge is figuring out in which ways I want to contribute to the struggle.

Con amor,
Jess