Departing from Quito, we made our way south to the lowlands where we were greeted by the immense expanse of the western coastline. When we were not meandering through the mountains or along the coast, we were holding one-day clinics, whose locations were scattered across the country. Quickly I discovered how simply a traveling medical clinic could be arranged. The 25 crates of supplies that Taiwan Root dragged from Taiwan across two continents, and through customs to Ecuador became our lifeline.
Although the first day we set up clinic was disorganized and rather hectic, the later clinics we held ran seamlessly by the time the last one occurred. The location of our clinic was usually a school and its surrounding courtyard, which allowed us to be accessible to the people and to also have space to organize the various stations. The first station was where patients received a number and a registration sheet of paper, la hoja, which essentially became their ticket to visit the doctor and to receive medicine from the pharmacy. Before patients could see the doctor, they were first screened and measured by the nurse’s station. Large crowds of people became assembly lines where information on weight, temperature, blood pressure, and pulse were extracted and recorded on their papers. We learned that the quickest way to screen through the hundreds of patients was to divide up the tasks so that multiple people handled one patient—one measuring weight and temperature, another recording it, and yet another measuring blood pressure.
Our toughest patients to handle were the little children, many of whom were scared to step onto the scale or to have their ear poked by the temperature wand. The clever solution was to weigh the mother holding the child, then remove the child and weigh the mother alone. Thus, we had the weight of the child. This maneuver meant there were instances when a charming baby was thrust into our arms and just for a moment we sensed the preciousness of life. By merely measuring body temperature we could assess the immense diversity of the Ecuadorian patients. I saw ears with tufts of hair curling out; limp ears of babies that were pressed to the side of their sweaty heads; dirty ears which left ear wax on the wand tip; sagging lobes of the elderly; and cartilaginous pinna of young adults. A few people found it scary to have a foreign object inserted into their ear so they would flinch and cringe until a beep sounded, but most accepted it passively. All the staff loved to play with the children who in their innocence saw our Asian features and promptly deemed us japonés. They liked posing for photos with us and often sought us out for the hairclips that we kept clipped in our hair and on our uniforms just for that purpose. With completed hojas, the patient was sent to wait in line for the physician, who would examine the patient and if necessary, ask for some lab exams. In a makeshift laboratory consisting of worn classroom desks, our sole lab technician carried out a dozen tests at a time ranging from urinalysis to glucose meter to white blood cell count. Although lab conditions were primitive with limited electricity and outdated machines, the tests were sufficient for giving the physicians enough information to make a diagnosis such as to confirm a urinary tract infection or disprove a suspicion of anemia. If patients were prescribed drugs, they took their prescriptions to the pharmacy, the last station in the clinic. The pharmacy was essentially a collection of crates holding large bottles filled with pills of all different colors. The quantity and variety of these drugs limited our capacity to help the sick patients. However, one physician told me that although he could not offer long-term assistance, he insisted on prescribing enough drugs to last three months, which was necessary for the regimen to be effective. I was nervous that our supply of drugs would not last us the whole trip if h continued prescribing them at that rate. However, I understood that it was more important to sacrifice the quantity of patients treated for the quality of the treatment. If we could not offer effective short-term treatment, our work in Ecuador would be useless. Thus, we sent pregnant women and children with parasites home with a decent supply of vitamins to help them regain and maintain their health. The dentists had the most decisive role in the clinic, giving the patients a simple choice of pulling out a rotting tooth or doing nothing and letting the pain continue. If the person was in pain, it meant the cavity was close to impinging on the nerves so it was critical that the tooth be removed. However, it was usually toothache that drove people to visit the clinic so tooth pulling was a more common procedure than filling. The dentist’s station required the least translation effort as most actions could be covered by a few basic words like sacar (to remove), abrir (to open), and dolor (pain). Sometimes the diagnosis consisted of an absurd exchange between the dentist and the patient of pointing, a mispronounced “sacar?” reluctant nodding, some poking around, and then “dolor?” answered with a grimace. Despite the makeshift setup of the dentist’s equipment, basic hygienic practices were maintained. One- liter soda bottles were reused as the receptacle for all the fluid waste—a large suspension of blood and saliva testifying to the dentists’ productivity. The dentists were so adept at their work that a tooth could be pulled out in less than ten minutes. The forceful yanking and jabbing that occurred felt more painful for the wincing onlooker than for the patient who was locally anaesthetized. Many children left with gaps in their mouth, the gums around the hole still tender and fresh with blood.
After the first few days, we began to notice the regional differences in health and disease burden of the Ecuadorian population. When we were in the more tropical or seaside regions of the south and the western coast of the country, we encountered patients whose ailments were more specifically related to their poor diet. There was an excess of adults with high cholesterol and hypertension. One obese patient revealed that her diet consisted of rice that was fried and salty, which likely kept the food from spoiling. She admitted that she had less access to fresh fruits and vegetables. Although the coastal villages are famous for their seafood, the way fish is cooked is simple—it is most commonly deep fried in oil. Aside from giving them drugs like beta blockers to treat hypertension and statins to control high cholesterol, the physician could only use health education to try to make a long-term impact on these patients. The cardiologist in our group patiently advised the more unhealthy people to eat a diet with less salt and oil and to increase intake of fruits and vegetables. I wondered if this advice was completely new to them due to a lack of public health education in Ecuador or rather it was the environment or lifestyle that dictated their deficient health. In contrast, the children in tropical regions were more likely to develop skin fungus and the overall most common complaint was abdominal pain, which was due to parasites. There was not much that could be done to improve the quality of food these children ate or the sanitary conditions of their surroundings so the pediatricians gave them antiparasitic drugs to kill the bugs and vitamins to improve overall health.
The environment also greatly influenced the health of people living in the mountains and colder climates. We set up clinic in the mountains of Tosagua, near the western coast of Ecuador, where homes are located so remotely from one another and from the city that every family had a donkey as means of transport. We must have driven an hour on a dirt path off of the main mountain road to reach the small elementary school where hundreds of locals had gathered to be examined. On that day, we saw more unique cases than we did at all the other locations combined. There were children with congenital birth defects like cataracts, which was likely the result of a viral infection that the mother had during pregnancy. The physicians speculated that one boy with cataracts who was also mute and deaf had a rare syndrome. Another boy had a botched operation in Quito where the cataract was incompletely removed and it left him with a cloudy white patch in the cornea. The lack of access to basic health care in this location meant that normally preventable conditions were neglected and allowed to worsen. Even the dentists noticed the greater number of patients needing teeth pulled compared to people living in more urban areas. There was not much we could do for the unusual cases, except give them a regular health checkup. What is clearly lacking in these rural areas is a regular local clinic that can provide important screenings.
Our last day of clinic was held in an Indian village of Otavalo, which is located high in the Andes Mountains two hours north of Quito. Perhaps due to its isolation, the Otavaleños make up a highly organized and productive society where indigenous social and cultural values are maintained. They are easily identified by their distinct traditional clothing: women wear delicately embroidered blouses with many strands of beaded necklaces while men keep their long hair braided and wear calf-length white trousers, ponchos and sandals. Whereas it was not uncommon to encounter a single mother as young as 16 years old in the urban communities, it was not the case in this Otavaleño village where mothers were typically middle-aged and married. Otavalo is famous for its textiles and many of the men and women who came to our clinic were laborers whose medical maladies were directly related to the nature of their work. Due to the cold climate in the mountains, many suffered from swollen hands and foot pain as well as wind-blistered skin. Working in the mountain sun also adversely affected their eyes, which watered easily and became irritated. The ophthalmologist examined many cases of pterygium, fleshy tissue that grows in a triangular shape over the cornea that can impede vision if large enough. It is caused by long-term exposure to sunlight, especially ultraviolet rays so wearing UV protective sunglasses is important. That day, the ophthalmologist distributed dozens of bottles of eye drops to patients whose eye complaints all stemmed from pterygium. Overall, the Otavalo Indians are significantly healthier than people living in the tropical and seaside areas, due in part to more nutritious food and constant physical activity. Cases of high cholesterol, hypertension or heart disease were rare.
During the five days of clinic, we treated over 2,000 patients with a staff of only four physicians. Some days the length of the line was unbelievable as hundreds of patients waited for hours to be seen for a variety of reasons ranging from request for vitamins to examination of a sick baby to treatment for a laceration. Despite the wait, people behaved orderly and expressed sincere gratification that we had traveled such a far distance to help them. Even if their government was too ineffective to provide medical help, we showed the Ecuadorians that the world still cared about them. It did not matter that they had never met an American and knew nothing about me; I could still touch their heart and leave a lasting impact. One woman who waited hours with her feverish daughter sought my help repeatedly to understand why they were being shuffled from station to station. After the dozen lab tests that had been ordered were finally completed, she turned to me and asked me to write a message to her son who was at school and as a result could not come to the clinic. She wanted to give him a message as memory and proof of the clinic and of me. I was touched by the acquaintance that we had developed over a few hours of time and sometimes I wonder if the mother and her children still remember me. We will never fully understand the true impact of our work in Ecuador, but it has the potential to persuade people to take better care of their bodies and to inspire the children to grow up to help their country. If anything, the efforts of Taiwan Root and Root International Peace Corps have shown me that little things can go a far distance where there is need. A simple clinic set up in the local schoolyard using just the desks and chairs is more than adequate. It is the medical knowledge, compassion, and generosity that the staff and volunteers provide that transform the classroom into a doctor’s office, albeit a primitive one.
Ecuador was an unforgettable experience, in both having the opportunity to work with such dedicated medical professionals and volunteers and learning to appreciate the value of basic medical care. If anything, our medical mission trip to Ecuador gave the local government an incentive to start caring for their people, whether they are urban inhabitants or mountains dwellers or Indians. At one point during a rare house visit, we discovered a newborn baby with a congenital heart defect that needed to be repaired urgently. The single mother was distraught over the news because she could not afford health insurance with her monthly income of $150. We called upon the local government and charities to take up this special case. By the end of the day, they had assured us that the baby would receive all the necessary medical treatment. Although through our daily clinical work could only provide immediate care, we left Ecuador knowing that we had saved at least one precious life.