Last Wednesday, our host Doctor had an afternoon meeting and so we left the hospital early. For the first time since our arrival in Chone, we had a free afternoon, and under the blazing early-afternoon sun, we decided to go spend the day in the Platanales river, about an hour away. We got there, tossed the ‘ol pig skin, did some swimming, tried to learn how to fish like the locals (which involved a giant net, some shaking of the reeds lining the river, and apparently a lot of cursing and luck). As we toweled off to head out, a group of pre-teen Ecuadorian boys, just done with school for the day, arrived at the opposite bank of the river. Delighted at our presence and desperate for the attention of us as foreigners, they did anything and everything that came to mind to try to get us to stay. They flexed their skinny arms, pushed each other around, flipped and even tossed each other into the water, but when all else failed, they resorted to shouting the extent of their English vocabulary in a last-ditch effort to get us to stay. They mustered up the incoherent phrase, “Man! Woman! OneTwoThreeNineteen!” and got us laughing at the least, so we stuck around for a few minutes before heading home. The randomness of their vocabulary really tickled me, and I thought it’d fit the theme of this blog entry nicely—an assortment of random anecdotes from my time in the hospitals down here. None of these felt like they merited a full blog post—some are just random observations—but I thought they’d be nice to share
The hospital itself is a rather shoddy-looking old yellow box of a building, but it sits right inoutside of “downtown” Chone, across the road from the top elementary school in the area. From 8 am until about 3 pm, it’s a hub of buzzing activity, but then families go home, the last rounds are finished, and most doctors either lock themselves in their offices to study or sit around the break room to shoot the breeze. This is where we tend to congregate at the end of the day, as it’s the best time/place to get to know doctors.
Speaking in terms of education, capability, and professionalism with patients, Ecuadorian doctors are very comparable to their US peers. But they’re fairly perpetually undersupplied, so there’s a pervasive understanding that you’ve just got to make do with what’s at hand. A friend and I independently, almost simultaneously, came to the realization that the vast majority of doctors in our hospital are women. Nurses are fairly evenly men and women, and every single department-head is a man. I find this telling of a general trend that the scientific (and general) community has been recognizing of late. Simultaneously, three forces seem to be causing a partial redistribution of the stereotypical gender roles within the hospital. First off, the nursing profession is slowly but steadily gaining a perception of gender neutrality. I say perception, because there have been male nurses for decades, but only now is the stigma being forgotten about men working in what was originally a woman’s field. Secondly, for a variety of reasons, more and more young girls are getting steered towards the hard sciences as more and more young boys choose to steer clear. I’ve noticed this trend since high school, and it has only been furthered in college (I was one of two guys in my 25 person Developmental Bio class this past Spring). I find it interesting that this trend holds true here in Ecuador. Finally it appears that, mirroring the vague trend in the medical field in the States, men are holding on to upper-managerial and executive positions while the tide shifts slowly below there feet towards a woman-dominated workforce. I just found it very interesting to encounter everything I had read about the changing landscape of gender in the United States workplace encapsulated in the microcosm of Hospital Napolean Davila.
There are also some cultural oddities that seem to be amplified by the fact that we’re spending 8 hours per day around Doctors with whom, when there are no patients around, the fourth wall is completely obliterated. For example, the first surgeon I shadowed in Ecuador spent the 30 minutes prior to his first surgery schmoozing with the young lady residents. The continuously risqué stream of flattery, flirty slaps, and thinly veiled innuendo seemed completely inappropriate in a sterile pre-operation room, especially considering the age/power difference between the two young lady residents and the middle-aged surgeon. Not to mention everyone was scrubbed up from head to toe—not exactly flattering garb.
I was initially shocked at how obviously he was flirting with the ladies and ignoring the young male residents. But I slowly came to realize that there was a switch, flipped in a patient’s presence, that reverted him to the capable surgeon, as skilled and professional as any I’ve ever shadowed. It still felt odd about that situation until I shadowed my second and third surgeries and realized that this is just kinda the norm here. I’m still not entirely sure this behavior is a cultural difference, or if this is just how doctors act behind closed doors. But I sure found it interesting and unexpected.
Another thing I’ve realized is that the concept of racism (and the constant hyperawareness of political correctness that comes with it) doesn’t exist very strongly here in Ecuador. People just tend to speak their mind and that’s the norm, as blunt as it may seem to outsiders. One of the girls on my program, Xuan Li (pronounced shwahn), was born in China but moved to the US with her family when she was very young. Ecuadorians cannot get enough of her. Without fail, every single day since we’ve arrived she’s either been asked if she is related to Bruce Lee, been greeted by a doctor or nurse pulling the corners of their eyes horizontally, been recommended “this great Chinese food place nearby”, or asked if she’s Chinese or Korean “yanno, because it’s impossible to tell the difference”. Initially, the rest of us were shocked, but Xuan, unfazed, took it all in stride. Later she told us about how this is nothing new to her in her travels. It seems that in many countries outside the US, these interactions wouldn’t be viewed as even slightly racist. Maybe is the US that lies outside the general trend in that we have a much more strict definition of what constitutes racism, and a heightened awareness of political correctness to go along with it. Keeping in mind our own nation’s rather blemished history, our stricter social norms are obviously based on very substantial grounds. But I definitely found it interesting to learn that a lot of the rest of the world operates on slightly a different set of social guidelines.
One other social difference that became shockingly apparent very quickly is that it’s completely acceptable to answer a phone call at any point in time. Whether it be the speaker at a meeting, the doctor or patient during a consultation, or even a professor during class—there does not appear to be a wrong time to answer the phone. One of our doctors even had a handless headset so he could take calls during surgery.
Last Thursday, our host Doctora Diaz brought us upstairs to internal med to show us a recent snakebite victim. As we were leaving the room, a toothless, legless, but nonetheless chipper-looking old man rolled by on his wheelchair, whistling merrily. He was on his way to another room on the ward to check up on an old friend. Our Doctora told us he’s slowly losing body parts to complications of diabetes, but apparently the one thing he refuses to give up to the disease is his sunny disposition. He was a pretty remarkable guy.
As Dra. Diaz told us about this jolly old fellow (who seemed to have a very personable relationship with every living person in the hospital), we came to learn about the dietary issues that have been plaguing Ecuador of late. There is no all-encompassing reason for the sharp decline in dietary health in Ecuador, but Dra. Diaz summed the problems up nicely in saying, “farmers are growing fruit and vegetables, so that they can sell their crops to the United States, so that they earn the money to buy the fast food and soda that has begun to filter down from North America”. It’s a pretty twisted cycle, if you really think about it.
A final quick note is that, unlike in the US, doctors down here often have to deal a variety of different beliefs in odd alternative medicines and antidotes. For example, I noticed a particular bottle on the bedside table (next to the omnipresent 1-liter coke bottle) of an overweight older lady with dangerously high blood pressure. In bold letters on the side, the drink claimed to clean out the drinker’s arteries in veins, thereby lowering blood pressure! What a miracle! When I pointed it out to Dra. Diaz, she shrugged her shoulders with a tired roll of her eyes, and explained that she’d long since given up on that particular battle. The patient remained adamant she felt the benefits of the drink.
All told, our time in the hospital here in Chone has been amazing, and it’s drawing to a close all too soon. On Wednesday night we’ll be leaving the wonderful Dra. Diaz to bus back to Quito for the end of the program. I’ll be departing soon thereafter to continue my adventure in Puyo, but it’ll be sad to say goodbye to all of the new friends who are leaving after this first four-week program. Either way though, I’ll try to keep the blogs coming (sorry for this one’s obnoxious length), and be sure to keep an eye on my flickr account! (No need to sign up for anything, just click the link and (hopefully) enjoy.)