My first day in the Puyo clinic, and things were rather slow. This seems to be a pretty common theme in this tiny city of ~35,000, everyone claims that they prefer Puyo to Quito because it’s “mucho más tranquilo”. And although tranquilo is a kind of a false cognate (it translates more directly to “quiet” than to “tranquil”) I can’t help but feel that the connotations surrounding the word “tranquil” actually do the city better justice. It’s situated a on the edge of the Amazon rainforest in the crotch of the “Y” at the intersection between the lazily meandering Río Puyo and the larger Río Pastaza. Everyone seems to know each other, and the whole city is within walking distance.
And so, on a lazy day, my host doctor and I sat in his office chatting, but when I began to ask him about his life as a doctor he became noticeably agitated. He was eager to talk about his situation, but it didn’t make him very happy. There’s a sort of general unrest about the state of the government right now in Ecuador, but it seems that doctors have been acutely adversely affected. While the government has been commendably spending a ton of money to subsidize/promote quality education (although unfortunately the majority of the money has been going to top students/schools, rather than being more evenly distributed), there has been a burgeoning mistrust for medical professionals. Wages have plummeted as the boundaries for what constitutes medical malpractice have broadened, and this creates quite the uncomfortable environment for the current Ecuadorian doctor.
Dr. Jimenez, general surgeon and chief of medicine at a small but high-end government-run hospital, makes under $22,000 per year. Granted, there is a lower cost of living in Ecuador than in the US, but it is apparent that the salary is not substantial enough. With the growing prevalence of lawsuits, skyrocketing lawyer fees, and the inherent need for doctors to be part of a global community/market, this is clearly not an adequate salary for a doctor, let alone a chief of surgery. To stay on top of his craft, Dr. Jimenez explained to me how he studies for hours each night after he returns home. But even to do this, he’s got to buy the latest medical textbooks, which run upwards of $300.00 each. That’s a quarter of his monthly paycheck gone, just to try to stay up-to-date. It’s just not sustainable.
But the government has been reducing salaries while tightening regulations. Initially you might think that it’s a good thing to tighten the rules to regulate malpractice, but when doctors live in legitimate fear of being thrown in jail for a misdiagnosis or flawed treatment, it’s impossible for them to work at full efficiency.
It’s like you’re shooting a free throw at the end of a basketball game. There’s tons of pressure, and even the best shooters in the world are going to miss once in a great while. But for doctors, rather than maybe losing a basketball game, they get tossed in jail.
“No vale la pena” (It’s just not worth the pain).
Dr. Jimenez sat pondering the state of medical affairs and eventually looked at me and said, “It’s just not worth it, I can’t keep this up for much longer. Once my kids are out of college, I’m going to try something new”. When I asked him what he was thinking, he responded, “I’ve put some thought in… think I’m going to become a taxi driver”.