Cochapamba, clinic week 1

This week I started my clinical experience at the Centro de Salud – Cochapamba Sur. This is a public health clinic and all of the services provided at it are free. They have a family doctor, an obstetrician, and a nurse who gives vaccines and draws blood. My preceptor is Dra. Silvia Sancho and she is a general practitioner in family medicine (medicina familiar). She sees mostly babies and kids but also adults. To get to the clinic I take two buses which cost 25 cents per bus.

Here is a picture of me in front of the clinic.

On the first day, I did not know what my role in the clinic would be. Would it be like rotations in the US where I usually see patients, do a history and physical and then present my findings to the preceptor? It soon became apparent that this is not how it would work. First of all, the doctor’s office is also the exam room and the patients come in one after the other, calling the next patient back as they leave the office so I simply stayed in the exam room with the doctor and tried my hardest to understand the patient interactions. Over the course of 3 days I think that I went from a 50% comprehension rate to 70%. I would do basic exams before Dra. Sancho and she would point out interesting findings (umbilical hernia, atrophic vaginitis, heart murmur etc). The majority of the patients were there for toz (cough) and gripe (flu). Most of the patients coming in with these complaints left with analgesics and orders to drink many fluids and chamomile tea.
I was struck by both the similarities and the differences between family medicine in the United States and Ecuador. Many things were identical to the US like height and weight growth charts, developmental milestone questions for babies and kids (does your child know his/her colors? What words does he/she know?). Some differences that I noticed this week are:
2 brothers ages 10 and 11 who came in without a parent or guardian. This was totally fine and the exams proceeded normally. When asked if they work they both responded yes. They sell food for a few hours every weekend to make extra money for the family. It struck me that you would never think to ask a 10 year old if he worked in the United States.
Most of the patients get a lecture about how they need to gain weight as opposed to loose weight (there was one woman who got a loose weight lecture). These lectures commonly include the need to emphasize the rice course (secundo) as opposed to the soup course.
Rarely does a baby or child cry during the exam (In the US I feel like it is rare if a child doesn't cry!). I don’t know why but babies and kids are much more mellow in Ecuador in general. They just hang out and don’t make a big deal about things. You see babies everywhere (On the bus, in the market, at soccer games, at late night parades) and they are never crying.
Every child gets treated for parasites regardless if they have symptoms or not. It is one of the standard procedures for every well child check.

This is the exam room and Dra. Sancho's office

Here is the waiting room that when I arrive in the morning is completely filled with people sitting and standing against all of the walls waiting for vaccines or for blood and urine tests or for the various doctors that work here.

This is Dra. Sancho herself with one of her patients. She is wearing that heavy sweater because it would get really cold in the exam room.