Week 1: Hospitals

So, this past 2 weeks have been CRAZY!  I haven't had hardly any time to blog/email because we've been super busy, which makes us so exhausted that all we do is sleep in our spare time.  Anyway, a lot has happened and I will try to fill you in on the best stuff.

The first week, I spent 4 days in 3 different hospitals:  Luis Vernaza (med-surg hospital), Sotomayor (maternity/women's health hospital), and Roberto Gilbert ____?___ (pediatric hospital).  The experience was really good, especially to see the differences and similarities between Ecuador and America.  The nurses here pretty much only pass medications, the nurse assistants take care of all the hygiene/comfort needs, and the doctors do assessments and write prescriptions.  The prescriptions that are written can be taken to any pharmacy--there is practically one on every corner--or they family can buy the medications from the hospital.  The nurses here also don't seem to have as much training/knowledge as we are given in the states, nor do they have the ability to exercise much power/authority.  I think the saddest thing though, is that there are upwards of 20 patients per each nurse, which means the nurses don't have any time to show compassion and provide for more than just the basic needs.
There is one experience that I really want to share, it was actually quite frustrating/traumatizing for me.  I was working in the emergency room and there was a patient that they were going to place a feeding tube in.  This patient was intubated due to a stroke, but awake and able to move--except for the restraints that tied his hands to the bed.  The doctors/nurses tried about 15 times to insert this NG (Naso-gastric) tube, unsuccessfully.  About half of the times it went into the lungs and the other half of the time it would just coil in the back of the throat.  Now, an NG tube is actually rather simple to insert,... if done the right way.  These doctors/nurses were doing it WRONG!  The patient needs to be sitting up with their chin to their chest, but this patient was laying down, arching his head back because it hurt so much to have a drinking straw-like tube shoved into your lungs.  Unfortunately, this was the second time that week that this had happened.  The day or two before, one of the students had to yell at the doctors to get them to listen to be able to successfully insert the tube.  During this huge ordeal, I just kept trying to get someone to translate my (rather forceful) directions, but the other student was timid and didn't want to be too overbearing.  Instead she tried making suggestions that went completely unheeded.  I was so angry that the doctors were putting this patient through all this, while this old, grandfather figure was tied to a bed, practically writhing in pain.  The hardest part?  All I could do was hold the patient's hand, try not to cry much, and resist the overwhelming urge to smack the doctors and walk out.  I just couldn't stand it, especially when one or more of the doctors started to get a very condescending, stubborn attitude towards the patient and the task of placing the tube.  Thankfully, they finally gave up and were actually able to remove the breathing tube, which made it so he can eat and drink on his own, without an NG tube.  After he was extubated, I just stood their by his bed, holding his hand, whispering words of encouragement, trying understand his mumbling, and wishing that I could remove his restraints.  After about 5 minutes of holding his cold hand and watching him squirm under the thin blanket to try to warm up, I didn't care what the doctors thought.  I untied his wrists and put his hands under the covers.  He wouldn't let go of my hand as I continued to stand at his side, trying to warm him up.  Unfortunately, I had to leave just 10 minutes later and had to re-tie his restraints.  Out of compassion and sympathy, I left the restraints loose enough that he could bring his arms to his sides and under the blanket, but tight enough that he couldn't pull out his IV (which was why they restrained him, even though he didn't look like he even had the strength to clasp his hands together).

Anyway, other than that one traumatic incident in the ER, the hospitals have really been great.  The treatments they provide are very similar to those in the States, but the care is just done a little differently.  It's kind of like they are in the pioneer era, policies-wise, with the delegation of power, the large, multi-patient rooms, etc.  Oh, and at the maternity hospital, I got to see my first (and second) cesarean section delivery.  It was really kind of neat to watch.

On Friday of the first week, I had the opportunity to go out into the community and help to build a house.  It was a really cool experience!  The family was so kind, and really grateful for our help.  Thankfully, there was a professional builder there to make sure everything was done right, because there is a lot that can go wrong when it comes to building a raised house, on a hill.  :-)  The house went up really fast, it took us just 5 hours--from post-hole digging to nailing on the roof.  It was so awesome to be part of such an important/special time in the people's lives.  Anyway, that's pretty much all that happened this first week.