24: Che

Dr. Jesus Bonifaz Q. was kind enough to provide his office for our use. The office wall contains scriptural quotations (the name of the clinic is “Christian Jerusalem Clinic”), flow charts for diagnosis/ treatment of H1N1 flu, pregnancy stages, and... a poster of Che Guevara.

At the bottom of the poster is an ad for a multinational drug company. Che se da la vuelta na tumba!

P.S, I asked our Ecuadoran translator what people think of Che: “He’s a hero.” A hero to some, Castro's executioner to others.

23: Donde le duele?

Riobamba turned out to be mostly outpatient, a little disappointing, maybe, but okay. Here's a summary from one day:

12 patients, including two men. All 12 spoke only Spanish (I could begin the conversation and understand much of what was said, with an excellent interpreter filling in the gaps).

Abdominal pain: 3
Symptomatic varicosities: 2 (I had brought with me compression stockings for surgical patients, ended up using almost all of them for outpatients)
Enlarged uterus: 1
Bladder prolapse: 1
HPV: 2
Worried well: 2
Persistent yeast infection: 1 (also sees Ecuadoran doctor; I reinforced his recommendations)

The three abdominal pains included:
1. prior abdominal surgery that lasted "15 horas", using an incision from sternum to pubis to remove what I assume was a benign tumor, which has apparently returned and appears to be wrapped around and may slowly osbtructing the bowel; I could only recommend returning in February when MMI returns with a general surgeon.
2. a "7 hora" vaginal surgery that left has left the patient with chronic abdominal pain and some difficult bladder issues.
3. pain associated with an enlarged uterus, heavy bleeding, and stress urinary incontinence which adds up to a sound indication for surgery--pt initially accepted surgery but then returned, and cancelled; it appeared that her husband didn't want her off work for several weeks.