85. OP #9: Riobamba II

Summary: Final post for this trip.

10 surgerical cases, short of the 12 from Guayaquil two years ago, but still impressive for 5 days.

82 outpatients, with the primary goal being to screen for surgery, so that means that for about every 8 patients I was able to schedule one surgery.  The secondary goal was to provide non-surgical outpatient care.  Except for most of the 13 "bladder" patients who expected to have surgery, I think they felt the visits were worthwhile. Anyway, here are the data, with a comparison from 82 random referral patients from my home practice:

category             Home Total    Home %     Riobamba Total     Riobamba %

abn bleeding       26                  32               4                             5
reproductive       14                  17               6                             7
abnormal Pap     11                  14               2                             2
abd pain/mass     12                  15             31                           38
prolapse               6                    7                5                             5
vag/vulvar             9                  11               8                           10
breast                   2                    1               2                             2
menopause           1                    1                3                            4
bladder                 1                    1              13                           16
worried well          0                    0               8                            10

Comments:
1.  Abnormal bleeding: in the U.S., thresholds may be lower; i.e., the level of bleeding that becomes an issue for Americans may be acceptive by Ecuadorans as, "that's life."  Or, there may be more pathology among Americans: external hormones, obesity, stress can all contribute to abnormal bleeding.
2.  Ecuadorans seemed sophisticated regarding reproductive/contraceptive issues and didn't feel they needed a consult.  Also, the average age was higher in Riobamba, so reproductive/contraceptive issues would be less common (maybe if we had advertised on Twitter or Facebooks instead of on the radio....)
3.  Finally, the radio announcement apparently mentioned that incontinence surgery would be available, unfortunately, that is not something I do, so I had to turn many away, some having travelled 5 hours to come to Riobamba.  Lo siento. Maybe that's a procedure I should adopt, though current methods require expensive supplies.

All told, a good trip, though I may not return, preferring joint local-community projects over the independent, self-contained work accomplished by Amigos de Salud.