Last Week in Puembo

Note: In case you haven't picked it up already, my ICRP/ internship is at a rural clinic in a sort-of-suburb (the type of suburb with cows in the road) of Quito. I go there on Thursday mornings and help out the nurse (who I refer to as Lcda (Licenciada) ) there. We write reflections for our programs, so this is written pretty formally. Expect one each week and more in January.

. Last week at the clinic, I did a lot of different thing. I got better at weighing and measuring, taking blood pressure, and filling out forms. I learned a great deal about the vaccination process, the schema of vaccines and how they are administered.

Discription: The most important moment, the one I’m choosing to write about came in the from of a 2 year old Quechua boy with a broncheal infection. His mother came in in typical dress with a baby tied in a scarf to her back. Her son was 25 mounths old and had a bad infection in his lungs. His mother had been told to go to the pharmacy and buy an inhaler mask, and was given three ampuoules of serum for the inhaler. The SubCentro de Salud has a portable nebulizar on hand, and they give you the medicine, but you have to buy your own mask and bring it and the medicine to the clinic. So it was this little guy’s first day of three with the nebulizar, and the whole family was at a loss of how to do it. Lcda broke open the glass vial and poured the liquid into the nebulizar chamber. It smelled very strongly of rotting eggs, sulfur, old foods. We tried to bend the nebulizar mask so that it would fit his small face, but it was really ment for an adult. The mask went over his face like they show you on airplanes, and he was having none of it. He started writhing and screaming, but he couldn;t really cry because he was weezing so bad.

His mother became pretty upset, having to watch her kid suffer. Also, he was thrashing around so that the baby on her back was pressed up against the back of her chair, so they handed the baby to me. I held him for the ten minutes the treatment lasted. He never stopped fighting. He traed to grab at the mask, thrash his head around, push the mask off, constalty yelling and crying. Also, the mask smelled like methane and made the whole room stink. When ten minutes were up, alter multiple yanks and mask removals, I handed him crying back to his mother who hurried out of the clinic as fast as she could.

Interpretation: How to interpret this? It was pretty clear that the mother handed her son to me because she didn;t want to be seen as the “bad guy,” she didn’t want her son to fear or dislike her because she was the one holding the dreaded mask to his face. Better to have a nameless volunteer doing the dirty work.

The buying/free things dyamic is also interesting. The clinic gives you medicine and treatment free, but you have to go to the pharmacy, about a kilometer away, to get your mask, a critical part of the curative process. This means three trips in total- first to the SCS, then to the pharmacy, then back to the SCS. And you have to return three consecutive days for the full treatment. Its probably the only way, but still I wonder if its the most efficient.

Evaluation: First of all, I don’t think that it is efficient, now that I’m free to say it in my Evaluation section. Why doesn;t the clinic sell masks on site and keep them there along with the medicine ampules for the patients? If the patients knew that the medicine was there, along with the mask which cost money, they would probably have more motivation to return and less motivation to, say, have the baby drink the medicine instead of inhale it. It would mean no trip to the pharamacy, which is a journey with no car, a sick kid, and a baby on your back. Actually, I don’t really understand the scheme of the medicine distribution. You can get some medicine free, but others you have to take your perscription to the pharmacy. I understand that some medicines are subsidezed by the government, but why not sell the other medicines in the clinic, deliver better adminstration instructions and generate revinue?