5:00 am wakeup call, “que bueno”.

A very early flight brings us to Guayaquil for the next leg of our journey. 

As soon as we negotiate our hotel rooms, we drop our bags and head to the National Institute of Health.  We meet with the head of the Infectious Disease section.  The meeting was brief because they were getting ready for a seminar.  Luckily, they allowed us to attend, and we got an interesting insight.  One of the doctors gave a very emotional talk about Tuberculosis.  She was in tears during multiple sections, and seemed to take her job very seriously.

The INH laboratory where we spent alot of time and learned a great deal.

It is quite disturbing that a disease like TB can still be affecting large populations in developing countries considering how much we know about it.  This is a disease that should have been wiped out a long time ago, but it still has a huge presence in the developing world.  Among other things, we learned that the US has recently taken an interest in TB specifically in Ecuador.  This decision came shortly after learning that most of the cases of TB being imported into the States come from Ecuador.   After the seminar, we gave ourselves a self-tour of the INH and the Infectious Disease Hospital across the street.  We also secured a meeting with another doctor who works at a private hospital with infectious diseases.  This doctor also had a private practice.  In fact, this seems to be the norm.  The public hospitals don’t pay the doctors very much, so the incentive to work long hours is not there.  Doctors who are capable, setup private practices in order to make more money.  In fact, Ecuador has one of the highest doctor-to-patient ratios in the world.  However, this is a huge problem, because competition between doctors is fierce, and the public hospitals suffer.

A patient getting blood drawn.

The discrepancy between private and public hospitals is so stark that you might think you are teleporting back and forth from the States.  The private hospitals have welcoming, clean glass doors that open into pristine waiting rooms.  The floors are polished tiles, with flowers and artwork on the wall.  The lighting is bright and the air conditioning is blasting.  In contrast, the public hospitals have a line of people waiting in the heat to get in.  There are no clean glass doors to welcome you inside, rather there are either no doors at all or rotating bars to keep people from entering too quickly.  The floors and walls are concrete with peeling paint.  The lighting is poor.  At the Infectious Disease Hospital, none of the patient rooms we saw had doors at all.  Each one was simply filled with cots.   Another point worth noting is that the personnel at the public institutions seem be majority female.  We’ve learned that most of the male doctors are able to have private practices, so they leave the public sector behind.  

The entrance to a private hospital.

And the entrance to a public hospital.

On a group trip like this, there are always defining moments.  One such moment occurred this morning.  Nick and I found ourselves on our own, without any supervision.  Of all places, a Dunkin Donuts sucked us in with the hopes of getting some real coffee.  (Even though Colombia is right next door, Ecuadorians seem to have no appreciation for the fine art of café.  The coffee here consists of a large portion of hot milk sweetened with way too much sugar, and a small shot of a dark syrup that resembles motor oil.)  Nick and I manage to order two cups of drip coffee with just the right amount of milk.  With our confidence high, we decided to get some donut holes.  The girl behind the counter spewed out a list of at least 6 different types of donut holes.  It was clear that neither of us had any idea what the different kinds were.  I look over at Nick, and with a Zen-like projection of confidence, he states, “El mixto, por favor.”  I couldn’t stop laughing, and “el mixto” has become sort of our mantra.  When in doubt, go for el mixto.  

-Tanner

Nick’s daily anecdote:

Night in a crappy hotel in Guayaquil: $40

10 minute phone call to the US: $1

Watching a local rip a payphone from the wall for spare change at 8pm on the way to dinner: Priceless 

The hotel we stayed in defines hot water as water that is slightly less cold than cold water. We had a taxi cab ride from hell on the way back to the hotel after meeting with the doctor.  Multiple pedestrians were nearly killed.  Here in Guayaquil, the right of way is given to whomever has the loudest horn, or whoever has their bumper in front.  If a two lane road constricts down to one, whichever car can get their nose in front can pass first.  This usually results in a race of sorts, whereby the ‘losing’ car ends up slamming on the brakes to avoid a collision.  The beauty of this particular taxi ride was that the driver was shifting gears and working the horn with one hand, while steering and texting on his cell phone with the other.  Definitely a multi-tasker.

-Tanner