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We received an amazing tour of the INH.
 The virology department at the INH (National Institute of Health)
We showed up at 8 as promised at the national institute of health (INH). Their normal working hours are 8am-2pm, and especially today being the last day before a long weekend, this was likely to be a day during which people would be more inclined to talk to us. We expected to meet with the head of the infectious disease department (AA), but the director of virology was introduced to us first. He sits in a long narrow office with dirty tan walls and flourescent lighting. Both his desks had neat piles of folders that seemed to collect dust, and the rest was an odd array of office furniture- the older ones of cheap aluminum and the newer of chipped particle boards. He welcomed us and proceeded to answer our questions. After the interview he showed us through the two floors of lab space belonging to the virology department at the INH. The floor in which he and the director sat had offices in front and lab space in back. They had a PCR machine, an ELISA, one or two autoclaves, lab benches, and refrigerators at -68 degrees centigrade. Walking through the narrow crowded hallway, Nick couldn't help but tip over items. I was thinking that they must not move around these hallways very much. However, once they were also doing some kind of construction both on this floor and the one below, so perhaps the hallway furniture was just temporary. The downstairs space was under renovation and seemed like it would be more functional once it is ready. There was more equipment down there, as well. At some point in the tour he wanted to show us the clinic space, where samples are taken. His objective was to demonstrate the cataloging system they have, and how they associate patient information with the diagnostic test results.
 The infectious disease hospital across the street from the INH that we got to tour.
We walked down to the infectious disease clinic. On the way, we happened to pass by the window in which people collect their results. This window was the westward facing side of a trailer. A woman was standing in the morning sun crying as she received her results. We rushed by and entered the clinic space. Rows of people on blue plastic chairs were seated waiting for their numbers to be called. They eyes our troup as we marched past to the inner room, where fewer rows of orange chairs had anxious people on them. We walked to the back of the room into a small office. Once he opened the door we saw the back of a woman doing data entry. He explained that here the patient information is logged and a bar code is produced to associate their test results with their personal information. I guess they have some HIPPA analog here, otherwise he may not have placed so much emphasis on this aspect of the data collection. We turned about to face the blood-drawing stations.  A patient with tuberculosis. A woman was having an HIV test drawn. He took her bar-code slip to show us. These slips later end up in a leger somewhere upstairs, cataloging all the infectious disease information. A step that seemed to be missing was the computer data entry of the test results. This probably takes place in that trailer we saw earlier, if at all. He asked if we wanted to see patients and took us across the street into the hospital for infectious diseases. This is a public hospital and is the place to which people with infectious disease from the entire county are referred. He marched us through the entire hospital, the inner courtyard, the makeshift sanctuary, looking for a dengue patient; but this being the dry season, they had none in-house. Perhaps also due to the season, I would estimate only 10 percent of the hospital beds were occupied. This seemed rather strange for a public hospital, even if it is the secondary station for infectious disease patients.
 Houses near the public hospital that has the biggest ER in the country.
After our tour, the head of virology introduced us to two additional people working under him. Unfortunately, he stayed around for the interview, making these interviews much less informative than we would have liked. He insisted on answering the questions for them. The first was C, a lab tech. The second was M, whose function was quality control. After both of these we were told that the director of the INH would see us. We rushed to his noisy office, which had other people in it. Unlike the barren offices we had visited at the INH thus far, this office had a nice desk, leather couch, several nice chairs. Some souvenirs were lined up on the desk- a hula statuette, some other shwag. It didn't seem like any of the pharmaceutical shwag was displayed anywhere in this institute.
 Walking through a market.
However, right before we were let in the office, he was negotiating a legal contract with representatives of a pharmaceutical company. The interview with him was cut short. He had to run to the American Embassy for an appointment. It was not clear whether it was personal or business related. In the symposium the previous day, the speaker mentioned that the US has taken interest in TB in Ecuador. She claimed that the largest percentage of immigrants with TB showing up in the US are from Ecuador. We were skeptical about this. Finally we got to see AAA, the director of the infectious disease division. A busy office with two phones (of which apparently only one is functional). Outside was a man extracting electrical lines from the dry wall; banging, dust and drilling does not seem to phase anyone around here. The interview proceeded. AAA is a serious woman.
 The very friendly INH crew.
She warmed up to us only at the end of the interview, as one of her administrative assistants presented us with crackers. Mary, another admin at the INH, came in towards the end asking to take out us in the evening. We worked throughout the afternoon, reviewing two of the interviews we had done in the days before. At 6 we headed out to meet with WC, a doctor who had worked with the INH before, but is currently in a private practice at a private hospital south of town. He also works with PAHO. He opened by explaining just how fractioned the health system is in Ecuador, providing us with additional insight about the private vs. public health system. He was a bit impatient, and may have rushed the end of the interview. At 7pm on the eve of a national holiday, he still had three pharma representatives competing for an audience with him. His office was filled with pharma shwag, as did the other private doctors' desks we visited so far. In fact, so far in our visits to private doctors, we had seem more pharma reps than patients. After our meeting our friend from the INH called because she was anxious to take us out on the town. What we ddin’t anticipate was she brought her daughter out with us. It is yet unclear, but it looks like she was hoping to have her daughter meet one of the American Berkley graduate students and find a nicer life in the US. For some reason she didn’t see the rings and notice that Tanner and Nick were married. The highlight was Nick teaching the daughter to throw a “Westside” gang sign.
 Nick being Nick.
-Anat
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