Friday, November 6, 2009

Thursday Part One

Quite early yesterday morning, I met my grandparents and Nieves on the corner outside my house, hopped in the car and headed out north of Quito to Cotacachi. We were fortunate at that early hour to have a splendid view of the snow-capped mountain Cayambe, and then as we neared our destination a panorama of smaller (though here, that is still quite large) green mountains and crooked quebradas. It was a beautiful ride, which culminated in our arrival in the beautiful old town around 8am. We wound around some cobble stone roads, past a school and little shops, and found our way to the little hospital at which we’d made our appointment.

There were already some people there, mostly just waiting around in the grass outside or in the large waiting rooms. In comparison to my experience of clinics/hospitals in Burkina Faso and Bangladesh, where more than an hour before doctors arrived there were usually crowds of people squatting out front, I felt it all to be quite calm and organized. However, I immediately noticed the familiar anti-septic smell of scrubbed concrete hospital floors and heavily bleached tile surfaces that I have come to associate specifically with rural health care facilities and that tends to always put me (and others I believe) in a mild state of anxiety or discomfort.

The doctor Audrey García, a young Columbian in her eighth month of pregnancy, kindly gave us over an hour of her time to explain a little about the health care system in the area, their particular program (especially around obstetrics), and their vision. She also gave us a short tour to check out the new birthing room for “vertical births,” the typical birthing room, and one of the labor rooms (in which we met two of the hospital’s obstetricians.) After the tour, we also had the opportunity to meet the gynecologist who is also the surgeon who performs c-sections.

Above: La Doctora is showing us how the wall bars work in their new birthing room.

What interested us in this clinic, and why we drove a couple hours to come take a look at it, is that it is known for trying to provide a mixture of Western (Oxidental) and Traditional healthcare practices. In terms of labor and delivery, this means that they are working with local midwives (training - especially around danger signs in pregnancy and birth- and encouraging them to refer women with complicated pregnancies to the hospital), providing in-hospital care that takes local practices into account (such as bringing the placenta home), and building a new birthing room next to the super "modern" delivery room that allows for what they are calling "vertical births" or labors and deliveries not confined to a table and stirrups.
Among the many interesting things that Doctora García told us is that the area they are responsible for is quite large (around 19,000 km with a population of 49,092 people) and diverse with a high Indigenous population (around 37%). Though the government is trying to centralize healthcare, in Cotacachi they have been doing such a decent job that the government has let them remain somewhat in charge of themselves. One of the things that they are doing especially well is sending out medical staff into the field, or doing something similar to mobile clinics.
She finished her mini-lecture by explaining that discrimination and prejudice are their biggest obstacles. To be truly successful at providing good care, everyone will have to overcome their prejudices and trust each other (for example, the Indigenous have expressed a fear that their ways will be stolen from them). I'll end with a quote from her that she said as part of this explanation:
"They are not dirty. They don't have water. It is hard to bathe without water. We have hot water. If they have water at all, it is cold. It is complicated and difficult to bathe with cold water."

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