Amazing!

Today was just amazing!
Kenny, Ami, and I were saying things like, "This was so refreshing!" "I saw more in three hours than I did this entire year!" and "This made me understand I'm doing what I want with my life."
Today was our first day of clinic. We shadowed Dr. Cadena in the ER and we were all very impressed with the entire experience - the doctor, the residents, the nurses, the hospital staff, and the health system worked much more pleasantly than we expected. A staff member walked up to us as we were waiting in the information line and asked how she could help us; she then proceeded to walk us to the Emergency Department and all the way to Dr. Cadena's office. Would the staff at a US hospital take the time to provide such service?
We walked into Dr. Cadena's office to find his nurse taking information from a patient at the computer as Dr. Cadena himself sat on the examination table writing on a tablet of some sort. He greeted us with a warm smile, shook our hands, and introduced us to his nurse. He then took us to the locker room where we could change into our scrubs. Dr. Cadena asked us our names and our year in medical school as we walked back to his office, and then the intensity of the day began! There were at least 10 patients waiting outside the Dr.'s door and we met with 5-6 patients along with the Dr.
The patients entered the room with one relative, sat down at a desk with a computer, and gave the doctor a sheet with their name and identification number. The doctor pulled us right into the interaction and asked Ami to read the patients' information to him. Ami was amazing! She jumped in, whipped out her Spanish abilities, and ended up writing the prescriptions and lab tests for all the patients! All of the patients medical information and previous medical visits are pulled up through their identification number (Our host daughter says that Ecuador has a mix of public and private systems for healthcare, so I'm thinking the database and identification number we observed show only the information from visits to public hospitals). A focused history is taken and then the patient is asked to go to the examination table, "Por favor, vaya a la camia." A focused physical exam is done, the prescription is written, and the patient is out the door as the next patient enters.
Dr. Cadena asked Kenny and I to present the patients' cases to him as he was performing the physical exam - this was preeeeeetty hard with our limited Spanish, but still awesome. We saw three cases of costocondral pain due to 1. kidney stones, 2. general gastritis, and 3. epigastritis. We saw a classic case of Bell's Palsy!!!!! We saw a patient on dialysis, a rectal exam, and herpes. Amazing, amazing, amazing. A couple things we noticed were that the Dr. did not change the bed cover for each patient and that the patients were in very severe pain. An 86 year old man who had previously had three hernias was asked to position himself on his hands and knees for a rectal exam - it was painful to watch someone in such pain. A patient who had previously been in a car accident and who was having ear pain and secretions from his ear was asked to walk up and down stairs to get a CT. But...overall, the service was quick and practical.
After seeing a few patients in his office, Dr. Cadena gave us a tour of the hospital (Hospital IESS - the Social Security Institute Hospital). It was newly renovated and very clean (except for the parts that were under construction). It seemed to have every wing that a normal hospital would have, and had a church on the top floor. After seeing a historical church out a hallway window as we were walking back down to the Emergency Department, Dr. Cadena asked us if we follow any particular religion and each of us had a different answer. As Kenny said in a later conversation, "The three of us are like a walking cultural experience from around the world."
The tour ended with a trip to the emergency room. We saw the critical care unit, surgery unit, and general emergency area. One of the medical students/ residents (he is in his 6th year of med school) let us assist in a catheterization of older female patient. We all wanted to comfort the patient because she was shaking, and Ami did end up putting her hand on the patient's shoulder, but it was obvious that the patient's comfort was not high on the resident's priority list.
The interaction between the doctors and residents was very interesting for all of us. They shook hands, hugged, and laughed together, and there was no visible sign of the condescending attitude we are taught to expect from our mentors while in residency.
The day ended with dinner in Old Town. We went to a posh rooftop restaurant called Vista Hermosa (beautiful view) and really enjoyed the atmosphere. "Old Town" looks like a European city and has beautiful buildings lined along winding streets on steep hills. I had a pina colata for the first time (virgin version) and really enjoyed it. Although the restaurant was much more expensive than the average restuarant in Quito (you can buy a good lunch from a touristy restaurant for around $4), the total for my meal, drink, tip, and tax came out to a little less than $15! The price is amazing for the experience: live music, rooftop view of the city, and good food & friends.
The picture is from our dinner table. Ami has better pictures and I will post hers when I get them.