Ecuador mission the rest.

Every year I vow to keep up on my blog however I never do and I am home now.  There are a number of factors. Firstly this year we were really busy, often not getting home until the evening and after dinner I just didn't have the energy to type.  I also blame Skype.  Whereas when I first went to Ecuador we used to make long distance calls from a call centre for a ridiculously low price; now many people on the mission communicate with their families by Skype which means that in the late afternoon and early evening, the Wifi in the hotel slows to a crawl.  

I normally don't like to criticize my hosts when doing missions in the developing world but it is hard this time not to.  Five years ago we moved to Santa Ines from Monte Sinai at the invitation of Santa Ines.  We did this because we were offered the use of 2 operating rooms which were larger than the one OR we had at Monte Sinai.  We felt that this would enable us to do more surgery and maybe finish earlier in the afternoon.  We met with the medical director and got the usual Latin American welcome, Mi Casa, su Casa.  This worked well for the past 5 missions.  A couple of years ago they took the monitors out of the rooms which meant scrambling to make sure we had monitors of our own but even that hadn't been a problem for the last two missions.

In December we got a letter from the medical director telling us we could only have the operating rooms from 1300 on.  This meant in order to have 8 hours of OR time we were really looking at 2100 hour finishes.  Keep in mind that the recovery room and floor nurses would stay 1-2 hours after the end of surgery.  Now you could say, okay you have the morning off but again the floor nurses have to be there in the morning and doctors have to round etc.  Makes for a long day.

We were able to get a compromise that maybe we could start one room a little earlier.  

It ended up however being a frustrating week, waiting around in the am to be able to start as soon as a room was ready and late days.  We also worked Sunday in order to get a few extra cases.  We ended up doing 34 or so total joints including 2 bilateral and one revision, which is only a little less than the 40 we normally get done but with a lot more time spent at the hospital much of it just sitting around.  

The hospital we work at is a for profit hospital like most in Ecuador.  In 10 years I haven't quite figured out the medical system which is a mixed public private system that right wing politicians would like for Canada.  There are public hospitals but a lot of public work gets contracted to private hospitals.  I often wondered how I would have reacted if our hospital told me that a surgical team from another country were taking over 2 ORs at my hospital for a week.   Probably with enough notice we would have just taken vacation as we do when the surgeons or the hospital close rooms for other reasons.  Anyway just saying that maybe with enough notice we could have accepted doing fewer patients or staffed differently to accommodate longer days.

The whole issue of voluntourism and should teams from the developed world even be doing surgery in the developing world is of course another topic.

I can't say enough about our team because as I say we worked some fairly long and irregular hours in order to accomplish what we did.  We do come down to help people but we also come down because we enjoy each other's company before, during and after hour and because we love hanging out in Cuenca.