El Subcentro de Cochapamba – Going to grade school

Wednesday was day one of the whole reason why I came to Ecuador – to gain more experience observing the practice of medicine.  The next three mornings I would spend shadowing a pediatrician named Dra. Silvia Sancho in a neighborhood clinic in the north part of Quito.  This neighborhood was known as Cochapamba and like basically everywhere in Quito this neighborhood was situated upon the hillside.

Another student named Daniel and I woke up early Wednesday morning to meet Benjamin (one of the helpers of the CFHI program) so that he could show us how to get to the clinic because this clinic was so far away that it was not a part of our city tour.  After Wednesday it was our responsibility to take the bus to the clinic, but for the first day Benjamin drove us.  The ‘Subcentro de Salud Cochapamba Sur’ was a very small building.  The waiting room was in the center of the building and had just over a dozen chairs and a TV hanging from a corner which played Spanish soap operas (aka telenovelas) throughout the morning.  On one side of the waiting room are three doors.  One leads to the nurses’ station.  Another leads to the Dentist’s office.  And the third led to Dr. Sancho’s office.  On the opposite wall of the waiting room were three other doors.  One led to a family doctor’s office.  Another led to a OBGYN’s office.  And the third led to the record keeping room.

So when the doctor is seeing patients, all of them show up when the clinic opens at 8am and the patients are then seen in order of pressing importance.  Serious problems are seen at the beginning and general checkups or follow-ups are seen at the end.  Therefore the waiting room is quite crowded early in the morning and steadily becomes less crowded throughout the day.  However, on Wednesday we were not seeing any patients in the office.  Today we went to a grade school (La Escuela Leonor de Stacey) and did routine checkups on all of the 7 yr olds (2^nd graders).  We checked their mouths, ears, hearts, stomachs, lungs, and privates – all the basic stuff for a physical.  Their heights and weights had already been taken earlier and shot records had been recorded.  We brought about 15 children at a time up to the health room at the top of the school.  We then had the girls wait outside while we looked at all the boys all at once and then vice versa.  There were very few things worth reporting.  One boy had poor cheek bone development and appeared to have undocumented developmental problems.  One girl had a heart murmur (which I attempted to hear multiple times with my stethoscope to no avail).  And another girl had an extremely fast heart rate – about 168 beats per minute.  She was recommended to see a heart specialist as soon as possible.  Beyond that, this day was rather uneventful.  All and all we checked about 60 kids that morning.  What fascinated me was that the government funded health in this way by taking doctors out of the clinic and bringing them to the schools.  I guess it’s certainly one way to ensure that the vast majority of children are medically covered.