Tuesday, July 19, 2011

8-June-2011: All Clinics are not Created Equal

Today was my first day in the clinic (up until now I've been in a Spanish language school), so I thought I'd start with a little info on healthcare, as it pertains to Ecuadorians.

First off, "a clinic" and "una clinica" are not direct translations of one another, at least not functionally.  To Ecuadorians, "una clinica" typically pertains to a private healthcare institution, which has more highly paid physicians and nurses, and is accordingly only available to those citizens for whom such service is affordable.

Most hospitals, on the other hand, are part of Ecuador's public health care system.  This system (I'm told) is free to patients, but it has a reputation for housing poorly-trained and underpaid staff...providing care that is expectantly lacking.  The government is working hard to combat this problem, or at least its reputation, judging by the by the sheer volume of television and outdoor advertising featuring smiling, confident-looking physicians at work in the hospital.

The other side to public health is the network of "Centros de Salud" (health centers) scattered around the nations cities and "Subcentros de Salud" (health subcenters) throughout rural villages.  These primary care "day clinics" appear better-thought-of, though the problems they address are admittedly less severe.  Wait times vary widely based on department and doctor/nurse availability, but usually in expected ways (vaccinations = minutes; gaping leg wound in the ER or busy psych consult office = hours).  Resources are dependent upon swings in government decision-making, so doctors and patients have admittedly fewer options, but most basic necessities seem accounted for.

The interesting result in this public-private setup is how patient decision-making flows around how they perceive their health.  Straightforward checkups and prenatal care?  Go to the Centros de Salud.  Major surgery?  Private overnight clinic if you can afford it; public hospital if you've no other choice.  Lots of symptoms, but no idea what's wrong?  Better hit-up the private clinic for a diagnosis, then seek treatment at some place public.  El Presidente Rafael Correa has vowed to "remake Ecuadorian health care", along with a slew of other liberal promises, but Quiteños' faith in such promises (and politicians in general) is mostly lacking.

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