Two Days at Hospital Voz Andes

For the past two days, Justus and myself have been at the Hospital Voz Andes in the small town of Shell. We've made it to 8am rounds both times, so I'll say we've been fairly successful. Actually understanding what is being said at rounds in Spanish is a bit harder, but we've been making progress.

The first day, I shadowed Dan, a family medicine doctor from Idaho. The first thing he did was show me a young baby with severe malnutrition and an unknown nasal infection. This was the first time that I had seen this extreme manifestation of hunger made flesh. It was haunting, this skeletal infant, whose every bone could be seen through pale skin. I wonder what the effect of malnutrition will have on the future development of this child. To make matters worse, this kid had an unknown nasal infection, similar to the one seen below. Any ideas on what this could possibly be?

We left the child with his mother, and proceeded on to a day of seeing other patients in the clinic. There were many cases of gastritis, well-child physicals for school, checking newborns to see how they are developing. We even applied the results of the Framingham study to see whether or not to counsel a man to take statins or an aspirin. Twenty patients later, our day was one and it was back to Puyo for dinner and to celebrate Meredith's 24th birthday at the Volcano! (That's a story for another time and place).

The second morning was spent observing three endoscopys, which was very cool to see done. It was pretty amazing to update ones mental imagery of the GI system with actual video of a person in front of you. I can now say that I have updated visual memory of the esophagus, stomach, and duodenum which is superior to the one from Costanzo. Down time was spent researching the malnourished childs mystery infection, which we narrowed down to mucocutaneous leishmaniasis or as it is known down here as espundia.

Leishmaniasis is caused by a protozoan parasite, which is transmitted by the bite of a female sand fly. The site of infection was biopsied and sent off to the lab. A picture of the kid will be sent ot a leishmaniasis expert in Quito, and hopefully th e kid will be started soon on some medication, and it will clear up. He'll be disfigured due to parts of his nasal septum being eaten away, but he'll be alive, provided if they can figure out why this kid is also malnourished.

Tomorrow we head off to the jungle to spend some quality time with the Sh'uar people. There will definitely be more posts on that, and hopefully plenty of pictures.

Un abrazo,
Matteo