Thursday, May 5, 2011

A Brush With Ecuadorian Healthcare

My dad and stepmom were here for a shorter trip than planned. We did get a week on the beach with them and my stepsister's family, but we were supposed to have them up in Cuenca for two more weeks after the Spring Break beach trip. But Dad's story continues to be one of dodging disaster (or surviving it, depending on how you look at it). So the latest chapter in Dad's "Someone's Out to Get Me, But They're Not a Very Good Shot" saga brings us a closer-than-we-had-hoped-for experience with the legendary Ecuadorian health care.

Dad's in pretty good shape for mid-70's, though probably not in as good shape as others that age who have not gone through a fight with cancer, spinal infection with reconstruction, and a handful of other incidental events he brushes aside as "oh yeah...that." But he, like many his age, has virtual meals of pills every day. One of those pills was giving him low blood pressure (I'm still not clear on whether that was an intentional effect of the drug). Low blood pressure, it turns out, is not the choicest pairing with a 12,000-foot elevation gain (coast to mountain pass) in 120 minutes, then "settling in" at about 9,000 feet.

I think we all blame Dad for being so tough and resigned to occasionally feeling "off", and leaving any indication of a problem to visual symptoms like dizziness and turning blue around the edges.

So at that point, having been back home for only a few hours, we headed for lower ground…the 8,200 feet of Cuenca. As his color and balance began to return, everything looked good, and we left them at a hotel in town for that night. All good…till about 4:30 a.m. when Beth called to say she couldn't wake up Dad. My first thought upon looking at the time, "Eh, maybe we let him sleep in a bit," was followed immediately by the second (a visual) of Beth jumping up and down on Dad yelling, "David, wake…up!" (she is a woman not to be ignored).

So I called an ambulance and started working my way down there from these hinterlands. I arrived as they were carrying dad out on a gurney with oxygen on him. His oxygen saturation, Beth told me, was 35. Beth is an operating room nurse (retired the day before they came on this trip), and dad is a retired orthopedic surgeon (though also with an encyclopedic knowledge of everything else in the world). She informed me that at 35 "O2 sat", you will typically get the body back, but not the person. Upper 90s is where we should all be.

It is at this point one of the EMTs asks, "Which hospital?" Ummm, the best? (Later Beth informed me that nurses and EMTs are the people to ask when you really want to know which hospitals are the best.) He nodded and proceeded on.

The look of the ambulance was less the boxy emergency room on wheels we're used to and more Ghostbustery. But the guys were professional, safe, and quick.

We found the emergency room at "the best" hospital (Santa Ines) to be at least as clean, efficient, and professional as the ambulance. (And I should note that when I say "we", I ultimately mean Dad and Beth. Well OK, Beth, who generally has the highest expectations of health care, particularly when it's her man in the butt gown.) The only exception there was one nurse's difficulty getting a needle in a vein. It was clearly taking all Beth's resolve not to just push her aside and say, "Oh, just let me do it!"

The E.R. time included a visit with a CT scan on his noggin to see what damage may have been done by turning off the oxygen to his brain. Though the doors were almost rickety, by our standards, when you open the door, there stands a fully clean, modern, room-sized scanner.

Dad's O2 Sat came back up while he had oxygen on, and miraculously, as I hinted before, so did all of Dad. By the time he was moved from the E.R. (including the scanner visit and about two hours later) he was Dad again, back from the O2-less abyss.

As he was stable, he was moved to a regular and very typical hospital room with very typical care and feeding. There he was visited multiple times by a neurologist and pulmonary specialist to try to figure out the cause. Traveller's Thrombosis was the winning guess for awhile. But whatever the potential causes, ultimately the course of treatment was "git 'im down where the oxygen is." And since they didn't want to spend their remaining two weeks in Guayaquil (where it was expected he'd do fine), they just took the first available flight home.

The final diagnosis was, shocker, low blood pressure with low oxygen supply at altitude.

After they got home they asked me to translate a letter to the doctors and staff for the exceptional care the provided from ambulance to discharge. I won't try to paint the picture of Beth, the O.R. nurse, and her exceedingly high standards of care. Suffice it to say that it is the most ringing endorsement of Ecuadorian (or at least Santa Ines) health care I could imagine.

And for that ambulance ride, E.R. care, CT scan, two nights in the hospital, daily visits from two specialists, purportedly good hospital food, and one cute nurse—all at high levels of professionalism and service--the tab came to just under $1,200 (that's still U.S. dollars here in Ecuador). A tissue for a sneeze in a U.S. emergency room will run you that.

I still can't figure out how the costs here are so low, but sacrificing quality and service don't appear to be part of it.

Dad is still as good as ever, and his medication has been modified to pump up the pressure in the veins a smidge. It's a shame he never got to see the city, but they are actually considering a return visit to the horse that bucked him.

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