Manta, Ecuador

June 2^nd, 2011

The mission continues.  We docked this morning off the coast of Colombia, after spending approximately 4.5 months in Ecuador.  Well, it seemed that way, anyway.  The 12-day mission was our longest so far, and was followed by 4 days of liberty in Manta.  Liberty was, of course, the highlight of Ecuador, but a close second was the opportunity to visit a large cancer hospital in a local city.

There were 4 different MEDCAP sites in Ecuador – Rocafuerte, Montecristi, Jaramijo, and the local free clinic in Manta.  I wrote previously about Rocafuerte and Montecristi, and the day I spent at the free clinic.   Toward the end of the mission, I worked at the MEDCAP in a very small town called Jaramijo.  Per the usual routine, our site was set up at a local school.  The school was very small and on one day we had 5 physicians (plus translators, patients, and family members) in one classroom – very cramped and not ideal. 

The Jaramijo site was where I met a fantastic translator named Rosa.  She grew up in Ecuador but moved to Spain several years ago, and was back in Ecuador visiting her family.  As with most South American families, hers was huge.  As we were talking, she mentioned that one of her nephews was a surgeon at a large oncology hospital nearby.  She asked if I’d be interested in a tour of the hospital, to which I obviously immediately said yes.  She made a quick phone call and it was arranged – on her end. 

On my end, the battle of the century had just begun.  My direct supervisor happened to be at the site that day, so I ran the idea by him – he was thrilled and pointed me in the right direction to get it arranged.  Little did I know what I was in for.  I emailed who I thought was the right person.  The next day, I received a visit from NCIS (the Navy equivalent of OSI – the Office of Special Investigations – people you generally want to avoid).  They had received a copy of my email and had consequently visited the hospital earlier in the day to assess security and “Force Protection” – a term that all my military friends are very familiar with.  They met with the medical director of the hospital, who had no idea about our planned visit but was very happy (by their report) to give us a tour.  They instructed me that when we went to the hospital, we were to use the back Emergency Room entrance, as there were 3 security guards there, instead of just the 2 at the front.  They explained the alternate route to the hospital in case the roads were closed or barricaded.  Overall, they gave their stamp of approval.  First obstacle cleared.  The next hurdle was finding transportation.  After making enemies then friends with the right person (who was offended that I hadn’t contacted him in the first place – sheesh), I secured a chartered van with a driver and security guard.  Check.  The last step was to make sure all the appropriate people knew of and approved of the trip.  Without boring you with details, let’s just say this was a learning process for me.  The email chain is laughable – everyone wants to be in the loop.  The funny thing is, everything was arranged and approved without about half of the “required” people knowing or helping.  After this ordeal was over, a friend remarked to me, “I always say you can tell the greatness of a man by the importance of his enemies.  You must be pretty great.”  I would say I’ve mended all bridges at this point, but it was a stressful few days.

Totally worth it, though.  The hospital was called SOLCA (Sociedad de Leche Contra el Cancer) and is part of the National Cancer Institute of Ecuador.  There were 9 of us that ended up on this trip, plus Rosa, our translator.  The director of the hospital was ecstatic to have us there and took us on a 3.5 hour tour.  The hospital was beautiful and huge.  Totally state-of-the-art equipment and medications.  Bright, airy waiting rooms and friendly staff.  Their population base is approximately 2 million people.  Their annual operating budget, which includes staff salaries, chemotherapy, radiology studies, labs, equipment, medications, and radiation, is…are you ready for this?  Nine million dollars.  Yes, you read that right.  Nine million dollars per year to care for all the cancer patients in an area bigger than my home state of RI.  Consequently, they are EXTREMELY short-staffed – the night shift on the pediatric ward has 1 nurse for 9 patients (day shift has 2 nurses) – the parents are given a lot of responsibility on that floor.  They obviously don’t pay as much for medications and chemotherapy as we do in the US, but they also do a lot more with less.  Their biggest backlog is in cancer surgeries – and this is because they don’t have enough anesthesiologists at the hospital.  Amazingly, they follow our same oncology guidelines (NCCN) and use fairly new drugs for nausea and pain.  They were very proud of their radiation suite, which is able to deliver modern radiation techniques.  The hospital is government funded, but patients have a 10% co-pay (so I guess technically, their budget is $9.9 million).  It was incredible. 

At the end of our tour, the medical director asked us to sit down with him and give him recommendations on what he could do to improve his hospital.  It was really touching that he valued the “American doctors” so much to ask for this.  He really wants to start a bone marrow transplant at SOLCA, so we talked about the feasibility of that.  We asked him what WE, the members of USNS Comfort, could do for his hospital that would help.  His response: surgeries, radiology readings, and Pap smears.  The number one cancer killer for women in Ecuador is cervical cancer.  This is in the day of Gardisil, the cervical cancer vaccine, and Pap smears, which detect cancer in its earliest stages.  Unfortunately, the vaccine costs $200 which is completely unaffordable for most Ecuadorans.  And the health care system is so lacking that annual or even bi- or tri-annual Pap smears are not even remotely possible.  Such easy interventions that would make a tremendous difference.  So we talked about those as well.  Overall the trip was amazing.  Scott and I have talked about trying to come back here with a group of doctors in the future.  Who’s with us?

The tour of SOLCA was our last mission day in Ecuador.  The next day started liberty.  To be continued…