My week has been quite well. It was officially my second week here in Quito with Spanish and Clinical Rotations. Spanish is going well and I am leaning more and more each day, but when in the clinics and hospitals it is so different and I am so far from being fluent!!! This week my rotation was at Hospital Eugenio Espejo. I was in the Emergency department and another kid from our group was with me, his name was Michael and he was from SeattleWashington and just graduated from BrownUniversity, and is taking a year off before applying to medical school. We went into this rotation thinking that we were going to be in the ER room, seeing lots of Trauma accidents and surgeries; however there ER room is more like "intensive care." On Monday and Tuesday we were with two doctors and spent our four hours doing patient rounds. We viewed each patient and went over there case, anything that was new for the day, and any new treatment ideas. We were able to see a lot of x-rays and interesting cases. For example one patient was a male and he was an alcoholic and had vomited and swallowed it back down into his lungs. He had to travel six hours to come to this hospital because he was very sick. We saw him aspirate black liquid acid up from his lungs due to this condition all over the floor and the nurses, they needed to clear out his lungs because his vitals were decreasing and he was having trouble breathing! We also saw quite a few patients who had had a stroke and had very severe side effects due to this. Many could not move, and/or had trouble talking. We also saw another patient who had a large cyst above his liver. It was so large that it was pushing up his right lung and he was having trouble breathing (I have posted pictures of his x-ray!). He has been waiting for over 48 hours now and still has not had this cyst punctured and drained, we asked to watch and they said yes but are not sure when it is going to take place! Hopefully soon! We also asked if we would be able to see a surgery or "Cuarto Once" (Where the trauma accidents come in from the ambulance) tomorrow and he said yes! On Wednesday we went into Cuarto Once and only one patient was there, she had a fractured ankle. We waited and spoke with the doctors for a little while and then went back to doing rounds for a little while. No surgeries were going on that we would be able to see….we were also able to help out in the front emergency office where patients are first evaluated for basic medical care. I was able to help take blood pressures, and patient histories in Spanish! This was cool! The doctor let me interview a patient on my own and then consult with him to see what we think the problem was (he listened in)! They draw blood and give shots differently here, they do everything through a needle and syringe. Unless in the US they draw blood into the syringe and then transfer it into the tubes later on. I found this to be different yet interesting and was able to help the nurse! I was also able to help draw up shots to administer to patients; I was drawing up about 10 while the nurse was giving them! I didn't get to give one yet! After awhile all of the doctors had a clinical meeting where one doctor was giving a presentation on Cardiology and ECG's. Michael and I were able to listen in, this lasted about an hour and he presented all of the different types of Cardiological diseases, diagnoses, and treatments in a 45 minute time span. We understand about 1/3 of what he was saying! He was talking so fast and going through the PowerPoint at lightning speed it was hard to follow! But we managed for the most part. After, a few drug representatives came in and spoke to us about their drugs and gave samples to everyone about how we should use their drug as the drug of choice; just like back at home! J lol! The rest of our morning consisted of going back and forth between the different rooms and doing rounds, getting to see a little bit of everything. I was able to see how they cast an ankle. So different than in the states, they only cast the back part of the ankle and then just wrap the ankle in gaze. I am amazed at how they do things here and how little they have, yet how far it can go. Another patient I saw came in because he fell from a two story building and landed on his feet with his knees locked. He was shaking uncontrollably, and unable to walk. Surprisingly, he only broke his ankle, and had a possibly hairline fracture in his Tibia. His joints were in complete shock from the accident though and he was give drugs right away. We were able to look at his x-rays and found that he had been shot with a pellet gun and the bullets were still left in his legs and could be seen on the x-rays. He informed us that these were old and have been there for quite some time. It was pretty cool to see though!! This just about sums up our day…Friday, we got there in the morning and were hoping to get to go into surgery today but we unable to! Our supervising doctor told us that we could only see Emergency surgeries on our floor and we didn't have any scheduled, but if any came up he would let us know…unfortunately none did. We did rounds again and got to see very interesting x-rays and went to Cuarto Once again. We were able to see how they do a spinal tap in Ecuador! It was very interesting and time consuming, I felt so bad for the patient. Once the needle was in his spine, they just sit and wait as the fluid drips out drip by drip into the vial and they needed two vials. It took about 15 minutes and the patient was screaming and moving in agony. We also were able to see x-rays of a patient who fractured his entire skull from side to side, it did not break through his skin so was only visible through the x-ray, and we were also able to see the hematoma that was present. This patient was intabaited and unresponsive. Another patient we saw was in the ICU; he had completely fractured his Tibia and Fibula, fractured his skull, and had bleeding in his brain. He was under anesthesia for the time being while the doctors were trying to decide what to do next. They had gone in an drilled a hole in his skull to relieve the blood and pressure in his brain and he was currently stable. After that we had another conference again today and learned about CPR and the Respiratory system! That about sums up our week!!! J Unfortunately we did not get to see the puncture surgery on the cyst above the liver…the guy was not there today! All in all I did not get to do a lot but got to see, observe and learn so much!!!! I had a great time and all the doctors, nurses, and residents were very nice and helpful with teaching us everything we wanted to know!One thing that I found very interesting was the way the hospital operates. All of the patients are in the same room, and the beds lay one next to the other. There are no individual patient rooms, or double rooms. Everyone is in the same room! Also, they only have a bed and all of their belongings are underneath that bed or on their bed, they do not have extra room to store or keep things. Another thing I found interesting was their cleanliness. If a doctor or nurse spills something on the patient bed or sheet they do not change it, if blood or fluid leaks they do not change it, if a patient gets sick they do not change it. This is because there are so many patients there, and so little resources that they are unable to change sheets and bedding on a regular basis. Also, if a patient needs labs, tubes, needles, sutures, gaze, etc. they have to have someone (family member, friend, etc.) purchase them from the Pharmacy and bring the supplies to the doctor/nurse before the tests/whatever can be done. This again is because resources are so scarce here that patients have to pay for the supplies in order for adequate care while in the hospital. They can however, stand in line to be repaid for their purchases after and if they are approved they will be reimbursed. I had the change to walk by this line, and during the day it was about 150-200 people deep waiting to talk to one cashier. Well that is all I have for you now! Clinic was only 4 days this week because Friday was a holiday here and we left for Tena (a city 6 hours away close to the jungle) where we went to stay for one night and then headed off to another city about 8 more hours south into the Jungle for the weekend! Much Love!XOXOLove, Brittany