9 hours

Jordan Lee - Ecuador

March 1, 2013

As I was thinking about what other fascinating aspect of my Ecuadorian life I could recount to all of you back home, I realized something. I have told you about my stint as a thief in the eyes of those in Pano, how annoying and perhaps powerful it is to have to give away half of your food to anyone that passes by, but I have yet to tell you what I do all day, and that seems like something you all should know.

Pretty much everything about my job here came as quite a surprise to me. When I saw the word “apprenticeship” in the Global Citizen Year curriculum, I imagined a situation where I would be working closely under and individual who would kindly and eagerly take me under his or her wing and teach me their craft step-by-step. Due to Ecuador’s agricultural economy, my sterotypes of the tropics, and my past missionary work in Brazil, I thought I would be doing some kind of intense physical labor in the brutal heat. And I was told, and told many of you, that I would be working with an NGO, or Non-governmental Organization.

But as it turns out, none of those things are true.

Instead of being carefully guided through a process step-by-step, I have had to learn with incredible speed and with very little instruction. Instead of toiling away in the cacao fields of the Amazon rainforest, I am stuck in a small concrete building for 9 hours a day. And as apposed to working for an NGO, I am actually working for the Ecuadorian government in what is called a “Sub-Centro de Salud” (Salud means health in Spanish). The public health system in Ecuador consists of the following institutions: Specialized hospitals, General Hospitals, Centros de Salud, Sub Centros de Salud, and Puestos de Salud. A Sub-Centro is pretty much the equivalent of a doctor’s office in the States, except that its services are free to anyone that walks in. Most of the patients are children with the flu or diarrhea, pregnant women getting check-ups, or people just suffering from general aches and pains. When emergencies do come, like when 2 people fell off of a motorcycle a few weeks ago, we simply clean the wounds and send them to the hospital. When I first got to the Sub-centro in Pano (abbreviated SCS Pano), I noticed something: this place does not need me. The staff worked like a well-oiled machine. Everyone had a specific job and knew how to do it very well. And if ever there was a special task to do, a type of non-verbal communication would take over and everyone would seamlessly and without intstruction do their part. Needless to say, there was little space for my non-Spanish speaking and non-medically trained self. But despite that, my first day was far from boring. By lunch time, I had been handed a pneumonic, 3-day old baby to look after, answered and completely fumbled a phone call from the local hospital asking why we at the SCS Pano had called for an ambulance (it turns out there was a woman giving birth in her house), and had assisted in cutting off the fingernails of a girl whose hand was smashed in a door (and due to both her horrible screams and the unbearable heat, almost fainted for the first time in my life). Thankfully, the next few days were much more relaxed, although the boredome did eventually begin to drive me insanse, but that steep learning curve I expereinced my first day did sneak back every now and then.

In my 2nd week of work, I gave my first health “Charla” (literally translates to “chat”) at the high school in Pano. I had no intention of doing so that day, but my boss, Dr. Rosa, invited me along and after she gave the first one, she asked me if I wanted to do the next one. Now, know that this charla was on Sex-ed, and Dr. Rosa had no reason to believe that I actually knew what I was talking about, nor do I believe I had demonstrated sufficient proficiency in Spanish to warrant representing a government institution, but that did not seem to matter. So there I was, nervous out of my mind, telling the people I would be spending the next 6 months with to wear condoms and beware of HIV/AIDS. Then in late October, we had to go back to that same school to give government-mandated check-ups to all of the students, part of which involved asking about their home life. So that translated into me, who to many was nothing but a stranger with wierd hair, asking if their parents hit them.

But my favorite learning experience occurred in Novermber. We were really stretched one day: Dr. Rosa was the only doctor there (there are usually two), and both nurses had to leave to give vaccinations. That just left the pharmacist, the secretary, and me to help her. So when I came into her office to hand her a needle to inject a patient, she said “do you want to learn?” Without thinking but influenced by my training to accept every opportunity that comes my way, I said yes. So I watched as Dr. Rosa injected the pain killer Diclofinaco into a patients’ right butt cheek, and when she finished she said “next time, you do it.” Well as fate would have it, the very next patient needed a shot, so I was up. I don’t think I’ve ever been that scared in my life. I could feel myself shaking and even dropped the needle on the floor as I prepared to give the injection. But for some reason beyond my understanding, Dr. Rosa still had faith in me. Was it legal for me to give that woman a shot? Probably not. But is sure made me feel proud (well at least it did before, but ever since I heard about Puerto Quito fellow Sydni Heron helping to deliver a baby, my venture with needles doesn’t seem too difficult).

 But apart from these and a few more exciting episodes, most of my learning took place much more slowly. As I said, most of the time there is really no need for me to be at the SCS Pano at all. So if I want to help, I need to prove that I can do the job well. So after a lot of observing, and even more mistake making, I am now helping in the pharmacy to fill prescriptions, checking in patients and getting their vital signs, and really anything else that needs to get done. I don’t think there is any area where I haven’t helped, I’ve even done a few teeth cleanings for the dentist. Most recently I was chosen to be part of the 4-person team that went to another sub-centro much bigger than the one in Pano (they have at least 10 times as many patients as we do). We had to revise the patient folders of all the pregnant woman and all the woman doing family planing. While it was great to feel needed and have a way to alleviate the boredom, it was a grueling three days of work.

But what really determines my experience at the SCS Pano is not the actual work I do, but the people I do it with, and that is a story in itself. Liz, my Spanish teacher, describes the staffing of the SCS Pano as “a parade of doctors”, and with good reason. When I first came to Pano for my week visit back in September, there was Dr. Viteri (my boss), Dr. Roger (the dentist), 2 nurses, a secretary, and 2 T.A.P.S people (they are effectively general assistants). However, when I came back in October, both Dr. Viteri and Dr. Roger were gone, meaning I was without a job supervisor. However, replacing them were Dr. Geovanny, Dr. Rosa, and Dr. Maite (the last two had been working there before, just on vacation during my earlier visit). Also, the pharmacist was back (she was on vacation as well), But that was just for October. In November, Dr. Geovanny took a month vacation, and both nurses had to participate in a vaccination campaign, which took them out of the SCS Pano all day. Then in December, Dr. Rosa and Dr. Maite finished their “Año Rural” (translation “Rural Year”, in Ecuador, all doctors must complete a year of practicing in a rural community before continuing in their studies), and therefore went on their way. So in order to fill the gap, Dr. Jenny soon came to the Sub-Centro, along with 2 dentists, Dr. Lidia and Dr. Estefanìa. Also in December came 2 assistants to the secretary, and someone to help us with “neighborhood relations. Then in th new year, Dr. Estefanìa went to work in the sub-centro in Archidona, one assistant to the secretary left to work in teh sub-centro in Muyuna. And just recently in February, the secretary herself got a new job in her home town.

At first, this shuffling of co-workers was disorienting to say the least. I was already experiencing enough change: new language, new culture, new bugs (lots of new bugs), and I was really hoping something would stay the same. But once I got over the fear of having to make good impressions on more and more people, I saw a positive side to it. Having bosses that were never contacted by Global Citizen Year meant that I could be more of a co-worker and less of a volunteer, and although that results in a bit more responsibility to be on task, I like it. If i don’t show up for a day, it’s not excused because I’m not on the payroll, but rather it is immediately questioned, and if I don’t have a good answer, I’m in trouble (but not really because no one at the SCS Pano would get someone else in trouble, the Ministry of Health does that for us). So all in all, my “apprenticeship” experience has been an ever-improving venture. During the first few weeks (or months, I can’t really remember), I would occasionally wake up incredibly nervous, afraid of what new challenges the day would bring. But slowly the nerves have gone away. I’ve grown closer to my co-workers through the conversations we have during our hours of down time. Since the SCS Pano is the only place to get medical care for about 6 kilometers, it is a great way to meet community members, and many children know me as “Dr. Jordan”. While I am still a little jealous of some of my friends’ jobs that give them more freedom, I’m happy with my 8-5 schedule.


Jordan Lee