Sitting in a chair on my verandah in Zambia overlooking my long grassed backyard, Ecuador seems like a different planet and a lifetime ago.

For me Ecuador was an experience in cultural immersion, and my first real time of living overseas with another family and working / studying in a foreign culture. Naturally, this came with a series of challenges, some petty (such as how do you get home when you cannot pronounce the name of your street?) to more complex ones, like learning to work with people who have a very different cultural background and consequently a very different attitude to doctoring.

I had to learn to balance my own practices to fit with their ideas. I suppose the major difference I noticed was the much more paternalistic style of medicine, one that has long ‘gone out of fashion’ in New Zealand. It felt strange at times, to listen to patients being told what was best for them, rather than a more holistic discussion being held.

I have gained huge respect for the team at Cinterandes. They are a small group of doctors who give up their time to come and provide surgical services to those who would otherwise have to travel a long way for health care, and would likely not make the journey.

While only a few of the procedures that we were completing on the surgical bus were ‘essential’ (i.e. not lipoma removals or hernia repairs), the philosophy of the organization is also to help build trust in the medical profession, something that is often lacking in the rural communities. I think that they can be proud to say that the fact people travel from miles around to come and see them, shows that they have earned the trust of the rural community.

I hope that they can achieve their goal of expanding the operations they can perform on their bus, with some collaboration from our own surgical bus in New Zealand.

They have certainly learnt to make do with the resources that are available to them. As I have said before, everything that is possibly reusable is reused. Drains are fashioned out of catheter tubing and gloves. The Kiwi attitude of anything is possible with a piece of number 8 wire, could definitely be applied to Cinterandes.

I liked to see this applied in medicine, as in New Zealand, the mentality is often not to look for alternatives if a piece of equipment is not available. While this is likely due to the fact we have a surplus of equipment and resources available at our fingertips, it is nice to be reminded that resources can be adapted to do what is best for the patient, even if it is not the ‘normal way’ to do it.

The work that I did in Clinica Humanataria was also extremely rewarding, but for other reasons. Here, I feel I got a taste of what it was like to be an Ecuadorian medical student and manage the pressures they are under. I liked that in times of uncertainty they would band together to make a collective decision and take collective responsibility. I feel that this will serve them well for working in a team environment in the future.

This clinic also highlighted the concept of the value of health care. At this clinic, no matter how poor you are, you have to pay something, even if it is just one dollar.  This is because for Ecuadorians, healthcare is not a right but a privilege. While I was in Cuenca, a story came out in the papers from another hospital, about a week old baby that died because the hospital refused to treat them, as the parents could not pay.

While this leaves me outraged that such things can happen anywhere in the world where there is medical care available that could have saved them, it definitely highlights the idea that healthcare is not a right. Clinica Humanataria was trying to bridge the gap between right and privilege by keeping a value on the healthcare, however small, to keep it attainable for all people.

In these 6 weeks in Ecuador I have met people and learnt things that I will never forget. I was lucky enough to spend six days in the Galapagos Islands, where I met some incredible people, saw some amazing animals and landscapes, and learnt a heap of Spanish (some how I got landed in the Spanish speaking tour group!). While my time in Ecuador was extremely rewarding, I was definitely ready to step on the plane and face my next adventure in Zambia!