Feb 20-28, 2016

A group of 24 volunteers representing Hands for Health and RVUCOM traveled to Ecuador to provide basic healthcare care to 4 rural towns located nearby the city of TENA, on the Napo River in the eastern part of the country.   There are only 150,000 indigenous people remaining in Ecuador they desperately need health care and this is where they live.   The in country experience was organized by Mr. Mark Backlin, originally from Colorado, now living in Quito with his Ecuadorian family.    He organizes and directs about 6 medical outreach trips per year, throughout the country.     He is experienced in the government regulations related to having out of country health care providers coming into the country to work.  Though costly and time consuming, all physicians must be approved by the MOH of Ecuador, prior to entry.  Also, there were preplanning costs of about $600 mostly for travel related costs for Mark Backlin to set up the trip.  The medical outreach was completed with the coordinated efforts about 20 additional volunteers form the Cruz Roja Ecuatoriana and the Department of Health in Tena under the guidance of our second trip coordinator, Mr.  Mario Arias of Tena.

This was the second medical outreach to Ecuador, the first in this location.    After arriving and spending the first night in Quito, we traveled for 5 hours, with a stop for lunch, by bus to Tena.  We spent the week at Cabanas Chuquitos, a very quaint hotel alongside the Napo River on the outskirts of Tena. A conservative but sufficient breakfast buffet was provided every AM.

Prior to the trip we were informed that we would have the assistance of 5-8 physicians from the Ministry of Health, as well as a small dental component and a faculty physician with 4 medical students form from the university in Ambato..  I only recall one physician working with us one day, and one dentist providing checkups and referrals to her clinic on 2 days.  I have learned from past experience never to rely on actual help form the local providers, and so was the case.

We worked 4 locations over the course of the week seeing about 500 patients in all.   A far cry from the 300 per day (1200 total) that the MOH had originally planned and which I knew and informed them early on would not be possible.     It was extremely hot and humid, if not raining, while we were there.   Despite this they were very please with our actions, and requested that we return again in the future.   When planning the trip, Mark felt it best to have a break in the middle of the week, so on Wednesday the students spent time on the river, visited a quite touristy indigenous demonstration, spent a brief time looking at medicinal plants, etc.    In hindsight, the day would have been better spent seeing patients, and/or spending more time being educated on the local remedies used for their chronic conditions.   I would change this in the future.   

The four locations were Pumacaya, Largarto Cocha, Campanacocha and Campocacha.  We worked in schools located in each area, sometimes outside in tents, but always had access to electricity for some fans, coffee and the Ultrasound Machine.   The Red Cross Volunteers did all the intake and triage, medicine saw patients and ran the pharmacy/lab area and dentistry saw their own patients.  The group (faculty preceptors and students) worked very well together.   Our students worked in pairs, one clinical student with one M1 student, and some teams were assisted by the bilingual Red Cross volunteers.    The rest of the students worked the pharmacy, and all students rotated daily working in different medical teams.  The upperclassmen were responsible to assist the M1 with their H&P skills, developing DDXs, and oral presentations to the faculty.   The physician preceptors for our students were myself, Dr. Phil Sullivan (EM) and Dr. Lorena Letkomiller (IM), all of which have had prior experience working with students in the past.   

While there, and due to MOH requirements, we spent about $2000 in local medications, of which we used less than half.   We tried to bring many of the meds back to use in Guatemala and in the future, but we also ended up donating about $500 worth to the next group from Project Cure, working in the highlands.   This would also have to be better scrutinized in the future, as it added most cost for the students.  

There was a closing ceremony dinner in Tena on the Friday night before returning to Quito, and every volunteer received a certificate for their participation during the week.  RVU presented 2 plaques one to the Director of the Tena Health Department, Dr. Diego A. Zumbana, and one to the director of the local Red Cross, Lucia Martinez for their assistance.    

The trip was captured on video, (fee of about $500), by a Mario Bastandes, who travel with us the entire week we were there. The video has been placed on the RVU shared Drive.

On the last day, Saturday, while we took the long bus rode back to Quito for a red eye flight back to the US, the students had time to hike through an underground cave and then relax at Papacallta hot springs.   We ate our final Ecuadorian dinner at a beautiful restaurant overlooking Quito then headed for the airport about 10PM.  

Student costs for the trip was $950.00, and despite the excessive cost for meds not used, and covering my costs for the trip, we were still able to stay within budget.   With the cost for a few additional meals, students did not have to spend more than an additional $100.

I would continue to encourage Spanish speaking students selected for this trip, and those who have prior travel experience.

Overall, the trip was a great success.  Everyone returned home, a better person than when they left!!    There was concern for ZIKA, Malaria and Dengue while there, but we did not seem to encounter many mosquitos.  Instead we were all bitten by were appeared to be fleas, bed bug or chiggers, in fact 2 weeks later, I am still recovering from those little red spots on my legs.   About half of the group did suffer from some GI virus, lasting about 24 hours.   Only one student required antibiotics after her return home, for prolonged symptoms.  

Camille Z. Bentley, DO, MPH, FACOFP

RVU Medical Outreach Director

President, Hands for Health, NFP