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Nursing on the Equator

Published: September 06, 2007

By Robin Roger

WriterOn a recent hospital visit, several nursing students looked on as a 19-year-old who had just had a stomach tumor removed discovered his family could not afford the Ensure needed to keep him alive.

“He was wasting away in bed,” said Karen Alford, a University of Tampa graduate student. “We didn’t know what would happen next.”

The students never learned what happened with the teenager, but they did learn about the state of health care in Ecuador, and how its system and values differ from those in the United States. Alford was one of seven UT students who traveled to Ecuador in May with Dr. Kim Curry and Dr. Kathy Ellis, assistant professors of nursing.

The group spent one week in Quito, the capital, and one week in the rainforest. They met with the faculty of the state school of nursing and saw patients in a variety of settings. They visited a maternity hospital, a home for the elderly, and a school in the rainforest.

“We’re not just going to see the sites,” said Curry before leaving. “We’re taking care of patients. Students learn a lot from the Ecuadorian patients because they have a very different medical system.”

The enlightening — and sometimes heartbreaking — experience taught the students that in other countries quality health care is not a right but a privilege that we sometimes take for granted in the United States. They also learned that our way of doing things is not the only way, Curry said.

The students learned about herbal medicine and traditional medical practices of the Quechua Indians. The students went on an herbal plant hike where they learned about the different medicinal benefits of native plants. They learned about herbal or “alternative” medicine, which has been practiced in the rainforest for centuries.

“You have to think about whose alternative it is,” Curry said. “We have a mindset that the scientific method is the only way. The answer is a lot broader than that.”

Many of the plants used by indigenous peoples have been proven by modern science to contain medicinal chemicals. For instance, if a bug did not like the taste of a plant, it was considered to be beneficial. Indeed, many of these plants contain alkaloids, chemicals active in the human body. Another example is aspirin, which comes from the willow tree and cinchona, which is used to produce quinine.

There are very few resources available to the Quecha Indians, and they don’t have the access to health care that we’ve come to expect in America, Curry said. Tradition and culture are the largest barriers to care.

“Not everyone trusts traditional Western medicine in the rural areas,” she said. “There are many superstitions.”

La Brujeria, or witchcraft, is still practiced by shamans. If someone is successful, someone may ask to put a curse on him. If someone feels they have been cursed, they carry out a healing session with a shaman who uses herbs.

The students visited a shaman, who conducted a mock healing ritual on one of them, demonstrating how he would cleanse a cursed person.

At the maternity hospital, the students saw one nurse attending to 40 women in one room. The hospital also had a high rate of cesarean sections, because many of these women were younger than 16.

“It was shocking,” said senior Laura Ackerman. “Here you hear about teens having kids that young. It’s heard of, but it’s not as prevalent.”

While Ackerman wasn’t as excited about going to the home for the elderly, she said it turned out to be everybody’s favorite. There she worked with a group of elderly women doing exercises.

“It was very interesting because it wasn’t all indoors,” she said. “It was a bit rundown and pretty shabby, but it was nice enough for them to live in, and they had everything they needed. The patients seemed to be real happy.” 
In the nursing home, graduate student Karen Alford noticed that very few patients took medications, while in the United States, 20 to 30 medications is the norm. Here, she said, half the patients are sedated and have to worry about side effects. It made her wonder whether a lot of medications are necessary.

Though there are pharmacies and health care clinics everywhere, funding is a problem. The first couple of days are covered by the hospital, but after that the family has to pay for everything, and go to the pharmacy and pay for supplies.

Alford, an Axel and Ann Claesges Study Abroad Fund scholarship recipient, said she was shocked by the chasm between private and public hospitals.

While the private hospitals look like something you would see in the United States, she said the public hospitals were a lot more rundown, with older equipment and fewer resources. They often re-used things, instead of disposing of them after one use. But it’s hard to look at them and criticize the conditions, she said.

“This is what nursing is all about,” she said. “Nursing is supposed to be low tech, high touch. The technology is not the end all be all; compassion can be more important.”