My Experience Working in the Jungles of Ecuador

I left the 2^nd floor of the hospital's labor and delivery unit after seeing my newly born nephew-Samir thinking about my recent trip to the Amazon region of Ecuador. I could not help but compare the stark differences between the labor and delivery experiences of my sister-in-law with women I saw at the Mondana Clinic. Whereas my sister-in-law was driven to the hospital, which was 10 minutes from her house, many of these women had to first walk at least 20 minutes to get to the Napo River and then take an average 30 minute canoe ride to the clinic.

One night the security guard woke me up at 3:00 a.m. and said: "Hay una emergencia en al Clinica." And I jumped out of bed and said "Ya voy". I got my flashlight and put on my muddy boots on and quickly walked down to the Clinic with the other medical student-Alison. When we got to the clinic, we saw this very pregnant lady in one of the consult rooms by herself; she was trying to induce labor by walking around. Meanwhile, the two doctors-Romero and Ranalto waited for her contractions to come closer together.

Two hours later, the mother was 5mm dilated and 50% effaced and she was in a great deal of pain and wanted some pain medicine, she would say "Ah, me duele, da medicina por el dolor", Romero kept insisting "No hay medicina por el dolor, el partos es natural". Finally, after hours of this back and forth struggle, she was given some sort of pain killer. (my sister-in-law, on the other hand, was given an epidural block). At about 12:00 p.m. that afternoon, there were a number of patients waiting in the clinic that needed to be seen as well as this pregnant lady, which was still in labor. The doctors became desperate and so Romero and I went down river to the nearby hospital house boat to buy some pitocin, but to our surprise, the hospital boat, which is a UNICEF-sponsored project was closed. The "hospital guard" told us that it is only opened 15 days out of the month and we had caught it on one of the days that it was closed.

While we returned to the clinic in the 60 foot motor powered canoe, Romero got a call on his CB from one of the health promoters about a sick child with a fever. Romero asked the health promoter to give him the classification for the disease that they were taught how. The child had yellow diarrhea and a fever. Romero then instructed the health promoter in which medicine to give the child, at what dosage, and for how many days; there own form of telemedicine, but adapted to the jungle. The health promoters would get this medicine out of the botiquin, which was there local small pharmacy in the hut-like edifice.

We returned to the clinic and still the woman was in labor. At about 2:00 p.m., she delivered a girl. This would be her eighth girl; the father seemed a bit disappointed. When she came out, that was the first baby that I had ever seen delivered. Thus, I had no idea what to expect. The baby was not crying and was bluish white. She was actually in bad shape, but after 10 seconds or so, she began to cry and breath, the color of her body began to redden and she was also given some oxygen to help alleviate her cyanosis. While we cleaned up the delivery room, I kept thinking about what Romero once told me.... He said: "the families in this indigenous population do not give their babies names for a approximately a year and half because they are afraid that the babies will die and thus they feel that it is useless to name a baby that has a high chance of dying. For them, if a baby dies nameless, it never existed."

Indeed, the infant mortality rate is around 60 deaths/1000 births in the Napo region. It is not that high in the major cities such as Quito and Guayaquil (20 deaths/1000 births). In comparison, in the states, infant mortality rates range between 7-12 deaths/1000 births depending on the population.

After the baby was born, cleaned, measured and weighed, she was given to her mother and they laid together like women all over the world do with their babies. This moment is as special in the jungles of Ecuador as it is in Lexington, KY.

For my sister-in-law, after things got settled, she immediately called her mother in NY to tell her the good news before she flies down on Sunday to see the baby. However, in Mondana, the father of the girl at the clinic could not tell other family members because they were no phones in the Jungle and he was an hour away from his home. Furthermore, whereas the father brought food in a steel pot for his wife to eat, my sister-in-law was served lunch and dinner in her bed.

Women in Mondana try to starve themselves as much as possible during their pregnancy so that the baby would exit the birth canal much easier and not tear the woman. There were no episitomies nor C-sections done at the clinic or anywhere in the area. In fact, even the women who gave birth at the clinic were rare individuals, because most women delivered their babies grasping a rope, while squatting and catching the baby as it exited the birth canal.

This was the life of pregnant women in Mondana and indeed is well as a very memorable experience for two medical students who had just finished their first year of medical school.

My other medical student friends naturally asked me about the trip and about what I did and learned. The most appropriate answer is that I learned about how simple and humble people live their lives.

Indeed, this trip has had a great impact on me because it has shown me how little many people in this world have and how those with a great deal more should help those in need. This applies to whether one flies to the Amazon region or helps their local community.