Week Five: Cultural Conflict and the Medical Field

Hello again,

 

This last week has been both the most invigorating and the most exhausting I´ve spent in Otavalo. Every day of work this week I spent venturing to rural villages as part of the Rabies Vaccination Campaign that all of Ecuador is required to participate in this month. We vaccinated in Achupallas on Monday, Gualsaquì (same village as the clinic) on Tuesday, Urcusiqui on Wednesday, Cambugàn on Thursday and Muenala on Friday. Each day, we traveled farther from Otavalo. Muenala was a good hour and fifteen minutes away.

 

Although the bumpy class-four roads are not easy to take, especially when our chauffer bombs down them at 100 km per hour, I enjoy the thrill--also the spectacular views we get from these unpopulated areas: the mountains are steep and pierce the dramatically clouded skies. We have vaccinated around 350 dogs, Maria Esther and I still sharing the job of actually injecting.

 

The Conflict:

I was recently faced with a difficult situation, however, that reinforced what I had only been told about being involved in the medical field and simultaneously made a cultural conflict between María Esther and me come to a head. It is customary to ask for what you need here, whether it´s a favor, food, or money. I have been struggling with this custom ever since I arrived; being brought up as a New Englander, expecting little from others and doing my best to accommodate anyone who asks a favor of me. The countless bus fares and childcare I have committed to is not, in itself a problem, but it occasionally makes me feel like I´m being taken advantage of. It turns out this is just the nature of the culture here. Constantly asking for favors, and rarely getting compliance is the norm. Not knowing how to decline, I am guilty of fulfilling many of these favors. And so, I was asked yet another by María Esther a few days ago, but one I had not yet encountered: she wanted me to fill in for her at the clinic for the afternoon—and I declined.

 

Thinking about it afterwards, it was one of the best decisions I’ve made since I’ve been here. I declined for one main reason: I would be at the clinic alone and therefore in charge of the entire facility. In the slightest off chance that there was an emergency, I would be in charge. Although I am confident in my EMT training, I do not know what the protocols are in Ecuador and more importantly, I don´t know Quitchua, the language spoken by most of the people in Gualsaqui. What would I have done with a patient in critical condition that I couldn´t communicate with, in a country whose medical system I have only recently become aquainted with?

 

I learned as an EMT that the Good Samaritan Act (doing what you can to help in a situation as a citizen with little training) doesn´t apply to EMTs because we DO have that training. This is called the Scope of Practice. As an EMT basic, I have the smallest scope. By stepping out of your scope of practice, you could be held responsible for a death, even if you were just trying to save a life.

 

Being here on my own, responsible for my acts and decisions, I utilized this lesson when I told Marìa Esther I wouldn´t stay at the the clinic on my own. I am not equipped to run an entire medical facility in the case of an emergency. I would be stepping out of my scope of practice, potentially facing huge consequences--if not with the medical officials in Ecuador, with myself and my own guilt for accepting a responsibility I had no place in accepting, saying I could do what I actually could not. Paying bus fares is not what I want to do, but there is no consequence in doing this favor, other than having to do it again. For me, recognizing and declining a favor that seems simple enough but has huge implications with even bigger consequences was a big step: it represents an attention for medical protocol, a good habit for me and my intended career.

 

A few other exciting things I have experienced:

 

- Injecting a person (not a dog) for the first time: Ana stopped by the clinic and needed her monthly shot of Mesigyna (a form of birth control). Marìa Esther showed me the steps, and I successfully administered the drug.

- Attending a Panedería class (bread baking) at night a few times a week with María Elena, my host father, Segundo´s sister who runs a tiny store next to our house.

- Hiking around Laguna Mojanda, a beautiful lake at a shockingly high altitude for a lake that size. It is tucked way up in the mountains, right next to Fuja-Fuja, one of three peaks that surround Otavalo.

-Picked up a puppy at a Hacienda where we vaccinated in Achupallas to take home to the house. My family named it Aido (the masculine form of Ida).

 

With one week left, I am eager to see my family and friends again (and eat some good chocolate!) but also sad that my time here is winding down. It has been such an important and excellent experience for me, thank you all for your support and interest in my ventures.

 

-Ida