Today we spent our final full day in Ecuador hiking at Quilotoa, a dormant volcano whose caldera has since filled with crystal blue water. The descent into the crater was steep and dusty but featured built in breaks to allow for the passage of donkeys and horses ferrying exhausted hikers. Despite spending over a week working in the dizzying heights of Guangaje, the altitude made for a heavy companion during the climb back up to the rim of the volcano.

Besides a little motion sickness on the way to trail, today was a perfect way to close out our trip. According to our fearless leader Devan, we attended to more than 470 patients across five communities in Guangaje. Several things stood out to us over the course of our week. Firstly, our patients were very special. We primarily saw an indigenous, Quichua speaking population who overwhelming spent the majority of their day engaged in subsistence agriculture. These are extremely hardworking people whose lifestyles were usually responsible for their clinic visits. Nearly every patient had at least one musculoskeletal complaint, with shoulder, back and knee pain being the most frequent. Part of our counseling included teaching simple stretching techniques. Headaches were also very common, as were ocular complaints. The dusty environment, long days in the sun, and dry weather predisposed to cataracts and pterygium, an eye condition thought to be related to chronic eye irritation. Stomach aches, sunburns, rashes, cavities and acute illnesses rounded out our list of most common problems.

Apart from adapting to the altitude, our biggest challenge was communicating with our patients. Nearly everyone in our group speaks Spanish, but the majority of our patients only spoke Quichua. Luckily many of the younger members of the communities we visited were happy to help translate. Another interesting challenge was our lack of formal laboratory testing. We were equipped with only 4 labs – serum glucose, hemoglobin, urinalysis and a pregnancy test. However, few patients had complaints necessitating more extensive testing, and we were lucky to be working with the local health center for those who needed more labs.

As we talked about in our video, nearly everyone in our group had engaged in some form of medical service abroad before coming to Ecuador. However, certain ethical issues always come up during such experiences, mainly around how to ensure continuity of care. In that regard, the approach and resources that Timmy Global Health brings to the table definitely stand out. We were equipped with an electronic medical record system which allowed access to a detailed clinical history and visit summaries. Every day we had a doctor from the local health center accompany use to the clinic sites, along with community health workers. Timmy has forged close relationships with several organizations in Ecuador, which gave us the ability to create referrals and plug patients into their local health resources. All of us were impressed with how refined, functional and sustainable the clinical processes were. We look forward to continuing to work with Timmy as we continue to grow in our careers.

This marks the final travel blog for our team. Before we sign off, we want to extend another thank you to Timmy Global Health, Med Plus Advantage, and the American Medical Association for facilitating this incredible experience. It was truly a privilege to visit and work with these communities. We are looking forward to reading about the experiences of this year’s winners!

-Zach Solomon, Team Leader, A New Pear-spective