Rachel Hoffman is a year-round media intern based in Riobamba, Ecudaor. Read her first piece on a special patient, Jose Gaucho, below:
The entrance of Hospital Provincial General Docente in Riobamba is flooded with sun.
It seeps in through the rectangular skylights dotting the high ceiling of peeling off-white paint. Alternating geometric patterns of blue and white tile line the floors and mid-wall. It looks a bit like an emptied out public pool.
PJ, the other year-long intern here in Ecuador, Maria, MEDLIFE Ecuador’s Patient Follow-up Coordinator and I are there to meet the Gaucho family. The father, Jose Emilio, 39, and his wife, Maria Juana Yatibug, 43, make a strange pair at first sight. Maria is dressed traditionally like most women from their indigenous farming community an hour outside of Riobamba, in the rolling hills of La Merced. She hides half of her round, tan face in a teal shawl made of thick wool; a black skirt falls to her feet. Her long, black hair is tied back in a pony tail that trails to her waist, with a dusty brown fedora on top. She whispers questions about us through thin fingers gathered around her mouth to her husband, Jose Emilio, who is wearing a simple black jacket, jeans, and black leather loafers.
Huddled next to them is their eleven-year-old son, Jose Francisco. Jose stands about five feet tall and is as skinny as a twig. He wears a track suit jacket and pants in red and blue alternating stripes. His head, a tuft of unruly black hair, is capped by a navy blue hat that reads “Dixie Babe” in rosy embroidery, I assume, unbeknownst to him. He greets us excitedly and checks his father’s small cell phone, frenetically sliding it in and out of his pocket, as if he has an appointment with friends.
But today is not just any other day for Jose, and he is missing school and soccer games with classmates to be here.
Jose suffers from cryptorchidism, or more colloquially, undescended testicles. According to Boston Children’s Hospital, the condition occurs during normal fetal development when the testicles do not move downwards from the abdomen into the scrotum. This affects one to two percent of the male infant population, and about 20 percent of cases resolve on their own in the first three to four months of life. Jose’s did not. Without surgery, this puts him at risk for infertility. Most importantly, his chances of developing testicular cancer are much higher than average. MEDLIFE Ecuador is making it possible for Jose to receive the surgery for his condition by covering the cost of his operation.
The health system of Ecuador is composed of a private and public sector, with the public sector guaranteeing, as stated in the revised 2008 Constitution, “permanent and timely access, without exception, to all comprehensive health care programs and services” for all citizens. The government funds 47 percent of outpatient and hospital services in the nation, in addition to the nation’s largest hospitals for referrals. However, overall, this covers the health care of only 51 percent of the Ecuadorian population, according to a June 2011 paper by the Ministry of Social Development in Quito, the capital.
Jose’s first consultation for his condition was the entire family’s first visit to a hospital. It then took three months to schedule a surgery for him. The paper acknowledges that “…actual coverage is limited to services whose quality is not always optimal.”
On October 24th at 7 a.m., we all wait with Jose on the day before his surgery to check in with the pediatric surgeon and prepare him for tomorrow’s operation.
We gather in a small waiting room with a large television blaring children’s cartoons. As PJ begins to interview Jose’s parents, I start taking photos of Jose.
“Let me see!” he says about the photos, and then, “and the other one!” He giggles in the raspy voice of a young boy and rushes his words tightly together as if he does not have time to say them all.
After struggling out of his mother’s lap, he snaps some photos of his own with the camera, and then tugs at the middle finger of my left hand. He holds it up to the florescent light like an unusual specimen in an experiment.
“I’m not as big as the other kids in my school…you’re hands are small too!” he says. He places our hands palm to palm and wrinkles his brow in thought.
“Okay, yours are bigger though,” he concedes.
Suddenly, his curiosity is piqued about who these strangers are, not to mention that waiting to see a doctor is quite boring for anyone, let alone a 7th grader. It’s time to reverse the interview.
“Where are you from? The United States?” he asks me.
“Yes.”
“Where did you buy that camera?”
“Over there, in a city called Chicago.”
“How much was it?” He says, raising his eyebrows. I awkwardly brush off the question.
“Oh, too much!” I respond.
Jose seems old enough and smart enough to recognize the importance of money — including who has it and who does not.
His father, Jose Emilio, works as a carrier of foodstuffs — such as sacks of potatoes — in the nearby city of Ambato, earning $60 per week. His mother does not earn money. She tends to the farm land around their house with the aid of Jose, growing vegetables to feed their stock. Both parents work from 8 a.m. until 8 p.m. every day, including weekends. Jose Emilio says that all of the money they earn goes toward his five sons’ clothes and school books, with the remainder for food. There is often not much of a remainder. The family eats two meals a day.
In Ecuador, Jose and his family fit squarely into the have-not category, and it’s a large one. Only about three percent of the population is covered by private insurance and prepaid health care, and they belong to the upper-middle and upper classes.
By 8 a.m., we are allowed to enter the inner waiting room outside of the “Sala de Preparacion de Pediatria” where the doctor will examine Jose. The family settles into hard, mustard-colored chairs in a hallway crowded with young mothers and babies swaddled in fleece blankets.
His parents have packed him a meal for the day. By 8:30 a.m., Jose hungrily digs into a bowl of white rice, chunks of potato, and cubes of lamb in a brown sauce.
A nurse walks by and says the doctor has arrived at the hospital. He is the only pediatric surgeon, working four days a week, and it is obvious. Dozens of families rise to their feet at the news, standing around the exam room door, silently hovering in a semi-circle of anticipation. Eventually, people grow tired and sit back down. Babies nurse at their mother’s bosom and blankets are re-swaddled.
In major cities, like Quito, with over 2 million inhabitants, wealthier patients often make direct payments out of pocket for health care to any one of the nations’ 10,000 private doctors. Riobamba is a smaller metropolis, with a population of about 160,000.
Jose becomes tired of waiting once more. He picks up a piece of meat between his forefinger and thumb and hungrily gnaws at it.
“What are you writing down?” he asks me, nodding his head towards my notebook.
“Notes for my work at MEDLIFE.”
“And what will you use it for?”
“I don’t know yet.”
He is wary of being observed, and decides instead to interact. His previously stoic father cracks a smile at his son’s inquiries. He’s analytical. It entertains him.
“What was flying in a plane like?” Jose asks me.
His father suddenly pipes in with a large grin.
“Where you scared you’d fall out of the sky in that big plane?”
“At first I was! Are you?” I ask. He shakes his head vigorously. No one in the family has flown in a plane.
PJ then asks Jose if he’s excited to return to school. He shakes his head in the affirmative, but then lowers his gaze and says briefly that they don’t treat him well.
“The don’t treat you well? What do you do?” PJ asks.
“They punch me.” Jose responds. The silence following hints at the possibility that he probably does not punch them back.
But he refuses to dwell on it. Jose continues and says he wants to be a farmer like his family when he grows up, but that he would like to learn English.
“What is the word for cow?” He asks in his Spanish, and we tell him. Then:
“A little cat?”
“Dog?”
“Elephant?”
“Tiger?”
“Lion?”
“Telephone?”
PJ and I give him a short lesson on how to introduce himself and ask how someone is doing. He mimics the English perfectly, but can’t remember on a second try.
Dr. Jorge Rios then appears. He is stocky with a tan suit jacket and a thick, black bushy strip of a mustache. He announces quietly that he has a meeting, and that we need to wait another hour, disappearing like a spectre. By 9 a.m., Jose’s name is called and he and his father shuffle into the exam room. Only one parent is allowed. His mother hunkers down with a torn army-style green canvas backpack holding Jose’s overnight clothes. She swaddles herself in a velvety red blanket as if preparing to stay the night as well.
After a blood test, we catch up with Jose. I point to a square of band-aid in the crook of his left elbow.
“Did it hurt?”
“It was nothing!” He says quickly, rubbing his arm. For the past few hours, Jose has been saying he is not scared of his impending surgery.
By nearly 10 a.m. he is ready to be taken to his room to rest for surgery the next day. We gather around the intake line at the entrance of the hospital. PJ and I ask to take a photo with Jose, and we sit on our knees on either side of him to reach his height. Jose kneels with us, ignoring the height tactic.
Before he is guided to his room, he asks “Will I be seeing you guys again?” in a firm voice, like a teacher keeping his students on task.
“Don’t worry, you will definitely be seeing us,” PJ answers.
Jose shakes his head affirmatively and gives us high fives.
The next day, Jose is laying prostrate in bed 188 in the children’s surgery ward. He has been fiddling with his IV, attached to the back of his right hand, and had begun to bleed a little. A nurse slowly walks over to re-tape him. There is a curious mural of a turtle with a pig, bear, and squirrel riding on it’s back above Jose’s bed.
Above each bed is a strip of white maker board, with the name of each child written in black. The room is painted aquamarine and smells of sweat. There are six white metal frame beds, each with a little boy wrapped in a flannel blanket. One mother is slumped across the bed of her son, asleep. Families huddle quietly in piles around the beds. Most are indigenous, as is 25 percent of the national population, as stated in the Census of Population and Housing from May 2010.
In bed 189, a child named Andres is declared ready for surgery. He lays alone and is no more than ten years old. A hospital worker comes to fetch him.
“Where are your parents?” he asks Andres.
“They are eating lunch,” the boy says.
“It’s such a pity they will not be with you for surgery,” the worker replies, and begins to roll the bed out of the room.
Andres lowers in head and looks confused. Just then his mother comes running down the hallway as the bed is wheeled halfway down the corridor. She looks at him lovingly, and scratches his head.
PJ turns to a very quiet Jose and says, “When they take you to surgery, they are going to make you count to ten as the anesthesia kicks in, and then you fall asleep,”
He adds jokingly, “I bet you won’t make it until three!”
Jose smiles slowly. His smile is a bit devious, the two wide white front teeth turned towards one another as if in embrace.
“I’ll make it until 12!”