Quito: “Gross Inequities”

We departed from our hotel at the break of day and ventured out into the concrete jungle that is Quito.  Dodging buses and weaving through traffic at break-neck speeds we caught our first glimpse of the chaos that would be paralleled in our visits to the health centers in the metropolitan area.  This chaos was underscored by several glaring inequities between the public and private health care hospitals.  Of these inequities the most striking were the differences in the medical equipment present, the quality of the treatment facilities, and the salaries of the physicians. 

 
Group visits the intensive care unit at H. Eugenio Espejo

Arriving at the public hospital (Eugenio Espejo Hospital), we were greeted by the wandering, sickly masses milling about the hospital grounds.  Our group was then quickly escorted into a small waiting room.  As we passed through the cardiology wing, we spoke with the chair of cardiology.  The doctor informed us of the threadbare that the hospital operated under.  In particular the doctor pointed out the hospital’s lack of functional modern medical equipment.  With antiquated X-ray machines, problematic autoclaves, and outdated surgery theaters the public hospital’s meager equipment status was well below the benchmark of healthcare standards held in the United States.  However, this quality of health care was the best available to the throngs of poor, sick, Ecuadorian people. 

In contrast, the privileged upper echelon who could afford health care at the private hospital were granted quite a different type of treatment.  At the private Metropilitan hospital all the amenities of an American hospital were available.  For example, the X-ray machines all functioned properly, the autoclaves worked consistently, and the surgery theaters all were completed within the last few years.  However, while these disparities illustrated an obvious distinction between the two hospitals their ramifications spilled over into the conditions of the hospital.

 
Dr. Luis Escalante gives a tour and explains the functions of the "Instituto Nacional de Higiene y Medicina Tropical"

Marching through the narrow, dingy halls of Eugenio Espejo Hospital we immediately noticed overworked staff working in disorganized and inadequately supplied departments.  The severely underpaid staff was required to work long hours and constantly find innovative and resourceful ways to provide care in a starving hospital.  In stark contrast to the public hospital, the Metropolitan hospital had an attractive lobby with attentive desk clerics, clean and tidy halls, ventilated and odorless air, private patient rooms, well-organized, equipped departments, and un-rushed nurses and doctors.  It seemed that whether bestowed with hardships and low pay, or contentment and high pay, staff at either hospital showed steadfast dedication and commitment to providing the best care possible for their people.  There were also differences noted between the doctors who were employed at each of the hospitals.  These differences perpetuated the theme of inequality between the poor masses and the wealthy few. 

 
Resident talks discusses with the group about his work and the needs at the Eugenio Espejo Hospital

Physicians in America hold a position of prestige and trust, but this is not the case in Ecuador.  Imagine a place where doctors are forced to leave their profession to be taxi drives just to allow them to support their own families; a place where medical students are required to spend three months in a hospital just to provide enough staffing.  This, in turn, makes the public hospital more of teaching facility with less experienced hands in charge and are there only to serve the poor.  Doctors in public hospitals here make an average of four thousand dollars a year - taxi drivers, about sixteen thousand.  This is a striking contrast to the physicians found in the private hospitals, which are very comparable to those hospitals in the United States. 

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