July 2009 : In late July 2009, I was fortunate to have the opportunity to join “Amigos de Salud” in Ecuador. This is a volunteer medical organisation that began in 1987 as a group of fourteen medical volunteers from Arizona to bring urgently needed medical care to Central and South America countries. Over the last several years, under the leadership of Nick Morrison, Amigos de Salud has been focusing its Phlebology efforts primarily in Ecuador. The logistics of this current visit were organised by another not-for-profit organisation “The Fundacion Cieolo Para Los Ninosi” (“The Foundation”). I joined a group of doctors, sonographers, nurses and a lymphedema specialist coming from Italy, France and the U.S.A. Only 2 of the Italian doctors, Attilio Cavezzi and Valerio Carigi, were known to me prior to the trip. The rules for participating are simple – all doctors self fund their trip and are expected to arrive at the destination with everything required to treat patients. My trip was helped by very generous donation of Venosan, who donated 200 pairs of stockings, and the ACP, who paid for the consumables. Knowing what to bring was not the challenge – fitting it all into 2 suitcases and carry-on luggage sure was! What this meant was 2 suitcases packed full with stockings, syringes, needles, 3 way taps, gloves and saline and carry-on luggage of my ultrasound machine and a small bag with all my clothing for 10 days (see photo with shameless acknowledgement for Venosan!). Only carry-on luggage for clothing was obviously a challenge as, although we were not expecting to be hitting the local nightspots, there’s just not much room even for the bare essentials!

Just getting the documentation and arrangements for Ecuador was about the most challenging logistics exercise of all time. The fundamental problem was that all communications from The Foundation were in Spanish, which sadly I do not understand. I was required to bring extensive documentation with me about what I was bringing into the country so I didn’t get charged duty etc. All documentation had to first be notarised in Australia and then sent to the Ecuadorian Embassy for stamping. Luckily I had a patient from Paraguay who was very supportive and did all the translating and letter writing for me. Next time will surely be easier!

The trip to Quito (the capital of Ecuador) was via Auckland and Santiago with lots of time spent wandering around airports waiting for connecting flights. I finally arrived in Quito 36 hours after departure and after a short jet-lagged sleep was up at 6am to wander the streets of Quito. The problem with that idea was that, like most South American cities, there was hardly anyone up at this time and all the shops were closed. There are few cultural highlights in Quito – the tourist trade is very thin and really only caters for those transiting on to the Galapagos Islands which are due west. Despite this I did however have an enjoyable day strolling around the city and then going for a hike in the surrounding hills. The food was “interesting” to say the least. I’ve always thought of myself as a fairly hardy and seasoned traveller but the culinary delights seemed to elude me no matter how hard I looked. Ecuador is a very poor country with limited fresh produce and the meals certainly reflected that. The beer however was good and cold so all was not lost!

I met up with the rest of the group that night and was informed that it was not safe to walk the streets of Quito alone as muggings were not uncommon. Ah, the joy of blissful ignorance. The next morning we all travelled 4 hours by bus to Riobamba, which was where we would be situated for the next week. The Foundation organised a military driver and guard amidst fears of hijacking but I suspect this was a bit over cautious. We were based at the military hospital inside the largest military base in the region. Waiting for us when we arrived were hundreds of people anxious to be treated. The word gets out to the people via an extensive television and radio campaign by The Foundation. The first job of the day was to clear out the desks from one of the schoolrooms so we had an area to scan patients prior to treatment the following day. After the initial scanning session the ultrasonographers on the team took over for the rest of the week to ensure a steady stream of patients.

Because my laser is not portable I was doing UGS for the week. Patients were triaged as a result of their initial scans but, as laser patients outweighed laser machines, I was often treating patients with very large veins. It took me back to pre ELA days which I thought I had happily left behind.

Each day started about 8.30 a.m. and finished about 6 p.m. with about 45 minutes for lunch. We all initially went to the Officers Mess for lunch but after a few meals some of us tried our luck with some of the local shops. I’m not sure that was a good move but at least it got us off base for a bit of variety.

The best part about treating patients was the fact that there were 5 doctors performing a range of procedures (ELA, UGS, Phlebectomy) all in one room. It was very stimulating to have Nick Morrison working next to me and Attilio Cavezzi opposite – it sure kept me on my toes! It is great to see people actually performing procedures and not just talking about what they do. Conditions were challenging for me as I didn’t speak Spanish and found it difficult to get an interpreter. Despite this I managed to perform over 100 UGS treatments in the 5 day period. There were many humbling experiences when treating such poor people but none more so than patients hugging me in gratitude after having their treatments. Patients would also bring in small presents. Not one patient complained about any discomfort, nor did they comment on the less than ideal conditions for treatment (sagging beds, sheets needing washing etc.)

The nightlife was non existent and even if there was any I’m sure we were all too tired to participate. I suspect it will be a long time before I ever go out for dinner at an Italian restaurant in theatre scrubs because I just couldn’t be bothered changing. I wasn’t alone – virtually everybody else adopted the same approach!

Overall it was a very special trip – it was very challenging and very tiring but I urge anyone who has the opportunity to take a trip with this wonderful organisation. A local hand woven mountain scene and a photo of the team now take pride of place in my clinic.

Back to Media Index