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POPULATION
shared call coverage and the operating room schedule generated by
the two full-time surgeons and many visiting ones over the years.
General surgery, orthopedics, pediatrics, obstetrics, gynecology, oph-
thalmology, ENT and the occasional epidural hematoma kept us
busy. We even assumed the role of intensivist as the need arose in
the hospital’s two ICU rooms. Interestingly, what I didn’t see was
much heart disease or obesity. A simple diet and prevalence of walk-
ing as the primary mode of transportation was striking. Conse-
quently, I found all intubations relatively easy... and I don’t say that thesiologist and intensivist, I was also the recovery room nurse. I
lightly. Though ever vigilant for the difficult airway, it never really
came. Occasionally, I would use a video laryngoscope to intubate a
trauma patient with an uncleared c-spine, not because their anatomy
was particularly difficult.
I practiced anesthesia, in general, much the same way I do in
America. The frequent use of spinal anesthesia being the biggest
exception. If it could possibly be done with a spinal, it almost al-
ways was. The culture of medicine was such that, if a pill was
good, an injection was sure to cure making it the natural choice
by most patients. Complementing this was the overall fear of a
general anesthesia that must have been sown liberally throughout
the community by frequent real world mishaps. On many occa-
sions, I heard of the unfortunate demise of some patient’s relative
or friend after “going to sleep” for their surgery somewhere else
HEALTH
Opposite page: View of Hospital Vozandes from my back porch
with Sangay Volcano in back. This page: One of my patients post
apendectomy.
in the country. Consequently, patients gladly “stayed awake” with
spinal anesthesia. Also, I’m grateful to God that this misfortune
never happened at our hospital.
I was thankful to have most of the same anesthetic pharmaceuti-
cals available to me here. What I occasionally lacked was medicine
choice “B” or “C” if what I had wasn’t quite what was needed though
this didn’t feel burdensome. Besides wearing the hats as an anes-
became adept at caring for both a recovering patient in one room
and preparing for the next anesthetic in the adjacent OR. Equip-
ment was thankfully very similar to what I had in residency. I
quickly learned what brand of anesthesia machine and monitors are
the most robust for the harsh 100 percent humidity environment
and those that most certainly were built to function only in the most
hospitable of Western hospital environments. ICU ventilators were
the most temperamental. I used several brands and models while in
Ecuador and they all kept me up at night wondering if they might
fail, and sometimes they did. Temperamental ventilators, combined
with frequent power outages, made things interesting to say the least.
When those “newer” models did fail, however, I always knew I could
pull out “old blue faithful.” This ventilator was so old that it prob-
ably is only one generation newer than the iron lung! I don’t think
it even had any computer chips, only vacuum tubes and metal dials
to make adjustments. It’s simplicity and ruggedness made it perfect
for that setting, I guess. It never failed to fire up and breath for a
patient so I didn’t have to. I was most thankful it was in the closet
and available when needed.
Many days were not so rosy and memories of tragic stories come
to mind. Those of children of children perishing from burns, snake
bites, and drowning are particularly difficult. Just as heartbreaking
is an episode of postpartum DIC that failed to respond to our best
efforts claiming the life of this new mother. Another is that of a 28-
week infant stillborn to a mother with ecclampsia. Other days, mir-
acles abounded including a child recovering from a craniotomy for
an epidural hematoma, cerebral palsy patients receiving treatment
for limb contractures and the countless healthy babies born, and gall
bladders and appendixes removed.
My family thrived in Shell and my four boys still consider it
home. My youngest was even born there. How can boys not thrive
with Amazon jungle to explore in their backyard and friends of all
ages living next door in every direction? I truly enjoyed beginning
each day with my 30-second walking commute to the hospital each
morning. The view frequently was that of a snowcapped, mostly
dormant, perfectly conical volcano to one side and uncut Amazon
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