December’s book review “Long Road From Quito: Transforming Health Care in Rural Latin America” by Tony Hiss
Before I get into the book review itself, it might be a good idea for me to explain why we have been making many changes to the list of books on our book club. Some books that we first intended to write a review of were hard to do so, for either luck of interest or too much fiction. I came across this book on my kindle and immediately caught my attention. Mainly because of the title “Long Road From Quito: Transforming Healthcare in Rural Latin America” by Tony Hiss.
Back in August we moved to Quito-Ecuador, and although we are not permanently established yet. We are continuing with our blog. We have been back and forth between North America and South America for the last 20 years. Coming to a new country is always exciting to us.
As soon as we heard about the move to Quito unconventionally to me. I decided not to do any research about the country or its people. Ecuador is a place that you hear little of. Aside the Galapagos Islands, the equator line, and bits of history dating back to when The Incas occupied this territory, I knew nothing else. And I didn’t want to know either. I wanted Ecuador to remain a mystery to me until the day of our arrival, coming across this book now, was perfect. This is best time to read it, while living in Quito.
Hesitant about the book’s content thinking it might be too technical. I started reading some sample pages until I ran out of pages. I had to buy the book and decided this will be December’s book review.
As I have said before, I particularly like books that start with a map. On the first content page we have a map of Ecuador. This puts the reader into a wider perspective. Of what we are reading about, while getting familiar with names and locations of cities and towns mentioned in the book.
This book is the life story, and achievements of one person, “David Gaus.” Who after visiting Ecuador. Discovering the terrible health conditions and suffering from the people. He changed his future. Instead of working as an accountant as he originally thought, and having graduated as one. He became a medical doctor, with a public health degree. Mr. Gaus had one vision “to pioneer a sustainable health care model for the marginalized and indigent…” Creating what it will be known as AHD Andean Health and Development. A nonprofit organization that he-confounded in 1996 with his mentor Fr. Theodore Hesburgh.
The story begins with “Rosa” a SimMom. An advance full-body birthing simulator heading to Santo Domingo de los Colorados, usually referred as the rural capital of Ecuador. The reason they brought Rosa to Ecuador was because of the high numbers in maternal mortality. Now Dr. Gaus’s goal is palpable with the two hospitals AHD has built. One in Santo Domingo, a city of the Canton with the same name. The other one in Pedro Vicente Maldonado a canton in the west province of Pichincha. It holds this name in honor to the First Ecuadorian scientist to achieve an international reputation. Both hospitals-as the author mentions-are open to all, either you can pay or not.
Mr. Hiss explains things assuming not everybody is a medical student or a doctor which makes the book easy to read. I like the way he explains how sim machinery started, and the use of the word “health” through history.
The story is also inspirational, based on how Dr. Gaus’s mission to help Ecuador came to be, and South America as well. Based on one fundamental quote “fulfillment of the sweeping global goal from Kazakhstan in 1978 of Health for All by the Year 2000.”
The author explains how Ecuadorians are used to other resources before they come to see a doctor. First, they try cures with home remedies, second a visit to El curandero. There is a mention to Tsáchila people recognized as the most powerful shamans in the country. Third a visit to a masseuse apparently very common in Ecuador, fourth a visit to the pharmacy to get any kind of medication a patient may require given by an untrained druggist. Finally, after all these tried failures they visit a doctor. This is what the author describes as el camino a la cura “the pathway to a cure.” In rural areas this becomes a literal affair, the road is long to the nearest hospital turning it many times into their last ride.
Mr. Hiss makes a point of the United States being number 37 in the world in Health Organization and Ecuador is number 111. This to have some perspective of the difference between the two in services and necessities. For example, there is the case on how many Quito hospitals are unprepared to diagnose diseases they are not familiar with from Ecuador rural areas. Diseases such as mosquito-transmitted viral infections. Especially the Chikungunya (CHIKV) virus. Doctors at AHD are keeping a close eye to CHIKV, Zika virus, and dengue. All three considered by these doctors the “unholy trinity of viruses” because these mosquitoes can bite day or night. Unlike the malaria transmitting mosquito that becomes active only at night time.
As important as the mosquito’s diseases in Ecuador are, so are the dangerous snake bites. Afflicting Ecuadorians in rural areas. We know the most dangerous snake is Bothrops, or what locals call equix. This means the letter X in Spanish because this snake has the X shape on its body. To quote Mr. Hiss “Bothrops asper a pit viper, a large snake measuring up to six feet long occupying areas near rivers and streams. Unlike a cobra bite, which is neurotoxic, paralyzing nerves, an equis bite is a very painful puncture, is hemotoxic, meaning it disrupts the blood system, preventing coagulation, so people can bleed to death.”
The Andean Health Development hospitals, are prepared to handle snake bites. These among other tropical diseases. These facilities are prepared to handle such common emergencies in Ecuador’s rural areas. AHD’s doctors, unlike doctors in the capital city of Quito. Who can misdiagnose patients, sometimes because of lack of familiarity with what goes in their own country. Are the best help they can get. And often their only hope. For these people where “time” plays an important factor in patients’ conditions. This is a threshold between death and life. These hospitals are fully equipped. They have doctors that possess (to quote the author) “proper training, procedures, tests, calmness, judgement, ongoing vigilance, and the adequate stock of supplies.” While also been reliable and constantly replenishing their supply of anti-venom.
Dr. Gaus’s vision, has surpassed his original plans. Now, not only these two hospitals are open to the public. But they also offer resident training to medical students. This is the only formal medical residency program in Ecuador that provides appropriate venomous snakebite management skills. And this is where the SimMom, comes to be a “hands on” practice, for these future doctors. This is what Mr. Hiss has to say about ADH “What Andean Health Development offers to these graduates is; the mentoring, the challenging, the injection of passion, curiosity, and enthusiasm, the constant commitment to learning… This produces an almost chemical change in the systems of young doctors serving rural Ecuador-they want to do more.”
Dr. Gaus’s life mission, in his own words was “to do something smart, effective, affordable, sustainable-for some of the poorest poor people on earth.” But to fulfill his vision, he encountered many obstacles in his endeavor being one of them the rural people themselves and their strong belief that “hospital were places to die.” This concept is nothing new to Latin America. They consider some doctors in Peru “mata sanos” or people who “killed the healthy.” With perseverance he crossed the chasm between the destitute people he intended to help.
The book shows one adroit man with a vision, combined with a group of people that made his vision possible. To quote Dr. Gaus himself “We are training tomorrow’s five-star doctors. This doesn’t make us heroes. I don’t feel like a hero. But in Ecuador I feel like I’ve got my hand on the pulse of humanity.”
Long Road from Quito: Transforming Health Care in Rural Latin America by Tony Hiss is a book that every Ecuadorian should read regardless of where we live, it should be of common knowledge the diseases that one can encounter any day, as well as, where to go get proper help.
Yanira K. Wise-December, 2019
Links:
Andean Health and Development Organization
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ResearchGate: James M. Wise
Author´s page: James M. Wise
Photography page: JamesM.Wise.com
Author´s page: Yanira K. Wise
South America seems to refuse to show its inexhaustible creative force.
