This first week of clinic started out pretty interestingly…. My homestay family came into my room at 6:45am and told me that my assignment had changed… and that I needed to meet with the coordinator at 7am… But I made it to the clinic in time and everything went pretty smoothly.
I spent this week in labor and delivery. Definitely received a decent overview of how things work. Basically I was just shadowing the doctors and residents. This maternity hospital is funded by the government. Some of the residents referred to it as a ministry hospital. Most of the patients are lower income and it is a large training hospital for medical/nursing students along with residents/fellows. The medical training here differs from the training in the US. Students complete 6 years of premed and then they complete an intern year followed by another year where they rotate around different hospitals and clinics throughout the country. I guess it’s similar to a year of service… After that year of service the doctors are technical licensed as a general practitioner. From there many go on to complete 3 years residencies in various specialties. Most specialties including IM, OB, Surgery, FM, Peds are 3 years from my understanding. Specializing past these is additional time. The public hospitals differ dramatically from the private ones in the environment, the attitudes of the staff and the type of care available to patients. For example, at this hospital they do not have epidurals, but it’s available at the private hospitals.
There is also a shortage of primary care physicians here and many of the individuals practicing in the primary care setting do not actually complete and IM or FM residency, they stop their training after their intern and service year. I found it surprising that doctors would discontinue their training after the two years because the mal-practice laws here are very harsh. The medical doctor of the program said that doctors can be placed in jail for malpractice until proven innocent. The current president discussed or perhaps is trying to implement even stricter rules for physician behavior which prompted physicians to threaten to strike here in which the current president (Correa) said that he would bring in Cuban physicians to fill the void. There are supposedly other healthcare changes that Correa is trying to implement, but I am not sure how successful that has been. It seems like healthcare reform is slow and challenging in many countries. The general population and the medical community overall seem to not welcome change…