My experience at Carcalen Alto has been the most enriching thus far. This is true for me to due a variety of factors, including: the stellar staff with whom I interact--- Dra. Carmen Rengifo (my preceptor), Dra. Giacomo (the Radiologist) and the remainder of general clinic staff. All are very welcoming, open, and treat the patients like gold. Aside from this, I appreciate the range of services provided here at the health clinic (Pediatrics, ObGyn, General) and my final reason is that I really enjoy the community in which the health center is set. I´ve made some great connections inside and outside of the clinic. Carcalen Alto is located in northernmost Quito, it is funded by a trifecta of private and public sources (see photo below.) It has the feel of an Open Door Clinic, similar to what I know in Eureka, CA. Here´s a day-to-day look at the range of activities & observation I participated in at Carcalen.
Day 1: Outreach day. An tiny pre-assigned group of Doctors and assistants walk through the neighborhoods inquiring door-to-door about whether or not there are disbaled people in need of healthcare living in each house. Just as soon as I arrived to meet Dra Rengifo, we turned back around and left the clinic to embark on this outreach adventure. We began by ringing doorbells, hoofing it through gated communities, flagging down cars and passersby asking if anyone knows of mentally, physically, elderly, or persons disabled in such a way that they might need special assistance int he form of a doctor coming to their house to provide healthcare for them. At first I had no idea what was going on and had to ask the Dra. quite a few times where we were, what was our purpose, and then what to say (because she asked me to start ringing doorbells and intercoms.) I finally got the hang of it, and was rather embarassed at first because I didn´t feel confident that I could communictae my purpose. Then I realized that most everyone was very grateful for the inquiry, and had only compassionate words of declination if there wasn´t anyone in their household who needed services.
Day 2:
Today I observed "Prenatal visits" (in inglés), "Control" or "Carnet Prenatal" (in Español). On account of the Free Maternity law, women between the ages of 15-45? receive free prenatal care including ultrasounds and paps-
Dra. Rengifo has a flip-book from the 80´s with collaged pics of proper nutrition for the woman and her child, how to stay healthy after your pregnancy, how to avoid getting varicose veins....... all kinds of fun stuff. There is a program offered by HUGGIES that she enrolls pregnant patients in: 3 months of free diapers if they filled out said application. This day was super busy, a constant flow of interruptions, Dra. R keeps her cool and maintains a tone of respect and level of patience I can´t imagine having with such demand from staff, patients, and pharm reps.
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| The sign that greeted me every day when if got off the bus |
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| the community-based mission and vision of Carcalen Alto |
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| A great sign encouraging all pregnant women to get HIV tests |
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| Dra. Carmen Rengifo y yo |
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| The brigade funding for Carcalen Alto |
PAPS GALORE!They sell an affordable pap kit here for patients who fall in the private pay category: $2.50 for a kit which consists of: plastic spec, spatula and broom. I got to do 3 paps, my first and most difficult on a woman with no cervix (she´s had a hysterectomy.) The other 2 went well, successful, and I felt more comfortable after the 1st. one spec exam just to check for a girl´s IUD strings. one breast exam. I held lots of crying toddlers while their mothers were getting exams. I battled my own intolerance of free-range children when one patient´s curious child proceeded to pull all items within reach down/off the doctor´s desk. The next thing I know he´s sticking his head in the spec bucket----then playing with the sharps container-- the mom seemed unaffected. I ran to his rescue and saved him from a certain fate more than twice. A good lesson of patience for me?
Day 4: A celebration
La aniversidad del Centro Salud Carcelen Alto: 11 years of operating as a clinic. Club de Leones. Policia judicial and ministerio publico. A solemn gathering (it was referred to w/ this wording) of all staff at carcalen alto. president, ministeria de salud and many other top-shelf staff gave speeched. it sounds as if it has been a successful 11 years, patient load has grown in size esp between 2008-now.
Day 5: Carmen Rengifo fashioned me a Thank- you letter for the supplies i donated to C. Alto. She couldn´t spell my name without studying my name tag (so adorable) so eventually she borrowed it for a few hours to produce a correct and official letter. Today (Friday) I got to work with Dra. Giacomo the Radiology dra. She´s amazing! I saw several routine exams and identified so much anatomy. She´s a great teacher, efficient in each U/S exam and compassionate with patients. I aspire to be like the 2 Radiologists I´ve met thus far. They know how to rock out a U/S shift--6 pts per hour-- and do a damn good job. Also, not sure if it´s just a coincidence that the two docs working in my field of interest are the only two medical providers that successfully put up boundaries with their patients.
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