Seven years on….. trails of blood and the sweat of healthcare workers mark the way to President Correa’s constitutional promise of health care for the people.
Dr Maria Cordez works in a sparsely appointed concrete bunker in the dusty heart of downtown Raita, on Ecuador’s dreamy Pacific coast. The clinic serves villagers from hundreds of pueblos speckled higgledy-piggledy along the beaches and adjacent cloud forest, but not even the most desperate tourist would stop here.
An hour by public bus from a busy fishing port to the north, and an hour from a buzzing hippy hangout to the south, little Raita offers nothing of what brings the big dollars; whale watching, custom-made surf boards, fashion, gourmet coffee and any drug you care to party with.
Despite surging trade along the nearby China-funded super-highway, and massive new investment all over Ecuador by hordes of land-hungry new expats, the dusty streets remain deliciously quiet. What gringos have arrived to exploit cheap tierra do so quietly, to avoid the lustful attention of their compatriots, notoriously plundering similar regions all over the nation and cluttering the peace with their in-fighting and conspiracy theories.
There is one store, reliably stocked with beer and jam, but not much else. A few sleepy cabanas host surfers and Argentine minstrels, while the occasional blue-footed booby, blown over from Galapagos, lands here to die on the un-manicured beach.
On the day I visit the public health clinic, the little rutted street it sits on is blistering under an unseasonably ruthless sun. A bashed up motorbike is parked delinquent to the building’s rickety gate, which hangs open like a wonky jaw.
Dried blood spots graffiti the winding pathway to the entrance, passed a clutch of gossipy chickens and into a cheerless waiting area, decorated with a decrepit dental unit, plastic wheelchairs and a strong scent of… what is that?
The patients avoid this maw in the same way they avoid the full equatorial sun, and gather instead in an unlit corridor cluttered with broken medical equipment and browning posters. Serene golden mothers, sun-bitten fathers, aunties and grandparents snuggle sweetly up against the three drab surgery doors, cuddling and singing to their lovely-eyed children.
Raita’s new clinic provides free medical attention to thousands of people living simple, substance lives in the region. It is the frontline of social change, where medical staff battle to deliver the promises of charismatic President Rafael Correa’s boastful social revolution government.
This place is real-life evidence of how Ecuador’s progressive new democracy is really for the people. How his is a truly left, conservationist and humble pie political vision closely shepherded by a President who cares… which is why, he says, he is in perpetual campaign.
Ecuador’s full-tilt dance with development tangos autistically with it’s hi-profile pledge of social change, and declaration of constitutional rights for the planet and all its beings, flaunted relentlessly by government spruikers and winning the President (if not the people) fame and fortune. The intoxicating Correal vision risks compromise every day by oil mining in the Amazon, expansion and illegal fishing in the Galapagos and a wildly undermined local economy.. it’s trail is horrifying to watch as it unfolds on the ground.
The tiny South American nation has private and public health sectors – the former heavily marketed to medical tourists and expats for cheap, quality surgical, cosmetic, dermatological and dental care on demand in 18 spanking new or up-graded hospitals. The latter visibly creaks.
Mercilessly under-funded, ruthlessly accounted and dangerously under-resourced, the public system has brave rhetoric but struggles to traverse the lovely nation’s wild geographies and live up to Correa’s own constitutional pledge, written in 2008, to provide, “permanent and timely access, without exception, to all comprehensive health care programs and services” for all citizens.
Raita’s is one of 250 promised regional health centres, and a vital source of help for wounds, trauma, pain, bites, burns, wounds, emergency dental care, education and cheap antibiotics. Given that public health is independently estimated to have reached only 50% of the needy, surgical wait lists surge as high as 4,500 names, and doctors in both sectors are stressed and nervous of further reforms, the people here are among the luckiest of the so-called poor.
Meanwhile, due to a fierce governmental campaign to attract swathes of Americans, fleeing their own dilapidated health system, economy and political hologram to the ‘good life’ in Ecuador, backed by the dubious writers at International Living, foreigners have indeed arrived and placed such a burden on both sectors that even the President raised an eyebrow.
There are at least 10,000 American expats in Ecaudor officially, and thousands more - they gloat about how they can live in luxury on less than US$1,000 a month here, paying next to no tax, receiving aged care benefits, buying waterfont parcels for under $100,000 and paying $25 for consultations at up-market new hospitals for elective surgery.
I”It helps to be rich” wrote one gringo recently on an expats’ message board, ” and rich is what you instantly become when you move to one of the world’s poorest nations from the USA – even if you’re on social security, as plenty of arrivals are.
If you retire in Ecuador, every cliché you’ve heard about living large on little money–about settling into the lap of luxury on even a pensioner’s budget –is true!
writes International Living magazine
Consuming health services is favorite pass-time which North Americans are particularly miffed about not being fully able to indulge in back home. Dizzying numbers of them who now claim Ecuadorian residence are therefore enthusiastically shoving their Ecuadorian brothers and sisters aside for all the cheap cosmetic dentistry, hip replacements, heart surgery, dermatology, lab tests and pharmaceuticals they can dream of.
Meanwhile, the real Ecuadorians, with an average annual income of less than US$10,000, have had so little exposure to the benefits of medicine that they tend not to get help, even when they desperately need it. Correa’s health plan was designed to harvest from the wealthy, by giving them what they want at attractive prices, to give to the poor.
But judging by what’s on offer in Raita, government care comes with its own risks. Sanitation, power and resources are a mess.
Mercifully, folk who may never otherwise see a nurse, and most certainly not a dentist, may have no idea how miserable this offering is.
Expected to provide a minimum of 10,000 appointments a year, with only two medical staff, no receptionist, no dental nurse, no actual doctor, lab, phone, computer, cleaner, steriliser and often, no electricity either, the Raita clinic treads a fine line.
Across the developing world, the World Health Organisation says progress means escalating road trauma, increased accidents at fishing, farming and in industry, diabetes, depression, loss of land for the poor and an oral health crisis, caused by multi-nationals like Coca Cola, Danone, Tony milk and other peddlers of sugar. In the case of accidents alone, lack of treatment for the poor means injuries have become a higher cause of death in these regions than HIV/Aids, malaria and TB combined. In rural Ecuador, oral health is described by Dr Cordez as ‘a disaster’. She reports rampant decay, infection, disease and lack of hygiene in almost every mouth along the whole tropical coast.
Recently graduated from the glittery city of Guayaquil and sporting hip blue Invisalign braces, she is in her compulsory year of social service and on the frontline of Correa’s mission. She is equipped with an unventilated, dilapidated and badly-lit one-chair room with broken cabinetry, adjacent to that of a community nurse who has adorned her space with little paper butterflies.
Both are required to see at least 16 patients a day, and are charming, but exhausted, rattled about how to attract that number of remote, hard-working, notoriously nervous patients to the clinic – and be there to treat them.
If they can’t prove the community seeks at least 600 medical contacts a month, the government will deduce a lack of need and close the centre. Just like that.
There is no education budget, or advertising of the free clinic, which is left to the medical staff. Nevertheless, what these two women provide in the region visibly changes, and frequently saves lives.
Today it’s another motorcycle accident. A family of three hit by a truck at an intersection on their clapped out Yamaha have been dragged in bleeding, numb and in shock. The youngest is tumbled onto a sagging gurney and washed off with saline as all the waiting patients – about 20 in all, rush in to watch, whisper, and quietly hand their faith to a medical service that is equipped to give nothing more than pain relief, band aids and a priceless dash of comfort.
The other injured people wait quietly, dripping more blood onto the pocked lino, and smiling gently when they catch my eye.
The dentist isn’t in – she’s teaching hygiene at a nearby school, reminding children to remind their parents to brush their teeth, with local salt and chamomile flowers – since toothpaste is a luxury in places where three generations might share one toothbrush.
I meet her a week later, when all hell is breaking loose.
The screams escalated wildly for half an hour as I hovered in the waiting corridor with 15 other people, smiling nervously and taking turns to peep through a crack in the door at the horror-scene inside.
A 5-year-old boy visiting with 8 family members is having his turn in the chair, and none of what the doctor wants to provide. Which is extractions. Three of them.
Family and other patients venture in and out of the surgery to stare, coo or speak tough love to the writhing infant who drools blood, sweats rivers and is held down by four large women at every corner as Dr Cordez tries to prize his mouth open and take the last molar.
Little red bubbles bloom and explode on his firmly closed lips. When jamming and squeezing burst those terrible rosebuds he explodes with yells that rack his body and screams of “No quierre! No quierre!” I don’t want. I don’t want. I don’t want.
It takes the pretty dentist more than an hour to complete the grizzly job, there being no sedatives available, comforts, audio-visual distractions or counselling, and no possibility of a return appointment in calmer conditions due to the family’s costs of travel (at least $3 a person) and a lost day’s work ($10, at minimum wage). Not to mention the doctor’s own desperate need to fill the quota that keeps the clinic open.
This is her seventh extraction of the day, and it’s only 1pm.
When it’s all over the family thank her with obvious gratitude, gather their babies and grannies, and leave after kissing and embracing me, one by one as they head back to lifestyles that only the rarest gringo here would care to even imagine.
Does the young doctor like the work? At the end of the day, her bloody instruments sit in a dry Tupperware in a waterless sink, her spittoon is caked horribly, yet she lingers happily an extra hour to talk with me. “I chose this profession because I love children, and Dentistry here is more practical than pure Medicine,” she says. “I love the service, with the people, and admire them – not because they’re poor, but because they are genuinely good.”
On an average day she sees three root canals, seven or eight extractions, unanimous gum disease, “even in the babies”, and a constant relay back and forth from the chair to the circuit board to re-boot the electricity. She cleans up afterwards herself and walks home to her rented cabin by the beach.
“The standard treatment for pain here is extraction,” she explains. “For carries it’s extraction, for emergencies it’s extraction – we don’t have the material to fill cavities and anyway, the equipment isn’t working. I spend a lot of time at schools, educating, traveling to pueblos to let them know we’re here – all of that I pay for from my pocket.”
The public system is a far cry from what’s available in the city nearby where Dr Cordez has a swank new practice waiting for her, state-of-the-art resources, a booming cosmetics trade and a wealthy time ahead, if all goes to plan.
“It’s hard work here for now,” she smiles, “and it’s hard to see the conditions, but I am lucky – there are other graduates who didn’t get such easy posts. Some of my friends are posted in the jungle, or the very deep Andes, and have to cross rivers, avalanches and forest just to get to work. For them it’s dangerous just to be there, for me this is a beautiful place, but a sad situation.”
At the end of my third day here, after four hours in the surgery, I am feeling ill – the stench, the blood, the broken cabinetry, the singing mothers, the rotten teeth, the beautiful babies, the caked-on drool…. and go home to vomit under a banana tree.
* I’ve changed the names of people and the village, in respect for their security.