Hospital Vozandes del Oriente – Ecuador
This 28-bed mission hospital is located on the edge of the Amazon rain forest in the city of Shell, population 5,000. Shell is rich in natural beauty, with a stunning variety of plants, insects, and landforms. The high elevation makes for cool, rainy weather. This community is a crossroads of Latino and indigenous cultures, and Spanish is the common language.
Most physicians at Hospital Vozandes del Oriente are board-certified Americans, and they host a family medicine residency for Ecuadorian nationals. Visiting students and resident physicians participate in the full range of family medicine, including obstetrics, general surgery and orthopedics. Classical “tropical diseases” are frequently diagnosed and treated, including leischmaniasis, tuberculosis, pyomyocitis, malaria, dengue, intestinal parasites and bacterial dysentery.
Location & Community
Hospital Vozandes del Oriente is a Christian Evangelical mission hospital that treats people of all faiths. It is located in the city of Shell, Ecuador. Shell is a small town with a population of about 5,000. The town itself is about 2 hours by bus from the nearest city with a shopping mall. The economy of the area is made of mostly small businesses and agriculture. Shell is full of beauty, with a stunning variety of plants, insects, and landforms that take one’s breath away.
With an elevation of 3,500 feet (1000 m), the climate has a perpetual spring feel, with some days being hot while others are rainy and cool. The temperature is usually in the 70’s, but can get much hotter in the afternoon sun. Considering that the seasons can be described as rainy and rainier, it comes as no surprise that most days consist of some rainfall. Shell averages nearly 20 ft of rain per year.
Visitors fly into Quito, the capital city of Ecuador. The staff at Hospital Vozandes del Oriente will arrange for a representative to meet and transport visitors to their guesthouse in Quito. The following day, a taxi ride can be arranged for $130 (much less hassle with luggage), or a bus ride for $5 (there has been some petty theft and there is the hassle factor with suitcases or large bags).
For current information, please visit the Ecuador Embassy website appropriate for your country. For American citizens, a valid U.S. passport is required to enter and depart Ecuador. Tourists must also provide evidence of return or onward travel. U.S. citizens traveling on regular passports do not need a visa in advance for a stay of 90 days or less. Students can get a 90-day tourist visa at the airport. The website for the Ecuador Embassy in the U.S. is https://www.ecuador.org
Traveler’s Health & Safety
One should consult with their personal physician before traveling, and refer to the CDC travel website for the most up-to-date health information: https://wwwn.cdc.gov/travel/default.aspx. HIV is unusual in Ecuador, and malaria and yellow fever is not a concern at Hospital Vozandes del Oriente unless a visitor is planning on venturing into the jungle. Visitors should be up to date on all routine vaccinations, including hepatitis A & B and typhoid.
Travelers are advised to refer to the United States State Department website for the most up-to-date general travel information https://www.state.gov/travel. Travel advisories regarding specific countries should be regularly reviewed at https://travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html
Hospital Vozandes del Oriente is at the crossroads of a number of cultures: jungle indigenous cultures of the Shuar, Achuar, Quichua and Waorani, plus the Quichua from the highlands and the majority of Latino culture. Patients range from indigenous patients without money to lower middle class. Most patients speak Spanish or are accompanied by a Spanish-speaking family member. The staff at Hospital Vozandes del Oriente treats a number of remarkable tropical diseases such as pyomyocitis and leptospirosis; as well as infectious diarrhea, pneumonia, trauma, and cholecystitis and appendicitis cases in surgery. Upwards of 18,000 outpatients are served and over 600 major surgeries are performed each year.
All students and volunteers must be fluent in Spanish and able to function independently in this language. Patients do not typically speak English. Spanish is the language of the hospital. Rounds, morning report, notes and orders are all written in Spanish.
Medical Care Facilities
Hospital Vozandes del Oriente is a primary care hospital with 28 inpatient beds located on the edge of the Amazon rain forest. The staff at the hospital provides the full range of family medicine, including obstetrics. Surgeries are performed three days a week. The hospital accommodates about 160 deliveries each year, with a 16 percent Cesarean-section rate. Upwards of 18,000 outpatients are served and over 600 major surgeries are performed each year.
The hospital sponsors a community health program that goes to the surrounding jungle to teach health promoters how to care for their small villages. The health program is also helping communities find and treat falciparum malaria.
Public Health Initiatives
The hospital sponsors a community health program that serves residents of fifteen small villages in the surrounding jungle. Public health personnel provide education that emphasizes in malaria prevention and treatment, personal hygiene and sanitation, vaccination and well child-care. Water borne diseases are common, and the community health program works with community residents and engineers to create functioning water systems that work in concert with personal hygiene and sanitation efforts to prevent such diseases.
INMED students participate in the complement health education activities and engineering efforts. Supervision of the public health program is provided by Bruce Rydbeck, a civil engineer with experience in hydrology and electrical engineering. His resume includes development to the famed hydroelectric system at Tenwek Hospital in Kenya.
Health Profession Staff
Hospital Vozandes del Oriente is attended by a staff of three family physicians: Joseph Martin, Dan Bennedick, and Matthew Kappen. General and vascular surgery is provided by David Graham (East Tennessee State), orthopedics by Eckehart Wolff-German (Germany), and anesthesiology by Germán Suárez (U. Católica Quito, Ecuador) and Paul Barton (Univ. of Texas Southwestern). In addition, there are always three Ecuadorian family medicine residents from Quito in a program based on the ABFP curriculum. There are also always three Ecuadorian fourth year medical students present at Hospital Vozandes. The current medical director is Dr. David Graham.
An self-paced at Hospital Vozandes del Oriente is supervised by the above staff. Students will:
- Write histories and physicals on all patients admitted to the hospital while on call.
- Perform preliminary history and physical exams on all patients seen in the three bed Emergency Department, discuss the patient, diagnostic and therapeutic plan with the resident or attending on call, and complete the Emergency Department progress note.
- Present histories and physicals on all admitted patients at morning report.
- First assist in the operating room for all surgeries on the day they are assigned to OR duty. Depending on the case, the student will often close the wound. The student will also follow the patients they saw in the OR, writing daily progress notes.
Students will have the chance to care for some diseases rarely seen in developed countries such as leischmaniasis, tuberculosis, pyomyocitis, malaria, dengue, intestinal parasites and bacterial dysentery, among others. In 2005, the hospital performed 132 deliveries. Medical students are an important part of the health care team at Hospital Vozandes del Oriente, and they enjoy their time there tremendously. Students in nursing, laboratory technology and ultrasound are also welcomed, as our staff in these fields are fully trained and licensed Ecuadorian nationals.
Student Lodging & Meals
Students are accommodated in dormitories, where they have a common living area and private sleeping areas. There is a kitchen in the common area where students can prepare a meal, or the student can choose to eat typical Ecuadorian food prepared in the hospital’s kitchen at a cost of about $1 to $2.50 US. Occasionally, medical students and residents stay in one of the houses associated with the hospital.
Students have access to two computers that can be used for email. They also have access to phone booth stations that can be used to call internationally.
In Shell, people pass the time with friends and family having cafecito (coffee) or playing soccer. Favorite foods available in town include salchipapas (french fries with little hot dogs on top) and fritada (fried pork). During the weekends, students can venture to a number of eco-tourism sites within 3 hours. The capital, Quito, is 5 hours away.
INMED invites all participants to consider raising extra funds to donate to support the facility. This is not required but allows INMED participants to become involved in every aspect of medical missions.
Behavior & Dress
Students should dress in business casual attire. For men, no ties are needed. Jeans and tennis shoes should only be worn on the weekend. Lab coats are options but are rarely used. For women, closed shoes are recommended for safety. Professional pants or knee length skirts are acceptable. Wearing shorts during free time is discouraged other than for exercising.
What To Pack
Students should bring along their personal checkbook to access cash. The nearest reliable bank machines are 1 hour away, so students can write a check in the hospital to receive cash.