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Sunday, February 9, 2014

How to handle life-threatening emergencies in Ecuador. February 2014.

from  Ecuador Welcome Forum
I have lived in Cotacachi since May of 2013. Having been one of the first paramedics in the U.S. in the 1970's and '80s and an EMS writer (, naturally I was curious about the emergency medical system here. 
I'm still learning and have much to pick up regarding the larger cities, but I can tell you this: if you have a medical condition that could spin you in to a life-threatening emergency DO NOT move to a rural area of Ecuador!

...and ANYWHERE in Ecuador, if you move here make sure as soon as you arrive you learn about the emergency services available to you, how to contact the proper agency and WHICH HOSPITAL you would be brought to. You MUST immediately plug in to the medical system that is here! And that is just for starters. 
What I'll say to anyone moving to Ecuador is this: You need to take a heavier responsibility for your own medical well-being here than you ever have at home.

Now Cotacachi is considered a "rural" area. But the ciudad has 10,000 population with another 50,000 in surrounding areas so it's not the styx. It has a Public Hospital there. 
It gets a lot of favorable press and has really been attracting a lot of jubilados.

But I'll estimate 10% of the Gringo residents fall into the category of high potential for an acute, life-threatening episode. This is based on meetings I've been having with residents. 
In the U.S. and most of the "1st World" the truth is the people take for granted the availability of quality -- or at least consistent - emergency medical response and care.

Ecuador, however, is very much like Forest Gump's Box of Chocolates; "You never know what you're going to get." 
I will go so far as to state that even in the bigger cities, unless you pre-plan you still won't know. 
It's two o'clock in the morning and you have chest pain and shortness of breath. You call 9-1-1 and find there is no 9-1-1 (in Cotacachi). You discover you must call the Hospital direct, (How is your Spanish coming along?)If you get through the communication part -- like how to get TO you since addresses are not marked well if at all-- you could get anything from a 1 hour response time because the driver had to ride his bicycle to pick up the ambulance (and when he the "chofer" arrives it's just HIM and no one else to help get you down the 2nd story walk-up you live in), to a fully equipped emergency room on wheels with a Physician, Nurse and driver on board.

Unfortunately, odds are none of them are trained in advanced emergency care and the defibrillator won't work. The nearest hospital with a Cardiac or Intensive Care Unit is 30 miles away in Ibarra. 
In one case I know of, by the time the expat got there and went into cardiac arrest they couldn't even find a defibrillator in that hospital that worked!

I'm specifying Imbabura Province now but as I go deeper, here's what I have learned. 
There's NOTHING wrong with the system here. It's appropriate for the culture which relies on family and extended family to handle all aspects of minor and emergency intervention. Utilization of "professional" emergency services is way down on the decision tree for the majority of the population.

Not only that but for the most part, the diseases they face are relatively simple and not as complex as In the U.S. which are further complicated by over medication. 
Folks, Gringos don't know how to take care of themselves medically -- all that power has gone to the Medical-Industrial Complex. And they also don't know how to take care of each other in community. These are essential survival skills that expats must begin to develop.

I've started working with the expat community here to develop what amounts to "Household Battle Plans" to be utilized in the event of a medical (or traumatic for that matter) emergency. 
Naturally, you'll hear more about this but rather than delay, I thought it would be important to start a serious discussion here (go to  Ecuador welcome forum for more info - L.B.)

Blessings to all!
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