This week I was assigned the task of analyzing club foot in the area of Otavalo, most famous for its all-day, everyday market. Our goal here is to get an understanding of clubfoot in more rural areas, since we are planning to partner with doctors in the major cities of Quito and Guayaquil.
First on the list of clinics and hospitals was “Hambi Wuasi.” Because the clinic wasn’t busy, I met immediately with the director. There are certain days when my Spanish is rudely incoherent, and lucky me, I chose my first day of real interviews! Nevertheless, I discovered some very interesting information:
- According to the director, the clinic hasn’t seen any clubfoot patients since his tenure began.
- If there were a club foot patient, he/she would be sent to El Hospital San Luis.
- The clinic doesn’t have the ability to treat clubfoot; it’s focus is primary care and not much else. If someone has a significant problem, he/she will go to San Luis.
- The clinic is partially free. The Ministry of Health provides some funding. A consultation is $5. Any medicine is also $5.
- The director explained that his clinic offers modern and traditional medicine (Otavalo is a very traditional town where many Quichua people reside).
- The director had never heard of the Ponseti Method.
Getting a meeting with the director of San Luis hospital was more difficult. Her secretary required that I write a letter in Spanish explaining the need for a meeting, who I am, and available times. While you may wince at my speech, you would literally cry at my writing (a bit of a stretch; my writing isn’t half bad, although I resort to the present tense mostly). After about 30 minutes, I was told that the director is ready for me. The director was very busy, but I managed to find out:
- There aren’t many people with foot problems at San Luis.
- It’s a basic hospital with internal medicine, etc.; but no orthopedic ward.
- If there are any surgeries, they are basic and on bones.
- Every service is free here, thanks to the Ministry of Health.
- If a clubfoot patient came to the hospital, he/she would be referred to Baca Ortiz.
I found it troubling that the Hambi Wuasi director said he would refer clubfoot patients to San Luis, while the San Luis director said she would refer them to Baca Ortiz Hospital (the large publich children’s hospital in Quito). This means someone with clubfoot in Otavalo will be shuffled around from one hospital to the next, finally ending up in Baca Ortiz. Ideally, parents will take their child with clubfoot to the nearest clinic to get treatment.
The Ponseti Method is fairly simple when the right tools are available. Because clubfoot treatment in Otavalo is essentially nonexistent, the parent must take his/her month(s)-old child to Quito, a 2.5 hour bus ride. There, the parent and child must take a metro, bus, or expensive taxi to Baca Ortiz, which is a good distance from the bus station. Upon reaching Baca Ortiz, the parent and child must wait in an endless line for potentially hours. They will probably have to spend the night in Quito with either family or at a pricey hotel near the hospital in order to make it back the next day to stand in line again.
This summer miraclefeet is getting a concrete understanding of clubfoot across Ecuador. Ideally, the clubfoot patients in rural areas would receive some help in getting access to treatment. This could be through mobile care or partnerships with other international health organizations that might know of people with clubfoot.