Overcoming Logistical Barriers to Health
By Alana Gilman
Former Medical Brigade Coordinator
Timmy Global HealthÂ met Victor on the January DePauw brigade to Tena, Ecuador. He is ten years old and had an inguinal hernia that had been bothering him since age four. He experienced discomfort while playing and painful urination. While this is a relatively simple and cheap surgery, the public hospital in Tena, Ecuador did not feel equipped toÂ provide the necessary operation due to possible complications from a heart murmur. Up until this point, the family of five had few options other than their local public hospital. Traveling to Quito to pay for surgery at a private hospital would be logistically and financially difficult and therefore outside of the realm of possibility. As Timmy discovered, the heart murmur was benign and would cause no barrier to surgery. It is hard to say exactly what may have happened at the public hospital that they felt unable to perform the surgery, but it is not unreasonable to believe that they may have been turned away simply because of a shortage of beds, resources, or the personnel needed to take on Victorâ€™s case.Â As is the case in many public hospitals in the developing world, the hospital system in Ecuador is overwhelmed and underfunded and patients such as Victor may remain on a waiting list for years forÂ surgeries that are not emergent.
Victorâ€™s parents completed public schooling through the US equivalent of 7th grade before dropping out to work the fields with their parents. They have two other children, ages 3 and 13 months. They have owned their own home for six years which they received free of charge from the Ecuadorian government through a housing project in the Amazon. They have no running water and use only a rainwater collection system. They have an outhouse next to the house and recently were able to purchase a stove for cooking. By Tena standards, the family is actually better off than most of our patients since Victor’s father was fortunate enough to get a job in a tourism company that pays him $300 a month. Victor’s mom stays home to take care of the children.
When we first spoke to Victor’s mom about treatment in Quito, she seemed hesitant and mentioned that she had been offered help like this before that never came through. After discussing our process with her and the fact that we would cover all transportation and lodging costs as well as the majority of the surgery, she agreed. On Tuesday, February 8th, Victor and his dad met the Timmy Foundation Medical Brigade Coordinator in Quito for their appointment with the pediatric surgeon the following morning. TheirÂ five hour drive from Tena was facilitated by Timmyâ€™s local government partner, Consejo Provincial. We put them up in a local hostel and provided all meals for the duration of their stay. On Wednesday morning we met with a physician at Timmyâ€™s international partner organization in Quito, the Tierra Nueva Hospital, Un Canto a La Vida. After a short consultation, he scheduled Victor for a 20 minute surgery on Saturday morning. The total cost of the surgery and necessary exams was $260. After an interview and economic evaluation with the Tierra Nueva social worker, they came to an agreement of a $100 payment from the family with the rest of the costs covered by the Timmy Social Work Fund. Each month, Tierra Nueva receives $2000 fromÂ the Timmy Foundation to defray costs of low income patients such as Victor.
The recent expansion of Timmy’s programming in the Amazon basin paired with the long-standing relationship and history in Quito with Tierra NuevaÂ allows us to locate patients such as Victor in remote areas of the country with limited access to health services, and provide them with prompt and effective care at the private hospital in Quito.Â Like much of Timmyâ€™s programming, the collaboration between Timmy,Â its local partners in Tena, and Timmyâ€™s long standing ally â€“ Tierra Nueva â€“ is an example of the behind the scenes â€œhealth systemâ€ Timmy has created to ensure that its patients receive quality care.Â While Timmyâ€™s medical brigades serve as an entry point, the healthcare infrastructure Timmy has helped create on the ground ensures that those medical brigades are supported by proper follow up.Â For Victor, this meant just a short stay in Quito and a successful surgery after years of a painful pediatric condition.Â Victorâ€™s story is the first of what are sure to be many more collaborations between Timmy and its partner organizations in the Amazon basin and Quito.