February 22, 2022

Taking Care of Ecuadorian Kids

Jay Crittenden, MD, FACR

About 22 years ago, an opportunity arose through our church. My wife (a sonographer) and I were invited to go to Quito, Equador, to do primary care for 500 impoverished kids. You can imagine my reluctance to switch gears from diagnostic radiology to pediatrics — especially considering we’d have no access to imaging of any kind. In spite of our misgivings, we decided to accept this challenge.

Prior to departing, our major job was to gather the medications we would use to treat common illnesses in Quito. These turned out to be parasite problems (ascaris and ameba), URIs and UTIs. We appealed to pediatricians at my healthcare facility and accumulated a basic pharmacy.

Upon arrival, we were housed in a facility with meager sleeping and bathing facilities. The male members of our team were amused at 11 female team members with a large, common bedroom. These accommodations included one shower and, even more telling, one small mirror for them all. Notwithstanding the housing, the major problem was the food and liquids, which were not sufficiently heated to kill the local E. coli. In the first few days, about half the team had significant enterocolitis, and we had to move to a better facility.

In spite of these problems, we managed to begin our work examining and prescribing meds for the kids whose ages ranged from infants to teenagers. I quickly discovered that my academic work-up was far too time consuming, and with the help of a wonderful Ecuadorian assistant and translator, I switched to a work-up more appropriate for the situation.

Our clinical work was supervised by a wonderful Christian Ecuadorian physician, Roberto Contreras, who had trained in the U.S. He was a fantastic resource when a puzzling pediatric case arose. A personal low point occurred in this regard when I discovered a bluish tumor protruding from what appeared to be the middle ear. The lesion was largely covered with earwax, resulting in limited visualization. I had never seen a glomus tumor clinically but thought this must be one. Excitedly, I took the child to Dr. Contreras for confirmation. One can imagine my chagrin when he asked the child’s mother, “How long has that blue marble been in the child’s ear?” Wow, how humbling.

By the end of the week, we had seen and treated about 500 kids. In subsequent years, we were forced to expand our patient age range as some parents, and even grandparents, needed care. This necessitated adding adult meds to our pharmacy, and eventually we turned to a wholesale drug house for meds at a lower price since used outside the U.S.

Our inclusion of adults was not without problems. One year we had expanded our physician staff to include a pediatric intensivist. She was concerned about the possibility of seeing adult patients outside the scope of her practice. I assured her we would triage patients, and I would take mostly adults while she primarily treated infants. Unfortunately, the first round of patients was reversed — I got an infant and she got a 65-year-old man with erectile dysfunction!

Over the years, we incorporated portable ultrasound as our sole imaging modality. We used sonographers who had trained at the Florida Institute of Ultrasound where I am medical director. It’s amazing the problems one can solve with ultrasound when pushed.

We also met Emelio Romero, a wonderful Ecuadorian radiologist. With his help, we established a free mammogram program and eventually achieved complete coverage for every woman over 40 in this small section of Quito. We are currently seeking funds to expand our program.

COVID interrupted our 20th trip to Quito in 2020. We hope to resume our program when immunizations and other situations improve. Nevertheless, this service will be a major chapter in a long, eventful career in the specialty I love.