So I finally figured out how to access the blog from the hospital library (note: it was not actually hard). I have been less than compliant blogger in the face of somewhat long hours, weekend travels, weekend gringa disease, and taking advantage of the international atmosphere of my hostel to talk with fellow travelers.

So to answer the spirit of learning from my Ecuadorian colleagues, I will reflect on the medical and non-medical cultural exchange exchange I have been fortunate to participate in.
First, from a medical perspective. What has been striking to me is the fact that I am at a private hospital in the capital city that only serves those with private insurance. Those with public insurance, unless there is a true emergency, are referred to the public hospitals. In fact, the patients I see here have better access to resources in general compared to the patients I see at Sunrise. This was not the original plan as Dr Wilson and I had discussed going to Clinica Carapungo, but such is Global Health. You gotta roll with it, especially when you are only around for a short time. So while seeing patients with my local host resident, Edwin, as well as other providers I have been rotating with, we have gotten to discuss our different healthcare systems, medical education system, and treatment strategies to common diseases. Outside the obvious infectious disease difference, common things seem to be common. Heart disease, diabetes, and hypothyroidism are often seen in the outpatient "consultas externas". One glaring difference is the use of ARBs almost exclusively instead of ACEi for management of HTN. The explanations I have gotten range from "They are stronger than ACEi" to "Well if 20% of people get cough, just start with with ARB" to "This is how we practice". Other medical management differs with availability of specific medications/different generics used more commonly/different brands for common generics (often contributing to my constant "What the heck medication is that" and either asking or Googling it quickly). Overall, either US or European guidelines are followed. With the inpatient service, I have seen a number of pyelonephritis cases, osteomyelitis, C diff, IDA, stroke, encephalitis, and MIs. Management is generally similar though treatment of infectious is naturally influenced by local resistance patterns.
During downtime, a few of the residents and I have had time on various occasions to discuss differences and similarities to our education and training. I give away too much at this time except to say, like many times when you get to know someone seemingly quite different than yourself, you find more similarities than differences.