Hombro Clinic Update (from Rich)

Let me start with last week's "paro", or work stoppage. We have a lot of taxis in this town, and Tuesday at dawn, every big intersection in the city was blocked by 8 or 10 yellow cars. No one was going anywhere, except on foot; the highways through and around Santo Domingo were also blocked, and nothing was moving along these important transit routes connecting the highlands and

Cristian, Leonardo Oviedo, Rich, Jemina, Jaqueline, Maricela & Rocio

Quito with big ports on the coast. The reason for this general strike was to procure provincial status (comparable to statehood) for the Santo Domingo area. A one-day paro two weeks ago had failed to get the attention of the national power base in Quito, so this paro was widely reported to be indefinido, lasting as along as it would take to get the job done. It didn't take long. The national assembly acted within 10 hours, and Santo Domingo, to everyone's gratification here, is now officially a province.

The local folks feel that this is their due because Santo Domingo has grown so rapidly over the past 40 years. From elsewhere in Ecuador and Columbia and other places, people move here for a better life; Santo Domingo is the land of opportunity. There are jobs here. A taxista can make maybe $20 a day, handsome pay in a country where the mean annual income is perhaps $1200. And there are places to live, places that range in level of organization and affluence from "invasiones" (invasion zones) - where a person can find themself a little unoccupied turf, sink some roots, and petition the local government later for property rights - to cooperativas, which are more or less organized efforts on the part of a large number of people to pool their resources, buy a tract of land, parcel it out and set up residence.

In the "suburbs" of Santo Domingo served by the Hombro A Hombro clinic, we have both types of communities, ranging from pretty rough, the coop part, to really poor, the invasion part. None of the roads are paved. Lots of chickens. As far as I know, we are the only clinic serving this area and we are up to about 25 patients per day, about 60% pediatric. Jubileo is currently providing the salary of our nursing assistant, Mercedes, and for half of the salary of our dentist, Jemina. We have also purchased or are purchasing a refrigerator for the clinic, and a sterilizer. We are paying to have the clinic cleaned twice a week, and are beginning a program which will pay for the prescriptions and specialty referrals for patients who can't afford them.

Our staff, in addition to Mercedes and Jemina, includes Maricela, the receptionist; Rocio, the nurse; Jaqueline, our administrator; Cristian Carrion, our general doctor who sees both adults and children; and our pediatrician (me). We are open every day from 8:30 a.m. until 2:00 pm. and have recently started Saturday office hours. We don't give appointments (not really a concept here), so whoever needs to be seen just shows up and the parents chat in the waiting room and the kids play on our front porch. We do lots of immunizations, of course, and are involved in a very successful goverment-sponsored food supplementation program for nursing moms and young children up to age 3.

Our little pharmacy stocks most of what we need and we can sell prescribed medications to our patients at a reasonable cost, usually less than $2 per prescription (medicines here are generally no cheaper than in the states, and Ecuador has no government subsidy, so this is a substantial saving). Subject to need, we charge $2 per visit if the patient is ill, but don't charge for preventive visits or for immunizations. We recently started a program for cervical cancer screening and have regular outreach to the three local elementary schools and one high school in our area; this outreach includes yearly blood screening for anemia, stool screening for parasites, growth monitoring, vision screening, dental screening, and, for adolescents, education regarding the prevention of sexually transmitted diseases.

We are very excited about this effort. Our staff is enthusiastic, hard-working and competent. Like us, they see this as a mission which has made a good start but has lots more to do. Thanks for your interest, and we hope you check in with us periodically to learn more about our progress.