"I’m just a CT1 and they are all Consultants"
I was born in Quito, Ecuador where I lived and studied for my
medical degree and then decided to move to London for my training
in Psychiatry. So I can say that I know very well my country -
especially after living there most of my life and during my medical
career. But I think that you learn to know and appreciate more your
own country, when your view of life has been changed after living
aboard and especially studying aboard; and that is what happened to
me in my last visit to Ecuador, my home country.
If I can say what the change was in this visit, I went not only
for holidays to spend time with my family, but I also went to work.
I thought going back to hospitals was going to be easy, but it
wasn’t. My goal was to liaise with the most important mental health
hospitals in the country and introduce to them our project/charity,
Sud-World Project to establish a link so we can work together to
meet their needs in the future.
I was really happy because the response was very good, but at
the same time I was so afraid. The only thought through my mind was
I’m just a CT1 and they are all Consultants.
"I think the most important change is the reintegration of the
patients in the society, especially for patients that have been
admitted for more than 20 years. This is the first time this has
happened in Ecuador; as there still exists the concept of “asylum”
or “madhouse” in the country."
In my first visit I went to visit the
hospital Lorenzo Ponce, currently known as Instituto de
Neurociencias, de la Junta de Beneficencia de Guayaquil in
Guayaquil which is the most important city port in the country. I
was received with great joy, but with high expectations. The
Lorenzo Ponce Hospital was the first Mental Health Hospital in
Guayaquil and one of the first in Ecuador, and covers around 60% of
the population of the country.
When I arrived I can say I was in shock, in a good way, for two
specific reasons; first the huge physical changes in the building.
It was not any more that old, depressing and scary hospital,
everything was new, cleaner and with new open areas, such as
gardens. The second reason was because of a presentation they did
about the hospital and the most important changes they have made in
the last 5 years. I think the most important change is the
reintegration of the patients in the society, especially for
patients that have been admitted for more than 20 years. This is
the first time this has happened in Ecuador; as there still exists
the concept of “asylum” or “madhouse” in the country.
I had the opportunity to visit the first residential house
for four women patients who were discharged from hospital after 20
years. It was amazing to see how proudly they show you their new
house, and how they tell you their own stories. They remain under
the care of the hospital. And this is exactly where they would like
our help: how to organise a mental health care plan in the
community so they can put reintegration into practice with the new
patients they are planning to discharge.
On the other hand in my other visit to Hospital Sagrado Corazon
de Jesus in Quito, capital of Ecuador, my impression was totally
the opposite. There still exist the long admissions to the wards.
Out of 230 patients, around 200 patients have been in the hospital
more than 20 years and they know that place as home. The remaining
30 are the ones that have money and a place to go after discharge,
such as families. Here the help that they seem to need is
completely different: a new structure on the ward, new
psychological inputs and a more comprehensive treatment plan.
"Hugging is part of their culture"
Personally I can say that going to Ecuador was an
overwhelming experience, but always in a positive way. I realised
the things are missing, but that things are changing, and I got
some ideas about things that we might be able to do to help
immediately and in the longer term..
But the thing that I like most that will never change is arriving
at a hospital where people are warm and cheerful and hugging is
part of their culture. This enables you in the end to see the
saddest and biggest problem in a different way, even with a smile
in your face. For example arriving and a patient approaching you to
say hi with a kiss on your cheek is something that I would never