Long Road from Quito

Transforming Health Care in Rural Latin America

Tony Hiss

• Publisher: University of Notre Dame Press
• Year: 2019
• Print ISBN: 9780268105334
• eBook ISBN: 9780268105365
• Topic: Medicine
• Subtopic: Medicine Biographies

Long Road from Quito presents a fascinating portrait of David Gaus, an unlikely trailblazer with deep ties to the University of Notre Dame and an even more compelling postgraduate life. Gaus is co-founder, with his mentor Rev. Theodore M. Hesburgh, C.S.C., of Andean Health and Development (AHD), an organization dedicated to supporting health initiatives in South America. Tony Hiss traces the trajectory of Gaus's life from an accounting undergraduate to a medical doctor committed to bringing modern medicine to poor, rural communities in Ecuador. When he began his medical practice in 1996, the best strategy in these areas consisted of providing preventive measures combined with rudimentary clinical services. Gaus, however, realized he had to take on a much more sweeping approach to best serve sick people in the countryside, who would have to take a five-hour truck ride to Quito and the nearest hospital. He decided to bring the hospital to the patients. He has now done so twice, building two top-of-the-line hospitals in Pedro Vicente Maldonado and Santo Domingo, Ecuador. The hospitals, staffed only by Ecuadorians, train local doctors through a Family Medicine residency program, and are financially self-sustaining. His work with AHD is recognized as a model for the rest of Latin America, and AHD has grown into a major player in global health, frequently partnering with the World Health Organization and other international agencies. With a charming, conversational style that is a pleasure to read, Hiss shows how Gaus's vision and determination led to these accomplishments, in a story with equal parts interest for Notre Dame readers, health practitioners, medical anthropologists, Latin American students and scholars, and the general public.

Index

achiote bush (lipstick tree), 34

Aedes aegypti mosquitoes, 74–76

Aedes albopictus (Asian tiger) mosquitoes, 74–76

Afro-Ecuadorian community, founding of, 129

AHD. See Andean Health and Development

AHI (Andean Health Institute), 188

Alfredo (boy dying of snakebite in Pedro), 56–57, 60, 145, 192

Alma-Ata conference (1978), 94–100, 101, 102, 104, 111, 186

Alvarado, Carlos, 162–63

Amerindians

Chachi people, 129

Columbian Exchange, 32, 34, 85–86, 129, 188

Maya-Kaqchikel people, 104–6

mestizaje, 31

Shuar people, 42

Tsáchila people, 24, 33–35, 38, 39, 56, 162

Andean Health and Development (AHD/Saludesa), 5, 44–45, 50, 77–78, 86, 114, 121–23, 154–56, 165

future of, 190–93

logo/crest, 44, 161

online publications, 191–92

residency/training program, 81, 172–75, 179–83, 186–87, 190

See also Hospital Hesburgh; HPVM

Andean Health Institute (AHI), 188

anemia/iron deficiency, 128, 146

Anopheles mosquitos, 73

antibiotics and antibiotic resistance, 30, 49, 57, 65, 101, 145, 162, 188

anti-venom, snake, 57–61

appendicitis and appendectomies, 25, 50, 111, 145, 163

Asian tiger (A. albopictus) mosquitoes, 74–76

Audy, J. Ralph, 170–71

autism, 67

balsa wood, 71–72, 83

Batwa pygmies, 4, 135

Behrhorst, Carroll, 104–8, 135, 141, 144

behvarzan program, Iran, 100, 186

Bill and Melinda Gates Foundation, 102–3

biopsychosocial (BPS) medical model, 110

Bitchin, Bob, 168

Black Death, 85

Bolivia, 72, 176

Boston City Hospital, 64–65

Bothrops asper (fer-de-lance/equis), 35, 55–56, 60, 76, 145

BPS (biopsychosocial) medical model, 110

Breslin, John, 137

Brezhnev, Leonid, 97

Bristol-Meyers, 134, 143

Buffett, Warren, 103

Bush, George H. W., 134

Bush, George W., 102

cabezudos, 80, 81, 84

Calmette, Albert, 58

camino a la cura, 23–25, 162

Cardijn, Joseph, 119–20

CARE International, 143

Carmen (woman dying of preeclampsia), 21, 145

Carondelet Palace (Ecuadorian White House), Quito, 5, 66, 156

Carroll, Lewis

Through the Looking Glass, 27

Carter, Jimmy, 111, 122

Catholic Worker movement, 119–20

cerebral palsy, 67

Cervero, Fernando

Understanding Pain, 139–40

Chachi people, 129

chikungunya virus (CHIKV), 72–75, 77, 78, 83

children survival revolution and selective primary health care, 101–2, 145

Chimaltenango program, Guatemala, 104–6, 107

China

Alma-Ata conference (1978) and, 95

“barefoot doctor” program, 92–94, 101, 105

diseases originating in, 72, 74

domestication of animals in, 84

Mass Education Movement, 91–92

World War I, “coolies” imported to Europe during, 90–91

Cho, Margaret, 101

citizens’ revolution in Ecuador, 28, 29

Civil Rights Act of 1964 (U. S.), 116

Clifton, Margaret, 17, 18

Cline, Barnett L., 111, 138–39

Clinton, Bill, 102

Colombia, 28, 37–38, 148

Columbian Exchange, 32, 34, 85–86, 129, 188

common cold, 84

Correa, Rafael (president of Ecuador), 28, 29, 64, 86, 108, 144, 178–79

cosmovisión (world view), 31, 161–63, 172, 181

CPR Annie or Resusci Anne, 17

C-sections, 108, 111, 163, 165

CT scanners, 49–52

Cuba, primary health care in, 100–101

curanderos, 24, 162

curative versus preventive medicine, 92, 93, 103–4, 122, 187, 190

Cutler, David, 177

Dalai Lama, 4

Darwin, Charles, 27

Declaration of Alma Ata, 94, 96, 98, 99

deforestation in Latin America, 74–75

dengue fever, 72–74, 78, 162

diabetes, 71, 82, 83, 172

diarrhea in children, 82, 101

differential diagnosis, 180

“dome of gloom,” 129, 144

domesticated animals, as disease vectors, 84–85

Dónde Coco. See Pescados Dónde Coco restaurant

Dooley, Thomas “Tom” A., III, 131, 134–36, 149

The Edge of Tomorrow, 135

Dries, Laura, 154–55

driving in Ecuador, 44–45, 47, ...

Table of contents

• Half Title
• Title
• Copyright
• Contents
• Foreword
• ONE. Rosa
• TWO. “Can You Fix Her?”
• THREE. Camino a la cura
• FOUR. A Beggar Sitting on a Bag of Gold
• FIVE. Transistor Radios
• SIX. Panama Hats
• SEVEN. The Honorable Chain
• EIGHT. Lightning Bolts
• NINE. Hospital Hesburgh
• TEN. Where’s Coco?
• ELEVEN. Transitions
• TWELVE. Souvenir
• THIRTEEN. Rosy Afterglow and Cold, Hard Dawn
• FOURTEEN. Family Medicine
• FIFTEEN. Father Ted
• SIXTEEN. The Big Stuff
• SEVENTEEN. Beyond the Dome of Gloom
• EIGHTEEN. In an Ecuadorian Way
• NINETEEN. How to Be a Hospital
• TWENTY. An Unremarkable Room
• TWENTY-ONE. A Pair of Boots
• TWENTY-TWO. Tell a Really Big Truth
• TWENTY-THREE. Health in Ecuador—The Next Ten Years
• Afterword
• Index