Greetings from Santo Domingo!

After a grueling 10-hour journey south, we landed in Quito, the capital of Ecuador. We felt the fresh difference in the air quality at 9000 feet elevation and got to meet the rest of the team as we traveled to our nearby hotel for a night. We came to discover how geographically diverse our team was as a couple doctors were from the Midwest, we were from California, and the nursing students were from Boston. Conversation flowed easily as we shared our mutual excitement for the food, the views and of course, the patients and clinic. The next day, we traveled another 3 hours to beautiful Santo Domingo by bus, where we would be doing the bulk of our clinic work. As we settled in our hostel, surrounded by lush flora and the sound of the rushing river and chirping birds, we began our preparations for the week.

Annie Allnutt, the Timmy coordinator for Santo Domingo, gave us a quick run-down of clinic, which would consist of registration and history, vitals, consults and pharmacy. As we got a general idea of our roles and stations, we quickly got to work packing medications into little bags for the week. Aaron and Cindy became master pill counters while Purnima furiously labeled medication bags to hold all the pills. We bonded with the nursing students, doctors and the Ecuadorian medical students and physicians through the flurry of packing and counting medications. After finishing and handing out high-fives, we got our first traditional dinner in Santo Domingo, which consisted of delicious chicken, rice and potato wedges.

Post-dinner, we had a quick rundown of TimmyCare, which is their mobile EMR system designed to provide long-term care. It was pretty amazing that the people of Ecuador could access a system that would keep track of their healthcare, provide consistent treatment plans and notes for the next brigade and referrals to local clinics and specialists. In addition, this system facilitates brigade transition and long-term continuity of care (since brigades visit every 3 months) by allowing future brigades to access previous notes and treatment plans for their patients. Through the referral system of TimmyCare, we also learned about the Sub-Centro community clinics, which are the main healthcare system provided by the government of Ecuador. We learned about their limitations, such as the number of patients per doctor, which was 1000:1.6. This meant that many people had to wait for long periods until they could even see a doctor. This is where Timmy fits in, by serving as an intermediary and providing healthcare access while patients were in-between appointments. Timmy also helps reinforce the relationship between the communities and Sub-Centro by reminding patients to follow-up with the Sub-Centro for their main healthcare.