Outpatient Clinic

Approximately 24,000 patients come through the outpatient clinic each year. Within the clinic itself are nine examining rooms where missionary doctors and Ecuadorian family practice residents who attend to the people who come each day. The clinic is open from Monday thru Friday with a charge to the patients of $3 for a first time visit and $2.50 for a return visit.

There are four family physicians, one part-time pediatrician, and one surgeon among the regular missionary staff. There are also two family practice residents from Hospital Vozandes in Quito who rotate through the Shell hospital each month.

Emergency Room

The emergency room (ER) is the point of entry for seriously ill patients and patients who become ill in the night or on weekends or holidays when the outpatient clinic is not open. The first person to receive these patients is the nurse on duty in the ER.

After vital signs have been taken, the intern on call will come in to assess the patient. Hospital Vozandes del Oriente receives two interns each month from the sister hospital in Quito for rotations in rural medicine. After reviewing the patient's vital signs and evaluating the patient he or she will call the family practice resident on call. The resident on call will receive the report from the intern and take an additional history from the patient and examine him or her as necessary. At this point laboratory studies and X-ray exams will be requested if necessary.

If the resident has questions or if the patient is to be admitted to the hospital, then the family practice staff physician on call will be consulted. If the staff physician feels that surgery may be needed, he in turn will consult with the hospital surgeon. At the time that a diagnosis has been made and a treatment plan suggested is often when a moment is taken to pray with the patient to ask for God's help and guidance for the patient and the attending doctors and nurses.

Operating Room

Surgery and the administration of anesthesia always pose some measure of risk. This is especially true in many hospitals where careful monitoring of patients is not performed and tragic outcomes ensue. In many hospitals in developing countries, the chances of surviving a major surgery are by no means guaranteed. However, Hospital Vozandes in Shell enjoys one of the lowest complication rates of any hospital of its kind in all of Ecuador. It is for this reason that many people come to our facility for their surgical needs. On average, 630 cases of general and ophthalmological surgery are performed at the hospital each year.

Laboratory

With 15,000 outpatient visits and almost 2,000 inpatients per year, one can imagine the volume of laboratory requests that come through the Hospital Vozandes laboratory each year. Pictured here is the head of the laboratory, Narcisa Brito. Although some basic services like pathology are not available within the Vozandes laboratory, it remains one of the best medical laboratories in the region.

The Vozandes laboratory includes the only tuberculosis (TB) laboratory in the eastern portion of Ecuador. This is important because the incidence of TB infections which are resistent to multiple antibiotics is wide-spread in this area. Being able to identify resistant TB organisms is critical to adequate treatment of this important disease.

X-ray

No hospital would be complete without an X-ray department. Although advanced radiology studies like CAT scanning and MRI studies are only available in the largest population centers in Ecuador, Hospital Vozandes is able to meet the basic X-ray and ultrasound needs of the province. Pictured here is Carlos Morales from Quito. He has been trained as an x-ray and ultrasound technician and is a valuable part of the healthcare team.

Like the laboratory, the X-ray department processes a large number of requests from inside and outside of the hospital. Plain X-rays and ultrasound examinations are the main procedures provided by this department. Normal working hours are from 9 AM to 5 PM, but the techs are always on call for emergencies.

Pharmacy

The pharmacy is another important part of the ministry of Hospital Vozandes. Without medications, most doctors would have little to offer their patients. And providing medications at a cost that the patient can afford is an important dimension of the Vozandes pharmacy.

Although many medications can be obtained more cheaply in country, there are a number of more expensive medications that are obtained through mission support programs like the Medical Assistance Program (MAP), International Aid, Interchurch Medical Assistance, and many pharmaceutical companies that have programs to support medical missions in developing countries.

Nursing

And where would a hospital be without nurses? Although the doctors often recieve a great deal of praise and attention with regard to the successful running of a hospital, it is also true that the nurse spends more time with any given patient on the ward than his attending physician.

The nurses at Hospital Vozandes are truly general. There is no such thing as a nurse who only does pediatrics, or obstetrics, or surgical patients. Here every nurse is called upon to do all of these things. one moment she might be suctioning an endotracheal tube for a patient on a mechanical ventilator, the next moment she might be helping with a delivery, and the very next moment she might be starting an IV on an infant.

Chaplaincy

To heal a person physically while leaving them dead spiritually represents an inadequate care plan at Hospital Vozandes del Oriente. Senior chaplain, Jesús Montero, visits each and every inpatient at the hospital at least once each day. During outpatient clinic hours his door is always open for walk-in visitors to discuss whatever happens to be on their mind. Many times the doctors will have a patient whose marriage is failing or perhaps who no longer feel that life is worth living. The chaplains represent a valuable adjunct in meeting these types of needs among the patients in Shell.

Administration

Administration is often overlooked as an important aspect of any missions activity. Typically viewed as folks who push papers and sit behind desks, their vital role in the day to day operation of the hospital is often overlooked. And yet without someone coordinating the work of multiple departments, it would not be long before everything simply fell apart. Issues of finance, national personnel, and missionary personnel are but a few of the many areas in which the Hospital administrators are involved on a regular basis. Although the vision for the future of the hospital is as likely to come from the staff as it is from the administration, it is the job of the administrators to maintain the focus of the ministry and to keep the budget balanced.

Accounting

The annual budget for Hospital Vozandes comes to approximately $500,000. About $100,000 comes from charity (most often the U.S. and Europe), and the rest comes from fees charged to patients. Sometimes people ask why charge patients at all if Hospital Vozandes is a mission hospital? The answer is to avoid creating dependency. This is an important concept currently being discussed in mission circles. Many missions are accused of undermining local efforts by people to care for themselves by providing for their needs free of charge. There also seems to be a biblical mandate that those who are able should work to meet their needs. Of course, many patients are not able to meet their own needs, and charity is a regular part of the work at Hospital Vozandes. It is estimated that 80% of patients receive at least partial charity for the cost of their care.

Computers

As surprising as it might seem for a jungle hospital, Hospital Vozandes del Oriente has a thriving computer system. The backbone of this system is a local area network (LAN)suplemented by a satellite connection for internet and e-mail. This same satellite connection also allows for satellite phone connections to Quito and the U.S. even when the local phone system is down. It is said that e-mail has revolutionized the mission field by allowing family and friends to remain in close contact even when they are literally half a world away. And for this reason it is likely true that if it were not for e-mail, there are many missionaries who could not remain on the field. The information services department in Shell is small (two people), but it plays an important role in archiving patient and accounting data and keeping the mission community in touch with the world.

Maintenance

It is not hard to imagine that when there are many technically complex systems in one place, that sooner or later something will break down. Add to that the need for maintenance and repair of mission housing and the Nate Saint Memorial School, and it is easy to see why the maintenance department is so important to the hospital.

Jobs like mowing the lawn, maintaining mission vehicles, repairing medical equipment, and answering maintenance calls from a medium sized mission community keep the maintenance team on their toes. These folks are truly jacks of all trades in that woodworking, plumbing, electrical, and engine repair are but a sampling of their responsibilities.

It has been said that there is no career that can not be used on the mission field. And there are certainly many uses for missionaries who are skilled in maintenance.

Kitchen

Even when they are sick or have had surgery, patients have to eat. The hospital kitchen is a busy place every day of the week.

And since many patients often "pay" for their hospital bills by bringing food or other items to sell, the cooks must often be creative with what they prepare. When patients bring chickens or a basket of corn, the decisions are easy. But when patients bring a container of smoked monkey meat or an entire cow, then the fun begins!

Laundry

Laundry is another service area within Hospital Vozandes. The commercial wash machines and dryers are kept going Monday thru Friday keeping up with the high volumes of linens and laundry generated by the patients on the ward and in the clinic and operating room.

Medical Records

Not long ago chart number 100,000 was opened at Hospital Vozandes del Oriente. This means that since the new hospital opened its doors in 1985, this many new patients have been seen. Of course, patients come to the hospital more than once, so that the total number of patients seen in Shell numbers several times that amount over the past couple decades. Every patient seen at the hospital receives their own medical record whether they are initially seen in the emergency room or the outpatient clinic. Along with these paper records, computer records of basic personal data and all laboratory results are stored and backed up regularly on the server for the hospital local area network (LAN).

Nate Saint Memorial School

While Mom and Dad are at work in the hospital or in supporting ministries, the kids need the opportunity to go to school. It is a blessing to not have to consider boarding school or to have the added responsibility of home schooling in addition to the many demands for ministry at the hospital and in the community. Teachers who volunteer their time to staff the Nate Saint Memorial School are truly appreciated. The average attendance for grades K-8 is between 25 and 30. Typically grades are combined in to kindergarten, first/second, third/fourth, fifth/sixth, and seventh/eighth.