Long Road From Quito—Transforming Health Care in Rural Latin America

Book Title: Long Road From Quito—Transforming Health Care in Rural Latin America

Author: Tony Hiss

Publication Information: Notre Dame, Indiana, Notre Dame Press, 2019, 224 pp., $10.99 paperback

Clearly a remarkably talented and experienced storyteller, Tony Hiss, a former longtime staff writer for The New Yorker, current NYU Visiting Fellow, and author of over a dozen books, tells the tale of Dr David Gaus and Andean Health and Development (AHD). AHD is a nongovernmental organization that founded two hospitals in rural Ecuador. Dr Gaus, who is an equally talented individual and hard-working physician, grew up in Milwaukee, Wisconsin. He later attended the University of Notre Dame, and then Tulane University for medical school and a master’s in public health and tropical medicine.

The bridge between his accounting degree and medical school turned out to be 2 years working in an orphanage in Quito, Ecuador. It was during this time that the course of Dr Gaus’ path was changed forever, upon realizing his desire to improve access to medical care for Ecuadorians. Soon after he returned to the United States to become a doctor.

Tony Hiss masterfully weaves in bits of medical history from all parts of the globe as he tells the story of how throughout the journey, Dr Gaus always focused on the singular goal of bringing access to quality medical care to the people of rural Ecuador. Dr Gaus’ clear and unyielding, yet ever adaptable vision shines clearly throughout the book, and readers will sense his steadfast devotion to the people of Ecuador as the tale unfolds. Personal conversations are recounted as Hiss brings the reader along with him on the path to discovery of how AHD came to be a reality, and the hardships, redirections, and successes along the way.

Especially powerful is the subplot of Dr Gaus’ personal encounter with a mother who brought her son to him after a snake bite. The boy later died because the antivenom he needed was not available, and the only service they had set up in the area was a small outpatient clinic. Hiss goes on to recount how with much reflection, some soul searching, reconsidering what the needs of the community actually were, and what his patients had been telling him all along, Dr Gaus transformed this painful experience into a program that currently offers not only antivenom, but also a test to discern whether it is needed. The program also brings trained physicians to rural Ecuadorians so that when people come in with snake bites, as they inevitably will continue to do in rural areas, they can receive the care they need.

Hiss also takes readers through Dr Gaus’ journey of learning from Dr Diego Herrera to integrate patients’ cultural beliefs (especially important when treating indigenous patients) into the care he provided, enabling his patients to trust him. He gives the example of when Dr Gaus first started seeing patients from the Tsáchila tribe, he would try to “correct” their long-held beliefs about meat consumption. These beliefs, although not founded on science, were not causing them harm. Once he stopped trying to do this, his patients began to trust him. It was this small act of taking the time to understand what was important to his patients that enabled him to begin building lasting relationships with them.

In the book’s foreword, Lou Nanni describes what many others saw in Dr Gaus as well:

I recall David lamenting, one particular missive, that he had experienced repeated bouts of lice while playing with the children at the Centro Muchacho Trabajador … The physician counseled David to stop wrestling around with the little children. Instead ... he opted to shave his head. “I need the warmth and affection as much as, if not more than, the kids,” he explained. He had discovered his calling to return to Ecuador to pioneer a sustainable health care model for the marginalized and indigent, especially the rural poor, who had little to no access to health care. I could feel his passion and determination jump off the page as I read his scribbled cursive: “Never underestimate a bold vision combined with fierce determination.” The purity of Dr Gaus’ call and the depth of his passion were positively contagious: “If you are lucky, a few times in life you will come across a person who is able to hew out of the mountain of despair a stone of hope.”

The most impressive part of this story, for many family medicine students and teachers reading this review, may in fact be the last part, where readers learn not only that Dr Gaus has achieved this immense task of helping to create two high-quality, sustainable, and reliable hospitals in rural Ecuador, but also how he took it a step further, and used these two hospitals to create a 3-year family medicine training program for young Ecuadorian doctors. This has provided opportunites for young Ecuadorians to become competent, lifelong learning, curious, family doctors themselves. These young doctors in turn would graduate from the program and go out and start their own programs, thus spreading not only access to quality medical care across rural Ecuador, but also a love and enthusiasm for learning, teaching, and collaborating.

For family physicians with an interest in global health, rural medicine, and tropical disease, plus an appreciation for a well-told story, this book is a great read. Thoroughly entertaining while still conveying a message about how global health can be done well and responsibly, the book gives a sense of hope and energy. The message rings clear that in order to properly serve rural communities, full-spectrum, acute, and hospital care are needed, rather than simply outpatient or community health worker services. This is certainly a worthwhile book for educators as well, a book that reminds us about the joy of teaching, and why we do it.