I am wondering about medical care in Quito. Like most places, I imagine it very good for some and inadequate for others. Several Ecuadorians I run into have been to the United States for treatment, many have chosen Hopkins for complicated procedures. I always find it odd that my parents when they visit are so eager to return to Canada for medical care. I try to point out that Baltimore has reputable medical institutions, but they have not had consistently good experiences in the States and probably have heard all the horror stories, and don't wish to get caught up in their own.
We had a couple alumni on our trip in the Galapagos who were hurt and required medical care. The physician on the boat was perfectly adequate and did what any doctor would have done in the circumstances. It is probably only in rather desperate circumstances, like when my brother in law was burned on over 70 % of his body and required many months of ICU care and millions of dollars in grafting procedures to survive ( and beat the odds), that the hospitals in Ecuador could not compete with their American counterparts. Perhaps it is just money that makes the difference, in that a country with over 300 million inhabitants has simply a greater amount of money.
I avoid doctors anyway. By the time I show up in a medical office for care, I have self diagnosed and already started treatment and am eager for confirmation that what I have recommended is appropriate. Rarely does what the physician say surprise me or reassure. I imagine I will avoid doctors if at all possible in Quito, much like I do here. My understanding is that one can purchase most medications in the pharmacies without a prescription, so it makes sense to prescribe for whatever ails us and simply pick it up at the drugstore.
Hopefully we will not be in situations that require immediate or urgent care, and we can hold off on screaming through the streets on an ambulance. We will be very very careful.