Dr Mary Bresnihan, a Dublin-based ENT surgeon, travelled to South America last autumn where she established an operating theatre in a remote Ecuadorian town
As the bus pulled out of Quito I wondered how I'd got myself into this. I was embarking on a two-month stint as a volunteer doctor in a town called Chone in the coastal plains of Ecuador and had just asked the busman "to take me when we arrived in Chone". No wonder he was looking so pleased. Clearly, I was absent the day we learned the verb "to tell" in Spanish class.
Having survived the con men in the bus station, the shock of being searched for guns as I boarded, and the leery driver, I arrived in my destination, a small town where most of the roads are dirt tracks, travelled on by machete-wielding hombres on horseback.
Chone has a population of between 70,000 and 200,000 - depending on who you ask. There is a real wild west feel about the place, with mean-looking mules tied up outside the market and saloon doors swinging. Out of every building blasts music, chain-saws, revving motorbikes and family rows.
I was the only gringa there under the age of 70. Unsurprisingly, the two other foreigners were both religious personnel from Ireland.
I found accommodation with Sr Margaret McCarthy, an inspirational nun in her 70s from Cork. With the help of Irish funding she has built and is running a day centre for the elderly, and a drop-in centre for women.
The accommodation was better than I'd hoped and while I could hear iguanas run across the corrugated tin roof at night, and windows were a luxury too far, we did have Barry's tea.
I borrowed a bike from Sr Margaret, much to the amusement of the locals. Going to work on my first day I got a great view of the town. In fact I saw most streets three times before I eventually found my way to the clinic.
However, my bike served me well and I quickly became a tourist attraction on the main street at 9am and 6pm. I was a veritable Pied Piper with groups of children following behind and everyone staring and calling "hola doctura" as I zoomed by.
The poverty in the town was shocking. Families of eight live in cane shacks that we wouldn't use as garden sheds. There are people starving despite the abundance of food - everything is available in Ecuador, but only to the rich, and there aren't many of them, as 85 per cent of Ecuadorians live below the poverty line.
There is a public health system of sorts but you have to pay in some way or another so most people can't afford it. The average weekly wage (for the few who have a job) is $7 but it can cost anything up to $10 to see a GP. The clinic I worked in was set up for the very poor so at least our patients didn't have to pay.
It is an Irish Augustinian project spearheaded by the remarkable Fr Mike Fitzgerald, and staffed totally by local people who themselves have very little. There are five local doctors working there. In the entire province of 1.3 million people there are no ENT (ear, nose and throat) surgeons, the nearest being in Guayaquil, six hours' drive away.
There was an operating theatre which was not in use, so I started by trying to bring it up to a functioning level. I was galvanised by seeing children on the street with cleft lips and the timely arrival of an anaesthetic machine donated by Limerick hospital.
Sourcing instruments was my biggest headache. It is so simple at home - you discuss what you need with the theatre sister, you get out the brochure and you order it. In Ecuador, there is no theatre sister, no brochure and, frequently, no phone. It's amazing the things you take for granted both as a doctor and as a citizen of a wealthy nation.
In search of essentials, I set off for Guayaquil and the instrument shop. All the shelves were barricaded by metal grids so I had to peer through and point at what I needed. It was progress. But with our operating date looming we still lacked many essential items.
In the meantime, I was met at 8am every morning by a queue of patients. My Spanish was slowly improving and, aided by gesticulation, pointing and face-making, I saw hundreds of ears, noses and throats, hundreds of worried parents and children, and received hundreds of "gracias".
As most people in the countryside have no transport, we decided to bring the clinic to them. On the appointed day, a convoy of 40 people set off at 5am - 10 doctors, nurses, a dentist, a pharmacist, cooks and drivers. After three hours of being jolted along dirt roads and riverbeds we arrived at our destination in the mountains.
A tiny shack was perched precariously on the hillside and the "school" (although no one can read or write), served as our clinic. As families and friends gathered in the field that was the waiting room, a carnival atmosphere developed with people selling popcorn and various unidentifiable homemade treats. The "car park" quickly filled with mules and someone started up a barbecue.
The lack of personal space was evident. I watched in amazement how everyone who was waiting gathered around the patient being attended to. I felt sorry for those attending the gynaecology GP - they had to give their history in front of at least 30 people.
However, from my own perspective, this actually proved quite useful as after about five patients I was able to ask them if they had the same problem as patients number one, two, three, etc. I also found this a valuable time- and Spanish-saving exercise.
After a few hours I became suspicious that some of the patients were just rocking up to the next doctor, the next showground attraction, with the same problem and sure enough, when I checked the names, there they were.
However, many patients walked for six or seven hours to the clinic so I guess if I had gone to that much trouble I would want to see at least five doctors too. Between us all we managed to see about 700 patients.
The designated day of operating crept up on us as my anxiety mounted. Nothing seemed to be ready and no one but me seemed worried. Three days before the operating day, I mentioned I hadn't slept well because of my concerns. That seemed to do the trick.
Within an hour there was an army of people sewing drapes, sterilizing equipment, fumigating rooms, cutting sheets of gauze, making instruments and buying medications and bed sheets. And before we knew it we were successfully operating.
As luck would have it my $1,000 headlight failed me within five minutes of starting an operation so someone was quickly dispatched to buy an Eveready workman's head torch for $7.
Eight hours later, after a stressful day of teaching, improvising and reassuring (all in Spanish with the occasional more colorful English word thrown in), we were hugging and kissing, delighted with our successful debut.
Then we were plunged into darkness with the start of yet another power failure.
And as I cycled home that night I realised I was actually enjoying the cacophony of sounds and the sweet smell of freshly cooked bread and rotting fruit from the market.
It's amazing what you can get used to.