Forget the assumption that modern neurology only thrives where resources are abundant. We sit down with Dr. Daniel Ontaneda and Dr. Nelson Maldonado—two Ecuadorian neurologists driving change across Latin America—to explore how world-class care is built on clinical craft, cultural fluency, and relentless advocacy. From bedside localization when the MRI is down to expanding stroke thrombolysis from a handful of cases to hundreds, their stories reveal a system where expertise is abundant but access can lag—and how that gap is closing.
We retrace Dan’s journey from Quito to leading-edge MS research, and Nelson’s decision to return home to build services few believed possible. Together they unpack what training looks like across the region, including long-format medical school, rural service, and residencies that demand deep exam skills. We compare public and private systems in Ecuador, break down why patients often want clear directives rather than options, and examine how cultural beliefs and language shape adherence. The conversation digs into MS treatment in low- and middle-resource settings, the rise of highly effective disease-modifying therapies, and the pragmatic use of cost-effective options like rituximab.
The episode also exposes a hidden threat: substandard medications entering through price-first procurement, undermining both acute care and chronic neurologic disease. Yet the momentum is real—regional MS registries, imaging collaborations that move faster than heavily regulated systems, and conferences that bring neurocritical care and MS experts under one roof. Even subspecialists practice broadly, treating Parkinson’s disease, epilepsy, headache, and ICU cases in the same week, sharpening an exam-first mindset that delivers results.
If you care about global neurology, stroke systems of care, MS access, and the practical ethics of delivering evidence-based treatment under constraints, this conversation will challenge assumptions and spark ideas. Subscribe, share with a colleague, and leave a review telling us where neurology should invest next.
Hosts:
Dr. Nupur Goel is a third-year neurology resident at Mass General Brigham in Boston, MA. Follow Dr. Nupur Goel on Twitter @mdgoels
Dr. Blake Buletko is a vascular neurologist and program director of the Adult Neurology Residency Program at the Cleveland Clinic in Cleveland, OH. Follow Dr. Blake Buletko on Twitter @blakebuletko
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