Another aspect of bureaucracy here - or rather the lack of it.   When I was here in November, I had a small infection and had it successfully treated (in English) by a doctor in Quito.  It has suddenly recurred, and I was not looking forward to telling a doctor here in Spanish, since there is very little English spoken here in the south, all my problems with antibiotics.

I consulted my American landlady about finding a doctor and the conversation went like this
"Do you have the original scrip"
"Yes"
"Then you take it to the nearest pharmacy and get it refilled"
"As simple as that?"
"Oh yes, you can use it until it falls apart"
So it proved. No questions, and I still have the original scrip.   Its a failure in the system, certainly, but saves a lot of hassles and expense also.