Boston University Medical Campus
International Health Program

Peru (1)

During the summer of 2010, I had the opportunity to work in Lima, Peru through the Tropical Medicine Institute of Universidad Nacional Mayor de San Marcos in Lima, Peru and National Institutes of Health in Bethesda, Maryland.

Although I had planned that my principal project would aim to determine the prevalence and risk factors of leptospiral serovars among Peruvian jungle rice growers, the start date of the data collection was postponed to late summer due to logistical issues between Universidad Nacional Mayor de San Marcos and the Association of Peruvian Rice Growers. Thus, I was assigned to another project – an observational, prospective cohort study aimed to describe demographic, clinical, immunologic, and virologic characteristics of HIV-infected children at Instituto Nacional del Salud del Nino (Children’s Hospital) in Lima, Peru.

On Wednesdays and Fridays, I worked at the Children’s Hospital on this study. I worked on the partner study at the maternity hospital on Thursdays, and either shadowed other physicians in the hospitals or conducted data analysis at the Tropical Medicine Institute on Mondays and Tuesdays. All the research and shadowing was conducted in Spanish, which helped both my general and medical Spanish significantly improve. I lived with a Peruvian family that only spoke Spanish as well. While working in the hospital on the protocols, I was able to practice my basic history and physical examination skills that I had learned during first year (vital signs, history in Spanish, etc.). Through my experience of working with HIV-infected children and their families in Peru, I was able to gain insight into the health-care challenges these families faced and the social, political, and economic factors that all directly impacted their health.

Peru (2)

This experience was undertaken by Jennifer Manne (BUSM Class of 2013). She received financial support from the Infectious Disease Society of America (IDSA) via the Medical Scholars Program and the American Society of Tropical Medicine and Hygiene (ASTMH) via the Benjamin H. Kean Traveling Fellowship in Tropical Medicine.

During the summer of 2010, I spent two months in Arequipa, Peru working on two research endeavors in collaboration with Principal Investigators from several US universities, the Universidad Cayetano Heredia and the Ministry of Health (MoH) of Arequipa. The first of these projects was a series of experiments testing the effectiveness of insecticide impregnated durable wall lining on the viability, mortality and feeding success of Triatoma infestans, the vector that transmits the T. cruzi parasite, the causal agent of Chagas’ Disease. In addition, I worked on a collaborative project assessing house level risk of infestation with T. infestans in the district of Mariano Melgar, Arequipa, in order to provide a “risk map” that will guide upcoming MoH spraying operations.

View Jennifer’s IDSA Summer Grant Report for more info.

Peru (3)

I was in Cusco, Peru with ProWorld for two months this summer. I lived with a family in the city as part of the cultural immersion experience. Also, every Monday through Thursday I had two hours of Spanish classes in the afternoons. Every Monday, Tuesday, and Thursday I worked at a local health center from 8:00am to 12:30pm. I shadowed in the emergency area called ¨Topico¨ for about three weeks. I saw lots of patients and different diseases, including typhoid fever, malaria, and rheumatic fever. I watched wound cleaning, stitching, and burn care and was taught to administer gluteal intramuscular injections. I also helped roll cotton balls and fold gauze into pads before sterilization because the clinic only had enough money to buy these supplies in bulk. Another area I shadowed in was with the obstetrics nurses. I got to listen to the fetal heartbeat, measure stomachs, and feel for the position of the fetal head. Here I also administered gluteal intramuscular birth control injections. Other areas I worked in at the clinic included the laboratory where I viewed blood smears, diabetes tests, fecal tests for parasites, urine analyses, and antibody tests for arthritis. I also shadowed a general medicine doctor for two weeks. Here I mostly observed and helped with paperwork, but it was very interesting to see how care was both similar and different from what I am accustomed to at BUMC. On Wednesdays, I went with other volunteers to a public school called Cachona about thirty minutes outside of the city center. Here we taught about personal hygiene and nutrition. We handed out soap, toothbrushes and toothpaste and taught the children how to use them. We also taught lessons and played games to help the students learn about the food pyramid and the importance of clean water. Fridays and Saturdays were the days we went on health campaigns in communities that could not access medical care. We brought a large medical team. Community members could see the general doctor, and then women would go to the obstetrician for a Pap test, and children would get tested for parasites and anemia. At these campaigns I was taught to give a Pap test, do finger sticks to collect blood samples, and give gluteal intramuscular injections. The doctors could write a prescription for the patients and we would then give them the appropriate medicine free of charge and explain how and when to take the medication. While the children waited, volunteers would perform puppet shows to educate them about personal hygiene and hand out toothbrushes, toothpaste, and soap. We also helped with a clean-burning stove project when we went to Chinchero to install stoves with chimneys. We worked with the family and used mud made by the family to seal the bricks together and to the platform we were building the stove on. With this stove the family can use less wood and the chimney allows the smoke to escape from the house. Overall I had an incredible experience this summer and would definitely recommend the ProWorld organization to future students.

COMMENT from Suzanne Sarfaty, MD, Director of IH Programs: The student who participated in this experience thoroughly investigated this organization prior to departure. It appeared to have good transparency and demonstrated a commitment to sustainable development by ongoing work in the same areas.

Bolivia (1)

1. Spanish Language Immersion. My summer experience began with intensive Spanish classes at the Spanish Language Institute (SLI) in the Achumani district of La Paz. I took one-on-one Spanish classes for four hours every day for two weeks. Prior to my summer experience, I had very little background in Spanish. However, by the end of my time in Bolivia, I felt comfortable communicating in Spanish. Additionally, I learned a great deal of Spanish because I lived with a Bolivian family with whom I spoke in Spanish.
2. Working with Bolivian Physicians, Viacha Clinic. For the final four weeks of my stay, I worked with Drs. Ruben Rocha and Raul Alanoca at a clinic in Viacha, a rural town 25 km southwest of La Paz in the Altiplano region. (The Altiplano region is an extremely impoverished area in Bolivia, the poorest country in South America). I worked with Drs. Rocha and Alanoca on Mondays, Wednesdays, and Fridays, and on my days “off” I researched the diseases I encountered at the clinic. I encountered diseases such as typhoid, urinary tract infections, amebiasis, and pneumonia.
3. Weekly Teaching Sessions with Dr. Chi Huang (BUSM faculty). I had weekly teaching sessions with Dr. Chi Huang. In these sessions we covered the topics of pediatric pneumonia, tuberculosis, pediatric UTIs, Kwashiorkor, and mental health care in Bolivia. Also, I conducted a follow-up visit with Dr. Huang of patients seen by residents of the Boston Combined Residency Program (BCRP) Bolivia International Health Trip. During the follow-up visit, we encountered pediatric patients with Seckel Syndrome, clubbing, failure to thrive, suspected tuberculosis, suspected tetralogy of Fallot, and bilateral cataracts with severe diabetes.
4. Bolivian Street Children Project. Dr. Huang has worked with street children in La Paz, Bolivia for over 10 years. I had the opportunity to work with the former street children now living in houses of the Bolivian Street Children Project (BSCP). Working with street children is both difficult and rewarding. I learned about the realities of living as a street child-physical and sexual abuse, psychological trauma, substance abuse. But I also learned about the potential of children living in homes of the BSCP-education, “normalization,” the sense of family and community, and being productive members of society.
5. Bolivian Society of Gastroenterology Conference. Lastly, I had a unique opportunity to attend a gastroenterological conference (Curso Teorico-Practico de Gastroenterologia). The conference covered topics ranging from Hepatitis B diagnosis, management, treatment, and epidemiology in the La Paz area, to laparoscopic treatment of duodenal ulcers. Interestingly, because it is financially difficult to conduct research in Bolivia, there was no presentation of primary research.

COMMENT

Bolivia (2)

This summer I had the opportunity to travel and work in La Paz, Bolivia. It was an unforgettable experience. I worked with Dr. Eduardo Mazzi in the children’s hospital (Hospital del Nino) in La Paz for eight weeks this summer. I planned to spend the majority of my time helping him on a research project on antibiotic resistance. As it turned out, I was unable spend as much time on research as I initially planned. One of my first lessons in La Paz was that research is a luxury. However, I was able to help Dr. Mazzi with his research three or four afternoons every week. I spent time reviewing hospital admissions and recording the number of cases in which antibiotics were prescribed. I also helped Dr. Mazzi set up a database to facilitate statistical analysis. Research took up about 30% of my time in the hospital with the rest of the time allocated to rotating through the various specialty services in the hospital. There was much to do and to learn in the wards; I helped the nursing staff serve meals, helped the children make their beds, took vital signs, heard unique heart murmurs, listened to lung sounds and saw hundreds of chest x-rays. I also witnessed some incredible diagnostic detective work. The physicians at Hospital del Nino must rely almost exclusively on their clinical skills and a plain film chest x-ray to make their diagnoses. Finally, my Spanish language skills received an intense workout. I lived with a Bolivian family in a high rise apartment about a half mile from Hospital del Nino. They spoke only Spanish and after about two weeks I was conversing comfortably. Some of the physicians could speak passable English and would explain some medically related things to me in English. However, they too preferred to speak Spanish if I was willing. Because of the amount of time I spent in the hospital, I felt comfortable with the vocabulary necessary to speak to patients about their medical problems in Spanish. I was even given several opportunities to practice taking a medical history in Spanish. I could not have asked for a more productive and enriching experience in La Paz. READ this student’s article in BU Today (September 21, 2005): “My time in Bolivia: Shadowing Pediatricians in La Paz”.

COMMENT from Suzanne Sarfaty, MD, Director of IH Programs: Due to political instability in Bolivia at this time (11/2008), students are advised not to travel to this country.

Ecuador (1)

I enrolled in the Cachamsi Program (Cacha Medical Spanish Institute) for 6 weeks. While challenging at times, it was a truly formative, worthwhile, and enjoyable experience. Here are the four main components of my trip:

1. Health and English Class in Cacha-My main purpose in going to Cachamsi was to create a Health and English class for 8-12 year old students in Cacha. I worked with 2 other medical students to help implement the class, which will be run on an annual basis by medical students. We taught two classes for two hours each in the morning. It was by far the best part of my trip. The students were very energetic and eager to learn.
2. Spanish Language Immersion- I had zero Spanish background before my arrival (i.e. no high school or college classes). Consequently, I was placed in the beginner’s class along with one other student. For 4 weeks, it was simply the two of us. After that, I had private one-on-one lessons for two weeks. Classes ran for two hours Monday through Friday. Our curriculum consisted of both general and medical Spanish. My professor was excellent and fortunately, fluent in both Spanish and English, which was very useful (though he rarely spoke in English to us). By the end of the class, I could comfortably conduct a medical interview along with basic physical exam skills in Spanish.
3. Working with Ecuadorean Physicians-Every morning for the first four weeks, I shadowed physicians. I chose to follow family medicine/primary care physicians, but you may choose any specialty. There’s also an alternative medicine hospital. I worked in both Riobamba (the city) and Cacha (a collection of 23 indigenous communities outside Riobamba) and observed first-hand the stark disparities between the two (not to mention the US). Since my Spanish was very limited, I mainly observed and would occasionally take a blood pressure or perform a cardiac exam if the doctor asked. Others in the program, especially those with greater fluency, were granted much more freedom. Some conducted physicals while another scrubbed in during surgery.
4. Home-stay with local family-For the duration of my trip, I stayed with a local Ecuadorean family. They were fantastic. The Dad drove me to clinic in the morning, the mom cooked three meals a day, and I’d often play Playstation 2 with the boys (14 and 12 years old). They showed me what life is like in Ecuador by showing me different parts of Riobamba and nearby towns. They were extremely patient and worked with me to learn Spanish. They didn’t know any English, though the boys could read and write a little, but really couldn’t speak or understand it.

Overall, Riobamba is an excellent place to learn Spanish, and Cachamsi will help you reach your goals. It’s not easy – no one in Riobamba speaks English, and in Cacha, most people speak Quichwa. However, if you’re serious about learning Spanish, this is the place to be.

Ecuador (2)

I participated in a program at Interhealth South America that integrates medical Spanish language course work, study of Ecuadorian culture and traditional medicine, and hands-on volunteer work through village health clinics. The schedule also leaves some weekends and afternoons for individual exploration of the country. For the first two weeks of the program, the beginner and advanced Spanish groups are together; for the last two weeks, the program is divided. I was in the beginners group. Every week we were in a different environment learning Spanish, international health, and about the challenges and differences in medicine in Ecuador vs. more westernized health care. The first week we will flew in to Quito (at 9500 ft., it is the second highest capital in the world), the second and third week we were in Otavalo (a small artisan village), and the fourth week we were in the Amazon rainforest. The program sets up opportunities to work and learn from local health care providers and rainforest curanderos (traditional folk healers). Common health issues included pterygosis-a thickening of the conjunctiva from lack of protective sun wear. In addition, we saw a lot of digestive issues from drinking contaminated water or eating unclean food. Many of the children we saw had various rashes such as scabies from living in close quarters with animals. Basic health care needs were unmet; joint-pain or mild headaches which would have been easily treated with aspirin or Tylenol became chronic issues afflicting many of the patients in the villages. Oral health was also severely neglected. We learned a lot about traditional medicine and interestingly one of their number one healers includes tobacco. Various forms of tobacco “unclog” the bad spirits from ones body, and the smoke carries prayers to a higher power. Especially in the Andes, the earth, nature, animals (i.e. guinea pig) and the elements (water, sun etc.) are an integral part of indigenous health care. One of the clinics was innovative in merging traditional healers alongside traditional western health care workers. Highlights of the trip included:

• Participation in health brigades for numerous villages and indigenous people groups, from outside the capital city of Quito to rural villages in the surrounding jungle communities of Mondaña.
• Providing medicine and support to various communities.
• Learning Español through Spanish classes and living with host families.
• On free days, I took advantage of the geography by climbing Volcán Imbambura: 15,435 ft and river-rafted in Mindo and down the Napo River, the thirteenth largest tributary of the Amazon River.
• Living in the Amazon rainforest for a week, teaching CPR to high school students, delivering water filters to local villages, and participating in local medicinal herbal healing ceremonies.
• Sampling a local delicacy: cuy, otherwise known as guinea pig.

The program director will advise you to bring small toys, stickers, school supplies for the children you will meet. I also suggest bringing toothbrushes, toothpaste, and sunglasses. I chose this program because of the variety and depth of experiences offered. Overall, the month in Ecuador was an amazing experience.

COMMENT from Suzanne Sarfaty, MD, Director of IH Programs: This program is run by two U.S.-based physicians who are very dedicated to global health. Program logistics have been variable in the past year. Please meet with me before applying to this program.

Ecuador (3)

I attended Cacha Medical Spanish Institute(CACHAMSI) for four weeks. Cacha is named after the village region outside of Riobamba that is comprised of 23 small villages. This area has a very interesting mix of Latino culture and Incan tradition. CACHAMSI is specific to medical personnel, mostly medical students, and is invested both in bringing extra hands to the area and sending personnel back to their homes with enhanced language and cultural competency for Spanish-speaking patients. The program was well-organized, and I was able to have a few days during my trip to travel and enjoy the natural beauty of the Andes and the Amazon basin. My “host mother” was La Senora Zuniga, and I lived in her home for the duration of the program along with four of her grown children, their spouses, and children. In total, there were 15 of us under one roof. The family was extremely welcoming and made my transition as comfortable as possible. After breakfast each morning, I was off to my clinical site of the day. Some days, I helped paint the new clinic being built in the Cacha village area. Other days, I worked on the labor and delivery ward in Riobamba’s public hospital. These clinical settings were prearranged with the program and were based on my interests. After work, I would go home to eat lunch with my family. Lunch was the large meal of the day and was an important time for family and relaxation. We would usually have a large plate of white rice with legumes, plantains and pork or chicken. On a special day, the family would have “kuy” (fried guinea pig).After lunch, I would go to class for two hours each day. There were 8 other students in my class and all were other medical students from the US, Canada, and the Caribbean. The class was conducted entirely in Spanish and focused on medical terminology and interview styles that are sensitive to Ecuadorian culture.

COMMENT from Suzanne Sarfaty, MD, Director of IH Programs: This program is very well run and students have had uniformly successful experiences. A student’s experience can be tailored individual needs/learning objectives.

Ecuador (4)

Ecuador (5)

Ecuador (6)

I spent my summer in Quito, Ecuador researching the “Effects of Zinc as an Adjunct to Treatment of Pneumonia in Young Children” in the main pediatric hospital, Hospital de Niños “Baca Ortiz.” This research is a collaboration between B.U. Center for International Health and Development (BU School of Public Health) and the Corporacion Ecuatoriana de Biotecnologia. Community-acquired pneumonia is the most common cause of death in children under five years of age in the developing world. Zinc deficiency is also widespread in developing countries and is recognized to play an important role in immune function. The hypothesis of the research project I worked on this summer is that zinc used as an adjunct to the treatment of pneumonia in children 2-59 months of age will reduce the duration of the pneumonia episode. In addition, we hypothesize that the benefit of zinc on the clinical response will be etiology-independent. The study is an ongoing, randomized, double blind, placebo-controlled clinical trial in 400 children aged 2 to 59 months with pneumonia admitted to Hospital Baca Ortiz. During my experience, I went on rounds with Dr. Gomez in the morning and Dr. Gilda in the afternoon to follow up on patients enrolled in the study. I listened to a lot of lung sounds, learned how to read chest x-rays and differentiate between bacterial and viral pneumonia. I also liked examining other patients on the ward who were not in the study to get a broader understanding of other common pediatric illnesses in Ecuador including rotavirus, kwashiorkor, and urinary tract infections. When I went on rounds with the two study physicians there were usually anywhere from 2-5 Ecuadorian medical students and residents that were a part of the process so it was exciting to be in an environment where other people were learning and seeing things for the first time as well. Lastly, I developed a questionnaire that is currently in the process of being approved by the IRB as part of a cost-effective analysis. The goal of this sub-study is to understand the cost implications of zinc used as an adjunct to the treatment of pneumonia.

COMMENT from Suzanne Sarfaty, MD, Director of IH Programs: Participation in IH research projects needs to be initiated 6-8 months prior to departure.

Ecuador (7)

COMMENT from Suzanne Sarfaty, MD, Director of IH Programs: Our students’ experiences with CFHI have been uniformly good. CFHI was started by a physician to promote local sustainable development and education. Although there is a substantial cost to this experience, the funds are truly invested into the local community.