Summer Experiences/Projects (South America)

Bolivia (1)

  
La Paz
Bolivian Street Children Project
Medical Spanish immersion;
clinical work; teaching sessions
Summer 2007
 
During the summer of 2007 I had the opportunity to work in La Paz, Bolivia. There were five aspects
of my experience as listed below. I had the unique opportunity to serve poor and marginalized people in a developing country, and I leaned a greatdeal of Spanish and medicine in terms of diseases, diagnoses, and treatments.

  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 from Suzanne Sarfaty, M.D., Director of IH Programs: Dr. Chi Huang is very selective about who may participate with him at this site. Due to political instability in Bolivia at this time (11/2008), students are not able to participate.

Bolivia (2)

  
La Paz
Hospital del Nino
Clinical work; Research
Summer 2005
 
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)

  
Quito; Otavalo; other
Interhealth South America
Medical Spanish immersion
(beginner); service learning projects
Summer 2007 (4 weeks)
 
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 (2)

  
Riobamba
Cacha Medical Spanish Institute
(CACHAMSI)
Medical Spanish immersion; Clinical
work; Service learning
Summer 2007 (4 weeks)
 
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 U.S., 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 (3)

  
Cacha
Cachamsi Medical Spanish Institute
Clinical work; Service
learning
Summer 2006
My summer experience
with Cachamsi Medical Spanish Institute in a small Andean community in central
Ecuador was very inspiring and eye opening. I spent six seeks with a dedicated
group of people in efforts to improve the poor health conditions of one
of many indigenous communities in Ecuador. I was involved in a community
of approximately 200 families located in Cacha (near Riobamba, Ecuador).
Health care for this community is provided by a rural allopathic doctor,
one dentist, and three nurses all of which are dedicated to their work in
the community clinic located in Cacha Machangara, the central village of
the region. Additionally, there are four local medicine men and midwives
who also provide traditional medicine. My summer project involved daily
work with all of these health centers and the community clinic in order
to conduct a health needs assessment. I interviewed the nurses, rural doctor,
and dentist who provide ambulatory care there. I was able to survey approximately
10% of the members from all surrounding villages. It was a challenge being
a foreigner and gaining the trust of the community, but I had the support
of a local translator who explained my role and focus on health improvement..
With much support and cultural sensitivity, I was able to conduct the surveys
by obtaining information from the adults that attended the health clinics
and health stands. When the patient volume was low, I visited homes seeking
participants to survey. I also attended community events to see about how
the community viewed their health and gain insight about their health priorities.
I also retrieved information about the children in the community by visiting
day care centers. Overall, there was a tremendous gap in education about
hygiene and health. After speaking with the directors and some of the active
parents, we were able to formulate a plan of action that would allow for
greater health promotion and health education. I was part of a group of
students that went to all of the eight day care centers throughout the distinct
villages to hold small health promotion sessions with the children and their
directors. The information that was gained from the adult surveys will also
be used to formulate other plans of actions that will help improve the poor
water quality, hygiene, and nutrition. In addition to the health needs assessment,
I gained clinical experience by assisting the rural doctor perform physical
examinations on the children in the day care centers and through clinical
preceptorships at Hospital Andino y Alternativo de Chimborazo, a hospital
in Riobamba. I learned about an entirely different dynamic where allopathic,
osteopathic, and traditional medicine healers of the Andes work together
to help an individual with their particular health needs. I was able to
see how the emergency room operated in this hospital and was able to explore
other therapeutic options for the patients in the areas of complementary
Eastern medicine and Andean medicine. My experience was very culturally
enriching and allowed me to gain awareness of the health care challenges
in Ecuador. Also, Cachamsi offers all levels of Spanish instruction to participants,
but because I am fluent in Spanish I was able to focus solely on my project
and did not attend these classes.

Ecuador (4)

  
Cacha
Cachamsi Medical Spanish Institute
Clinical work; Service learning
Summer 2006
My summer experience
with Cachamsi Medical Spanish Institute in a small Andean community in central
Ecuador was very inspiring and eye opening. I spent six seeks with a dedicated
group of people in efforts to improve the poor health conditions of one
of many indigenous communities in Ecuador. I was involved in a community
of approximately 200 families located in Cacha (near Riobamba, Ecuador).
Health care for this community is provided by a rural allopathic doctor,
one dentist, and three nurses all of which are dedicated to their work in
the community clinic located in Cacha Machangara, the central village of
the region. Additionally, there are four local medicine men and midwives
who also provide traditional medicine. Community members arrive at the community
clinic from outlying villages seeking ambulatory care and referrals to the
closest public hospital. Other health stands exist outside the central community
health clinic in two other villages, Cacha Chuyug and Pucara Quinche, for
people who cannot easily reach the community clinic in the central village.
My summer project involved daily work with all of these health centers and
the community clinic in order to conduct a health needs assessment. I was
able to visit all the health centers and assess their health resources by
holding interviews with the nurses, rural doctor, and dentist who provide
ambulatory care there. I was able to survey approximately 10% of the members
from all surrounding villages. It was a challenge being a foreigner and
gaining the trust of the community, but I had the support of a local translator
who explained my role and focus on health improvement.. With much support
and cultural sensitivity, I was able to conduct the surveys by obtaining
information from the adults that attended the health clinics and health
stands. When the patient volume was low, I visited homes seeking participants
to survey. I also attended community events to see about how the community
viewed their health and gain insight about their health priorities. I also
retrieved information about the children in the community by visiting day
care centers. Overall, there was a tremendous gap in education about hygiene
and health. After speaking with the directors and some of the active parents,
we were able to formulate a plan of action that would allow for greater
health promotion and health education. I was part of a group of students
that went to all of the eight day care centers throughout the distinct villages
to hold small health promotion sessions with the children and their directors.
The information that was gained from the adult surveys will also be used
to formulate other plans of actions that will help improve the poor water
quality, hygiene, and nutrition. In addition to the health needs assessment,
I gained clinical experience by assisting the rural doctor perform physical
examinations on the children in the day care centers and through clinical
preceptorships at Hospital Andino y Alternativo de Chimborazo, a hospital
in Riobamba. I learned about an entirely different dynamic where allopathic,
osteopathic, and traditional medicine healers of the Andes work together
to help an individual with their particular health needs. I was able to
see how the emergency room operated in this hospital and was able to explore
other therapeutic options for the patients in the areas of complementary
Eastern medicine and Andean medicine. My experience was very culturally
enriching and allowed me to gain awareness of the health care challenges
in Ecuador. Also, Cachamsi offers all levels of Spanish instruction to participants,
but because I am fluent in Spanish I was able to focus solely on my project
and did not attend these classes.

Ecuador (5)

  
Quito
Hospital de Niños “Baca
Ortiz”
Research
Summer 2008
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.
First-year students planning to undertake a summer research project are
required to participate the IH mini-course: Creating
an International Health Summer Project from Start to Finish.

Ecuador (6)

  
Quito
Child Family Health International
Clinical work; Service learning
project
Summer 2005
My goals for the summer
were to provide help to underprivileged communities abroad, be exposed to
different disciplines of medicine, and finally, to practice another language.
Knowing that my medical knowledge was not developed enough to help communities
through clinical medicine, I believed an established program that would
help me carry out my altruistic intentions would be most beneficial. CFHI
allows students to choose from a variety of specialties in medicine and
participate in four one-week rotations in each of those specialties. The
program also provides an outlet to bring medical supplies from the states
to the small clinics around Quito. CFHI has programs around the globe such
as in Africa, Asia, South America, and Central America. The program has
several paths to choose from like infectious diseases, pediatrics, surgery,
and women’s health to name a few. I was able to work in the emergency department,
the delivery room, observe surgery, and work at a small clinic. The students
have to stay with a host family which is a great environment to practice
Spanish. I highly recommend this program for first years that may have similar
goals as mine.


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.
 

Peru

  
Cusco
ProWorld
Medical Spanish immersion; Clinical
work/shadowing; Service learning
Summer 2008
 
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.
Primary teaching affiliate
of BU School of Medicine