So I finally figured out how to access the blog from the hospital library (note: it was not actually hard). I have been less than compliant blogger in the face of somewhat long hours, weekend travels, weekend gringa disease, and taking advantage of the international atmosphere of my hostel to talk with fellow travelers.

So to answer the spirit of learning from my Ecuadorian colleagues, I will reflect on the medical and non-medical cultural exchange exchange I have been fortunate to participate in.
First, from a medical perspective. What has been striking to me is the fact that I am at a private hospital in the capital city that only serves those with private insurance. Those with public insurance, unless there is a true emergency, are referred to the public hospitals. In fact, the patients I see here have better access to resources in general compared to the patients I see at Sunrise. This was not the original plan as Dr Wilson and I had discussed going to Clinica Carapungo, but such is Global Health. You gotta roll with it, especially when you are only around for a short time. So while seeing patients with my local host resident, Edwin, as well as other providers I have been rotating with, we have gotten to discuss our different healthcare systems, medical education system, and treatment strategies to common diseases. Outside the obvious infectious disease difference, common things seem to be common. Heart disease, diabetes, and hypothyroidism are often seen in the outpatient "consultas externas". One glaring difference is the use of ARBs almost exclusively instead of ACEi for management of HTN. The explanations I have gotten range from "They are stronger than ACEi" to "Well if 20% of people get cough, just start with with ARB" to "This is how we practice". Other medical management differs with availability of specific medications/different generics used more commonly/different brands for common generics (often contributing to my constant "What the heck medication is that" and either asking or Googling it quickly). Overall, either US or European guidelines are followed. With the inpatient service, I have seen a number of pyelonephritis cases, osteomyelitis, C diff, IDA, stroke, encephalitis, and MIs. Management is generally similar though treatment of infectious is naturally influenced by local resistance patterns.
During downtime, a few of the residents and I have had time on various occasions to discuss differences and similarities to our education and training. I give away too much at this time except to say, like many times when you get to know someone seemingly quite different than yourself, you find more similarities than differences.

A Week In

I've been here a week now and have found some semblance of a routine. The first I was here, the 30th annual Jornadas Medicas somewhat disrupted the normal course of hospital rounds and teaching. But this week we're back to business. Yesterday was a full day of inpt work, were my host resident, Edwin, and I speed rounded on patients before morning bible reading and the overnight resident briefly checked out to the family medicine attending. Afterwards, we met up with our IM attending, Dr. Vasconez and were 'pimped' on anemia work-up. Interestingly enough, there are no family medicine attendings who see patients with the residents, only IM or peds as well as the specialists. Though per Edwin, family medicine attendings work at other hospitals, I found it somewhat counterproductive to try to promote the value of family medicine to not have FM attendings at the main residency hospital. But why do the family medicine faculty hear about the admits? More for a review of more serious/sick patients and some quick teaching for everyone present. Before we could discuss this further, we go called to admit a peds patient (yes, inpt work means both medicine and peds). Edwin, knowing my interest in OB, then advocated on my behalf to attend a c-section with our pediatric attending (which really just required asking as the pediatrician seemed very willing to have me along). So my first experience in a non-US OR was spent mostly examining the healthy newborn with the supervising pediatrician. After that, I luckily was in a good position to observe the OB/GYN close the hysterotomy, bring the rectus muscles together, etc before handing things over to the OB/GYN resident. Now if only family medicine doctors were able to do c-sections here...

So now that I'm here and we're back to the grind, what's my daily life like? Each day is different in the way my schedule worked out. I'm solely at Hospital Vozandes. This facility has two inpatient floors, including an ICU/NICU, an ER, a 24 hour lab, and "consultas externas" for both PCP and specialty clinics. My Mondays are basically entirely inpatient, with the last 2 hours spent in clinic with IM. Tuesdays are currently spent with an endocrinologist, who very much enjoys teaching, and a dietician. Wednesdays have worked out to be a cardiology day, which involved clinic and stress tests and the possibility of seeing more invasive procedures. Thursdays worked out to be a mix of rounding with ID, then joining the medicine team, and ending with dermatology. Being Ecuador, I've seen some fascinating cases already (to be explored at a later time). Fridays... well, last week neither of the attendings I was scheduled with were available so we shall see what this week brings. Responsibilities of independent direct patient care at this point are somewhat limited with lack of access to the computer system and working with such a variety of residents and specialists. It's also unclear at this point how many foreign residents have worked here and what expectations are from each individual attending I work with. The general reaction, however, tends to be "oh so you do have a basic grasp of Spanish!" Once that happens, most have been excited to teach and answer questions. We'll see what the rest of week brings...

Global Health Track International Elective

Blogging Prompts:

 

PART I. SUMMARY REPORT OF EXPERIENCE

Where did you work? Describe your daily responsibilities and location assignment. Describe the clinical and teaching environment: inpatient and/or outpatient.  Expound on interesting clinical cases and patient/family interactions. Would you recommend this site to future residents, and why? Any significant non-medical experiences you had during your rotation that you would recommend to future residents?

PART II. REFLECTIONS FROM THE FIELD

1. Discuss how you feel your own culture and nationality played a part in your patients’ expressed needs and perceptions of you as a health care provider, and how these may have been different from your patient care experiences in the U.S.  How did you manage those needs and perceptions as you cared for your patients abroad? Describe and discuss a situation in which you were aware of your own ethnocentrism and how you managed that conflict personally.
    
2. The global health competency objectives for professionalism stress the values of curiosity, openness to learning from other cultures, and acknowledgement of the privilege it is to work with international colleagues. Describe and discuss a situation in which your openness and curiosity fostered a situation where both you and your international colleagues were able to learn from each other.
    
3. Prior to your departure for this experience, describe how you prepared to be able to control stress while you were abroad, e.g., losing your passport, becoming ill, preceptor plans don’t work out, communication difficulties, or lack of diagnostic or therapeutic resources, death of a patient, etc. , Reflect on whether this preparation was adequate. If not adequate, write how you could have prepared differently, or how you wish you had prepared.
    
4. Give one or more specific examples of a challenge of equity in ethical considerations of undertaking research in resource-poor areas, distribution of vaccines, distribution of medicines, and/or distribution of knowledge.
    
5. Write about one thing you learned in the international setting that would be useful in building a better health care delivery system in the U.S.  Describe one or more strengths you identified as part of the different system of medical training that you observed, and what that system’s strengths bring to the practice of medicine, research and teaching in that country.
    
6. Describe and discuss a situation in which you reserved a judgment of the medical system or a political opinion while abroad. How have you reconciled that conflict in your own mind since you have returned home? (If not reconciled, see your global health mentor to discuss the situation further!)
    
7. Discuss how the international experience has informed your practice of medicine in the U.S. Has the experience transformed how you view your role as a physician? Explain.
    
8. Will this experience impact your career plans? If yes, how?

Ya Llegue a Quito

So here I find myself in a new city, a new country as a ~newly~ minted doctor (though still in my "posgrado"). My past experiences in global health have largely been related to a research project, whether it was tracking down influenza patterns in the Peruvian Amazon or collecting a variety of soil samples or attempting to find not-sketchy medicinal plant users/vendors/experts (again, in the Peruvian Amazon). My first ever experience in global health was literally making cotton balls in a Centro de Salud in college. So finally here I am, in a position to provide some actual medical care except I'm in a large city at Hospital Vozandes, a private hospital, working with local family medicine residents, attendings, and specialists. There's no obvious need for me. In fact, this residency has one of the best reputations in the country. While my personal idea of how I fit into global health is not quite this, I find myself in an interesting position to see how our Ecuadorian family medicine colleagues train and work. Ecuador has been fighting for family medicine physicians to have recognition beyond a "medico general". The residents and faculty at Hospital Vozandes seem especially invested in this. One wonderful example of this was witnessing a POC ultrasound workshop where multiple family doctors came to get hands on practice with OB ultrasounds.

Other than discovering our common fight for recognition of the value of family medicine, I've experienced the typical gringa things: getting lost in the hospital, getting lost walking back to my hostel, trying to figure out transportation and failing, misunderstanding local phrases, and I'm sure about a million other things I haven't even realized yet. Thankfully the majority of the those I've worked with are gracious hosts to the poor, fumbling gringa. We shall see what the rest of the rotation brings as I rotate with the resident-run medicine team, the ED, a handful of willing specialists, and the family medicine clinic.

Welcome to NCFM Global Health!

Welcome to NCFM Global Health!

Welcome NCFM Residents (future and present), Alumni and Family and Friends!


This is the official North Colorado Family Medicine Global Health Track Blog. The purpose of this blog is for reflection and communication between NCFM Residents and the faculty at NCFM. Each resident will be expected to write a blog reflecting on their experience while there are in their host country about once ever 3 days (as we know sometimes time, electricity, access can be limited we don't expect a daily report, but also want you to be free to write as often as you like). This also fulfills many of the required competencies for the Global Health Track and allows you to self-assess your own learning and growth through this experience. In the folder is a list of possible questions or thoughts if you are having difficulty with writing, but mostly would like you to write in freestyle about your experience. Thank you and happy travels!


NCFM Global Health Track Faculty
Joy Ruff
Wayne Jeffers
Jeff Cook