MED Students Without Borders
Ecuador program gives first years a perspective on global health| From Commonwealth | By Leslie Friday. Video by Robin Berghaus
In the video above, BU medical students learn about global health by running health education camps for children, working in clinics and hospitals, and living with host families in Ecuador.
Thumbs were not supposed to look that way. That was Owen Kendall’s first thought when he spotted the green wrapping around the thumb of an elementary school student in Obraje. The first-year BU School of Medicine student led the boy from the dim cinderblock classroom into the Andean sunlight of rural Ecuador.
Kendall (MED’14) squatted down and peeled a leaf from the boy’s thumb, revealing a swollen, mud-encrusted gash. He grabbed some wet towels and dabbed at the wound, asking the impassive boy in halting Spanish how and when he got hurt.
Seconds later, Kendall was on his cell phone calling for assistance. Within half an hour, a driver arrived from the Cacha Medical Spanish Institute (Cachamsi), a nonprofit international medicine program less than 10 miles away in Riobamba, through which Kendall and five other BU first-year medical students were volunteering last summer. The driver questioned the boy in Quichua, the local language, then whisked him away to the nearest clinic.
For the past two days, as part of their monthlong health education camps for children in the indigenous Cacha region, an autonomous union of 23 Quichua communities, Kendall’s group had been talking to children about the best way to care for nasty cuts. Apparently the lesson hadn’t sunk in. The Quichua remedy—cover with mud or cow liver and wrap with a leaf—clearly trumped the Americans’ advice.
Owen Kendall (MED’14) (left) and local doctor Patricia Reátegui examine a boy in a clinic in the rural Cacha region of Ecuador. Photos by Vernon Doucette
“I just hope that some of the stuff that we teach sticks,” Kendall said. “I think we’re doing a good job, but we just need to keep trying.”
The students in the Cachamsi group worked primarily as camp counselors, but they also took medical Spanish classes, shadowed doctors at hospitals and clinics, and lived with families. For some, the trip was an adventurous way to learn Spanish (a useful skill at Boston Medical Center, where it is the first language of many patients). For others, it was a trial run at a career in global health.
They were the third wave of Boston University medical students to conduct health camps through Cachamsi, a program that Suzanne Sarfaty, MED assistant dean for academic affairs and director of international health programs, discovered and hopes will continue.
Sarfaty knows the value of an experience like Cachamsi, which teaches a few things that aren’t ordinarily learned from textbooks or rotations at BMC. Most of it is about the limitations of health care in remote parts of the world. Talking to kids about hand-washing falls a bit short when even the schools lack running water. Encouraging people to brush their teeth is tricky when local water is laden with parasites. And preaching about protecting the skin from the high-altitude sun is useless when most families have no access to (and can’t afford) sunscreen.
Caroline Mullin (MED’14) teaches a lesson on bones and muscles.
Many Cacha adults suffer from rheumatoid arthritis (which is made worse by the cold mountain climate), high blood pressure, tuberculosis, and lung disease from cooking over wood fires. It’s not uncommon to find a seizure-inducing disease called neurocysticercosis, caused by tapeworm cysts from eating undercooked pork. The water in Cacha is also problematic. Unfiltered and unchlorinated, it infects many people—especially children—with intestinal parasites.
At the program’s end, the students agreed that their journey took them to another world, one in which hospitals and clinics have few anesthetics, antibiotics, and painkillers, let alone medical staff. Adriane Levin (MED’14) witnessed skin grafts. Caroline Mullin (MED’14) took medical histories for a pediatrician. And Stephanie Feldman (MED’14) assisted on a laparoscopic surgery to remove a gallbladder.
Some of the things they learned were heartening, and some were not. On one home visit, Peters Otlans (MED’14) saw a Quichua woman who had spread liver on a weeks-old gash and was in severe pain from the infected wound. After cleaning the wound, the doctor Otlans was shadowing told the woman to go to Riobamba for treatment.
“It’s eye-opening to see the way people are out here,” Otlans said. “Until you actually see it, it doesn’t have the same impact. The woman still refused to go.”