Education and ServiceinEcuador

By Maggie Bucholt
Global Health

Many of the public health challenges Boston University researchers engage on a daily basis occur thousands of miles from campus. The University’s global initiative to improve health in low-income countries around the world includes projects such as an evidence-based study of childhood pneumonia that changed the World Health Organization’s guidelines for treatment. A Spanish immersion program for School of Medicine students that benefits local citizens and community health care projects in Ecuador. In Nicaragua, researchers are seeking answers to a kidney disease epidemic affecting young workers, and in Peru, a theater arts pilot program has shown promise in improving public health.

At the heart of these efforts is the Center for Global Health & Development, where numerous research projects in Africa and Asia contribute to the body of knowledge about HIV/AIDS, malaria, and infant mortality. A new focus is rapid urbanization in India and its impact on public health. To support the complex strategic and operational issues involved with international research, education, and community service, the University established the Global Programs Office and is encouraging cross-disciplinary collaborations to address major global challenges.

The six-week Spanish immersion program for School of Medicine (MED) students in Ecuador’s Andean Highlands accomplishes two goals.

A portion of the students’ tuition to the nonprofit Cacha Medical Spanish Institute (Cachamsi) in Riobamba is funneled back into the community to construct medical centers, stock medicines and equipment, and provide emergency care for severely ill patients. And MED students learn Spanish, teach children in summer camp about healthy practices, and shadow physicians—often traveling to farms where parasite-free drinking water is unavailable.

“It’s an opportunity for students to see how difficult it is to practice in a poor, rural community where there are few resources,” says Suzanne C. Sarfaty, assistant dean for academic affairs and director of International Health Programs at BU School of Medicine, who discovered the program six years ago. “You have to dedicate a lot more time and energy to make things work. It’s a good lesson.”

Sarfaty met Jorge Duchicela, founder of the nonprofit and director of the integrated rural training track at the University of Texas Medical Branch, at a global medical conference. Spanish immersion programs often do not cater to the needs of U.S. medical students, she says. Sarfaty collaborated with a colleague at Dartmouth Medical School to vet the programs.

“Cachamsi is a well-run organization that gives back to the community in thoughtful ways—many Spanish immersion programs charge students high fees, but there is no transparency where the money is going,” she says.

Five BU students are selected for the program each year and receive a small scholarship to offset the cost. Students live with local families in the Cacha region, a cluster of indigenous villages where farm families subsist on rice and meat, and local customs for treating illness include using mud or cow liver on deep gashes.

“It’s hard to step into a community and effect change without ongoing reinforcement and financing,” Sarfaty says. “You have to be humble. You’re getting more than you’re giving.”

Students understand that their first medical training will likely be in an area where Spanish is the first or second language spoken, and being able to communicate with patients is a top priority. “Learning Spanish is worthwhile,” says Sarfaty, who speaks from experience. A 1988 MED graduate, she spent time in Chile as a student; she practices at an East Boston health center where she uses her Spanish. “It’s hard to deliver effective health care if you don’t speak the language.”

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