Biography of an Ecuadorian Resident: Juan Carlos Perez

My name is Juan Carlos and I am 30 years old. I was born and have always lived in Quito, Ecuador. I studied in a well-known school, Colegio Media.  I have very fond memories of living in Quito. I graduated from medical school at the Central University of Ecuador and then applied to the Andean Health and Development post-graduate family medicine residency program. I am interested in the different ways of approaching medicine. I like to view medicine in both a biological and a psycho-social light.

Andean Health  & Development has been a great experience! I always hoped to be part of an institution that really has a primary objective: to provide care to the neediest communities and in places where they really need health services.
I am growing every day with this program. I am learning medicine while reaching more needy people in a rural part of my country.

I’m single, I’m the third of four siblings, my parents and my family are very close and have always supported me.  I thank Andean Health for this opportunity to further my career while serving those in need.

A Rural Visit by an Aspiring Doctor

The following reflection is from Notre Dame graduate, Mark Sullivan. Mark volunteered with Andean Health in Ecuador during the summer of ’08. He is now in his first year of medical school at the University of Rochester.

While hiking with a rural Ecuadorian medical team, I felt like I was a general practitioner from the late 1800s on his way to make a house call. Modern medicine is relatively new to this region of Ecuador, so I perceived that its unfamiliarity to the local community would make for an interesting encounter.

We arrived to a shelter that looked like an abandoned tree house and met with a 25 year-old pregnant mother of six children. Although we were complete strangers to Maricela and despite her extreme poverty, she kindly welcomed us into her home. She confided in us and let us examine her children. When I asked Maricela what her hopes were she quickly responded, “good health and a better future for my children”; the latter being clearly dependent on the former.

My experience with the EBAS team opened my eyes to some of the social, economic, political, and cultural barriers that prevent rural populations from receiving quality and equitable care. Working under the Ministry of Health was a beneficial experience, as it allowed me to integrate myself into the Ecuadorian system of law, government, and culture. More importantly, it provided me with a once in a lifetime opportunity to obtain a thorough and pragmatic introduction into policy strategies in Ecuador. Working for the MOH also introduced me to the challenges that exist because of the disconnect between health policy makers and those that make financial decisions in the country.

One question that was often brought up was whether the people living in the rural Ecuadorian communities were receptive to “modern” or “western” medicine. I found the people of Sarahuasi, Pilalo, and Guasaganda to be very open to whatever assistance that was available to them. However, I could notice that the EBAS teams are still in the process of establishing trust with some of the members of the community.

The most important lessons learned from my experience with AHD and EBAS are twofold. First, I learned that all of the theories and frameworks that I read in health policy textbooks will not be able to be successfully applied to the communities that I worked in this summer. Instead, these theories must be adapted to local customs and time tables.

Cultural, political, and socio-economic realities must all be taken into account when trying to successfully develop a viable model of health care in these regions. This is a very important lesson for someone interested in global health, as these are the pieces of the puzzle that one must fit together on a daily basis.

I believe that the success of AHD is largely derived from its ongoing responsiveness to the personal needs of the community. In both PVM and La Mana, I met physicians, nurses, and staff who are enthusiastic about the work of AHD and its dedication to serving the individual patient within the context of his or her cultural and socio-economic reality. Thus, AHD’s future success will not only be a result of its financial sustainability, but also its “personal” sustainability.

Second, I learned that my contribution to the people of Ecuador this summer was small compared to what they gave back to me. The patients, doctors, and friends that I came to know invited me into their lives. I had the privilege of learning about their hopes, joys, fears, and anxieties. More importantly, their life stories allowed me to reflect on my own life, to rearrange my priorities, and to develop a clearer understanding of the common human bond that we all share.

 

Learn more about Andean Health & Development at www.andeanhealth.org.

Biography of an Ecuadorian Resident

Amanda is one of the Ecuadorian residents at Hospital Pedro Vicente Maldonado.  She has a focused curriculum specific to the Rural Hospital Model.  This is one of the best programs in the country for medical training.  She has written her bio in both Spanish and English!

“My name is Amanda Elizabeth Tene Rueda. I am 26 years old. I was born in Quito, but my family is originally from Loja. I studied in Universidad Central del Ecuador. I was interested in family medicine when I was working as a rural physician in San Gabriel.  I liked my first rotation in Hospital PVM.  It was very hard and I learn very much about rational medicine, even though I never had enough time to study!!

I think family medicine is very important in order to improve the health conditions in my country, especially in rural areas. Fortunately, I can dedicate more time to my career because I don’t have children or any other huge responsibility. I am single, my family is big – 8 members, I am the second, but I am the only physician.

Mi nombre es Amanda Elizabeth Tene Rueda.  Tengo 26 años.  Naci en Quito, pero mi familia es de  Loja.  Estudié en La Universidad Central del Ecuador. Hice el año de medicatura rural en San Gabriel provincia del Carchi.  Ahí me nació la el interés por la medicina familiar. Me interesó mucho desde el principio la idea de hacer un postgrado en hospital rural. La primera rotación ha cumplido con las espectativas, aunque siempre hace falta mas tiempo para estudiar. Estoy contenta de haber escogido la carrera.

Pienso que la medicina familiar será un pilar importante para el mejoramiento de la salud sobre todo en las comunidades rurales.  Afortunadamente, puedo entregar mucho más tiempo al postgrado porque no tengo hijos, ni otra responsabilidad mayor. Mi familia es un poco grande somos 8 personas, soy la segunda, la única médico de la familia.“

Learn more about Andean Health & Development at www.andeanhealth.org.

Reflections from a Visiting Hospital PVM Resident

I found the elective in PVM a fantastic cultural and educational experience.  From the moment I arrived in PVM, I felt welcomed by the community and the hospital and right at ease in the working and living arrangements.  The faculty, residents and staff were all warm and inviting; everyone was helpful and with answering my many questions.  The patients were friendly and easy going and the medical cases were varied and intellectually challenging.

Initially, it is always disorienting to be in a new environment and unfamiliar medical system, but the small hospital, helpful staff and open atmosphere made it easy to adapt.  Educationally, it was a good contrast to what I normally see in the US.  The pathology was often more acute and severe, but the cases tended to be less complicated with polypharmacy and multiple medical comorbidities. It was a different sort of challenge than I am used to, and it taught me to think through the cases differently.

Instead of relying on a battery of easily accessible tests and an entire pharmacy of different medications, we were forced to think carefully through what we needed, what we actually had and how we could make do to best serve the patient.  It was in many ways a more refined and intellectual approach to medicine in that the cases required critical thinking and decision making instead of following a cookbook algorithm approach to medicine.  I came back feeling more confident with my own ability to work in new environments and approach problems from different angles.

Living with the Ecuadorian residents was probably the highlight of my trip. It was an excellent way to make fast friends and learn the inner workings of the Ecuadorian medical education system.  The residents were wonderfully kind people and included me in everything.  We had a great time making meals together, staying up late to study over cups of coffee, sharing gossip and venting about the usual frustrations of work and life.  It was hard to part ways when my time came to leave but we still keep in touch by email.

-Rienera Sivesind

Please visit www.andeanhealth.org to learn more information about Andean Health and Development.

Board Approves AHD Model Expansion!

The Andean Health and Development Board has approved the building of a new hospital in Santo Domingo, Ecuador. The city of 350,000, many of whom are in extreme poverty, is grossly under-served in terms of health care. AHD plans to create a Physician and Nurse Training Facility. This will be the new location for the Center of Gloabal Health!

Andean Health is now starting a capital campaign project to raise $2 million dollars in the next year to fund this project to save the lives of even more Ecuadorians.

1. Hospital Pedro Vicente Maldonado: Pilot Hospital – 100% self-sustaining
2. Hospital La Maná: Partner Hospital with the Ecuadorian Ministry of Health (MOH)
3. Saludesa Field Office, Quito
4. Catholic University, Quito: Residency Affiliation
5. La Concordia Nursing School: Nursing Affiliation
6. Future Hospital Hesburgh, Santo Domingo: Physician Residency and Nursing Educational Facility; Global Health Research Center

How Can a Hospital in an Impoverished Villlage be 100% Self-Sustaining?

Since 2007, Hospital Pedro Vicente Maldonado, in rural Ecuador, has been self-sustaining thanks to Andean Health’s community partnerships. This model has been so successful, that AHD plans to replicate the model in new locations. These sites then are used to train Ecuador’s health workforce and the health care leaders of tomorrow.

*Ecuador's Social Security pays more than what Hospital PVM typically charges for certain services. This allows us to cross-subsidize other nonpaying patients.

Have a question about this model for sustainability in developing Latin America? Please leave your questions and comments below.

Please visit www.andeanhealth.org to learn more about Andean Health and Development.

Electronic Medical Records at Hospital PVM!

“It’s difficult to contain my excitement today. We are fully operational with electronic medical records at the hospital!

In addition to all the obvious, wonderful things this allows us, I would like to share another one:

Our teaching faculty was watching from a remote computer what a resident was writing in the electronic chart as he was attending to a patient in the outpatient office. The attending noticed that the resident’s decision and management of the patient did not quite fit with the history that the patient had given to the resident. So the attending went into the room and discussed the patient with the resident, who changed the diagnosis and treatment plan. We can’t even do this in the US… This is incredible, realtime, teaching and learning! It’s also great for the patients, of course!”

~Dr. David Gaus, Hospital Pedro Vicente Maldonado

Some words from a visiting medical intern…

“I hope all is well in Pedro Vicente Maldonado. I have been meaning to write since my return to the US to thank you for helping me organize the elective in PVM.

I was very impressed with the care provided and the level of medicine practiced. I felt that the residents and attendings used an elegant approach to medicine, keeping unnecessary tests to a minimum and using history, physical and common sense to guide the diagnosis and management.

After spending so much time in a system where the resources seem unlimited and are therefore wasted, it was refreshing to see how carefully all the patients and staff guarded the resources available. Above all, it was a great experience to be able to share a living space with the other residents as a way to get to know them and see their journey through residency up close.”

-Rienera Sivesind