At the Feet of the Andes

Eleven medical students serve and learn

As part of the Student Alliance for Global Reach (SAGR), I traveled with 10 other medical students to Peru in order to serve, research, and learn in February 2010. We arrived in Puno, Peru after roughly 24 hours of transit, thrilled to have reached our destination unscathed. We began by rounding in and touring Puno Hospital. A variety of excellent speeches highlighted what the crux of our visit should entail: learning from each other.  We acknowledged that our healthcare structures, education systems, and cultures were very different, but it was because of those very differences—and not in spite of them—that our partnership held value.  In an impromptu speech, Ian, the M2 who came down with us, said, “cuerpos son cuerpos” (bodies are bodies) – in the end, no matter the lingual or cultural or even technological barriers, we are all just people and, if nothing else, our humanity connects us more essentially than anything else ever could.

During our time in Peru, we learned much about traditional Peruvian medicine—giving birth at home, without health professionals, in a series of ancient protective rituals. We also learned about how, even within the general Puno area, different villages had very different perspectives about family planning.  While it was completely acceptable in one village, in others there was a societal concern that women would become promiscuous if provided with family planning resources, and the overall machismo disallowed their use.  My experience in the hospitals and clinics made me reflect on the difficulties of seeing how the lack of resources translated to differences in health care practice and delivery. I was struck by a combination of frustration and shock, for example, when I saw doctors not wearing gloves while caring for certain patients, or not washing their hands before moving onto another. While in the US a great deal of care is placed on patient comfort and privacy, that was less of a concern in Peru; they would, in fact, pack students into rooms to enhance their learning. I acknowledge the dire need to train physicians, but I can’t shake the feelings wrenching through my gut when I looked at the doe-eyed patients who listlessly complied with the doctor’s commands to show the rashes on their hands or roll up their sweaters so we could examine their abdomens.  I appreciate all the more the humanistic approach to patient care we emphasize here at UM.  There is an essential quality of humanity we should never forget, especially as physicians.

The patients I encountered were some of the strongest people I met, never complaining about pain, even while being administered excruciating treatments.  But this attitude can also be problematic–some healthcare workers just ask women if they feel any pain, and when the women respond in the negative, the workers sometimes forego physical exams which could otherwise have picked up on potentially serious complications.  Even the children we encountered seemed to be made of smiles and rosy cheeks (sunburnt, actually), completely different from some of the spoiled American children I have encountered. We are worlds apart, in some ways, and they have a lot to learn from us.  But we also have a lot to learn from them.

As part of efforts to give back to the community we gave talks and held a health fair. During the previous year’s visit, the students of ACEM (our partner medical student group, Asociación Científica de Estudiantes de Medicina (ACEM) at the Universidad Nacional de Altiplano (UNA)) had expressed interest in learning some biostatistics, so we translated some of our own curriculum into Spanish and taught them in lecture format, followed by working on problems in small groups.  Teaching the concepts in another language proved quite a challenge, but a worthwhile one.  It’s incredible to think about how we, just by learning a language, gain access and insight into people and cultures we could never achieve by mere translation.

Another great aspect of these trips is the ability to get to know your own peers—and let me tell you, Team Peru bonded hard core.  Too often we content ourselves with superficial interactions, as we often don’t have the time to dig deeper.  Well, that, or it involves asking personal questions, which makes some people feel awkward.  But on these trips, when you’re inoculated with a small group of people in a foreign environment, you find yourself able to ask questions that might be inappropriate in normal social context.  Through personal conversations, I discovered the complexities of personalities that helped me appreciate each member of my group.  It’s amazing how much you can learn by just paying attention to people’s stories, spending the time to ask the right questions, and really taking the time to hear their answers.

Looking back, I’m flummoxed by how quickly time can fly.  Moreover, I’m impressed by the amount we were able to accomplish in our short time.  It’s incredible how motivated you can be when necessary; whenever I travel, I feel like I have the strength and energy of five people—a feat I cannot replicate once I return. I’m still amazed by how incredible my experience truly was.  I learned about medicine, Peruvian healthcare and its culture, my teammates, and myself, personally and professionally.  My interest in health care disparities has increased exponentially.  I am grateful for the people I got to know, from Michigan and from Peru, for the improvement in my Spanish, and for the insights I gained.  The value of these trips, I realize, is hard to gauge; but to the many of us who went, it was invaluable in our common experiences as rising physicians.  Now, I am more able to appreciate the resources I have, and am more inspired towards my goal of serving as a health care professional in those communities that need it most.  I feel honored to have had this experience, and to have grown from it.



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