Previous Experiences
Previous Experiences
My summer in Panama was a great way for me to experience many aspects of the Panamanian healthcare system and the practice of medicine there. From the largest hospitals in Panama City, to smaller regional hospitals, to community health centers and smallest of rural clinics, I saw and practiced first hand what it means to be a doctor there. In addition to seeing a range of illnesses I may never see here and practicing my PD skills, I also had the opportunity work on a public health project, with help from the local board of health. Not only did this count towards my MPH degree requirements but it exposed me to yet another aspect of the Panamanian health system.
But it was not all entirely about medicine either. Living with the host families enabled us to really become integrated into the local culture, learn the languagle, and better understand the patients we were seeing. Most importantly, it helped me to feel grounded while I was there, really have a place that felt like a home to me and a family that cared about me.
There was also plenty of time to take weekends and extra days off to travel, and since Panama is a relatively small country, we got to see many different regions, some quite different that the part we called home. It was truly an unforgettable summer and I would recommend it to anybody.
Some tips for going. It is essential to come with at least a basic knowledge of Spanish as it takes a long time to adjust to communicating entirely in that fashion. But if you have taken it, even if you took it back in high school that's enough, it'll all come back to you as you speak it more. Don't get frustrated if you have early problems fully communicating, it will get easier. Be easygoing! Go with the mindset that you're ready for anything and take things as they come. Nothing is set in stone, things start hours late, and sometimes you just gotta eat the mondongo that's piled on the plate in front of you. Medical students in Panama actually wear blue jeans (nice, neat ones) as their normal uniform, so bring a couple pairs of those and some nice white shirts. Although clothes are insanely cheap at the department stores, so you can come down with little and buy a bunch when you get there.
Favorite part of traveling was staying with a Kuna family in San Blas. Favorite part of living with the families was the party they threw for us when they dressed us all up in Polleras and set off fireworks in our honor.
-- Sarah Gottfried, M09
For nine weeks, I called Panama my home, or perhaps I should say mi hogar. I lived in the city of La Chorrera, a bustling suburb of Panama City, in the home of an incredibly welcoming family of two parents and five children. Not since middle school have I been so well taken care of. Whether I asked them to or not, they insisted on cooking and serving me enormous amounts of food, doing my laundry, making my bed and making sure I knew how to get anywhere I needed to go. For nine weeks, I was immersed in Panamanian culture, language, and medicine. I would like to say that I became a bit of a Chorrerana myself. My Tufts classmates were living on the same street as I was and so, like our families, we all became vecinos for the summer.
Marjory and I rotated through the health centers together. First stop, El Centro de Salud de Capira. Capira is the next major town west of La Chorrera, smaller and with a much more rural population in the vicinity. On our very first day we went even further into the countryside along with one of the doctors to one of the smaller sub-health centers, in a village called Ollas Arriba. While the health center in Ollas Arriba is often open, it is normally staffed only by nurses. They are visited by a doctor only once a week and so upon our arrival, the waiting room was packed with patients, some who had been waiting since early morning. In Panama, as soon as you become a medical student, people call you Doctor and so I, alternatively referred to as “La Doctora Americana”, “Doctora” or just plain “Joven” was ushered into the exam room along with the (real) doctor, unsure of what to expect. By the time we saw our last patient, I had looked down throats, listened to lungs and hearts, performed abdominal exams and seen several cases of cutaenous Leishmaniasis, a parasitic disease that causes skin lesions. I’d like to think Dr. Barnewault would be proud.
Each day brought a new experience. A new sub-health center to visit, new doctors to work with, new patients and some medical conditions we would have never seen here in the States. We got a true taste of general medicine, pediatrics and gynecology. We gained insight into the medical conditions that are common, that are seen every day all over the world, and those that are more unique to Panama. We saw fungal and bacterial skin infections (who knew dermatology could be so interesting!?), intestinal worms, inguinal hernias, UTIs, strep throat and flu, pregnant women, well-children, children with downs syndrome, hypertension, enlarged prostates, vaginal infections, organophosphate poisoning, possible appendicitis and ectopic pregnancies, strabismus, rotator cuff injuries, machete wounds and clinical depression. We were reminded over and over again that while first year doesn’t seem very clinically relevant, Moore’s blue boxes really do happen and cranial nerve pathways come up all the time.
Read more of Sarah's article in the TCI.
Sadness, helplessness, anger, guilt. All emotions I encountered in passing the street children of Kampala, Uganda. Although this was my first time to travel abroad, I had heard of these young children in the streets throughout the developing world. I had been warned by various American citizens not to hand out money to these children, as a matter of safety. I felt as if this advice was more than a little heartless, but I kept it in mind nonetheless. I wondered at myself as I passed a small girl, with a baby on her back. How could I just ignore this beautiful child? Who gave me the right, with all of my riches and blessings, to just walk on by?
Early in my stay, I questioned a doctor about the circumstances surrounding these children. It was quite curious that the children populated the streets only at certain points during the day, but disappeared at night. Why were they on the street at all, and where did they go at night? The doctor stated that not all of these children lived on the streets- most had homes. Some were orphans taken in by relatives, but forced to beg on the street because their families could not afford them. Some ran away from home and chose to spend their days on the street. Either way, I was instructed to stay away from these children because "they [were] bad kids and pickpockets." The strong judgment of these children by a Ugandan citizen surprised me; I had expected pity for their plight. The negative stance of the doctor struck me with a profound sadness. If their own community was against them, what future could these kids have?
Everyday I passed these children I wrestled with the dilemma of either giving them money and food, or ignoring them. On the one hand, there would be a temporary relief from hunger, and I almost felt as if I were doing the "right" thing. However, this did not solve the long-term situation, and in some ways worsened it. One man I spoke with stated that by providing handouts, these children had incentive for the begging to continue. However, if there are no jobs for the adults to provide for these children, incentive or not, what else can these families do for food and money? If I were to be pick-pocketed, would it really be so bad? What would twenty dollars be to me? And, how was I supposed to choose which children to give to? As relatively rich as I was, I did not have enough money to help them all.
I spent close to two months in Kampala, and I never came up with a satisfactory answer to any of these questions. Reflecting back on my stay, I still have no good answer for the issues surrounding poverty. The children could not help the unfair status they bore no more than I could help the riches of mine. I agreed to write this article, not because I have any clear answers to difficult moral issues, but to raise awareness and hopefully encourage those who read these words to become, or to continue to be, engaged in caring for their communities, locally and abroad.
-- Anita Sarathi, M09
"A memorandum of understanding between Tufts and Father Muller Medical School got the program off the ground. We’d be taking classes with their students, visiting their out-patient departments, going to their special guest lectures, and living in their hospital. They’d actually remodeled a floor of the hospital for us, giving us each a room with a bathroom, a balcony, even cable tv. We got HBO in India. Since there were no patients on the floor, we took over the nurse’s station as our common room – we needed a place to hold poker tournaments and make hot-plate grilled cheese. And living in the hospital, rather than the dorms, meant we were exempt from the 8pm curfew on-campus students had to observe.
Weekdays were fairly structured. In the morning, we’d go class. We were in 2-week rotations between general medicine, OB, pediatrics and surgery. ‘Class’ consisted of a topical lecture followed by a trip to the general wards and a case presentation or a visit to the OR. It was also a fantastic chance to get to know other students. There are five or six ‘local’ languages in Mangalore, but English is the common language of education so lectures were no problem. The patients in the general ward usually didn’t speak English, so there would be a scramble to find a student who spoke the same dialect and that student would translate between the patient and the others in the class. All that talking made it easy to make friends, which in turn made it easy to find out all the good restaurants, bars - all two of them - and entertainment hotspots. We managed to attract a fair amount of attention at all of them, too. Mangalore isn’t exactly a tourist spot, so we attracted a lot of attention."
-- Jessica Heath, M09
Read the rest of Jess's article online at the TCI.
I spent my summer in rural south India, helping a physician set up a clinical research project examining the effects of maternal HIV infection on the health and development of her children. I spent half of my time working on this project, consisting of a lot of paperwork, but also a lot of designing protocols and questionaires, in order to find ways to adequately test our research question. I worked with many different physicians in determining how we would structure the project, including child psychiatrists, ID specialists, dieticians, and social workers. I also spent a lot of time in the HIV clinic, meeting with the patients that the study would examine, and hopefully most positively impact.
The other half of my time, I spent practicing and seeing more medicine than I had seen cumulatively up until that point in my life. I was located at a community health center, where the most high-tech piece of equipment was a suction machine in the OR, and luxuries such as AC were nonexistent. When assisting in C sections, I had to manually take the patient's blood pressure every 90 seconds with an old-school cuff. I also stood on my feet for hours at a time and assisted in countless tubal ligations. Every day was a different clinic, ranging from ID on tuesdays, to the child immunization clinic on Thursday afternoons, to the leprosy/diabetes rounds on Saturday mornings. It provided me with a wide spectrum of clinical exposures, and I was allowed to pick and choose what I did based on what most interested me.
The one negative in the experience, which ultimately translated to a positive, was the fact that I was alone, in a very rural area of south India. The only people there who spoke English were the doctors, who were often to busy to help me out and provide me with company. At the same time, I ended up becomming friends with some locals, as well as some of the interns, which provided me with the opportunity to better integrate into the community, and experience the Tamil culture.
-- Chris Bielick, M09
My summer was spent at the National Institute of Public Health (INSP) in Cuernavaca, Mexico. My project focused on the care that HIV/AIDS patients receive in the public sector in Mexico. I helped to design surveys for patients, doctors, nurses, and health care centers that dealt with practically every aspect of HIV/AIDS care. However, there are countless other ongoing projects at INSP, so there is guaranteed to be one that will suit your interests. Cuernavaca is a great, Boston-sized city and the folks at INSP work hard to find a place for interns to live. Plus the people of Cuernavaca are very welcoming and happy to accommodate visitors.
If you are interested in working at INSP, it is important that you are comfortable speaking Spanish continually. To me, having to speak Spanish was a major benefit of the experience. It never felt like I was having my hand held or being walked through the experience. My summer was much like a 9-to-5 job - as a side note, I had GREAT colleagues - and I appreciated the responsibility that was given to me. The hours were flexible, which allowed me to travel from time to time as well. If you are interested in INSP, please email me at Colin.Robinson@tufts.edu, or my summer advisor at Anthony.Robbins@tufts.edu.
-- Colin Robinson, M09