Global Health Experiential Education in Ecuador

I’m a fourth-year medical student who participated in the Global Health in Quito, Ecuador program through CFHI. I would highly recommend this program to anyone interested in learning more about the unique Ecuadorian healthcare system, practicing Spanish with host families, patients, and other healthcare workers, and exploring Quito, surrounding cities, and the Galapagos! I spent three weeks in Quito and 1 week in Otavalo at many different clinical sites including OBGYN clinic and wards, the OR, the pediatric ED, and primary care clinics. I spent many hours practicing speaking with Spanish and building my physical exam skills. I was able to really explore what makes the Ecuadorian healthcare system so unique and get an understanding of how it operates. Throughout my month, I participated in many home visits for patients that couldn’t make it to the clinic, which allowed me to see more of the country and the people of Ecuador. My host family was amazing. They made me feel very welcomed and treated me as a part of their family. We only spoke in Spanish so that I could be fully immersed and continue to improve my Spanish. They made sure I had everything I needed and gave me wonderful advice on fun things to do in the city and surrounding areas on my free afternoons and weekends. My daily Spanish classes were very helpful and focused on getting a solid foundation in medical Spanish to make my time in clinic easier. The afternoon excursions through the school allowed me even more time to learn about Ecuadorian history and culture and practice Spanish in a real-life setting. After my program ended, I went to the Galapagos Islands where I saw thousands of animals and saw firsthand many of the things I had learned as an undergraduate Biology major – including visiting museums focused on the discoveries of Charles Darwin!

I never thought virtual experience can be this enriching until I participated in the internship program by CFHI. They made sure to make this virtual space the most engaging and interacting one. Everything starting from the correspondence, timely response and process of selection is highly appreciable. The program, discussions and content gave me Public and Global Health perspectives from a lens I had never imagined. This experience had definitely added value to my professional and academic journey by allowing me to explore different health care systems in an innovative manner. I had the opportunity to: Virtually engage with different countries and health care systems added value to my existing knowledge and experience, Self paced learning and activities provided the time of self reflection and evaluation and helped me design my own pathway towards work in domain of public and global health issues, and More time to interact with fellows and colleagues from different demographic regions created opportunities for more networking and socializing.

This was a great program. Everything was very organized and structured so that I didn't have to worry about not knowing where I was supposed to be at any given moment. There were many points of contact throughout the whole process. From being picked up at the airport, adequate knowledge about the program from the host family, tour of the city and public transportation on the first day, coordination of hospital sites and physicians, the whole process was very seamless. Quito is a very easy city to navigate with great and cheap public transportation. Uber is also very cheap there. There are also lots of weekend trips that can be done to explore more of Ecuador. The rotations were all interesting and educational, with physicians teaching in between seeing patients. You get to work in a maternity hospital ER, adolescent pregnancy clinic, postpartum floor, outpatient clinics, and labor and delivery. I felt that the spanish classes were excellent especially since there were only 4 students or so in each class. Would definitely recommend this program!

Prior to depature, CFHI coordinators were prompt and sent helpful reminders on how to prepare beforehand. The local coordinator was very receptive to feedback, she checked in part way through to see if we needed to adjust the difficulty of Spanish medical language instruction. The shadowing experience in the clinics and hospital had an appropriate amount of time and the preceptors were kind. There was enough time to explore the community and practice Spanish. Quito had great public transportation and it was safe and easy to get around. I was warned by locals to avoid getting in a cab by myself as a female foreigner but also not to get ripped off with paying a flat fee instead of the ticker. Ecuadorian food is a little bland but affordable. It is great that you can explore the Galapagos Islands afterwards, would highly recommend!

I spent a month is Ecuador in April 2017

I’m a physician with a great deal of clinical and administrative experience and am also a graduate of the Michigan School of Public Health. Because of this, I’m probably not very typical of the majority of folks who are reading this but for a few, my comments may be helpful. I was most interested in population health, delivery systems and vector control. I also hoped to do something that might contribute to the place I was visiting. Finally, I wanted the opportunity to have meaningful conversations with people in Spanish.

The month I spent in Ecuador was more than I could have hoped for. This was in large measure due to the programmatic flexibility of the sponsor and my assigned preceptor.

My first two weeks were spent in Guayaquil. The first week was weighted toward language classes with a couple of mornings visiting a local clinic. The next week was spent with vector control with some afternoon language classes. This was a good balance of time. I would say that the language school was more conversational and less structured than the school I attended in Oaxaca on a different trip.

My time with vector control was terrific. I was able to observe a highly organized and effective program on the ground. Wilfrido (my preceptor) is the vector control officer of a program that is responsible for diminishing the threat posed by mosquito bone illness (dengue, zika and chikungunya) in a huge, economically depressed area of Guayaquil that includes 500,000 people. I went out with the home visiting crew who charmed their way into most homes and provided personal and high quality education. I also spent time with the fumigation team and had the opportunity to see many different barrios, some of which don’t have basic water and electrical services.

Before going, I read a good deal about how tough Guayaquil can be and I had some anxiety. My preceptor who also hosted me not only kept me secure but also made me feel comfortable in that environment. They often provided transportation and gave careful advice on how and where we should go.

The second two weeks were spent in Puyo, a much smaller town on the edge of Amazonia. Because Puyo is at about 3000 ft above sea level, the weather was very comfortable with thundershowers almost every day and just a bit of heat for a couple of hours in the afternoon. Folks told me that there really isn’t a dry season in Puyo. It is about the same all year around. (Guayaquil does have a wet season and a dry season with May being variable.)

During my two weeks in Puyo, I was able to work on a project in which the local medical care community and hospital are trying to implement a major program advancing the care of type 2 diabetes. The Ecuadorian Ministry of Health has recently released a set of guidelines and I happened to arrive during a time of intense planning. My fellow participant and I were able to develop a set of recommendations that we discussed and modified with the help of community members and medical personal. I believe that this work will contribute to the eventual success of the program. This was more than I hoped for and we were supported fully by Child Family Health International.

Additionally, I was able to visit San Virgilio for a couple of days. This was an experience of a lifetime. I stayed in a comfortable bungalow that was in close proximity to members of an extended family. My host, Rodgrigo kept in almost constant contact with me and thought of everything, including providing a walking stick to help with stream crossings and slippery slopes. You are actually driven to the main village and do a bit of walking to get to the family compound (you cross the stream twice). You do need to purchase rubber boots but that is easy to do at the Mercado in Puyo and it costs about $10.00. I was introduced to Kichwa culture and tradition in a genuine way. By the way, the meals I had in San Virgilio were the most interesting I had on my trip. Amazingly enough, there were no mosquitoes! (Because I am older than 58, I chose not to be vaccinated for yellow fever). Rodrigo told me that there are mosquitoes during the “drier” months of July and August.

I feel particularly fortunate to have stayed with my preceptor, his wife and their two children during my two weeks in Guayaquil. They were more than generous hosts. It felt like I was actually part of the family. Guayaquil was warm and humid and it was comfortable to be able to sleep in an air-conditioned room. My hosts for the second two weeks were also very generous and provided a very comfortable home during my two weeks in Puyo.

I had given no thought to weekends before leaving but this turned out to be an important part of the trip. I feel very fortunate that my companion during this month was a young woman who is just graduating from the University of Oregon. She was a courteous, flexible and interesting working/educational partner and traveling companion. We had the opportunity to visit Cuenca and Caja National Park, Latacunga and the crater lake called Quilotoa and of course Banos and the waterfalls (only an hour and one-half away). By the way, at this moment, Ecuador is a great travel bargain.

Thank you and CFHI for helping me have a remarkable experience.

A few additional thoughts:

1. I think a person with at least basic conversational Spanish competence will be able to take best advantage of the opportunities presented in Guayaquil and Puyo. I think a person wishing to be introduced to an “intensive” Spanish instructional experience might be better served at a different site.

2. I think a person interested in population and public health might find this experience exceptional, as I did.

3. This program demonstrated flexibility.

4. I studied almost all the materials provided and I suggest that participants take the time to do this as well. I had realistic expectations going in and this was important.

Honestly, before starting my program, I had no idea what to expect. I had never traveled to South America and I was quite nervous. Before starting, communication with the United States program staff was always swift, polite and understanding. This gave me the assurance that they were an efficient program. Upon arrival, everything was just as they said it would be. Fortunately, I arrived with two other program participants (one of whom ended up being my roommate!). I was in the Intensive Beginner Spanish Program and I am glad I chose that program. After my preliminary lessons with Angel, I felt adequately prepared to be useful in the hospital setting. The weekends were also sufficient for short trips to other parts of Ecuador. Living in Quito was great but the pollution from cars was one thing I did not like at all. This is however not the fault of the program since there is nothing they could do about that. The hospital contacts we met were also very helpful and understanding since they were used to having interns. Going to Ecuador really helped me be sure that becoming a doctor was what I wanted to do with my life. It gave me the conviction I now have and it is the main experience I cited in my medical school essays. The only mistake I made with this program was not deciding to do it for longer.

I simply loved this program. I actually went with four other medical school classmates, but I appreciated that we each had such separate volunteer and clinical experiences. I'll start with the educational experiences first. I really learned a great deal from my Spanish instructor. I think learning the medical terminology in Spanish was extremely useful for the following 2wks of my program, and when I reached the clinics, I was able to at least converse in simple sentences. The volunteering experiences were unparallel. Multiple programs offer the standard experiences of helping build homes or playing with children, but in Quito, I actually felt like I was directly affecting childrens' lives in a unique way. I helped volunteer with a group that promoted safe childhood safety from domestic violence and child trafficking. To really speak to the children, we put on a play about when to say no to people and strangers.
Next, to speak of my clinical experiences: my time in the Maternidad wards, as well as the general medicine clinic, actually helped me decide to focus a career more on internal medicine than on OBGYN---a decision I had been confused about for years. Other positives of the program? The culture. the location. the weekend trips. We visited Mindo, Ecuador, a wonderful and beautiful reprieve for my friend who was suffering from altitude sickness! We participated in canopying and rafting galore. We also ate such great foods---starches, perfect soups, and great quality meats. Overall, I was very satisfied with my trip and would recommend this program to everyone.

This past March I participated in CFHI's Amazon Community and Indigenous Health program, which brought me to Ecuador for the first time in my life. My experience was one of personal growth, adventure, friendship, and broadening of the mind. Our first week was spent in Quito - a large beautiful, but culturally rather bland city (coming from a snooty native San Franciscan, mind you). The intensive spanish helped refresh my spanish and prepare me for the challenge of adapting to the various dialects I would encounter throughout my trip. My time spent shadowing a doctor in the emergency clinic was full of excitement, and I left with a better understanding of the routine of admitting and examining a patient. At the end of the first week we took advantage of the days off in Baños, a cool little adventure/eco-tourism town in the cloud forest of the eastern Andes. We had a large group of students from the program in town together, so we had a blast getting to know each other while enjoying the attractions the town has to offer. The next three weeks of the program were spent in and around Puyo, a larget town of roughly 70,000 inhabitants on the western edge of the Amazon. While based there, we spent our three weeks at clinics in Pitirishca, Mera, and staying with a Shuar family 12 km into the Amazon from Pitirishca. The last week in the Amazon was an especially enlightening experience. A challenging 6 hour hike through jungle mud brought us to a beautiful and humble small village tucked alongside a winding river bend. We were immersed in a world completely alien to us, and we experienced the lifestyle of a community completely in tune with their natural environment. Gustavo, our Shuar host and guide, lead us through his world and shared with us his peoples culture and practice of natural medicine. It was an experience I will never forget, and one I will be hard pressed to replicate.