Global Health Experiential Education in Bolivia

Several years ago, I spent two years living in a rural village in the Dominican Republic as a Peace Corps Volunteer. Immersed in a different culture, language, and way of life vastly different from my privileged upbringing, I experienced immense personal growth and gained a perspective that informed my path in public health and medicine. Now in my 4th year of medical school, I had the opportunity to spend a month living in Tarija, Bolivia through Child Family Health International, rotating in clinics and hospitals, improving my Spanish language skills, and immersing once again in a vibrant culture and community. While these two experiences were different in many ways, what ultimately remains etched into my mind and my heart remains the same - the people I met and the relationships I built.

I lived in a 3 generation household consisting of my host mom, her son (host brother) , and her 6-year-old grandson. My host mom does it all. She works as a dentist, is the chef of the household (cooking not only for her family but also for her fiance and his daughter), attends to her plants, and keeps everything in order. The more time I spent with her, discussing everything from the weather to cooking to U.S. and Bolivian politics, the more it felt like a genuine friendship, similar to that which I have with my own mom. In addition, we realized that we both have a second stomach for sweets, which came in handy when we went to dinner and could back each other up on wanting to order dessert. It also made teaching her how to bake tres leches (my host brother’s favorite cake) a no-brainer. It lasted less than 2 days!

My host mom created the sturdy, comfortable envrionment that made me feel like I had a home away from home. She had a genuine curiosity to get to know me as well as teach me about the aspects of her life and Bolivian culture that she loves and appreciates. It was her delicious, traditional meals that kept me energized during my month there (well that and the coffee I enjoyed multiple times a day). Some of my favorite memories in Tarija were the times we spent in the kitchen/dining room, preparing food, eating together, or talking over tea and snacks. The previous student was right when she said that our host “is the best host mother!”

Then there was my host brother, who is around my age. When he’s not taking care of his son, working as a dentist, or taking online courses to become a professor, he runs with a local running club. During the first two weeks as I was preparing my residency application, we’d sit together at the living room table after dinner, doing our respective work. The companionship during this somewhat stressful time was unexpected and quite calming. More unexpected, however, was when he invited me to sing-up for a 5k race that he and his running club were participating in. I ran cross-coutry and track in college (over 10 years ago), and it had been a hot minute since I participated in any competition. But as soon as we arrived in the early morning, doing warm-up experciese together, I had the familiar nervous excitement that always comes with racing competitions. After the race was over (I came second in my age group with the prize of a botte of wine made in Tarija!), we joined the rest of the running club members for a celebratory brunch. The following week we ran in another, more low-key 5k, and afterward I chatted with some of the same running club members as the week prior. They tried unsuccessfuly to get me to join the triathlon the following week. Though brief, I felt I was part of this energetic and supportive community.

The day before leaving Tarija, my host brother brother messaged me: “You’re not leaving yet, and I’m already missing you 🥲.” This sentiment alone describes what I find most valuable about my experience: the ability to connect with people, to compartir (share) parts of your lives, even if briefly, in a way that leaves a positive mark.

My name is Jenna Frantz, and I am a fourth-year medical student (just weeks away from graduating as an MD) at Wright State University Boonshoft School of Medicine. As I am preparing for my residency and career in emergency medicine, I am continually inspired by my foundational goal: to serve Hispanic patients facing barriers to healthcare, both domestically and abroad. When I found the rotation to Tarija, Bolivia, through Child Family Health International (CFHI), it was a great fit with my goals to obtain further education and experience in global health. I had previously rotated in Peru, Guatemala, Ethiopia, and Puerto Rico for service-learning opportunities (not affiliated with CFHI), and I could tell my experience with CFHI would be different. I was so excited for the stellar learning experience and cultural immersion provided by CFHI.

While still stateside, CFHI made sure I was well prepared for my trip logistically, culturally, and educationally. To facilitate this, there were multiple required online modules about the program, Bolivian culture, cultural sensitivity, and global health ethics. Additionally, the team remained in close email contact with me, and there was even a virtual orientation session to ensure I was prepared prior to takeoff.

Once I arrived in Tarija, I was immediately received with warm, kind smiles from Fabricio – the local program coordinator – and my host family. I got to live with a lovely host family for 8 weeks. The family had 3 daughters about my age, and they took me under their wing immediately, inviting me to hang out with their friends, to walk around the town, to go to the local cultural festivals, and so much more.

Aside from the amazing experience I had with my host family, I had a very comprehensive medical rotation. I rotated for 2 weeks in internal medicine, and 1 week in each of the following: rural primary care, urban primary care, Chagas’ disease clinic, emergency medicine, general surgery, and OB/GYN. I quickly found that the rotations through CFHI are not the same as my medical rotations in the United States – despite being fluent in Spanish, it is difficult to be fully-integrated into the care team as a foreign student where the documentation and work-flow are entirely different from the system in the United States. Furthermore, the local students had to start pre-rounding on their patients at 4-6am; as my scheduled arrival time to the rotation was at 7-8am each day, it was hard to be as fully-involved in patients’ care, since much of the decision-making took place in pre-rounds prior to my arrival. Despite this, it was not at all a barrier to my learning experience, but rather a shift of focus. My learning on this rotation was much more focused on cultural influences in medical decision-making, the influence of government in healthcare in a universal healthcare system, and navigating barriers such as broken equipment and out-of-stock medications.

Another amazing part of this rotation was the extreme kindness and generosity of the local physicians and medical students. Although they had absolutely no obligation to do so, they frequently invited me out to experience the beautiful nature and the lovely culture and customs in Tarija. While rotating in the rural clinic in San Andrés, the physicians took me to the river in the countryside after clinic to enjoy the gorgeous views and to take a dip in the water. At the urban clinic, the physicians invited me to hang out with them during the Carnaval Chapaco, as they wanted to ensure I could experience this great cultural tradition. While rotating in internal medicine, I became good friends with a local medical student, and she and I learned more about the local cultural importance of wine while we toured the local vineyards together. During my experience in general surgery, the residents invited me to get coffee, dinner, and to take a hike to the Chorros de Marquiri, the most beautiful waterfall I’ve seen in my life. All of these people went above and beyond, helping me to have an amazing time in Tarija, and it was truly one of the best parts of my CFHI experience.

My experience with CFHI was valuable and enjoyable learning experience, and I knew I had the constant support of my caring host family and the local team. I would highly recommend an experience through this organization for any students in the medical field who plan on having a career in international medicine.

I completed a global health practicum in La Paz, Bolivia in March 2018. Rather than working in a clinical setting, I worked with an NGO that had developed a micro health insurance (MHI) product for very low income persons living in La Paz. The NGO was experiencing challenges in meeting their sales goals, and the focus of my practicum was identifying barriers in selling/purchasing MHI and providing recommendations to overcome these barriers.

This practicum was a particularly important experience for me because I did not have any previous experience in public health. In addition to learning about what it is like to work in the field, I also learned several invaluable lessons about developing, implementing, and promoting public health programs.

I found both the NGO and CFHI staff friendly, supportive, willing to teach me, and willing to learn from me. The local CFHI staff was particularly helpful - they were always available to answer questions or help resolve any issues. My homestay accommodations were very high quality, and in a location convenient to the office.

The also program offered flexibility to travel on weekends, so that you can explore and learn more about Bolivian culture.

All in all, this was a wonderful experience and I am glad I participated in the program!