Community Health and Sustainable Development Intern Immersions

My experience with PACH was absolutely incredible. I had the opportunity to visit Ecuador for the first time and was fully immersed in its rich culture. I appreciate the professionalism, organization, and respect PACH showed in terms of working with FIBUSPAM and treating our community partners and community members with respect and compassion. I also appreciated the opportunity to learn more about Systems Thinking, Implementation Science, and community health. As a current medical student, this experience has continued to have a lastic impact on me as I've been able to utilize my knowledge of Spanish, work with individuals from different cultures, and engage with marginalized members of the San Francisco community to provide accessible healthcare.

This summer I had the opportunity to complete an 8-week internship with Partners for Andean Community Health(PACH) in Riobamba, Ecuador. Riobamba, located in the Chimborazo province, is home to many rural communities and a large indigenous population where healthcare disparities are especially pronounced. PACH works closely with Hospital FIBUSPAM to improve healthcare accessibility and affordability in Andean Ecuador.

Projects

During my internship, I worked on three key projects:
1. Cervical Cancer Screening, Treatment, and Prevention: Cervical cancer is a highly preventable disease, yet it remains a significant global health issue, especially in Ecuador, where it is the second-most commonly diagnosed cancer and cause of cancer death in women. My role was to create an intervention framework and project plan for cervical cancer screening, treatment, and prevention programs in Chimborazo. This involved reviewing past cervical cancer initiatives, conducting an inventory of supplies, recommending new equipment, and identifying barriers to care. I also developed educational material, tailored to specific audiences to increase awareness and acceptance of screening and treatment.

2. Nutrition Project Implementation and Sustainability Planner: This project aimed to address the dual issue of malnutrition, stunting, and obesity, in Chimborazo. Building on previous research, I designed a comprehensive program that focused on nutritional support and education for parents and children. I also created educational material on maintaining a balanced diet and complementary feeding guidelines, incorporating local foods and nutrition.

3. Educational Institution Health Study: My last project identified gaps in educational and institutional health outreach in rural communities around Riobamba. I discovered a significant lack of data in these areas, despite numerous health intervention programs in Ecuador. This gap is alarming because it hinders accurate health assessments and can lead to inefficient or even socially and culturally unacceptable interventions. To address this, I conducted a survey on the school environment, community health services, and women's health services in Riobamba. Over two ways, I visited more than 15 schools and surveyed over 100 school administrators and teachers.

I also had the opportunity to work closely with FIBUSPAM staff. Whether consulting for my projects, learning about their daily lives, celebrating birthdays, or joining them in the OR, I was surrounded by amazing people. It was fantastic to be present in the hospital and shadow various specialties including gynecology, family medicine, ophthalmology, general surgery, pediatrics, and radiology.

During the final week of my internship with PACH, I had the opportunity to join and assist with a medical caravan in the communities of Otovalo, Ecuador. Access to healthcare is a significant issue in these areas, as even though some communities may have health centers, these facilities often lack staff or essential equipment.

The caravan offered services from five specialties: general medicine, chiropractic care, dentistry, optometry, and gynecology. We also set up a pharmacy where patients could receive free medications. Over the course of two days, we treated over 150 patients and provided more than 240 different services. We performed cervical cancer screenings using colposcopy, treated cervical dysplasia with thermal ablation, distributed reading glasses and dental supplies, and even offered training in CPR techniques to the community.

I had the privilege of working closely with the gynecologists and directly engaging with the patients. One of the most rewarding aspects was holding "charlas," or informative discussion circles. During these talks, we covered a range of topics, including female anatomy, cervical cancer, the use of pessaries, and mental health. I had the opportunity to lead these discussions and assist with translation. Interacting with patients, addressing their questions, and helping them understand these important topics was very enriching. I firmly believe that prevention is just as important as treatment, and these charlas emphasized the importance of health education and awareness.

In line with prevention, during the caravan, I initiated conversations with community leaders and patients about cervical cancer screening and treatment. While my project allowed me to consult with experienced doctors and experts, I found that discussing with the patients themselves and those who are being served is just as important, if not more. These conversations gave me a lot of insight into the challenges that patients face and reinforced the significance of community engagement in addressing health disparities.

Living in a Different Country

Being the only intern with PACH this year, I didn’t have a built in friend group that came down from Princeton with me. However, this turned out to be a blessing in disguise. It pushed me to step out of my comfort zone, make new friends. My new friends were always eager to share their culture with me, and so with my free time, together we explored the city and culture of Riobamba.

On weekends, I had the opportunity to explore and travel a bit more. I visited the beautiful mountains: Cotopaxi and Chimborazo and traveled to cities like Cuenca, Quito, Mindo, Baños, Guaranda, and Ambato. I watched numerous local events such as desfiles (parades). I got to experience music, traditional dances, and saw traditional clothing that I had never seen before. Visiting markets was another activity I loved doing. Being a part of such vibrant places, people, vendors and shoppers all chatting was amazing. I got to explore, learn about local goods and ingredients, and really understand the daily life of the people here.
Another highlight of my experience was the culinary adventure! I tried a variety of traditional Ecuadorian foods and many many different fruits which was probably my favorite part. The fruits were never-ending ranging from tomate de arbol, guanabana, passion fruit to dragon fruit and guava.
Beyond having so much fun through these cultural experiences, they also strengthened my belief in the importance of respecting and valuing different cultures. I believe it is crucial to get to know people from all over the world and to experience different cultures in order to develop a broad worldview and an open mindset. These experiences also deepened my understanding of the importance of approaching my work with cultural sensitivity and fostering a deeper appreciation for the communities that we served—an essential aspect, especially in the field of healthcare.