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Dome - A Bolivian education

April 2011

A Bolivian education

Date: April 6, 2011

Spring break trip offers valuable perspective for Hopkins medical students


Medical students Ian Hsu, Eugene Semenov, Javad Azadi and Ani Ramesh visit an orphanage in Montero.
Medical students Ian Hsu, Eugene Semenov, Javad Azadi and Ani Ramesh visit an orphanage in Montero.

The infant at the hospital in Montero was critically ill, swollen with fluid, feverish and coughing up blood. When the Bolivian doctor determined that the baby had sepsis, the only option was to drive him to a better equipped facility in the city of Santa Cruz, more than an hour away.

As he watched the desperate situation unfold, Johns Hopkins medical student Javad Azadi confronted one of the stark differences between health care delivery in the United States and many other parts of the world. But he also found inspiration in a system where nurses often vaccinate children in their homes and know patients by their first names.

Last year when Azadi and a dozen or so other Hopkins medical students visited hospitals, community clinics and even foster homes in Bolivia to learn about a different system of health care, they received lessons that expanded their own perspectives on practicing medicine. (A similar trip took place in late March.)

Since Hopkins medical student Robert Wicks organized the first trip to the Highland Bolivian Mission in 2008, roughly 40 first- and second-year students have spent time in Montero, a small town in eastern Bolivia. The students observe and assist in clinics, help with health screening projects and accompany nurses into private homes to administer child vaccinations and tuberculosis medication. Along the way, they also gain insight into Bolivian society by visiting such facilities as homes built for children who are orphaned or living in the streets.

Lacking high-tech instrumentation, medicine outside major cities relies more on health care providers’ knowledge and understanding of their patients.

“Because there’s not as much diagnostic equipment, physicians have to deal with their patients in an intuitive way,” observes medical student Eugene Semenov. “They need to develop a stronger relationship and practice medicine in a more personal way.”
The experience also illuminates different medical priorities.

“Here we’re concerned about cardiovascular disease and cancer, while over there the first-line physicians are dealing with infectious and communicable diseases,” says medical student Ian Hsu, recalling the troubling sight of a 4-year-old who’s infected with HIV and unable to get any of the medication that could help her.

Some of last year’s Bolivia travelers are now participating in a new “interprofessional” program at Hopkins developed to improve teamwork between physicians and nurses in primary care and preventive medicine. Created jointly by Hopkins’ schools of medicine and nursing, the Worth and Jane Daniels Scholars Initiative offers courses for medical and nursing students as well as for residents and nurse practitioners in training. For part of the semester, students accompany community health workers into homes to check up on patients, mostly elderly, who are at high risk for rehospitalization.

“I think this program helps develop a greater social awareness that is difficult to teach in the classroom,” says co-director Rosalyn Stewart, an assistant professor in internal medicine and pediatrics.

Medical student Meghana Desale agrees. She also says her trip to Bolivia increased her desire to provide patients with education and treatment outside a clinical setting.

“There’s so much you learn about by going into the home that’s different than when patients come to see you,” she says. “That understanding is crucial to addressing public health concerns, especially in a community like East Baltimore.”

—Linell Smith

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