Sites Visited (International):
Location: Rurrenabaque, Bolivia
Setting: Rural
Prerequisites: Foreign language proficiency: Spanish; Specific medical knowledge/experience: None
What sort of costs does the resident incur? Flight to/from Bolivia (roughly $800-1000). $500 payment to Concern America (American NGO that supports the development effort there), the $500 goes to support the organization and your involvement. Concern America recommended that I bring down $1000 in cash for my room and board, weekend travel, etc. Concern America put me up in a room in the clinic free of charge (with bathroom/shower with running water). So even with weekend trips, I'd say roughly $500-800 would be plenty for the month. Bolivia is VERY inexpensive ($1-3 for sit-down, restaurant meal).
Comments: The experience was an excellent exposure to rural primary care in Bolivia. The focus of the NGO supporting the work is largely outreach, so on average 2-3 days per week were spent travelling either by car or by boat to outlining communities that had no access to medical care. These trips were the best and worst of my experience. Best in that like most home visit-type experiences, you obtain a much deeper understanding of your patient's living conditions and limitations as far as clean water and sanitation. However, these trips were very physically difficult: heat, insects, unfamiliar food, no running water, often no access to toilets (not even latrines). Additionally, I felt torn between the enormous effort it would take to pull off a trip such as we were, but yet the medical services we were able to provide on the road were very limited (antibiotics, wound care, skin infection treatment).
The experience did not include any exposure to inpatient medicine, which I would have enjoyed. I saw a large number of skin infections, several not seen in the U.S. such as leischmaniasis. One of the most excellent aspects of the programis the support before, during and after provided by office staff from Concern America in the states. They have offices in California and Chicago. I was extremely impressed by the ongoing work and development over years that Concern America has in the communities they serve. Concern America in Bolivia worked with the health promoter model, using "Where There is No Doctor" as their instruction manual. I was able to participate and help teach a one week course to health promoters which was really interesting.
Experience rated (1=worst, 7=best) as 6
Application process: Through "International Health Immersion Program" on Concern America website: www.concernamerica.org
UM Resident to contact: Sara Boblick
Other contact information: ssb712@hotmail.com
Location: Lima, Peru
Setting: Urban; Hospital Dos de Mayo, Servicio de Enfermedades Infectiosas
Prerequisites: Spanish
What sort of costs does the resident incur? Travel, room and board. There are cheap places to stay that can be found.
Comments: Most common diseases are TB and HIV. There is definitely some Tropical Medicine too (we saw Leprosy, Systemic Bartonellosis, Leshimaniasis, Malaria).
Experience rated (1=worst, 7=best) as 6
Application process: Dr. Del Valle actually made the primary contact.
UM Resident to contact: Zach Hector-Word
Other contact information: zhword@gmail.com
Location: Lima, Peru
Setting: Urban
Prerequisites: Any level of medicine, but spanish fluency definitely recommended if not absolutely necessary.
What sort of costs did you incur? Plane ~$600; Board $100 for the month; Food $2 a meal, if not less; Transport $.33 cents each way to work on the combi (bus); Buses/trains to travel destinations in Peru $20 trips to most places you would want to go by bus. Overall, cheaper than living in Ann Arbor for a month.
Comments: The biggest challenge was the language barrier. I used to know Spanish, but hadn't spoken in ten years. Peruvian Spanish is also very different from Spanish Spanish with different accents and very fast. I went from understanding 10% of what people were saying when I arrived to 50% by the end. Everyone is very friendly though and they don't let you cheat by speaking English. The HIV/ID service is very unique. It is a poor hospital, you wear a TB mask to work while you round. You see TB, HIV, crypto, neurocrypto, all sorts of diarrhea, leishmaniasis, bartonella, brown recluse spiders, etc. Very unique experience. The professors there are very esteemed and friendly. Not a heavy workload. Arrive around 8am and leave anywhere from noon to 3 depending on lunch plans. Not much work is done after noon. Patients are all poor, working class, some of whom migrate in from the jungle when their symptoms get bad enough. The hospital is not in the safest part of town, but okay during the daylight. They usually work 6 days a week, but seemed fine with us working 5 and traveling on weekends. Avoid any fruits or vegetables, you will regret it when you get sick. Lima itself is not the most interesting city, but Cusco and Arequipa are awesome. Your job is in Lima, however. We lived in the gringo house, which is mostly english speaking grad students from Hopkins and other locales. Pretty comfy, cheap, and fairly convenient. Hard to find a better deal for a one month stay.
Experience rated (1=worst, 7=best)? 5
Application process: mmeza@prisma.org.pe (Marjori, only speaks a little English) for housing arrangments and to put you in touch with Dr. Ticona, who runs the clinical HIV service.
UM Resident to contact: Robert Kennedy or Zach Hector-Word
Other contact information: rdok@alum.dartmouth.org
Location: Ahmedabad, India
Setting: Urban, Inpatient and Outpatient
Prerequisites: Fluency in Gujarati is a must. None of the patients spoke English.
What sort of costs does the resident incur? None of the expenses were paid. Travel is the most expensive. Round trip ticket cost me $1500. Did not have significant room and board expenses because I was able to live at a family friend's place. Actual room and board will cost you ~$800-1000.
Comments: I was able to get a combined inpatient and outpatient experience. Saw patients from lower class and lower middle class with a variety of diseases. Aside from common cardiovascular diseases and diabetes related complications, I had exposure to various diseases such as Malaria, TB, Typhoid, Hepatitis and infectious diarrhea. Language and costs are the major limitations.
Experience rated (1=worst, 7=best) as 5
Application process: On individual basis
UM Resident to contact: Jignesh Bhavsar
Location: Haiti (affiliated with the Albert Schweitzer Hospital)
Setting: Rural hospital
Prerequisites: No need to have any special language skills; they provide you with a translator
Was room and board provided? Yes
What sort of costs does the resident incur? Cost of flight is roughly $500
Experience rated by one resident as “amazing,” no scale provided
Application process: No specific application dates
UM Resident to contact: Amanda Osta
Other contact information: Satish Gopal (former Med-Peds Resident) may be of help. Dr. Robert Carraway’s (medical director of HAS) e-mail is rcarraway@hashaiti.org
Location: Lima, Peru
Setting: Urban hospital
Prerequisites: Spanish language fluency
Was room and board provided? No
What sort of costs does the resident incur? Travel, room, and board
Experience rated (1=worst, 7=best) as 6
Application process: No specific dates to consider.
UM Resident to contact: Arshiya Baig. Her email is arshiryab@hotmail.com
Other contact information: Paula Maguina (administrator in Peru, contact information per Arshiya)
Location: Lima, Peru
Setting: Urban hospital
Prerequisites: Spanish language fluency
Was room and board provided? No
What sort of costs did you incur? Unsure
Experience rated (1=worst, 7=best)? Pending
Application process: No specific dates to be concerned with other than UM deadlines
UM Resident to contact: Joyeeta Dastidar
Other contact information: Dr. Robert Gilman; gilmanbob@yahoo.com - If you email him, he will put you in touch with the attending in Peru, who is Dr. Eduardo Ticona Chavez (eticonacrg@terra.com.pe). The coordinator is Paula Maguina (PMaguina@prisma.org.pe) if you have any logistical questions. Another attending is Marcos Navincopa (mnavincopa@yahoo.es).
Location: Chile, Ecuador, Cuba
Settings: Rural and urban hospitals
Prerequisites: Spanish proficiency
Was room and board provided: Yes
What sort of costs will the resident incur (travel, room and board)? All costs were covered except for Ecuador (resident paid $1000)
Experience rated (1=worst, 7=best)? Cuba- 7, Chile- 5, Ecuador – 6
Application process depends on destination.
UM Resident to contact: Joanne Torres (Emergency Medicine)
Other contact information will be provided by Dr. Torres
Location: RuJin Hospital, Shanghai, China
Setting: Urban Hospital
Prerequisites: Proficiency in Mandarin
Was room and board provided? No
What sort of costs will the resident incur (travel, room and board)? Ticket $1100, Room $300, Food is very cheap in China
Experience rated (1=worst, 7=best)? 4
Are there any special application dates or forms that must be considered? No
UM Resident to contact: Soojong Hong
Location: Shree Sayaji Hospital in baroda, India.
Setting: Urban, both inpatient and outpatient.
Prerequisites: Language. Unfortunately it is a very indigent population and knowing Gujarati or Hindi would be a prerequisite; saw nearly 70-80 patients, none spoke English.
Was rood and board provided? No
What sort of costs might the resident incur (travel, room and board)? Flight to India is about $1400. Lived with family friend so did not have to incur living costs and also did not incur transportation costs. These would be about additional $1200 roughly.
Experience rated (1=worst, 7=best): Definitely a 7
Any special application dates or forms that must be considered? Likely to vary on an individual basis.
UM Resident to contact: Smit Vasaiwala
Comments: I have a feeling that it would be very difficult for another resident to spend a month there for several reasons. First of all the cost; if you do not have family there is not cheap. The previous contact is no longer involved, which may make matters more difficult. Finally, language proficiency in the language is very important at this hospital given the patient population for a worthwhile experience.