2019-05-06 MDB Reflection- Silvia Vaca

As a Colombian-born US medical student, my experience in Ecuador was one of striking familiarities with nuanced differences. The rotation provided varied experiences within the care continuum, starting with a rotation in the ICU at the safety-net hospital. The routine was not unlike my experience on clerkships: patient rounds with the team, discussions of relevant literature, and constant documentation. Rather, the differences were in the types of patient cases, the accessibility of literature, and the use of paper charts. Since Riobamba has one of the highest maternal mortality rates in the country, many of our patients had been admitted for post-partum hemorrhage. The hospital was addressing this issue through two initiatives: creating evidenced-based management protocols and increasing cultural competency regarding the large indigenous population.

I had the opportunity to help update the hospital’s post-partum hemorrhage protocol. I quickly realized the majority of physicians were eager to follow evidence-based protocols, but frustrated by paywalls and language barriers. Given that the protocol impacted various teams across the hospital and that I am by no means an expert on the topic, this project reminded me of the importance of clear roles and closed-loop collaborations in global health. Instead of arriving in a new healthcare system and imposing my views of how they should practice, my job was to listen to the team’s identified need and use the resources at my disposal to help address it. In this scenario, that meant using my access to the latest literature and bilingual skills to translate up-to-date protocols that the team modified to be setting-appropriate.

I concluded my rotation in the clinics of Cacha – the rural indigenous community neighboring Riobamba. While the setting was markedly different, the themes of maternal-child health and cultural competency continued to resonate. Many in Cacha were wary of seeking healthcare, so the team would regularly ditch the white coats and make home visits. In a particularly striking case, we visited a 4-month-old for a well-child check and found her crying alone at home, bundled in a hammock. Eventually, the father made his way back from the fields and informed us that the mother had been tending to her duties on the farm for a few hours. The team counseled the father on safety considerations, fed the child, and reviewed vaccinations. As we walked back to clinic, we discussed the importance of building trust with the community and seeking to understand their reality to provide better healthcare.

Along with the clinical experiences, I greatly appreciated the medical Spanish classes. When asked why I was taking the classes as a native speaker, I was reminded of the preclinical years of medical school: despite being fluent English speakers, we fumbled to find the right words to break bad news or present a complicated case. As I prepare for neurosurgery residency at Stanford, I’m immensely grateful for the opportunity to better serve my patients with a more nuanced medical Spanish vocabulary, a deeper understanding of Latin American cultures, and a revitalized passion for global health.

Silvia Vaca is a graduating Stanford medical student who will start her neurosurgery residency at Stanford this summer. During her time at Stanford she has collaborated with teams in Colombia, Tanzania, and Uganda on a variety of global surgery projects. She looks forward to continuing her international work in residency with the goal of increasing neurosurgical capacity in low resource settings.

Her rotation in Ecuador was supported by the Mary Duke Biddle Scholars Program.