2018-10-02 Zlotnick Reflection Benjamin Lerman

Ben Lerman, after rounds with Attending Physician Anita Qishpi, medical student Martina Czechowicz, and visiting high school and university students.

Photos courtesy of the author

   I spent my first two weeks on the inpatient pediatrics service at Hospital IESS, a government-run institution that serves Riobamba’s population with the Ecuadorian equivalent of employer-based health insurance. I was immediately struck not by the differences between this hospital and those in which I’ve worked in in the United States, but the lack thereof. Were it not for the language being spoken, I would have had a difficult time (on first impression) distinguishing the facilities at IESS from those of a county hospital in the bay area. As a teaching service, Hospital IESS pediatrics worked quite similarly to LPCH or the pediatrics service at Santa Clara Valley. Rounds were led by residents and supervised by attendings, and teaching points were emphasized for each patient. This was a wonderful first rotation for me personally because the teaching immediately immersed me in medical Spanish vocabulary and provided the opportunity for meaningful conversations with both patients and residents.
   I was particularly struck by the handling of a new leukemia patient who had arrived the previous evening in the emergency department with severe pancytopenia. While this particular hospital did not have a pediatric oncologist on staff, the general pediatrics team successfully provided the patient with the care he needed in preparation for transfer to a tertiary care center, including transfusions, tumor lysis syndrome prophylaxis and family counseling. The clinical decision-making, coordination of care, and overall treatment of the patient were outstanding, and nearly identical to what I observed on my pediatric oncology sub-internship at LPCH.

Ben and his extended host family in Riobamba. L to R Rodrigo Pantoja, Ben Lerman, Hilda Calle, Amy Rogers (Stanford Medicine PGY-3) and Darius Filsuf (Stanford Medicine PGY-3) 

     My experience was vastly different during my second rotation in the outpatient clinics of Cacha, the rural indigenous community just outside of Riobamba. The contrast between the resources available in Cacha and at Hospital IESS was stark. Whereas IESS was well-staffed with experienced attending physicians, each Cacha clinic had only one physician who was serving a rural service year between his or her internship and residency. Furthermore, these clinics were dramatically under-stocked with medications—some did not even have oral NSAIDs or first generation cephalosporins available to their patients. The patients served by these clinics compose one of the poorest and most vulnerable populations in the country. I was struck by the many structural challenges in providing equitable care in these communities. My two weeks in Cacha, seeing multiple patients pass away from complications of diseases that could have easily been treated just a 20 minute car ride away at Hospital IESS, were among the most difficult of my medical training so far.
   The Mary Duke Biddle Clinical Scholars program has, without a doubt, prepared me to better serve my future Spanish-speaking patients. I now feel comfortable tackling almost any medical complaint without relying on an interpreter, and this freedom will allow me to better connect with and care for Latino and Latina patients as I move forward in my career.

Ben is a medical student at Stanford who has worked in global health education, research, and practice in South America, Africa and Asia. After graduation this year he will be moving on to residency training in Pediatrics, and looks forward to a career filled with many more adventures around the globe. His rotation in Ecuador was supported by the David A. Zlotnick Memorial Scholarship and Mary Duke Biddle Scholars program.