Zlotnick Memorial Scholar Reflection, Jecca Steinberg
April 22, 2020
Rotating with Cachamsi in Riobamba, Ecuador was invaluable, exciting and inspiring. I am extraordinarily grateful to the Zlotnick Scholarship, the Cachamsi community, my host family, the wonderful physicians and staff, and the tremendous patients. Each day brought new lessons, delightful exchanges and experiences that inspired reflection and growth.
On my first day of rotation, a red van carried me up a winding mountain road to a clinic which served the Cacha community. That morning alone we saw more than 20 patients. The doctors and staff walked a fine balance I have witnessed throughout medical school: They compassionately listened to each patient while gently pushing the appointment forward in anticipation of the many patients still waiting outside.
One of our first patients, a pale woman in her twenties, spoke to the physician in Quechua. The physician, whose first language was also Quechua, had learned Spanish and attended medical school through public-health community partnerships. The government funded the community development with the hope of creating empowered community leaders, like this physician, who could elevate the voice of the community and improve the quality of local healthcare. The patient had delivered and experienced a post-partum hemorrhage at home with her husband and mother-in-law three days earlier. She came to the clinic on the insistence of her mother and also to obtain long-acting birth control, which she had heard was free. The physician gently asked about the barriers to going to the city hospital during labor, and they discussed issues of transportation, the precipitous delivery and concerns about finances.
Their exchange captured several of the lessons that I took from my experience. I was deeply moved by the commitment of Cachamsi and the physicians I worked with in Cacha to the empowerment of the community. In addition to promoting Cacha community members to lead many of the development efforts, they focused on small details to ensure that community members felt safe and valued in the clinic setting. Our orientation included instructions on how we could best make all of our patients feel comfortable regardless of their cultural background, and what gestures we could make to demonstrate respect and deference to the Cacha community members. In the clinic, all materials and signs had both Quechua and Spanish. Subtle gestures between the physicians and the patients demonstrated the commitment of the public health workers to the population.
On a larger scale, much of the funding for the program went directly towards education, medical resources, and supplies for the community. The national government complemented these funds with free contraception, a program for house visits and improved care for all differently-abled, elderly and pregnant patients and other programs. The community members, public health workers and physicians I worked with in this setting were all proud to collaborate and improve the quality of life for the residents. Many aspects of the public-health community partnership and the Cachamsi program reinforced lessons I had internalized reading Amartya Sen and sitting through global health classes in medical school and undergrad. I was humbled to partake in a program that had such a transformational impact.
The second lesson on the power and importance of contraception, though familiar to me in theory, took on new nuance and power during my rotation. One woman’s story exemplified the impact. She like many of her neighbors, was one of 13. Three of her siblings passed in childhood from preventable causes and she initially had to drop out of school in the second grade to help support her family. Through a community development project, she went back to school and eventually became and engineer. As she reached adolescence, a new government program providing free long acting contraception reached her community. She described how controlling when she had children gave her access to education. Among her parent’s generation women had between 8-12 children on average. She had her peers were having between 2-4. Contraceptive inserts were widely popular and accepted, enough such that they incentivized patients to attend clinic for postpartum visits when they might have otherwise stayed home. Birth control and reproductive rights are foundational not only to women’s rights, but also to community development. Although I understood this conceptually, I gained a new appreciation as I listened to this woman’s story and over the weeks as I helped place over 50 implants for young women and new mothers.
Despite the inspiration I felt witnessing the progress of community development, the patient also demonstrated the need for improvement in many aspects of women’s health. Ecuador has among the highest rates of maternal mortality in South America. When I rotated on the labor floor of the hospital, we had two maternal deaths. My patient that day was one of many I spoke with who delivered at home without a trained medical professional. The high rates of maternal morbidity and mortality felt heartbreaking at times, only counterbalanced by the clear dedication of the community towards making change.
Throughout the rotation, I met patients like that woman, who embodied the complexity of health care in low resource settings, the importance of cultural humility and the potential for and limitations to progress with greater public health infrastructure. It was a privilege to improve my Spanish while learning about medicine and about the Ecuadorian health system. I will take the lessons of the program with me into residency. I cannot imagine a more meaningful capstone to medical school before embarking on a career in Ob/Gyn.
Jecca earned her bachelor’s degree at Rice University before earning two masters degrees in the UK as a Marshall Scholar. At Stanford, she has been recognized for her work on several community based pediatrics projects in San Jose and East Palo Alto, as well as in developing a course to highlight how physicians can serve their communities. Jecca will be headed to Northwestern for residency in Ob/Gyn. She is excited to continue her commitment to diminishing health inequities and serving global communities both domestically and abroad.
Her rotation in Ecuador was supported by the David A. Zlotnick Memorial Scholarship.