Zlotnick Reflection - Kate Turk

My global health experience in Cusco, Peru was filled to the brim with incredible clinical and public health lessons, new colleagues and friends, deep community connection, and a heaping dose of serendipity.

I have been committed to global health since my early undergraduate years, and when I was selecting my global health rotation for residency, I had a few goals. I wanted to work in a Spanish-speaking country, join a site with strong community partnerships, ensure project sustainability, participate in both clinical and public health/research opportunities, and focus within general acute and critical care pediatrics. Through prior contacts at my alma mater, the University of Washington, I connected with a researcher who has done extensive public health work and research in Peru and her colleague to collaborate on additional pediatric public health projects in her hometown, Cusco.

Their research project focused on improving the early recognition and management of pediatric illnesses and emergencies in the Cusco region. This idea stemmed from the observation that children from an extremely wide geographic area often presented to care in the city of Cusco with severe illnesses. Despite the severity of these cases, hospitals had limited resources and bed capacity to care for so many critically ill children. For example, the primary Ministry of Health hospital in Cusco, Hospital Regional de Cusco, which serves a catchment area of over one million children, has only two pediatric intensive care unit beds. The thought was that if frontline healthcare providers throughout the region were better equipped to identify and treat pediatric illnesses and emergencies early, we might prevent more children from progressing to critical illness.

When I arrived in Cusco the research team hit the ground running, quickly building many meaningful connections. Soon, a Peruvian pediatric resident and an economist joined our small research team, and together we set out to better understand how we could address this issue. We first decided that partnering with the local Ministry of Health, which provides medical care for most of the population in the province of Cusco, would be essential to the project’s success. After several meetings with Ministry personnel and receiving their approval, we undertook a large multisite needs assessment.

Our team visited 17 postas de salud, healthcare centers throughout the region where caregivers typically first bring their children when they are ill. During these visits, we conducted surveys and interviews with both frontline medical providers and caregivers. We assessed the burden of pediatric disease, providers’ levels of training and experience, comfort with managing pediatric emergencies, interest in future interventions such as video-based trainings and offline mobile clinical decision-support tools, and anticipated barriers to implementation.

The results were striking. We surveyed over 100 individuals, and found most  caregivers and medical providers expressed strong interest in additional training and tools to improve the identification and management of pediatric illnesses and emergencies. I was incredibly proud of the progress we made in just six weeks and the momentum we created for the next phases of the project, which will focus on implementing the educational sessions and clinical support resources.

Throughout the process, I learned quickly that things often get done through strong personal relationships, actual paper documents with very official stamps, a lot of showing up in person, and persistence.

Additionally, during four of the six weeks I spent in Cusco, I worked mornings and early afternoons at a public teaching hospital called Hospital EsSalud, which is part of a health network that serves approximately 15–20% of the population who contribute through social security. In the hospital, in classic Cusqueñan fashion, I was affectionately referred to as “doctorita,” working alongside incredibly thoughtful pediatricians. I met residents and medical students, gave academic presentations in Spanish to the department, and learned what pediatrics looks like in the Andean region. I encountered illnesses I had never seen in the United States, including dengue and listeria meningitis, and I witnessed how physicians practiced medicine with far fewer resources. Despite major barriers to care and limited infrastructure, the children and families I met were among the most gracious patients I have encountered.

Outside of work, I loved walking through the city each evening, eating endless amounts of delicious Peruvian food, exploring the Sacred Valley and surrounding mountains, spending time on my beautiful terrace overlooking the city, finding every possible way to consume maracuyá (passion fruit), buying far too many silver rings and alpaca wool sweaters at local artisan markets, and going salsa dancing with people who quickly became a source of community. I realized early on that Cusco is filled with joy, warmth, and celebration. People show up for life and for one another, and I felt incredibly lucky to be surrounded by that energy.

Leaving was emotional, and I certainly was not ready to go. But I am excited to continue working with my team from California, and I cannot wait to return next year for another six weeks to continue this important work.