A Rotation in Ecuador Yields Lessons in Global Health

IM resident Brandon Todd goes to Ecuador as part of the Global Health Leadership training program.

Brandon Todd, a second-year internal medicine resident on the primary care track who hails from Memphis, Tennessee, recently spent several weeks in Ecuador as part of the Global Health Leadership Track.  Sponsored by the Center for Global Health, the GHLT offers UVA residents a chance to spend a rotation in an overseas clinical setting — and experience the practice of medicine in resource-limited countries.

In Ecuador, Brandon worked at Hesburgh Hospital in Santo Domingo, a city of about 300,000 in the Andean foothills, about 90 miles west of Quito. He returned to Charlottesville shortly before a 7.8 magnitude earthquake struck the country; the earthquake’s epicenter was not far from Santo Domingo, but he says the hospital and hospital staff were not harmed.

Brandon generously took time, upon his return, to respond to a Q&A about his experiences in Ecuador; he also shared some terrific photos. Thank you Brandon!

Tell us about the hospital where you worked.

Hesburgh Hospital was established in 2014 and is part of the Andean Health & Development organization (AHD). It provides care to a large area that encompasses about 600,000 people — half of whom live below the poverty line. It is also one of two sites in Ecuador that provides residency training in family medicine, geared towards rural health care.

I worked alongside the family medicine residents there, but didn’t provide direct patient care because I don’t have an Ecuadorian medical license. I helped evaluate patients, formed differential diagnoses, suggested appropriate tests for work-up, and aided in interpreting the results. It was actually quite nice to let the Ecuadorian residents work on the notes while I spent more time with the patients or helped the team by researching a particular clinical question!

I also gave a teaching session on a topic — insulin administration — suggested by the residents (easier than if they’d suggested some rare tropical disease).

In general, the hospital had more resources than I’d expected — including access to a number of specialists. I discussed patient cases with a cardiologist, a gastroenterologist, an ophthalmologist, and a neurosurgeon.

What were some of the common medical conditions you encountered?

Among both hospitalized and ambulatory patients, many presented with diseases or conditions similar to what you’d find in the U.S. patient population, including uncontrolled hypertension and diabetes. A significant proportion of the population is overweight, although I saw few who were morbidly obese. I also saw patients who had familiar conditions but with unusual (for me) pathologies — for example, a patient with severe facial trauma due to a falling palm tree, and another who had heart failure secondary to a history of tuberculosis.

I also saw some of the tropical diseases that would be rare in the U.S. — e.g., infections from various viruses, including dengue, chikungunya, and zika.

Who made a particular impact?

Really, all of the residents I worked with. I was inspired by how passionately and effectively they care for their patients, with the sometimes-limited resources available. Their approach reminded me of the importance of a solid history and physical exam.

What cultural barriers did you experience?

Language (predictably) was the biggest one. I’d studied Spanish in school, and then for several months prior to my trip, but I still wasn’t fluent, and that made functioning effectively and efficiently at the hospital very challenging. It’s discouraging when you have a useful insight about a patient but can’t formulate the right words to communicate it. It certainly forced me to learn more Spanish, and I became fairly adept at using hand signals to clarify my meaning while I was talking. Working in a foreign setting really challenges you to be creative and adaptable.

General observations about the GHLT program?

I am very thankful to the leaders of the GHLT for their assistance, guidance, and support. The work they do doesn’t start or stop with the international rotations themselves; they organize preparatory training and education well in advance of the actual rotation. The GHLT experience will help keep international medicine at the forefront of my future career plans.

Brandon with one foot in the northern hemisphere, the other in the southern.