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Cacha Medical Spanish Institute – Arielle Randolph, MD

Written by Arielle Randolph, MD, PGY-3 at Kaiser Permanente Oakland Pediatrics Residency Program while on Global Health rotation at Cacha Medical Spanish Institute (Cachamsi) in Riobamba, Ecuador in August 2017.

My experience in Ecuador was a memorable one to say the least. I remember flying into the country ,after a brief layover in Bogota, Columbia, and being taken aback by the breathtaking landscape. Most striking were the clouds. At 10,000 ft elevation, it literally looked as if you could touch the sky. The clouds hovered barely above the ground. Interestingly enough, the weather was surprisingly similar to my home in California. Not too hot, but not quite cold either. There was a cool breeze as well. I immediately observed the warmness of the Ecuadorian people as I was welcomed into the hotel I stayed for a few nights prior to going to Riobamba. This warmness that I…

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Cacha Medical Spanish Institute – Afton Chavez, MD

Written by Afton Chavez, MD, PGY-1 at Kaiser Permanente Oakland Internal Medicine Program while on Global Health rotation at Cacha Medical Spanish Institute in Riobamba, Ecuador in March 2017.

I highly recommend this global health elective.  In just a two-week period (8 days of Spanish classes), my medical Spanish improved significantly.  The teachers at the institute are very professional and are excellent at teaching Spanish.  My professor had a degree in Linguistics and was incredibly

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Cacha Medical Spanish Institute – Eric Bautista, MD

Written by Eric Bautista, MD, PGY-3 at Kaiser Permanente San Francisco Internal Medicine Program while on Global Health rotation at Cachamsi in Riobamba, Ecuador in March 2017.

Global Health Background and Departing for Ecuador

I took off for Ecuador after my last night shift in residency. I left one of the most resource-rich and connected systems in the world and was off to experience medicine with much more limited resources. Being in a “developing country” is not new to me; my parents emigrated from the Philippines a year before I was born and I had spent some time back in the Philippines. I had also spent a summer visiting HIV organizations in India during college to investigate the impact of discriminatory laws against sexual minorities on the HIV epidemic there. Just this past year, I took a trip to visit my relatives in the northern tip of the Philippines. About a full day drive from Manila, it is a poor region of the Philippines that is not on the typical tropical tourist circuit. Having been to the Philippines multiple times in the past, I never recalled obesity as something I commonly encountered in trips in the past. This time was different. My family had asked many medical questions knowing that I was doctor: not about exotic tropical diseases, but about hypertension, hyperlipidemia, and arthritis. To me, “global health” for my family in the Philippines looked a lot like my practice in Kaiser. I was heading to Ecuador reflecting on this.

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Cacha Medical Spanish Institute – Brittany Kausen, MD

Written by Brittany Kausen, MD, PGY2 at Kaiser Permanente San Francisco OB/GYN Residency Program while on Global Health rotation with Cacha Medical Spanish Institute (CACHAMSI) in Riobamba, Ecuador from April-May 2016.

My first two days were spent in the Ob unit that carries all postpartum (12 cs beds, 12 vag delivery beds), antepartum (alto riesgo 6 beds), and early laboring patients. There are also separate rooms for pre-eclamptic patients that have big black curtains to make them dark with little stimulation – so as not to piss off the pre-eclampsia. Days start with table rounds at 7am followed by walking around seeing patients with the whole team which is a small army. There are approximately 6 interns, 2 resident doctors, one junior attending and Dr. Lino who is the chief. Dr. Lino quizzes everyone — on everything. From pre-eclampsia to doses of antibiotics to units on lab values. The level of training is very different here; interns are more like medical students on their first year of clinical rotations and the residents are more like interns. As a second year resident from the US, my depth of knowledge is probably greater than theirs especially on topics like pre-eclampsia, but having to answer questions in Spanish is a whole new challenge. My first day he quizzed me all about pre-eclampsia – questions I actually knew – but translating it into Spanish was difficult. I somehow got through

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Name, Insurance, and Neighborhood – Tessa Stecker, MD

Written by Tessa Stecker, MD Fellow with Kaiser Permanente Napa-Solano Community Medicine and Global Health while on rotation with Cachamsi in Riobamba, Ecuador in October 2015.

What is your name? Do you have insurance? What is your neighborhood? These three questions begin every clinical encounter in Riobamba.

The Ecuadorean health system has undergone an immense and impressive transformation over the last 15 years. Ecuador has become one of the leading countries in the region (and in the world) regarding healthcare efficiency spending (surpassing the U.S. by at least 30 spots on the world rank list). One of the reasons for this success is the strict adherence to patient centered medical homes. Each Ecuadorean is assigned a doctor/clinic based on his/her address and is expected to visit this clinic first except for in an emergency.

The clinic I’m assigned to this week reminds me of

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