KP Global Health Blog

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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Kapenguria District Hospital – Chemtai Mungo, MD

Written by Chemtai Mungo, MD, PGY-3 at Kaiser Permanente San Francisco Obstetrics & Gynecology Program while on Global Health rotation at the Kapenguria District Hospital in Kapenguria, Kenya in December 2016.

I spent my 3rd year rotation at Kapenguria District Hospital (KDH), in Western Kenya. Kapenguria is a small town of approximately 300,000 people, located in West Pokot District, in Western Kenya. The District hospital in Kapenguria is a regional referral hospital serving this population, as well as the surrounding region. The West Pokot District of Western Kenya is a rural, marginalized area of Kenya, where the population faces a heavy burden of maternal and neonatal mortality due to lack of timely access to medical care, inadequate numbers of providers, as well as the burden of the HIV/AIDS. Maternal mortality and morbidity are exacerbated by the practice of female genital cutting, which women in

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Obras Sociales del Hermano Pedro – Madeline Hellendag, MD

Written by Madeline Hellendag, MD, PGY-2 at Kaiser Permanente San Francisco Obstetrics & Gynecology Program while on Global Health rotation at Obras Sociales del Hermano Pedro in Antigua, Guatemala in October 2016.

As the only Spanish-speaking physician on the gynecology team, I had the incredibly special job of talking to each patient’s family member(s) after the surgery was finished. At the end of each case, I would peek my head outside of the operating room hallway and call out “Familia de [patient’s first name]”. If it was one of the first cases of the day, I would be calling out to a large crowd of people made up of all of that day’s patients and their families. If it was the last case of the day, there would be just a couple of people left who had been waiting all day for their turn. I was able to give these family members the wonderful news that their loved one’s surgery had gone very well and that the surgery would likely make her feel much better. Without exception, the family members would praise me, pray for me, and thank me profusely. I felt undeserving of their gratitude, but also

madeline

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Karvan Public Health Center – Bhakti Patel, MD

Written by Bhakti Patel, MD, PGY-3 at Kaiser Permanente Oakland OB/GYN Program while on Global Health rotation at Karvan Public Health Center in Kayavarohan, Gujarat, India from November-December 2016.

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My Global Health Rotation was in India, specifically at an urgent care clinic in a rural town outside of the large city of Vadodara (Baroda) in the state of Gujarat, which is a few hours north of Bombay. The site is a government-run Primary/Public Health Center (PHC) which has two employed physicians, one as the chief Medical Officer (MO) who supervises the site and faculty, and one Ayurvedic doctor, as well as an onsite pharmacist, lab technician (who does on-site AFB and malaria culturing), medical assistants, and employed health care workers who draw blood work, give vaccinations, and travel to nearby villages to promote health care and prevention. I worked with both doctors but primarily Dr. Mewada, the MO at the site. But I did have the opportunity to learn some insight into Ayurvedic medicine and patient views on disease and illness particular to the culture of Gujarat. I also had the opportunity to improve my

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Matibabu Foundation – Deepika Parmar, MD

Written by Deepika Parmar, MD, PGY-2 at Kaiser Permanente Oakland Pediatrics Program while on Global Health rotation at Matibabu Foundation in Ukwala, Kenya in October-November 2016.

Matibabu Foundation Hospital is a Level 4 hospital located in Ukwala, Kenya serving the community at large. *Note: Kenya Level 1= pharmacy; Level 2= dispensary; Level 3= Clinic with pharmacy; Level 4= inpatient hospital with outpatient clinic, lab, pharmacy; Level 5= inpatient hospital with intensive care unit and some sub-specialties; Level 6= referral center.* It is primarily privately-funded via Tiba Foundation, Dutch Rehabilitation non-profit organizations for the disabled and other private donors. They have an inpatient unit with laboratory services, maternity services (pre-/post- labor), maternal child health services but does not have ICU level care. They see patients in on-site outpatient medical clinics, HIV clinic, optometry clinic, dental clinic, and pharmacies. They excel in community health-based projects including reproductive health services, cervical cancer screening and cryotherapy, disability support/physiotherapy/orthopedic device fitting, HIV screening, and many other community based projects. Social services and fieldworkers identify families in greatest need qualifying for government subsidies. Many families have been

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ENLACE Foundation – Jennifer Hsu, MD

Written by Jennifer Hsu, MD, PGY- 2 at Kaiser Permanente Oakland Pediatrics Program while on Global Health rotation at ENLACE Foundation in Las Lajas, Taulabé, Honduras in November-December 2016.

It has been a little over 2 weeks since I’ve come back from Honduras. This marks my 7th international medical trip (not that I was keeping track), yet, this brief trip was just as memorable and transforming as my prior trips. The last time I had been to Honduras for a medical missions trip was the week before medical school started. That trip had sprung my passion for global health. This trip has also been amazing in different ways, but has also helped me to be more grounded in the realistic nature of global health work.

As someone who has gone abroad many times and also read books such as “When Helping Hurts” and watched documentaries such as “Poverty, Inc.”, I’ve become more

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Hospital de la Familia – Jonathan Lin, MD

Written by Jonathan Lin, MD, PGY-3 at Kaiser Permanente Oakland Otolaryngology Program while on Global Health rotation at Hospital de la Familia in Nuevo Progreso, Guatemala in November 2016.

As a third year resident physician in Otolaryngology-Head and Neck Surgery,
I had the amazing opportunity to be part of a surgical mission trip to Nuevo
Progreso, Guatemala. As a resident in a busy surgical residency, I cherish any
opportunity I have to get away from the usual “grind.” In this case, it meant going
somewhere new to try and improve the health of people living in a community.
Having gone on mission trips as an undergraduate, I learned early on that as
foreigners visiting a country, the residents of that community often

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Hospital de la Familia – Alexander Rivero, MD

Written by Alexander Rivero, MD, PGY-4 at Kaiser Permanente Oakland Otolaryngology Program while on Global Health rotation at Hospital de la Familia in Nuevo Progreso, Guatemala in November 2016.

A known entity – this time, I was less nervous and more confident as we took our 12 plus hour journey from San Francisco to Nuevo Progreso, Guatemala. I felt empowered, sharing with my co-resident, Dr. Jonathan Lin, the ins-and-outs of the trip like when we would have a rest stop along the long way or to make sure and wear pants because they blast the air conditioning on the bus. We were greeted by the staff and locals with a small fireworks display as per custom and unloaded our bags quickly as we dawned our scrubs to start a planned clinic that same day. We immediately began signing several patients up for surgery the following day. As a senior resident on the trip, I was able to have first pick at the complex cases as well as provide guidance on OR planning and scheduling. The transition from spectator on my first trip to Hospital de la Familia (HDLF) to active learner and organizer this time was perhaps the most notable change for me. I quickly realized that

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Reflections on Belize

Written by Luke Rohlwing, MD, PGY4 at Kaiser Permanente Oakland Internal Medicine Program while on Global Health rotation with Hillside Health Care Center in Eldridge, Belize in February-March 2016.

I had never traveled to a developing country prior to my trip to Belize.  Prior to embarking, I naively thought that the combo of my upbringing in a lower-income rural town in the Midwest, and later travel and studying abroad in Europe, were the right combination to prepare me for my trip.  Although my prior time outside the U.S. was mainly in developed nations, I was a seasoned traveler and well-prepared for a good amount that I might encounter, whether it be socially or culturally.  What I hadn’t considered though, is despite having worked with underserved populations and communities back home, this was the first time I had ever traveled outside the U.S. to serve as a physician.

The connecting flight on a twin engine prop plane – the type where a form asks for your weight before getting on so they can pre-assign your seat to distribute weight properly – and the seven-hour school bus ride along the length of the country were both new to me, but were a strangely exciting welcome.  However, I recall being struck by the reality of my location and situation when the bus pulled to the side of the road to let me and a colleague off in what I could best describe as farthest-suburb-of-distant-city meets dense jungle.  My caution was also slightly heightened when the bus driver gave the directions of “walk up that (gravel and dirt) road a little ways and you’ll find the clinic.”  What had I gotten myself into?

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Un toque de Honduras – Geoff Winder, MD

Written by Geoff Winder, MD, PGY3 at Kaiser Permanente Napa-Solano Family Medicine Program while on Global Health rotation with ENLACE Foundation in Las Lajas, Taulabé, Honduras in July 2016.

While climbing the road to El Diviso yesterday morning, our little silver bullet of a rented van sputtered its wheels against the rocky ruts worn deep into the ruddy soil. Fifteen eager volunteers from across Honduras and the States (and one from Switzerland) had packed in shoulder to sweaty DEET-soaked shoulder. Violeta dug her fingers into Eric’s arm as the momentum around a now familiar curve weighed heavily across our back (the fifth) row. Moments later Lago Yojoa made its brief appearance below, framed amid sloping hillsides and, at the northern horizon, the hazy peaks of one of two transcontinental mountain ranges.

Geoff Winder_Honduras_photo 01At some point along this daily trek, I’ve no doubt that each of us contemplated in some manner the beauty of the countryside around us…I suppose Violeta may have spent more time contemplating her mortality, but clearly there’s value in that too ;).

Un toque more than five days in, we’ve collected more

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