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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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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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