Nikil Swamy - fourth year rotation  USC School of Medicine

One of the main reasons for me going to Bolivia, my last year of Medical school is because I

share an immense passion for Global health. I wanted to take this opportunity to accomplish

a few objectives. First of all, I wanted to work with and provide adequate medical treatment

to the patients I encountered in Bolivia. I felt that as a fourth year medical student I had

enough knowledge to do this adequately and efficiently. Second, in the course of treating my

patients I would gain additional training in the management of typical diseases and conditions

encountered in this endemic area. Third, I would get first hand experience with utilizing and

improving upon my Castellano. Fourth, in my time there I would make contact with many

physicians, and develop invaluable relationships. Ultimately, I succeeded in achieving all of my

goals and much more.

I started my first week off in Obstetrics. At first, its took me some time to orient myself to

where, how and why they did things. However, once I had these questions answered, it was

easy enough to get acclimated and start practicing what I had come there for. One of the key

obstacles, as one might imagine was communication. I knew as much Castellano as one who

had studied it in middle and high school might know. I can say from experience, it was enough

to get by on the first day, but I needed practice. The first day I assisted in the delivery of one

baby, and observed several operations. It was more than I had hoped for, because of two

reasons. One, I had gotten few opportunities during my OB rotation in the US to deliver babies,

and I had the mindset that I would have a similar experience this time. Two, I was made aware

that most of the previous students that had rotated through were students that were still early

in their medical education, with few exceptions. I however made the effort to involve myself in

as many cases as I could, which eventually gave me the chance to perform procedures on my

own, as I gained the trust of those around me.

Next, I moved to working in the emergency room. As this is in a different hospital from the

obstetrical building I encountered new individuals, specifically interns and residents from

Internal medicine and Surgery. They were very welcoming, but I once again had to foster

relationships in a short period of time that would allow me to be involved hands on with the

patients. I worked with the interns mostly because they were the ones that worked up the

patients, collected the pertinent information and documented it. However, I rounded on all

the patients in the unit with the residents to know what's going on with each. During my time

in the ED, I noticed a lot of differences between how the patients are managed medically in

comparison to the US. This in my perspective is not due to a lack of medical knowledge, but

due to a lack of resources. Although slightly different in practice the overall goal was the same,

doing what is best for the patient. Interestingly, I saw quite a few cases that are very rarely seen

in the US. Most memorable of which was the case of a gentleman who came in for shortness

of breath and swelling of his feet. It turned out to be a case of CHF exacerbation secondary to

Chaga's disease. I also got to go in on surgery cases for patients whom I was managing.

My remaining time I spent between burn surgery and infectious disease. I really enjoyed

scrubbing on the burn surgeries. I was very interesting to see how these cases were handled,

especially since I had little experience with burn cases at my home institution. I also liked

spending time with the peds patients and conversing with the physical therapists who were

taking care of the patients and learning about the similarities and difference in patient

management. I also got an insider's glimpse into the work of volunteers and workers who

sow the pressure garments for the patients postoperatively, and learned about the financial

challenges the patients and their families face to pay for needed medical equipment.

During my time in infectious disease, I learned about an array of medical conditions rarely

seen in the US. I also attended the Second Jornada Internacional de Actualizacion en Medicina

Interna in Cochabamba. This was a three day conference with well known physicians presenting

on topics such as diabetes, atherosclerosis, and antimicrobial therapies, coming from regions

such as Argentina, Brazil, Chile, Mexico, and Paraguay. It was a very informative three days.

I spent some time talking with the physicians after the lectures to get to know a little bit about

their regions and the practice of medicine there.

I also took some time to attend religious gathering with friends and acquaintances to better

understand the cultural workings affecting the social structure of Bolivia, and in turn the delivery

of medical care to its residents. In all, my trip to Bolivia put many things in perspective for me.

I really enjoyed my time in the hospital, spending time with the patients, getting to perform

procedure, seeing how endemic diseases are managed, delving into the local culture, and

getting a taste of how medicine is delivered efficiently in a setting with limited resources.