Medical students learn about practicing medicine with limited resources in Peru

All return to graduation with 'a priceless dose of perspective'
Molly Sprague
UCLA medical student Molly Sprague cradles a newborn baby during a home visit in Iquitos, Peru.

Five UCLA medical students flew to Peru shortly before graduation to complete a clinical rotation at a hospital in Iquitos. Surrounded by the Amazon jungle, it's the world's largest city that's unreachable by road.

After four years of working with the latest technology and state-of-the-art treatments, the students found their interaction with patients, who sometimes traveled weeks on the Amazon River by boat from remote villages, a life-changing experience.

Organized by the global health program in the David Geffen School of Medicine at UCLA, the three-week training, which was captured by NBC News, immersed the budding doctors in an entirely new culture and health care system. The tightknit group included Alexandra "A.J." Greene, Aleksandr Gorin, Nahda Harati, Molly Sprague and Diana Partida.

Limited access to the equipment and medications that the students took for granted at UCLA forced them to trust their instincts and depend on the new skills they acquired.

"I learned to rely on my diagnostic findings from physical examinations, and how to make decisions in clinical settings where resources are not readily available," said Partida, who added that what she learned in Peru will make her a better doctor in "countless" ways. "The experience taught me to recognize my emotional resilience and to have confidence in the training I received at UCLA."

The students encountered tropical diseases, an unfamiliar Spanish dialect and prickly gender dynamics in a hospital culture where female physicians are a rare sight.

"Working in the infectious diseases unit of the hospital allowed me to meet patients with malaria, dengue fever and tuberculosis," said Gorin. "The opportunity to see tropical parasites under the microscope and learn how they are diagnosed was an experience I won't soon forget."

Co-founded in 2010 by Dr. Lee Miller, director of clinical rotations and the medical school's associate dean for student affairs, the global health program offers research opportunities abroad after the first year of medical school and clinical rotations for senior medical students.

Jake Whitman/NBC News
UCLA medical students Aleksandr Gorin and Diana Partida consult with a colleague in Peru.

"Our students gain a priceless dose of perspective," said Miller, who is a professor of pediatrics. "They return with a deeper understanding of health care disparities, richer cultural sensitivity and a greater commitment to addressing inequities in their own backyards."

Designed with UCLA's medical partners in China, India, Malawi, Mozambique, Peru, South Africa and Thailand, the global health program is enormously popular. This year alone, almost one-third of the graduating class flew overseas to learn from host medical teams how physicians practice in that country.

According to medical school dean Dr. Kelsey Martin, the program has a dual focus: developing sustainable health care programs in low-income countries while delivering a transformative learning experience to UCLA medical students.

"Our program embeds students in settings in which UCLA has established larger partnerships for capacity building, clinical care and research," said Martin, who accompanied Miller and the students to Peru.

Perhaps the trip's most valuable lesson was that compassion is a universal language.

"The experience taught me to never lose my humanism," Greene said. "Sometimes the best medicine I could provide a patient was a brief conversation, a warm smile or a hand to hold."

UCLA's pediatric partnership in Peru

A decade ago, Dr. Lee Miller collaborated with physicians from UCLA Mattel Children's Hospital, with the support of leadership of the Department of Pediatrics, to launch Partners for Pediatric Progress, a non-profit under the umbrella of the school's global health program.

The organization builds training partnerships that improve the care of children in Peru and Mozambique, supporting local clinicians who in turn teach the next generation of health care leaders.

Learn how to make a difference in the lives of Peruvian children at Partners for Pediatric Progress.

Meet the Students: From global health trainees to new MDs

Alexandra "A.J." Greene, MD

Residency: General surgery at Harbor-UCLA Medical Center to advance her goal of becoming a trauma surgeon for underserved urban communities.

Biggest impression: Three days after a patient’s ‘routine’ operation, she did not look well. I shared this with the surgical team and began a work-up to figure out what had changed. During this time, she lost consciousness. I was the only medical person in the room. I was able to resuscitate her and help her be transferred to the intensive-care unit, where she stabilized. The next day she embraced me and thanked me for never leaving her side.

Life lesson: The experience taught me that I should never lose my humanism. Sometimes the best medicine I could provide a patient was a brief conversation, a warm smile or a hand to hold.

Nahda Harati, MD

Residency: One year at The Mount Sinai Hospital in New York City before pursuing advanced training in anesthesiology at UC San Francisco.

Biggest impression: People spoke a different Spanish dialect than the one I know, but this improved over time. Understanding the hospital culture, its method of triage, and limitations to specialty care were the toughest challenges. Coming from a tertiary-care hospital like UCLA, which has little to no resource barriers to treatment, the latter was especially hard to reconcile.

Life lesson: The patients were some of the kindest, most resilient individuals I have ever had the privilege to meet. They faced hardships and diseases that most of us will never encounter. My most valuable takeaway was that compassion and humility are universal languages.

Aleksandr Gorin, MD, PhD

Residency: Research track in internal medicine at UCLA with a later specialty in infectious disease.

Biggest impression: As a physician-scientist, I have always been interested in tropical infections and the science behind them. Working in the infectious disease unit of the Iquitos regional hospital allowed me to actually meet patients with malaria, dengue fever and tuberculosis. The opportunity to see firsthand what tropical parasites look like under the microscope and how they are diagnosed was an experience I won’t soon forget.

Life lesson: The experience offered me perspective on what healthcare looks like in other parts of the world and forced me to appreciate aspects of our own healthcare system that I took for granted.

Diana Partida, MD

Residency: Internal medicine at UC San Francisco to prepare for working in a public hospital in an underserved community.

Biggest impression: The Iquitos medical team would admit to the six-bed intensive-care unit only those patients they deemed most likely to survive. I can recall the difficult moment when a woman in the ICU was exchanged for a man I was caring for on the ward. I was relieved that my patient was going to get the care he desperately needed, but conflicted that the other patient was moved back to the ward, perhaps before she was ready to leave intensive care.

Life lesson: I learned to rely on my diagnostic findings from physical examinations, and how to make decisions in clinical settings where resources are not readily available. I learned to recognize my emotional resilience and to have confidence in the training I received at UCLA.

Marina “Molly” Sprague, MD

Residency: Internal medicine at UCLA

Biggest impression: Many patients traveled more than a week by boat to receive medical care. It was difficult see their family members running to the pharmacy to buy medical supplies for the doctors to use, including thermometers, needles, syringes and medicines. I have a greater appreciation for the incredible resources available to me.

Life lesson: Nahda and I were given the incredible opportunity to accompany the clinic director on home visits to women who had given birth to their first babies five days earlier. These visits epitomized ‘whole-person care’ to me and emphasized that the core of what we do comes from connecting with our patients, understanding the challenges they face and delivering patient-centered medicine.

Hippocratic Oath Ceremony: The group reunited after graduating with their medical degrees from the David Geffen School of Medicine at UCLA.

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