February 1, 2011

The Peruvian Hospital Experience

A significant amount of our time in Peru has been spent in the Belen Hospital of Trujillo. A typical day in Peru has us shadowing Peruvian physicians in either pediatrics, surgery, internal medicine, or OB/GYN. We arrive at 8am and leave the hospital usually just before 12:30. So far, we've been doing two days in each service, and in groups of two students with a FIMRC staff member or Peruvian medical student to help translate.

So far we've done 7 days in the hospital, and everyone has had at least one day in each service. From my own experience, surgery and OB/GYN have been the most interesting- a sample of what I saw in each: in GYN I had a Peruvian physician who was interested in teaching and took the time to explain important information about each patient. We saw many women with pre-eclampsia, and many who had had C-sections due to high blood pressure, although the doctor said they probably were not really in pre-eclampsia at all. We saw a number of premature rupture of membranes also. In OB, I saw two natural births. An episiotomy was performed on one mother because it was her first child- it seems to be standard practice to do an episiotomy for a first time natural birth.

In surgery, I saw two C-sections, which seemed to me to be done quickly and professionally. Although I haven't seen much surgery in the US, I imagine it would be hard to tell the difference between a Peruvian and American surgeon unless you know where to look- for example, to save money on buying booties for the OR, most doctors have plastic bags wrapped around their shoes; they use every last bit of their sutures; and one doctor told me he doesn't change his gloves as often as he would like to in order to save money. The doctor told me that 50% of all births in Peru are by C-section, and the national health insurance covers the cost.

I also saw a prostetectomy, and the doctor invited us to get as close as possible to see the surgery. They made an abdominal incision and when it was time to remove the prostate, the physician had his entire hand up to his wrist inside the abdomen, he would occasionally pull out chunks of prostate. The blind feeling for the prostate was fairly surprising, but the surgery was very professional and quickly done.

Pediatrics and Internal Medicine were interesting at times- both services had patients with interesting diseases that you don't see often in the US, such as congenital CMV infection, Stevens-Johnson skin rash, spider bites with necrosis, and lots of cancer. However, these services are busy, and the floors are loud. Although I can have a conversation in Spanish on most topics without too much of a problem, I was completely lost in IM and Peds because of the background noise, the fast cadence of speech, and the fact that the doctors were often speaking to a group and not directly to me. Those services were not as educational as the surgical ones, where you get more personal attention from the physicians and there is less distraction from noise and bustle of the hospital.

Overall the hospital experience has been educational- we've seen how things are done differently, and in many cases, how similar medicine is - in Peru. The Peruvian medical students have been great about volunteering their free time to come and shadow with us, to make sure that the Peruvian medical staff knows who we are and to help translate and to keep us company.

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