University of South Carolina 2019

Pharmacy, Peru Arequipa

Roberts, CarolineI had never been to South America but had a working knowledge of Spanish so I felt that Peru would be a great opportunity to use and grow my language skills.

The hospital was definitely reflective of the people it served. Economically disadvantaged and lacking many of the resources we take for granted at home. I remember how every ward was open to the outside, kind of like a campus of sorts. So to get a patient from, say, the pediatric ward to the operating rooms, you had to walk outside. I definitely got lost a few times, which is not much different from my first experiences in hospitals back home. 

The wards themselves were crowded, with no partitions between patient beds. I remember walking the stone halls outside of the entrances to each ward and seeing families crowded by the doors, waiting for rounds to be finished so they could go inside and be with their loved ones.

Many of the disease states I encountered were just as prevalent as they are back home. However, this particular patient population seemed to have the worst of the worse cases. Cancers were all extremely advanced, infections were overwhelming, and many disease presentations were masked by poor hygiene and malnutrition.

Roberts, CarolineOne unique thing I remember learning in my first week was that there is no Spanish word for ‘gallbladder’. The term used on the wards was ‘vesícula biliar’, which literally translates to ‘bile vesicle’ in English. 

One of the most difficult things for me as a pharmacy student was taking all the evidence-based medicine I learned in the US and trying to make recommendations using only the medications that were available in Arequipa. This particular hospital doesn’t have the ability to acquire and keep newer “brand-name” medications on the formulary, so instead of using what would be considered a “first-line” treatment for a patient back home, we would sometimes have to use an older drug with a so-so response. 

One particular example of this is seen in the way heart failure is managed. I spent one day with a cardiologist in clinic and we did nothing but echocardiograms. We spoke at length about a relatively new drug that had recently risen to “first-line” for managing symptomatic patients with systolic heart failure. This doctor was only able to acquire samples of the drug, so it was impossible for him to keep his patients on maintenance therapy. 

Roberts, CarolineI’ll never forget speaking to a surgery resident during rounds one day, and him explaining how common it is for surgeons to “go in blind” on routine procedures. While the hospital had access to diagnostic imaging (like X-ray, CT, or MRI), these were only used when absolutely necessary because of cost and other limitations. So for an otherwise healthy patient needing an appendix removed, the procedure would often be performed with no pre-operative scans. The resident told stories of discovering more than one intra-abdominal tumor during a routine appendectomy.

I was on general surgery for a few days, and remember being pulled out of a routine cholecystectomy by a neurosurgeon who wanted me to watch him remove a tapeworm from someone’s brain. The case was surreal. The patient was a local farmer who had acquired neurocysticercosis from ingesting tapeworm eggs likely from contaminated water. Amazingly, the patient only complained of headaches and vomiting, and only sought medical attention after the vomiting began to interfere with work. Computed tomography (CT) scans revealed multiple viable cysts, as well as one lesion so large that at first I thought it was a brain tumor. Unfortunately, these kinds of parasitic infections are much more common among this patient population than back home, for many obvious reasons. Thankfully, the surgery was successful in removing the larger of the cysts, and the patient was discharged on antiparasitic medications per the hospital’s protocol.

I quickly learned that while medicine is practiced very differently in Peru than in the US, the knowledge and skills of providers are no different than those back home.

Roberts, CarolineIt is very easy to fall into the trap of thinking that because something is different, it is wrong. I quickly learned that while medicine is practiced very differently in Peru than in the US, the knowledge and skills of providers are no different than those back home. One of the residents explained to me that the lack of certain resources makes you rely more on your clinical knowledge and skills. I believe that may be true to a degree, but I am certainly thankful for the diagnostic and monitoring tools we have available in the US.

The city of Arequipa had a lot to offer, and the city center Plaza de Armas was only a 10-minute walk from the hospital. We took many after-placement strolls to grab lunch, a juice, hot chocolate at Chaq Chao (a favorite of everyone at the house), and even went white water rafting. 

It was entirely worth it and absolutely breathtaking. 

Roberts, CarolineThe area surrounding Arequipa was beautiful, and I spent weekends exploring monasteries, watching the sun set between the El Misti and Chachani volcanoes, hiking the Colca Canyon, and visiting local markets. Being only a 10-hour bus ride from Cusco, I decided to make the trip to see Machu Picchu during my last weekend in Peru. It was entirely worth it and absolutely breathtaking. 

From required travel documentation to indemnity insurance, hospital dress code, and a recommended packing list, the Work the World team were in contact with me on a regular basis to make sure I was completely prepared for my placement. The in-country team became as much as family as my housemates. They ensured someone was at the airport when I arrived, provided a thorough city orientation, and introduced me to the hospital staff. I even had to stay home from placement one day because I was sick, and the cook made me homemade chicken soup. 

Roberts, CarolineThe in-country team even worked with my school to ensure requirements were met so my 4-week placement could be credited as an advanced practical experience. The program director completed my evaluations, signed off on hours, and acted as my preceptor as I had various supervisors throughout my time at the hospital. As an advanced practical experience, my placement was considered elective even though I primarily spent time in the inpatient setting. In addition, my pharmacy school’s experiential education department worked with the university’s study abroad office to ensure that the proper documentation was obtained at the front-end, so I knew before I even left for Peru that my rotation would be credited. 

I strongly believe any student who is pro-active, flexible, and open-minded would thrive in an international placement.

I would encourage anyone that has even the slightest inclination to travel internationally during a clinical rotation to do it. My experiences overseas gave me skills, knowledge, and experience I would never have gained in the US. I strongly believe any student who is pro-active, flexible, and open-minded would thrive in an international placement.

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