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It might be hard to imagine what a P&S student could learn from working in remote clinics in
Left to right: Jamie Pinto, Rebekah Hofstra, and Katie Martin (all '06) in front of the ambulatorio, or clinic, in Maracaibo, Venezuela
Left to right: Jamie Pinto, Rebekah Hofstra, and Katie Martin (all '06) in front of the ambulatorio, or clinic, in Maracaibo, Venezuela
foreign countries, often with inadequate sterilization and no running water. After all, at P&S students have access to state-of-the-art technology, diagnostic procedures, tests, and informational databases and they graduate with more book knowledge than many practicing physicians have in undeveloped parts of the world.

But every year, an increasing number of students at P&S sign up for an elective that takes them away from the usual lecture halls and far outside their comfort zones. In the last year, P&S students completed 60 international electives.

“They go to Viet Nam or Africa or South America, work in rural clinics and come back with their eyes absolutely wide open,” says Dickson Despommier, Ph.D., professor of microbiology at P&S and professor of environmental health sciences at the Mailman School, who oversees the tropical medicine elective that is part of the international elective program.

This year, Rebekah Hofstra’06, Jamie Pinto’06, and Katie Martin’06, were three of the students who packed their bags and took off to participate in one of the 23 programs in about 18 cities around the world where the International Elective Program has formal exchange programs.

“We wanted to do something international so we could see medicine in a different culture and country, and I wanted to go to a Spanish-speaking country to improve my Spanish skills,” says Ms. Hofstra.

They chose to do their exchange in the Maracaibo Lake region of Venezuela with Gladys Maestre, M.D., Ph.D., associate research scientist at Columbia’s Sergievsky Center and associate professor of neurobiology at Zulia University in Venezuela.

The Maracaibo Lake region has been of particular interest to researchers and physicians for some time because of a quirk in its genetic history: In the early 1800s a woman named Maria Concepción Soto moved into one of the stilt houses on the lake and brought with her the gene for Huntington’s disease. Concepción was an appropriate name – she left an unusually high number of descendents, each of whom was at risk for also carrying the gene, and many of whom ultimately developed HD.

Now the Maracaibo region is a sprawling urban area encompassing small communities of varying social and economic classes where nearly everyone has a relative or neighbor affected by HD. Most people in the area, however, do not consider HD so much a disease as a curse. Residents refer to it as el Mal de San Vito, or simply, el Mal –“the Bad.”

After meeting with Dr. Maestre to discuss their goals, the three students were sent out to visit ambulatorios, or clinics, in the region’s poorer communities to get a sense of the medical care system and assess how they could best address the health needs of a particular community in the short time that they had.

Learning Cultural Competency

“It was pretty shocking,” Ms. Hofstra says, remembering her first impressions of the area. Ms. Hofstra, Ms. Pinto and Ms. Martin decided to focus on the most poverty-stricken communities they had visited. “The clinic was really impoverished. It was in a temporary building with dirt floors and no bathrooms.”

In addition to working alongside doctors in the clinic, the students were to design a project that would continue to benefit the community after they

left, and address the prevalence of HD without directly challenging the community’s understanding of what it was. “Working within the community required a great deal of cultural competency,” says Ms. Pinto.

The students were exceedingly competent – so much so that a Venezuelan newspaper did a full-page story on their visit, titled, “Maracaiberas por 28 dias,” or “Maracaibans for 28 days.”

“They came out with the true American spirit, not afraid of touching, talking about the perceptions and beliefs they had about Maracaibo and their impressions of so much poverty and the way medicine is practiced there,” says Dr. Maestre.

The article got the attention of the American consul who invited them for a private dinner and praised them for exhibiting the academic excellence and cultural sensitivity that the United States would like the world to know about its people.

Ms. Hofstra, Ms. Pinto and Ms. Martin determined that developing “a guia” – a pamphlet tailored to the community’s specific needs – would be most useful and could benefit all residents whether or not they suffered from HD.

At the end of their month-long elective, each student says she not only felt a sense of having made a real difference, but also gained a new perspective on their careers.

“I took a lot away from it,” says Ms. Hofstra, who is pursuing a psychiatric specialty and found the work with HD patients enlightening. “In the United States we rely a lot on lab exams and imaging studies to make diagnoses and determine treatments. There, doctors are much more adept at their physical exam skills – taking histories and learning about the patient by looking and talking. We need to be reminded that these technologies are here to assist us but we also need to have good practical skills.”

That is exactly the perspective that Lisa Mellman, M.D., senior associate dean for student affairs, who oversees the exchange electives, hopes students who do the exchange will get.

“At this point in our global world most cities in the United States have a diverse population so physicians must be capable of treating patients from a wide variety of cultures,” Dr. Mellman says. “The experience of treating patients from different cultures and developing comfort is an essential part of the skill set of all physicians and one that is furthered by international electives.”

The Harold Brown Fund, established by the Class of 1953, provides financial assistance for students who take part in the international electives in the developing world.

—Keely Savoie