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B. F. Fellowship Proposal
Proposed site: Esmeraldas, Ecuador
Applicant name: Benjamin Huntley, M1
Background [1, 2, 4, 5]
Esmeraldas is a city caught between two worlds, minutes from peaceful rain forest that starkly contrast the grunge of impoverished urban living. It was initially built on sugar plantations and mines, made possible through the importation of slaves, who have since merged cultures with native Ecuadorians to create a vibrant new environment. As capital of its own province, located in the Northwest corner of Ecuador, this busy port town of 126,000 knows few tourist dollars, but no shortage of indigenous poverty. Although locals make a living on agriculture and lumbering, the lack of wide-scale industrial development translates to economic restriction. Moving in from the shore, down dilapidated streets to the part of town that does not make the guidebooks, is a busy but under-resourced hospital that serves the community. According to NGO reports, it is not uncommon here for needles to be reused, nor for physicians to send patient families to find medical supplies needed for basic procedures. With guidance from the Yanapuma Foundation (http://www.yanapuma.org/), this environment, along with its hardworking staff, will extend my medical education through the summer.
Health Profile [3]
Perhaps in large part due to Ecuador’s economic turnaround in the mid 1990’s, its national health profile has a number of encouraging statistics, such as an average female life expectancy of over 70 years. There have been significant health advances in recent years, like a 50% reduction in mortality due to intestinal infectious diseases; however still over 27/100,000 Ecuadorians die yearly from pneumonia and about an equal number strokes. Paralleling those numbers, the Pan-American Health Organization painfully reports that, “In Ecuador, 13.2% of the population suffers from some form of disability. Given the link between disability and poor living conditions, low income, and difficult access to health services, the incidence of disabilities is greater in marginal urban areas and in rural areas”. The same authors go on to report that between 60-70% of black children in Esmeraldas are malnourished. This is where I have arranged to spend my summer months.
Rationale
The purposes of this trip are two-fold: to improve Spanish proficiency and to gain an understanding for the realities of health care in less-privileged environments. From the language standpoint, being confident in Spanish will prove useful both immediately in the Free Medical Clinic where I volunteer, and latently in the hospital, during clinical rotations in years to come. I strongly believe that investing in language skills up front will lead to better health care for future Spanish-speaking patients. From the standpoint of global awareness, understanding differences and discrepancies in health care now will challenge me to better understand the meaning of being a socially responsible physician through the remainder of my training and the career beyond.
Goals
Goal 1: Analyze illnesses common to the local community, especially malnutrition and malaria (both of which are present at high rates in Esmeralda)
1.1 Recognize common disease presentations
1.2 Use training in physical exam skills, history taking and knowledge of the disease process, coupled with self-assigned learning issues for unfamiliar illnesses, to contribute to the health of the community
1.3 Learn and practice common procedures such as suturing and pelvic examinations
Goal 2: Improve Spanish and contribute to patient education
2.1 If appropriate to my language abilities, by summer’s end I should be engaging in conversation with patients, counseling them about lifestyle modifications for healthier living. The means to this goal incorporate language development strategies through daily interactions that I will rely on to meet the overarching goal of Spanish proficiency.
Goal 3: Gain appreciation for social and cultural customs environment and their impact on health
3.1 Learn what Ecuadorians in Esmeralda believe about Western and Traditional medicine through conversations with patients, coworkers and friends.
3.2 Attend cultural and religious events to better understand forces that influence daily choices, which ultimately bear on health.
Evaluation
- Spreadsheet of common medical problems and how they are treated, along with a list of procedures performed and observed
- Journal of cultural and social experiences either via a written journal or a web log, pending internet availability
- Feedback from supervisor on performance during internship
Preparation for internship
An undergraduate degree in Biomedical Engineering coupled with training as an Emergency Medical Technician were, for me, the foundation of a powerful year spent in East Africa, just before starting medical school. I spent a few months with warriors and nomads in Kenya, and then moved to Kigali, the capital of Rwanda, to teach well-dressed university students the Physics of Medical Imaging. Between the two placements there is neither a shortage of stories nor of lessons, and as a result I know more about linking educational abundance from the US with educational scarcity abroad. I’m optimistic that a background in teaching and traveling, along with a good start in medical training, will lead to a beneficial summer for all parties. Toward that goal, I have already researched common morbidity and mortality causes in Esmeraldas, which gives me a sense of the diseases that will be encountered.
I also come into this summer with previously acquired language abilities. Throughout high school and into college, Spanish was the primary language I studied. Spending time in Spain and Mexico helped solidify my speaking, reading and writing proficiencies. Although I used to be quite adept, much of that slid when I learned Swahili last year. However, I have a sharp ear for language and look forward to re-strengthening my abilities as I immerse in Spanish again.
In closing, thank you for taking your time to consider my application and the applications of my peers. I am deeply moved by the role you play not only in our education, but also in instigating positive change in the world through these experiences. It takes more than generosity to support these endeavors; thank you for believing in the hope of effective change through cross-cultural interactions.
Sincerely,
Ben Huntley
References
1. http://www.ecuadorexplorer.com/html/esmeraldas_province.html
2. http://www.thebestofecuador.com/esmeraldas.htm
3. http://www.paho.org/english/SHA/prflecu.htm
4. Lonely Planet Guide to Ecuador
5. Personal interview with Andy Kirby, legal director of Yanapuma Foundation
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