Child Family Health International

I had little to no experience going in but it has made me see how social and economic forces affect health. And how doctors in under-resourced conditions are forced to do nearly everything and in doing so become master clinicians. I became immersed and I learned so much about how health, medicine, race, and class are all intertwined.

CFHI provides life-changing experiences for all students who are passionate about global health and medicine. This CFHI experience has definitely strengthened my passion for global health and delivery of health care to the underserved. Before my experiences in Bolivia, I always envisioned directing my efforts towards third world countries in Asia and Africa, but now I realize how dire the situation in South America is as well, and I definitely volunteer there in the future when I become a physician.

I had such a life-changing experience in La Paz, , and the program exceeded all my expectations. I loved how structured and organized the program was, and that our days were filled with meaningful experiences, ranging from hospital rotations in the mornings to medical lectures in the evenings. Gonzalo was an amazing local program director, and he was always there to assist us with anything we needed. All the information he sent to us via email before the program started was truly helpful. Cecilia, our local medical director, was one of the most inspiring individuals I have ever met, and she ensured that all of our medical experiences were as fulfilling as possible.

I have so many wonderful stories. Working at Hospital del Nino with Dr. Velasquez was rich with learning opportunities. He is not only an excellent teacher but a role model. In particular, we had a case of pediatric endocarditis which was diagnosed after many consultations among different specialists. For me, the experience of working in that collegial environment with such dedicated physicians was inspiring. My time with my home stay family and also traveling was invaluable. Perhaps the most breathtaking aspect of the trip, however, was our journeys through the salt flats of uyuni and on Lago Titicaca. The vistas, the people we encountered, the opportunities to bond, left an indelible and unforgettable impression on me.

The medical rotations and being outside your comfort zone in another country is a phenomenal learning experience.

The medical lectures were an important part of the program. The content of the lectures was well-chosen for the country and the culture and medical issues associated with both. The program itself was really good. Everything was well organized from the classes, the hospitals, to airport pick-up and homestays.

It was very informative, interesting and useful, especially for a pre-med student. It has made me want to become a doctor.

It was so valuable to see how another country's healthcare system works, especially the public system. Coming from, the public system is very different at home, and this experience has just emphasized how important it is for governments to care for their citizens by providing adequate healthcare. I really feel a strong draw towards working with marginalized people, whether abroad or even in my own country where poverty, mental illness, disability, and addictions are rampant.

I really enjoyed the clinical experiences and felt that I gained really valuable insights into various types of medicine in, including the successes and difficulties of the health care system.

I think CFHI is doing a really fantastic job at providing a unique healthcare experience for students. I really don't think there is another international organization doing what your organization is, so I congratulate you!

It was one of the most beneficial experiences that I have had in my college career. I now have a much greater appreciation and understanding of the medical field in less industrialized countries.

I thought the Urban and Rural Program was very organized and educational. The host families showed a lot of care and attention to the students and tried very hard to make us feel like home. I would recommend CFHI to other students, because I had one of my greatest experiences through the program.

CFHI has not only changed my perspective of medicine, but also of my role in this world. Since the program I have become enthralled in international public health and medical anthropology. This has been a great way to learn about what it means to be a doctor in the world. There have been many things I had to adapt to while abroad and I have met some wonderful people and had some pretty crazy adventures! But I have to say, the biggest benefit from this program was that it allowed me to analyze my path in this life and appreciate where I come from while, at the same time, opening my eyes to the many amazing people, customs and experiences another culture has to offer.

One of the greatest lessons I learned was about the importance of striving to provide quality medical care in the face of limited resources and legal barriers. It was refreshing to see how hard Dr. Torres and Dr. Mora work to improve the quality of health care for all, without concern for social status or financial gain. They seemed to make many sacrifices to put their patients first, and that is what health care is really all about.

I believe CFHI's Amazon Community Medicine program helped build a foundation for my familiarization of pathologies, community-based health and overall sensitivity of global health issues. The program offered a unique learning experience of understanding both the private and public aspects of the health care system in South America while supporting my educational goals of studying Public Health in Graduate School . With the new found ideologies that CFHI has catalyzed, I feel that I will be able to achieve my goals of being an advocate for global health equalities and a voice for the destitute. As I am making my decision for my future in Public Health I now have faces to put behind my future research and communities to inspire the promotion of a healthier global community.

I am a member of several honors programs for premedical students at my university, and I think that CFHI programs would be an excellent choice for study abroad for this group. It gives a wonderful balance of language learning and clinical experience that can really give students an upper hand when they start medical school. It also has all of the components that attract the attention medical school admissions committees.

Great trip. Organized, and people very responsive. Loved the host family stay, and the opportunity to work in different hospitals and learn Spanish.

Good support, friendly staff, and provided a good safe environment to learn medicine and Spanish.

Our local coordinator, Shali and our India coordinator Hema, were extremely integral to our experience. Shali was especially helpful. We had many different programs while we were there. Shali was with us on our first day of each new program date. She was there to orientate us and to make sure we knew what to do for the rest of that one program. She made us feel like we were always being guided and watched. This was a great help. We felt taken care of and because of that, we were more comfortable with our rotations. Feeling comfortable in a foreign country is extremely important. Shali gave us that comfort. Beyond that, Shali treats her job more than a job, but a passion. She would stay over our rooms and talk to us about the programs for hours. One time, she stayed and talked with us for 3 hours, and this was in light of the fact that she was extremely tried that day. She shares with us stories beyond the program. She told us about her life, growing up in India as a girl, her typical day at work, even what kind of man she wants to marry. She went above her duties. And because of this, we got the opportunity to appreciate an intimate cultural, social and life experience from her life stories. The medical director, Dr. Raina, wasn't that helpful. He was too busy for us for the most part of the trip. We were suppose to have a orientation at Apollo Hospital, where he works, but he was caught up with his duties and we just sat in one of the Hospital's lab for two hours. Many times, he canceled weekly meetings with us. We never understood his role, beyond the fact that he is responsible for our health. However, of the times he was with us, I can see that he is a very warm and loving person. He shared his journey from learning ABCs under a tree to ending up as a doctor. He told us a few life lessons that were very inspiration. He's a good man and very knowledgeable. I don't know his role, so I can't really comment on him that much. The only thing would be to say that he should dedicate more time to us because he's too busy most of the time. Hema, our India coordinator, is like a mom to us. She always calls in to check on the three of us. We would be wandering around Delhi on one of the weekends and she'll give us a call every few hours to see if we were okay. And we call her constantly, asking her to bargain with the taxi-drivers for us. Even though she was not around us all the time, we felt like she was always next to us. We felt safe in India with her constant phone calls. And she was very good about helping us get supplies, food, etc. All in all, the coordinators were great, especially Shali. I think that CFHI could open up scholarship programs to local underrepresented students from within the country that the program takes place in. I believe that these local students are a huge resource to instill social and medical change within the country especially since they are from these countries themselves. Besides that, I feel that the international program was wonderful. I had a mix of medical and social exposure. Hema and Shali made a wonderful Delhi program. I am so thankful for their work. The experience they gave us changed three lives. I also thank CFHI and its staff for making this possible. Now I know that third medicine is something I want to do in my future. I am so grateful. I thank you again.

It was a wonderful and eye opening experience to the public health problems in Delhi. I was amazed by the country and the people I met and will forever be changed.

I would like to start out by saying that I feel the trip to began for me long before I actually arrived there. I graduated from nursing school this past June. After graduation I wanted to begin exploring the path to fulfilling my aspirations of pursuing a career in global health. During the months before graduation I began doing research on a program that would facilitate both a learning and cultural experience. I came upon the CFHI website during a Google search. From the time I entered the website, until the moment I returned home from I could not believe how professional and organized CFHI was. When I told my friends and family that I was going to they thought I was crazy, they were worried for my safety. I never felt afraid or anxious at all due to the fact that I was provided with so much information about life in and the logistics of the program. All of the webinars and reading materials sent to me before the start of the program really gave me insight into what I would be experiencing in.

Week 1: I didn't sleep the whole flight. Not for fear of flying, (although this was my 1st time flying overseas and there were moments of turbulence) but I didn't want to miss a single sight whizzing past my window. As if the sun rising over the cotton ball clouds wasn't enough, I took in the most beautiful landscape I'd ever seen as we made our descent: snowcapped mountains, lush ridges and valleys with silvery rivers coursing through. This is Ecuador. My host, Lorena, met me as I was exiting the airport and we took a taxi to her home. Coincidentally, Lorena was a teacher at the Spanish language school where I and other CFHI students would be taking lessons. Her sons Marin, 6, and Alex, 4 were shy but adorable. I only wish I had brought gifts for them all. After settling in, the sky turned dark and it rained all afternoon, providing the perfect environment for a nap. I would soon learn that this was to be the weather pattern: the golden rays of sunlight every morning were almost always balanced out by clouds and rain in the evening. I woke to the sounds of the next CFHI volunteer arriving. The three of us then had dinner and attempted to converse in Spanish. I knew when it came to Spanish I was a beginner, and the dinner conversation definitely confirmed this. I couldn't wait for Spanish lessons to begin so I could see improvements in my Spanish. However, before Spanish lessons could begin, we had to take a test for the teachers to assess our language level. It was then that I met the other CFHI students. There were both medical students and pre-med students from California, New York, Oregon, and Massachusetts. Getting increasingly nervous about my beginning Spanish skills I decided to take nothing but Spanish lessons the first week and postpone my clinical rotations. In retrospect, I'd advise students to just go ahead to the clinics and hospitals because you can't make up this lost clinical time in the future. Plus, you will easily pick up Spanish from the interactions between the doctors and nurses and their patients. That first Friday was a national holiday, la Independencia de Guayaquil. The other students and I took advantage of the three day weekend by arranging a trip to Tena. The bus ride was an experience in itself. The roads quickly became unpaved and narrow, steeply weaving down through the mountainside; with the bus wheels unbelievably close the cliff edge of the road the entire six hours. All of us were also easily amused by an elderly man who briefly hopped onto the bus to sell pills he called 'Ameba Plus,' which he claimed cured everything from cancer and parasites to menopause. Ridiculous, considering they were mainly made of sodium! You could definitely feel the climate change toward the end of the bus ride. While Quito was rather chilly, it quickly turns warm and humid as you travel down in elevation. During the weekend, we went on an Amazonian jungle tour, white-water rafting, tubing, and hiked to an indigenous village. It was an amazing experience and allowed us to meet many locals and learn about the various plants and insects of the Amazonia. A spider managed to bite me in my bed the first night and I had a close encounter with a scorpion, but all in all the trip was fantastic.

Ecuador was nothing like what I imagined. I was surprised by the beauty of the country's diverse landscape. In Quito, I never got tired of looking at the magnificent mountains in varying shades of green on my daily commute to the hospital. I could also never imagine what I would see inside the hospitals in Quito and Chone. It was a completely world that what I'm used to and it taught me to view things from an outsider perspective. I came away with a deeper understanding and appreciation of our own healthcare system than I would have in any other way. The first part of my experience was spent in the emergency room of Hospital Eugenio Espejo in Quito. It's the largest public, tertiary hospital and in the city. Each morning, I had to squeeze past a mass of patients in the waiting room to get inside. I saw numerous patients with Dr. Vaca in triage which was a small curtained space with one examining table. This hospital is the primary hospital in Quito that provides care to the indigent population and many patients travel here from communities several hours away. The variety of pathologies I saw in one day easily surpasses what I saw in the U.S. in an entire month. Because many of these patients do not access to preventive health care, they often come in with untreated chronic health conditions that ended up in acute emergencies. A middle-age man with untreated hypertension came in with end stage renal failure requiring dialysis. An elderly, jaundiced woman with petechiae throughout her abdomen was diagnosed with metastatic cholangiocarcinoma. I was amazed by the expediency with which patients were seen. The history taking takes two to three minutes: What's your name? Where do you live? What brings you here? Lab work and imaging studies are done only when necessary and if patients are able to pay the minimal fees right away (usually a few dollars). An elderly woman who suffered from likely a large stroke had to wait until her granddaughter found ten dollars before her head CT scan could be done. It was an enormous contrast with the ER I worked in the States. Here, efficiency and resourcefulness are key. With one triage table and very limited space for beds, the goal of the doctors is to give care to the greatest number of patients who cannot afford care elsewhere. Although it is a major trauma center, there are only three mechanical ventilators. The doctors recalled tragic moments when patients passed away because they lacked the equipment to save them. Their mode of operation often comes at the expense of patient privacy, comfort and autonomy. Still, I have deep admiration for the physicians I met here. Working for very little pay, these knowledgeable and hardworking doctors are doing the best they can under very challenging conditions. They demonstrate a strong desire to learn and teach and are dedicated to serving the poor. For the second part of my experience in Chone, I worked at Hospital Napoleon Davila Cordova, the only hospital serving this rural town. Once again, I was transported to yet another completely different environment. Situated at sea level near the coastline of Ecuador, Chone is a locus of many tropical diseases. Working in the pediatric ward with our preceptor Dra. Diaz, I saw many children afflicted with infectious diseases that I saw for the first time-dengue fever, parasitic infections and more. I witnessed first-hand how public health problems like unsanitary food and water can take such a huge toll on the health of the population, especially the very young. Furthermore, Chone's hospital suffers not only from a lack of technologic resources, but also a shortage of physicians. Their small 3-bed emergency room is populated by sick children becausethere are only a handful of pediatricians serving the whole community and parents have no where else to take their children. Children with complicated medical problems have to be transported to large urban cities several hours away in order to receive care from specialists. Educating patients about health prevention is a very important task of the physicians. At her clinic, Dra. Diaz tirelessly counsels parents of her patients about nutrition and the importance of childhood vaccinations. Although the government sponsors a free vaccination program for children, some families living in faraway, rural areas choose not to vaccinate their children because of lack of knowledge or to avoid traveling long distances to get to the clinics. My experience in Ecuador was very eye-opening. I learned a lot from working with physicians in the different healthcare settings in an urban, tertiary care hospital and a small, rural community hospital. At both places, I was inspired by physicians who were doing their best to care for their patients although their care was often compromised in the face of limited resources. In meetings with my preceptors, I learned about the sharp contrast of the quality of care delivered between the private and public hospitals in Ecuador. The socioeconomic status of the patients strongly determines the quality of care they receive. It gave me an appreciation of the health care resources we have in the United States to allow us to provide a high quality of care to the poor. At the same time, it showed me the great inefficiencies in our system. My experience in CFHI's program was very enjoyable and rewarding. It instilled in me a desire to provide care for indigent populations both at home and overseas in my future work.

I thought that I knew what to expect, I thought that I would be prepared. I read all the 'culture shock' books, all the, 'what to do', 'where to go' travel books about Ecuador, but when it came down to it, I didn't know. I wasn't even close. Ecuador is a small country, but packed with variety and diversity. I quickly found out that the amount of things that you can do and see there are endless. My experience in Ecuador is one that I will remember forever. I chose the Andean health program in Quito, Ecuador. The clinical experience was great. I worked in a variety of settings. Every week I would rotate from a different hospital or clinic. The clinics that I worked in ranged from inner city to countryside clinics. The patient population also varied. In the countryside I saw more of the indigenous culture mixed with the local population as well. In the inner city clinics I saw patients from the lowest socioeconomic classes to mid-upper range socioeconomic class. I thought that it was a very good experience to rotate from the different hospitals because it allowed me to view the differences between the two. Not only did I view the differences between the patients, but also between the approaches of the doctors, their interactions with the patients, and their methods of treatment. Working at the clinics I was expecting to see all sorts of unusual diseases, but to my surprise I wasn't exposed to a lot of them. I saw many of the same health issues that I do in the United States like: Hypertension, diabetes mellitus, and viral upper respiratory infections. Most of the treatment was the same, however the names of the medications were different. I was quite astounded by what I saw when I worked in the adolescent clinic. I saw numerous young teens pregnant or postpartum returning to clinic for either their prenatal check-up or for their newborns well child visit. It was very disheartening because they were children coming in with their children for checkups. There seemed to be a lack of knowledge about sex education and preventive measures. To many of these teens it seemed to be the norm. They lived at home with their parents, they didn't work, and a large number of them didn't attend school. One of my fondest memories of clinic was my opportunity to visit an alternative medicine clinic in a city north of Quito. The city of Otovalo has a large indigenous population. The clinic combines natural medicine with western medicine. While there, I had the pleasure of meeting a shaman, or yachak as they refer to them as. He showed us his room full of herbs and even prepared an antidote for us while we were in the room. Later we were able to observe the fregador and partera, other health care providers, perform their patient encounters. They use a variety of different tools during their visits like eggs, rocks, and oil to heal and clean their patients of their 'bad energy'. It was very interesting to see their different beliefs in practice especially because they are so different from our medicine. The homestay experience was equally as outstanding. The family was so nice and provided delicious meals and good conversation. The home that I stayed at also hosted other students as well so it was nice to converse with them at the end of the day. In the evening we would practice our Spanish and talk about our day over dinner, where we worked, what we saw. After dinner we would usually continue our conversations, play card games, or even show our pictures of our family and friends from back home. The language school was great. They have a wonderful group of Spanish teachers. They are all very nice and eager for us to learn. Classes ranged from group to one-on-one classes. I learned a lot during them, I wish I could have had more time. After class or before depending, we would do extracurricular activities like cooking classes or tours of different parts of the city. I learned how to make ceviche and llapingachos, some typical dishes. Another very enjoyable part of this program was just being in Ecuador and being able to experience the culture. On the weekends, all of us students planned weekend excursions. We were able to view a great deal of Ecuador. We climbed a volcano, went to the jungle where we went white water rafting, and we even had the opportunity to visit an indigenous village. We met a family and went up into their home to see what their lifestyle was like. It was very amazing to see how the people lived and functioned day to day. All of the people in Ecuador I found to be very nice and hospitable. Over all, I had the time of my life. I got to experience things that I will probably never get to do again. I got to see health care from a different perspective. I got to meet people from around the world and I have made new friendships that I intend to keep for the time to come. I have been involved in service learning and international travel. This experience has sparked my interest to continue practicing and serving others in other countries around the world. I am blessed for such a memorable experience. Thank you CFHI for allowing me this great opportunity.

The program went by so fast and I was sad to be leaving at the end of the week. I made great friends, met good people and learnt new things. India won the cricket world cup this week and even the doctor we worked with was watching the match with his patients who were happy to wait until the match was over, it felt so natural. A day after the cricket match was the final day of Ganesh festival. The excitement and noise of the week was inconceivable. HOSPITAL AND CLINICS We were at two clinics for the most part of the week. Evening clinics were very useful. I had hands-on experience at Dr. Bathla's and his mum (also a doctor) taught us everything there is to know about Malaria. A very clean clinic and friendly as well, the patients all seemed like family members of the doctor's family. On the last day, we were at a Leprosy dispensary run by Dr. Bhatki, the co-coordinator for the Mumbai program. It was the most effective clinic I had seen through out my stay in India. If there was anything I gained from this program, it was definitely the fundamental information given to us about Leprosy, which helped me get rid of the fear I had for leprosy-infected individuals before I got to India. By the last day of the program, I was examining lesions and palpating swollen nerves of infected patients with absolutely no fear of getting the disease. Among other things, we saw how paraffin waxing could markedly reduce stiff joints so that patients could go in for corrective cosmetic and nerve decompression surgeries. The dispensary not only diagnosed leprosy cases but also made differential diagnoses and sometimes treatments for other lesions. The surrounding community members, young and old made use of the clinic without any shame and that was remarkable. In summary, I would like to say that first of all, you should have the right attitude towards your co-participants because you will need each other's help during the program. Secondly, it is important that though you have expectations, you keep your mind open so that you are prepared for new things that do not include your preconceptions about the program. Thirdly, although it is really cheap to live in India, you might find yourself spending a bit more than you intend to because there is so much to buy, so many places to see, so many rickshaw drivers who will take you on a 10-km drive instead of 2km because you do not know any better. Lastly, the food is really only vegetarian, which you might not have come to terms with and it is spicy (I mean as far as buying juice and finding out that there is masala in it). So get ready for a food adventure!! In all, it was one of the most interesting places in the world where wealth and poverty meshes like an entangled twig and people love you maybe because you are foreign or maybe because you are you. Thanks again to CFHI for an opportunity of a lifetime.

I think everyone will eventually experience cultural diversity, personal growth, depression, anxiety, death, disease, satisfaction, love, history, and peace at some point in their life. I got to experience them all at the same time and it was remarkable. It has completely changed my mentality. My perception of the people and places I experience on an everyday basis has been heightened beyond any level I could have expected. Sure I got credit for my time in and the clinical work might help me get into medical school, however, the mentality I have developed, my heightened perception of others, an appreciation of diversity and a newfound patience with life are the most important things I will take away from this experience.

It was an incredible journey of personal growth as well as learning a lot about medicine.

I thought this trip was perfect for my personal goals. The trip allowed us to see different clinical setting and how doctors practice medicine in a different environment with different resources. It also allowed us to experience a different culture and to get a glimpse of how cultures think differently and how it can affect how we practice medicine.

The program was clinically relevant, and personal learning was significant, both in clinical and cultural realms. The structure of the program was well thought-out, with appropriate communication and safeguards. Staff in the central office was available and helpful; staff on location was a tremendous resource.

It is one of the best opportunities to develop [a] student's sense of being a part of global village. I grew up a lot as a more independent thinker and became more outgoing, asking opportunities to learn things from the doctors I was working with. I really enjoy the fact I gained [insight into] various aspects of health care practices not only limited to one discipline.

I am thankful for everything that I have learned in India and the relationships with the doctors, patients and people I met. The differences in the healthcare systems of the United States and India are vast, yet similar. Doctors, nurses and medical assistants, no matter where they are, want to help and heal their patients. This is the common ground of medicine throughout the world and a lesson I will never forget.

I would highly recommend the Maternal and Child Health Program to anyone interested. The coordinators were highly supportive, went out of their way to ensure you had the best experience you wanted, and had interactive education to further our understanding of maternal, child and public health.

Wonderful program! I was able to fulfill all of my public health requirements based on the clinical exposure that was offered to me... The CFHI staff was very helpful and accommodating to my late interest in the program. Everyone was so friendly and very professional!

I liked seeing the variety of clinics, from very poor and rural, to more urban, private, public, etc.

It has made me want to view first-hand the level of health care for many of our own rural areas, as well as wanting to continue to help those overseas.

The clinical experience I gained in Oaxaca was a life changing experience. Not only change me on my personal views on medical care in Mexico but change me as a person who inspires to be a physician near future. Volunteering in various clinics and hospitals helped me to learn and gained knowledge about medicine. I am convinced that this unique experience will shape me into a physician who provides health care services in low-income communities. Part of my childhood and teenage years, my family and I lived in a community for farm-workers. Migrant camp homes were next to our community and every year I saw families come to live temporarily in those homes to work in the fields. Like my family, I witnessed migrant families delaying to go to the clinic for treatment due to language barriers between doctor and patient. We did not have medical insurance since my father was a farm-worker and there were only a few clinics we could go for medical attention. It was hard for my family to find a family doctor. Not many doctors spoke our language and understood our cultural background. The idea to be a physician came later when I volunteered in clinics in poor and low-income communities. My desired to pursue a life of service where I can contribute to society by helping others came when I volunteered in a free clinic, Clinica Tepati, for uninsured and underrepresented population in Sacramento for more than two years while studying at the University of California, Davis. I gain valuable experience interacting with patients in the process of greeting, weighing, and checking for vital signs. I listen to patients life stories. Some patients came for medical care at the clinic as a last resource. I translated for patients since the majority of them did not speak English. To better understand the role of a physician, I shadowed and observed them. The doctors took their time to give underrepresented population in Sacra proper medical attention. I observed how doctors treated patients with care. From this experience I found my passion for taking care for low-income community families. Upon graduating from University of California, Davis, I took some time off to explore and learn about both the world and myself. I remembered when I was a child living in Mexico, I witnessed deprived families not getting the medical attention they required. During my visits to Mexico as a young adult, I became aware of the low health care services in rural communities in Mexico. I was interested to explore, learn, and work in clinics in poor and low-income communities to expand my knowledge in medicine. I applied to Child Family Health International program to have an experience in working in underserved communities. I volunteered in clinics and hospitals in Oaxaca, one of the poorest indigenous states of Mexico. I spent one month going on clinical rotations gaining experience to work and interact with diverse group of people. I gained exposure to many different fields of medicine. I was with pediatricians, general doctors, and surgeons. I triage patients in clinics. In an effort to gain experience in the medical field, I ask patients for their chief complaint, history of present illness, and pass medical history with the support of the doctor. Indigenous families living in remote homes in the mountains walked to the community clinic for medical attention for their sick and malnourished children. Some of them could not pay 15 pesos ($1.50USD) for the doctor's consult but still they were treated. I observed how the doctor-patient relationship evolved from shyness to trust. The enjoyment and enthusiasm that doctors displayed while treating their patients was an experience that I enjoyed watching them having fun. The satisfaction I gained by noting a patient appreciation gave me a deep fulfillment to one day become a physician. I gained cultural knowledge. I witness in-patient surgeries procedures and participated in out-patient treatment. During my experience in hospitals, I was thrilled to witness my first group reunion of specialty doctors discussing about a patient status. Each of the doctors gave their own perspective in their own field of expertise about the patient's condition. At the end of the program, the insight I gained on issues of International health and underserved communities in Mexico has helped me to understand more about medicine. Health services in Mexico cost a lot of money for people who do not have medical insurance. About 40 million out of 100 million people living in Mexico mostly agricultural workers, retailers, craftsmen, etc do not have health insurance. The programs to help the uninsured population with primary medical care such as Extension of Coverage for rural communities and Oportunidades which purpose is to improve of the lives with healthcare, alimentation, and education has improved somewhat the lives of low-income population. The secretaria de Salud de la Nacion has provided partial health care services to the uninsured population. The lack of infrastructure in remote communities and doctors who are not interested to provide medical services in remote rural areas has challenge the government to provide medical care to everyone. In Oaxaca the demand for medical care is arising due to few clinics and hospitals available for the population. In 2001, the program Seguro Popular emerged to help the poor people cover partial or all doctor's consults and medication cost. Common diseases in Puerto Escondido are malaria, dengue, diarrheas, dermatology, and other diseases that are not given proper attention due to cost are changes, pulmonary tuberculosis, and lepra. Child Family Health International program has given me an opportunity to improve my medical education by witnessing and observing physicians in clinics, has motivated me to someday work in low-income communities, and most importantly I gained cultural knowledge. Dr. Javier Pastrana medical director and Soledad Fernandez local coordinator supported me to have a great experience in the clinics and Spanish classes. I enjoyed this experienced and hopefully near in the future I can have another experience in another country. Thank you.

I think this program was good because I was able to experience a different style of health care while at the same time learning more Spanish and learning more about a different part of Mexico.

...my program clinical rotations gave me fantastic exposure with tropical diseases. Above all, the chance [to] learn basic Spanish skills specific to a medical interview was the most valuable component of the program.

Today was my first day at the clinic. The hospital is like any other hospital from the 1940's. The knowledge and education was right up there though. The doc I was with was awesome and really good at teaching. I spent the morning on the OB floor and the afternoon confused about where the doctor went. Overall it was a pretty good experience. Today we started a new rotation at an orphanage. The kids are great and really just want attention. They certainly aren't shy and apparently know nothing about stranger danger...I suppose that's what happens when you have so many people in and out of your life. There are about 1/3 of the kids that are on Aids treatment. Most are doing really well now that the drugs have become more available. These kids don't lack medication or food but they are starved for attention. The orphanage staff does the best they can but even then the goal it just to keep everyone happy and from crying, there just aren't enough staff workers to go around. I also spent some time doing some of my osteopathic manipulation on a couple of the kids. There were two youngsters who haven't begun to crawl and are pretty far behind on their milestones. The nurse asked me to do some physiotherapy on them so I did a little OM. They both seemed to respond very well, one of the little guys even allowed me to hold him and put his feet on the ground for a bit. The little 11mo man had no urge to use his little legs. I worked with him all last week and by Friday he was balancing on my leg with his feet on the ground trying to bounce a little bit. Apparently two weeks before he wasn't able to hold himself in a seated position. The little girl just came to the orphanage a month ago, at 9mo of age. She was undernourished and under cared for; her little legs didn't have the strength to move herself even though she really wanted to. By the end of the week I was able to get her to pull herself up to a seated position by using my fingers and even balance for a few seconds before toppling over in one direction or another!! I got them both set up with a young volunteer from Germany who will be at the orphanage for the next few months... Can you believe it is already my third week here in South Africa!! I finished up last week at the orphanage with a bang...got peed on and spit up on all in one day! I spent my last week at King Edward's hospital in the pediatric resuscitation unit (PRU), which is basically a pediatric ER. Lots of dehydrated babies secondary to gastroenteritis...for all you lay people, vomiting and diarrhea! Not pleasant. I saw some pretty unique things throughout the week...Stevens Johnson syndrome (a pretty rare drug reaction or reaction to a virus), chorea (uncontrollable movements like an arm flailing in one direction or the other without the patients control) in a patient with rheumatic fever, congestive heart failure in a 7 year old possibly secondary to rheumatic fever in the past... This week I am on to hospice care in Chatsworth, a suburb of Durban. Today we spent the day making home visits to people with HIV and end stage cancer. Hospice care in South Africa is a little different than in the US. Here they begin treatment earlier in the disease stage, the belief being is that if you get to know a person before their disease progresses to end stage you will be able to care for them at a much greater level later when they are about to cross over. Therefore not everyone we visited was bound to their beds, there were multiple people up and about such as a man with a brain tumor for the last 6 years, a mentally challenged woman with HIV, and a woman with stomach cancer who was babysitting 3 small children when we got there. So I have finished up my program in Durban. I ended my last week with hospice care. I have never been in a situation where the doctors, nurses and staff are so comfortable with death. In my experience in the states everyone likes to scoot past the issue and most doctors feel the need to give each person that extra two days of life even if the quality is low. I am home now and my reflections on my experience in South Africa are something that I will never forget. It was a truly amazing two months of my life.

My experience has been phenomenal. The networking that occurred among me and the program participants has been life-changing. Ian Metzler, a fellow CFHI group member, ironically met a dermatologist on the plane on his way to . After he learned of my future career aspirations of becoming a dermatologist, he provided me with her contact information. Dr. Dlova oddly worked at King Edward's hospital, a large facility where our group would visit. The dermatology department was extremely welcoming, allowing me to observe a myriad of skin, hair and nail pathologies and educating me with different treatment plans. Following the conclusion of the program, Dr. Dlova allowed me to contiattend the facility, invited me to her private practice, and provided me with a beginning dermatology manual to assist me with terminology. I was also encouraged to take pictures of HIV related skin diseases. As a measure of taking full advantage of this opportunity, I opted to postpone my visit in by two months, originally due to return to the on Nov. 2nd, 2006. I did not return until Dec. 21st. I have been able to better contemplate my desire to become a dermatologist, and am now considering a career in cosmetic chemistry to assist patients with products that will expedite their physical and emotional healing processes. I am also more aware of HIV related skin diseases as Dr. Dlova provided me with a parting gift of a signed copy of the first color atlas of HIV- related skin diseases she authored!

I was frequently asked by classmates in my program why I chose the international program in Mexico, being fluent in Spanish and Mexican, to which I simply responded, 'Because I've never been in Oaxaca.' Mexico is a huge country with thirty-one unique states, each with its own variation on the theme of Mexican culture. And Oaxaca is one of the brightest gems that Mexico has-rich in art, music, architecture, cuisine, and native customs that have long been the attraction of tourists. Mountains surround the great valley in which the heart of the state of Oaxaca - Oaxaca City, the capital-lies. While these mountains are breathtaking to anyone who takes the time to observe them; and while they have been the focal point of countless photograph and paintings; and have been the themes of many songs and poems, they have historically deprived the heart of Oaxaca from what lies beyond the horizon - the resources of industrial Mexico. Don't get me wrong! Oaxaca City has every modern commodity, including a very nice airport to fly into and a great highway that connects it to Mexico City, but the tradition of Oaxaca being last in line to receive any type of federal government funding still continues. Add to this a shortage of water and corrupt state government leaders and the result is a society with a minute upper class, very few middle class citizens, and an overwhelmingly large poor population. Our language school, Becari Language School, where we had a minimum of two hours of Spanish lessons every day, had outstanding teachers patient, caring, and flexible. Though it is obvious that the school focuses on teaching more beginning and intermediate Spanish learners, the teachers made a great effort to select a challenging and interesting curriculum that helped expand my vocabulary and refine my grammar skills - things all native speakers living in the United States need practice with. Living with a Mexican host family really allowed me to immerse myself even more in the language and culture. And our host families were all wonderful and provided us with the best of hospitalidad Oaxaquen?a, Oaxacan hospitality. We all had our own rooms - some of us even had televisions in our rooms and our own bathrooms. Our group would often debate on whose host mother was the best, based on the delicious meals we were served. The weekends were great for going on day trips or even long weekend trips like the one our group took to the beaches of Puerto Escondido. Through our weekly lectures with the program medical director, Dr. German Tenorio, we learned how the Mexican health system divides to serve various groups, ranging from the government funded institutions for the poor all the way up the hierarchy to the private sector. In between these extremes are the institutions for working class citizens who can't necessarily afford the private sector. Our health system is a young system, only about fifty years old, said Dr. Tenorio. Essentially everyone has access to healthcare in Mexico, but the quality of care depends on how much you can pay. The private hospitals have the most resources, the best equipment, and are well staffed. The working class institutions are well equipped, but slightly understaffed and are constantly jam packed with people waiting many hours to be attended. Interestingly, there are some types of insurance schemes where these people pay a small monthly charge that will allow then to walk right into the hospital and be attended without having to wait. Did I mention that triage is pretty much non-existent? And then there are the government institutions that are, of course, the least equipped and most understaffed. This is where I spent the majority of my time. In one week I was at the Hospital Civil observing in the labor and delivery operating room and in another I was helping combat dengue with the staff from a 'Centro de Salud' located in one of the poorest neighborhoods in the hills of Oaxaca City. What does one make of these unique experiences? Well, I have come to realize that you just cannot compare the Mexican health system to the American health system or its standards; they are like apples and oranges. However, in one of our lectures we learned that the vaccination program in Mexico is the only thing really up to par with the American health system. It is tied in with the public school system parents must prove that their children have been vaccinated in order to enroll their children in school, and the vaccinations are free. Such programs have completely eliminated diseases like polio throughout Mexico. However, if people are living in third-world situations, then they will be prone to third-world diseases. During one of my conversations with my host father, Dr. Vicente, retired gastroenterologist, we discussed the economic situation of the poor people living in the hills. He assures me that because public schools are free, including universities, people in Mexico do have the opportunity to overcome poverty. This experience really does make you appreciate all the resources we have in American healthcare settings, including the privacy and confidentiality regulations. That the lack of resources severely compromises the health and safety of patients in Oaxaca is undeterminable in such a short amount of time. I would be curious to know how often urinary tract infections occur in the 'Hospital Civil's' obstetrics and gynecology operating room due to the lax practice of sterile procedure during foley catheter placements. But what one has to understand is that the Mexican health system really does work and is improving slowly but surely. Indeed, everyone in their respective healthcare profession does want nothing but the best for their patients. I forgot to mention that fried grasshoppers, seasoned with salt, lime and chili are a traditional snack in Oaxaca. Everyone eats them like we eat potato chips. An old wives tale says that if you eat 'chapulines,' as they are called, you will return to Oaxaca some day. I can't wait until I become physician so that I can return to Oaxaca and actually lend the healthcare system a hand - yes I ate grasshoppers and they were quite tasty! Thank you CFHI.

I enjoyed my clinical rotation at Carmen. I was able to see a great deal of surgery, and as I am interested in pursuing a career in surgery I found this experience very valuable.

I enjoyed interacting with the children and parents, even though some of them were very sick, since they all were extremely friendly and welcoming. I learned a great deal about medicine, public health, and myself... It was great to be exposed and learn about Oaxaca, the entire surrounding region, and Mexican culture and the health system firsthand.

The clinical rotations were life changing. I was able to prepare better for my career in health, because I was able to actually experience different aspects of healthcare which I would not have been able to do back home. From seeing live-birth to death, surgery, working with autistic patients, local medical students and doctors, I now have a whole new perspective on healthcare and how to really become a better professional in my field.

CFHI does a wonderful job of integrating the students with the local culture. The coordinators in Oaxaca made us feel extremely welcome and safe there. We always knew we had someone in time of need and to support us.

I already have recommended it to one of my pre-dental friends and would most definitely recommend it to anyone interested in learning more about healthcare delivery and HIV/AIDS in a disadvantaged country.

Marion, the local coordinator, and Avril, the medical director, were both incredibly welcoming and made me feel comfortable immediately.

It was an amazing experience, one that I will never forget; both for the medical exposure and the life long friends that I made.

This program was amazing; it worked as a great cultural experience, a volunteer opportunity, and a chance to learn more about medicine and public health around the world. My experience with CFHI was incomparable. I enjoyed myself thoroughly, while meeting great people and experiencing a great culture. The homestay was extremely comfortable and the family was so kind the other students and I. Every one of the doctors that I was fortunate to work with was very welcoming and did their very best to make my experience as best as possible. They went out of their way so that I was able to observe and help with as much as possible in the hospitals and clinics. I learned a great amount about the public health system in Bolivia through informative medical lectures, and through the doctors themselves. My medical coordinator, Cecilia Uribe, was amazing. I worked on my own individual research while in Bolivia, and she was extremely helpful and worked with me so that I had all of the resources necessary. Finally, I was able to improve my Spanish and see another part of the world. I would highly recommend this program to any medical or nursing student. We learned about healthcare issues in Bolivia, their medical insurance programs, diseases prevalent in the area, and many other interesting topics.