Internships in Ecuador

My experience with International Medical Aid in Peru was transformative, and the staff were at the heart of it. Their guidance, care, and example shaped not only my learning but also the way I now see medicine. Dr. Fabrizio was one of the most down-to-earth and knowledgeable teachers I have ever had the privilege of learning from. He led many of our lectures and constantly reminded us that health is never just physical; it is also mental. He taught us how to approach patients holistically and how to rely on our clinical skills and hands as tools when technology was limited. His way of teaching made complex concepts accessible and grounded, and his example will stay with me throughout my career. Dr. Miriam was equally impactful. She not only lectured with clarity and compassion but also worked alongside us in the community clinic in Andahuaylillas. I had the privilege of being with her when we saw a 78-year-old farmer who had not sought medical care in years. Watching her balance empathy with clinical skill as she cared for him was deeply moving, and it showed me what it means to treat a patient as a whole person, not just a list of symptoms. Our program coordinator, Manuela, created an environment where we always felt supported and welcomed. She was consistently kind, approachable, and attentive to our needs, which allowed us to feel at home even when we were far away. Surabhi and Juda also played an invaluable role in ensuring our safety and comfort throughout the program. They were present and attentive, often behind the scenes, and their commitment gave us the confidence to immerse ourselves fully in the experience without worry. What stood out most to me was that each staff member went beyond their formal roles. The physicians modeled the kind of care that sees patients as individuals with stories, while the program staff ensured that we had the structure and security to learn and grow. This combination made my time in Peru not only eye-opening but also profoundly fulfilling. The program has given me lessons about privilege, resilience, and holistic care that I will carry into my future in medicine, and for that I am deeply grateful to every member of the team. “Un día.” One day. This is what a nine-year-old girl said to me when I showed her pictures of my life back home. That simple phrase has stayed with me as it revealed both her dreams and my privilege. We don’t realize the opportunities we hold until we’re met with the reality of others. This was the greatest lesson I learned throughout my internship with International Medical Aid in Peru. Over several weeks in Cusco and the surrounding mountains, I saw the ways limited health education, scarce resources, and cultural barriers shape how people experience health. I listened to children who had limited education about hygiene or menstruation, to patients who had not seen a physician in years, and to elders who still relied solely on traditional remedies. I also saw resilience—in girls who proudly signed their names on pottery they sold to support themselves, in communities who welcomed us into their schools, and in physicians who made the most of every tool available. These experiences challenged me to rethink what it means to be a healthcare provider. They taught me that medicine is not just about treating disease; it is about building trust, offering education, and meeting people where they are. My time in Peru deepened my commitment to a career in healthcare, one rooted in empathy, humility, and advocacy. In every school and orphanage we visited, I realized how much of healthcare begins long before a patient steps into a clinic. Many of the children we met had never been taught how to wash their hands properly, why brushing teeth matters, or what to expect when their bodies begin to change. At the girls’ orphanage, we gave talks on dental care, handwashing, and menstruation, and their questions reminded me just how powerful basic education can be. Some of the girls believed that menstruation meant they were sick, while others were shy to even say the word. Watching their faces light up as myths were debunked was a reminder that information can be as healing as medicine. Back home, I had always taken school health classes for granted; in Peru, I saw what it meant when those lessons were missing. It struck me that the first prescription a physician can give is not always a pill—it is knowledge, dignity, and understanding. As a future physician, this lesson reminds me that I cannot assume patients come with the same baseline of health literacy I had growing up. If I want to truly serve my patients, I will need to carry this humility forward, taking the time to listen, explain, and leave them with more than a prescription—with the confidence and knowledge to care for themselves. That same lesson came into sharper focus during my rotation in Tópicos, where nearly every patient who walked in had varicose venous ulcers. We cleaned and re-dressed wound after wound, with many returning with infections and deterioration. One woman had scratched at her ulcer, not realizing the bacteria under her nails could worsen it beyond recognition. It wasn’t neglect; it was lack of guidance. The nurse explained that these ulcers were so common in Peru due to long-standing labor in agriculture and markets, high rates of obesity, and almost no access to early preventive care. She enlightened me that chronic venous disease thrives where occupational risks, delayed treatment, and poverty converge, and I could see that truth in every leg we bandaged. What I had glimpsed in orphanages—the cost of missing basic education—I now saw magnified in adults whose wounds had spiraled because no one had ever taught them how to care for themselves. In Canada, I grew up with hygiene lessons, clean water, and health literacy woven into everyday life; in Peru, those privileges were often absent, and the consequences were written directly on people’s skin. These structural inequities became even more visible during our community clinic in Andahuaylillas, where many of the patients we saw had not accessed medical care in years. One man I encountered, a 78-year-old farmer, had bilateral vision loss, severe back pain, and a chronic cough that had persisted for more than five years. Decades of agricultural labor, exposure to wood smoke from cooking fires, and his deep mistrust of physicians reflected patterns I later recognized were not unique to him, but part of a larger reality in Peru. He told us that nearly thirty years ago, doctors had advised amputating his leg due to a severe problem, but he refused and “treated it at home,” now claiming it was fine. That experience convinced him that doctors could not be trusted, reinforcing a reliance on home and traditional remedies—an approach I saw echoed in many rural patients. Chronic obstructive pulmonary disease (COPD) in Peru is often driven not by smoking, as in wealthier countries, but by biomass fuel exposure in rural areas and past tuberculosis infection in urban centers (Miranda et al., 2015). His case was a striking reminder of how structural and environmental conditions dictate disease pathways. I saw similar themes in patients who were either visibly malnourished or living with obesity—two extremes often rooted in the same absence of nutritional education and preventive care. Nearly 30% of Peruvian children suffer from anemia, with prevalence reaching 38% in rural areas, largely explained by socioeconomic and educational disparities (Al-Kassab-Córdova et al., 2022). These same inequities perpetuate adult conditions like venous ulcers, which worsen without early nutrition and wound care. At the other end of the spectrum, I also met patients struggling with obesity and hypertension, consistent with data from Lima showing that more than half of patients with type 2 diabetes live with additional chronic diseases such as obesity, hypertension, and dyslipidemia (Bernabé-Ortiz et al., 2015). My patient in Andahuaylillas was not just an individual with COPD or TB; he was the embodiment of Peru’s double burden of disease, where poverty, environment, and education converge to shape health outcomes. His story made me realize how much of my own access to clean cooking, preventive care, and trusted physicians has been a form of privilege I had never questioned before. This showed me that medicine is as much about context as it is about cure, and that healing begins with seeing the whole person along with the conditions that shape their daily lives. Another significant lesson I carried home was the manner in which Peruvian physicians approached mental health. Although I learned in lectures that Cusco has only about fifteen psychiatrists for the entire region, the doctors and nurses I observed never disregarded psychological well-being. They recognized that health cannot be separated into physical and mental dimensions, consistently seeking to make patients feel heard and understood. This was especially evident in the orphanages, where many of the girls had endured poverty, trauma, or domestic violence. Their questions to me revealed how deeply their environment shaped their sense of identity and purpose; some, not even two years younger than myself, asked whether I had a husband or children, as if a woman’s life were confined within these boundaries. At eighteen, I was struck by how different our realities were, and how limited social and educational opportunities had already narrowed their vision of what was possible for themselves. These conversations underscored that health is not only about physical well-being, but also about how people understand their worth, their opportunities, and their place in the world. I saw this perspective carried into practice at the community clinic in Andahuaylillas, where the physicians made it a priority to establish a station for a psychologist so that patients could receive mental health support after their medical evaluations. Their example reminded me that being a doctor requires seeing patients not only as clinical cases, but as whole individuals whose stories and experiences profoundly shape their health. They showed me that holistic care does not always depend on advanced technology or specialist services; it begins with empathy, attentive listening, and presence. While in Canada I have often taken for granted the growing recognition of mental health and the availability of counseling, in Peru I witnessed how deeply impactful it can be when physicians themselves integrate mental well-being into every encounter. This approach is one I intend to carry forward in my own career, ensuring that my patients feel acknowledged not only in their symptoms but also in their humanity. My time in Peru taught me what it truly means to be privileged. I had never realized how far my liberty extended or how much I had taken for granted. The ability to imagine a successful future for myself, to believe I could pursue it, and to access clean water, preventive health, and nutritional education are privileges that often pass unnoticed. In Peru, I saw the reality behind what happens when those pieces are missing: children growing up without health education, adults unable to manage preventable conditions, and elders relying on traditional remedies after losing trust in the medical system. Yet I also witnessed resilience—in young girls who inscribed their names into pottery to claim a sense of identity, in communities that welcomed us into their schools, and in physicians who, even with few resources, practiced medicine with empathy and intentional care. These experiences taught me that medicine is never only about treating disease, but about restoring dignity, sharing knowledge, and meeting people where they are. The physicians I shadowed modeled what it means to care for the whole person, listening to stories, acknowledging mental as well as physical well-being, and ensuring that every patient left feeling seen. Their example reshaped the vision I hold for myself as a future physician. I want to carry forward what Peru gave me: the discipline to look beyond symptoms, the humility to learn from every patient, and the responsibility to use my own privilege to bridge gaps in care. One day, I hope to stand fully in that role, offering my patients the same compassion and hope I once witnessed in Peru. Un día.

Overall, I really enjoyed my time with IMA in Peru. I thought the program was very well organized and thought out. Our mentors/coordinators were great and easy to contact when needed. As the fluorescent light of the operating room shone on my face, I looked over to my father in awe of his work after performing an Ablation on a patient. From a very young age, I was exposed to the medical field and the U.S. health system, as my father is a cardiologist and my mother was a nurse. After my first visit to the hospital with my father to shadow him, I knew the medical field was where I wanted to be in terms of a career. Fast forward to my sophomore year of college, and I knew it was time to get serious and find unique ways to gain medical experience. That’s when I stumbled upon International Medical Aid online. I had no prior knowledge of this program except that a friend of a friend had completed it in the past, and I had seen a few photos from her time in Peru. Almost completely unsure of what was yet to come, I later embarked on my journey to Cusco, Peru. The feelings of excitement, curiosity, and eagerness were overwhelming, but I was excited to see what was yet to come. I had set many goals for myself before leaving for this trip, the main one of which was to explore different careers in medicine. During my time shadowing in the U.S., I spent time with only a Cardiologist, Pharmacist, and Anesthesiologist. After spending many days with an Anesthesiologist and Anesthesia Assistants, I was set on attending anesthesia assistant school rather than medical school. Now that I have spent time at Hospital Nacional Adolfo Guevara Velasco – EsSalud with General Medicine physicians, Pediatricians, Gynecologists, Obstetricians, and Ultrasound Specialists in Peru, I have decided to keep an open mind about attending medical school since I need to take the MCAT before anesthesia assistant school anyway. My favorite department that I spent time in was Ultrasounds, shockingly. I was not expecting to enjoy this specialty as much as I did, but being able to actually perform ultrasounds on patients and learning how to read them really sparked my interest. I also thoroughly enjoyed being with the Obstetricians, seeing the joy on the mothers’ faces, and hearing their babies’ heartbeats was so rewarding. One thing that stood out to me was that, regardless of the department, a large number of patients were seen within a short period of time. For example, one morning when I was in General Medicine, the doctor saw eighteen patients in the span of 3 ½ hours. That being said, I noticed many differences between the way medical professionals and patients interact with each other in Peru versus the United States. There were many times when other patients would walk into an examination room while the physician was meeting with another patient. This caught me off guard because in the U.S., this would not be tolerated, as it is seen as an invasion of the patient's privacy. I also remember Dr. Pedro (General Medicine physician) telling me, “Patients come to doctors with symptoms and expect a remedy; if the doctor doesn’t provide a fix, they are considered to be bad at their job.” I’m unsure why, but this stuck with me because it made me think about the cultural viewpoint that patients in Peru have on healthcare and doctors. Both of these instances made it seem as though patients in Peru feel they are superior to other patients and that the doctors don’t receive as much respect as they deserve. Oftentimes, patients would speak openly about their concerns or disregard for their physician, which can be a good thing, but also is something you don’t see often in the United States. The overall relationship between patients and doctors was something that stood out to me as I was observing. As a student also pursuing a certificate in Public Health, being immersed in the Peruvian health system was eye-opening and put my learnings into perspective. I had recently taken a class called “The U.S. Health System in a Global Context,” where we learned about foreign healthcare systems, the role insurance plays worldwide, and different cultural views on healthcare. Although I wasn’t specifically taught about the Peruvian system, after learning about it through IMA, I was able to quickly compare it to the Canadian or German system. Much like the German and Canadian systems, Peru launched Universal Healthcare Insurance in 2009 (International Medical Aid, 2024). While the country as a whole is still working to achieve this, it’s in the process of expanding public and private sectors. Peru is made up of two different public sectors. MINSA, the Ministry of Health, provides healthcare for low-income informal workers. EsSalud (one of the hospitals we were in) is a type of social health insurance that covers formal workers and their families (International Medical Aid, 2024). I found learning about this interesting because I have spent a long time learning about U.S. insurance plans, such as Medicaid and Medicare. In terms of quality of care, the U.S. has high-quality care available. Outcomes on certain health measures, like long-term health and certain treatment results, can be worse than in other wealthy countries. In Peru, quality varies, with private providers generally offering better services but higher costs. The public system struggles with strained resources, fragmented communication, and long waiting times for appointments and procedures. Aspects of public health vary between the U.S. and Peru; having first-hand exposure to a foreign system will be beneficial in my studies moving forward. One challenge I faced while being in South America was the language barrier. In high school, I had taken German classes; therefore, I knew little to no Spanish when I entered the internship. This was my biggest worry before leaving for Peru; I was concerned about how I would communicate with/understand patients and the medical professionals I would be working with. Oftentimes, I was paired with someone in my cohort who spoke or understood Spanish proficiently, but there were a few days I was alone in the clinic. Being in this position allowed me to push myself and become creative in my communication methods. I always had a translator app pulled up on my phone to help me understand what was being discussed between the medical professional and the patient. Although sometimes inaccurate, having a translator gave me a general idea of what was going on and allowed me to engage in the consultation versus just observing. I also learned that hand gestures were a fun way to communicate, especially in pediatrics. After taking the provided Spanish classes and being surrounded by so much Spanish, I am more confident in my Spanish understanding skills. Language barriers are something I am likely to face again while working in the medical field. The skills I gained from this experience will allow me to navigate those situations better and communicate smoothly in the future. My favorite part of the internship was the day we visited the rural town of Casacunca and set up a Community Medical Clinic for the town's residents. This was when I applied my learnings from our Clinical Simulation Sessions at the Hospital Nacional Adolfo Guevara Velasco – EsSalud. After being taught how to perform an initial patient workup, being able to apply it hands-on with real patients made it a full circle. During the clinic, we saw many families with young children, the majority of whom presented symptoms of anemia. Poor appetite, fatigue, and slowed development were all prevalent when doing initial work-ups. Anemia is an indicator of poor health and nutrition (International Medical Aid, 2024), therefore coinciding with the fact that these patients live in a rural area with a lack of resources. My most memorable patient interaction was with a 60-year-old male who came to us with upper left leg/hip pain. He presented with an X-ray of his hip from 2019 that showed a clear fracture in his right hip. Without updated scans, we couldn’t determine the state the fracture was in, so we diagnosed him with atrophy. All we could do was suggest that he go to Cusco for new scans, a hip replacement consultation, and prescribe Meloxicam to help manage the pain. While conducting a physical exam, we noticed worrisome symptoms such as severe hand tremors and a fixation of the eyes. These symptoms suggest that the patient likely has Parkinson's disease, but without an official neuro exam, this could not be confirmed. The reason this patient stood out to me was that it put into perspective how many people struggle with underlying symptoms but never receive the opportunity to be treated due to location and resources. Although it was sad to see struggling patients, this was such a rewarding and fulfilling day. Being able to treat those who needed help confirmed my love for working within healthcare and pushed my drive to continue down this path. Overall, my time spent with International Medical Aid in Cusco will be something I always remember. Whether I was attending Spanish class, exploring local markets, shadowing in the hospital, or giving health presentations to children, I was always learning and exploring. I not only achieved the goals I had set for myself, but I exceeded them. In just three short weeks, I watched myself grow as a person and became even more passionate about pursuing a career in medicine. Being in Cusco changed my outlook on not just the medical field, but life in general. Every chance I had to immerse myself in the Peruvian culture, I took it, and I am grateful I was given opportunities to do so. In addition, having first-hand experience in another healthcare system has helped me make connections between things I am learning in school (public health classes) and real life. All in all, this internship has taught me many things, and I can’t wait to take those learnings into my future endeavors, whether that be school or a career. It truly was a once-in-a-lifetime experience, and I forever have IMA to thank for that.