Spring Study Abroad Programs in Ecuador

My time in Cusco was amazing, and I really appreciated everything and all the staff who took care of us. Juda, Manuela, and Surabhi were all very helpful when it came to asking them questions about the program, and they were equally helpful when we asked questions about Cusco, such as restaurant or shop recommendations and how to navigate around the city. I have no complaints with any of the doctors; all of them were super nice and answered any of our questions. Particularly, Dr. Silva and Dra. Yadhira stood out to me, and I really liked their approach to medicine. Lastly, I participated in the Machu Picchu trek, and I want to shout out Hans and Raul, who were our guides. They were amazing and very accommodating. I am a slow hiker, so Raul stayed back with me and my friend so that we wouldn't get lost or be unsafe. They were also very fun and did karaoke with a few of us after the trek, which is forever going to be memorable for me. Overall, I have no complaints with any staff. I also want to shout out Victor for being the best driver, and all of the staff in the hotel for all their hard work. My experience being a pre-Physician Assistant intern through International Medical Aid (IMA) in Cusco, Peru is an experience I will be eternally grateful for—not only because it was a determining factor in why I want to pursue medicine, but also because I learned so much from the social and medical culture in Peru. A reason I applied specifically to the Peru location is because I never hear much about South America as a whole in U.S. media, and if I do hear about it, they only mention the “dangers.” However, the three weeks I have spent here gave me so much growth and knowledge about Peru. I was able to connect deeply with the mentors and other locals in the city of Cusco, and getting to talk to the doctors about their experience in the medical field was eye-opening. Coming to Peru was like finally understanding the expression, “Don’t knock it till you try it,” because all my preconceptions were erased and replaced with true knowledge of the culture and the socioeconomic structure. Ever since I was younger, I was always interested in the medical field, and as I grew up, I started to become more and more aware of how medicine is run in the U.S. I am lucky to have grown up in a household where we are able to afford sufficient insurance, so personally, I have never dealt with the hardship of large medical bills, but through personal research, I have learned how difficult it is for people of low socioeconomic status to get proper insurance and medical care. In the United States, healthcare is not free, but as I learned in Peru through our cultural presentation sessions, all Peruvians have the right to universal healthcare. Though I did not know this before coming to Peru, I was not shocked. It is rarer to see countries that do not provide free healthcare, such as the United States. One of the largest ongoing debates is whether the U.S. should pivot to a universal healthcare plan; some of the disadvantages include “significant upfront costs and logistical challenges,” while the advantages could create “a healthier populace and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation” (Zieff et al., 2020). Due to the U.S. having an extremely advanced healthcare system that can offer some of the best care and procedures for extremely unique cases, many people disagree with the idea of offering a universal plan because it will create more complications in how healthcare should be divided. However, the latter perspective suggests that having an option of universal healthcare will create a healthier America and illness in our population will decrease. Furthermore, in Peru, the way healthcare works is that everyone has access to universal healthcare, but if they are employed, they can opt in to affordable insurance that gives them access to more advanced hospitals such as EsSalud, which is a division 3-1 center. The level of care there is not entirely comparable to the advanced care in the U.S.; however, these hospitals provide general and some specialized care, which is considered high level. The highest level of care in Peru is division 3-2. These centers contain sub-specialized fields and are only found in the capital, Lima, because it is the most populated city (International Medical Aid, 2025). This is unfortunate because if someone were to have a unique medical emergency, they would have to be rushed to Lima to get quality care, while in the U.S., it is common to live closer to hospitals with specialized care. During our time with IMA in Cusco, we also made a short trip to a nearby rural city called Casacunca, where we held a community clinic to help and provide medical attention to the citizens of the city. As we learned in our clinical debriefing sessions, most of Peru’s population is in the large cities such as Lima and Cusco, but there are a vast number of rural cities that, unfortunately, rarely get medical attention, so it was amazing that we were able to assist those who deal with this misfortune. Through my American perspective, I initially thought it was so unfair that people who live far from major cities hardly ever seek medical attention from doctors, and I believed it was almost diabolical that the government hasn’t expanded and created more large hospitals in these regions. However, as I learned by being in the rural cities in Peru, a lot of the citizens do not go to physicians and/or do not believe in Western science and instead prefer herbal medicines and advice from shamans/healers. This is because they strongly believe in the powers of traditional medicine, and access to it is more proximal (van Soeren & Aragon, 2016). In contrast, in Cusco, more people tend to turn to Western medicine because they have access to it, and the EsSalud hospital and many clinics we shadowed at are examples. In an even larger contrast, in the United States, we are the pinnacle of Western medicine—so much so that we try to cure anything and everything with medicine or medical treatment. The U.S. also spends the most out of all wealthy countries on healthcare, which allows us to have many advanced hospitals and medical technology throughout the country. However, we still see a lot of problems with the health of our citizens (PFPG, 2022). Even with this level of spending, we see high infant mortality rates, unmanaged diabetes, and more (PFPG, 2022). This shows that maybe Western medicine is not always the cure for medical problems, and instead there should be a balance between traditional and Western medicine. In one of my classes in college, I learned how if someone is pre-diabetic, instead of instantly starting insulin doses, they should invest in caring for their diet by cutting out artificial sugars and eating more protein. Ultimately, from my knowledge of Western and traditional medicine, I believe that they are both valuable and people should research both when they are looking for a “cure” to what they have. Additionally, through the IMA program, we had weekly presentation sessions, and in one session we specifically discussed the disease burden in Peru. One large takeaway I had from this presentation was that many people die from disease annually in Peru, and some of the main diseases that are killers in Peru are completely managed here in the United States. From the lecture, we learned about the most common communicable and non-communicable diseases found in Peru. Communicable diseases are transmitted between people or other organisms, and the common ones in Peru are malaria, dengue, tuberculosis, and acute respiratory infections (International Medical Aid, 2025). Non-communicable diseases are not spread from person to person, yet they arise due to the individual’s behavior, and the most widespread ones in Peru are hypertension, diabetes, and COPD in adults and anemia and malnutrition in infants/children (International Medical Aid, 2025). Two diseases that stood out to me from being in the lecture and staying in Peru for three weeks were tuberculosis and anemia. According to the lecture, there are about 27,000 cases of tuberculosis (TB) annually in Peru. In the U.S., we have less than half that rate annually, at around 10,347 cases reported by the CDC in 2024 (CDC, 2025). One possible reason that could explain why the U.S. does not experience as many TB cases compared to other countries like Peru is because of our widespread healthcare system. Again, as I have mentioned earlier, U.S. healthcare is considered to be one of the most technologically advanced and is well known for having extremely specialized care. This is most likely the reason why we do not see as many cases of TB, and if we do see them, there is less chance of it leading to mortality. In Peru, healthcare is not as widespread, and what I mean by this is that large hospitals with specialized or sub-specialized care are only seen in the most populated cities. If people are diagnosed with TB in a rural city, they will have to travel long distances to get specialized care in a hospital, and if they can’t afford the travel or do not have access to travel, they have to treat themselves the best they can. This is why TB is extremely prevalent in Peru specifically, and the reason why TB is one of the most deadly diseases in Peru, causing an estimated couple thousand deaths annually (International Medical Aid, 2025). This is why Peruvian healthcare should be more accessible, and this can start with the government allocating more funds to build more division 3 hospitals throughout the country, not just in major cities. Anemia was another disease that I became more familiar with through this internship. Working alongside the doctors and nurses in the EsSalud hospital, I learned that anemia has a different detection threshold in Cusco, Peru in comparison to the U.S. and even other cities in Peru, such as Lima, due to the high altitude. In Cusco, Peru, a detection of 11 mg/dL or below in the hemoglobin is considered anemic, but in the U.S. it is 13.5 mg/dL for men and 12 mg/dL for women (International Medical Aid, 2025; American Society of Hematology, 2025). The high altitude causes there to naturally be less oxygen in your blood because there is less oxygen in the atmosphere, and that is why anemia has a lower threshold in Cusco than in other cities/countries—because Cusco stands at about 12,000 ft, being one of the tallest cities in the world. Anemia is also highly prevalent in infants and children in Cusco, and this is due to malnutrition. Children in Cusco do not eat enough red meat and, in general, have poor nutrition, and I was able to actually see this while shadowing in the pediatric and nutrition departments. Fortunately, most of the doctors I worked with explained that anemia usually goes away after about 3–4 years of age, so it is able to be managed, but they did explain that malnutrition is something that is very common in infants throughout all of Peru, and this is the larger problem. Malnutrition comes with a lot more problems than anemia such as irregular bowel movements, thermal issues, dehydration, and even mortality. Chronic malnutrition in infants in Peru is at levels of 11.5%, and in the U.S. it is about 1%, which shows that our government has more control over infant malnutrition. However, according to the USDA, 1 out of 5 children in the U.S. lack food security, so the statistics on chronic malnutrition could be fluctuating regularly depending on the state of the economy (International Medical Aid, 2025; USDA, 2025). Ultimately, infant malnutrition should not be something prevalent in any country, and it should always be a priority that children have access to sufficient nutrition and meals. To conclude, my pre-Physician Assistant internship with International Medical Aid was life changing and taught me more about medicine and myself. I learned exactly how passionate I am about medicine, and I am grateful that I was able to learn in a new environment where I experienced medicine in ways that I have never seen or heard of before. Now, as I pursue my future career, my perspective on medicine and patient care has broadened, and this is for the better because I can approach medicine with the structured U.S. mindset and also the more interactive Peruvian mindset. I will always remember my time in Cusco, and I cherish it. Thank you for giving me this outstanding opportunity.

Overall, I loved the program. I loved how all the doctors were inclusive. On off-clinic days, the program mentors always had an event planned, which was so nice. Being able to learn about the city and tour around was great, and I loved all the food they offered. I want to thank the mentors for being flexible with the interns. They would ask daily who was going out to eat and who was eating at the accommodations. The mentors were always concerned about our health if we did not feel well. I remember the day I got sick—Juda and Manuela kept checking up on me to make sure I was okay. I really appreciated their concern and willingness to help us. Manuela did a great job letting me know who was going to pick me up for my trek, and all the drivers were on time. Big shoutout to my trek guide, Hans. We got to know each other very well and really enjoyed the lunch spot he picked out for us. During my three-week internship with International Medical Aid (IMA), I gained a vast variety of knowledge and experience that has permanently impacted my medical journey. One of the most memorable moments of my internship happened at the community medical clinic. We traveled to Casacunca, a small village in the highlands of Anta, where I gained knowledge on how doctors diagnose patients based on their symptoms and physical examination. I also observed how doctors provided exceptional patient care with limited resources. Having the ability to apply my acquired knowledge of physical examination under the supervision of a physician and contribute to essential healthcare access was my favorite part. Furthermore, this experience is one I will carry with me throughout my medical journey to becoming a physician assistant. It helped me understand the importance of patient care, cultural sensitivity, and the value of healthcare access. At the beginning of the internship, I was excited and curious to see how the clinical rotations were going to be organized. I was looking forward to being hands-on and eager to learn from all the medical personnel at the hospitals and clinics. I have a healthcare background—my mother is a medical assistant, and I work at Stanford Health Care—but my patient care experience is limited. Moreover, I was indecisive about my career path in medicine at the beginning of this program. I have a bachelor's degree in Economics, and starting a career path in medicine would mean I would have to go back to school and start over. My plan is to become a nurse to gain patient care hours and then become a physician assistant. By the end of the internship, I was confident and certain my plan was the right one for me. One of the most important lessons I learned during this program was that patients are not just data or markers you read from an exam. They are human, just like us, so we must take the time to get to know them. This made me realize that becoming a nurse before I become a physician assistant is the right path for me. While shadowing the doctors in the IMA program, I learned something new in each rotation and gained an immense amount of experience in general medicine, urgent care, ultrasound, wound care, and pediatrics. Starting with urgent care, working with Dr. Pedro was great. The environment was fast-paced, as he only had about seven minutes to see every patient, but he always took the time to explain the key points to the interns after seeing each patient. During my time with him, we had a patient who came in with complaints of fever, dry cough, and throat pain that had lasted four days. The patient's oxygen saturation was at 88%, which is normal in Cusco. Dr. Pedro explained that the elevation causes physiological changes to the body. We see these changes not because there is less oxygen at higher altitudes, but because of the change in pressure. With the decline in barometric pressure and the ambient partial pressure of oxygen during ascent, the partial pressure of arterial oxygen and the oxygen saturation are reduced (Luks & Hackett, 2022). I was able to observe this change as soon as I started to walk around Cusco. I was out of breath and felt my body working harder to breathe. As we continued to examine the patient, Dr. Pedro auscultated the patient's lungs to check for any abnormal sounds. Dr. Pedro allowed the interns to participate, and we all heard a crackle in the patient's breathing. This moment stood out to me because I was able to put a sound and label on what abnormal sounds could be during a lung auscultation. When the patient was asked if they were taking any medicines for the cough, the patient said yes, they were taking antibiotics. However, the antibiotic the patient mentioned was indicated for someone who had a cough with phlegm, not the dry cough the patient reported. Dr. Pedro then highlighted the pharmaceutical problem they face in Peru. A pharmacist in Peru can prescribe antibiotics based on someone's symptoms. This causes an issue for doctors, as many patients don't need antibiotics for their illness. From this rotation, I learned that the environment and background of a patient become as important as the symptoms you see present. In addition, although Dr. Pedro had limited time with each patient, he made sure to answer all of the questions the patient had. “It's important to get to know the patient and understand them so they trust you and feel comfortable sharing their history with you,” Dr. Pedro would say. The more information you have, the better evaluation you can assemble, which is especially valuable in a setting where healthcare access has its barriers. These barriers can differ from country to country. Some are systemic differences, and others are economic differences. Having the opportunity to shadow at EsSalud helped me understand these differences. I have the privilege of working at Stanford’s Emergency Department, where resources are abundantly available compared to other hospitals. When shadowing at EsSalud, doctors highlighted the limited amount of resources they have to work with. They don't have every specialty at their disposal, so they work with what's available. One of the systemic problems they face consistently is the use of antibiotics. In Peru, pharmacists are allowed to provide antibiotics to patients without a prescription. Doctors are not supportive of this practice, as the patient could be taking medication that does not treat the illness they have. Many infections are caused by viruses, and antibiotics will have no effect on them because antibiotics are prescribed for bacterial infections (What Happens If You Take an Antibiotic You Don’t Need? | UNC Health Talk, 2024). I recall Dr. Fabrizio teaching us the Centor criteria to determine if an infection is viral or bacterial. The Centor criteria had different components in which you awarded a 0 or a 1. If the total came out to be greater than or equal to 4, then the doctors would consider the infection bacterial. This is when the use of antibiotics becomes most practical. Having this understanding of antibiotics has helped me educate my family members. My father is from Mexico, and they have the same type of pharmacy system. Throughout my childhood, I would visit my family in Mexico, and having the ability to discuss my complaints with a pharmacist and then obtain medicine in the same moment was something I always viewed as beneficial. However, after interning in Peru, my perspective has changed. I now remind my family to be cautious about going to the pharmacy right away when we visit Mexico. I advise them to see a doctor first so they can be evaluated and prescribed the right medication. As patients have easy access to antibiotics and are exposed to consuming so many, it's concerning that patients can become antibiotic-resistant. A study was carried out analyzing 10 hospitals across Peru to see the effects of antibiotics given to patients in a hospital setting. About 900 patients were given antibiotics, and around 70 percent of those patients were prescribed antibiotics as empirical treatment, with only about 4 percent of those prescriptions being effective (Rondon et al., 2023). Although this study does not address the specific reason why so many Peruvians are antibiotic-resistant, when I asked the doctors at EsSalud, they all attributed it to the easy access to antibiotics. Patients can simply walk over and obtain medication based on their symptoms from someone who is not licensed to prescribe. Over time, patients have taken so many unnecessary antibiotics that they have become antibiotic-resistant. Comparing this system to the United States, back in 1951, the US government passed the Durham-Humphrey Amendment. This amendment categorized prescription drugs and over-the-counter drugs, with the intention of preventing harm to patients. Prescription drugs would be monitored by licensed medical professionals, and over-the-counter drugs would be available to patients at any local pharmacy (Harrington & Jarrell, 2024). This amendment laid crucial groundwork in controlling access to antibiotics and many other drugs within the United States. Furthermore, another factor that has contributed to the control of antibiotics is antibiotic stewardship programs. These programs aim to optimize the use of antibiotics and minimize the harm caused by unnecessary use (Centers for Disease Control and Prevention, 2024). With programs like these in place and with political influence, the United States is able to control a problem other countries are still facing. The pharmaceutical industry is not the only systemic difference between the United States and Peru. The next topic of discussion looks at the economic differences between the two. During our lecture series with Dr. Fabrizio, he educated us on the economic differences between the healthcare systems of the United States and Peru. In the US, hospitals rely on private funding and public funding. Private funding comes in the form of private insurance companies and patient out-of-pocket payments. Public funding usually comes from government programs like Medicare and state-to-state insurance programs like Medi-Cal. My eyes lit up during this part of the presentation, as I deal with insurance as part of my job at Stanford, and I understand the struggles with funding. Most patients do not understand how insurance works. They think that by paying their monthly premium, they have nothing else to pay. Unfortunately, that is not the case. Some insurances have deductibles, and insurance companies want you to pay out-of-pocket to meet that full amount. However, there is another part of your insurance that many do not know exists, which is your out-of-pocket maximum. This number is the amount of money your insurance company wants you to pay out-of-pocket before they start covering all your medical expenses. So, in addition to paying your deductible, you must also meet your out-of-pocket maximum. When patients receive their estimate for their emergency visit, they are astonished by the high amount. The reason the bill is so high is because of the out-of-pocket maximum that patients are not aware they have. Consequently, patients have shared with me that the high bill is a reason they do not seek medical attention at times. Not everyone can cover the thousands of dollars it costs to be seen in the emergency department. It's always a tough conversation to have with a patient when they are dealing with an illness, accident, or injury, and my job requires me to collect payments from patients. Now, looking at public funding programs like Medi-Cal, which is insurance for low-income individuals and families in California, there are both benefits and setbacks. Patients with Medi-Cal insurance will have their emergency visits covered, but when they want to see a primary care provider or specialist, that becomes difficult. Patients insured by Medi-Cal have to see a primary care provider within the network before they see other doctors. These in-network doctors are usually based in small clinics around the communities and don't typically work at these clinics for very long. Patients have a hard time building a relationship with their primary care provider because they will see them a couple of times in the year, and by the following year, they have a new doctor. Patients have shared with me that they prefer Stanford's doctors, but their insurance makes it difficult to see them. There are even times when patients obtain an appointment, but at check-in, we have to inform them that their insurance has denied the visit. If they want to pay out-of-pocket to see the doctor, we have to advise the patient that they might lose their insurance coverage if they proceed. This can be a very frustrating process for the patient and is a reason why patients don't continue with their medical care. In comparison, the economic problems Peru faces are a bit different. When it comes to funding, they rely on public funding and insurance to cover the costs. Public funding comes directly from the government. In 2009, the government created universal healthcare for all Peruvians to address the health inequities and disparities in its most vulnerable population (International Medical Aid, 2023). Peru's healthcare system is divided into different sections. The Ministry of Health (MINSA) provides services to patients under universal healthcare. Social health insurance, or EsSalud, is a medical service that is paid for by patients' employers. Lastly, there are private clinics that typically receive their funding from patients paying out-of-pocket for their services. Many would think that having universal healthcare would solve healthcare access problems, especially for the most vulnerable and poor populations, but this is not the case. Although these services are built to help, access to these locations is still the biggest problem. Another complication is the distribution of funds from the government. When I asked our mentors in the program what they thought of the government, no one was in support. Some of the things they mentioned were the inconsistency of presidents and the misuse of funds. A study was completed in 2020 about the use of funds, and they found that 3.4 billion soles (1 billion US dollars) was not used (Rolf Erik Hönger & Montag, 2024). These funds could be very useful in many different areas, from healthcare supplies to healthcare infrastructure. No one’s healthcare system is perfect, and both systems could use improvements in different ways. Learning about each country's economic differences was interesting. There was always new information I learned throughout my internship. During my rotation at the private clinics, I observed how to perform an arterial blood draw and how doctors use it to obtain a more accurate read on a patient's oxygen level. Being able to see this in person was fascinating, and the lab technician explained all the new information in a simple manner. However, the patient interaction that stuck with me the most was with the community medical clinic patients we saw at Casacunca. Seeing doctors travel hours to provide care to people in rural communities, all while doing it with a smile, has shaped my perspective on being a healthcare provider. Being a provider is not only about giving care to those who can access it or afford it, but also about providing care to anyone, because everyone should be cared for regardless of their social or economic background. At the community medical clinic, I worked in general medicine with the doctors and attended to a mother and her son. The mother came in for a headache, and her son came in for throat pain. I was able to improve my communication with patients as I completed the lung exam and checked if the patient had any tonsillitis with the supervision of the doctor. Having this opportunity helped me better understand the importance of communication in the medical field. You want to make sure the patient understands how to take care of themselves once they go home, and being able to communicate that with your patient is essential in medicine. Being a part of the community medical clinic was my favorite part of my internship with IMA. Not only do I feel I made an impact in this community, but likewise, this community has made an impression on my future goal to become a physician assistant. In closing, this internship has shaped the way I will approach my medical journey. All of the rotations helped me understand the importance of patient care. The lecture series from the doctors improved my cultural sensitivity, and the community medical clinic helped me recognize the value of healthcare access. My career goal is to become a physician assistant. Before, this idea was up in the air. I was thinking of becoming a nurse first and then seeing if I still wanted to go back to school. After being around providers for three weeks, I have never been more certain that being someone who can diagnose and care for patients is my ultimate goal. I want to have the knowledge and autonomy to care for patients and help them understand what is going on with their bodies so they can care for themselves as much as I will. My next steps are to complete my last couple of prerequisites and apply to nursing school. If I don't get accepted in my first round, I will transition into working as an EMT, CNA, or MA to gain patient care experience and then become a physician assistant. Additionally, working in a rural community has sparked my interest in rural medicine, as it resonates with my family background. When we were in the Casacunca community, I felt at home. My father grew up in a village where you would have to drive for hours to seek medical care. I aim to study rural medicine or conduct research and be able to go back to my father's town or Peru as a physician assistant to provide care. I have already talked about applying to IMA again as an official provider with some of my IMA classmates. Not only do I want to provide care in a hospital or clinical setting, but I also want to travel to provide care to those with limited access. Healthcare should have no barriers and should be accessible to all. I intend to contribute to this belief by sharing my knowledge and being part of medical humanitarian programs throughout my medical career. This program will have a lasting impact on my medical journey, and I cannot be more thankful to IMA for allowing me to have this life-changing experience.