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Hospital Dos de Mayo. Lima, Peru March/April 2006 Joyeeta G. Dastidar. Peru. Population: 24+ million 45% indigenous, 40% mestizo, 15% white Three major geographic regions The coast The Andes The Amazon 20% of population controls >50% of wealth
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Hospital Dos de Mayo Lima, Peru March/April 2006 Joyeeta G. Dastidar
Peru • Population: 24+ million • 45% indigenous, 40% mestizo, 15% white • Three major geographic regions • The coast • The Andes • The Amazon • 20% of population controls >50% of wealth • 50% of Peruvians live in poverty, 20% in extreme poverty • Main cause of illness is communicable disease
Why Peru? • Interest in international health • Desire to improve medical Spanish • Exotic medical diseases • Warm weather • Why Lima? • Preference for urban setting • The capital city has a wide range of hospitals to choose from
How the rotation was set up • Heard about it through prior resident (Arshiya) • E-mail • Bob Gilman (Hopkins ID attending who has longstanding research connections in Peru) • Or Local MD contacts at Dos de Mayo • Eduardo Ticona • Marcos Navincopa
Logistics • Where to stay • Miraflores • San Isidro • San Miguel (Gringo House) • Getting around • Taxis are relatively cheap • Buses and combis are even cheaper • Dining • Being vegetarian is difficult (hope you like fried yucca) • For everyone else, Peruvian food is great
Healthcare in Peru • Three major providers • 1) MINSA (Ministry of Health) • 81% of service infrastructure, 87% of primary healthcare • Includes some of Peru’s largest hospitals (e.g. Dos de Mayo) • 2) EsSalud (the Peruvian social security system) • Funded by employers and employees • Mostly hospital-based and in urban areas • Often duplicates services with MINSA in more populated areas • 3) Private sector • Mainly provides ambulatory services to wealthier population with private insurance, available to less wealthy patients on a fee-for-service basis
Hospital Dos de Mayo • Located in an unsafe area in Lima Centro • That being said, all of the American students/residents there with me did not have any problems • Also, enforces compliance with work hour restrictions in terms of when you get out : ) • Division of Infectious and Tropical Diseases
The Residents/Students • San Marcos • San Martin • Peruvian Armed Forces residents • US M4s • US R3s
The Rotation • Teams normally consist of two residents, one intern, and ten (!) medical students • Patients are admitted only during the day, though residents have overnight call in the ER throughout the rotation • The service is divided into two teams, can switch teams halfway through to get exposure to more patients • Daily lectures for medical students and residents, you can attend both, time permitting • Weekly case conferences (both departmental and division-wide)
Responsibilities • Knowledge of Spanish a huge plus in maximizing your experience during this rotation • Serve as additional resident on inpatient service • Help interns and medical students pre-round • Rounds begin between 7:30 to 8 a.m., Mon through Sat • Oversee admissions admitted to your half of the service • Can help intern out by writing up the admit H&P form
Responsibilities (contd) • Present the patient on rounds the next day • Rewrite orders and all prescriptions on a daily basis • Supervise and/or perform procedures (LPs, punch biopsies) • Can also arrange to have days in the outpatient clinic • Present cases or topics at the weekly clinical case conferences and/or the daily resident lectures
Cool Cases • Neurocryptococcus • End-stage AIDS • Acute retroviral syndrome • Kaposi’s sarcoma • TB – the great mimicker • Infectious diarrhea • Leischmaniasis • Malaria • Chagas
HIV • Predominantly a disease of homosexual men (and their wives) • Growing heterosexual population • Social stigma • HIV+ patients are not dialysis candidates • Nor are they CCMU/ventilator candidates • The government does fund antiretrovirals for HIV+ patients
Fun • Lima nightlife • Weekend trips to beaches or local ruins • If you have extra time • See the condors in Colca Canyon • Sail the highest navigable lake in the world (Titicaca) where you can visit floating islands • Cusco • Hike the Inca Trail to Machu Picchu (but it’s very steep, so maybe don’t drag your mom along)
Source (for stats): • http://www.dfidhealthrc.org/shared/publications/Country_health/Peru.pdf • Hope you get to go!