From English to Medicine to Ecuador - one medical student's career path leads to an immersion program in Ecuador

Incoming students will have a great deal to weigh as they plan for the new semester. And there are many questions to be answered before taking the plunge. How am I going to fund my education? What are the mentorship practices at the university? What am I getting myself into? A question that increasingly looms large is whether institutions offer opportunities to learn abroad.

Global presence played a major role in Cameron Jones’s decision to attend the Medical University of South Carolina (MUSC) College of Medicine. While comparing medical schools, he found his desire to pursue global work could be sated by the program offerings at MUSC. Jones is a first-year medical student and recipient of the MUSC Center for Global Health Trainee Travel Grant whose interest in the human condition and anatomy marries well with the cultural competencies required for global medicine. “As an English major, I figured I’d pursue a Ph.D. after finishing my undergraduate program,” said Jones. “I decided to attend medical school my senior year. My experience working in Costa Rica with the Foundation for International Medical Relief of Children was a confirmation that I had made the right choice in pursuing a career as a physician, and it impacted my desire to become involved in global health specifically.”

Jones still has a passion for the humanities, only now he seeks to understand how culture and tradition influence healthcare decisions. His interest in combining social and biological sciences is not atypical for students pursuing health-related work in low-resource settings. Students are increasingly seeking global humanitarian work, and a growing proportion of these students have backgrounds in the liberal arts. In fact, MUSC’s incoming class of medical students is comprised of roughly 11 percent liberal arts majors from across the country (from self-reported data provided by the Office of Enrollment Management at MUSC).

J. Michael Kilby, M.D., Director of Infectious Disease and Professor in the College of Medicine, said in a recent interview that the “best recruits for programs at MUSC are asking questions about the university’s involvement with global health because they are interested in investing their time and education in global medicine.” Kilby also majored in English as an undergraduate. Even he finds that more students from humanities backgrounds are interested in medicine and come to class with sterling records in the hard sciences.

Students begin to seek out global programs for a slew of reasons: genuine interest in serving the underserved, clinical rotation requirements, and the ability to challenge oneself to a new environment, where empathy and trust are most valuable in health interventions. A broadly shared belief among the medical community is that bedside manners and thoughtfulness cannot be taught. Jones realized his ability to empathize with patients was largely contingent on his command of not only the cultural norms but the native language. He recently completed a rotation in Quito, Ecuador as part of Child Family Health International (CFHI), a non-governmental organization recognized by the United Nations. CFHI runs more than 20 community-based global health education programs in seven countries (Argentina, Bolivia, Ecuador, India, Mexico, South Africa, and Uganda) placing students in clinics and public health facilities alongside local health professionals. One of Jones’ objectives was to gain proficiency in Spanish to better connect with the patients he was observing. He did so by working directly with the local patients and physicians to better understand medical Spanish and by living with a good-natured Ecuadorian woman who forced Jones to only speak the native language. “I realized how daunting a task it is for patients to navigate through healthcare systems and the physical infrastructure,” remarked Jones. “Language, cultural, financial and even knowledge barriers make this process even harder. Access issues are comparable no matter where you are.”

Jones believes his experiences to date have shaped his perspective on treating across cultures. In many ways, patient care in Ecuador and the U.S. are comparable in service provisions but differ in physician-patient dynamics. Jones saw that Ecuadorian doctors are more forthright in administering care and deducing conditions; whereas, in the U.S., patients are empowered to take charge of his or her healthcare. Patients in Ecuador mitigate speech to avoid what they perceive as disrespect; U.S. doctors invite discussing the full scope of patient health. According to Jones, adult patients in Ecuador wait until conditions become unbearable to seek medical care. Conversely, pediatric care is heavily sought out.
“It was difficult for me to get an overarching impression of the system,” said Jones. “However, the nationalized health system there is mostly efficient and care coordination begins at primary care providers for preventive care if patients seek timely care for illness.”

The greatest public health issue Jones and his colleagues witnessed was teenage pregnancy. By anecdote, Jones found that religion plays a dominant role in public life and sometimes confounds appropriate healthcare practices for young Ecuadorian women. This, along with the poor resource management and pervasive machismo, has led to high rates of teenage pregnancy and exclusion by families.

Jones is committed to safeguarding the public’s health regardless of geography. He cares enough to go great lengths in learning a group’s native tongue to understand why and how familial dynamics impact healthcare decisions. However, barriers line the way to achieving even measured success. It is ever more important for students to pursue global programs irrespective of background. Time and financial forces may work against students, but opportunities are available that remedy a lot of the constraints students face. The MUSC Center for Global Health provides information on grants and research opportunities on its website and offers a trainee travel grant to defray some of the costs associated with global travel. “I think that anytime you can diversify the faculty, students, and staff, you can wholly diversify the types of education students can get,” remarked Jones. “And one of the many ways to do that is to give opportunities for international experiences. Everywhere you go in the world, you’re going to have a different, unique experience and you’re going to learn something new. I think that just the way medicine is going, with the cultural exchanges happening all the time, it’s kind of an expectation that health care professionals are going to be involved in global health whether they want to or not.”

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