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Hospital Dos de Mayo

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

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  1. Hospital Dos de Mayo Lima, Peru March/April 2006 Joyeeta G. Dastidar

  2. 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

  3. Peru

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. The Residents/Students • San Marcos • San Martin • Peruvian Armed Forces residents • US M4s • US R3s

  10. 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)

  11. 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

  12. 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

  13. Cool Cases • Neurocryptococcus • End-stage AIDS • Acute retroviral syndrome • Kaposi’s sarcoma • TB – the great mimicker • Infectious diarrhea • Leischmaniasis • Malaria • Chagas

  14. 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

  15. 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)

  16. Lima

  17. Condors at Colca Canyon

  18. Cusco at night

  19. Machu Picchu

  20. Source (for stats): • http://www.dfidhealthrc.org/shared/publications/Country_health/Peru.pdf • Hope you get to go!

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