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Take-Home Lessons From Abroad

Medina, Cindy

doi: 10.1097/ACM.0000000000002105
Teaching and Learning Moments
AM Rounds Blog Post

C. Medina is a fourth-year medical student, University of Florida College of Medicine, Gainesville, Florida; e-mail:

An Academic Medicine Podcast episode featuring this article is available through iTunes.

Author’s Note: The names and identifying information in this essay have been changed to protect the identity of the individuals described.

Amid the tropical heat in Manabí, Ecuador, my peers and I provided care to those devastated by a 7.8 magnitude earthquake. I felt connected to Ecuador, neighbor to my homeland of Colombia, and was heartbroken by the sight of collapsed homes and uprooted crops. Amid this devastation, we established our clinic by a playground.

There, I met two boys, Pablo and Juan, who were interested in using my stethoscope. Wanting to give me something in exchange, they removed the boards from a swing set, leaving the ropes for the other children to climb. I offered them a high five, which they returned with a series of fist bumps and peace signs. Other children joined in this neighborhood handshake. We joked in Spanish, and I found myself transported to my childhood.

Later, the boys approached our clinic to be examined. Juan sat quietly as I auscultated. “What grade are you in?” I asked.

“I should be in second grade, but I had to leave school to work in my family’s bakery after the earthquake. I wish I could return. I don’t even know what 20 + 20 is.”

I was ripped out of the naïve joy of nostalgia and reminded of the difficulties these children endured. I felt ashamed of my privileges. “Forty,” I mumbled. Juan screamed excitedly, “Pablo, guess what? 20 + 20 is 40!” They exchanged the familiar handshake.

Before visiting Manabí, I envisioned the Ecuadorians as being in great need of health care; however, the people I met reminded me that there’s more to one’s quality of life than health, whether it’s an education, social support, or opportunities to work. In Florida, I had tutored children like Juan at a family resource center that was developed in response to the health, educational, and socioeconomic inequalities in Gainesville. I wondered if such programs could ever exist in Manabí, and I felt guilty that we’d soon leave Ecuador without giving Juan a more comprehensive education.

Critics of the short nature of international trips like mine have labeled these experiences as “voluntourism” and argued that physicians do more harm than good. There is an emotional struggle we must face to deliver quality care to patients despite our limited time and resources. How can I safely diurese someone without following up? How can I comfortably gift someone a cane, while noting that she may be mugged because she has such a valued item? Will I make a difference by prescribing metformin if refills are unavailable?

Yet months later, I still think about Pablo and Juan. International trips like mine also motivate participants to improve the health care services in communities like Manabí and extend them beyond our stay. Clinics abroad teach us how to practice medicine in diverse settings, while introducing us to the unique needs of a community. Perhaps Manabí did not have a family resource center, but why couldn’t we help them establish one? It was in Ecuador, while answering Juan’s mathematical question, that I recognized our opportunity to help.

While international trips allow us to provide care for underserved communities, they also grant us the chance to build and strengthen health care systems. Working in Ecuador shifted my focus from the diseases to the conditions affecting patients’ well-being and access to care. Pablo and Juan challenged me to meet the needs of my patients, whether they are directly articulated or implied in conversation. Would it be possible to develop and support longitudinal health care and educational opportunities at clinics abroad? After all, education and health go hand-in-hand.

I returned from Ecuador with an expanded understanding of my role as a physician in society. My time abroad strengthened my resolve to empower my patients, advocate for the underserved, and break down barriers to care.

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The author offers special thanks to Dr. Zareen Zaidi for her mentorship and insight throughout the writing process.

Cindy Medina

C. Medina is a fourth-year medical student, University of Florida College of Medicine, Gainesville, Florida; e-mail:

© 2018 by the Association of American Medical Colleges