Hospital Dos de Mayo

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Hospital Dos de Mayo

• Lima, Peru
• March/April 2006
• Joyeeta G. Dastidar

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Peru

• Population 24 million
• 45 indigenous, 40 mestizo, 15 white
• Three major geographic regions
• The coast
• The Andes
• The Amazon
• 20 of population controls gt50 of wealth
• 50 of Peruvians live in poverty, 20 in extreme
  poverty
• Main cause of illness is communicable disease

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Peru
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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

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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

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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

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Healthcare in Peru

• Three major providers
• 1) MINSA (Ministry of Health)
• 81 of service infrastructure, 87 of primary
  healthcare
• Includes some of Perus 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

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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

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The Residents/Students

• San Marcos
• San Martin
• Peruvian Armed Forces residents
• US M4s
• US R3s

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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)

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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 730 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 HP
  form

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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

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Cool Cases

• Neurocryptococcus
• End-stage AIDS
• Acute retroviral syndrome
• Kaposis sarcoma
• TB the great mimicker
• Infectious diarrhea
• Leischmaniasis
• Malaria
• Chagas

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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

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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 its
  very steep, so maybe dont drag your mom along)

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Lima
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Condors at Colca Canyon
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Cusco at night
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Machu Picchu
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• Source (for stats)
• http//www.dfidhealthrc.org/shared/publications/Co
  untry_health/Peru.pdf
• Hope you get to go!