SCOPE Exchange in Peru

Text: Noelie Lengeler | University of Berne

For my final year of internships of medical school I wanted to challenge myself to learn Spanish and do an internship in a South american country, a continent I’d always wanted to visit. I read reviews on “pj-ranking.de” on the different possible countries and talked to friends. Finally I decided to apply to Chile, Peru und Bolivia and got accepted in Peru. Due to Covid-19 uncertainty I only got my confirmation a week before departure. I booked my flight and then spent a day feeling like a paranoid person walking around town buying all the PP gear I needed to take.

I arrived in Arequipa in southern Peru to be greeted by my lovely contact person Andrea with a sign, chocolates and a rose. She was very helpful during my whole stay - answering all my questions, helping me get set up with a local SIM card, taking me to my second PCR test and to the hospital on my first day. After my quarantine I was lucky enough to stay with my host family who could not have been nicer and made me feel very much at home. To get to the hospital every day I took two different small minivan buses called “combis”. Since there is no plan, only people who know the city or at least the route can use them. The bus stops are flexible – everyone just calls out when they want to get down. I very much enjoyed jumping off and onto them – it made me feel like an Arequipean!

My internship was in oncological surgery, accompanying Dr. Augusto Martinez during consultations, medical rounds and operations. I had initially applied to do different specialities within internal medicine and was less interested in surgery. Whilst I still wouldn’t have applied for it, it was very diverse and I learnt a lot about the field and the health system in Peru. Some things I found to be very similar to Switzerland and others very different. I was impressed by the knowledge and dedication of the medical staff but not so much by the overall organisation of the hospital.

For example, patients need to organise their own blood reserves for operations. This means that ten of their relatives come to the hospital at a given time to get tested and donate if compatible.

One patient I met didn‘t get a time slot before her operation and therefore had to wait in line to get an extra slot with the already totally booked out surgeon to obtain a note saying she really did need the earlier time... Further differences were toilets with no toilet paper or soap, covers for operations that were made of cloth and repaired countless times and the fact that patients seemed to be more dependant on doctors. I felt that the image of doctors being “all-knowing gods” in white was still present and that their advice went unquestioned. In some situations I felt uncomfortable when a serious diagnosis was being discussed in a room with medical staff going in and out and the doctor’s telephone ringing. The patients on the other hand didn’t seem to mind this. At the same time I did feel that medical staff went the extra mile for patients and had a warmer interaction than in hospitals I had been to previously. I was also able to spend a few half days on the internal medicine ward for an insight into this field in Peru. Interesting here was how many young people were hospitalised. For example with systemic tuberculosis and biliary pancreatitis - pathologies rarely presented in Switzerland.

In Peru there are three different types of hospitals. The “Seguro integral de Salud”, which is funded by the ministry for health for poor people with no insurance, the “Salud social” which is designed for working class people funded by employers and the private sector, which only a small proportion of the population can afford. The hospital where I spent the majority of my internship was the “Salud social Carlos Seguin Escobedo” but because Dr. Martinez also works in different private clinics I also had an insight into the private.

The building and infrastructure of the private hospitals were definitely more fancy and there were a lot less people around. In the "Salud social” there would always be crowds of people waiting in the hallway before the consultations rooms for Dr. Martinez to show up to ask for additional slots in his schedule. This meant that we literally had to squeeze past them and the cries of “Doctor, Doctor!”.

Something I felt bad about was the fact that Peruvian medical students have not been able to step foot in a hospital during the last two years due to the Covid- 19 pandemic. It seemed absurd to me, that I was able to do an Internship here whilst they could not. Instead they have had two years of online classes and case presentations. This made me appreciate the privilege of being able to do my internship even more. Quick travel tips for southern Peru: Arequipa (climb a volcano, Santa Catalina Monastery, Colca Canyon), Cusco, Machu Pichu, Palcoyo Mountain, Tambopata national park staying by the Sandoval lake, Lake Titicaca with a homestay on the Amantani island.

In conclusion I could not be more grateful for the month that I spent in Peru. Thank you to IFMSA for organising it!