Our group of exchange students outside the Hospital San Juan de Dios in Armenia, Columbia.
A personal blog by Ian Ferguson (2nd year medical student)
Last summer, I was lucky enough to participate in a four-week IFMSA clinical exchange in Colombia. Working in the emergency department of Hospital San Juan de Dios in Armenia was an experience I will never forget! Not only was I exposed to a variety of interesting medical cases that demonstrated that the fundamentals of medicine do not rely on technology, I also had the chance to enjoy the many cultural opportunities Colombia has to offer!
Since I was working in the emergency department of a public hospital, we received the worst of the worst in terms of medical cases, including many types that I likely never would have seen in Canada. The first and most frequent type of patient that I saw was a victim of a machete attack. Since the city in which I was staying received patients from the surrounding rural coffee growing areas and most farmers carried around machetes, machete-related violence was an unfortunately common end to many fights and robberies. Almost as ubiquitous as machete attacks were dog bites, allowing for more than one opportunity to practice suturing! A handful of times I also saw the aftermath of handmade firearm usage, mostly resulting in significant soft-tissue destruction. In one instance, a patient was shot in the back of the head, but luckily did not suffer major damage because the bullet did not have enough velocity to penetrate the skull. Arguably, the most interesting case I saw was a snake-bite victim, something rarely seen in Canada! After being bitten in his right hand, this patient presented with complete right arm paralysis and a strong headache. Despite not knowing the species and lacking the appropriate antivenom, the patient survived with nothing but fluids and observation! Needless to say, I was exposed to a wide variety of new and interesting medical cases.
A view of the ER at the Hospital San Juan de Dios in Armenia, Columbia.
It addition to seeing many incredible cases, being exposed to a foreign healthcare system with gross differences in resources compared to Canada made me realize that the fundamental principles of medicine are universal. Amazingly enough, it is true that a good history and physical go a long way! In the absence of the veil of sophisticated technology that many of today’s doctors tend to hide behind, I felt that the medicine in Colombia was more fundamental and authentic, albeit more difficult and uncertain. For instance, there was no CT scanner to be found in the hospital! Doctors couldn’t default to sending the patient for a scan and instead had to truly understand the patient’s pathobiology based on the history, physical exam, and basic lab tests. They made use of what they had available to them and effectively managed their patients in spite of their technological disadvantages. It was a good reminder that although we are lucky to have certain tools in Canada there is no substitute to learning the fundamentals.
Hiking to La Ciudad Perdida (the lost city).
Outside of my medical experiences, I also had the opportunity to experience Colombia on a more cultural level. Whether it was the family I stayed with or the doctors at the hospital, everyone treated me with nothing but respect and generosity. I can safely say that Colombians are the friendliest people I have ever met, and that their country offers many diverse and exciting outdoor opportunities. My favorite part of the trip was easily when I went on a five day jungle trek to La Ciudad Perdida (“the lost city”), where I got wonderfully sweaty, dirty, and insect bitten before reaching a vast complex of ruins engulfed by the surrounding jungle. It was an exceptionally rewarding experience. After this quality time with nature, I spent some time in the historical city of Cartagena and its nearby Caribbean islands, which boast immaculate white sand beaches; the perfect location to relax and recharge. During my time in Armenia I spent my weekdays in the ER and the weekends exploring the surrounding areas with the other international exchange students. We visited the incredibly culturally rich city of Medellín, various Colombian fincas (coffee plantation country homes), and even went camping in a nearby national park. It was a refreshing surprise to realize that my exchange was about more than just medicine!
Cartagena architecture.
After spending a month and a half in Colombia, I learned a lot not only about myself, but also about what the art and practice of medicine is. The variety of medical cases I was exposed to increased my awareness about what it is possible to do to help your patients even in the face of limited resources. Also, the way doctors treated their patients showed me what fundamental medicine really looks like. Outside of the hospital I met some incredible people and had an amazing time experiencing some of what real Colombian life is all about. I had the time of my life, having my eyes opened in Colombia!
~Ian Ferguson