Matt: During our discovery learning course, Alex and I went to Rio de Janeiro, Brazil to study at the National Institute of Infectious Diseases housed within the Oswaldo Cruz Foundation. It’s a national-level, federally-funded patient care and research facility with different clinics for each infectious disease they study and treat.
Alex: The facility was especially interesting because of its historic background. Oswaldo Cruz was an important figure in Brazilian medicine as a leader of public health. He pushed for vaccines and improved sanitation systems to fight endemic diseases such as malaria, the plague, and yellow fever. There’s a castle in the middle of the campus that was his home and research lab. So not only is the Oswaldo Cruz Foundation a research facility, a group of infectious diseases clinics, and the centerpiece of public health in Brazil, it’s just a beautiful and historic place to be.
Matt: When I was given the chance to study medicine in another country, I couldn’t really turn down the opportunity. I was eager to gain more international experience because I’ve always been interested in experiencing different cultures. Infectious diseases are also of interest to me, so being able to study in Rio meant I would be able to explore that topic.
Alex: I was excited about this specific opportunity too, but for a different reason. I was born in Peru and one of my career goals is to practice medicine in South America, so this opportunity was perfect for me. I knew I would learn new things about healthcare in another country, language skills in Portuguese, and more about infectious diseases.
Matt: While in Rio, we stayed in Copacabana, an affluent, touristy part of the city for safety reasons. We saw a different side of Rio when we were going to the clinic every day, which was located around 45 minutes outside of the city in the middle of the favelas, the Brazilian slums.
Alex: Since neither one of us speak Portuguese, we weren’t able to take a very active role during this experience because we could only communicate with the bilingual doctors, not the patients. Instead, we went to the clinics to see how they do health care for some of these infectious diseases, including tuberculosis, leprosy, and Chagas disease, things we don’t have here in the U.S.. We also got to attend some educational sessions that taught us about the history of the campus and the history of public health in Brazil.
Matt: We also got to tour their pharmacy, their patient record facility, a couple of research labs, and their pathology unit.
Alex: While we were there, we found that most of the patients treated by the National Institute of Infectious Diseases were of a lower socioeconomic status due to the location of the facility, the fact that treatment is free since it is a government facility, and that the diseases normally affect people of lower socioeconomic status.
Matt: Yes, much of the reason they see mainly lower socioeconomic status populations at their facility is that the diseases are treatable, they can just be costly to treat. For example, Rio is currently battling the spread of animal-borne illnesses. Poor people are releasing their pets into the wild when they get sick because they can’t afford to treat the animal, so the disease spreads to other animals and then spreads to people.
Alex: The poorer population also doesn’t always have reliable transportation, so it’s really difficult for them to get to the clinics to get help. They aren’t going until it is absolutely necessary. Once they get to the clinic though, they can be helped for free, and the clinics try to prescribe preventative medications to the at-risk population for diseases like HIV. There are also medical teams that go into the favelas to provide care there.
Matt: As part of our preparation for going to Brazil, we did a cultural competency session, run by Professor Ann-Perry Witmer. She has a lot of experience in international consulting and engineering. Professor Witmer’s main message was that she did not want us, as American medical students, to go to a foreign country with its own unique set of challenges and resources and try to tell them “the right way” to fix their problems. Instead, she wanted us to focus on a process of mutual learning and collaboration.
Alex: Being trained as physician-innovators, though, we’re always looking at problems through the lens of how they could be solved. From what I understand, their electronic medical record (EMR) system is not very fluid and makes it difficult to share between physicians. I think this facility, Rio, and Brazil in general want to improve their EMR system to make medical treatment easier, so it was interesting thinking about how they could best incorporate this technology. I also witnessed a dermatology resident use her phone to look through a magnifying glass with a bright light and taking a picture of what she saw to collect data and diagnose a lesion. If her method works, she is able to diagnose these lesions without the normal lengthy process of taking a biopsy and waiting for test results. I think it would be great to develop a phone app or a device that takes the picture and uploads it to a program that uses image processing to analyze the histology and characterize the disease instantly.
Matt: In terms of research, Brazil is in a unique position. In the United States, we often focus on diseases that happen frequently here and tend to forget about diseases that are prevalent in much of the rest of the world. Parts of Brazil are still developing and suffer from endemic diseases that have been eradicated, but because the whole country isn’t in that state, they may be able to leverage their resources to address this research gap in developing countries.
Alex: This experience helped affirm that I do want to work outside of the United States for my career. It also showed me that I’m interested in solving some of the social problems surrounding health care, such as access to treatment and using new and lower-cost resources.