In Panama Exchange, Medical Students Learn Through a Global Health Lens
Jessica Simon and Jacqueline Mosher met during their first year at Tufts University School of Medicine, but they developed a strong bond through shared experiences as roommates and providers in Panama City, Panama this spring during the Tufts Fourth-Year Global Health Elective in Panama.
The elective was created to provide an exchange for six students from the School of Medicine and six students from the Universidad de Panamá Facultad de Medicina (UP). It places students at hospitals affiliated with the respective universities in Boston and Panama City, where students engage in four-week rotations in a variety of specialties. Tufts students travel to Panama City in the spring, and Panamanian students travel to Boston in the fall each year.
Simon, who chose an internal medicine rotation at the Irma De Lourdes Hospital in Panama City, said experiences there forced her to think more critically about what doctors in nations like the United States really need to effectively and safely treat patients.
“In the U.S., we use and waste a lot of things,” reflected Simon, who matched into a psychiatry residency at Harbor-UCLA Medical Center in Torrance, California. “The one thing that really stuck with me was the resourcefulness of the medical team within the hospital in Panama.”
Simon noted that gloves, for instance, weren’t worn for every procedure, and in most cases, blood was drawn with a syringe and later injected into a tube, rather than a vacutainer, which allows for automatic collection of a blood sample.
Mosher was placed into a rotation in obstetrics and gynecology at the same hospital. There, she spent most of her time in labor and delivery or operating rooms for cesarean sections and learned to adapt to new standard treatment protocols.
“One thing I found really surprising was how labor is managed,” said Mosher, a current obstetrics and gynecology resident at Mountain Area Health Education Center in Asheville, North Carolina. “There is essentially a laboring room that has about 12 beds in it for all of the patients who are in labor but not ready to give birth, and there’s an expulsion room that patients will go to when it’s time to actually deliver.”
Another major difference Mosher observed was the absence of pain management options for Panamanian patients in the public hospital setting. She learned that resources for pain management and patient-centered care are more abundant in private hospitals.
This awareness forced Mosher to reflect on the ways that health inequities manifest in different countries, and on the similarities and differences that exist between the Panamanian and U.S. healthcare systems.
Cultivating Cultural Empathy Abroad
Simon and Mosher’s takeaways reflect exactly what Richard Rohrer, a professor of surgery, hoped students would learn from the program when he became the faculty lead in 2019.
“Exchanges are the most robust form of global health that you can participate in,” Rohrer said. “Global health experiences elevate cultural empathy and understanding and make for better doctors who develop compassion for people with fewer means. And how much better would it be to do that as an exchange and have people come here, too?”
Rohrer doesn’t think that the exchange should stop there. “I’d like to bring not just medical students, but Panamanian residents to Tufts as well,” he added.
Rohrer’s experiences in global health in the 1970s—at hospitals in Gabon, Tanzania, and on the border of Thailand and Cambodia—continue to influence his practice today as a surgeon at Lowell General Hospital, part of the Tufts Medicine health system.
“It’s so clarifying to have been abroad and have had these experiences of working with and observing doctors from other countries,” Rohrer said. “There’s a wonderful mix of influences that you get from doing global health work.”
Welcoming Panamanian Students to Boston
Diana Tejera, one of the four exchange students from Universidad de Panamá Facultad de Medicina who traveled to Tufts in 2023, said she is grateful to have had the opportunity, and although she was excited about the exchange, she was also wary of barriers that could have made the experience more challenging.
“I cannot deny that I was very afraid of all the things that could go wrong,” Tejera said. “From being worried about being able to cover my expenses, to fearing that the patients would not understand me when I spoke, and so on. Fortunately, neither of these happened, which taught me that it is very important to trust yourself, be brave, and dare because if you give 100%, the fruits of the effort will be seen.”
While on the Boston Health Sciences Campus, Tejera participated in a renal disease rotation, treating and monitoring hospitalized patients presenting with a kidney condition. She was then responsible for structuring care plans, depending on the patients’ condition. Having never explored the specialty, Tejera was grateful to learn “that opportunities are very close—you just have to pursue them.”
Bringing Parity to Global Health
Ramnath Subbaraman, associate professor of public health and community medicine at the School of Medicine, believes in the power of programs like the Panama exchange.
“Global health experiences are highly sought after, especially in medical school, and they really benefit the student and the broader American public because they educate students about the rest of the world,” Subbaraman said.
As an expert on global and community health, Subbaraman believes establishing exchange programs in parity is critical to decolonizing, or removing the effects of colonization, global health care. In many cases, a lack of parity with medical programs of other countries leaves room for improvement in global health, Subbaraman said. He hopes that global health best practices continue to adapt to meet the needs of all nations.
“These global health experiences create informed citizens,” Subbaraman added. “Because we have disproportionate power in high-income countries, the experiences are hopefully reflected in the ethical choices that students make in the future and the contributions they make to populations in need.”
Department:
Public Health and Community Medicine