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4 weeks of time in Colombia have passed. I am in the middle of my internship and boy, time travels fast if you have stuff to do. And stuff I do! Whereas I am used to relate South-America to space, freedom, reflection and travelling, I now have a settled 7 to 5 agenda from Monday to Saturday. Articles, research, clinical rotations, classes and so forth keep my busy during the day, while I stick to homework assignments at night. Don’t get me wrong, I’m not complaining, I just want to address that I had some trouble in the beginning getting used to this kind of living while being in a Latin American country.. But hey, all is good and right now I’m happy to get to know this continent from another perspective!
Little did I know when I arrived. Naive as I could have been, with my ORS and diarrhea pills in my backpack, I expected outback, poverty and huge adversities. Nothing of the like is happening here. Sure, Colombia is a country with shortcomings when it comes to equity, public health, infrastructure, solid policy and education. Still, it’s a country on the rise and living standards are improving for many people. I see this when I wake up every morning at 5 or 6 and the half the city is already up and running to get to work. Development is the key word, although developing comes with its growing pains and unfortunately it seems to be always the metropolitan elite enjoying the first richness arriving to a country. (For now, I’ll leave corruption, violence, pollution and welfare disease out)
For the first time, I behold Latin America through a medical lens. I run clinical rotations of family medicine in a rural town about an hour from Bogotá and the University Clinic of La Sabana university in Chía were I get to see, question and examine patients with all sorts of medical problems. Apart from a wide variety of clinical presentation which I haven’t seen in the Netherlands (Dengue, Chagas Disease, Common Non-Communicable diseases hopelessly uncontrolled due to lack of treatment) it’s fascinating to see how a country tries to build up a Primary Line health care system, such as we have in The Netherlands, with unimaginably many bridges to cross. With private and public health care being insurmountably separated, and government strength or willingness suboptimal, the gap between rich and poor/healthy and sick is huge. Student’s preference for Family Medicine or Public Health is low because of its salary and reputation. This is an arid soil for a well-organized, all-coverage, (cost)effective primary line health care system and that is, strangely enough, why I feel exactly at the right course! No better place to compare health care systems, no better place to find out what means ‘Public Health’ and how people relate to it.
At the same time, I am becoming aware of how well-organized and structured the NL system is (even though we might curse it from time to time), and my preference of working in such an environment arises from the things I see around here. I feel like I need something solid to build my dreams on professionally, although I was perfectly fine out in the unknown and unpredictable while travelling.
One of the things I’m struggling with is the scholastic system the university seems to reside on. Imagine, me being from Maastricht University with its PBL, sitting in frontal lectures for more than 10 hours a week. Luckily the rotations proved to be more practical, but the first weeks I had a hard time concentrating in class. My mind kept drifting off to questions as: What would other students think of this? What does this mean in practical day to day life? It this useful? What percentage of this content will eventually be used by us as future physicians? And can’t this be more efficient? Haha, I laugh upon the faces of my fellow students when I tell them about this, some can’t seem to understand there’s another way of learning more in less time. This is perhaps my greatest challenge here: to accept this is the way things are happening here and have patience, even though I am constantly thinking about how to improve or change. Easy on yourself, big boy…… Can’t bring Dutch efficiency to South-America overnight. Even not in 4 weeks and probably not in the next 4 either.
And that’s ok. If I manage to get myself through with more knowledge about general infirmities, investigation skills, health system awareness and a few friendships my time here will have been worthwhile. And maybe, even if it were just for a little while, Colombia will sometimes remember me and the effort, love and interest I put in its people, country and culture.