Education, patient care and a good dose of Colombian culture

UF COMJ pediatric resident Michael Haynes, DO (second from left), gathers for a photo with other residents and fellows who trained at Fundacion Cardioinfantil in Bogotá, Colombia. They are shown with attending physician Martha Alvarez, MD (pictured third from left), who helped establish the training partnership.
Haynes marveled at the views during his two-week stay. He captured this rooftop shot of downtown Bogotá from the hospital’s coffee shop.
Haynes had a chance to absorb some of the culture while in Bogotá. Sights included an art festival in the city’s Usaquen Park, where local vendors regularly sell their goods and wares on the street.
This was Haynes’ view from the hotel he initially stayed in. “Bogotá is surrounded by beautiful green mountain landscapes,” he said.

Bruno Family Memorial Fund helps pediatric residents complete electives

Michael Haynes, DO, has a strong interest in international medicine and plans to pursue emergency preparedness and disaster relief as a career focus.

He wants to learn more about diseases that are uncommon in the United States and knows that direct clinical exposure abroad is the best way to do so. As such, he jumped on the opportunity to train in South America for a few weeks.

Haynes, a second-year pediatric resident at the University of Florida College of Medicine – Jacksonville, completed a two-week rotation in Bogotá, Colombia, in November. He worked in the capital city at the hospital Fundacion Cardioinfantil, where he observed pediatric patients being treated for various infectious diseases. He also gave presentations on antibiotic stewardship and chikungunya, a virus spread by two types of mosquitoes that causes fever and joint pain. 

The training opportunity is the result of a fairly new partnership between UF COMJ and El Bosque University, the university affiliated with Fundacion Cardioinfantil. The hospital initially focused on pediatric cardiovascular care but has since expanded to include other pediatric diseases.

“These international experiences are important to me,” said Haynes, who’s been part of medical outreach trips to Ecuador and Vietnam in the past. “Being exposed to different cultures, as well as disease processes uncommonly seen in the United States, provides me with the background that will help me in my career.”

Each academic year, two UF COMJ pediatric residents will have the option of traveling to Colombia as an international elective. Haynes was the first resident to go, with William Chotas, MD, set to head there in late February. This is the first time the department has officially sponsored an international elective. The opportunity, in large part, results from the financial generosity of the family of Scott Bruno, a former pediatric resident.  

Nizar Maraqa, MD, an associate professor of pediatrics and director of the pediatric infectious diseases fellowship program at UF COMJ, speaks of how beneficial it is to train abroad.

“The world is becoming smaller because of travel access,” said Maraqa, who is also associate director of the pediatric residency program. “Pediatricians are seeing patients from all over, and those people come with international medical challenges. By spending time in another country, a pediatrician can gain the necessary tools and experience to manage them.”

Maraqa adds that advancements in medicine have led to disparities in clinical exposure. As examples, he points to tuberculosis, measles and other vaccine-preventable illnesses that are seen less frequently in the United States nowadays, but remain prevalent elsewhere.

In addition, there are some illnesses that only present themselves in tropical regions, making it particularly beneficial for pediatricians to train in those areas.

“They get to go where the disease is. And through the experience, they’re finding out how other health systems work, learning how to manage illnesses with limited resources and growing their professional and personal network,” Maraqa said.

Two weeks in Bogotá

While in Colombia, Haynes gained clinical exposure to a host of disease processes, including congenital varicella, fever of unknown origin, norovirus, secondary tuberculosis, specific antibody deficiency, autoimmune lymphoproliferative syndrome, hyper IgE and salmonella endocarditis. He and the other residents also discussed brucella, dengue virus, chikungunya virus and leptospirosis.

Haynes said the biggest challenge was the language barrier. The patients primarily spoke Spanish. But fortunately, most of the medical personnel there also knew English.

“My presence gave them a reason to work on their English proficiency,” he said. “In return, they expected me to work on my Spanish skills, which I have not used in some time. However, I made an effort to do so.”

From a health systems standpoint, Haynes said the area he was working in was similar to a typical American city. But beyond Bogotá, in Colombia’s rural areas, the medical needs are dire.

“In the past, Colombia has required first-year physicians to work in rural areas and be the primary doctor for a year,” Haynes said. “In some of those locations, they may act as the pathologist, obstetrician, pediatrician, internist, etc. Doing that as a new medical school graduate seemed like it would be a daunting task.”   

While gaining valuable medical experience over his two-week stay, Haynes was able to absorb a lot of the Colombian culture. He says the natives have an unwritten rule about hospitality toward guests.

“They were as kind to me as they were to their patients,” Haynes said. “I was able to appreciate the authentic food, dancing and landscape that beautiful Colombia has to offer. I would love to go back in the future.”

The program and partnership

Ayesha Mirza, MD, an associate professor of pediatrics and director of the pediatric residency program, looked to a longtime colleague in helping establish the partnership between UF COMJ and El Bosque University. Years ago, she trained in Louisiana with Martha Alvarez, MD, who is chief of pediatric infectious diseases at Fundacion Cardioinfantil. Alvarez also serves as the attending physician during the two-week resident rotation there.

“It has been great to again work with Dr. Alvarez, who is a phenomenal preceptor,” Mirza said. “Not only is she passionate about pediatric infectious diseases, she also has a strong background in immunology and loves to teach.”

The initial aim was to establish a one-month rotation in Bogotá for UF COMJ’s pediatric infectious diseases fellowship program. Based on positive feedback about the experience, faculty worked to open this opportunity for residents.

“While two weeks may not be long enough to learn about the entire spectrum of diseases in a new country, it is certainly enough time to arouse the curiosity of those who wish to venture outside our borders and learn more about diseases we may not always have the opportunity to see in the U.S.,” Mirza said.

Maraqa said other residents in the department have travelled abroad for work in the past. But because those trips weren’t program-sponsored, they had to take personal vacation time and cover most of their expenses.

“This type of training rotation is unique to our area,” Maraqa said, referencing the contributions from the Bruno Family Memorial Fund that helped fund the Colombia elective. “The partnership removes most of the financial burden, making it easier for residents to gain the type of international experience that will make them more well-rounded physicians.”

Click here to learn more about the pediatric residency program at UF COMJ.

Featured Faculty

Nizar F. Maraqa, MD

Nizar F. Maraqa, MD

Associate Professor
Medical Director, UF Cares; Program Director, Pediatric Infectious Diseases Fellowship; Associate Program Director, Pediatric Residency

Ayesha Mirza, MD

Ayesha Mirza, MD

Program Director, Pediatric Residency