Dr Rodney:
I am interested to know about your involvement in Ecuador. I have been taking medical teams there the last 6 years. We work in far south Quito and among the indigenous people there. I have always wanted to know more about the training of FPs there and would love to know what you're doing there.
I am headed back to Quito end of July for a couple of weeks.
R. Stewart, MD
Family HealthCare Associates
Shawnee, OK
WMR replies:
First, let me insert a disclaimer for all I don't know, and the people I fail to mention.
Your inquiry reminds me that we should update an article on la Sociedad Ecuadoriana de Medicina Familiar, the Venezuelan Fundacion de Pedro Iturbe in Venezuela, SOBRAMFA in Brasil. Dr. Iturbe started several programs in Venezuela circa 1982. Julio Ceitlin tried the same in Argentine. Pablo Blasco seems to be the man in Brasil. A tip of the hat to Mark Lepore and others at Ventura who have tried to carry the Hospitalito project in Guatemala.
Ironically the opportunities for curriculum expansion are probably greater in Latinoamerica than they are in Europe and the USA. In 1982, we took a huge leap forward by establishing a family medicine hospital service at UCLA. Family Medicine faculty daily rounded on Medicine, Pediatrics, OB, and nursery. I don't see much of this in South America, and 50% of USA FP's seem to running away from this. Did FP's jump ship or were they pushed? This would be another discussion for another time.
In 1985 Cal Wilson and others established a family medicine residency program at the Voz Andes missionary hospital in Quito. They also have a rural hospital in Shell Mera which is about 6-7 hours by car from Quito. I think Rita Bedoya MD established a program Lojas which is a telemedicine partner for the annual VozAndes Jornadas Jan-Feb.
We presented ALSO in Quito VozAndes 2003, and it has been given annually by Ecuadorian faculty ever since. In 2006, I tried to start a colposcopy skills program in Quito but failed. In 2009 I installed ultrasound to Shell and in 2010 to North Quito. I was there last week.
David Gaus MD of Wisconsin has moved mountains to establish a program in Pedro Vicente Maldonado which is 2-3 hours Northwest of Quito by car. Medicos-Memphis will sponsor his faculty for two week immersion courses in Family Medicine OB/Gyn ultrasound. We hope his faculty will be able to participate in our Surgical Family Medicine OB ultrasound workshops September 4-6.
Bob Gobbo seemed to have some success in Domingo de las Colorados, Ecuador. But no one has sustained a break through program for enhanced family medicine yet. By breakthrough program, I mean visible and important to the Deans of the medical schools. Marc Nelson, JPS grad, has sustained GI endoscopy at the Carapungo clinic in Quito. I am trying to help support that effort and the effort of David Gaus as much as possible. Ecuador seems to have the lead here.
To develop the next generation in Latinoamerica, I believe that family medicine should rebrand itself as "Surgical Family Medicine OB". For lack of an effective urban example, medicina familiar is viewed as a dead end street for 99% of South American medical students. In Colombia , Medicina Familiar seems synonymous with family therapy/behavioral counseling.
Currently there is no board certification available, and there are no faculty privileges in the teaching hospitals. This will change.
Especialidad Medicoquirurgico y Obstetricia;
Medicina Familiar Avanzada
De la maternidad hasta la ancianidad
Comments and corrections would be appreciated.
With best wishes for your professional success
Wm. MacMillan Rodney MD
Private Practice, Medicos para la Familia
Memphis, Nashville, and International
p.s.-We are trying to upgrade the family medicine residency curriculum for programs in Ecuador and Venezuela, by purchasing a video endoscope unit which works well. We would accept a snap on camera for old Olympus scopes but prefer something that is an immersible videoscope. A fancy information management outfit is not necessary.
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