I woke up as the plane approached Cuzco and saw half the passengers straining out of their seats, trying to get a glimpse of something outside the window. “What’s going on?” I asked my seat mate.
“The mountains,” she said. “They’re so high they almost touch the plane.” At that, I too turned in my seat and watched as the city came to view amidst clouds and mountains. At over 3,300 m (10,800 ft) above sea level, Cuzco is one of the highest cities in the world. It sits in the southern part of Peru and was once the capital of the great Incan empire. It is home to approximately 300,000 people and is a popular site for visitors.
I went to Cuzco this summer in order to improve my Spanish skills. Because of its location and history, Cuzco provided a particularly rich setting to do this. I enrolled in a medical Spanish program called AmeriSpan SALUD, which consisted of language classes, cultural activities, and medical site rotations. For nearly one month, I lived with a host family – my host mom Marí and host brother Jonathan – in a modest two-story house outside the city center. From them I learned how to navigate the city like a local, tasted homecooked Peruvian meals, and got an insider’s view on everything from popular hangouts to current politics.
I had class four hours each day, five days a week at the school called Academia Latinoamericana. With a tutor and three classmates, I reviewed grammar and vocabulary through conversations, movies, songs, articles, and written assignments. More importantly, though, the daily interactions I had with people throughout the city helped enforce my language skills. In the end, these simple interactions – lunchtime conversations with my host family, shopping trips to the market for food, asking for directions from random passersby – became my most effective teachers.
Our Spanish lessons weren’t just limited to language skills; the school helped us become immersed in Peruvian culture as well. This we did by exploring the city on our own – learning to dodge zooming taxis, children walking to school, women in traditional garments, and even llamas and alpacas marching behind their owners. Also, we visited art museums, old Incan ruins, and traditional Indian markets. We even had salsa lessons and night time soccer games against our Spanish tutors. A particular highlight was a weekend trip to Machu Picchu. From these experiences I learned to appreciate not only modern Peruvian culture but also the influences of the country’s Incan history and indigenous communities which continue to permeate modern Peruvian society.
The many influences which shape Peruvian society also became apparent as we learned about the country’s healthcare situation. We learned that patients turned not only to physicians and hospitals for medical care but often also to local healers and alternative medicine. When evaluating patients, physicians have to take into account these cultural influences as well. There are three types of hospitals in Peru – those for the uninsured, those for workers who received public health insurance, and those for people who can afford to pay out-of-pocket or who have private insurance. We rotated through the Hospital Nacional Adolfo Guevara Velasco or Hospital EsSalud, which treats patients with public health insurance. For two weeks, I rotated through the oncology, trauma, and internal medicine departments. The patterns of the days were familiar to me – as at Duke, we rotated in the mornings with interns, residents, and attendings; we looked at patients’ charts and lab results, did physical exams, and discussed their treatment plans. There were differences as well. While EsSalud had many of the latest technological equipment (the hospital was the biggest and best in southern Peru), doctors relied less on them for their daily activities. I had gotten used to seeing numerous beeping monitors by patients’ beds and computers all over the hospital wards here at Duke; these were more difficult to find at EsSalud. The types of diseases we encountered differed, too. We learned that infectious diseases were the leading patient concerns. Within two days of my internal medicine rotation, I had seen patients with miliary TB and malaria, two diseases not commonly seen here in the U.S.
I came to Cuzco hoping to learn about a new culture and to improve my Spanish skills. I felt that I definitely accomplished my goal by the end of the trip and now feel more confident communicating with Spanish-speaking patients and colleagues whether in the clinic, on the wards, or in the lab. A suggestion for improvement in the program would be to add rotations at different hospital sites. We worked in only one hospital, the leading hospital for publicly-insured patients; it would have been valuable to experience hospitals or clinics for the uninsured and for the privately-insured as well. Also, because of insurance concerns, students did not get as much hands-on experience with patients as we would have liked; a lot of the rotations involved observation and shadowing. For students looking for more hands-on programs, I would suggest looking at volunteer opportunities in smaller clinics or NGOs. Nevertheless, for students looking for programs that combine language training, cultural immersion, and medical exposure, the SALUD program in Cuzco is a good choice. Peru itself is a breathtaking country, and Cuzco is an excellent classroom for learning Spanish.
