“At the Crossroads” symposia series continues to inspire

Physicians and social scientists spoke about the relationship between humanitarianism, medicine and anthropology in Latin America on May 2 at the final symposium in a series hosted by the Latin American Institute.

 “At the Crossroads” symposia series continues to inspire

One key element of successful, sustainable medical aid is to partner with local doctors, nurses and volunteers, rather than imposing on and/or excluding them, said Dr. Daniel Levi.

by Jeanne Marie DiNovis and Michelle Sinness

UCLA International Institute, May 22, 2014 — The final symposium of the six-part “At the Crossroads: Medicine, Surgery and Anthropology” series took place on Friday, May 2, 2014. “Humanitarianism, Medicine and Anthropology in Latin America” brought together all aspects of the series as a whole and concluded by reemphasizing the interdisciplinary, collaborative nature of the project.

  Spearheaded by UCLA medical anthropologist and professor Bonnie Taub and UCLA surgeon Dr. Reza Jarrahy, the Latin American Institute symposia series established connections not only between the academic worlds of medicine, surgery and anthropology, but also among communities in Latin America where collaboration and resource sharing in health care can make an immense impact on the lives of local people.

Opening the program, Consul General of Ecuador Diego Jaramillo spoke about the Ecuadorian government’s policies related to “buenvivir,” or good health, in a broad sense. Although Ecuador has made many advances in health policy over the last few decades, he noted that there was still much work to be done, especially regarding the increasing incidence of diabetes nationwide.

Jaramillo stressed that academics and policy makers needed to collaborate in order to find new and innovative means of improving health care — a message which has been a central theme of the symposia.

Cindy Fan, vice provost (interim) of the UCLA International Institute, remarked on the dynamic partnership and commitment of co-investigators Taub and Jarrahy to the symposia series, describing the program as an impressive undertaking to “marry the people and the place.” The series, she observed, has seen an unusual coming together of many groups who often become isolated in their own disciplines, including scientists, medical doctors, anthropologists, public health workers and students. Dr. Reza Jarrahy and Professor Bonnie Taub. (Photo: Erick Pena/ UCLA.)

Thomas Coates, director of the UCLA Center for World Health, a joint program of the David Geffen School of Medicine at UCLA and the UCLA Health System, underlined how the series has created a forum for medical professionals and social scientists to work together on global heath challenges — an endeavor in line with the Global Health 2035 Convergence, a set of priority goals identified by The Lancet medical journal. 

The symposia and the research project that it has engendered have also inspired a more holistic approach to the implementation of aid programs in Latin American communities. Jarrahy and Taub welcomed participants and spoke about the importance of storytelling as being both a fundamental aspect of the human experience and essential for humanitarians.

Jarrahy noted that hearing peoples’ stories is important for a surgeon and physician in order to “view. . . patients as human beings, not just cases.” Similarly, Taub remarked how medical anthropologists collect illness and medical narratives as a central component of their research in ethnographic studies and at medical field sites; the narratives help them understand peoples’ experiences from a cross-cultural perspective.

Following these opening remarks, Dr. Nicolas Cuttriss presented his impressive work on diabetes in various communities in Latin America. Cuttriss is a Pediatric Endocrinology Fellow at the University of Miami and co-founder and chairman of the board of AYUDA, Inc. His advocacy work in Latin America began when he was 15 years old and met an Ecuadorian boy who was experiencing incredible difficulties controlling his Type 1 diabetes, even though both of his parents were doctors. 

Even at such a young age, Cuttriss realized that lack of knowledge about diabetes among the general public was a problem that needed to be brought to the attention of both citizens and policy makers. His initial interaction with diabetes inspired him to continue researching the condition and to create advocacy programs to address it in Latin America. As Cuttriss emphasized “[a] lack of education is just as dangerous as a lack of insulin” when managing the diseases.

The American doctor eventually created a comprehensive approach to teaching young people about Type 1 diabetes and created an organization called AYUDA (American Youth Understanding Diabetes Abroad). The program focuses on empowering youth with diabetes and allowing young people to serve as “agents of change.”

AYUDA teams up with other organizations throughout Latin America, such as foundations in Ecuador, Haiti and the Dominican Republic, to offer a “Campo Amigo”, which creates interactive experiences for children and their parents to learn how to manage diabetes and promote healthy living. The program embodies the ideas of humanitarianism and collaboration, both across disciplines and across borders, to positively change lives and promote sustainable health programs.

Dr. Daniel Levi, an intervention cardiologist on the faculty at the David Geffen School of Medicine of UCLA, operates on children with congenital heart disease in impoverished regions of South America, such as Peru and El Salvador, through the organization Hearts for Hope.

Levi spoke about key elements of successful, sustainable medical aid. First, medical aid workers aim to partner with local doctors, nurses and volunteers, rather than imposing on and/or excluding them. Visiting medical professionals try to understand local culture and be respectful of it. Successful medical missions also strive to make a long-term commitment to the communities that they serve and coordinate with local government and hospital administrators in their work abroad.

Even while following these guidelines, Levi noted that he had encountered many obstacles. Airport customs, equipment expenses and technological deficiencies, for example, create challenges. Echoing the concerns of speakers at previous symposia, he pointed out that the screening process for surgery considers the type of procedure a patient requires, the necessity of subsequent surgeries and treatments, and the level of care and resources needed during their recovery. Given these considerations, his team sometimes needs to decline to operate on patients whose surgeries would entail unavailable follow-up care.

Dr. Frederico G. Velez, a UCLA pediatric ophthalmologist on the faculty at the Jules Stein Eye Institute at UCLA, treats patients with cataracts in Latin America. Velez explained that medical outcomes in the region often depend on where people live. In rural areas of Latin America, people are unlikely to have access to opthalmological care, whereas in urban areas, they can usually find eye doctors and other specialized care (although often only in a private hospital).

“In this country,” he stated, “patients get cataract surgery when they can hardly read the New York Times or the Wall Street Journal. In other countries, people cannot get cataract surgery until they're hitting walls because they cannot see anything.”

Velez explained that innovative individuals are finding creative ways to bring eye surgery to people in rural areas of Latin America. For example, Colombian ophthalmologist Dr. Virgilio Galvis created a mobile bus clinic to treat poor people living in areas without access to eye care. Since there is no electricity in most of the communities the bus serves, it is followed by a truck carrying a powerful generator.

Today, hundreds of Colombians can see clearly because of the treatment they have received at the mobile clinic. Imaginative interventions such as this are powerful examples of positive change for underserved people in Latin America, he observed.

Nongovernmental organizations (NGOs) play an important role in the delivery of medical care to people in developing countries. UCLA Professor of Anthropology Thomas S. Weisner, who serves on the board of ChildFund International, explained how ChildFund and other global NGOs work with local governments and community partners to make a sustainable difference in the lives of children and families around the world. The goal, he said, is for recipient countries to eventually become donor countries.

Effective NGOs, said Weisner, have outside accountability systems, strong leadership, quality standards and good financial management. “For these global health initiatives to have a chance, these things have to exist.” Weisner concluded his talk with a quote from the ancient Chinese philosopher Lao Tzu: “Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say, ‘We have done this ourselves.’”

Undergraduate, graduate and medical students, together with UCLA faculty and other community leaders who have attended the various “At the Crossroads” symposia for the past two years have consistently been inspired by them to create positive change in the world. The series exemplifies the quote of the famous 20th-century anthropologist Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

  From left: Thomas J. Coates, Director, Center for World Health, David Geffen School of Medicine;  Nicolas Cuttriss, MD, co-founder and chairman, AYUDA, Inc.; Cindy Fan, Vice Provost  for International Studies (interim), UCLA; Reza Jarrahy, MD., associate clinical professor  and co-director, Craniofascial Clinic, David Geffen School of Medicine; Professor Bonnie Taub, co-chair,  UCLA Latin American Studies Graduate Program; Federico G. Velez, MD, assistant clinical professor  of ophthalmology, David Geffen School of Medicine and Jules Stein Eye Institute; Professor Thomas S. Weisner,  professor of anthropology, UCLA Diego Jaramilo Jaramillo, Consul General of Ecuador in Los Angeles. (Photo: Erik Pena/ UCLA.)

Professor Bonnie Taub is the Chair of the Latin American Studies Graduate Program and on the faculty of both the Department of Anthropology and the Fielding School of Public Health at UCLA. Dr. Reza Jarrahy is a plastic and reconstructive surgeon at UCLA Medical Center, an associate clinical professor and co-director of the Craniofacial Clinic at the David Geffen School of Medicine at UCLA.

The two professors are the co-principal investigators of the Working Group on Indigenous Children’s Health in Central and South America of the UCLA Latin American Institute, which is funded by a Title VI grant from the U.S. Department of Education, with support from the UCLA Center for World Health. Their joint research has received a UCLA Clinical and Translational Science Institute, Transdisciplinary Seed grant through the Office of the Vice Chancellor for Research(OVCR).

This article was originally published on May 22, 2014, and updated on May 29, 2014.