Around Lima

I spent most of the first week back from Julcan helping my mom move from her apartment to a new house.  Moving is just as painful here as it is in the states, but we're settled now and feeling more like I really live here.

This last week the goal of universal health insurance got a little tiny bit closer when the Peruvian congress made the it a law.  Still far away from a reality, but it's a first step. 

This week, I spent some time with some family practice doctors.  It was really good to start seeing what they are doing down here.  There are scattered family practice programs around the country, but there doesn't appear to be any association that sets guidelines, so they can vary pretty widely.  The family practice program that I'll be spending some time with is based out of la Universidad Peruana Cayetano Heredia.  It is arguably one of the best medical schools in Lima.  

The family medicine residency has been in existence for about 6 years, but they haven't always had residents.  There is a national residents committee that determines how many spots to grant a residency program each year and it varies widely.  3 years ago Cayetano got ZERO residents, the next year they got 6 residents, and this last year they got 18.  They haven't heard how many they'll get for the next year.  It's partly determined by the hospitals where the residents spend their first year and half.  My understanding is that they assume the cost of these residents and their budgets fluctuate (although I'm still trying to figure this out).  

So the family practice residency is 3 years, but they spend their first 18 months rotating in different, mostly hospital based specialties, with one day in family practice clinic each week.  The last year and a half is spent in the community.  They spend a 6 month block at one of two health posts seeing patients, but also doing some serious community work.  The rest of their time is spent rotating in other community settings.  During this whole time they continue to have family practice clinic at Cayetano.  I don't think there is really a concept of continuity care here for patients, but I haven't spent enough time with them to know for sure.  

I went to visit one of the health posts where the residents spend an extended period of time.  It's in one of the poorer parts of Lima.  It's a small, but nice facility.  The resident just started there about 2 weeks ago so she's just starting with her community assessment.  She has the help of a volunteer preceptor doctor who is employed by MINSA (the ministry of health) and an intern (med student in their last year of school).  She is expected to see patients in the clinic for 4 - 1/2 sessions - each week and the rest of her time is working out in the community addressing the problems they've identified.  The amount of stuff they have to cover is pretty daunting...but she starts and the next resident will continue.  Anyway, hopefully I'll get to see some more of how this works.