Tropical Medicine, Traveler’s Health Training Takes USU Graduate to Peru

UNITED STATES

07.28.2022

Story by Vivian Mason 

Uniformed Services University

Ever hear of “snake on a stick”?

Navy Lt. Claudia Mondragon, a Class of 2022 graduate from the Uniformed Services University of the Health Sciences’ (USU) F. Edward Hébert School of Medicine (SOM), saw one up close and personal during her infectious disease rotation in Lima, Peru, as part of USU’s Tropical Medicine and Travelers’ Health Training Program recently.

Snakes, as it turns out, were a normal part of everyday life in Lima, according to Mondragon. “One day, I was on my way to make a home collection for the malaria project, and I saw a man come by with a snake on a stick. I couldn’t keep my eyes off of it. The man wasn’t even in a rush or anything. I’ve actually run into other people holding snakes in their hands.”

Snakes, insects, other creepy creatures and pathogens were the norm for Mondragon as she participated in the Tropical Medicine and Travelers’ Health Training Program, which she learned about through a friend.
“[My friend] connected me with Dr. Kyle Petersen, current director of USU’s Tropical Medicine and Travelers’ Health Training Program,” Mondragon says. “He explained the program to me. But, I was already onboard.”

Mondragon adds that she knew ahead of time that Peru was a hub for all of the different research labs throughout South America. She wanted to go because she was interested in the types of research they conducted, and through previous patient care exposure in Peru, Mondragon knew how the system worked. Regardless, she viewed the four-week rotation as a learning opportunity.

“I was born in Peru, actually,” Mondragon says. “I did missions for four years in the Andes with the Peruvian American Medical Society. I wasn’t a medical student then. There, I worked as an interpreter, a scribe, a liaison, or whatever was needed. I saw the challenges and hardships of the medical system, but from a provider perspective. I find that infectious disease is relevant in every single field of medicine.”

During her four-week rotation in Peru, Mondragon’s priority was to see infectious diseases that are not endemic in the United States, such as malaria, dengue, leishmaniasis, and leptospirosis. Her first week was research based, and she got to know the labs. After that, it was a week and a half in the jungle going out into the community of Padre Cocha to collect blood samples for one of the main parasitology projects at NAMRU-6 (Naval Medical Research Unit 6). She spent the remaining 10 days in Lima doing clinical work.

Mondragon worked at two different sites of NAMRU-6: Lima and Iquitos, which exposed her to their different departments – entomology, virology, parasitology, and bacteriology – and their projects.

“The labs were well equipped and quite nice. Leadership is all naval officers. The lab techs, biologists, etc., are all Peruvian,” Mondragon notes.

At the Iquitos site, Mondragon participated in field work in the community of Padre Cocha. There, she collected blood samples of patients enrolled in a project dedicated to identifying submicroscopic and asymptomatic patients with malaria. During this trip, she was also able to visit a level III regional hospital in the area and participated in the infectious diseases department rounds.

“I saw two patients with mucocutaneous leishmaniasis that presented with septal perforations,” Mondragon recalls, “which is something I’m highly interested in because it ties together two of my passions: infectious diseases and otolaryngology. While doing patient rounds, we talked about the different reasons why a patient may present with a perforated septum. My differential diagnosis was limited by my geographical location, the United States. However, our attending developed an extensive differential diagnosis with various pathogens that included tuberculosis, leishmaniasis, Balamuthia, and paracoccidioidomycosis.”

Mondragon notes that the opportunity offered by the USU program to study the healthcare system of Peru in a hands-on setting was vital to her learning.

“Our military men and women will be serving in different parts of the world,” she says, “and their geographical location will always be extremely relevant to medical officers so that they can provide proper medical care.”

Mondragon was able to broaden her medical knowledge and treatment for different infectious diseases, but she admits that “one of the biggest takeaways… was seeing the incredible Peruvian doctors battling these diseases with minimal support and equipment, something that I may experience as a Navy medical officer. Originally, our mission was to be mostly research based, but because I speak the language and can communicate, I started networking and that’s how I ended up visiting most of the hospitals in the area.”

But, she adds, she learned a wide variety of things spanning across plenty of valuable perspectives.

“From a social perspective,” Mondragon says, “this experience was eye opening. However, now that I have gone through four years of medical school training, I can see and understand how precarious the healthcare system in Peru can be. The local doctors used everything they had to provide appropriate care and, most importantly, they welcomed and taught me the different ways they overcame their lack of resources.”

Mondragon says that from her perspective as a medical student, “the [Tropical Medicine and Travelers’ Health
Training Program] allows you to experience and see cases that you would otherwise not see in the United States. Yet, from a former molecular biologist perspective, I was able to learn and experience the different research projects NAMRU-6 is currently working on, from data collection in the Peruvian Amazon to molecular processing in the labs.”

Going down the list of ways she spent her time, Mondragon notes that she saw primary care patients at the local medical post in Sungarococha, attended the infectious disease grand rounds and morning rounds at the regional hospital, and participated in a one-on-one teaching experience with an infectious disease specialist at Hospital de Apoyo. Additionally, she visited two sexually transmitted disease clinics, one of which was part of an Army hospital.

Mondragon also had the opportunity to visit a serpentario.

“It’s a wildlife rescue center that prevents the illegal trafficking of various animals that live in the Amazon,” she shares. “Most of these animals are sought after for collecting purposes or even as food. Because of the extreme poverty in the area, these animals are often sold to the highest bidder.”

And while her work and studies covered most of Mondragon’s time, she explains that life in the Amazon was a bit of an adjustment.

“We got around using boats,” she explains. “It’s super scary because the river is full of piranhas. A young child drowned while we were doing collection specimens for the malaria project. When he was pulled from the water, parts of his body had been bitten and eaten by the piranha fish.

“There’s extreme poverty in the area, and food is very expensive,” Mondragon adds. “The native people eat everything and anything, including giant white worms called suri, alligator legs (sold in the market with their claws still attached), monkeys, etc. I tried the suri and the alligator, but nothing else because I didn’t want to get sick. It was quite a cultural shock.”

Her advice to others considering the Tropical Medicine and Travelers’ Health Training Program at USU?

“If you’ve never been outside of the United States for a clinical rotation, I highly encourage it. It’s an enriching medical opportunity, but most importantly, the cultural impact that it will have on your life is priceless. It gave me a different perspective. Even though a lot of people believe infectious disease is rare, we’re all going to encounter it regardless of what specialty we’re involved with.”

• Date Taken: 07.28.2022
• Date Posted: 07.29.2022 09:36
• Story ID: 426094
• Location: US