Orthopaedics and Traumatology at CES Universidad, Medellin, Colombia
Post by Jack Dunne, Student Ambassador at National University of Ireland (NUI), Galway who has completed an elective exchange at Universidad CES Escuela de Medicina.
Why Medellin, Colombia?
I wanted to explore my interests in trauma medicine. Ireland lacks trauma as a specialty, so an elective abroad offered me the only opportunity to experience it. I looked for a location that offered this practical experience but also one that offered cultural and travel opportunities. I read positive reports on Colombian hospital electives. The reports detailed a practical and intensive environment, where the standout point for students was that it had been very rewarding.
I chose Medellin simply based on the many positive touristy accounts I heard of it.
The Application Procedure
I Google searched Universities in Medellin and found various websites and email addresses. I came across CES Universidad and the organizer there was very prompt and helpful in her replies. I then noticed it was a GEMx University, so I made my application through the GEMx portal, rather than through the CES portal, and this saved me the cost of fees. Winning straight off the bat! Overall, the application procedure was very straightforward, I just needed the usual documents (letter of recommendation, grade transcripts etc).
CES Universidad is a small private university in Medellin, based in the leafy ‘El Poblado’ suburb. On the CES University application page on the GEMx website, you have 2 hospital options for each specialty available, CES Clinica or a General Hospital. I chose CES Clinica, just on the flip of a coin, and can only comment on that.
I was very happy with CES Universidad. The programme was run professionally; I had an orientation before beginning and was also brought on a guided graffiti tour with other exchange students. The hospital knew I was coming was used to taking foreign students and had preassigned me to a doctor.
I initially assumed I would be placed in Clinica CES, a hospital close to the city centre of Medellin, however there all multiple ‘Clinica’s’ for medical students across the city and I ended up in a hospital called Clinica Del Norte. The hospital was actually in Bello, a suburb of Medellin. It’s a private hospital and has various different specialties and 4 theatres. It’s close to a busy commercial centre and the public metro station, Niquia.
It’s hard to judge an area you’ve never been to, halfway across the world, so I decided to figure out accommodation once I arrived, had spoken to people, and could ‘feel out’ the place. Don’t stay in a hostel if you’re doing clinical rotations (as I considered), that’s the 1st piece of advice. Colombians I asked said accommodation is advertised either on Facebook or through the grapevine. Hence, there’s only Airbnb available if you’re looking for a short-term rental. There’s tons of availability though. No tourists stay in Bello so every Airbnb was available for however long I wanted to stay. My advice would be to find accommodation for the 1st few days and then revaluate. I actually got lucky in that I had an Airbnb for 3 days, then met someone with a room to rent out and got a great deal, close to the hospital.
In Bello, Airbnb might set you back €12 a night, while finding local rent generally goes for $400,000-$500,000pesos (€115-€140) a month. Closer to Medellin city centre, however, the rent can be much higher: $600,000-$800,000pesos.
Orthopaedics and Traumatology
Traumatology, in this case, was essentially an orthopaedic doctor based in the Emergency Department. In Ireland, orthopaedic doctors would be on call and required to come down to the Emergency Department. But there are so many orthopaedic cases in some hospitals, it’s far more efficient just to station an orthopaedic doctor there.
Clinica Del Norte is a private hospital for patients with good insurance, and this really dictates the patient cases that walk through the hospital doors. The vast majority of patients I saw were involved in low speed, minor trauma, motorcycle accidents. Know your bone anatomy of the upper and lower limbs as they’ll be your bread and butter for the 4 weeks. Though there were some polytrauma/major trauma cases, such as pelvic fractures and cranial fractures which I got to view/assist in. As I was based in the Emergency Department, I got to view/assist in many other cases, for example, a resuscitation case and a patient with a ventricular tachycardia. If you want to see big trauma, with gunshots and stab wounds, all the Hollywood gore of very sick patients, going to a public hospital is what you need to sign up to, according to the staff in CDN. There is something to be said though for the less hectic, private hospital clinical rotation, especially when you don’t speak fluent Spanish.
I got a lot of practical experience from my time in CDN:
- Doing various types of casts, splints
- Suturing for various cuts/wounds
- Intramuscular Injections
- Digit ring blocks
- Venous catheters
- Urinary catheters
- Taking blood from veins
- Resuscitation procedures
- Pelvic fracture stabilization
- Shoulder relocation
The big piece of advice I’d give is don’t come over without knowing how to put on sterile gloves, wash your hands, and scrub in (your sterile techniques, essentially). I was most taken aback by the attitudes of the doctors and nurses towards medical students getting involved. I was never turned away from doing a procedure and was actively encouraged to try my hand wherever an opportunity presented itself. The staff was happy to teach the procedure and to patiently guide me through it.
7 am: starts and finishing at 6 pm most days, Monday to Friday. Weekends off for Orthopaedic students, not for emergency medicine students.
7 am: Reviewing the cases with students and doctors. Received teaching throughout the cases.
9 am: Go see the patients and do any of the tasks e.g. casts.
10 am: Teaching on a specific topic.
11 am: Go see patients on the wards/do any practical tasks/write up patient notes.
Lunch for an hour.
1pm-6pm: Based in the Emergency Department and seeing patients that came in/writing up notes.
I expressed my interest to see orthopaedic surgery, and one of the students mentioned it to the doctor who then happily brought me along to theatre with him, making me feel very welcome. I got to scrub in, assist and close on all the operations they performed. The consultant would then struggle with his English to teach me what was happening in the surgery, which I really appreciated.
I got to see rotator cuff repairs, internal fixation of the tibia and LCA repairs.
The Colombian students on the placement were lovely and helped me a great deal both with my medical knowledge and with my struggling Spanish.
I was also lucky in having another native English-speaking student from New Zealand there.
CES Universidad doesn’t require a Spanish competency certificate, however, this may change after my stint there. I would advise practicing your Spanish as soon as you make the decision to go to Colombia. It would take a high B1/B2 level in order to work competently and at least somewhat independently in the hospital.
Orthopaedics, however, is an ideal rotation for those with less Spanish ability. You need far less medical Spanish, and the nuances of a medical history aren’t as relevant.
Still, you should make a decent attempt at learning all the relevant vocabulary in order to get the most out of the elective
Things For Eager Students
Learn lots of medical Spanish and improve your all-round conversing Spanish.
How to type up a history in Spanish.
I was fairly wrecked by the time the weekends rolled around, and I imagine you will be too. Probably best not to plan your weekends down to a T, to try and cram in as much culture as 48hours allows. I’d recommend allowing time to travel before or after for a couple of weeks. I arrived in Colombia early and did my traveling in the 4 weeks before I started in the hospital. There are tons to do, and it would be disappointing to leave without thinking you made a least a decent crack at ticking off the touristy stuff.
If somehow stuck with weekends, however, Medellin has lots to offer. The nightlife is great (I got to go out with the Colombian students which was a lot of fun).
The graffiti tour I’d recommend. Taking the cable cars around the city was cool. There’s a walking tour of the city which was OK (you might as well do it, but don’t rush to tick it off). Paragliding was by far the highlight of Medellin for me. Super cheap (130,000pesos) and you get to soar in the winds on Medellin, with a panoramic view of the city.
Safety of the city
I feel tourists love to downplay the safety of Medellin, based on their own well worn, insulated paths through the city. Medellin is still a city that can be dangerous in every zone, and there are places non-locals should never go. I’ve read often that if you ‘use common sense you’ll be fine.’ However, common sense in Medellin differs vastly from common sense in a European city. For example, you shouldn’t flaunt your wealth, or take out your phone in public, regardless of the time of day. No zones are safe to walk around in late at night, so take Uber where possible. Be very cautious of your drinks on nights out, and be very skeptical of anyone showing interest in you on a night out.
All in all, I never experienced any problems or frightening experiences, and I would have no hesitations about returning or encouraging my friends to visit.
It’s highly recommended though to read up on the do’s/don’ts, the common pitfalls, and dangers, and to have backup plans if an unfortunate situation arises.
There were no hospital/university costs for the elective, and I got a free lunch every day, so technically I was making money!
My accommodation was €165 for a month.
Food per day was maybe €15, including breakfast, the free lunch at the hospital and a nice meal in a restaurant that night.
For food, transport, and accommodation, Colombia is cheap. However, any ‘western’ goods (electronics, clothes, food brands) will be far more expensive than in Europe.
I would highly recommend doing a traumatology rotation at CES Universidad. The practical experience amongst such warm and friendly people has been so memorable. I thoroughly enjoyed my time both at the hospital and around Medellin.