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Regina Melendez Recipient of 2015 Major José Jamil Miranda Memorial Fund for Clinical Rotations

The Major José Jamil Miranda Memorial Fund for Clinical Rotations was set up by Jose's Yale Medical School classmates in 2009 to memorialize Jose.

The fund awards a scholarship each year to a medical school student to assist Yale School of Medicine students who are pursuing a short term clinical, public health, or research experience, by enabling the exploration of an area of medicine or public health in a unique and under-served setting.

While an international experience is preferred and encouraged, the location may also be domestic.

This year's recipient was Regina Melendez, Yale School of Medicine MD Candidate 2015.

As fate would have it, Regina served in Peru, where Jose Jamil Miranda lived for 2 years in High School and also served on his first medical mission trip!

Regina had these nice words to say and an amazing reflection report!

Dear Miranda Family and Friends, I'd like to begin this letter by extending my warmest thanks to you for all that you've done in support of Yale student travel. Traveling to Peru was a life-changing experience! I worked for two weeks at Cayetano Heredia Hospital in Lima .in the department of psychiatry. During that time I worked side-by-side with psychiatrists and residents to evaluate and treat psychiatric patients. After my time in Lima, I spent two weeks in Ayacucho, a poorer area in the mountain region of Peru. I was welcomed by the community and got to see first-hand the challenges of delivering mental health care to poorest communities in Ayacucho. Beyond the immense opportunities for learning about psychiatry, I was able to appreciate and immerse myself in a new culture. This experience truly opened my eyes and has inspired me to continue to work globally. This all would not have been possible without your generosity, and I cannot thank you enough for allowing me to have this wonderful experience. I have written a reflection about my trip, which I hope captures a few sentiments in my writing and photos. Thank you so much again! Sincerely yours, Regina Melendez, Yale School of Medicine MD Candidate 2015

Regina Melendez's Reflection

Lima, Peru

Walking slowly up the winding hill, I had to stop to catch my breath. We were being led by a nurse in her late 60s who was surprisingly agile and fit for her age, and who knew the muddy hillside of this region of Ayacucho like the back of her hand. On this visit, we traveled to the home of two patients, brothers who had not seen a psychiatrist in the last year, and their Quechua speaking mother. They both suffered from schizophrenia, and were isolated at the top of their hillside, living in extreme poverty. When we arrived, we were welcomed by Marni to sit on little stools and share a cup of cocoa tea as she swatted the flies from away from our gathering. She explained in frantic tones how she was afraid for what would become of her boys, because she could no longer afford their medicine after her husband's death, and they had both relapsed to once again hearing voices. One was so sick he could no longer control his bladder or bowels, and was confined to his room. Unfortunately, their situation was not unique. That day alone we visited 4 other patients with similar stories and struggles in the vicious cycle of poverty and psychiatric illness.

Ayacucho is considered by some locals to be the true capital of Peru- it is the home of Peru's most ancient civilizations of Wari and Quinoa- predating the Inca empire- and was the site of the signing of the independence declaration for Peru and the surrounding countries from the Spanish empire. When we arrived that first day, the businesses were shut down as the people paraded in the streets in one of the largest Carnival celebration in Peru. It was hard to imagine that few years prior this area was also the site of terrorism and political turmoil, which claimed the lives of hundreds of thousands of men, women and children in this region in the 1980s and 1990s.

Given this context, one might expect there to be numerous psychiatric services in place to help the victims of torture, survivors of rape and families of the "desaparecidos" or disappeared persons recover from their losses. It was strikingly the opposite. There were no psychiatrists, let alone psychiatric facilities. A handful of heroic psychiatrists and residents from Lima (over a 10 hour bus ride away) have taken upon themselves to travel to Ayacucho once a month on weekends to attend to the massive need. Given the limited resources, they must see close to 60 patients in one day- barely time to refill medications and offer a brief counsel.

I traveled to Peru to expand my knowledge and skills in psychiatry, but as I reflect on my experiences and emotions, I am struck by severity of need, juxtaposed to the lack of resources and providers. I was challenged to interview patients in Spanish, think of differential diagnoses and make treatment plans- all skills that were invaluable to my training. But more than this I was encouraged to discuss the ethical dilemmas of providing resources and care in this setting and engage in thoughtful reflection on how to influence change.

I am so grateful to have been given the opportunity to work in Peru. It was a privilege beyond words to be invited into so many homes and share in the care of such amazing people. They had a spirit of resilience and kindness, unmatched to any place I have traveled.

Psychiatry is a unique field in which we are given the gift of sharing in someone's vulnerabilities, insecurities and sorrows and treating the very part of them that makes them who they are- their mind. In Peru, I found myself immensely moved by the strength of the bond between the psychiatrist and patient. This may have been due to the warmth and respect of their culture or to the skill and patience of my team.

As a student, I could not have asked for a better way to grow in clinical knowledge but more importantly as a person. I learned as much from my patients as my teachers, and the experience opened my eyes to a new appreciation for global mental health care and social problems.

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