Hilal Akman '27: PACH internship in Ecuador

Welcome to Summer Spotlight: where HPA explores the summer experiences of our students.

Hilal Akman '27 completed an 8-week internship with Partners for Andean Community Health (PACH) in Riobamba, Ecuador, her first-year summer.

This summer I had the opportunity to complete an 8-week internship with Partners for Andean Community Health(PACH) in Riobamba, Ecuador. Riobamba, located in the Chimborazo province, is home to many rural communities and a large indigenous population where healthcare disparities are especially pronounced. PACH works closely with Hospital FIBUSPAM to improve healthcare accessibility and affordability in Andean Ecuador.


Hilal Akman in Ecuador

Projects

During my internship, I worked on three key projects:

  1. Cervical Cancer Screening, Treatment, and Prevention: Cervical cancer is a highly preventable disease, yet it remains a significant global health issue, especially in Ecuador, where it is the second-most commonly diagnosed cancer and cause of cancer death in women. My role was to create an intervention framework and project plan for cervical cancer screening, treatment, and prevention programs in Chimborazo. This involved reviewing past cervical cancer initiatives, conducting an inventory of supplies, recommending new equipment, and identifying barriers to care. I also developed educational material, tailored to specific audiences to increase awareness and acceptance of screening and treatment.
  2. Nutrition Project Implementation and Sustainability Planner: This project aimed to address the dual issue of malnutrition, stunting, and obesity, in Chimborazo. Building on previous research, I designed a comprehensive program that focused on nutritional support and education for parents and children. I also created educational material on maintaining a balanced diet and complementary feeding guidelines,
    incorporating local foods and nutrition.
  3. Educational Institution Health Study: My last project identified gaps in educational and institutional health outreach in rural communities around Riobamba. I discovered a significant lack of data in these areas, despite numerous health intervention programs in Ecuador. This gap is alarming because it hinders accurate health assessments and can lead to inefficient or even socially and culturally unacceptable interventions. To address this, I conducted a survey on the school environment, community health services, and women's health services in Riobamba. Over two ways, I visited more than 15 schools and surveyed over 100 school administrators and teachers.
Hilal Akman shadowing surgery in Ecuador

I also had the opportunity to work closely with FIBUSPAM staff. Whether consulting for my projects, learning about their daily lives, celebrating birthdays, or joining them in the OR, I was surrounded by amazing people. It was fantastic to be present in the hospital and shadow various specialties including gynecology, family medicine, ophthalmology, general surgery, pediatrics, and radiology. During the final week of my internship with PACH, I had the opportunity to join and assist with a medical caravan in the communities of Otovalo, Ecuador. Access to healthcare is a significant issue in these areas, as even though some communities may have health centers, these facilities often lack staff or essential equipment.

The caravan offered services from five specialties: general medicine, chiropractic care, dentistry, optometry, and gynecology. We also set up a pharmacy where patients could receive free medications. Over the course of two days, we treated over 150 patients and provided more than 240 different services. We performed cervical cancer screenings using colposcopy, treated cervical dysplasia with thermal ablation, distributed reading glasses and dental supplies, and even offered training in CPR techniques to the community.

I had the privilege of working closely with the gynecologists and directly engaging with the patients. One of the most rewarding aspects was holding "charlas," or informative discussion circles. During these talks, we covered a range of topics, including female anatomy, cervical cancer, the use of pessaries, and mental health. I had the opportunity to lead these discussions and assist with translation. Interacting with patients, addressing their questions, and helping them understand these important topics was very enriching. I firmly believe that prevention is just as important as treatment, and these charlas emphasized the importance of health education and awareness.

In line with prevention, during the caravan, I initiated conversations with community leaders and patients about cervical cancer screening and treatment. While my project allowed me to consult with experienced doctors and experts, I found that discussing with the patients themselves and those who are being served is just as important, if not more. These conversations gave me a lot of insight into the challenges that patients face and reinforced the significance of community engagement in addressing health disparities.

 

Living in a Different Country

Hilal Akman horseback riding in Ecuador

Being the only intern with PACH this year, I didn’t have a built in friend group that came down from Princeton with me. However, this turned out to be a blessing in disguise. It pushed me to step out of my comfort zone, make new friends. My new friends were always eager to share their culture with me, and so with my free time, together we explored the city and culture of Riobamba.

On weekends, I had the opportunity to explore and travel a bit more. I visited the beautiful mountains: Cotopaxi and Chimborazo and traveled to cities like Cuenca, Quito, Mindo, Baños, Guaranda, and Ambato. I watched numerous local events such as desfiles (parades). I got to experience music, traditional dances, and saw traditional clothing that I had never seen before. Visiting markets was another activity I loved doing. Being a part of such vibrant places, people, vendors and shoppers all chatting was amazing. I got to explore, learn about local goods and ingredients, and really understand the daily life of the people here.

Another highlight of my experience was the culinary adventure! I tried a variety of traditional Ecuadorian foods and many many different fruits which was probably my favorite part. The fruits were never-ending ranging from tomate de arbol, guanabana, passion fruit to dragon fruit and guava.

Beyond having so much fun through these cultural experiences, they also strengthened my belief in the importance of respecting and valuing different cultures. I believe it is crucial to get to know people from all over the world and to experience different cultures in order to develop a broad worldview and an open mindset. These experiences also deepened my understanding of the importance of approaching my work with cultural sensitivity and fostering a deeper appreciation for the communities that we served—an essential aspect, especially in the field of healthcare.

 

Skills

During my internship with PACH, I think that I was able to gain several valuable skills and significant insights. This experience really complimented my education by allowing me to take on real world projects in the world of healthcare and global health. I had the opportunity to work and communicate closely with doctors, health professionals and patients in a low resource setting. I learned about the challenges and
solutions in providing healthcare in underserved and resource-limited areas. It was really interesting to see firsthand how social determinants of health, such as poverty, education, access to clean water and food significantly impacted the community's well-being and often created barriers in accessing healthcare and contributed to health disparities.

Hilal Akman with rural healthcare team in Ecuador

In this context, I found it extremely interesting to observe the interactions between doctors and public health workers. There were times when differing opinions arose between these professionals. This provided me valuable insight into how balancing these perspectives required making decisions that were not always straightforward but necessary given the resource constraints and unique challenges of low resource and developing countries like Ecuador.

I was really able to improve my project management abilities by managing various health projects, ensuring they were completed on time and met their objectives. I coordinated and consulted with various people including my supervisor Zac, and other members of PACH and doctors and health professionals of Hospital FIBUSPAM.

The internship also improved my problem solving and adaptability skills. I learned to address challenges and adapt plans, and develop creative solutions, all while utilizing my critical thinking skills. Working within the specific context of healthcare in Chimborazo, I learned to analyze problems through the lens of the local environment. This deepened my cultural competency, as I learned to understand the unique
challenges faced by the communities we served and develop solutions that tailored to their specific needs.

Additionally, communications–especially cross-cultural communication–was another critical skill I developed during my internship. I improved my ability to effectively communicate with individuals from diverse cultural backgrounds, learning to navigate language barriers and cultural differences. My Spanish language skills also improved significantly, not only through classes but also from daily interactions with patients and staff at Hospital FIBUSPAM.

 

Overall Experience and Advice

This internship has not only allowed me to contribute to meaningful projects but has also been an incredible experience for my personal and professional growth. It has really solidified my passion for global health and my commitment to working in underserved communities. I have always wanted to pursue a career in medicine and this experience has reinforced that this is indeed what I want to do, with a focus on global health.

I think that my favorite part of my internship was the relationships that I formed and all the amazing people that I met in these two months. None of this would be possible without hours of hard work and commitment, and I am deeply inspired by the dedication and passion of everyone I worked with. Growing up, my dad always reminded my sisters and me to "live for others," and this experience has emphasized
how significant that principle is to me. Working alongside committed and selfless individuals within PACH and Hospital FIBUSPAM was invaluable and motivates me to continue serving others in the future. I had an incredible experience in Ecuador and saying goodbye was extremely difficult, but I know I have gained another family in Ecuador, and that these relationships will be long-lasting. I am eager to
continue working together and to return to Ecuador very soon!!

I found this internship through the International Internship Programs (IIP), and it perfectly aligned with my career aspirations in medicine and global health that are centered on prioritizing empathy and community engagement. I am passionate about and deeply enjoy engaging with communities, understanding their unique experiences and building meaningful relationships–all of which are crucial to effectively addressing people’s needs. As I explored all the different programs, I looked for opportunities that embodied these values, which led me to PACH. Their mission to improve Andean community health, with a focus on education, resources and sustainable solutions, resonated with my own values.
I would also advise them to look for internships and programs that align with their personal and professional goals. I think identifying organizations whose mission and values resonate with yours, will make your work more meaningful and enjoyable. Be open to new experiences.. I think it is so important to step out of our comfort zones. Whether that is learning a new language, engaging with different people and cultures, adapting to a new environment, these experiences are so valuable and allow us to grow so much. While in your internship, focus on forming meaningful relationships with those that you are working with. Not only will those connections provide support and motivation but will teach you so much. The relationships that you built during your internship can be just as important as the skills that
you will develop.

My advice for first and second years seeking internships is to fully utilize the wealth of opportunities available to us at Princeton. The university offers a wide range of programs and internships that many students at other schools may not have access to, so it’s important to not only be grateful for these resources but to take full advantage of them.

I would also encourage students to seek out internships and programs that align with their personal and professional goals. Finding organizations whose mission and values resonate with yours will make your work more meaningful and enjoyable.

Additionally, be open to new experiences and willing to step out of your comfort zone. Whether it’s learning a new language, engaging with different people and cultures, or adapting to a new environment, these experiences are incredibly valuable and contribute significantly to your personal growth. During your internship, focus on forming meaningful relationships with those you work with. Not only will those connections provide support and motivation but will also be incredible learning opportunities. The relationships that you build during your internship can be just as important as the skills that you will develop.