By Dr. D. Sofía Villacís Núñez
Following graduation from medical school in Ecuador, I was determined to pursue pediatric training in the United States. After two hard years of study, while practicing medicine in an underserved community in my home country, I matched in a large pediatric residency program in Miami.
The transition to a new country was relatively smooth thanks to my cultural similarities with the large Latinx representation in South Florida. In contrast, adjusting to the use of electronic medical records, morning reports, and multidisciplinary rounds in a new healthcare system was challenging at the beginning. Nonetheless, I felt privileged to be able to care for and learn from multiple patients with chronic medical conditions, many of whom called our center their medical home. Amongst them, I found patients with rheumatic diseases to be the most intriguing, not only because of how rare these conditions are in children, but also due to the scarce exposure I had to this branch of medicine during my medical education in Ecuador.
This sparked my interest in pediatric rheumatology, and I spent two months of my residency on a pediatric rheumatology elective. In that time I learned how to do a proper joint exam, how to approach a patient with suspected rheumatic disease, and how to disclose the diagnosis of a rheumatic disease to a family, among other important lessons that would later prove to be very valuable. As my fascination with this field continued to grow, I wondered why similar patients were not as common in Ecuador. I soon understood that this was not due to a lower prevalence of pediatric rheumatic disease in the region, but to the lack of subspecialty care access, as, at the time that I was undergoing my medical training in Ecuador, there were less than a handful of pediatric rheumatologists in the entire country. This realization saddened me, as I thought of the patients that might not receive adequate care due to the lack of provider awareness and subspecialty care access. This further fueled my interest in the field and motivated me to pursue a pediatric rheumatology fellowship in Atlanta upon completion of my pediatric residency.
Two of the most challenging and rewarding years of my training came next. Merely six months after starting my fellowship training, a global pandemic struck and forced everyone in the world to redefine the standards of “normal.” I was unable to travel home to visit my family for over a year and a half. These were emotionally draining times, through which I would not have been able to get through without the support of my husband and sister who live in the United States. Despite battling with homesickness and concern for the welfare of my relatives, I felt encouraged by my family to continue my training in the United States.
I was fortunate to meet and learn from patients with rare rheumatic conditions, diseases estimated to have a prevalence of three per one million children, and others that are even more rare. I have also cared for several patients with hyperinflammation in the setting of the novel multisystem inflammatory syndrome in children due to SARS-CoV-2. In addition, through research within my fellowship program, I have been involved in a project aiming to understand how the new virus affects the lives of pediatric patients with rheumatic diseases on immunosuppression, and have participated in describing the outcomes of multisystem inflammatory syndrome in children. As much as I would have loved to be home during the pandemic, I realize now that I would not have had these opportunities had I stayed in Ecuador.
I now look forward to completing my fellowship training with the hopes of someday being able to join forces with scientists and physicians in my country, to increase awareness about rheumatic diseases and potentiate the field of pediatric rheumatology in Ecuador.