By: Crystal Long

On the border of Venezuela sits the small city of Cúcuta, Colombia, one of the most heavily trafficked border crossing points for fleeing Venezuela refugees. The city struggles under the weight of a massive exodus of over 4.6 million people escaping a protracted political and economic crisis in Caracas.

For those trying to rebuild their lives, leaving the turmoil behind is often only the beginning – most arrive to Cúcuta suffering from malnutrition, without money, and with nowhere to live apart from makeshift squatter shacks in sprawling, malaria-ridden refugee encampments.

Complicating matters, control of the area is contested between the Colombian military and the Ejército de Liberación Nacional, or ELN, a militant guerilla group known for carrying out attacks on infrastructure and government targets to exert control of the border.

The situation is difficult and desperation often leads to volatility in the refugee camps, but it is here that Riley Jones, M.D., DTM&H, a global health postdoctoral associate in the University of Florida College of Medicine’s department of medicine, is in his element.

Jones arrived in Cúcuta in mid-February 2020 to work in the camps, where he would apply his training in internal medicine and tropical diseases to the humanitarian crisis and provide treatment to Venezuelan refugees.

At first glance, Colombia appears to be a dangerous place, volatile and violent. Jones recognizes the conflict and instability, but added, “Like most places, one of the keys to working safely in Cucuta is learning how information spreads. It’s usually there, you just have to learn how to listen for it. For the most part, people are reasonable, especially when it comes to medical services.”

Surprisingly, movement and safety information that Jones and his local colleagues came to trust came from the local hair salons. According to the gossiping customers, a tell-tale sign of trouble is a lack of taxi traffic. If the taxis are running, you are probably safe to go out. If not, you should stay inside.

Within a week of his arrival, Jones received a recorded message, delivered on WhatsApp. It was a warning from the ELN that they would enforce a border lockdown for the next 72 hours – anyone attempting to cross, except for medical personnel or for medical reasons, would be killed.

Jones is part of a niche group of internists who focus on the long-term assistance that is needed to rebuild the health care infrastructure of areas such as Cucuta that are recovering from conflict or civil war. His research as part of a fellowship in global health has led to several trips outside of the U.S.

Global health has traditionally been a profession of solitude, but Jones, and others, are working to change this by integrating their families. His travel companions include his wife, Rachel, and 3-year-old daughter Coraline. Jones acknowledged that traveling with his family isn’t always easy, but he said they’ve learned to adapt.

“Early on, we had to come to an understanding on what is negotiable and what is nonnegotiable for us as a family,’’ he said. “Every day, we designate family and play time with our daughter as nonnegotiable.”

As a family, they have figured out what amenities are wants and what are needs: Reasonable access to food, shelter, clean water and safety for his family are necessities.

The key, he said, is being able to adjust to a new culture, learn how to prepare and have realistic expectations. For example, Jones would buy bags of reliably clean water from the same man every day on the same corner of the road.

“My idea of what is negotiable has changed since I first began traveling,’’ he said. “You can’t expect to always have access to running water, cell phone service or electricity.”

You also learn to expect the unexpected. Jones recalled how quickly things changed when COVID-19 first came to the area. Knowing the order would soon come to evacuate, he did his best to prepare his local counterparts for the coming COVID-19 surge.

One major effort was putting together a public health education campaign to teach handwashing, social distancing and principles of practical case identification and isolation to the residents of El Talento, the largest of the refugee camps. Less than a week after learning that COVID-19 was in South America and three days into the educational campaign, he and his family were given 24 hours to evacuate.

Upon returning to the U.S., he was immediately back at work at UF managing patients admitted with COVID-19, developing and disseminating treatment protocols, and working with UF epidemiologists on research and community contact tracing.

As the pandemic grew, he was asked to present webinars for UF’s international partners and nongovernmental organizations such as MedGlobal and the United Nations High Commissioner for Refugees on adapting COVID treatment protocols to low-resource settings and refugee camps.

His experiences, Jones said, have prepared him for an outbreak like the novel coronavirus pandemic.

“Not to lessen the seriousness of the pandemic, because this virus deserves respect, but reusing PPE and working with limited resources is not unusual in global health,’’ he said. “My experiences in South America and West Africa, for example, where I’ve had to reuse the same mask, gown and goggles for multiple days, has prepared me for this like no other practice could have.”

When he was in Colombia, Jones partnered with MedGlobal to work in a small clinic in Cúcuta. He noted the importance of working with the local doctors and respecting the way they have to practice medicine in their country. Each provider arrives with their own specialty and background, but you have to be prepared for anything.

“To be successful, you have to be flexible, but it also requires a sense of self-awareness and knowing your limitations,” Jones said. “You cannot take a cowboy approach to medicine, no matter where you are in the world.”

Recognizing that some physicians may be hesitant to travel to conflict areas to provide medical care, Jones views it as vital to his career satisfaction and family life.

“When we set out to clarify, as a family, our shared sense of vision for our one life, we kept coming back to our work in global health,’’ he said. “UF sees the value in what we’re doing in these refugee and conflict zones, so we’ve made it work well for us and for UF.”

As more stories appear in the news about physician and health care worker burnout, he said, “Practicing in recovering countries reignites me. There is a return of purpose when you consider what you’re doing here. The problems are incomprehensibly large and so many are in need of urgent help, but you do what you can for one person at a time. Drop by drop, rivers are made.”

By: Lauren Gajda

Even after 10 years and more trips than she can count, when UF Health pediatric surgeon Robin Petroze, M.D., M.P.H., moves about in Rwanda, she’s still called “Mzungu.’’

Translated as “foreigner’’ or “outsider,’’ the word reminds Petroze of the importance of building strong collaborations with the small medical community serving this country of 12 million in East Africa. As with any type of mission trip or international academic venture, she said, the important thing is to avoid a savior complex and to develop sustainable local relationships.

“Given the history within Rwanda, you have to remember that you are a guest and have the option of leaving,” said Petroze. “It’s also really important to understand your role and the historical/political context in which you are working. Going in unprepared is one of the most dangerous things you can do.”

Petroze’s passion for Rwanda began when she was a general surgery resident at the University of Virginia and spent two years as a research fellow in the country studying the burden of surgical disease and contributing to surgical education.
Now an assistant professor in the UF College of Medicine’s department of surgery, she travels to Rwanda to deliver care in their 520-bed hospital as well as mentor, train and teach medical students and residents.

There is only one pediatric surgeon in the country, so for nearly two years, Petroze has provided some clinical respite for him and filled in as a faculty member at the University of Rwanda on the pediatric surgical service. Together, they are developing outcomes research and quality improvement projects for neonatal surgical conditions.

Before her first trip to Rwanda in 2009, Petroze researched the nation’s history. Much of what she learned dealt with the 1994 genocide against the Tutsi ethnic minority, where close to 1 million people were killed during a 100-day period.

Since then, Rwanda has developed a reputation as one of the safest places in the world, according to websites offering advice for travelers. The ongoing COVID-19 pandemic, however, has led to a travel advisory from the U.S. Department of State about traveling to the country.

Petroze said she has been able to do her work in Rwanda without fear for her safety. “I feel more comfortable there walking on the streets than I do here in the United States,” she said.

The genocide wiped out the health infrastructure in the country. In the early 2000s, Rwanda had the worst health indicators in the world with the highest maternity mortality and the worst child survival rates. Since then, the country has made dramatic strides in health care development with a substantive focus on health equity.

“Seeing both the need, as well as a government and a population that is really engaged in making changes, are part of why I chose Rwanda,” said Petroze.

Much of Petroze’s international work is done in academic collaboration with surgical training programs around the world. She is involved in the College of Surgeons of East, Central and Southern Africa, or COSECSA, which is the regional college for higher certifications of surgeons in regards to education, research and publications and is similar to the American College of Surgeons in the U.S. COSECSA has worked to standardize training certifications in different regions in order to improve access to surgical care in multiple nations.

While Rwanda is considered relatively safe for travelers, regional conflicts, particularly in the neighboring Democratic Republic of Congo, and significant health concerns such as Ebola are present. Over her time in Rwanda, Petroze has noticed times when there have been larger refugee populations from conflicts in bordering nations.

“I’ve had to trust the local government and my direct colleagues to tell us what is happening in the country,” said Petroze. “Trusting others has allowed myself to be more vulnerable, which can be both scary and liberating.”

Petroze’s passion for global health and providing care in distant countries is rewarding, she said, but it can also be emotionally challenging.

“There are times when you do the right thing, but the patients don’t survive because you don’t have the same resources you have here in the U.S.,” she said. “Some conditions we treat as pediatric surgeons have a 95% survival rate here and a 5% survival rate there.

“Sometimes, going back and forth can be frustrating and heart-wrenching,’’ Petroze said, “because you know there are kids in parts of the world who have access to great health care and kids in other parts who don’t.”