From Bolivia to Mankato: Residency helps doctor bring hospice care home
Jul. 28—After a residency learning from hospice care teams in Mankato, Dr. Brenda Toboada Ovando said she hopes to expand access to the services in her home country.
The Bolivian doctor recently completed the three-week residency, most of it spent in Mankato, working with and shadowing Mayo Clinic Health System's hospice and palliative care providers, chaplains, case managers, social workers, volunteer coordinators and more.
Hospice care isn't yet common in Bolivia, Toboada said, and the experience in Mankato affirmed her belief in how helpful it would be.
"For me hearing the patients and how they (the care team) really help them, it's the reason for everything and makes me say, 'Yes this is the way I want to go,'" she said.
Toboada has faced challenges trying to talk to patients and fellow providers about end-of-life care over her years in the field. End-of-life discussions can be an uncomfortable topic.
"We don't talk about hospice and most people don't have that care at the end of life because we're not used to talking about that," she said.
As Dr. Jennifer Derrick, a palliative medicine physician with Mayo Clinic Health System, put it, sometimes "hospice needs a champion" like Toboada in order for more patients to access it.
"You need somebody who loves it and somebody who says this is a worthwhile endeavor," Derrick said. "It's not something most people want to think about or talk about."
Derrick and colleagues Betsy Bolint, an advanced practice registered nurse in palliative medicine, and hospice chaplain Jacek Soroka, recall similar challenges for U.S. providers. People hesitated to talk about death and dying and therefore hesitated to talk about hospice care, Soroka said, but more people are recognizing it's part of life and part of health care.
Toboada also felt the people she'd talk to about hospice in Bolivia weren't as open to the discussion because she was a general physician rather than a specialist. In response, she's working on a specialization in internal medicine.
Between the specialization and her residency experience, she's optimistic more people will come around on the idea. Hospice care could gradually follow in the path of palliative care, or specialized medical care for people living with serious illnesses, which is starting to become more available in Bolivia.
One of Toboada's main takeaways from the residency was seeing the hospice program's patient-centered approach. She spoke about seeing the appreciation that patients showed to their hospice team for bringing them comfort in their later stage of life.
When Toboada found out about the residency opportunity, she said she felt disbelief. It all set in once she arrived, and she said she's been taking in as much information to bring back as possible.
"I'm like a sponge," she said with a laugh. "I'm trying to catch everything."
For the hospice and palliative care teams in Mankato, working with Toboada helped put the work done locally in perspective, Bolint said.
"It's humbling to recognize the resources we have at our disposal," she said.
Conversations between Toboada and Mayo Clinic Health System will continue after she returns home. A trip in the other direction could someday happen.
"We hope this relationship continues and hopefully some of our providers will go to visit Brenda or maybe we can work together to organize a conference," Soroka said.
Funding through the Mayo International Health Program supported Toboada's residency in southern Minnesota — she went to Mayo Clinic in Rochester after Mankato. The Mankato team said they'd be open to more residencies if it means more patients around the world end up benefiting from their hospice and palliative care approach.
"It's humbling to know that the work we do will be shared with others across the world and Bolivia," Derrick said.
Follow Brian Arola @BrianArola
Follow Brian Arola @BrianArola
