Improving the System

College student Sourav Bose works to improve emergency response care in Guatemala.
September 1, 2009

Sourav Bose, C’11, W’11, has been working with emergency medical services since he was in high school. He volunteered with the local ambulance corps in his suburban New Jersey hometown, and at Penn he is a member of the Medical Emergency Response Team, a student-run service organization that provides emergency medical services to the University community. Despite his expertise in the area, Bose faced a new world of challenges this past summer when he volunteered with the 45th Company of Bomberos Voluntarios (volunteer firemen), the emergency response organization for the Maya town of Santiago Atitlán in Guatemala. These included climbing through mountain forests to retrieve cadavers and caring for patients during three-hour ambulance rides on unpaved back roads.

The experience was part of Bose’s summer internship, which was funded by the Blutt Internship Term Fund established by Mitchell J. Blutt, C’78, M’82, WG’87, and Margo Krody Blutt. As a Penn Civic Scholar and a major in the Vagelos Program in Life Sciences and Management (LSM), Bose was seeking an internship in a developing country that would allow him to do service work as well as conduct research that merged systems analysis and the life sciences. Penn’s Guatemala Health Initiative (GHI), an organization of Penn students working in partnership with Guatemalan communities to develop effective, sustainable and culturally sensitive health interventions, fit the bill.

“I learned that systems don’t work without people and culture and interactions—which isn’t all too clear when you’re in a lab setting.” - Sourav Bose

“It was a tall order, and GHI was perfect,” Bose says. “The program places a tremendous amount of trust in students and allows them to work with a lot freedom. It brings a lot of results.”

After graduation Bose plans to attend an M.D./M.B.A. program and eventually enter the field of disaster management. His goal in Santiago Atitlán is to understand and improve the pre-hospital care system there. “The town needs improvements to its disaster preparedness and emergency response,” Bose explains. “It sits between three volcanoes, and two years ago its hospital was destroyed by a mudslide caused by Hurricane Stan. The current hospital is a temporary replacement that operates out of a rented vacation home, and patients often need to be transported to other regional hospitals that are an hour and a half or more away.”

Working alongside the bomberos gave Bose the chance to both assist in their runs as well as analyze their practices through participant observation and qualitative interviews. He collected data on patients that the firemen assisted, such as when and where they were transported, their epidemiology and how they were treated. He also studied the bomberos’ scheduling systems, placement of resources and the cost-effectiveness of resource use. Additionally, he observed the firefighter’s interactions with each other, with doctors and with patients. And because there are currently no official records of patient outcomes, Bose is working on developing and implementing a system to gather this data.

Over the next year, Bose will analyze his data to identify changes in infrastructure as well as in the training and behaviors of the bomberos that will help improve care. He then wants to return to Santiago Atitlán to develop interventions that can be tested for effectiveness in facilitating some of these changes.

Bose calls his summer in Guatemala one of the best he’s had primarily because of the rewards—and challenges—presented by the relationships he built there. On one hand he developed close bonds with his host family, but on the other Bose also had to negotiate language barriers (he had to learn Spanish on site) as well as internal politics among the firemen and the perceptions they had of him as an American. These interactions added a crucial dimension to Bose’s understanding of how the bomberos work.

“I had already been doing statistical research with Dr. Roger Band at Penn Medicine on the calls that come into Philadelphia’s EMS,” Bose explains. “So, at the beginning of the summer, I thought, I’m a systems guy and I can learn a lot through collecting statistics. And then I became ingrained in the daily life of the town and worked with an organization that represented the town. I learned that systems don’t work without people and culture and interactions—which isn’t all too clear when you’re in a lab setting.”

The internship also helped renew Bose’s enthusiasm for LSM’s interdisciplinary curriculum. “Last year I was wondering how my accounting 101 and life sciences classes would eventually fit together in something I wanted to do,” he says. “This project has grounded my studies because I now see clearly how my classes will help me pursue it. That’s a revelation for me—to be completely immersed in my studies because I understand their impact.”