Recently I had the opportunity to pilot a new psychiatry elective at the Mental Health Commission of Ayacucho in Peru. Beyond everything I learned about the practice of psychiatry, it was also one of the most personally meaningful experiences of medical school for me. 

In Ayacucho, where James Phillips, M.D., associate clinical professor of psychiatry, and Mark D. Rego, M.D., lecturer in psychiatry, have developed an international psychiatric collaboration, about 25,000 people died in the conflict between Shining Path terrorists and the Peruvian military between 1980 and 2000. Today a different type of violence predominates, with most of our patients reporting histories of physical or sexual abuse. 

In the setting of such violence, however, I was struck by the widespread desire to overcome terrible circumstances. Two cases stood out. 

In the first, a middle-aged woman with severe cognitive impairment came for follow-up care, accompanied by an elderly Quechua woman. When I asked if they were related, the older woman replied, “No, but she was living on the street and people were mistreating her. I just couldn’t leave her there.” And so this elderly woman had brought a stranger into her house and cared for her for the past five years in spite of the latter’s substantial behavioral difficulties. 

Later, a man in his 30s sought help in controlling his aggression. Every two or three weeks, he admitted with shame, he would drink heavily and beat his wife. Then his 7-year-old son would wet his bed. Suddenly, he was jarred by memories of wetting his own bed at that age after seeing his father come home drunk and beat his mother. He was ready, he said, to “break this cycle of violence.” 

I admire the courage of our patients and their caretakers to make better lives for themselves and others, and I am grateful to have been a part of this healing process. I highly recommend the rotation to other students and thank my mentor, Alfredo Massa, M.D., FW ’09, for his dedication. 

Tyler Dodds
Yale School of Medicine
Class of 2011