The teaching of medicine at Universidad del Valle

The first formal attempt for medical education in Valle del Cauca was in the Faculty of Medicine and Surgery in Buga, which was part of the Colegio Académico between 1866 and 1871. It only had one graduating class of ten physicians in 1871. Its foundation was contemporaneous with the faculties of medicine at Universidad de Antioquia and Universidad del Cauca; the reasons for its prompt disappearance are unknown.

The professional training concerns of the región were maintained through the creation of the Sociedad de Medicina del Cauca (Cauca Medical Society) in 1887, which gave rise to the Boletín de Medicina del Cauca (Cauca Medical Newsletter) (1887-1910) which published the works of Evaristo García and his partners Daniel Quijano Wallis, Pedro Pablo Scarpetta, Agustín Escobar, Enrique Garcés, Adolfo Tenorio, and Pablo García Aguilera, among others.

The need to create a school of medicine in Cali was aired since the 1940s among trade groups at the Colegio Médico del Valle (Valle Medical School), although some thought that the warm climate in Cali was not suitable for intellectual development because such required cold environments like those in the Cundinamarca and Boyacá plateau. History managed to reveal how wrong these believers of geographical determinism were.

The Humphreys Mission, commissioned by the National Government in 1948, delivered a bleak report (1950) on medical education in Colombia suggesting the creation of new medical faculties, among them one in Valle del Cauca.

Guillermo Orozco, a physician from Anserma and living in Cali, with support from the Colegio Médico del Valle, managed to get the Governor, physician Antonio Lizarazo, to expedite Decree 641 of 1950, ordering the creation of a faculty of medicine affiliated to the recently created Universidad del Valle. The University had been founded in 1945 with the name of Universidad Industrial del Valle del Cauca; the name was changed in 1954 to Universidad del Valle when the Dean of Medicine, Dr. Velásquez, was designated Departmental Secretary of Education.

With support from Carlos Arturo Cabal, then Rector of the University, in November 1950, the Governor named Dr. Gabriel Velásquez Palau, a physician from Cali, as Dean of Medicine.

Classes began on the 12th of October of 1951 with fifty students at the former convent of San Agustín already converted to Colegio de Santa Librada, located in Carrera 4 with calle 13; the medical practices took place at the San Juan de Dios Hospital.

Excited by the collective dream of accomplishing a change in medical education, prestigious professors started arriving in Cali from many latitudes like Jorge Araújo Grau, Luis María Borrero, Plutarco Naranjo, Pelayo Correa, Carlos Restrepo, Jorge Escobar Soto, Miguel Gracián, Jaime Korgi, Carlos León, Lupi Sergio Mendoza, Santiago Rengifo, Vicente Rojo, and Carlos Sanmartín, among others. This group of adopted «Caleños» joined prestigious local physicians, many of them trained abroad with support from the Kellogg and Rockefeller Foundations, until forming a critical mass, a sort of athenaeum of the enlightened, which would change the Colombian and Latin American educational model, and even influence on the global educational model.

The influence from Universidad del Valle may be synthesized through various contributions that became reference points. For didactic purposes, they are presented in isolated manner, but in practice these accomplishments were closely linked to each other.

  1. The initial educational proposal was inspired by the recommendations of the Flexner Report for medical education in the USA: neglect of eminently theoretical education, with great emphasis on anatomy and based on the authority of big figures or clinical chiefs, to develop another one based on the emphasis of basic sciences and learning next to the patient, along with a more democratic relationship between the professor and the student. This learning process close to the patient and to the disciple required a closeness of the professor with the faculty, which in Hopkins since 1914 was reflected in teaching with «exclusive dedication». At Universidad del Valle, this model was adapted as «geographic» time of exclusive dedication: professors were paid to teach while conducting their private practice where they were teaching.
  2. But the classical Flexner model was son modified, improved, we could day, with the addition of the social dimension. Community medicine was added to the departments of basic and clinical sciences, which son evolved into the Department of Preventive Medicine and Public Health, years later called Social Medicine. The idea was that students would become familiarized with the diseases from the social context in which they were developed so they could better understand the diseases and the patients. The departmentís teaching purposes were joined by the need to conduct research and offer consultancy to government entities. Siloé, was the first neighborhood where the students carried out their medical practices. Santiago Renjifo Salcedo, professor of parasitology, was the heart and soul of this novel focus, adopted then by the rest of the medical faculties in Colombia, which until then could only timidly show hygiene cathedra.
  3. Obligatory Social Service, approved since 1948, was only complied with when it was changed to Compulsory Rural Medicature. Universidad del Valle responded by signing an agreement with the Departmental Government for the Health Care Center-Hospital of the municipality of Candelaria to be outfitted for the Rural Medicature practices and, thus, offer a physical space in the rural setting, where the young professionals could comply with the legal requirements, acting as a group and supported by the University.

Soon, Candelaria turned into a research hub for the whole University. A novel housing improvement program was conducted with the Faculty of Architecture. The Department of Nutrition, headed by Leonardo Sinisterra, established a Home for nutritional recovery. An innovative health care volunteer program was begun who focused on home visits to detect pregnant women and malnourished children. These experiences, exposed by Gabriel Velázquez at the World Health Organization, became the base for the World Program on Primary Health Care Service, approved years later at the Alma Ata meeting.

An aspect in the evolution of the Faculty of Medicine at Universidad del Valle has gone unnoticed and has not received the importance it merits. It is the reorganization of the diverse faculties, to create the Division of Health, registered in Agreement 04 of 1969 by the Directive Council, signed by Alfonso Ocampo Londoño, Rector. In addition to placing the faculties of medicine, nursing, medical laboratory, and physical therapy under the academic authority of the Division of Health, conceptual definitions were made that would thoroughly transform the educational model in effect at the time.

Numeral 5 of the 3rd article of the aforementioned Agreement defines as an objective of the new division to prepare the professional and para-professional personnel required… for the health care system. Personnel had to be at the sufficient level, number, and quality to decrease morbidity and mortality in the Colombian south western area. It was not enough to train the best professionals as they had so far been trying to do, but rather it was necessary to train all the human resources necessary and sufficient to help improve health conditions, especially in the Colombian south west.

Numeral 2 of the same 3rd Article ordered to design, experiment, and promote ways of improving the productivity of the Colombian health care system. The University had to investigate the reality of its environs and the ways of improving the systems and factors affecting health care services. Therein, emerged the revolutionary System of Simplified Surgery, directed by Adolfo Vélez Gil; the renowned University Center of Population Research (CUIP for its name in Spanish) directed by Ramiro Delgado; the Research Program on Operational Health Care Models of Rural Development (CIMDER for its name in Spanish). The Department of Stomatology, with Gustavo Ulloa and Fernando Barreto, began to train Odontology Aides (following a very successful model developed in New Zealand).

As a corollary of the prior considerations it was decided that the University should always be willing to collaborate with municipal and departmental administrations and make it possible for its professors to hold public office.

This change in paradigm of the educational model placed the University in front of its reality and admonished it to comply with its high purpose of academic formation while helping to solve health problems.

The projection of all these innovations of the new educational paradigm at Universidad del Valle had begun with the First Congress on Medical Education held in Cali in 1955, which was attended by representatives from all the faculties in existence in the nation and then with the creation of the Association of Medical Faculties in 1959, promoted by Gabriel Velázquez and José Félix Patiño. Then through the Pan American Federation of Medical Faculties, the innovations were projected throughout the continent.

We sought to create a narrative memory of these events during this year when we are celebrating 60 years of the foundation of our Faculty. And to summarize, it may be said that the Faculty of Medicine at Universidad del Valle was not so much the «gardenia in the swamp» as defined in somewhat pessimist manner at one point by Santiago Renjifo, but rather the flower that transformed the swamp into a lake, and the stone that upon falling on the quiet lake of medical education in Colombia, produced important concentric waves that are still felt to this day.

Rodrigo Guerrero, MD, DrPH
Honorary Professor, Universidad del Valle
Cali, Colombia, e-mail: guerrerr@yahoo.com

Pedro Rovetto, MD
Full Professor and Head of the Department of Pathology, School of Medicine, Faculty of Health,
Universidad del Valle, Cali, Colombia
e-mail: rovettos@gmail.com