Featured, Preclinical
comment 1

A Drop of Water On a Parched Wasteland


K-Constantino

I was on a plane heading towards Santiago, the capital of the Dominican Republic. From there, I would take a two-hour bus ride to Mao Vallerde, where we would be working for most of the week. I was going on a global health trip through Jose’s Hands, an organization that sponsors medical students interested in going on mission trips. For this particular trip, they had partnered with One to the Other Ministries, a Tulsa-based ministry involved in both medical and non-medical mission trips since 1986. This being my first global health trip, I had no idea what to expect other than the usual warnings of tropical diseases endemic to the area.

I have always dreamed of being involved in global health work. For me, there was something exciting about traveling to medically underserved areas and working out of my comfort zone. According to the 2014 Matriculating Student Questionnaire published by the Association of American Medical Colleges, almost two-thirds of matriculating medical students expect to participate in a short-term experience in global health during medical school. In turn, medical schools have responded to this interest by creating programs that provide students opportunities to participate in global health work. A literature review from BMC Health Services Research reveals that medical missions were viewed by physicians as opportunities to remind them of their reason for pursuing medicine. In addition, short-term global health experiences were felt to provide significant educational opportunities that is crucial to developing globally-aware health care providers.

Nothing could have prepared me for the rush of emotions that welled up within me with each patient encounter. There were some patients who were there to ask for vitamins, simply because they lived in a community where malnutrition was rampant, and others who needed access to lifesaving medications like antibiotics. One such patient stands out firmly in my mind. He was wearing rubber slippers and his feet were caked in mud up to his knees. He had been complaining of difficulty with urination and was diagnosed with a UTI several weeks ago but couldn’t afford to buy his antibiotics. I still remember him leaving, clutching the tiny bag of antibiotics to his chest. I will always remember the gratitude in his eyes and the elation that I felt when I learned that the antibiotic he was prescribed was available in our formulary.

However, there were times when the need was truly overwhelming. It was our second day and we were located in Cerritos Gordo, a town less than twenty miles from the Haitian border. Our patient population was largely Haitian and communication was a challenge, as we needed interpreters in Creole and Patois. There were some patients that we really couldn’t do anything for except to tell them that they needed to go to the local clinic or hospital. As they left, a picture of dejection, the interpreter that I was working with explained to me that it was unlikely that they would go to the hospital or clinic since a good number of them were undocumented. It was during those times that I felt frustrated and helpless, that what we were doing was merely a drop of water on a parched wasteland.

Dr. Yi Jiang, the resident who worked with us, warned about these frustrations on our very first day. Born and raised in the Dominican Republic, she completed her medical education in Poland before working on several long-term mission trips with Cure International, an organization that operates charitable hospitals in underserved areas worldwide. She warned us against developing a savior complex: “If you do not have humility, it will be given to you.” It seemed that each day was a lesson in humility as I quickly learned that the therapeutic interventions I had learned in school were things that my patients could barely afford. In one specific community, there was a large volume of children with suspected intestinal parasites. My suggestion was to prescribe anthelmintics, but the local doctor that I was working with interrupted my thinking. “Think about what the root of the problem is. The children drink contaminated water because they have no other water source. If we were to do that, then they would have to take anthelmintics every day. You can tell them to buy filtered water but they cannot afford that,” she explained. I realized then that aside from focusing on a short-term solution, what I needed to do was focus on preventive measures, such as education on water purifying measures. It was easy to overlook something as simple as water when looking down from a first-world perspective. I realized that in order to treat my patients, I needed to look at their problems from their perspective.  

Throughout my trip, I realized why more and more medical students were interested in global health experiences. According to 2012 Journal of Graduate Medical Education article, the number of U.S. medical graduates who participated in global health experiences rose from 6 percent in 1984 to 31 percent in 2011. Although it is difficult to pinpoint a single cause, I believe that part of the reason is that we are looking for ways to reconnect with the reason why we became doctors. As a medical student, it is easy to get lost amidst a barrage of never-ending examinations that seem to hold little or no relation at all to actual patient care. I remember moments of frustration memorizing different microorganisms with their all too-similar presentations and their easily confused treatments. When faced with a patient who had possible Leptospirosis, I was quick to bemoan my inability to recall the responsible agent and the appropriate antibiotic. I remember thumbing through my microbiology text after the incident, properly chastised. As Dr. Jiang succinctly explained to me, “It is very humbling for a doctor to realize that although I have this body of knowledge, although I know exactly what is the best course of treatment, what tests I need to order, I cannot do anything for my patient because I don’t have the resources. It really brings you to the core of medicine and the reason why you became a doctor.”

As cliché as it sounds, I believe that all medical students took up medicine because we have a passion to heal others. It is not our medical equipment nor our medications, not our medical journals nor our medical knowledge that marks us as doctors. Rather, it is the burning desire in each of us to alleviate human suffering by treating the human body. It is this desire that fuels late-night study sessions and practicing procedures endlessly. It spurs us to go to areas where health care is nonexistent and without any thought of recompense. Thus, global health opportunities provide us with an intimate experience of the need for health care. Once you feel that need, it forces you to work harder to become a better doctor for the sake of your patients. I believe that this unending struggle is at the heart of every doctor.

Krishna Constantino Krishna Constantino (3 Posts)

Writer-in-Training

University of Illinois at Chicago College of Medicine


Currently an M2 at University of Illinois at Chicago College of Medicine. Interests include global health, health disparities, and emergency medicine. Also enjoys photography, classical music, travel, and medical history. Will work for dessert.


  • Aguas De Unidad RD

    Santiago IS NOT the capital of the Dominican Republic. The capital city is Santo Domingo. https://en.wikipedia.org/wiki/Santo_Domingo. Mao, VALVERDE, is 45 minutes from Santiago, which is the second largest city in the Dominican Republic. Please get your facts & names straight before publishing. Thanks. 🙂