Outside apartment 13C the street is empty. It is early in the morning, and yet sounds echo from the metal shop beside the lake, roosters crow, and the children upstairs patter back and forth across the tiles. I roll up my yoga mat, shaking dead cockroaches from its rubbery bottom. Through the grated windows I catch a glimpse of Lake Victoria, shimmering out from the cluttered shore of shanties and deconstructed docks to eventually blend with the blue of the morning sky.
I recently returned from a medical outreach trip I went on with other students from my school. We traveled to the state of Gujrat in India and treated patients from a very rural population. Medical outreach trips are an excellent experience for medical students still in their pre-clinical years because they allow you to see firsthand the information you are learning and apply skills you have been taught.
One such opportunity was presented to me the same week of my acceptance phone call earlier this spring: a fully-funded trip to a previously unattended region of Nicaragua with a volunteer medical brigade. It was led by physicians from my institution looking to recruit our entering first-year medical school class to help lead the trip.
Ana and I sat at that table for a few hours, enjoying each other’s company and stories told in choppy combinations of Spanish and English, some laughs of word-finding frustration spattered throughout. We talked about her daughter and grandson who lived with her, the colorful birds that were caged in her open-air courtyard, and the fact that I had come to Antigua from North Dakota to work with the God’s Child Project. As fond as I am of this memory, now that eight years have passed, I look back on my time in Guatemala with some degree of uncertainty about my intentions. I was what many would call a ‘voluntourist.’
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 at 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 that has been doing mission trips, both medical and non-medical, 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.
In medicine, there is a saying that the training is onerous but the rewards are many. More often than not, these rewards come coated in a myriad of shapes, including lucrative incentives, personal gratification, warm contentment and sated joy. For some physicians, a last wound-closure of the day, a smile on their patients’ faces, or warm, heartfelt regards from the people they care for carry immense significance. Yet, for many others, lucrative incentives seal their fate, becoming a bane to the integrity of the medical profession as a whole.
It’s okay that you forgot who I am. My name is David, and I was the student doctor that made the orthotic you wore on your leg for a year. Do you remember where we were when we met?
In undergrad chemistry lab, you likely were introduced to the terms accuracy and precision, often represented visually by the spread of darts on a dartboard. You were told to keep track of significant figures based on how well the various graduated cylinders and titration pipettes could measure volumes. The goal was to express the answer with as much certainty as possible, given the tools at your disposal.
There is little doubt that many in the world lack access to adequate public health systems, and we know that good global health work can help these individuals. Fortunately, institutions and individuals are becoming increasingly interested in contributing to the field of global health. In fact, global health has become increasingly integrated into medical schools, so even tertiary care centers with little-to-no public health offerings afford their students opportunities to go abroad.
“Race is a social construct.” This is a statement that we hear frequently but don’t fully believe or understand. In the United States, we may superficially state that race is a social construct, but in reality, we understand it as genetic underpinnings. In medicine especially, race and genetics are often understood as interchangeable.
“Puedo tomar su presión? Puedo tomar su pulso?” I butchered in Spanish, over and over again. Sometimes I received a smile and laugh in return, sometimes a look of confusion, sometimes a placid unfolding of the patient’s arm. I pumped the cuff up repeatedly and listened intently over the screams of playing children and the chatting of a long line of patients.
How can doctors-in-training build relationships with patients despite language barriers? Chelsea, a fourth-year medical student who will soon begin family medicine residency training in Boston, recalls the lessons she learned about the power of nonverbal communication from a patient she met while working in Rwanda.