My arm was still aching from the yellow fever injection when I saw my first real patient.
Sitting across the table from me was a woman with four children, whose hesitancy towards their foreign doctor mirrored my own. I still wonder sometimes how I ended up in that tiny cinderblock-and-corrugated-metal church in Bolivia, not even finished with my first year of medical school. At the time, I felt frantic. I was convinced I had no skill and no knowledge to help the people who waited patiently in line all day for our little plastic baggies of vitamins and antiparasitics. Less than a week later, when I stepped off the plane and back onto American soil, I felt very differently about my capabilities.
Medical missions are a popular part of medical school culture. Heading off to the Caribbean or South America as a first-year is exciting and a great resume item for residency applications. It makes you feel good about yourself and your clinical skills. Despite the obvious dangers of traveling abroad, many organizations on campuses across the nation make it a key selling point of membership. Spring break, for those lucky souls who are accepted to the team, is an adventure totally beyond any previous experience. For some of us, it is life-changing.
Last week, I sat down with the officer team of the Christian Medical and Dental Association to review applications for our annual trip. Looking over the applications brought back memories of writing my own application: the frenzied preparation, the anticipation, the terror of landing in a country where my solid A’s in high school and college Spanish suddenly felt useless. I remembered talking to many of the first years whose applications now were neatly organized across the screen of my laptop, and telling stories of exploring the city while dodging the paint-filled balloons of kids celebrating Carnival. I found myself excited for the twelve who made the cut, knowing the memory of this trip would subtly shape them, as it had shaped — and still is shaping — me.
I am not the same person I was when I left the States bound for South America last spring. The first-year who got on that plane was tired, sad, and burned-out. After an extremely difficult academic and personal quarter in school, I was starting to doubt that medicine was right for me. I spent most of the long flight worrying that I didn’t know enough to do what I needed to do, and that when I got home I’d be calling my parents to give them bad news. However, a small part of me clung to the hope that Bolivia would heal some of the damage.
The things we expected, happened. We saw hundreds of patients in those few days. As I expected, I gained experience in physical exam skills and comfort in patient interaction, confidence in my abilities and knowledge, and a greater appreciation for the quality of medical care I can receive just by walking into student health. Working in small teams of two students and a translator with only a few upperclassmen and two doctors to fall back on, we learned to recognize and triage chief complaints. My first-year partner and I quickly learned the use of most of our medications, and could explain the dosing regimen of almost every item of our formulary in Spanish without the help of our translator by the end of the week. Since I traveled with a religious organization, I also anticipated the renewal of faith and purpose that comes from constantly praying and reflecting on little moments of the day. I was not disappointed socially, either. The new closeness with my team, some of whom I barely knew beyond a name and a face before the trip, has continued and strengthened as we’ve moved into our second year. Like many medical students on mission trips, we worked long hours. We’d leave the house early in the morning and stumble back in wrinkled scrubs, but still summoned the energy to play soccer with the locals and stay up late with games.
I don’t think, however, that I anticipated how a one-week medical service trip could reignite my passion for medicine and service work, and begin to direct my career path. Since our return, I have seen many of my teammates (and myself) leaning towards primary care. I was interested in providing care to underserved populations before medical school began, but since my trip, it has begun to solidify as the end-goal of my education.
Medical mission work does not have to require vaccinations for tropical diseases, a passport and a warning note on the sink reminding you not to drink the tap water. While there are plenty of organizations that allow practicing physicians to travel abroad and provide care, there are large areas of our own country that can benefit from the same services. There are government-funded programs that require a commitment to practice in a medically underserved area in exchange for tuition payments. Large urban centers have neighborhoods in which health care access is desperately limited, and many of the far-flung rural communities that exist across the nation are dangerously far from hospitals and trauma centers with only a few general practitioners serving to cover large geographic areas. Religious and secular charities fund nonprofit free clinics staffed entirely by volunteer providers. And you need not cross a national border to find patients who need translators to tell you about their shortness of breath.
Medical mission work as a medical student is mind-altering if you let it be. Finding yourself autonomous, useful, and knowledgeable in a difficult clinical setting breeds a confidence that medical students crave. For some, it also feeds a fire we may not have noticed smoldering inside our hearts. These are the students who come back in third and fourth year, and who apply for service positions and residencies in rural and impoverished urban settings. Some of them go on to work for free clinics, to travel with international aid organizations and charities, or to live as missionary doctors in foreign countries.
When I first began meeting with the incoming students this year, I told them both sides of the medical mission story. I told them about the joys of listening to the heartbeat of an unborn child with the mother for the first time, hearing a native Quechua woman call you doctora, having a precious little boy and his tiny puppy fall asleep in your arms as you listen to the murmur in his heart. I laughed and nudged my teammates as we recounted the tales of soccer games won and lost, impromptu sing-a-longs in the van, the lack of fresh vegetables, and the swollen ankles from travel and a high sodium diet. But interspersed among the laughter were more serious things: the poverty, our nerve-wracking firsthand experience with local medical care, the heart-breaking gratitude of people our limited resources were unable to help, the feelings of guilt, and longing for my narrow bunk in a room with six other women upon my return to the comforts of my own home. Warnings about low-maintenance lifestyle requirements, disguised as jokes about the shower tap that shocked you every morning, were counterbalanced with exultant stories of catching rare diagnoses. I admitted to them that I still find myself homesick for Bolivia, and that if I could, I would gladly return to the humid heat and the mosquitos and the ramshackle churches that served as temporary clinics for our team.
In telling both sides, I hoped to show them what I learned when I sat down with that first patient and her children: there is selfless service that benefits others, and there is selfish service that benefits the servant. And sometimes, a mixture of both sends you on a mission to discover who you are, what challenges and excites you, and what role you will take in the world.