Developing skills of cultural competence requires an open heart and mind—and often an uncomfortable examination of personal biases. It takes time, but along the way physicians gain greater humility and compassion, which translates to expanded access and higher-quality care for patients.
On Wednesday, September 20, 2017, after an already uncharacteristically volatile hurricane season, Hurricane María made landfall on the island of Borikén (“Puerto Rico” in the indigenous Taíno language).
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.
Like most people, I watched the Ebola plague tear through Africa two years ago with a feeling of helpless horror. I saw the victims dying by the thousands on television, all eulogized by the same stark words: “No cure.” There seemed to be some unstoppable and malevolent force in the universe, seeking not only the destruction of human life, but hope itself.
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.
Four years ago I was sitting in the living room of my basement apartment in Ann Arbor, Michigan watching the opening ceremonies of the Olympic Games. Now I am a week away from starting my second year of medical school, and the opening ceremonies for the 2016 Rio Olympics are upon us as well.
Among my professor’s stories from Lima, the chicken dinner story haunts me most. It features two students from his time as a middle school teacher in one of Lima’s most dangerous outskirt neighborhoods. A young teacher working at a Fe y Alegria school in North Lima, my professor, Kyle, had promised to take them anywhere they desired for dinner in exchange for exam success. The students requested chicken, standard Peruvian celebratory fare.
In El Salvador, 17 women imprisoned after experiencing miscarriages or stillbirths began a campaign against reproductive injustice. “The 17” were sentenced for up to 40 years in prison for miscarriages or complications during delivery, after being convicted of attempted or aggravated homicide. This was the outcome of a total ban on abortion: young, often unmarried, women of lower socioeconomic status are suspected of inducing illegal abortion when experiencing emergent obstetric complications. Stigma and misogyny play into the result, in which a woman’s health during pregnancy is viewed with distrust.
I recently finished reading Tracy Kidder’s Strength in What Remains, which highlights one man’s journey from the genocide in Burundi and Rwanda to becoming a refugee in New York City. Some chapters are quite graphic in their descriptions of the slaughtering of Hutus and Tutsis — the pain, suffering and atrocities he witnessed. These deaths seemed nothing like being on a morphine drip in an ICU bed or falling into a final deep sleep as your family surrounds you with tears and prayers. Instead they seemed gruesome and inhumane.