Columnist
Washington University in St. Louis
Austin is an MD/MPH candidate at Washington University in St. Louis (WashU) who is taking a year off of medical school to complete a Doris Duke research fellowship in Malawi through UNC - Chapel Hill. After spending the last eight years in St. Louis as a WashU undergrad (chemistry, music) and graduate student, Austin is loving the opportunity to experience a new culture and explore his interests in global health. His column seeks to illustrate a raw, human, vulnerable lens on the joys and struggles of working abroad.
Lessons in Lilongwe
Global health work can seem glamorous, exotic, and noble. Lessons in Lilongwe presents introspection and critical observations to illustrate what global health research and living in Africa are really like. Come join Austin on his year off of medical school for a research fellowship in Lilongwe, Malawi.
Shortly before returning to the United States for the holidays from Malawi, a truck full of police and military men pulled up next to my car as I was driving and demanded my driver’s license. They claimed I was “dangerously parked” while stopped in a long queue of traffic to let my friends hop out across from a bus station and would, therefore, be fined K10,000 (approximately $18).
While I could list close to 100 lessons, I believe focusing on three of the most important ones would aid other future health professionals in managing and ultimately treating the chronic illnesses that will become even more prevalent in many of our future patients. As a disclaimer, I do not claim to be an expert on this topic, but these ideas spring from my own personal reflections.
My attending / looked at me / and asked, / What is killing your patient?
Almost every morning, one of our physiology lecturers asks a question. Usually, it’s a question to which most of my 200 classmates would know the answer. Every day, the professor asks their question, often losing their rhythm in the twenty seconds it takes to shake an answer out of us. The silence lingers until finally they get a response, often whispered like an embarrassing secret by someone sitting near the front. The timid self-consciousness on display in this small ritual is a major part of the socialization that happens in medical school.
As future physicians, understanding the consequences of absolute resource levels impact health is critical. A physician who advises a better diet to somebody without the ability to act on that advice is of little more use than the physician who prescribes an imaginary medication. However, institutes of medical education do a disservice to their students by keeping the conversation so narrow. Medical schools must begin to more fully teach how relative inequality impacts health.
Exquisite Eliza Jean, / Oh my, our 22nd playdate and I still have so much adrenaline; / Last time I thought I might lose my finest specimen. / Yesterday while under the scalpel, dear Betsy barely made a sound, / So please take heed, and don’t excessively squirm around.
The cultural competency framework that has become the mainstay of medical education is often times employed in incredibly reductionist ways. It seems to propose that exposing physicians to homogenized, static and packaged ideas of culture will aid them in estimating patient behavior, preference or response in the clinic, thereby diminishing health care inequality. Training like this paves the way for even well-intentioned student-doctors to be explicitly ignorant under the auspices of clinical benefit. It spoils the good intent to create better patient outcomes by legitimizing the validity of stereotypes and the development of physician bias.
“You need to come in to the E.D. ASAP.” A new patient was admitted at 2 a.m. and requested for a crisis counselor. Back in 2009 when I was volunteering in New York City, unlike with cases of sexual assault, survivors of domestic violence had to specifically request for the presence of an advocate. This woman, I’ll call her Sadie, had already taken the first courageous step to seek help.
December 10, 2015 marks the one-year anniversary of the inception of White Coats for Black Lives, a national organization of medical students that aims to eliminate racial bias and racism in the practice of medicine — as they are threats to the health and well-being of people of color.
Today is International Human Rights Day and the one-year anniversary of last year’s national White Coat Die-In to support the #BlackLivesMatter movement. The coordinated die-in protests drew national attention highlighting racism as a public health issue. Across the nation today, silent protests at medical schools in New York, Philadelphia, Houston and San Francisco call on medical schools and academic medical centers to move beyond mission statements and slogans in their efforts to promote racial justice.
One year ago, on December 10, 2014, over 3,000 medical students participated in the National White Coat Die-In. We knelt to the ground, rested our backs on concrete and tile, looked up at the ceiling and contemplated what it meant to be a citizen. We embraced a deafening silence pregnant with the implications of erasure. Our bodies, cloaked in the privilege of a white coat, painted a complicated image of advocacy and appropriation.
Our American democracy was founded on the promise of freedom of religion, a conviction that invites immigrants from all over the world and enables our country to grow and prosper. Our health care system is strong because we celebrate that diversity — understanding diverse perspectives and cultural practices is fundamental to providing the highest quality of care. Today, hatred and xenophobia have been thrust into our daily lives in a way that degrades our common humanity and impairs our ability to work together.
Contributing Writer
SUNY Upstate Medical University
Sriharsha Gowtham is a third-year medical student at SUNY Upstate, with a BA in Neuroscience from Columbia University. Born in India and raised in New Jersey, he enjoys political discourse and speaking to whoever is willing to listen. He serves as a fellow at Public Citizen’s Democracy Is For People Campaign and looking for more causes to support.
