“Is the pain sharp or dull?” I say to the teenaged translator next to me. Rolling her eyes, she quickly mutters something in Spanish to my distressed patient and then relays his response back in English. As she returns to texting on her cell phone, I make the final notes for this patient. Although I have reached the end of an extensive two-page history, I can’t help but feel completely unaccomplished. I’ve been told this is the most important part of forming a diagnosis, yet the unyielding language barrier has caused me to fail to form any sort of trusting relationship with my first patient.
While we wait for the doctor to come to our station, I study my patient. His build is strong, in stark contrast with the heaves and lifts of his overworked frame. The patient looks up at me, with skin leathered from the Costa Rican sun, and wears a big smile—he is excited to see an American “doctor.” His son, wearing a cloth diaper and a mysterious rash, eagerly plays with the other students in my group. I smile back, but only for a moment. I find it difficult to look my patients in the eyes sometimes, fearful that they’ll read me for the inexperienced medical student I am.
It isn’t until the doctor comes by that the real magic happens. I methodically repeat a summary of my history and, instantly, she can tell this man suffers from chronic, untreated hypertension. She writes a prescription and sends him off to our improvised pharmacy. A student fills his order, and my tired patient faithfully takes his first dose while waiting for his son to be treated.
Five minutes later, I hear commotion coming from the waiting area. The man has fallen unconscious, and his son is screaming in terror next to him. Ten minutes later, the doctor discovers that the pharmacy filled the wrong drug; this man is now fighting to stay alive. Thirty minutes later, he’s loaded into an ambulance, and yet an hour later, things are back to normal at our clinic. We’re almost glamorously serving these people, taking pictures with their delightful malnourished children, and practicing our sub-par clinical skills.
In our seven days, we never saw the man again. In fact, we never saw any of our patients for a second time. Not one of the 1,427 patients was ever seen for follow-up of their diagnoses. I worry that they did not consider it important to finish the full course of their antibiotic, that their children ate too many sweet gummy vitamins, or that they simply did not see their transient dizziness as the serious medical concern diabetes is.
On my airplane ride back, I couldn’t help but wonder:are we just fooling ourselves? We hold up our stethoscopes to their skinny bodies in excitement, our unsophisticated ears hear something (anything!), and we call it normal. We are afraid to touch the patient, we cannot even hold a conversation with them, and yet we truly feel that we are helping others. Are we just playing doctors?
I agree that the intentions behind hosting a medical missionary trip are good. However, as the premed and medical students who run these endeavors, we must appreciate how great of a responsibility we are undertaking. Much work needs to be done on our part to make sure the service we provide abroad is of the same caliber of that which we would provide in our own clinics.
Before we step inside the other country, education about the language, clinical skills and culture needed to best serve the area should be customary. Even if we still require translators, imagine how much of a difference simply asking the history in the native language would have on the patient-provider relationship. In addition, native doctors for supervision and establishment of proper follow-up for patients must become protocol. Lastly, an emphasis on public health education must become a priority for these underserved areas, where a month’s course of vitamins will not accomplish as much as an informative focus on nutrition and hygiene.
Our purpose is sincere, and sometimes we truly are able to help the febrile child with antibiotics or the middle-aged woman to discover her condition as menopause. Other times, we are walking a tight rope. Focused on serving an abundance of people with very few resources, we may forget that being a medical professional relies on the principle of nonmaleficence. Often, these people see students on mission trips as a reflection of modern medicine itself. If we fail them, they may lose their hope in all doctors. It is imperative that we uphold a high standard during such efforts, not only to show the validity of quality healthcare, but also to help more than we hurt.