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Thursday May 01, 2014

Global Health Offers Unparalleled Opportunity to Learn While Helping Patients

"It will be another adventure," I thought as we prepared for our journey.

I was just a few months shy of graduating from residency, and my mind was racing. What could I cram into my sparse free time to help me be prepared for anything and everything? Of course, with the demands of residency, there wasn't enough time to prepare for much.

As August approached, we were as ready as we could be to move to another country for a year. We were headed for Santa Lucia, Honduras, a little more than a month after I had graduated. I could only imagine what awaited us there.

Working for 11 months in Honduras allowed me to put all of my training into practice and help people who really needed it.

We were going because we wanted to serve people and give back a portion of what we had been given by so many others -- compassion and care. Edwin, my husband, was going to be the information technology manager at a clinic there, and I would be a staff physician.

We lived in Honduras for 11 months. Now we are often asked, "How was it there?" I reply, "It was good." But it's not the travel, the food or the scenery that stands out in my memory. The "good" is when I realized that my character as a physician, a person and a citizen of the United States had been challenged during our time there, and I am better for the experience.

Many of our days in Honduras were hard. Some were fun beyond measure. Whether the days were good or bad, there was always something to learn. I saw malnourished children and a horrible shoulder dystocia. I traveled down a mountain into El Salvador with an 11-year-old girl -- who was in status epilepticus -- in my lap, trying to make sure her airway was protected. She ended up having neurocysticercosis.

We routinely had to think about both time and distance when we were managing a laboring patient because the nearest hospital was at least 2 1/2 hours away. More specifically, it was 2 1/2 hours away during the day, in the dry season and with a skilled driver. Otherwise, it could take a minimum of four hours to get to the nearest hospital with a surgeon.

There were many days I rode down the mountain with a woman in active labor, trying to ascertain her progress and determine whether her pain was due to contractions or from the combination of contractions and going bumpety-bump on the glorified path through the woods we called a road.

Good roads are just one of the things we take for granted in the United States that were lacking in Honduras. More importantly, access to clean drinking water was a problem, and I was struck by the number of children who needed oral rehydration solution.

With limited resources, I learned how to take and develop my own radiographs. I also learned how to set an IV drip rate without an electronic monitor. The nurses at our clinic counted the number of drips per minute and adjusted the flow of the IV fluid accordingly. I had never done this or seen it done before.

Although we worked hard in Honduras, we made time to play, as well. We traveled to the Copan Ruins and Guatemala. We saw waterfalls and breathtaking views of the mountainous countryside. We ate wonderful food (but also had occasional bouts of traveler's diarrhea).

Overall, international medicine can be quite an adventure for a family physician. You not only get the opportunity to put all of your training into practice, you also are extremely useful to those you serve. You become the physician for anyone you encounter.

Global health provides both a great learning opportunity and a chance to help in places where there is great need. Perhaps that's why interest in these opportunities is growing. Two-thirds of family medicine residency programs now offer international rotations or electives, and more than 30 percent of medical students completed a global health rotation in each of the past four years. These days, medical schools and residencies that have faculty with knowledge and experience in global health have a competitive edge over those that do not.

The AAFP responded to this growing interest by creating a Global Health Workshop in 2003. The annual event is scheduled for Sept. 11-13 in San Diego.

The Academy also has developed a new global health strategy with four key objectives for the AAFP:

  • Be a leader in promoting family medicine and population-based, patient-centered primary health care on a global scale.
  • Provide support to members through development of comprehensive, member-focused global health resources, information and networking avenues.
  • Educate and engage members in global health through development of educational products specific to needs and interests of AAFP membership groups.
  • Become a clearinghouse of international family medicine opportunities to foster collaborations between members and domestic and international agencies, foundations, educational institutions, training programs, and businesses relevant to AAFP content expertise.

I encourage students, residents and our more seasoned physicians to experience health care beyond your own community. During my year abroad, I learned health care administration -- although probably by default -- management skills and how to deliver care with limited resources.

I also learned that medicine in the developing world is in some ways not much different than what we practice in the United States. Of course, there may be some diseases that we only remember from an infectious disease lecture, but the overwhelming majority of disease processes are those we are quite familiar with: diabetes, hypertension and hyperlipidemia, as well as musculoskeletal complaints and dehydration.

Just like here in the states, I met patients who used a lot of resources unnecessarily as well as those who really needed them. I met worried mothers with small infants and worried children caring for elderly parents. The human aspect of medicine was exactly the same. People are people in need of compassion and care wherever you are.

A few years ago, the World Conference of the World Organization of Family Doctors (WONCA) declared May 19 World Family Doctor Day(www.globalfamilydoctor.com) to highlight the role and contribution we play in health care around the world. If your medical school, residency or organization is planning activities to celebrate this year, we would love to hear about it in the comments field below.

Meshia Waleh, M.D., is an assistant professor of family and preventive medicine at the University of South Carolina School of Medicine.

Posted at 05:05PM May 01, 2014 by Meshia Waleh, M.D.

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