Reality Check

I've just started my second year of medical school (which I spent most of the summer dreading), and it has definitely hit like a ton of bricks, but in a different way than I was expecting. The class isn't that bad, and the work isn't that bad, and really if you want to do medical school I definitely don't mean to discourage-- it's just that it contrasts so wildly with my experiences this summer.

I mean, there's the obvious level of lazy-ish summer of absolute fun vs. daily routine of getting up, going to class, procrastinating, eventually studying, sleep, and repeat. That's the one I guess I was planning on, dreading.

But there's another level. I spent two weeks on a health-focused mission trip in Fundong, Cameroon at the Harvest Children's Home, and it was just absolutely eye-opening. I mean, I know it was only two weeks, but it was just vastly different from anything I've experienced before. And I've spent time (longer blocks than this, in fact) doing healthcare work in developing countries-- I worked at a leprosy hospital in Nepal for a month last summer, and last Spring Break I went with our school's medical brigade to Honduras. But I feel like none of that was really anything like the conditions at the HCH, or of the Cameroonian health care that I saw in general. Every health problem we encountered led us to other, bigger, related, and extraordinarily difficult systemic problems. It was like a Pandora's box of Russian dolls.

So it was surprising. But what's even more surprising is how I feel about it now that I'm back in school. We had our first Introduction to the Patient II lecture the other day (the class where you learn the sort of doctory skills, like interviewing and the physical exam and how to do a differential diagnosis), and I realized I had forgotten how different Western medicine really was from what I had experienced. There's just so much that we take for granted here-- of course in terms of supplies and money and standard of living, but even more than that.

The first thing you're supposed to do before you have begin your examination of a patient is wash your hands: what if there's no running water? And what if less than 1 of 100 people in the country washes their hands? (I'm not suggesting that you shouldn't wash them, but maybe you need to provide a detailed explanation about germs and disease and hygiene, just so they aren't offended, for example.)

One of your first interview tasks is to find out the patient's age. What do you do if they don't know how old they are? I think I'd get a good laugh if I asked this in class, and that would make sense because it's pretty much unimaginable here. But very few of the kids we talked to got their age right according to the records that we had for them, and to complicate matters some were missing birth certificates, and many were extraordinarily small because of nutritional issues.

So where do you begin?

I am really glad that I am in medical school, especially at EVMS. I think they will do a great job of preparing me to be a doctor in America. And that will be important to my career. But lately it's become very apparent to me that it will only be the very first step in preparing for a career in a developing country, and there will be a lot of practical health ground to make up.

Oh, and I have got to get me an MPH.


{By way of explanation, I'm stating this blog as a way of sort of reflecting on my experiences in Cameroon. I can't say that I'm going to have a lot of time this year, but the overall idea is when I do, to take my journal entries from while I was there and either directly repost them or distill them into a more expository format and put them here. Other subjects might wander in from time to time, too. I hope you enjoy!}