Trip Feedback from Students and Physicians
The most significant experience I had there was with a woman who had a stroke because of her husband's physical abuse. Her left hand was clenched into a tight fist, and she had very little movement of her wrist. She wanted us to help her regain the use of her hand so that she could work as a laborer and not have to depend on him anymore. The third year (medical student) that I was with was absolutely amazing. She started working her hand to relax the fist while one of our attendings fashioned a hand splint so that when she slept, she would keep her hand open. Then, I got the privilege of working with her to make sure that she understood all the exercises that we showed her. I also helped her figure out how to put the splint on by herself. She came back on Friday, only 4 short days later, and her hand was already better! It wasn't a tight fist anymore!! Later that night, when we were reflecting on the trip and our experiences, I felt like we really made a difference, and I know, without a doubt, that this is what I want to devote my entire life to.
My last patient of the day was 6 year old boy, who had recently been hospitalized for asthma. I soon learned that he had been hospitalized nearly once a month for the past 6 months, because he had not been taking long-term corticosteroids to control his asthma. Given the simplicity of his condition & treatment, I was outraged by his current state of health. And yet, I realized that there was no one person to blamenot his mother, not his school nurse, and not even the physicians at the under-equipped hospital he was admitted to in Kingston. I have spent time living abroad before, and studied public health and access to care for several years now, but this example reminded me again that there are real people involved and that global health is not an abstract issue.
Mid-week, an M3 (third-year medical student) and I saw the mother of one of our drivers in the clinic. She was a strong, relatively healthy older woman, but her chief complaints reflected the differences in social and economic lives between Jamaican patients and those typically seen at a city hospital like Northwestern Memorial Hospital. Like many Jamaicans, hers was a life of physical labor and long days spent outside in the fields, in the sun; her strong arms and legs reflected this lifestyle, but so did the chronic pain in her joints. She was relatively wellthere are other, more emotional medical stories that other team members will probably reportbut her parting words were especially memorable: she gave the M3 and me a big hug and a bigger smile, saying I love you!, at the end of her visit. Her personal strength in the face of encroaching old age and chronic joint pain was a demonstration of the stoicism that was common to many of the people in Hagley Gap, which is practically a necessity when affordable health care is rarely offered and usually inaccessible.
An M4 and I made a house visit to an elderly man who had just recently had a seizure. After taking a look at him, we went to a nearby neighbors house to gather some more information about his past medical history. While there, there was a 90 year old woman whose family members asked if we could see her. All we had on us was a stethoscope and a blood pressure cuff. So, the M4 and I did a very basic physical exam and told her that she was in great condition. She kept saying Thank you doctors with such a look of appreciation and gratitude even when we had only really done a simple check-up. This to me will be a lasting memory because all the patients we saw were so grateful and had so much respect for us that it was at times overwhelming.
At one of the clinic sites in Nicaragua, I got to see and treat a woman who was near the end of her first pregnancy and had not seen a doctor prior to her visit to our clinic. She had walked about 3 hours to get to the clinic that day and was so grateful to have us there. We were able to see her and give her a prenatal check-up. It made me realize how much we are needed in these areas and how much the people in the Jinotega really appreciate what we are doing for them there. It was very rewarding for me to be able to help this young woman during her pregnancy and know that I was making an important difference in her life. It was amazing that after being pregnant for 7 months, she had not seen a doctor and that her only opportunity to see a doctor was to travel 3 hours on foot to get to our clinic. This is only one of the many examples of experiences on the trip that gave me a new perspective on international health.
On our last day of clinic, we saw patients at the Casa Materna in Jinotega for most of the morning. One of the patients I counseled that morning had complaints of dizziness, lightheadedness, and headache which sounded like it could have been the result of inadequate liquid/water intake (she mentioned that she only drank about 2 cups of water per day). When I explained to her that her dizziness and headaches might improve by drinking at least 8 glasses of water a day, she looked at me and shook her head, saying, I didnt know that drinking 8 glasses of water per day was so important. It really amazed me how even something which we consider to be common sense in our society can really improve the quality of life of a person who may not have access to such information.
On our final day of the trip we traveled to a retirement home in the city of Jinotega. While there, we provided medical care and open ears for los ancianos the ancients. The elderly smiled toothless and wrinkled, as we ran around with our stethoscopes and intake forms. The elderly rocked in their chairs and complained of lack of sleep, body aches, coughs, diarrhea, and of being old. But most of all, they thanked us. They took our hands and thanked us for being there.
Then I took a wrong turn into the intensive care room. There was a man there I will never forget. When I first entered he was hiding under a thin sheet, and all I could see were his dark eyes peering out. As I approached, I noticed the flies - hundreds of little creatures flying in and out from underneath the sheet; a chaos of motion and whispers. The closer I got the more the man revealed his face. It was gaunt, yellow, and sad. He writhed back and forth not even making the slightest effort to clear the flies from his emaciated body. A tube ran from his torso to the floor into a cereal bowl of pus and mucous. I pulled the sheet further back. Curled in a ball, he sank naked into the bed, alone...in pain. I put a glove on, took his hand, and stared into his dark, dark eyes - fizzling embers on a cloudy night. Life on the verge of death is strange and unsettling. Time no longer hurries. As I held his hand, the flies paid no attention and continued to buzz.
When we left the retirement home, not much had changed. We left some medicine for everyone. We covered the man with a fly net. We instructed the nurse to keep the man hydrated and comfortable. All these things are helpful, but fleeting. One very important thing did happen, I believe: we paid attention.
The most memorable part of the trip to me was the altruism expressed by the medical students in our group. It was obvious, through their words and actions, that the Northwestern medical students wanted to do everything they could to assist this poor population of people. Several instances come to mind that exemplify these thoughts. On many of the days, it was difficult to round up the team members to leave, knowing that there were still people waiting to be seen. On one of our most productive days, one of our team members was even trying to treat a patient as we were loading and boarding the bus. On another occasion, after seeing an extremely ill and dying patient in a nursing home, the members of the team decided to make a return trip to the nursing home in order to deliver hydration salts to the patient. Although there was only a very limited amount of care that we could provide to this patient, the team felt that we had to perform as much as we could within our power. I even noticed, on more than one occasion, team members giving away their own personal clothes and belongings in order to just give a little something extra to these people.
The medical students were inspirational to me, and I feel that the team leaders especially inspired the whole group. For medical providers, I feel that these types of experiences will be carried throughout their lives, and help them to remember the true reason why they practice medicine: in order to care for people in need.