International Medical Education
Kristin Lynch - Class of 1998
During my fourth month in Ecuador I found myself in a small, remote indigenous community in the Andean Mountains call Zumbahua. I was ultimately assigned to fulfill the role of traveling community doctor. Five days a week I went out, accompanied by a nurse and local man who served as our translator, to do "La Vista".
Some of the communities we could reach in our truck, but others were accessible only on foot, and so we would drive as close as possible and hike in the rest of the way, which was over an hour and a half at the farthest location. The three of us hiked the half hour up the mountain to arrive at out destination, a one-room mud brick house, with a thatched roof, and not a single window. I stooped to enter the doorway, and saw in the dim light a straw pallet on the floor in the far corner on which lay a figure that I couldn't see clearly but assumed was the patient. I crossed the room slowly, careful not to step on any chicks or guinea pigs, and knelt down beside the boy.
I asked for a lamp or a light so that I could examine him, and was brought a candle. It was enough to see by, and I noted that the boy was covered in places with a green salve and the leaves from a certain plant. Apparently, the "currandero", the local healer, had been called twice to try to cure the boy. I quickly examined him and further found that he was tachycardic to 120, with an official temperature of 40C, a remarkable blood pressure of 115/80, and the most obvious surgical abdomen I had ever examined-rigid, exquisitely painful to palpation, percussion and with severe rebound tenderness.
I informed the family gathered around us that the boy was gravely ill and needed to go to Quito to have emergency surgery, they had a fear of modern hospitals that was unshakable, because, in their experience, everyone who went to the hospital, died. After a more detailed explanation of the boy's condition, the family consented to turn him over to my care. The issue then became one of transportation. I asked if they had a horse, but they did not-their neighbors however, did have a fine, surefooted donkey. I was delighted when he returned to us the following week to complete his convalescence under my care.
No experience in my life was as rich and rewarding as approaching that little house, already having been announced by the younger children playing in the dirt in the yard, "La Doctora viene, La Doctora viene!!", to see my young patient come walking, still somewhat stiffly, to the doorway to greet me. With a smile of utter appreciation and gratitude, he said, "Thank you for coming for me Doctora Again." When my work was finished, I left the house amid a chorus of thank you's, and began my walk down the mountain to the truck, feeling for the first time in my medical career that I had truly done something deserving of my title Doctor, and reveling in the sheer joy of it.
In the ultimate example of continuity of care, I was sent back to remove his stitches for him at home, by the same candle light I first examined him under. (They were well encrusted in the wound, and required careful mobilization-trying at the same time to avoid burning his abdomen with hot candle wax made for an additional challenge.)
Emily Dulude - Class of 2000
Patient who refused hospitalization for hepatitis
"As I sit here thinking about Isuseile's case, I can't help but believe that there are others like her who lack trust and confidence in the abilities of doctors and hospitals in general. These same people look not to the support of drugs and tests and IV's but to the support of their friends and family, of the community and of God. To be monitored in a hospital for days on end, is to be imprisoned, isolated, and perhaps killed slowly under the guise of "medical care". To the medical professional, the issue is quite simple: to improve the patient's condition, it is necessary to place them under medical supervision and diagnose accurately the illness. However, to the patient who does not possess confidence in the capabilities of science and white-coated persons, the issue is this: to thrive, I need the care of those who love and need me, and I need God's will to get better. So I see that what is obvious to the doctor is invisible sometimes to the patient, and vice-versa. I hope as a doctor, I may be able to reconcile my beliefs and knowledge of the capabilities of medicine with the obvious limitations that medicine present to all patients."