|
Virtual Mentor. December 2006, Volume 8, Number 12: 855-858. Op-Ed Student Clinical Experiences in Africa: Who Are We Helping?Identifies the pitfalls of improperly organized international medical student electives and the hazards of volunteering for the wrong reasons.Craig J. Conard, Mark J. Kahn, MD, Karen B. DeSalvo, MD, MPH, MSc, and Lee Hamm, MD Consider the case of 9-month-old Soleymane. She visited her village clinic in rural West Africa where a fourth-year medical student from the United States was doing a rotation. The initial exam revealed a very ill-appearing, febrile infant who was lethargic. She was also grunting and had chest wall retractions. The medical student assisted the nearest physician in arranging immediate transport to the local medical center for emergency treatment of cerebral malaria. Just as the local physician was discussing the situation with the infant’s parents, Soleymane went into cardiac arrest. The medical student started CPR, only to be told a minute later that his efforts were futile. Occurrences like this are all too common in rural Africa. This continent, where thousands die each day from easily preventable diseases such as malaria, dehydration and diarrhea, serves as the ideal setting for medical students and residents who wish to experience medicine in the trenches. When deciding whether or not to do an international rotation, medical students must weigh the benefits and disadvantages inherent in these programs. While most of the rotations are brief, the impacts of the experience can be life-altering. In one study students who had participated in an international experience in rural Nicaragua reported a growing awareness of the social determinants of health, an increased global perspective and an appreciation of cultural influences on health [1]. Other studies have noted that the most frequently reported outcome from an international experience was greater cultural sensitivity; participating students tended to think more positively about people from other countries and were more adept at treating patients with diverse cultural backgrounds [2]. Other secondary benefits included an increased interest in primary care, improved history and physical examination skills, and experience in practicing medicine with limited resources [3, 4]. Students also experience many limitations and frustrations when working overseas. These include difficulties accepting local customs, beliefs and practices, the slow pace of implementing change and problems in communicating goals and objectives of the experience. While at the moment these frustrations may impinge upon the students’ experiences, in the long run, students benefit by learning how to cope with problems and find solutions. Global public health Programs aimed at improving global health are often affiliated with academic medical centers. The increased resources associated with these programs have created support for undergraduate and graduate medical education to develop the next generation of global health physicians. These international curricular offerings are of great interest to a growing number medical students. In 1982, an estimated 6 percent of U.S. medical students participated in an international rotation [7]. By 2004, that percentage had increased to 22.3 [8]. While students clearly perceive that they benefit in many ways from international rotation, the benefit to the citizens of the developing countries who receive the care is less well known. Are we really helping? One may be cynical here and say, as an Ayn Rand objectivist might, that the main reason medical students volunteer for electives in underdeveloped countries is that doing so is in their own rational self-interest; that is, they benefit more than their global patients. A reasonable response to such a charge is this: the fact that those students promote their own learning by providing health care in underdeveloped countries does not diminish the help they provide to patients they serve there. Yes, Soleymane’s death is an invaluable lesson for the student. And, yes, the medical student’s presence, help in transport and administration of CPR gave Soleymane’s parents the solace of knowing that everything possible was being done for their baby. As global health interests and activity rise, educational opportunities in global health experiences become increasingly available to medical students who want to explore this field. And as more encounter the challenges associated with such experiences, some may even question whether their desire to train overseas was a selfish one. But such direct experiences, and perhaps even the tangential cultural experiences, transform the students who have them, inspiring more lasting and widespread efforts to improve the health and quality of life of people around the globe. Craig J. Conard is a fourth-year student at Tulane University School of Medicine in New Orleans, La. He received a National Institutes of Health Fogarty-Ellison Fellowship to study malaria vaccination in Mali, West Africa. Marc J. Kahn, MD, is a professor of medicine and associate dean for admissions and student affairs at Tulane University School of Medicine in New Orleans, La. His research interests include palliative care and medical education. Karen B. DeSalvo, MD, MPH, MSc, is an associate professor of medicine and the C. Thorpe Ray Chair of Medicine at Tulane University School of Medicine in New Orleans, La. Her research interests include health care delivery and health policy. L. Lee Hamm, MD, is a professor of medicine and chairman of the Department of Medicine at Tulane University School of Medicine in New Orleans, La. Related in VMDo international experiences develop cultural sensitivity among medical students and residents? December 2006 The value of international electives, December 2006 A caution against medical student tourism, December 2006
The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
© 2006 American Medical Association. All Rights Reserved. |