Just some general comments:
At bottom, and as a rule, the medical education system, wherever it may be, is very keyed to the medical practicing system of its locale. Hence, the key principle in being equipped for international-tropical medicine abroad is to
train in a context as similar as possible to the one(s) wherein you will actually practice. But, as the director of a particular South African rural residency program I am familar bemoans, "At present, many doctors are trained in situations very unlike those in which they intend to practice."
The bulk of the clinically-oriented material, and a good deal of basic science oriented material in U.S. med schools, is greatly oriented for practice in developed nations, dealing primarily with the diseases of affluence of our western world (obviously). True, there are some things where medicine is medicine is medicine is medicine. Still, in contrast, infectious diseases usually claim peoples' lives in developing nations long before they are blessed
to even think about the health problems of our Western world. And there are many other ways in which the context is so very different.
In short, the first-world trained have, as a rule, been taught to practice the most technologically advanced medicine in the world; and this can be significantly irrelevant to a third-world setting.
Added to this is the fact that U.S.-trained physicians are taught within an environment of much competition from other physicians and intense litigation by lawyers, which two play off and feed one another. Add to the mix dealing with insurance and HMOs, and how what you are trained to do is sooften contingent upon them. Perhaps the impediments of this is best evidenced in the U.S. laws which tend toward prohibiting physicians to practice except in their narrowly defined area (i.e., their specialty), without having first undergone a residency for that particular area. It is also evidenced by the U.S.-trained physician being taught to rely heavily upon medical tests, often defensive, and referrals to still other specialist, both luxuries beyond even the dreams of most international-tropical physicians abroad.
Decrying the rural health problems of their respective countries, an international team of physicians referred to these dynamics as "learned helplessness." They stated that
The highest that many new medical graduates aspire to in dealing with medical problems is being able to assess to which specialist to refer the patient. Consequently, it is a frightening prospect for them to contemplate rural practice where they have to manage problems themselves without immediate access to high technology medical facilities and specialists.
The physician in a third-world hospital, particularly a rural one, must often have had training in nealry every branch of medicine: general medicine, general surgery, peds, OB/GYN, ortho, uro, ophth, derm, ENT, plastic surgery, OMX surgery, neuro, trauma medicine and surgery (the list goes on), as well as must function as the gas-doc and even general dentist. This is because such a physician is often the only physician around for many, many miles, and patients have in many instances been carried for actual days to arrive at care, and that in often the worst possible condition.
My experience with U.S. rural med school programs and residencies is that they
are not rural in the sense spoken of above. Still, they are better than many U.S. urban situations.
This all is to simply let you know some things so you can prepare as best you can while in whichever med school context you are about to head into. I would urge you: if international rural medicine is truly a big area of your interest,
do ALL of your fourth year electives overseas in a rural, tropical medicine context. As well, anything pertinent during basics. When transplanted into a third-world setting, many a first-world-trained physician finds him or herself at once over-prepared and under-prepared--over prepared in knowing how to do high tech medicine, and dependent upon it, and underprepared in knowing well a braod array of procedures and surgeries, without much access to the former. Hence, you must go both broad AND deep.
An exception is if you intend to primarily engage in the clinical training of indigenous physicians overseas--where you improve their skills in certain speciality areas. My experience with the higher tier US med schools who have international medicine programs is that this area is where the programs are most geared for--not necessarily preparing their graduates for the nitty-gritty of actually fleshing out long-term practice abroad, and the broad AND deep skils so often needed therein.
The other thing is med school debt, which is so very often a malevolent dictator against international medical practice.
Best wishes.
