JoBlo

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I've always heard of the great things that physicians do on international rotations in underserved communities. Surgeons with charity work repairing deformations, wounds. OB/Gyn's helping to birth healthy babies, and repairing maternal wounds...

... but what can an internist do in such a resourceless environment...

I've always felt that at its core an internist options are rooted in the pharmaceuticals that he has availabe... and a internist without his drugs/abx is like a surgeon without a scalpel. That being said, if a internal medicine resident went internationally to a very poor/underserved region without those resouces... then want really can he/she accomplish? You can load up the suitcase with as much Abx and analgesics as you can for temp fixes while your their... but as soon as you leave, the situation of the people is unchanged.

Does anyone have any good or bad experience with internation rotations that the would like to share? Particularly where they feel they were most able to help or want they felt was the biggest obstacles to care.

thanks
jb
 

DavidHasselhoff

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you can do a lot, even without medicines. though i see the point of your analogy.

i went abroad with a NGO based in the US and did HIV/AIDS work in Africa. i saw the impact of lack of resources there, but that's not to mean you can't be useful. there is a need for education, promotion of HIV awareness and testing. there are patients with AIDS who don't see a physician regularly - treatment and testing can be free in some countries. i saw a young patient who by history had a peripheral 7 palsy that resolved after infection - something a doctor told them was a stroke. correcting a bad dx is just as good as making a good one. so yes there is still plenty to do. for one, you are useful to everyone else that may volunteer abroad that is not a physician. and then there's appreciating the culture and its influence on health care - gender roles, attitudes towards health care, etc. i highly recommend going abroad.

as for what group, be careful. you buy infrastructure when you pay to go with many organizations, but beware. look for feedback from old volunteers if you go with an established organization. many times they are great in the US, have a sexy website, but the money disappears as it trickles down and you may find out that lack of structure means lack of available resources, that is, if you're not finding out that people steal.
 

Geri_Gal

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I struggled with that same thought as I was deciding between surgery and medicine.

I did an elective with a hospice in Uganda, however, which helped me see that IM physicians have a place in international medicine. The hospice that I volunteered with was the effort of a GP or IM doc from the UK who saw the need for palliative care in the developing world.

Dr. Paul Farmer, of Partners in Health, is an IM doc specializing in infectious disease. (If you haven't read "Mountains Beyond Mountains" and have an interest in international health, you should!) :)

Many resource poor environments have a very important resource: PEOPLE. As a doc volunteering abroad, you can do much good by educating health care providers or lay public in communities about good health practices, disease prevention, etc. ...good that will last after you return to your country!
 
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You can treat and cure TB!

Its amazing the number of easily treatable and curable diseases that are still a scourge in the third world.
 

NDESTRUKT

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You can learn how to operate from surgeons and operate in the third world, mostly by assisting in surgery then doing many cases yourself. It's been done many times over. In fact some of the missionary hospitals were founded by FP's that also do surgery (simple things like appys and choles) similar to the primary care docs in rural areas in the US.
 

mtoto

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I think that as an internist or anything really there is great value in doing a rotation abroad. You bring up a good point... in questioning how helpful we really are when we are there one month and then gone the next. I think that if it really did stop there for everyone that went then there would be some cause for concern.

On the other hand, I think that when we make the effort to work internationally for any length of time we are giving ourselves the opportunity for deeper involvement. International work is not everybody's cup of tea (and it should not have to be) but for some of us it may become a life's passion. I remember seeing an interview with Paul Farmer where he answered the question about how people who are interested in international health should proceed career wise. Should they become infectious disease doctors, and do a PhD in anthropology, like him? And his response was that that was not necessary, that people should do what they like (what they can conjure up a passion for), for eg. computer people are an invaluable resource in poor countries, and that what mattered is the committment, and that committment, when it comes to international health, has to be measured not in years but in decades. I find that that makes a lot of sense. Like if you really want to make something better you need to be there in the long term... how you choose to "be there" however is up to you. For some this might be going to a poor country and working there (there is a shortage of doctors in poor countries!), for others it might be financial support of a trusted organization (look at Warren Buffet!), for others still it might be advocacy or awareness in their own countries!

I remember an experiment that I learned about in an undergrad psyc class where people where told to shock other people (actors) that they could view through a glass in the next room. The actors where supposed to look tortured everytime they were shocked and they were supposed to make gestures to stop the shocking. The subjects were assessed to see how long they would go on shocking the actors even though they were clearly suffering. One thing that was found was that the closer in physical space the actors were to the subjects... the sooner the subjects would refuse to shock.

So I think that one of the barriers to greater concern for the problems of people living poor countries is proximity. I think that there are many people out there who would would be moved to help given the opportunity to experience the problems of people living in poor countries first hand (consider even numerous actors/actresses/random rich). I'm not saying that this applies to everyone. I have met my fair share of people who have returned from international electives bitter and frustrated and that is fair. I have known attendings who earlier in their career did international electives and then have not returned since. Some people are happy just for the "experience", to appreciate what they have at home and that is fair also. On the other hand, I believe that there are also a significant number of people who after a month elective, sought out another month and then another and then another...

I think the important thing, for those who do not succeed in making international med a part of their careers, is not to become "jaded", not to roll your eyes when you see a young med student in the future who thinks that he/she might want to do "international medicine". Not everyone feels that they are able to "commit" to international work but that doesn't mean that we can't support the people who do... and by support I mean intellectual and emotional support as much as or even more then financial. On the other hand, for those that do end up "committing" I think that the important thing again is not become "jaded" not to treat international health and international experience like an "exclusive club", not to turn off others who may have only recently become interested in IH and who may not be as knowledgeable... not to demand a ridiculous level of self sacrifice from others. There is a Buddhist saying that goes that life's greatest consolation is charity... so in a way we are all in it for ourselves. And if we are lucky enough to be able to help someone else in the process then that is a privilege and we should not judge others who for whatever reason can not do the same.

My feeling is that the world is getting so small that in the very near future medicine may become truly "multinational" with large universities setting up satellite campuses to train global physicians. How exciting would that be?
 

DavidHasselhoff

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i couldn't agree more about this global perspective on health being undervalued and undersupported.

the psych study you mention is the one where Mr. Wallace directs subjects to give shocks - it was meant to demonstrated obedience, with implications about war crimes, etc. but i do see what you're saying.

regarding being jaded: it's hard not to be. i saw first hand my organization was stealing and the whole town knew it too. but things aren't quite so simple abroad...it's slow, hard to change, and if you want it done right, you just have to do it yourself. that's what the major contributors have done.
 
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