During the third year of my residency in internal medicine at Rush University, I had the opportunity to experience something that many young physicians cannot: a global health initiative. I am thankful for being in a program that allows residents to be able to travel to underserved areas around the world, while working to make a lasting impact on the health care system. Lasting impact on the health care system. This would have a completely different meaning to me by the time I completed my global health elective in Jerusalem, Haiti.
Prior to my trip, I was under an oversimplified impression that we would travel to an underserved area and treat patients with what we could, while patting ourselves on the back for helping others and enacting sizable change. By the end of our week, I realized that a “lasting impact” meant so much more.
I was surprised and impressed to find that Community Empowerment has a continued interest in improving the health care facilities, despite having successfully built a stand-alone clinic months prior. For example, while I was there, the team was implementing an electronic medical record (EMR) system, which would improve continuity of care. As a result, I could use notes and data from prior clinic visits to treat patients. Instead of solely dealing with acute chief complaints, I could manage chronic disease maintenance as well. This was a new revelation for me. Being able to provide care longitudinally, by coming back every few months, is truly what it means to have a lasting impact.
Furthermore, I learned the value of testing and physical exams. Given the limited resources, it was often hard to tell whether the diagnosis was accurate or confirmed, so I learned to rely on history and the physical exam. Having to obtain our own vitals and urine dipsticks really emphasized how much we rely on other professionals, such as MAs, PAs and RNs, to make our own system run smoothly.
Since returning to Chicago, I’ve implemented some of the lessons I learned. My next rotation was on the HIV service at Cook County/John Stroger Hospital. Interestingly, the socioeconomic demographic was similar to the residents of Jerusalem. I began to evaluate the need of testing even more. For example, I found myself asking, “is this really going to change my management of patient care?” We often ask these questions when obtaining more intensive or high cost exams, such as MRIs, but rarely do we ask about smaller tests like blood draws, which still are a cost and resource burden for many. Furthermore, I prioritized patient comfort by trying to do more “lab add on” tests instead of subjecting patients to more needle sticks. Similar to Jerusalem, I found myself managing patients with available medications as the medicines I generally administer were not available on formulary. I was more comfortable with this approach having rotated through the pharmacy station in the Jerusalem clinic.
Through my experience, I’ve learned that it is a slow and arduous process to create a sustainable program where local physicians can be self-sufficient. During a trip, we can only work to help fill the gaps of health care accessibility, but impacting the system at large requires long-term commitment. But it’s incredible to see how far we’ve come as a team. The standalone clinic, with its separate exam rooms plus the EMR system are examples of this progress. I hope to be able to continue the lessons learned in my future practice and more importantly, return to practice medicine in global health.
- Anuhya Gampa, MD