Reflections on Belize

Written by Luke Rohlwing, MD, PGY4 at Kaiser Permanente Oakland Internal Medicine Program while on Global Health rotation with Hillside Health Care Center in Eldridge, Belize in February-March 2016.

I had never traveled to a developing country prior to my trip to Belize.  Prior to embarking, I naively thought that the combo of my upbringing in a lower-income rural town in the Midwest, and later travel and studying abroad in Europe, were the right combination to prepare me for my trip.  Although my prior time outside the U.S. was mainly in developed nations, I was a seasoned traveler and well-prepared for a good amount that I might encounter, whether it be socially or culturally.  What I hadn’t considered though, is despite having worked with underserved populations and communities back home, this was the first time I had ever traveled outside the U.S. to serve as a physician.

The connecting flight on a twin engine prop plane – the type where a form asks for your weight before getting on so they can pre-assign your seat to distribute weight properly – and the seven-hour school bus ride along the length of the country were both new to me, but were a strangely exciting welcome.  However, I recall being struck by the reality of my location and situation when the bus pulled to the side of the road to let me and a colleague off in what I could best describe as farthest-suburb-of-distant-city meets dense jungle.  My caution was also slightly heightened when the bus driver gave the directions of “walk up that (gravel and dirt) road a little ways and you’ll find the clinic.”  What had I gotten myself into?

Any slight wariness I originally felt was quickly abated by the welcoming staff at Hillside.  The other practitioners and I – a mix of physicians, physician assistants and pharmacists – were oriented together to our location, what our schedule in Belize would look like, and how the clinic functioned to serve the citizens of Punta Gorda and the nearby towns, as well as the remote villages of Belize.

In addition to a quality education in clinical knowledge and practice, I remember leaving with two distinct impressions of practicing medicine in Belize.  Being a physician in the U.S. typically comes along with a varying degree of explaining why, and in a sense, truly convincing a patient why a certain lifestyle choice, taking a medication and/or undergoing a procedure is being recommended.  Although there is certainly some variation between patients in terms of preconceived beliefs of “being healthy” and how the body works, most patients I have treated in the US came from a somewhat similar background and thought process.  However, while treating a native woman in one of the jungle villages of Belize, I was not prepared on how to counsel her after she stated she believed her back pain was due to an evil spirit, as her local shaman had informed her.  This experience, as well as others like it, were culturally eye-opening to me and certainly broadened my understanding of how individuals can perceive their health and well-being.

Yet, despite the numerous differences between my patients and I, the other deeply impacting impression I remember leaving Belize with was that of gratitude.  Although I’m sure my concepts of disease, health and medication seemed as foreign to my patients as theirs did to me, they were always incredibly appreciative of my viewpoint and any assistance I was willing to offer, even if that was if there was nothing to do.  After visiting various villages during my month in Belize, I have left there with a different concept of the word “poor”.  Despite living in villages with thatched-roofed houses without plumbing or electricity, the native people of Belize never considered themselves poor, and were certainly amongst some of the most joyful and grateful people I have ever met.  I am sad to say that it made me think of a quote from Alexis de Tocqueville’s Democracy in America, where he describes Americans by saying that “…a strange melancholy that haunts the inhabitants…in the midst of abundance.”

Although I’m sure the impact that my time in Belize had on me will certainly wane, as it already has started to do so, I am hopeful that at least a part of it will remain.  In time, I hope to go back to Belize, as well as other underserved areas, both domestic and abroad, to not only serve with education and skills that I have been blessed with, but to rekindle an internal focus on the true aspects of life that bring joy and deserve gratitude.