Written by Maria Martin, MD, PGY-4 at Kaiser Permanente San Francisco Obstetrics & Gynecology Program while on…
Written by Tuong Van Nguyen, MD, PGY-3 at Kaiser Permanente Santa Clara Obstetrics & Gynecology Program while on Global Health rotation at Hospital de la Familia in Nuevo Progreso, Guatemala in April-May 2017.
It began with a 6-hour red-eye flight to Guatemala City and then a 5-hour bus ride to the small town of Nuevo Progreso. You would see small shacks lined up along the road that were homes for families of five or more, amongst the luscious jungle spotted with mounds of litter. I thought that traveling abroad a few times, including medical mission trips to similar areas such as Nicaragua would make me acquainted to the setting, yet it ceases to give me a new perspective each time; a new experience, a new family, a new community and never ending knowledge. It revives the awareness and appreciation for life. But it also forces
me to reflect on how I got so lucky to be born in America and reminds me of the vast majority of the world who were not born to the same level of opportunity.
Meeting my first patient in clinic after a long day of travel, I couldn’t complain, as some patients may have traveled even further with less means or comfort. Patients would line up as early as 5 a.m. and wait all day to see the “specialist”. Not to mention that some of them came in “NPO” in anticipation that they might get surgery the same day. It seemed almost contradictory as I initially fumbled through the paper charting system and learned how to hand-write orders in Spanish, compared to the advance EMR technology we are accustomed to in the U.S. All the patients were amazingly kind with strangers smiling at you as you walked past the crowded patient waiting areas to the clinic office. Some were just appreciative of the reassurance and the fact that surgery was not indicated when someone else had told them that it was.
One particular experience stood out to me in clinic, when we had conveyed to a patient that her fibroid uterus was so enlarged that surgery would be recommended, as it was causing her symptoms. She had seemed fine and her adult son was there helping her make some medical decisions. As we were wrapping up and scheduling the surgery for the next day, she started to cry. It had put things into perspective for me; the emotions and fears that must be going through her, to put all her trust, and literally her life, into the hands of a stranger that she just met an hour ago. Of course we offered her non-surgical options and the option to defer if she felt like she needed more time, but she felt reassured in the end. Fortunately, her procedure went well and we removed her uterus, which was the size of a cantaloupe and she recovered without any complications. She was so thankful after the procedure that I almost felt selfish to feel like we did something heroic. But it was interacting with those patients in Guatemala that reminds me of the moral obligations of physicians and the basic principles of medicine; in caring, serving and healing humanity.
Professionally, I learned how to navigate the archaic paper charting system, expanded my medical Spanish, gained countless skills in the OR, being resourceful with supplies and instruments, and managing complications in a developing country. Personally, it has reminded me how we should not take so many things for granted and prioritizing what really matters in life. It has allowed me to connect with my patients to a different level and will continue to humble me as a physician for years to come. As I visited the Children’s Nutrition Center on one of the last days there, a place for malnourished infants and toddlers, I felt awful as I had to place Jefferson, the 1 year old toddler, back into his crib. He started crying furiously, wanting to be held again. One of the nurses reassured me that he would be okay. Although there was a sense of guilt in having to leave him, I felt a small sense of hope for Jefferson; that although he may not be born in America with endless opportunities that some take for granted, I took some solace in the fact that he was in such a caring setting and that he was being fed nutritious meals, so his opportunities aren’t taken away from him.
I feel fortunate to have had the opportunity and support from the Kaiser Global Health Program to participate in such a humbling and worthwhile experience. Talking to other residents from various programs, this experience is definitely not something offered in every residency. I’ve learned so much not only from the attendings who supervised me, but from all the kind and generous CRNAs, RNs and volunteers from all walks of life. Not only does it allow you to become a more well-rounded, culturally-sensitive physician, along with exposing you to the social and financial factors in healthcare in a developing country, it teaches you a multidisciplinary approach to patient care and teamwork.
Thank you so much such a wonderful experience and opportunity.