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The future global health physician (MS)
I still remember the moment I realized my future was going to be in global health. It was the summer between my first and second year of medical school at the Loyola University Chicago Stritch School of Medicine, and I was in the middle of an international service immersion trip to Guatemala. It had been a long day, and I sat along the side of the local hospital, reflecting on the patients I had met and the work we were doing. The degree of poverty we were facing was just so overwhelming. In fact, it was only matched by the incredible sense of gratitude nearly all the patients had, even if sometimes all we had to offer were a few packets of Tylenol. I am not sure I can explain exactly what happened next – something just clicked. I had entered medical school with high hopes and big dreams, and all of a sudden, it felt as though they were finally coming together into one clear and concrete vocation. It felt good.
The very next morning I asked our attending if I could ever come on another trip with her. Excited to hear I was interested, she told me she was actually headed to Peru in another couple of months. Thus, just a few months after my introductory experience of global health in Guatemala, I was preparing for round two. This time I was only able to go for a week, but I had the opportunity to meet a few Peace Corps workers who were working in the community for the next 2 years. It was then, in witnessing their incredible language skills and tight connection with the local community, that I realized I would need to go beyond the standard short-term medical trip if I were to really make global health a substantial part of my future career.
Returning to medical school, I immediately began working with the newly created Center for Service and Global Health as well as my academic deans to try and put something together. Ultimately, thanks to an overwhelmingly generous attending who had started a clinic in rural Bolivia 10 years earlier and the incredible open-mindedness and flexibility of the Loyola administration, I was given the chance to spend a year working at the clinic in Bolivia.
Despite its ups and downs, that year provided me with what is probably the most powerful learning experience of my young medical career. In the short trips I had been on previously, I had been introduced to both the immense logistical and cultural challenges involved in delivering healthcare halfway across the world in a resource-poor setting. But, as I learned time and time again during my year in Bolivia, being aware of these challenges is far different than having actual and concrete experiences of how they happen and why. The answers were not always pretty, and I will admit there were times during the year where the sheer size of need in combination with the ethical complexity of determining how best we could help was simply too much. I will also admit that even at the end of my year, I still had far more questions than I did constructive solutions.
Thankfully, that was not the end of my story. During our fourth year at Loyola, we were given the opportunity to spend up to 2 months abroad. With this opportunity, I was able to spend 1 month at another clinic in the jungles of Peru as well as return to the clinic in Bolivia. This has given me the opportunity to not only learn from the contrasting example of another rural clinic, but also return to my original site after 8 months of processing and reflection.
It has been an absolute gift, and I could not imagine a more fitting bookend to the comprehensive global health training that Loyola has provided me. Like many other young medical students, I was given the chance to volunteer abroad in the summer after my first year, and the experience left me changed. However, through the focused mentorship and constant emphasis on personal reflection, I was inspired to go back and continue building on the experience. Then, with the seeds firmly planted, I was given the chance to go even further thanks to the courageous support of the administration which helped me design a year-long global health fellowship position. And finally, through the continuing effort of the Global Health leaders at Loyola to solidify a standardized global health curriculum, I have been given the opportunity to bring meaning and closure to my many experiences by going back and reflecting more formally on what has happened and what I have learned.
Together, these experiences have left me changed – not only as a future physician, but also as a human being. And though I have no idea where my training will take me next, I know I would not have come this far if it had not been for the unique support Loyola has provided me. But, as I move towards a likely future in academic medicine with a focus on global health, it is my hope that students will continue to be offered these life-changing opportunities for years to come.
The accidental medical tourist (NR)
My interest in global health first surfaced at the University of Michigan where I studied Spanish with a pre-medical focus. As my knowledge of Spanish strengthened and the pressure of medical school applications approached, I often wondered how I could gain clinical experience while putting my language skills to use. When I learned about the global health initiatives on campus, all the puzzle pieces fell into place. Whatever the motivation may be, pre-medical students and medical students alike are drawn to global health, which has become a hot topic in the medical community. The incentives to participate in international service trips are big these days. The global perspective gained by participating in international mission trips is indispensable: understanding social determinants of global healthcare, cultural competency, and comprehension of public health issues. Although these are compelling reasons to join the global task force, they cannot be the only considerations academic centers have in mind when designing their global health programs. Many students will select a college or medical school based on the availability of a global health program; however, students need to probe deeper and evaluate the integrity of the programs instead. Though it is clear that students benefit immensely from participating in immersion trips, do we also need to ask what impact these trips have on the local community?
While at the University of Michigan, I participated in various global health programs and clubs to get exposed to this expanding field. I read about barriers to healthcare in Third World countries; I followed Paul Farmer's work trying to understanding the intricacies of politics, geography, and culture and how these factors intertwine to limit healthcare efforts. As many of my fellow pre-medical students traveled abroad on medical mission trips, I was intrigued by their experiences but I could not help but feel that my contribution as a ‘pre-med’ would fall short of benefiting the parties involved. At the end of the day, several thousands of dollars were invested in these trips per student, but at whose cost were the students ‘gaining global perspective?’ And while I do not want to undermine the importance of expanding one's global outlook, it is imperative that global health programs formalize these immersion trips in an attempt to benefit all parties involved: students, patients, local communities, and academic centers. There is no doubt that many global health programs are created with good intentions, but without a thorough examination of implications of global relief work, many of them have the potential to do more harm than good. When programs neglect the involvement of the local community and fail to create bidirectional relationships, they also fail in creating sustainable, long-term healthcare that should be the foundation of every global health program.
This need for accountability materialized during my own global health trip to Quito, Ecuador with the International Service Immersion program (ISI) at Loyola's Stritch School of Medicine. Over the past 18 years, the ISI program has worked to establish long-term relationships with established clinics and medical relief groups abroad. With only four students in its first year, ISI has grown dramatically with over 85 students participating this year. I applaud the program for its emphasis on public health and preventative health measures that is incorporated into every trip, along with its emphasis on reflection and research. But that same old feeling of incapability I had in college flooded my mind once again: what am I really contributing to this community in Ecuador? Certainly as a first-year medical student I could take a blood pressure and other vitals, but did my limited medical skills warrant an expensive trip to a foreign community with complex medical problems outside my scope of understanding? Sitting in this poor, underserved clinic, I wondered how many other college and medical students were in my same shoes, many of them lacking even the minimal language skills to communicate. These foreign clinics should not be the practicing grounds for inexperienced students. With the ‘preferential treatment of the poor’ model in mind, these patients deserve the utmost respect and quality of care. Despite my eagerness to help, I found it unjust to have this vulnerable community be my first patients.
The two students’ essays here reflect different experiences with global health immersion experiences. The first student is someone who is committed to this area as a career goal and found the experience transformative on many levels. The second is someone who has some interest in this area but came away with many more concerns about the appropriateness of such global health experiences. Both experienced challenges and triumphs as they embarked on their respective immersion experiences. As one of the student authors (NR) asked, ‘I wondered how many other college and medical students were in my same shoes, many of them lacking even the minimal language skills to communicate.’ In light of these student narratives, we wanted to review a handful of US medical schools to see what kind of commitment they have to global health training and opportunities.