Driving down unpaved roads in rural Mirebalais, Haiti, I had a flashback to my childhood in rural Ethiopia: scorching heat, children tending domestic animals, and women carrying water baskets on their heads. These images are not uncommon in many developing countries.
I was in Haiti in July on behalf of the AOA to attend an immersion course in social medicine offered through the non-governmental organization EqualHealth.
If you are fortunate enough to travel to such a country and assist in the care of patients in medically underserved areas, here are five tips to keep in mind before you go.
1. Practice self-awareness. Probably one of the most important skills to cultivate as a student doctor is the ability to gauge the unintended consequences of your behavior. Knowing how patients perceive your appearance, language and gestures is key to building trust and rapport with a patient. For example, just because you are providing medical services to poor, underserved populations doesn’t warrant the assumption of health illiteracy. Asking culturally sensitive health questions will allow the patient to showcase what they already know.
2. Know the value of resources. People in developing countries do not have access to clean water, essential medications or safe housing. Many illnesses affecting the poor stem from the lack of these basic resources and knowing how that affects the patient population is important.
3. Practice transforming suffering. In order to develop the skills necessary to do work in these countries, you must be able to transform suffering. What that means is if you are in the hospital and you see a patient who is suffering from terminal cancer and depression because she has no one to visit her, spend a few minutes chatting with her. While you are not curing the patient of cancer, you are transforming suffering by alleviating other factors contributing to the illness.
4. Maintain balance. As students and physicians, we’ll encounter patient suffering at many levels. Therefore, it’s imperative that we do not allow it to make us cynical or burn us out. One takeaway from my trip to Haiti was that compassion requires detachment from outcomes. That means you have compassion for the terminal patient but you do not allow your attachment to the patient or their outcome to overwhelm you.
5. Be a patient’s first advocate. In medically underserved areas, many of the socioeconomic factors of health can be alleviated by health-conscious policy changes. Therefore, remember that you are the patient’s first advocate. Speak out about injustices and do something to make a difference on a policy level. One great example domestically is the AOA’s DO Day on Capitol Hill event, in which DOs and medical students raise awareness of patient health concerns.