Thanks to the generosity of the class of 2010, I was afforded the chance to participate in Kaiser Permanate's elective in mass gather medicine during America's Cup. The elective took place during the latter part of the summer of 2013 and involved a fascinating combination of policy discussion, large scale medical operations, and daily shifts in a makeshift emergency room. The fact that the provision of care was no different than any emergency department was itself remarkable; the coordination and planning required in this undertaking was laid out in a series of lectures and meetings with city and hospital administrators as well as regional disaster experts.
I walked into this elective wanting to expand my breadth and depth of both experience and knowledge in the field of mass gathering medicine. I walked out with an expansive appreciation for a burgeoning academic field, spurring on an interest in arenas of remote medicine, telemedicine, international medical ethics and operations. Most of the faculty mentors/instructors have ongoing involvement in disaster medical response teams and USAR and through them, I too have been moving in that direction through regional and state fire and rescue training and service.
Thanks to the Spirit of 2010 award, I was able to spend my elective in Ireland, getting to know the healthcare system as well as the ins and outs of emergency care. I spent my time with Dr. Andy Neill, an avid proponent of #FOAMed (Free open access medical education) and emergency physician at the Mater Misericordiae University Hospital in Dublin.
During my clinical time there, I realized that there are as many similarities as there are differences in the way we practice. Many of the similarities lie in the shared frustrations of EP's everywhere, though we have much more litigation concerns here in the US than they do in Ireland. The differences are many. One of the most striking differences is the structure of staff there. Very few doctors seek out EM as their specialty. Their equivalents of attendings play a much more administrative, hands-off role and do few clinical shifts, if any. Most of the resident staff in the ED at a given time are rotating residents from other specialties who spend as much as six months at a time there.
Another observation was that of the lack of a regulated trauma system (though it is something they are working towards). Right now traumas can go to any ED and most rely on a general surgeon taking home call overnight to respond to emergencies. Luckily traffic is tight in Dublin, so they don't see a lot of high speed MVCs.
Lastly, I was able to learn a lot from Andy about the FOAMed movement. Andy's blog "Emergency Medicine Ireland" contains tips, tricks and pearls for EM physicians everywhere. We reviewed podcasts and spoke a lot about emergency medicine education and where it is headed. Exciting things are in store and I was glad to be a part of it. Thank you, 2010!
For my elective I spent a month at Clinica Esperanza on the Island of Roatan just off the north coast of Honduras. I had a mixed role in the clinic where I spent many of my mornings providing basic primary care, peds and OB consults to some of the 80 patients the clinic sees each morning. The clinic is the primary healthcare provider for over 10,000 island families treating everything from hypertension and diabetes to snake bites and scuba diving injuries.
In the afternoon, I spent time helping the administrative staff of the clinic complete a formal evaluation of the visiting medical student experience. I was responsible for talking to the permanent clinic staff, the visiting medical students as well as community members and small business owners to help assess the status of the current rotation and provide suggestions about how it might be improved. Through this collaborative effort we were able to provide the clinic with many suggestions that will hopefully both improve the visiting medical students' experience and also begin a more thorough discussion of how to best utilize visiting medical professionals and students for the benefit of the clinic and the larger community.
With the support of the Spirit of 2010 award, I went to Pursat, Cambodia in collaboration with Stanford University and URC. My role was an educational one, I was responsible for beside teaching with the local doctors as well as creating lectures on basic scientific topics for future learning. The project was focused on education in order to create sustainable change to the current medical system. The most beneficial part was teaching the staff how to use a defibrillator. The defibrillator had been donated from Australia a few years back, however, no one was trained how to use it. Many people were scared if they touched the defibrillator, they would shock themselves; therefore, they didn't want to learn. After practice and demonstration however, they became much more comfortable with the machine.
In addition to my clinical duties, I had a little free time to take a long weekend to Siem Reap to visit Angkor Wat. In addition, I had an extended layover in Seoul, South Korea where I visited my cousins.
This elective took place at Hospitalito Atitlán, which is located in the town of Santiago Atitlán, Guatemala. This hospital serves approximately 75,000 indigenous Mayan Guatemalans who live along the beautiful Lake Atitlán. It is a clinical elective, with volunteers providing 24 hour solo coverage in the ED. The hospital also provides primary care, prenatal care, and labor and delivery services; last time I was there, they were expanding their capability to provide surgical obstetrics. It is a true emergency medicine elective: the breadth of cases included cardiac arrest, fracture reduction and splinting, deliveries, neonatal resuscitation, pediatric respiratory disease, etc. One of the best aspects of this hospital is that while serving an indigent community in need, the hospital also has the resources so that you as a clinician can provide a high level of care. You are challenged to work independently, without the supervision of an attending, and you must become more thoughtful about your work because the patients cannot afford for you to be wasteful.
Lastly, this hospital is located in a beautiful part of the country. The lakes is surrounded by volcanos, and on my days off I would take a boat across the lake, settle into a hammock, and read a good book while enjoying the most amazing view.