Thank you to the Spirit Award for providing me with the opportunity to attend the Humanitarian Response Intensive Course (HRIC) hosted by the Harvard Humanitarian Initiative. It’s been a long time dream of mine to attend this two-week workshop and it was made possible by the class of 2010.
HRIC brings humanitarians together from all over the world to learn, collaborate and their field of practice. It focuses on the tenets of humanitarian intervention and the historical context that informed these tenets. Unfortunately, humanitarian response has all too often been initiated without sufficient forethought resulting in further harm instead of relief. As doctors it’s so easy to jump at international opportunities to care for those in need, but HRIC provides a sobering reminder of the pitfalls that follow poorly planned interventions. Medical care is only as sustainable as the system providing it and unsustainable solutions may actually do more harm than good.
This year the workshop hosted 70 students ranging in age from 22 to 65, many of who have been practicing in the humanitarian world for decades. I was particularly struck by participants whose lives were directly shaped by conflict and disaster, forcing them to cut short their formal education in order to enter the humanitarian field. For example, there was a young Syrian at the workshop who had dropped out of university, moved to Lebanon and started working for an NGO to provide safe passage and shelter for Syrian refugees. He was one example of many HRIC participants who dedicate their lives to the humanitarian imperative:
That action should be taken to prevent or alleviate human suffering arising out of disaster or conflict, and that nothing should override this principle.
I was deeply moved by the embodiment of this principle among people who have been afforded lives far less flexible than mine. It was the most diverse and accomplished classroom I have ever been in. HRIC and the colleagues I met there inspired me to be pragmatic without sacrificing my ideals. This is an uncomfortable interplay full of compromise, but one that ultimately allows for evolution of my practice as a physician and a humanitarian.
Thanks to the generosity of the Class of 2010, I was able to spend my fourth-year elective combining my passions of ultrasound education and international medicine in Roatan, Honduras. I worked directly with the Honduran doctors who provide care to over 100 patients daily at Clinica Esperanza – a clinic that provides pediatric, medicine and obstetric care to the island natives.
The clinic had two ultrasound machines for use. However the Honduran physicians are not instructed in ultrasound during their medical education and training so they were not utilizing the machines available. Each day, I would spend 3 hours in the morning and 3 hours in the afternoon teaching ultrasound while caring for patients.
The Honduran doctor in the morning, Dr. Emma Nova, evaluated all of the obstetric patients. When I arrived she told me the ultrasound wasn’t working because the screen was too dark. I increased the gain and the image improved and she was amazed! When I arrived she did not use the ultrasound in her evaluation of the pregnant patients. Instead she measured uterus size with a tape measure and used a Doppler to assess fetal heart rate. Dr. Nova was a fast learner and when I left she was using the ultrasound to assess fetal heart rate and also to date pregnancies in each trimester. The best part of this was seeing the joy in each mom ‘s face when they saw their babies for the first time!
Dr. Jayleen Coleman was the afternoon Honduran physician. She saw general medical patients and was excited about all aspects of bedside ultrasound. We used the ultrasound to evaluate gallbladder, kidneys, aorta, heart, lungs, DVT – basically anything and everything we could! Because of the broad range of applications, Dr. Jayleen was not independent with any one ultrasound exam. But I know that with more practice she will be able to incorporate point-of-care ultrasound and improve care for her patients at Clinica Esperanza.
While in Roatan, I also hired a local woman, Karina, for individual Spanish lessons. I spent 2 hours a day with her in her home. It was such a pleasure getting to know Karina, her nine-year-old daughter Alice and her dog Molly. It was an experience I will never forget!