Thank you to the Spirit of 2010 for providing me with the opportunity to attend the Ecela Spanish Schools in South America. The ability to pursue this type of training was a rare experience and provided skills that will be invaluable over my career.
Prior to enrolling in medical school, I had studied Spanish for several years in school, but had not had the opportunity to receive formalized Spanish language instruction since college. Next year, I will be working in a community with a significant Spanish-speaking population – I wanted to make sure that I can easily communicate with my patients.
For my elective experience, I attended courses through the Ecela Spanish schools in Chile and Argentina. This experience provided a cultural and language immersion with training through a well-established, structured Spanish immersion course. The program set-up involved several small group lessons with a focus on grammar and fluency, followed by conversation classes led by an instructor. During the conversation classes, we would focus on the concepts learned in the preceding grammar class. I also took several hours of semi-private lessons with an emphasis on medical vocabulary, history taking, and the physical exam. In addition, we practiced consenting for procedures, describing medical treatments, and answering patient questions. Our instructors also took the time to focus on some important cultural aspects of communication that are unique to Spanish. In addition, we discussed common cultural practices and customs, as well as colloquial or slang terms that patients may commonly use.
One of the benefits of being in an immersion setting is that you are speaking Spanish for the entire day – not just in class. As a consequence, you improve much more rapidly than in a typical class setting. In addition, learning Spanish in two different countries (with vastly different cultures and accents, despite being geographically adjacent) was incredibly useful. I feel that this will help me to better understand and communicate with Spanish speaking patients from different parts of Central or South America.
I learned a great deal through the courses and felt that my fluency improved to a significant degree. Since returning, I have noted a significant improvement in my ability to use Spanish on shift. One patient in particular stands out – she gave me a hug at the end of her visit and told me how grateful and relieved she was that her doctor spoke Spanish. I hope to use the skills I have gained to provide the best possible patient care both next year and throughout my career.
Thank you again to the Class of 2010 for supporting this rare opportunity and incredible learning experience.
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!
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.