Finishing Out Fourth Year Abroad

Victoria Konold, M4

I had my last day of medical school as a Feinberg student last week, not in Chicago, but in the rural town of Malinalco, Mexico. One of the main reasons I chose Feinberg for medical school was the strong global health program, and so I decided to finish out my fourth year of medical school with 2 months of global health rotations in Ecuador and Mexico, organized by our Office of Global Health and funded by the Global Health Initiative. And let me tell you, it made for an interesting send-off.

My interest in working with global populations started early- I grew up in a family where one side was Caucasian, college educated, and had multiple doctors in the family, whereas the other side was Spanish-speaking, needed food stamps despite the adults working multiple jobs, and never went to see the doctor. Seeing the difference between these two sides of my family encouraged me to concentrate on treating underserved populations, and especially Spanish speaking ones. And although I majored in Spanish and lived abroad as an undergrad, I never felt my grasp of Spanish, and especially my medical vocabulary, was enough to actually treat one of my patients in their native language. Similarly, my time volunteering at free clinics taught me a little about treating underserved populations, but I felt what I was learning was superficial. My goal was to be well-equipped for treating underserved Spanish-speaking populations in the US, and I knew I needed more exposure to get there.

And so I stepped off the plane in Quito, Ecuador a couple months ago, ready for an immersion in medical Spanish and an experience in rural indigenous health. After a week of intensive Spanish classes that was essentially a review of all the grammar I ever learned, we were dropped at the edge of the Amazon rainforest in rural Puyo, Ecuador to work with a physician in a 2-room clinic who was treating the indigenous Shuar population. This month was certainly an education in physical barriers to health: many of the people we treated did not have basics such as clean running water, and some even hiked 5 hours through the jungle to come see us. To combat this, several mornings were spent traveling to one-room school houses in the middle of nowhere, where we brought the kids their biannual antiparasitic, gave them all screening physicals, and a health talk where we addressed everything from where to get your potable water (NOT from the river), to the symptoms of Dengue fever (which it turned out, the kids knew better than those of us from the states).

During this rotation I also experienced some social barriers to health: as a native group, the Shuar has a strained relationship with the government, and this was particularly obvious during a meeting I went to between the Shuar representatives and the Ministry of Health regarding a cow that had died exhibiting signs of rabies, but had been eaten by several people in town before rabies tests could be done. The issue was how to treat whom for rabies, and how to handle future cases and prevention, but both sides were frustrated; the government because the village had not informed anyone of a possible outbreak and had let the animal be consumed, and the village because the government refused to vaccinate them all because of cost and availability of the vaccine. All together my time in Ecuador taught me, in a very visceral way, how healthcare is determined by so much more than a diagnosis and the right medications, and gave me some ideas as to how we can address these barriers to health.

Just as quickly as I found myself in the Amazon, I landed in urban Mexico City for a rotation that focused more on vocabulary building and history-taking skills at a large hospital. However the most interesting part of my time in Mexico turned out to be the last week, which I spent in rural Malinalco, a small town a couple hours and a world away from cosmopolitan Mexico City. Here I gave clinic completely on my own in Spanish, and found that I could do it (with the supervision of the Mexican doctors on site, of course). This was a big confidence builder for me- one of my main goals at the start of medical school was to be able to conduct a whole clinical encounter in Spanish without help, so that I could truly treat Spanish-speaking populations as a physician. And here I am about to start residency, and I find I met my goal, thanks to the 2 months of medical Spanish immersion.

Despite this month’s focus on using Spanish clinically, I still learned a lot about socioeconomic determinants of health. My most interesting patient of the whole rotation was a patient who could not read, and so was injecting himself with an oral solution, having misunderstood how he was supposed to take his medication for a chronic condition. Predictably, he was not feeling well, and I was shocked: at home I would have never considered that the underlying problem in a patient’s “non-compliance” was not being able to read the instructions on the prescription, and so this was a first for me. So I went over the patient’s medications again, and wrote a new prescription with color-coded drawings indicating the time of day and which pills to take- after this it was clear that we were on the same page, and he showed up as planned 2 days later so I could see how he was doing. This was exactly the sort of case I came here to learn from, and it will definitely make me think twice the next time I am trying to figure out why a patient is not doing as well as I expect them to be doing.

The language skills I learned on this rotation and my experiences with patients who face a variety of barriers to health will be something I take with me into my residency, where I hope to continue treating a global population closer to home. I am now more confident treating patients in Spanish and hope my use of the language and understanding of where some of those patients are coming from will improve the therapeutic relationship I can have with these patients, and help to make healthcare more accessible to them.

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