On Rounds

The men’s ward is a truly frightening place. There is a long, narrow hallway of concrete with little light aside from that which comes in from the doors at each end. Passing by the patients’ rooms, their sunken eyes stare up at me. God only knows what they’re thinking. Each room contains a row of beds and nothing more, windows with bars, and draping mosquito nets. The men are wasted away – some just skin and bones. There is so much AIDS here in Zambia, it’s horrifying. The stigma associated is still so bad that Dr. Lena never says “HIV” or “AIDS” around patients. Though most of them don’t speak English, they definitely recognize those words. Instead, she says patients have RVD – retroviral disease. The people are also plagued by malaria, tuberculosis, pneumonia – all things that no one should ever die of, but still, so many do, especially when their immune systems are compromised by HIV.

The stench is absolutely suffocating. Sometimes I can hardly stand it. Clearly, Dr. Lena has gotten used to it – nothing seems to faze her here, and that gives me hope. I know that if I was forced to, I too could adapt, but this initial difficulty is really troubling. I feel so guilty because I want to care for these men, I want to help, but how can I if I’m scare to be near them? And I am scared. I’ve never felt disease so close to me before – disease is the inescapable presence, bearing down on me in every room. Everywhere I look, I see it. I feel it. I step outside and gasp for air, but still, it’s there – the stench, the sickness, the death and the rot. And I don’t know what to do.

Today was a better day, spent mostly in the children’s ward and malnourishment ward, which is basically just an extension of the children’s ward, since everyone here is malnourished. Children tend to start crying when we come on rounds, our white faces and white coats, strangers in a strange place. Big steps, however, were made today when I realized that the crying eventually dies down, and just like with children at home, it helps to come at them sideways. I smile at them out of the corner of my eye and wink. Some play coy, hiding their faces in their mother’s chest for a moment, then looking back up, smiling, to see if I’m still smiling at them – a game played back and forth.

One baby boy, about 2 years old, cried and clung to his mother when we tried to examine him. The baby had pneumonia, and it was impossible to listen to his lungs while he cried. I rubbed his back and gave him the end of my stethoscope to hold. He eventually took it, touching it carefully at first and then shaking it in his fist. I traded him a pencil for the stethoscope, and I was finally able to listen to his chest. I made several little friends in the children’s ward today, and I feel as though my hope has been renewed.

The First Baby, Cont.

Finally, it was my patient's turn to deliver, but the baby was slow coming. The mother was only 15 years old. Dr. Fee said her malnutrition and underdeveloped hips, combined with the fact that it was her first baby added up to a long labor. I felt a connection with the young girl, it being each of our first deliveries. I stroked her arm and swollen belly, whispering words of encouragement. She stared up at me with big brown eyes, full of fear and pain, and she cried out for her Mama.

Hours passed, and as Dr. Fee and I waited, the midwife informed the doctor that the girl would need a particular medicine after delivering. I asked Dr. Fee what that meant, and she said that the girl was HIV positive. We had been informed that the HIV rate in this are of Zambia is around 16%, so I wasn't surprised by this news. I wasn't scared either, though I probably should have been. I just wanted the baby to come.

Finally, the baby was close. The girl pulled off her shirt, as it is their custom to give birth naked. I put on sterile gloves and assumed my position between her legs, gently tracing the crown of the baby's head with my fingers. Dr. Fee stood by, calmly instructing me, and before I knew it, I was sliding the baby out. What happened next is a blur.

As the baby slid out, I was hit in the face by a wave of fluid that entered my mouth and eyes. I spat, completely stunned, the baby in my hands. I told Dr. Fee that it was in my eyes and she told me to put the baby down and go wash my eyes out in the sink. I did as I was instructed. I think that it was then, eyes wide open, splashing water into my face, that I began to panic. She was HIV positive and I could get it through my eyes from her amniotic fluid. I began to shake I think. I finished at the sink and walked, stunned, to the crib where Dr. Fee was taking care of the baby - a very, small but apparently healthy baby boy.

I stood there, trembling with silent panic, until Dr. Fee finished. Shaking, I said, "She's HIV positive. I can get it through my eyes." Dr. Fee told me no, no, it was the other woman, the other woman who had been silently moved into the empty second bed who was HIV+, not the girl whose baby I had delivered. I broke at that moment and began to cry. "Are you sure?" I asked her. She checked the girl's papers, and she was negative. I fell onto Dr. Fee's shoulder, crying for only a moment, trying to shake it off as best as I could. I was so afraid. Dr. Fee had a rapid test performed on the girl to confirm her status, and she was HIV negative. For a moment, nothing else mattered besides holding the new baby.

I'm sitting in our cabin now, having showered and rested, and I still feel so shaken, so afraid. I love Africa, but today, I'm ashamed of how much I fear this place.

It takes a village...

If there was one thing that struck me from the first moment that I stepped off of ILAC's "Gringobus" onto the dirt road of Yaque Abajo, it was a sense of familiarity. Now, I have never traveled to the Caribbean or to Latin America before, certainly not to the DR, much less to this idyllic mountain village two hours outside of Santiago. However, there was something so familiar about that place. After a few hours, it finally dawned on me: Yaque Abajo was the Dominican version of my family's village in the mountains of Cyprus. From the gorgeous mountain vistas to the donkeys along the side of the road, everything (save the fact that it was Spanish rather than Greek being spoken) reminded me of Omodhos, the village where my father grew up and where I have been lucky to spend many summers of my life. Perhaps the most impeccable similarity between these two villages that each hold a special place in my heart was the people. Everyone is family in Yaque Abajo, regardless of whether or not you share DNA. As you walk down the road, you are greeted by aunts, uncles, cousins, and grandparents, all eager to make you a cup of coffee or pour you a soft drink. All of the children playing and singing up and down the road are family, and even after just a few hours in the campo, they began to feel to me less like new acquaintances and more like any of the dozens of my cousins running around Ohmodos. I'll never forget 8 year old Brianna's excitement to meet us all that first day, Alex's insistence that we would look FABULOUS in one of his fashion designs, or Esther's unyielding hospitality and endless supply of quite possibly some of the most delicious food I have ever tasted.

As we got to know the people and way of life of Yaque Abajo over the next 10 days, I constantly kept coming back to the notion that a village is a village, no matter where you are on the globe. The importance of family and friendship in the village was infectious, and it became second nature to value taking time to share your experiences with others. It was such a rewarding feeling to walk up the village's main road each day after clinic, passing the homes of our new Yaque Abajo family members, knowing that we were able to have reciprocated a bit of the hospitality that they perpetually offered to us. For the first time, someone was calling ME their doctor, and going out of their way to let me know how something as simple as the Tylenol or vitamins that I had given them made them feel better. I can imagine that the pride I felt at having the privilege to treat these people would be similar to how I will feel when I am someday able to treat my own family members and fellow "campesinos" back home in Omodhos.

Yaque Abajo, Dominican Republic

It’s been almost two weeks since I left the Dominican Republic but it’s still hard to let it go. I find myself listening to Merengue or Bachata or Spanish radio stations to try and bring myself back to our days in Yaque Abajo, a serene little town in the rolling hills of the Dominican Republic.

Upon arriving in Yaque Abajo, we were met by Dominicans of all ages, many of them eager to hear news of the students and doctors who had been there the year before. It was very apparent that the Loyola crew from the year before had left a lasting impact on the people of this community and we had big shoes to fill.

Soon after we arrived, the rains also arrived in full force and we were left huddled under a small shelter, which we shared with our new friends and a few wandering roosters. By dusk most of us were settled in our new homes, the pharmacy was ready for business in the morning and we shared a delicious dinner together.

The clinic doors opened at 8am (or close to it) every morning and we were scheduled to finish by 12:30pm although some days went on until around 2pm. We saw about thirty-five patients every day ranging from small babies to resilient ninety-year-olds. Common complaints included, “gripe” (flu/cold), back pain, headaches and occasional GI problems. Sometimes it was frustrating to send patients away with a bag of acetaminophen, telling them they just had normal body aches and it was part of life, when they had arrived with so much hope for a concrete diagnosis and cure. I often felt like we weren’t living up to their expectations but when they left they would pour out their thanks to us as if we had saved their life. I slowly began to understand that sometimes living up to their expectations often meant just taking the time to hear them out and acknowledge that you understand and care about them.

After a full morning of clinic, we always had an amazing lunch waiting for us. We were fed extremely well and the food was beyond delicious. In the afternoons we always hoped for at least a short siesta, but the majority of the afternoon was spent visiting with host families or kids from the village and making house calls. After dinner the kids from the village organized various activities from dancing to dominos. Needless to say we were never bored or lonely.

I don’t think I would ever have been really ready to leave Yaque Abajo but when the time came, we said our tearful goodbyes. I held it together pretty well until our little host brother began to sob uncontrollably, to the point of hyperventilating, which caused our host mom to start crying, and although Maria stayed strong, I have to admit I did not. There were more tears and letters exchanged down by the clinic as we all boarded our “Gringo Bus,” and I am sure we will all wait eagerly for next year’s group to bring back news of our friends in Yaque Abajo.

Delivering Babies

Tuesday, June 8, 2010

Today is our third day at the Minga Mission Hospital. We have delivered several babies, and although I have assisted and watched, I have not delivered one myself. One of the few things I dreaded about medical school was labor and delivery. I have never had any desire to deliver a baby and to be honest, the whole thing makes me nervous because I feel like I have no control over the situation. Dr. Fee was great about explaining everything ahead of time so that I knew what was coming. After watching a few I decided it was time to deliver one myself.

As we finished breakfast this morning, one of the nuns told us that there were three women in labor. Sharla and Mike have delivered a few babies and are kind of done with the labor and delivery ward, so MaryBeth and I headed over with Dr. Fee. I delivered the first baby and MaryBeth delivered the second, both without much difficulty. About an hour after I delivered the first baby, the baby’s grandmother came in looking for whoever delivered her grandchild. Dr. Fee pointed to me, and she immediately began dancing and calling out in excitement. She danced around me for a while, there was a lot of hip thrusting and I was kind of shocked. She told the midwife that her daughter had been in labor at home for two days and could not deliver, and she was endlessly grateful for such a successful delivery.

I spent a few hours with the third woman in labor. She was 19 years old, and this was her first baby. She was screaming and crying a lot throughout the labor. Dr. Fee instructed me on positions that may make her more comfortable, and I rubbed her back but she was inconsolable. She was thrashing around a lot and yelling. She kept saying “Help me Medicine” because I think she forgot the English word for Doctor. As her labor progressed, she seemed to start to remember more English. She started trying to rationalize with me, saying that she “had no power to deliver” because she had been up all night. She was asking for “some medicine to drink” but the only pain medicine we have is acetaminophen (panadol) and we can’t give it to them until after they deliver. When I explained to her that we couldn’t give her medicine until the baby was out she screamed even louder. Eventually she began begging for a C-section, which was completely out of the question. Twice during the labor, as she was kicking and screaming she almost threw herself off of the bed. I caught her once, and the second time she caught the bedpost just in time.

When the woman was finally ready to deliver, she kept rolling on her side and closing her legs every time she had a contraction. The midwife explained to her that she needed to push, so eventually she rolled on her back. As the baby was crowning, she started kicking and screaming and trying to pull my hands away and grab the baby herself. I was fighting her off with my elbows because I was trying to keep my gloves sterile, and MaryBeth and the midwife were attempting to hold her legs down. As the head came out, her perineum tore. I delivered the baby and started to clean her up while she continued to kick and scream every time I touched her. From behind the curtain, Dr. Fee asked me how the perineum looked and I guess I was still in shock because the only reply I could muster was “It’s…. not…. there?”. She took a look and concluded that the tear would need to be repaired. Dr. Fee and the midwife gave me the syringe of lidocaine and said, “you know how to inject, right?”. I know how to inject for vaccination, but not lidocaine! They were trying to explain the technique to me, but as I looked at the perineum it just looked like a mess. The midwife offered to do the first injection so I could see how it is done, and as soon as the needle touched the woman she started kicking, screaming, thrusting her hips and trying to grab the syringe out of the midwife’s hand. We decided the midwife had better do the injections and I would attempt to hold the patient down on the bed. The woman screamed the whole time the midwife was suturing. When she was finished, I left to meet the rest of the group at the convent for lunch. I was shaking and covered in sweat, and as I looked down I saw scratch marks all over my arms. Although delivering babies wasn’t as bad as I expected, I think I can safely rule it out as my calling in medicine.

First day in Zambia

Saturday, June 5, 2010

We arrived in Malawi yesterday, drove to the Bishops house in Chipata, Zambia, took a much-needed shower and had dinner before collapsing into our beds. After two full days of travel, we really needed a good night’s sleep. We woke up this morning and had breakfast at the bishop’s house before our orientation to the healthcare system in Zambia.

As we finished breakfast, we were told that a tribe of dancers was arriving to dance for us. We headed outside and sat on the steps of the Bishop’s house as the dancers walked up the driveway. The tribal dancers were a group of about 30 men, women and young boys. The women were dressed normally, in chitengas and shirts, while the men were wearing skirts made of animal furs and carrying tall, thin sticks and wearing headbands and bracelets made out of animal skins. The women stood in a semi-circle around the back, singing and clapping. The men and children spread out in front of us to dance. Their dance involved a lot of stomping, that added to the ‘music’ coming from the women. The chief stood in the center, dancing and directing the other dancers, holding a decorative shield and sword.

One of the men who works for the Bishop explained to us that the dance was a traditional dance of celebration, reserved for when the men of the tribe had had an exceptionally successful hunting trip or had won a battle. The animal skins they wore were those of the animals they had killed. Today, the men no longer hunt or go to battle, so the dance is reserved for times of celebration, such as our arrival.

The dance went on for 30-45 minutes. I was a dancer when I was younger and have taken classes in African Ballet, but nothing I have ever seen compared to what I saw today. As I watched the dance, I saw the passion in the dancers, even in the young boys. It almost seemed as if this dance was something that they were born with, not something they learned. It was not merely for our entertainment, it was an uninhibited expression of their excitement, joy, pride and gratitude. I have seen a lot of dancers from the western world, but never have I seen such a raw expression of emotion. It was our first day and we didn’t understand any of their language, but there was no ambiguity within their message. Talk about cultural immersion.

The First Baby

I told Dr. Fee and Dr. Lena that I wanted to catch a baby. I know, that doesn't sound like the most technical of terms, but it was all I could think about doing. They chuckled. They said that would be fine - I'd have to just hang around the labor ward and see what happens. Today was our first day in Minga, a little village southwest of Chipata. We got up this morning, dressed for the first time in our scrubs and white coats, ate breakfast and waited outside the hospital for Dr. Lena to take us on rounds. We didn't make it on rounds at all today - we were notified quickly that three women were already in labor.

Before too long, Dr. Fee had arrived. She's a high risk Ob/Gyn surgeon, delivering risky babies for a living. What a remarkable woman, so intelligent, kind, poised - everything you'd want her to be. She has taught at medical schools in the past, so she's used to giving instruction, and I felt comfortable with her immediately. There were three beds in the labor ward and three women filling them - one for each of us, Sharla, Mike and me. Sharla and Mike quickly walked to the first and second beds, and I to the third. Dr. Fee explained that she wanted to deliver the first baby so that we could all watch one before delivering on our own. She showed us how to examine the cervix, sliding our index and middle fingers in, pressing down on the perineum, widening our fingers to trace the circular edge, feeling the baby's head and fontanels. I was nervous and excited - ecstatic I think.

It was Mike's patient that went first, and Dr. Fee caught, talking us through it while Sharla and Mike held the woman's knees and ankles, and I stood staring behind Dr. Fee. The vagina stretched and stretched, exposing the wet, round, curly haired head of the baby. Dr. Fee guided the head out gently, feeling with her fingers for the neck, making sure the umbilical cord wasn't there. Suddenly a face appeared, eyes closed, covered in whitish mucus. She maneuvered the shoulders through and guided the rest of the body as it slid out - a healthy baby girl.

I seem to have skipped over so much. The labor took a long time - there was blood and shit and piss and screaming. There were words of encouragement, gloves taken on and off. There was moaning and grunting, people coming in and out, flies flying, landing and being shooed away. There was the distinct smell of fresh blood, a language I didn't understand being spoken, sunlight coming in from the windows and sweat running down my chest and stomach. There was new, pulsing, screaming life right in front of me.

Vietnam: The Cultural Experience

Particularly in comparison to other students' experiences, the orthopedic hospital in Ho Chi Minh City was quite modern and advanced. Joint replacements, even microsurgeries occur on a regular basis, and given that the hospital is a Communist government-run institution, it is incredibly impressive what the staff is able to accomplish with its resources. While rotating through the ER, OR and wards, many of us witnessed cases that were unique and unusual to us: a fairly young man living with the consequences of polio, a teenaged girl with an incredibly advanced bone tumor requiring total amputation, a child with severe and untreated bone malformations. Yet, what seemed to truly resonate with many of us was the cultural aspect of treatment and patient expectations.

Without an ambulance system, patients would find a way to get themselves to the emergency room, often with make-shift splints or bandages holding them together. After arriving at the hospital, they would wait outside. In the heat. Did I mention how hot it is in Vietnam? There is no possible way these people were not in excruciating pain; one may came in holding his four severed fingers, another man sat holding his dislocated shoulder and severely broken clavicle. And yet, no one made a sound. No one complained. Even the admitted patients would share a non-air conditioned room with six other patients and would need to rely on their own family for basic care and food. We could only imagine such a scene in the U.S and the uproar by the patients. It was a difference in expectations of care, a difference in cultural beliefs and behavior. It was not right or wrong, just different. We respected the patients for their stoicism in the face of pain, their families for finding a way to care for them, and the doctors for doing their best to bring relief. We may have even felt a little guilty for complaining about circumstances in the U.S or for times we cried out in pain for something small. Whether it has a religious component in the Buddhist tradition, or a historical one in that many of these people lived through a catastrophic war, we couldn't say for sure. However, appreciating the difference was an important learning experience for us.

The cultural differences extended beyond the reaction to pain. Anesthetic was used quite differently at the hospital, with an emphasis on local blocks rather than general anesthetic. This may not seem like a big deal until you are scrubbed in during the middle of a hip replacement (which is a very, lets say, aggressive surgery) and the patient starts talking to the anesthesiologist. He wasn't in pain and he was somewhat sedated, but he wasn't knocked out either. Again, this is a difference in practice and truly has its merits for patient safety and pain management, but it was none-the-less shocking.

Lastly, exposure to the medical system itself had a cultural component. Our experience in Ho Chi Minh showed a city that was very commercial and appeared quite Capitalistic. Many of its citizens still referred to it as Saigon, and stories were of times pre or post 1975. The Communist influence was obviously still present as the physicians were required to work at the state run hospital for little money, and even a site like Facebook was blocked. The patients still had to purchase health insurance and pay for every component of their treatment. Only one

X-Ray was taken because other views would be too expensive. There was not a central charting system or records, the patients brought their own documents and films. How the chaos was somehow controlled was amazing; the physicians were very efficient and managed to keep track of the patients very well despite the overflowing waiting room.

Yet, despite all the cultural and economic differences, the medicine was the same. The doctors emphasized the patient and educational advancements and despite some limitations, everything possible was done. When congratulated on a successful operation removing the massive tumor from a young girl, the doctor replied sadly that there was nothing good in that situation; the girl's prognosis was poor and there was only so much he could do. Medicine is clearly not an easy profession, but it is inspiring to see that regardless of the location or the people, the drive to help and do no harm is universal. As a group, we too were limited in what we could do and how we could help. Yet, the experience provided us with a perspective and an appreciation. We will be reminded to check our egos, understand that people vary in their expectations, and to respect what we can learn from those with different backgrounds and experiences.

Reflection on Haiti (Port Au Prince trip)

Although I got back from my Haiti trip more than a month ago, the experience still resonates with me. I realize how lucky I am, with easy access to food, clean water, secure housing, and sanitation. I also enjoyed the Haitian people, food, and culture very much while I was there and am constantly on the look out for Haitian recipes that I can replicate when I am home.

Of all the fascinating, heartbreaking, and educational instances throughout the trip, there is one particular experience that I feel is truly important to share. On our fourth day in Haiti, four of us (3 students and a physician) ventured to a tent city in Petionville to assist in a clinic run by a Haitian physician. We arrived at this clinic around 10am, drenched in sweat already. The clinic was a tent, with no windows and two openings in the front and the back. There was a waiting area with 30 people or so, that quickly filled to at least 60 once the word got out that there were "blanc" doctors at the clinic. Working the day in the tent was extremely difficult. Inside it was at least 95 degrees and 95% humidity. I kept thinking what if I had to live in this tent like so many people do now. I could not imagine spending day in and day out here. I couldn't imagine cooking dinner, doing laundry, sleeping and living with my family in this small area. Then I began to think about if another natural disaster would hit this country. The devastation that a hurricane or even a strong tropical storm could do was unthinkable.

One could see the effects of living in this tent city through the people. Although everyone I met was friendly and kind, each person had a sense of sadness about them. When I was working with most patients, I could see their sorrow in their demeanor and I couldn't help but empathize with
their situation. It was truly a learning and emotional experience.

Since I have been back, I remind myself of what I saw. With the limited attention span of the media and the American people, it is very easy to forget what is going on in other parts of the world. I hope sincerely that the plight in Haiti is not forgotten and we continue to remember that this country needs support in order to gain stability and security within its borders.

Nana

Upon getting back into the swing of things in the US and telling people about my trip, a few things stick out in my memory more than others. I realize how wonderful the physicians were that accompanied us and how lucky we were to have their instruction and advice for the three weeks that we did. I realize how unique and perfect the group of students ended up being, and I am so glad to have made such good friends from this trip. I realize the importance of the role of the church in Africa and in our Zambian program in particular. Finally, I realize that although Africa now seems like a world away, it is so very important to not shove what we learned and what we saw into the back of our minds. It should be more than a story we tell to our family and more than a cool photo album of giraffes and cute kids. It should be something that we constantly think about and to which we continue to contribute. Yesterday I packed up two flat rate boxes full of clothes I do not wear and sent them over to my friends in Lumezi. Today we are working with Steve and Andy to try to raise the money to send one of the clinical officers to medical school in Tanzania. The work can’t stop at the end of our trip. We have to keep these people and this culture in our thoughts; we have to strive to get back there in the near future; and we have to strive to maintain the friendships that we made during our work.

I made one friendship in particular that will never be pushed to the back of my mind. A six year old little girl took a liking to me very early on when I gave her a sticker in the childrens’ ward (her brother had malaria). I noticed her because she was shy but not afraid and she never stopped smiling at me. The next day she was waiting for us by the hospital gates. Again I gave her stickers. Again she got me with that sweet quiet smile. It became a routine and by the end of the week she was literally sprinting into my arms at the end of the day. Any time she saw us she would come running from a mile away and then I would pick her up and hold her and try to converse with her. All she could say in English was “Hi” and “I’m fine.” For a long time I would say “I’m Kathryn what’s your name?” And she would say, “I’m fine.” Steve and Andy had me convinced that maybe her name was Fine….those silly doctors. At some point she finally said “Nana” and I realized that was her name.

After the hospital one day I gave her a pair of socks with tinker bell on them. The next day Chris and I were walking back from the rural health clinic van (chicken in hand at this point) and he said, “Katmac look behind you. You have a little visitor.” Sure enough I turn around to a beaming Nana with a bag of strawberries. I later discovered that her father was the gardener of the nuns’ garden and so the strawberries were her way of saying thank you for the socks. Brought tears to my eyes.

Needless to say, that little girl generally came back each night and honestly would have made the whole trip worthwhile even if nothing else had gone right. She became a friend and face I looked ever so forward to seeing each day. Even though we could not speak the same language we had a connection that I will never forget. We understood enough to know that we were friends. Any clothes I do not wear will go to that little girl for years to come. Every picture I have of her I have printed and sent along with the clothes to her father so that she may remember me.

So, I suppose the greater meaning of this particular situation that especially stands out to me, is the realization that by the end of a trip like this you come to understand that you are not just here to help the poor people of Africa who are denied health care….you are here to help Nana, our cook Josaphine, her daughter Hilda, and nurse CJ. Being able to put faces and friends with a cause not only makes that cause more real; it makes you that much more likely to want to return to continue your work in the future. The thought that if you wait too long, those friends you made may no longer be around, or even worse, may no longer be living, is enough to get your mind racing about possible fourth year rotations. That is for sure!

Outreach Health Centers of Zambia

Today I went to an outreach center in Zambia to administer vaccinations and weigh babies as well as give prenatal exams to any pregnant mothers. The day began with a long drive on “back roads” of Zambia aka, lots of bumping around and a bit of Bob Marley in the background. We just kept going and going, passing many villages along the way with its members walking behind us with their numerous children and their “under 5 cards,” (basically childrens’ charts). This sight made me think about patients in America. These women were walking miles and miles in the heat with 2 children on their back and one holding their hand to get to the mobile clinic. They know the day and the time they are supposed to be there and they keep track of their own charts. In America, doctors take the time to call patients to remind them of their appointments; they keep their charts; and they often times have to call patients to remind them to come in to take this test, or pick up that lab result. And you know what happens when the patient does not come in to take that test or get that lab result and they end up sick? Lawsuit. I could not help but admire and respect these peoples’ perseverance and personal responsibility. It’s amazing what happens when one simply does not know any better circumstances and is therefore appreciative of what ever they can obtain. The journeys these women make to get their children taken care of is the perfect example of the opposite of the laziness and forgetfulness often demonstrated my members of our own society and other parts of Zambian society.

In terms of Zambian society, our other team perhaps experienced the best example of cultural frustration on their rural health experience. There was an automobile accident and they were supposed to be the ambulance for the day. Unfortunately, their team simply did not wish to mobilize until after they had eaten their lunch, delivered a few watermelons, and picked up a few chickens. This seemed to be a cultural way of life in that no matter how insistent our team was upon rushing to the scene, mindsets simply could not be changed. So I suppose the reality of the situation is that every culture has areas of laziness that compromise the lives of professions of others. Perhaps the biggest problem is when cultural tradition serves as a barrier to growth as a country.

Now, back to my personal rural health experience…when I arrived at the rural health center, we went to a local home that belonged to a friend of one of the nuns. I learned one thing about myself on this trip that I had not entirely known before. I love the kids. I was never without stickers and colored pencils. So upon arriving at this village I immediately began my sticker distribution process. The adults loved watching this whole little routine and before I knew it a group of children was handing me a live chicken that they had caught at the instruction of their father. Sister Piara explained to me that this was a gift and I must accept. I looked at the malnourished kids who were gifting this bird to me and couldn’t help but feel sick about the fact that they were giving me food that they needed. However, I also understand from a cultural stand point that it is very important to their pride that I accept this gift with gratitude.
So there I was, chicken in hand, walking back to the rural health center. Now that our patients had enough time to walk there, it was time to get down to business. We gave vaccinations and weighed babies in a sack attached to a contraption much resembling a vegetable scale in a grocery store that was being all held together by a bent safety pin. We did prenatal exams on the floor of the local school teacher’s office using the width of our fingers to determine the number of months pregnant. It is amazing to see how resourceful one can be without the supplies we in America have come to rely upon. I personally found it very interesting to watch medicine being practiced in its rudimentary form; to watch doctors use their 5 senses to make a diagnosis; to watch decisions be made without a million tests to back them up. In some ways I can’t help but think that it’s what medicine should try to get back to. In other ways, I know that as a first year medical student I cannot presume to make such statements with the little experience I now have in the medical field of our own country.

After all of the vaccinations, weighing, etc. we went to a local village for lunch. I learned to eat Nashima with my hands correctly. I learned how to create a new pocket in my stomach in an effort to get down all of the food the nuns kept piling on my plate. I also observed the inside of a house of a “wealthy” villager. Our call room at Loyola was larger. There was a cupboard made of cardboard boxes with stuffed animals and plastic plates on display. There was a large watch as a clock. There was a radio for entertainment, two couches, and a table cloth that the owners seemed to be so proud of. One word for all of this: perspective. We all define luxury differently; we all define wealth differently. However, the underlying qualities of generosity and family pride transcend all cultures. I ate every bite of the food placed before me because, as in the case of the chicken (still at my side), I needed to show my true appreciation for the generosity being shown to me.

They say there is no such thing as an altruistic act. Even letting a bee sting you should not count because then the bee dies. I can’t help but think that giving when you have nothing to give falls under that category. In fact, genuine generosity defines altruism in my mind. I came home that night with a new African name: Mrs. Piri (my new Zambian husband Mr. Piri was the distributer of the chicken), a chicken, 12 pumpkins, and a new appreciation for the concept of appreciation and ways in which it can be expressed. It was an invaluable day to me.

Honduras Part II

Greetings from Tegucigalpa! Andrew and I have just returned from what the director of Global Brigades stated as the program's record "longest consecutive brigade." We feasted at TGI Fridays last night when we arrived (my first hamburger in over a month and a half) and today will be the first day that a tortilla will not be part of at least one of our meals. We are currently waiting to be taken to the airport in an hour, which gives me a nice window of time to reflect on our Honduran adventures...

Reflecting on these last five and a half weeks, I keep thinking about all the faces of the trip. We have "brigaded" with quite a number of schools including Arizona State, UC Irvine, UC Riverside, University of Chicago, UC Berkely, Depaul, Western University of Health Sciences, and John Hopkins. We have joined these groups in building pipelines to provide clean water to a community called Joyas del Carballo, concrete floors and latrines to help provide basic sanitation for the families living there, as well as participating in a good number of medical brigades that help to provide medications for both acute illnesses (we had plenty of cases of gripe and tos) and chronic conditions (yes, even in Honduras there were cases of type II diabetes). Although Andrew had worked with this program multiple times in the past, this was my first time working with the Global Brigades group. I have been blown away by how fast this group has grown and developed. It was started by a doctor who took a small group of undergraduates from Marquette to work with an orphanage an hour outside of the Honduran capital. That was 2002. Eight years later Global Brigades has expanded from just medical brigades to also including dental brigades, architectural brigades, water brigades, public health brigades, and even microfinance brigades. This year, brigades will likely host near a thousand undergraduate and graduate students and health professionals. It is exciting to know that there are so many out there wishing to fulfill the mission of Brigades--students working to empower communities.

Although we certainly did create new friendships with other gringos during our weeks playing cards, mafia, and 20 questions on the busrides (everywhere in Honduras is 2 hours away...), the relationships that I know that both of us will really cherish will be with the Staff of Global Brigades. These were the people who were there with us throughout our whole stay, helping us work on our Spanish, teaching us the right way to mix concrete, and providing immediate medical attention whenever a parasite or fungal infection might strike. We shared many great conversations over our lunch hours at the work sites discussing family, friends, and work. These men and women were having huge impacts on their community, most of them without ever receiving a college diploma. This was perhaps the most important learning point for my summer. Just to be reminded of the incredible things that people are doing when they are passionate about their work. These last weeks have been a refreshing break from the dulldrums that medical school can become as the last weeks of the semester drag on. Don't get me wrong, this trip has only gotten me more excited about a future in medicine, but sometimes it is easy to get trapped in the microcosm that med school can be. We both agree that this trip has been a great reminder of the reasons that we became interested in medicine, and hopefully these memories can help fuel us through second year and boards. I know that as we board the plane in a short bit, both our minds will still be with our new Catracho friends. It was difficult answering the question of when we were going to return, but who knows, a fourth year rotation in Honduras doesn't seem completely out of the question? Si dios quiere...


David Murray

Andrew Putnam

Santiago, DR - 3 weeks in, 2 weeks to go!

We have just finished our three weeks of language school in the DR! Simply the practice of speaking Spanish, especially about relatively complex topics - education, poverty, medicine, etc. - I saw improvement in everyone's ability to communicate with the Dominicans. It was also especially fun to communicate with Europeans in Spnaich, because that was our shared language.

With the language wchool, we were able to visit the public hospital to interview several patients. At public hospitals, the government covers medical insurance, but of course the quality of the care that the patients receive is not as high as it is in the private clinics, which are only accessible to people who can pay for better insurance on their own - definitely not the majority of people. What happens at the public hospitals is that there is not always access to the appropriate instruments, tools, or medication needed to treat the patients. There is also a lack of available doctors, which results in patients having long stays at the hospital just waiting to carry out their treatment plans or surgery. Needless to say it was an eye opening experience. Here's some of the things we noticed:

-there are vendors immediately outside the front entrance shoving things in your face to buy.
-clocks don't work
-there are armed military men present to "keep order" because sometimes the doctors strike
-people form a line at the main staircase leading up to the wards and wait their turn to get up the stairs - they are guarded by security
-after you get up the stairs, you have free reign of the hospital; all we had to do was walk into any room and say we were medical students from the States and ask if we could interview them; they gladly complied
-doctors wear tight white pants, and a slimming white blazer
-men will still cat-call at you in the hospital, the stethoscope we were wearing doesn't even act as a "shield"
-no hand sanitizer anywhere. sinks are a rarity. we only washed our hands after leaving the hospital
-many patients do not seem to know the name of their doctor or how their illness is being treated
-men are not allowed to sleep overnight in the hospitals, only women are allowed; I'm still not sure if this is for safety measures or if it is just another demonstration of machismo

I was pretty nervous interviewing the first couple of patients in spanish because I have never done it before. They spoke quietly, very quickly, and with a much heavier accent than many of the other Dominicans in the city, but they were patient, not to mention very gracious for allowing us to speak with them. They were definitely more willing when they heard we were from the U.S. This wasn't the only time, however, that people seemed to view us as better than them- as more knowledgeable, wealthy, whatever it may be. It was something that made me uncomfortable because I didn't feel like I was worthy of being held in such a light - I certainly hadn't done anything to prove that I had earned their trust or approval. Additionally I don't believe that just because I am American that I myself, or the way I do things, is any better than anyone else and their culture.

Aside from practicing Spanish, my favorite thing about the last 3 weeks in Santiago was learning about the Dominican culture. Maria and I were blessed to have become pretty close friends with two Dominican guys - our homestay brother and one of his best friend. During the first week, they gave us a detailed tour of the city, showing us not only its beauty but also the less appealing parts as well. They were very frank with us in explaining the "disaster that is the D.R." After many long discussions about the state of the DR, it seems apparent to me that the basic principles from which their greatest political, economic, and social issues have developeed are not so different than those in the U.S. There is an overwhelming disparity between the rich and the poor here so much that you may see a multimillion dollar house with a Range Rover parked in the driveway on one side of the street, and a small home that houses a large family on the other side of the street. Of course, the different socioeconomic classes allow some to obtain an education from the university; to afford the best (private) health care; and advance themselves within their profession, while the poor do not have the same opportunities. Unfortunately, even from a soical perspecctive, there are still many disparities when it comes to race. The DR is a very mixed country since the people are of descendants of the aborigines, of Europeans, and of Africans. The skin color of Dominicans ranges from white to very dark. Just as I see it happen in America, "los blancos" and mestizos are a bit pretentious and see themselves as better than "los negros." There is also a very apparent sense of superiority over Haitians, the darkest people on the island. What is a bit different from the U.S. though is that there seems to be a total lack of desire to help ones neigbhor here, in an effort to improve the overall state of the country. Dominicans tend to only look out for their own well-being and that of their closest friends, even if it means stepping over someone else to get there. As difficult as hearing about this "disastrous" situation was, and wanting to do something about it, even the Dominican we were with - a wealthy, highly educated individual, felt like no matter how badly he wanted to change the situation, he said he wouldn't even know where to being because he is so jaded by it all. And while he doesn't just want to leave his country behind, he does think he may want to start a life in the U.S., a sentiment shared by nearly all of the Dominican people.

Besides for everything that is "wrong" with the DR, it really is a beautiful country with a very interesting culture and many gracious, outgoing people. We learned how to dance the merengue, bachata, and salsa; to cook a couple of traditional Dominican dishes; to appreciate the vendors on the street; to not be bothered by the cat calls however crude they might be; to accept the presence of machismo while appreciating the fact that it does not exist to the same degree in the States; to run on "Dominican time;" and to navigate the city in a concho, a public car that squeezes as many people in as possible so that you end up sitting on stranger's laps. Despite being out of our comfort zone, or perhaps because we were out of our comfort zone, I think we came to appreciate and understand many aspects of the Dominican culture. There are many things we experience that we cannot express in words, and it will be something that we may not be able to communicate after we return to the atates. I am very thankful I have had Maria, Erin, and Jackie here with me to process our experiences and emotions.

Oh, and the Docs arrive in just a couple hours, we're all eagerly awaiting their arrival.

Global Health Fund Trip Report: South Korea

This summer, I returned to South Korea to work with an organization that provides medical support services to North Korean Defectors. Unlike last year, in which I participated in direct service, this year, I wanted to do something that would further increase awareness of North Korean issues and went with the intention of writing a grant or publishing a paper on North Korean issues.

When I arrived at the organization, they were busy carrying out various programs for the North Korean Defectors who utilized their services. Interestingly, the organization had received a grant to create a women’s support group, in which the women were being trained to support each other in everyday tasks (e.g. babysitting, grocery shopping, etc.), rather than having to hire sometime to help them out, or in most cases, not being able to accomplish the task. It was inspiring to see grandmothers and other older women participating in this program, in which they would also have to learn the basic English that is used in South Korea. For example, even a simple concept like “pizza” was very foreign to these women, as most of them had never saw a pizza in their life. But can you imagine trying to learn these words and items in a foreign language at the age of 50-70? Nevertheless, these women did extremely well and showed great enthusiasm in learning. (Side note: North Koreans are extremely good at memorizing, as they did not have very many electronics to remember things for them in North Korea.)

Even with all the great services and programming for North Koreans Defectors in South Korea, as well as wealth of research and knowledge, there is huge gap between what the East and West knows of North Korean issues. In fact, if you were to do a simple Medline search for the keyword North Korea, it will produce 63 publications, with a large number of them not being related to medicine. With so little data and knowledge that makes it to the West, it is inevitable that North Korea remains very mysterious and misunderstood by the West. So, my work was cut out for me: find a study or paper in Korean, translate the paper, and prepare it for publication in an English journal. Sounds easy enough and I plan to have the paper mostly finished by the end of my 11-day trip.

Step 1: Find an appropriate study or paper.

After spending a day reading several studies and papers, we finally narrowed down the options to two studies that had not been published in any journal before. We went over the background information, methods, results, etc.; however, as both studies were compiled a few years ago, it would take us another few days to find the raw data in order to analyze it.

Step 2: Networking and finding appropriate co-authors.

In the meanwhile, I met with several other students and researchers in Korea, networking on their interests on North Korean issues, as well as sharing my plans for this trip. Eventually, I traveled to Seoul National University Medical School (SNU is the top university in Korea and is recognized as one of the top universities worldwide) in order to meet with several physicians who are interested in North Korean issues and are currently helping the organization with a few projects. After discussing my plans and the study topic, one of the physicians, who had seen the data presented before, was on board to assist with the statistical analysis.

Step 3: Writing the paper

With sufficient interest in the paper and several experts on-board, I began writing the paper and working with the other co-authors to clarify everything. One day, two days, three days... the paper slowly began to take shape and it looked like I was going to have the paper finished in a few days.

Step 4: Setback

Once most of the paper had been outlined and drafted, I realized that this study may not have an associated IRB. And to my dissatisfaction, I was right. Ahh!!! Not only did this mean that this study would not be publishable, but it meant that six days of hard work had gone out the window! Well most of it, at least. In fact, I was very shocked to learn that IRBs are not standard in South Korea yet, though they are rapidly becoming more prevalent.

Step 5: Re-work project

So, in my last few days in Korea, I began reworking the study and creating a timeline to re-conduct the study. First, replicate and expand upon the current study and prepare for obtaining an IRB when I get back to the States. Second, send the appropriate IRB back to South Korea, where the organization will continue the study. Third, analyze and interpret data. Fourth, re-write the paper.

Though I was not able to accomplish what I had initially set out to do during my time in South Korea, there are several valuable things I learned on my trip:

1) There is a lot of great work being done to support North Korean Defectors in South Korea- much more than I expected before I began volunteering in South Korea.

2) There is a plethora of research in South Korea, some of which provide amazing insight into the situation of North Korean defectors. However, because every country has its different research standards, many of the studies may not be publishable in Western Journals, ultimately leading to a gap in information.

Ultimately, this trip has given me insight into the difficulties of publishing from one country to another and the possible methods of long-distance publishing. Hopefully, my second attempt at this paper will be successful, proving that international research with collaborators on two different continents is possible and opening the door to more studies in the near future.