As our Summer Program students prepare to return to Canada and continue their studies we have one last reflective piece to offer from Jocelyn Stairs, a medical student, who spent the last 5 weeks as a member of the GHO Summer Program at Khon Kean University (KKU) in Thailand.

 

 

It’s hard to believe that the third week of my obstetrics and gynecology elective in Khon Kaen Thailand is coming to a close. I spent today in the gynecology outpatients department. It wasn’t my first time there, but I had a really great translator today, so I was able to conduct some history and physical exams with her help. The morning was a little slow which gave me a chance to reflect on some of the differences in the clinic that exist in order to conserve resources.

First, there are no appointment times for a clinic visit. The clinic starts promptly at 9 am following inpatient rounds, but patients start flooding the outpatient departments at 6am to stand in line to be seen (all outpatient departments are located on the first floor so there is an absolute frenzy of patients in the hallways). patients are seen by a medical student or a group of students who take their history, then they must wait for an opening in the physical exam room, then wait again for the pelvic exam table to free up. Most women wait 5-6 hours just to have a well woman or antenatal exam.

As well, to maximize the number of patients that can be seen at one time, patients are seen on bridge chairs in a narrow hallway behind the exam rooms. These chairs sit back to back and the medical students flit between them. To maximize space in the exam room, one patient will be interviewed at the desk while the other patient will receive a physical exam on the other side of a curtain. As a result of this setup, there is really no confidentiality. I asked the medical students about this, and their response was that Thai people are pretty easy going, so they aren’t really concerned. This made me rethink the reasoning behind the emphasis on confidentiality (or concern over lapses in it): it is a problem when it is broken not because it is an inherent requirement of medical practice but rather because our North American society expects it and we in turn promise to provide it. Therefore, any breach in confidentiality can be seen as a breach of contract between the physician and the patients. In the Thai context, confidentiality is not offered, either because it is not an option due to resources or because Thai people do not value it. As a result, the lack of confidentiality is an expected norm and is not regarded as a problem because it is not part of the doctor-patient contract.

While I found these differences to be a bit jarring, I keep trying to remind myself that this is their normal and that it works relatively effectively for them. My experience thus far has provided with a wealth of new experiences and learning about clinical medicine, social determinants of health, and healthcare practice in a low resource setting. Seeing medicine practiced in a manner that is so different from home has afforded me the opportunity to reflect not just on differences in healthcare but on why we practice healthcare the way we do in the West. I can’t wait to see what else the final week will bring.

To learn more about GHO Summer Programs please visit: http://gho.medicine.dal.ca/dalhousie-students/dalhousie-individual-electives.htm

To read a story, published by KKU, about this program. click here 

The following is an update from Tanzania submitted by Catherine Brown (CHE).

 

Time has simply evaporated in Dar es Salaam.  It’s hard to imagine that I have now been living here for over two weeks.  It feels like only yesterday that we arrived.  In a short period of time, we have learned and experienced so much.

By Sunday, June 17, all nine members of our inter-professional team had arrived. Our group comprises of three nursing students, one pharmacy student, four medical students, and myself, a community health and epidemiology student.  Some members are well traveled, while for others, this is their first time leaving North America. While most us were strangers upon arrival, we have quickly become a close-knit group.

We spent the first week in intensive Kiswahili lessons. Our teacher was patient with us as we struggled to learn this language.  Kiswahili is highly structured (like French), but full of foreign sounds that took some time to become comfortable pronouncing.  I enjoyed our time as a Kiswahili mwanafunzi (student), and it only took me a few days to realize that ninaipenda Tanzania (I love Tanzania). From my short time here, I have gathered from the generous people, the delicious curries, the warm beaches, and the lively quarters that Dar es Salaam is an exciting and rewarding place to live.

On June 22nd, half our group departed on a ten-hour train ride to Ifakara in Central Tanzania.  There, they will be shadowing health care professionals in a rural hospital.  The remaining five us our were placed at PASADA (Pastoral Activities and Services for Oeople with AIDS Dar es Salaam Archdiocese) – a faith-based NGO that offers medical care and social services for people living with HIV.

Tanzania has an HIV prevalence rate of 5.7% in the sexually active adult population, and in the neighborhoods surrounding PASADA, the prevalence is even higher.  PASADA services over 30,000 clients at various locations across Dar es Salaam.  It boggles my mind to grasp that given Canada has approximately 65,000 individuals living with HIV, PASADA’s population alone – just one of many similar organizations in Tanzania – approximates half of Canada’s epidemic.

We have received an incredibly warm welcome from the staff and clients at PASADA.  On different days, students in our group have shadowed a variety of health care professionals – nurses, doctors, pharmacists, counsellors, and  lab technicians to name a few – to learn more about HIV and how it is managed in Tanzania.  I look forward to sharing more about our experiences at PASADA over the next few entries.

There are many challenges to consider when completing a Global Health Elective, whether locally or abroad.  In our 3rd part to this series Catherine and Haley examine the challenges they expect to face during their time in Tanzania and Thailand.

Can you name some challenges you expect to face during your elective?

Catherine Brown (Tanzania)

I have only met a few people living with HIV/AIDS – a woman with remarkable inner strength who acquired HIV during the Rwandan genocide; a man who regretted his wild youth of injection drugs. To help prepare my mindset for the challenges of working in an HIV/AIDS agency, I have been reading as much as I can about the epidemic.  Randy Shilts’ And the Band Plays On describes why AIDS was allowed to spread unchecked during the early years of the epidemic; Elizabeth Pisani’s The Wisdom of Whores takes you from Jakarta to Geneva to explain why in the past three decades, despite spending billions of dollars, we have been unable to curb the epidemic; Stephanie Nolan’s 28 Stories of AIDS in Africa vividly narrates the individual experiences of hope, love, and courage from people living with AIDS and their loved ones.  Despite this immersion, I expect to be overwhelmed while at PASADA.

I am in my final year of a MSc in community health and epidemiology, where I am writing my thesis in the field of maternal and child health. I completed a BSc at the University of Toronto, specializing in global health.  I first discovered global health when I happened upon the Human Development Index as a preteen and wished to better understand disparities in population health.  I am delighted to be joining the interdisciplinary team of Dalhousie students travelling to Tanzania, and I look forward to learning first-hand about the challenges and opportunities related to the care and management of HIV/AIDS in Dar es Salaam.

We would also like to recognize all students participating in the 2012 Global Health Office Summer Program with Catherine:

• Joe Sadek (Medicine)
• Sarah Grant (Nursing)
• Jennifer Aucoin (Nursing)
• Jessica Gubernt (Nursing)
• James Hudson (Medicine)
• Dustin Conrad (Medicine)
• Alexandra Bishop (Medicine)
• Emma Reid (Pharmacy)

Haley Augustine (Thailand)

One personal challenge I commonly face with the idea of international electives is the use of local human resources. I worry that there is a lack of reciprocity between the students, like myself who are learning and the host site’s resources. While completing international electives there are competencies and objectives a student must fulfill. In meeting these requirements the student may require input and resources from the host site, such as training from their preceptors. This is a challenge, I know I will personally face.

Conversely, the student-preceptor relationship may also be a mutual exchange, as students tend to challenge their preceptors by bringing a fresh perspective and asking questions. In settings where there are limited resources, students can also assist in extending services by providing additional person power once they have developed the necessary skills. For these reasons I can help rationalize some of the resources I know I will use.

Another concern I have is the communication barriers and unfamiliarity with cultural practice. Communication is a key component in the foundation of medicine, which enables empathetic and productive interactions with patients. Different local customs and norms may limit a foreign student’s ability to communicate through body language and verbal communication. I am therefore very grateful for our language training and opportunities to meet with previous students to discuss some of the cultural practices.

Education and fieldwork are investments in human capital; therefore I will also find it challenging coming to terms with the sustainability for host countries once we have completed our placement. I am always aware and concerned that I may limit placements for local students who would eventually work as local physicians. I am therefore grateful of the longstanding relationship Dalhousie has with Khon Kaen University in Thailand. On previous electives I was fortunate to be placed in a setting where I could collaborate with local occupational therapy students for translation and knowledge sharing. I am hopeful I can once again link up with local students to collaborate and learn form each other.

Throughout these experiences I recognized that we don’t have to travel to experience and be an advocate for global health. I started to get involved in local global health programs such as the Aboriginal Health interest group, universities allied for essential medicines and local global health initiative programs. I gain a sense of energy and enthusiasm from these programs and am always learning from my peers, international partners, and experiences and therefore find them extremely rewarding experiences.

Thank you to Catherine and Haley for sharing these insights.  We wish them rewarding and collaborate experiences and look forward to hearing more when they return.

If you have any questions please review our website at http://gho.medicine.dal.ca/ or contact us at gho@dal.ca

 

 

Our Summer Program students have all arrived at their destinations and are into the language training component of their elective.  This is an exciting and stressful time as they prepare themselves for new clinical and cultural experiences.  Before they left we asked some specific questions; here is #2 of 3 in the series.

What are the 3 things you are most looking forward to about your upcoming Global Health elective?

Catherine Brown (Tanzania)

I am excited to combine the knowledge and skills I have gained through my BSc in global health with my MSc in community health and epidemiology.  At PASADA, I hope to engage in research – from surveillance to clinical studies – as well as shadow community health programs from education to counseling.  I am also curious to learn firsthand the challenges of healthcare in a low-resource setting.   Finally, I cannot wait to discover more about the country itself.  Following my placement, I will be spending three weeks learning about different corners of Tanzania.  I realize I will only be skimming Tanzania’s surface, but I look forward to watching animals migrate in the Serengeti, summiting Mount Kilimanjaro, and lazing on Zanzibar beaches.

Haley Augustine (Thailand)

I am most looking forward to the cultural experiences, working with the local students and the patients I encounter.

The Thai culture is one I am excited to experience first hand. From the food, the people, the art, music and the landscape, Thailand offers a unique cultural experience. As Khon Kaen is not a typical tourist destination, I am looking forward to being immersed in the Thai lifestyle working in the hospital alongside local Thai students and physicians.

I am very much looking forward to partnering with local students to better understand their experiences in student life and enhance cultural knowledge with respect to medical practice. As Canadian students, we learn from our preceptors and the local students, by working alongside and learning from their diverse experiences. While completing international fieldwork through a previous degree in Tanzania, I had an incredible experience working closely with local students comparing and contrasting our approaches to care and learning about each other’s culture. Working together in a mutually respectful learning environment.

Lastly, I am excited for the experiences and encounters with Thai patients. I believe this will offer me insight on cultural differences while treating patients from diverse backgrounds. The common diseases and conditions in Thailand vary from Canada and I anticipate learning a lot about these conditions not typically seen in Canada. About 6 years ago, when I was volunteering in Nepal I was exposed to a variety of medical conditions I never imagined I would witness. There were new diagnoses of leprosy and many traumatic injuries from fire and motor vehicle accidents. It was a stark contrast to Canada, offering incredible insight to witness conditions and injuries that are rare or nonexistent in Canada.

To find out more about GHO  Summer Programs and other electives please visit: http://bit.ly/LkapR3

 

The Global Health Office is excited to have another group of students participating in our Global Health Summer Programs.  This year, students in Tanzania, Thailand and The Gambia were asked to respond to 3 questions about their experiences.  Over the next few posts we will share these responses with you.

Question 1:  What draws you to pursuing a Global Health Elective?  What draws you to an elective in your specific country?

Answer 1:

Catherine Brown

 

MSc Candidate, Community Health and Epidemiology, Dalhousie University

Destination:  Dar es salaam, Tanzania – Pastoral Activities and Services for people with AIDS Dar es Salaam Archdiocese (PASADA)

As an undergraduate student, I specialized in global health.  I learned through lectures and lively classroom debates about concepts in global health – the intertwined domains of health, education, poverty, and the economy; the importance of ethical and human right issues; the burden of disease – but I never had the opportunity to experience first-hand global health outside a Canadian perspective.

A decade ago, I had the opportunity to visit Kenya.  This was my first time travelling in a developing country, and while I marveled at the pristine beaches of Mombasa, the wilds of the Masai Mara, and the warmth of Kenyans, it was also my first true exposure to poverty.  When the opportunity arose to return to East Africa through Dalhousie’s Global Health Office, I knew I wanted to learn more about Tanzania, and specifically more about the fabric of Tanzania’s health system.

Answer 1:

Haley Augustine

Medical Student, Dalhousie University, Global Health Award Recipient 2012

Destination:  Khon Kaen, Thailand – Khon Kaen University

Participating in global health offers unique challenges to be creative while taking initiative and learning in a non-conventional environment from colleagues and peers. For these reasons I find global electives personally challenging yet fulfilling. There is a plethora of knowledge, skills and insight to be gained from our international partners. Not only that, but international electives provide opportunities to enhance ones education and future practice by educating professionals experienced working in different settings, cultures and language.

During my occupational therapy education I completed part of my training in Tanzania Africa. This was my first experience abroad in an academic program, where I learned valuable clinical skills through my colleagues in Tanzania. Based on these invaluable experiences I am motivated and excited about the elective in Khon Kaen, Thailand. I view this as an opportunity to continue and foster my passion for global health while communicating and working with peers and leaders with similar interests in a foreign environment.