Closing and Calling

I have now been back from Africa for a week. It's amazing how fast this life will suck you back in. I didn't think I would struggle much with reverse culture shock. I have seen and worked in poverty stricken countries before. I realize it is OK to own a car, make rent payments, and spend money on luxuries like meat. What I didn't anticipate being so hard was transitioning back to the role of a US medical student. I went from rounding on 30 patients a day in Africa to having seen exactly 1 patient for the entire week on Neurology. There were so many patients in Africa to be seen and so few doctors that what I did actually mattered. Here, my one neurology patients is cared for and seen by a nurse, a nurse aid, a medical student, an intern, a resident, and finally the attending. This is not to mention the speech therapist, ultrasound tech, and physical therapist. I'm not needed here. I do realize that my role isn't primarily to care for these patients, it's to learn. And having realized my medical knowledge is so incomplete while in Kenya, I have a heightened sense of responsibility to learn as much as possible the next few years. Still, it's frustrating being here when I know I could be doing so much more somewhere else. I have a good story to illustrate my point.

My last week in Africa I worked in Casualty, or the Emergency Department. It is a 10 bed room, with limited supplies, one thermometer, one automatic blood pressure cuff, and very few staff. My last day working there started off much like the others. It was slow in the morning, but picked up as the day went on. By evening, when I was supposed to leave and join some friends for one last dinner in Kenya, the ED was overflowing. There were at least 25 patients, some sharing beds, laying on the floor, or sitting in wheelchairs outside. I couldn't leave yet. Patients were dying of organophosphate poisoning, diabetic ketoacidosis, sepsis, poly trauma victims, malnourished kids with gastroenteritis, a man in shock who had acute urinary retention (eventually requiring a supra pubic catheter), and the list goes on.

I will always remember standing in the middle of that room in Kenya, feeling overwhelmed by the need. The lack of resources, training, and physicians. One of my mentors, a US trained Family Practice physician walked in about that time. He looked at me with a knowing smile; I'm sure he had seen bewildered look on a numerous medical students faces over the years. I tried to convey to him what I was feeling, experiencing. He understood. What he also realized was that in a few short hours, I was getting on a van, leaving the hospital, then flying back to an entirely different world. In this other world, things aren't always so clear as they are in Africa.

What he has witnessed time and time again is young medical professionals see a real need, want to make a difference, but eventually lose that vision. Residency, families, debt, and life have a way of making you forget. It is with this realization in mind that I make this post. By sharing my experiences and convictions with many people, I hope to be held accountable.

The hospital I worked in was mostly staffed by Western trained physicians. It served as a tertiary referral center for Western Kenya. We even had referrals from the bordering countries of Uganda and Sudan. It was likely one of the best staffed hospitals in Eastern Africa. And still, I was overcome with the need and lack of resources. If I was this overwhelmed at this hospital, I can not imagine what the need is like at other hospitals.

I have shared this thought with a few people here in the US, and a response I occasionally hear is, "Why would you travel so far when there are underserved areas here in the US?" Sure, there are many underserved areas here, but in other parts of the world, there are NOserved areas. Take Zimbabwe for example. In a country of 13 million, there are 37 OB/GYN docs, 2 neurosurgeons, one dermatologist. The doctor:patient ratio is 1:12000 compared to the United States 1:390. And Zimbabwe doesn't even compare to the worse countries such as Tanzania and Malawi boasting a ratio of 1:50,000

That night, I walked out of the hospital with tears in my eyes. These were not tears of grief or tears of frustration. I was overcome by the realization that I could not turn my back on what I had just experienced. I think many of us expect a sign from God, clearly spelling out his divine plan for our lives. Perhaps I was expecting a bright flashing neon sign in the sky. But God does not often work that way. In Matthew 22:36 Jesus was asked what the greatest commandment is, and his response was to love God, and love others. By loving God, our heart becomes closer in line with His heart. And He loves his children. The best way I now know to love others is by sharing with them the gift of medicine. It has been said by people far wiser than me, that God’s will for our lives is where our greatest joy intersects with the world’s greatest need. From what I have experienced so far that intersection, for me, lies in Africa.