By Adam Lewkowitz
“¿Hay algo más que quiera decirnos usted sobre estos temas? Sobre su aceso a medicamientos, o sobre lo que come su familia, o algo más? Hamideh Moayedpardazi and I were standing in a floorless two-room shack, where a mentally handicapped child lived with her mother and five siblings after losing everything they owned five years ago in Hurricane Mitch. Moments before I asked her if she wanted to tell us anything else about her access to medical care or her family’s nutrition, I had seen a rat bigger than those in New York City’s subways scamper across a roof beam.
Along with five other members of Medical Students Making Impacts (MSMI), I was in a small village in Honduras. We went there with Drs. Sigrid Hahn and Anu Anandaraja to complete a preliminary needs-assessment report for a local non-profit that wanted to improve the quality of life for the six families it had provided housing for following the hurricane. After the surveys were complete, we taught the children about personal hygiene, nutrition, and malaria prevention before playing Frisbee with them. However, instead of enjoying this idyllic moment, I felt guilty. We had learned that these families could not afford enough food but lectured their children about the importance of eating fruits and vegetables every day. We had emphasized that malaria was best prevented by dumping out standing water without knowing that the lack of running water in many villages in rural Honduras forces families to be dependent on large, uncovered, above-ground wells. Most disturbingly, we had interviewed people who acted as though our visit heralded a beginning of a relationship that would alleviate their paralyzing poverty. I felt guilty because I didn’t think the invaluable experience we gained while conducting epidemiological interviews and witnessing extreme poverty firsthand was worth starting a relationship with these families without offering any solutions or even follow-up. We had stumbled upon the most fundamental debate in modern global health: whether groups of American medical students traveling to other countries do more good for themselves or for those they go to help.
The irony of my sentiments was that MSMI had deliberately designed a new itinerary for first-years to ensure that the trip would not be a typical medical mission that introduced medical students to clinical skills with questionable benefits for those treated but instead an educational experience that provided sustainable aid to a needy community.We met every two weeks during first semester in Curriculum Sessions that taught us about successful ongoing global health projects, about international aid organizations, about economic trends in Central America, and about Honduras. We arrived in San Pedro Sula excited to try to do something positive for the community, and we did. We helped the Ministry of Health of Honduras give vaccines to the elderly at an open-air produce market (and vaccinated a record number of people for one day) and assisted a physician at a local clinic in providing check-ups for orphans who can rarely seek medical care. We also contributed in data collection in 12-hour shifts for an ongoing cross-sectional study on trauma surveillance in the Emergency Room at one of the country’s largest hospitals. Once published, the conclusions of the epidemiological research will help the Honduran government determine how to best decrease trauma incidence in the country, be it by enforcing seatbelt laws or regulating machete use in nightclubs.
Thus, the hours of logistical planning that Drs. Hahn and Anandaraja, second-year trip leaders Jackie Karmath and Lauren Marcewitz, and the Honduran medical students and physicians all spent was worth it: a large group of first-year, American medical students provided manpower for ongoing Honduran public health projects in ways that could impact Honduras long after we left. While doing so, we were also exposed to healthcare in the developing world-where people came to the E.R. with gaping machete wounds, where the lack of modern machinery means that exploratory surgery remains the preliminary treatment for baffling abdominal pain, where the doctors do not take into consideration the potential for malpractice suits in their diagnoses and treatments. For some of us, it was the first time we had been to a developing country; for others, it was the first time we had witnessed uncontrolled bleeding or observed actual surgery. For everyone, it was the first time we were viewed as physicians due to the scrubs we wore and the stethoscopes we carried.
It will be difficult to quantify over the long-term how much we helped the communities we visited in Honduras, and whether the aid we dispensed came close to matching the innumerable experiences that our activities seared into our memories. As Dr. Anandaraja explained on the bus ride back from the village, one of the most exasperating facets of short-term global health missions is that once you complete your project, you must relinquish your findings to those who remain in the field (in ideal circumstances, international aid foundations or governments) and hope that they heed your suggestions. Luckily for us, our week in Honduras introduced us to more than just the frustrations of global health. Above all else, we discovered that it may be impossible to travel to a developing country and solve its complex sociopolitical and economic problems, but that during our lifetimes as future physicians, we can devote our time, knowledge, and resources to try to establish parity in global healthcare opportunities.
Adam Lewkowitz is a first year medical student at Mount Sinai School of Medicine in New York. He is a participant in AMSA’s 2008 Global Health Scholar’s Program. He can be contacted for questions or comments at Adam.Lewkowitz@mssm.edu.