PERSONAL ESSAY: Inside the Travel Diaries of a Pre-Medical Student

BY HANNA MANDL

Receiving a baby during a Caesarian section in the obstetrics and gynecology department at Iringa Regional Hospital.

Receiving a baby during a Caesarian section in the obstetrics and gynecology department at Iringa Regional Hospital.

What motivates college students to volunteer abroad in medical clinics, orphanages, and schools? Universities, institutions and non-governmental organizations provide seemingly limitless opportunities for undergraduate students to travel to foreign countries in order to help others. These opportunities allow students to immerse themselves in global development and to play a role in diminishing health disparities. The experience of volunteer work represents merely a small part of the discipline known as global health, a multidisciplinary field that encompasses medicine, epidemiology, demographics and economics, and includes the interactions of individual nations in an international context.

But in the context of global health, what does “help” truly mean? When I travelled on a pre-medical internship with fifty other undergraduate students to Iringa, Tanzania, in June 2013, I was prepared to extend a helping hand to local people in need of foreign aid. But, as a rising sophomore at the time, I had no practical medical experience. I quickly learned that I lacked the training, expertise and medical skill set necessary to influence the health conditions in Iringa Regional Hospital and directly advance global health.

Visiting a Tanzanian tribe, the Masai, on a weekend trip to Ruaha National Park.

Visiting a Tanzanian tribe, the Masai, on a weekend trip to Ruaha National Park.

After three months of planning, twenty hours of air travel and nine hours of bus travel, I arrived in Iringa with the other interns. Upon arrival in our local townhouse, each student was assigned the departmental rotations that determined where he or she would be placed for the remainder of our stay. I was assigned to four different departments, one for each week that I would spend in Iringa Regional Hospital: outpatient clinic, surgery, internal medicine, and general medicine. The staff also presented us with extracurricular opportunities: night shifts in obstetrics and gynecology, epidemiology lectures, and the chance to volunteer at a local orphanage. As a group of fifty pre-medical students, we filled the sign up sheets for these activities  before the staff could even finish introducing themselves.

When I arrived at Iringa Regional Hospital for my first shift in the outpatient clinic, I did not know what to expect. First, the open-air clinic already had an extremely long line of people waiting to be seen by a doctor. The doctors and nurses working in the clinics were general clinicians who would listen to the chief complaint of the patient, run rapid diagnostic testing for common diseases such as malaria, tuberculosis, and HIV/AIDS, and then provide a treatment regimen. These health care providers were brilliant, dedicated, and welcoming individuals who were excited to educate students interested in practicing medicine. I was equally eager to learn about local diseases and medical techniques.

Unfortunately, not one of the interns could speak the local language, Swahili. Both our trip leaders and the local physicians attempted to teach us conversational Swahili, but their efforts could not overcome the significant language barrier. As a result, our verbal communication with patients was limited. We relied on translations from the English-Swahili speaking doctors and our own nonverbal methods of communication to interact with patients. The language barrier made it extremely difficult to understand cases to the fullest extent or to make accurate assessments. The language barrier was my primary concern. How could I help people if I could not even talk to them?

Surgeons performing a toe amputation in the operating room at Iringa Regional Hospital.

Surgeons performing a toe amputation in the operating room at Iringa Regional Hospital.

I also noticed that the doctors took copious amounts of time to explain each patient’s case to us students. As my week in the outpatient clinic rapidly came to an end, I briefly wondered whether the hospital was too focused on teaching. Each doctor in the outpatient clinic had as many as six students shadowing him or her. More often than not, all six students were crowded inside a small examination room, eager to ask questions and get a good look at the patient’s condition. Furthermore, the doctor would divert her attention to teaching by explaining the treatment regimen she would implement, a great benefit to us students. We were able to observe outpatient cases firsthand while having the opportunity to ask detailed questions. Unfortunately, this shifted the doctor’s attention from the patient to the student. As a result, our presence unintentionally contributed to a lower quality of healthcare.

During my second week at the Iringa Regional Hospital, I observed hands-on procedures in the surgical department. I also spent several hours volunteering in the obstetrics and gynecology clinic. Here, I observed over 25 live births and Caesarian sections. As students, we were allowed to see everything. The doctors in Iringa Regional Hospital did a wonderful job teaching, encouraging us to ask questions, and showing us the detailed steps of their procedures. One of the most memorable experiences was observing an exploratory abdominal surgery. I eagerly stood next to the surgeon at the operating table as he discovered a small intestine infarction, leading him to perform a bowel diversion on a middle aged man.

At the Iringa market with a local seamstress.

At the Iringa market with a local seamstress.

Although these cases were some of the most fascinating I have ever observed, I still felt unsatisfied. Standing next to highly trained doctors who were able to improve the health of their patients was exciting. But, as an undergraduate observer, I could not make a difference in the health of the patients. The purpose of my travel was left unfulfilled. While this internship provided us with medical observation opportunities that changed our lives, it did not change the lives of the patients. I quickly learned that I would not be able to actually help people until I qualified as a trained medical professional.

I completed the next two weeks at Iringa Regional Hospital in the internal medicine and general medicine departments, and continued to observe captivating cases. But I remained unable to help. As an untrained undergraduate student, I realized that I was unable to directly contribute to improving health standards in Iringa. I lacked the ability to communicate with the local citizens because I did not speak Swahili.  Despite the obvious shortage of healthcare personnel, I did not have the skills needed to perform medical procedures. Since there were fifty students present on the internship, the focus frequently shifted to the students, not the patients. The doctors were so interested in learning about where we had come from and how much medical training we had received that our presence actually proved detrimental to patient care.

Surgeons executing an exploratory abdominal surgery at Iringa Regional Hospital.

Surgeons executing an exploratory abdominal surgery at Iringa Regional Hospital.

Despite my inability to directly impact the patients in Iringa Regional Hospital, I learned that I had a desire to help those who suffer. My trip to Tanzania revealed that there are communities worldwide in need of individuals who want to help. While I might not have had the skills needed to help patients the first time I went, my goal is to return to Iringa Regional Hospital one day as a fully trained physician. When that happens, I hope to directly improve patient care and impact global health. 

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Hanna is a junior in Timothy Dwight College majoring in Molecular, Cellular and Developmental Biology. She volunteers in the Nicoli Lab at the Yale Cardiovascular Research Center, where she studies hematopoietic stem cells in zebrafish. Hanna is also a member of the varsity women’s hockey team and teaches health workshops with Yale Community Health Educators.

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