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THE RAY OF LIGHT: Remembering the poor in pre-clinical years By Landon Roussel
Published on June 2009 As I sit to compose my thoughts, the sunshine that brightens my ninth-floor apartment in Manhattan’s Upper East Side reminds me of those summer days in the threadbare room I inhabited in the Quiche region of Guatemala. During the country’s rainy season, no matter how dark and wet it was the evening before, a ray of light would always shine through my window and let me know that a new morning had come. It is not just the tropical weather I am nostalgic about - experiences of my first major global health field project as an undergraduate resonate fresh in my mind. With med school pre-requisites, the MCAT, Medical Spanish and Latin American culture courses out of the way, it was my opportunity to actually be there and work with the problems I had studied in class. The project I was working with, “La Propuesta” (“The Proposal”), focused on implementing a community health model in rural, indigenous communities, where basic primary healthcare services are provided by health promoters - “promotoras de salud” - under the supervision of a doctor and a larger, more-equipped central clinic that attends to more serious cases. My role as an undergraduate was to help the doctor and health promoters however I could—basic triage, taking temperatures, hauling vaccines—so they could see more patients. I helped with little things and also put my skills to work where I thought I could help. When the sunshine lit my room each morning in Quiche, I felt the brightness kindle inspiration and hope in my spirit. Now, more than three months into medical school, the darkening skies of New York’s December lead me to question whether that sunshine is forever lost. My brain is still winding down from the hundreds of tissue preparations I have scanned this week in preparation for our histology practical. And there is more to come. For two years, we will spend four days a week in the same two classrooms in the school’s Education Center, watching Power Point slides roll through mechanisms and pathways, diseases and drugs, pathologies and statistics. In the present it is hard to realize how longitudinal sections of cat duodenum or monkey tongue relate to caring for the world’s poor. I chose medicine because I want to put my university knowledge to use in helping the emaciated toddler I saw in a rural clinic in Guatemala. I want to do more than just sit and watch him cry as he eats a little piece of tortilla while his eighty-pound mother watches him in hopelessness, as she holds his younger sister. I want to fight to give people like the Quiche, especially the children, the basic rights of healthcare, so they can live to see past their fifth birthday. I want to help their mothers be healthy enough to give them the maternal love and care every kid deserves. I want more than just an erudite understanding of the world. There are too many in need of help to let my head and heart go to waste. The path I am on right now seems a far cry from fighting for human dignity. Spending five days a week sitting in the comfy swivel chairs of the red-carpeted Weill Cornell Auditorium, trying to steady my concentration - as yet another scientist details new breakthroughs in understanding mitochondrial fusion mechanisms - seems woefully insignificant to that mother in Quiche who is starving for enough food just to feed her two toddlers and the unborn child she is carrying. Yes, I know that basic science classes are part of becoming a doctor. But during the past three months of lectures, I have heard very little of these words: malnutrition, hunger, or infant mortality! These conditions that plague the daily lives of nearly half the world’s population are circumstances from which we in the Upper East Side are completely insulated. Many give steady lip service to helping the poor and providing holistic care, but are we really following through? It feels like the enculturation process is meant to desensitize us. Going through the initiation rites of basic sciences is supposed to help us become more qualified practitioners, but what about when education distances us so much from that fervor that we can no longer claim it as our own? Insulated lecture-hall learning and a reductionist approach to disease and the body feel like blinders to my conscience. What happened to Osler "know what sort of a patient has a disease [rather] than what sort of a disease a patient has"? We have hailed him as our great model, but once again, it seems like lip service without substance. There are too many questions to ask, whose answers are not in the classroom. What does this mean for our future patients? How does this help the lives of people who are ill? How can this bring justice to the poor? But alas, it must not all be in vain. No road in life is disconnected from our past. A quiz every two weeks, journal clubs, histology labs, problem sets and physician preceptorships may be a sharp turn that takes me by surprise. True: the blinders of doubt and uncertainty may leave me with more questions than answers. What if I do not reach my fullest potential? What if this five star education ends up being mere self-indulgence? What if it really does not help children like the one in Quiche have a better life? The beauty of my memory of the morning sunshine, though, is that reminds me of the meaning of my medical school classes. I chose medicine because it would help me be the best I can be. It is not enough to be just kind of familiar with illnesses of the poor, or to just vaccinate some of the children, or to only treat diarrhea before it leads to life-threatening dehydration some of the time, or to only sometimes catch eclampsia before it leads to maternal mortality. Call me an idealist, sure, but that should not keep me from trying. The path does not start later, when I am a doctor equipped with only a few medicines, a stethoscope and a blood-pressure cuff. If my future work is restricted by scarce resources, I will have to think critically. The formal thought process begins now. I give my histology labs the best because developing visual recognition abilities could mean catching a potentially lethal infection on a blood smear before it gets serious. And I engage my pre-clinical education right now - imperfect as it is - just as one day I shall have to work with NGO bureaucracies, budget shortages, grant writing and all the other barriers to gathering support for those who have been relegated to society's margins. Changing the medical school curriculum to better equip doctors to face today’s health challenges is as much of a job for students as it is for faculty. Each generation comes in with a fresh and different perspective of the world’s problems. If we want to move the field forward, the time to start is now. The question of how to affect curriculum reform as a medical student has as many answers as there are students. For instance, at my medical school, I have organized an elective medical anthropology seminar series to better understand better the connections of human health and illness to culture and society. Who knows? Maybe if it’s successful the seminar series will get integrated into the required curriculum. What is imperative, I believe is not always the particulars of what I’m doing as it is making sense of the medical school process. Helping the lives of society’s traditionally overlooked, like children in mountainous Quiche, takes more than just mastering our first module of Molecules, Genes and Cells. My world-view is going to change, but chalking up that college idealism as an impractical dogma would be untrue to myself. I wouldn’t have gone to medical school if it didn’t allow me to work with the world’s poor. Synthesis of me as physician, into me as person, must be organic and part of my integral maturation as a reflective individual. It’s an uphill battle, I’m sure, but I’m writing them down to remember that when I’m up late studying histology slides, it is so I can do something the next time I see a malnourished kid in the clinic. I’m writing my struggles so I do not forget why they are struggles. And when the burden of classes gets to me, sometimes I just need to take the evening off with a pen, my journal and my thoughts, so I can keep alive that ray of sunshine. Landon Roussel is a first year medical student at Weill Cornell Medical College in New York City. He majored in Hispanic studies at Rice University and conducted various medical service trips to Central America as an undergraduate. He plans to focus on addressing child health issues in Latin America as a physician. He can be contacted at lsr2001@med.cornell.edu. Article downloaded from http://www.globalpulsejournal.com/2009_roussel_landon_remembering_the_poor.html | ||||||||
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