I spent a week in the Dominican Republic along the Haitian border as a first year medical student. I knew just enough medicine to know when something was wrong, but not quite enough to know how to treat ailments. A few things we could do solo, triaging patients after we took vital signs, organizing the pharmacy and helping fill prescriptions, gathering basic histories in our meager Spanish. The rest was with the help of the physicians who ventured to the island with us. One of which is to this day, the most intimidating physician I’ve ever worked with. She was a Harvard Medical School graduate, internationally known for her work at Memorial Hospital after Katrina hit New Orleans. She headed up our Center for Medical Humanities and Ethics, and was the type that you never quite knew what she thought of you. She was a very competent infectious disease physician, known for her global health efforts especially in Haiti and the Dominican Republic, spoke fluent Spanish and Creole, and still somehow managed to run marathons. She was the type of person that inspires others to better themselves, even if she was difficult to connect with on a personal level. It was an honor to work with her so closely over the week, an experience that I never had again during my four years in medical school.
Every morning, we woke up relatively early to pack up our gear. We rode in the back of a pick up truck, bumping up the mountain to whatever border area we served that day. The school had forbade us from going directly to Haiti given the unpredictable political climate in the country, so we instead worked in pop up clinics in whatever churches or shacks were available, as close to the Haitian border as possible. In the morning, we typically saw Dominican patients, but as the sun continued across the horizon, more Haitian patients made their way to our clinics, usually after long hours walking from afar.
We treated a wide variety of illnesses, from common diseases like hypertension and diabetes, to longstanding untreated conditions that we typically don’t see in the states: goiters the size of softballs, vaginal prolapse, tumors that have long evaded the confines of skin or bodily contour. The physician leadership of our group was intent on forming sustainable bonds with the community, ensuring that we didn’t hand out medications this month without health care providers to follow up next month. None of that drop in and drop out stuff. We partnered with a local organization that organized monthly to quarterly medical trips to the region. Although teaching the locals to be autonomous health care providers would have been more ideal, it was what we had to work with at the time.
This was the first step on my inward journey to realizing my dream of global health care was not a realistic or fair goal. If I wasn’t willing to uproot my life in the states to dedicate years to fundraising, teaching, and forming a sustainable, long lasting, local system of health care, then I was truly doing more harm than good. So often, international medical experiences are a form of tourism, a way to see a country without making a lasting impact on anyone other than the traveling provider. Cynical as it may sound, after reading extensively about global health and doing quite a bit of introspection, this is what I have come to. And it’s the reason that global health will no longer be a part of my life despite participating annually in international medical trips all four years of medical school. It is something that no longer aligns with my values, something I can no longer endorse.