Saturday, November 29, 2014

Sorry Y'all, Still Not Premed

                One of the things it seemed like almost everyone felt during our week at the clinic was the feeling of being reminded what we love about the careers we're pursuing, and I was no exception to that. I had three days of reminders why I do not want to be a doctor, or a nurse, or a physician's assistant. I do not want to see patients and I do not want to prescribe medicine or give referrals. None of that means I didn't have fun during my days at the clinic. In fact, I enjoyed them immensely. Neither is it disrespect for the medical field, which I hold in high esteem, and not just because my pre-med classmates might read this and ostracize me. That week simply reminded me that public health is not medicine and that I am most certainly a public health kind of girl.
                Part of it has to do with me as a person. Medicine is speed-dating, and I am not a small-talker or a fast friend maker. I could not see different patients every day and talk to each for half an hour before never seeing them again and still have a consistently pleasant and fulfilling work day. Put me into a small community for a year to get to know the people there and work with them to figure out how they want to solve the problem of their contaminated water sources or their school non-attendance rates and I will be golden. I would feel far more satisfied watching dozens of my friends keep their children in school and free of water-borne illness than I would no matter how many strangers' wounds I stitched or how many people I prescribed painkillers. I like creating long-term changes, I like affecting communities, and I like helping people I have grown to care for Public health.
                Secondly, as much as I respect medicine, I couldn't help thinking during our clinic days how much it needs a good dose of public health. I watched one too many doctors look a patient in the eye and tell them how important it was to go and get such-and-such checked out by a specialist. The problem with that, though, is that many patients are here because the clinic is free and close to small rural communities, but healthcare in Nicaragua is not free and specialists are far from small rural communities. The doctors must understand that, but none of them acts on it. No one asks the patient if it's possible for them to get that care. Maybe it's because they don't have any suggestions for what the person should do if they can't get it, either because they want the patient to think the doctor has the answers or because they don't want to face the reality that there's nothing they can do to fix the patient's deeper issues. Either way, it feels disrespectful to ignore that the person's life is more complex than their injury or illness. The opening of an honest dialogue between the doctor and patient is worth the doctor's having to feel powerless and uncomfortable.
                My other unpleasant surprise regarding medical mindsets came just when I thought we were going in a public health direction. We'd had a patient with migraines, gastritis, and vaginal pain during sex and urination, and the doctor diagnosed her with stress. This was a perfect example of a time when a mental health problem created concrete, physical manifestations that harmed this woman's wellbeing. I was excited both that the doctor acknowledged it as a legitimate problem and that we'd get to present it as a case study to the rest of the class. Unfortunately, the doctor wasn't quite as public health minded as I'd originally thought. When we presented, she talked about how it was a good example of how patients don't always come only for medical attention—sometimes they just want someone to listen. It was frustrating to me because it seemed to diminish that woman's difficulties. I don't doubt that she could have used someone to talk to, but that's not why she came to the clinic. She was having legitimate health problems, and they were no less existent simply because they weren't physical in origin.
                As was the case for patients who needed a specialist's attention, though, I'm not sure what more we could have done for her than listen and give advice. Well, maybe I do know. We could have implemented a community education program on sex and relationships after communicating extensively with the people who lived there and figuring out what would be a culturally sensitive and appealing way to discuss the topic. After setting a time when the class would be accessible to those who might be interested, providing childcare and food so they would be able and interested in coming and using local women as teachers to establish an environment of trust, then we could probably solve many of the stress-related problems this young woman faced. I guess that brings me back to public health, doesn't it? I have a tendency to do that. As much as I respect the field, there's no way I'm leaving the fate of my world up to medicine alone.

Submitted by Casey Morrison

PC: Rebecca Passman

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