Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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454 Surgery and Healing in the Developing World
subject populations as estimated by the criteria of Taylor-Ide and Taylor and Wright. 2,3
By unofficial recording, there were no major complaints on the part of the patients
cared for despite long waiting queues in tropical heat, and occasional short falls in
medical supplies with which to treat them. To the contrary, there were open displays
of affections and gratitude at nearly every mobile clinic we had held, and much
overt response from many patients and their representatives relayed through translation.
This experience is not for everyone, and perhaps volunteering for such mission
service self-selects a different kind of individual than might be the frequency of
humanitarians in an unselected entering health care team. So, a bipolar response
was anticipated from the participants when asked for the effect of this kind of experience
upon them personally, with part of the group declaiming that they wanted no
part of such an experience of deprivation and inadequacy again. This was emphatically
not the case when the evaluations and interviews were analyzed. The results
were expected to be mixed, with one of two typical responses being that the kind of
patient population represented by the Haitian poor was frustrating and thoroughly
disagreeable and not to be repeated by any health care professional who would like
more control over the environment in which they hope to take care of the sick and
with higher predictability on the yield of this effort. This kind of biphasic response
was predicted on the basis of the literature review previously carried out and reported
in the prior paper.
From personal experience on many prior missions, I had assumed a mixed reaction
to exposure to hardships and deprivations in dealing with a mission set up to
travel “into harm’s way,” where the unexpected is the norm and the kind of student
preselected for health care education, often on the basis of a somewhat rigid discipline
and compulsions may sometime decompensate when the environment and his
or her own reactions to the setting and problems may be out of control. There were
only minor mutterings about the “disorganization” and changes in expected scheduled
plans, and that was from the students least secure in their knowledge base or
capacity to carry out a flexible approach to patient care, and even these students
adapted under the example of others in the group.
Not everything went right during this trip, including the long rides on very
difficult eroded roads, with one instance in which a rendezvous with previously
reserved vehicles was delayed for a day, and the vehicle delivery longer still. A big bus
was rented to solve the immediate problem, but was still not a comfortable mode of
transport to arrive at our Haitian base late to start up our most intensive clinical
experience. At the time each hungry, weary and exasperated participant might have
been snapping at each other for getting any one of us into this situation, but for the
people we had come to see, who cannot escape worse than inconvenience. This kind
of educational experience might be considered inefficient when compared with a
well-organized classroom approach to, for example, the teaching of parasitology and
tropical medicine. But nearly every student testified that this service learning was
the most intensive educational process they had ever encountered and had learned
more in this two week period than in any intensive seminar setting. The AMA-motion
on recommending such service learning (Appendix E) on the basis of this research
into the self-reported changes in knowledge, motivations and behaviors would appear
to be strongly supported as a valuable addition to the enrichment of most
health care students’ education in a very real world setting. This kind of service
learning might be the kind that Benjamin Rush had wished for in the quote cited by
Link (see Ref. 4, p.132): “I wish a society could be formed to humanize physicians.”