Fourth Year WCM Student Stories from the Field | Office of International Medical Student Education

Name:

Elliott Brea

Location:

Moshi, Tanzania

Program:

Kilimanjaro Christian Medical Center, 2018

My clinical observership experience at Kilimanjaro Christian Medical College in Moshi, Tanzania was incredibly illuminating as to the differences in management, disparities in clinical care and challenges with management of complex disease in a resource limited country. My host mentor, Dr. Neema Minja, was an incredible teacher and clinician who pushed me to become involved in clinical decision making during rounds. I spent 6 weeks on the internal medicine ward at KCMC as a member of the inpatient team. I spent about 3 weeks in the Medical Intensive Care Unit, a 6 bed unit where patients were triaged based on the need for the most acute level of care. I was able to participate in rounds, physical examination, reviewing clinical data, and assessment and plans for patients. I also spent an additional 3 weeks on general inpatient medicine, rounding with Dr. Deng Madut, and an Infectious Disease fellow from Duke who served as an attending on general inpatient medicine. My responsibilities were similar to the MICU.

One of the biggest challenges with clinical care at KCMC was the limited resources available for patients who were critically ill or presenting with complex diseases. Diagnostic tests were often ordered sparingly, and many times were not available due to lab equipment not functioning. Imaging as well was highly limited. While chest x-rays were available and routinely utilized, throughout most of my elective the CT scanner was not functioning and we routinely sent patients to the nearest CT scanner about an hour away in Arusha, even for situations where stat CT scans were necessary...Read more

Name:

Ali Berman

Location:

Glasgow, Scotland

Program:

Glasgow Royal Hospital for Children, 2018

I participated in a 4-week international elective at the Royal Hospital for Children in Glasgow, Scotland. I spent two weeks in the PICU and two weeks in the pediatric A&E department (their emergency department). My main goals during this elective were to see firsthand how the differences in the healthcare systems between Scotland and the US play out in practice from the perspective of medical student/physician. I also hoped to see a different patient population and get a sense of the unique medical issues that affect Glasgow, which is known to have particularly bad health outcomes.

Scotland’s healthcare system is called the NHS, which is a system in which everyone is guaranteed healthcare from birth to death. It is paid for through taxes. There is no private insurance at all, which is in slight contrast to England’s NHS, which has some private components. In contrast with this seemingly idyllic health system for all, Scotland has one of the lowest life expectancy levels among countries within the EU. Glasgow specifically has the highest mortality rates in the UK, and is among the highest in all of Europe. As mentioned above, with this project I was hoping to gain insight into the day-to-day workings of the NHS and how it affects medical practice in Scotland. I was also hoping to see the unique health issues that may affect the children of Glasgow. Working at the Royal Hospital for Children in Glasgow was an incredible experience...Read more

Name:

Amanda Su

Location:

San Vito, Costa Rica

Program:

Rural Primary Care, 2018

I spent six weeks in San Vito, Costa Rica, from March 21-April 27, under the supervision of Dr. Pablo Ortiz. I rotated through three different primary care clinics in and around the San Vito area, observing and assisting during patient visits. I also participated in health screenings and health classes at local elementary and middle schools. Living in Dr. Ortiz’s house in San Vito, I also had the opportunity to discuss the Costa Rican healthcare system with Costa Rican medical students, residents and public health professionals.

Costa Rica has a universal healthcare system, where all services in public clinics and hospitals are free of cost for all residents. However, in poorer areas, many of the medical centers have limited resources in terms of clinic equipment and medical services available to the population. In this elective, I rotated through 3 local primary care clinics with the Costa Rican medical students. Mostly, I observed patient appointments and was able to discuss some differences in standards of care and practice. I also helped to conduct health screenings and educational sessions at local public schools. My main goals for this elective were learning about the Costa Rican healthcare system and improving my medical Spanish.

I spent the majority of my time at the clinic in La Casona, where the vast majority of patients are part of the indigenous Ngobe population...Read more

Name:

Amelia Kelly

Location:

Lima, Peru

Program:

OB/GYN El Hospital Nacional Docente Madre Niño San Bartolomé, 2018

For the past six weeks, I have been living in Lima, Peru working at one of their public hospitals for women and children. This experience was made possible because of Weill Cornell Medical College’s relationship and exchange program with The National University of San Marcos. The San Marcos medical students rotate at many of the public hospitals throughout Lima, including the hospital that I worked at, El Hospital Nacional Docente Madre Niño San Bartolomé. During my stay, I did an Obstetrics rotation where I spent three weeks helping to care for patients on the antepartum high-risk ward and three weeks on labor and delivery. As an aspiring Obstetrician and Gynecologist, my primary goal, in addition to improving my Spanish vocabulary and fluency, was to learn about the women’s health and birth practices in another country.

One of the most challenging aspects of my rotation was becoming oriented to my clinical site and learning the Spanish medical vocabulary required to take a patient history and present a patient on rounds. Like in the United States, there are an innumerous number of acronyms that Peruvians use on rounds, which made it difficult to understand rounds for the first week or so. Another immense challenge was utilizing the paper charts are used in Peru (I am now so thankful for the electronic medical record!). To be honest, I spent the first one-two weeks of my rotation trying to learn key vocabulary words and acronyms, understand rounds, and understand how the charts were written and organized.

However, with time, my comprehension improved and I started to be able to decipher the charts better. This enabled me to participate more in rounds and in patient care...Read more

Name:

Vincent Raikhel

Location:

Paris, France

Program:

American Hospital in Paris, 2018

I walked off the streets and onto the red carpet that welcomes patients and physicians to the American Hospital in Paris. Startling quickly, I was dressed in scrubs, stepping into an operating theater to watch a robotic thyroidectomy. I would later learn that this procedure is only practiced at the AHP and in South Korea. This encapsulated much of my experience at the AHP, a place that shares much with the American philosophy of medical care. The patients at the AHP are all insured, there is often a dual role of patients also being customers that physicians need to navigate, and new procedures and medications are often utilized and publicized to the patients. While at the AHP I rotated through a variety of departments including oncology, anesthesia, radiology, critical care, emergency, neurology, and nephrology. I saw procedures I’ve never seen before such as cardiac catheterizations, pacemaker implantation, and breast reconstructions among others. The patient population at the AHP was enormously diverse (only 40% of the patients at the APH are French), with many patients coming from Africa (the continued relationship France has with its former African colonies was clear), the middle east, and elsewhere in Europe. The AHP treats all the diplomats from the Japanese and Chinese embassies adding further diversity. It was also clear to me that medicine at the AHP reflects a very specific slice of the medical world in France. To be treated at the AHP patients need either supplemental private insurance in addition to the public insurance, or the ability to pay a deposit to cover their care.

One patient from Togo arrived at the cardiac catheterization lab accompanied by his own cardiologist who watched the procedure (there is not a single cath lab in Togo). Another patient, this one from America, came to the AHP to have half of her thyroid removed robotically, and to have a nodule in the other half stereotactically embolized. These patients clearly had means to allow them flexibility in choosing their care. To gain a more complete picture of medical care in France I was lucky enough to be able to visit the cardiac critical care unit at Pitié-Salpétrière, University Hospital (Paris’ largest hospital), and the neurological ICU at Sainte-Anne Hospital. The teams at these hospitals more closely resembled the large teams at academic medical centers in the US, with medical students and residents working with an attending. These public hospitals gave me a deeper perspective on some of the significant differences between medical care in France versus in the United States. One example was the utilization of the opt out organ donor system in France. At Pitié- Salpétrière I saw several patients in their 20s who were in heart failure due to idiopathic cardiomyopathy. They were being managed with advanced life support and were waiting for a heart donor. The residents told me that the patients would need to wait around 4 days each. By comparison, patients in the United States would wait 3-6 months on average. What was evidently clear was that the French people value and take pride in their medical care system. Quality care is available at little to no cost at the point of care, physicians enjoy a great quality of life (everybody takes hour long lunch breaks!), and public insurance is provided at no cost aside from taxes. It is a medical system that shares much with the US, yet also stands apart in dealing with finances in a more equitable manner.

Name:

Jacqueline Parker

Location:

Sydney, Australia

Program:

Concord Dermatology & Nepean ICU, 2018

I spent four weeks rotating through the dermatology clinic at Concord hospital. I saw a variety skin conditions ranging from common to extremely rare. The training I received was important because regardless of what field of medicine I pursues every time I see a patient there is an opportunity to observe something about their skin. I had felt that my exposure to dermatology in medical school before this experience had been lacking. Like many fields in medicine, dermatology is best learned through observing lesions over and over again so that you can build confidence in making a clinical decision. My experience at Concord was a good foundation to start building that confidence.

It was interesting to see the cutaneous manifestations of many diseases and humbling to witness how debilitating or chronically uncomfortable many skin conditions can be. There seems to be a very limited number of medications at the disposal of dermatologists and especially when conditions are severe there is a great deal of trial and error. I assisted in many punch biopsies and small procedures, which I anticipate doing soon as an intern. In the mornings we saw hospital consults. This was an opportunity to learn about the more serve and sometimes life threatening skin conditions...Read more

Name:

Danielle Daniels

Location:

Kwazulu-Natal, South Africa

Program:

KwaDakuza (Stranger) Hospital, 2017

I recently completed a clinical elective at a hospital in KwaDakuza (Stanger) located in the province of Kwazulu-Natal in South Africa. KwaDakuza is a town located approximately 75 kilometers north of Durban along the eastern coast of South Africa. I spent 6-weeks during March and April of 2017 rotating through several pediatric units at the hospital. I was supervised by the Department Chair of Paediatrics, Dr. Jeroen Van Lobenstein.

To give you a better understanding of the community which the hospital serves, KwaDukuza has a population of a little over 230,000.1 Demographically, the population is 78.8% Black African, 14.1% Indian, and 5.6% white. Twenty-nine percent of the population is below the age of 14-years-old. Only 28.4% of those over the age of 20 have completed matriculation and the unemployment rate is 25%. Although 80% live in “formal dwellings,” only 33.6% of those dwellings have piped water inside. Geographically, as you move away from the coast into the more rural areas, the unemployment rate and the number of individuals in poor living conditions rises dramatically.

Stanger Hospital is a regional hospital with 500 beds and a catchment of over half a million people. In South Africa, the public health sector has a hierarchy that includes community health care centres, primary, secondary, and tertiary level hospitals. Stanger is classified as a secondary-level or regional hospital. Resources are more available than in district hospitals, however are still limited. Regarding imaging, there is one CT machine for the entire hospital and no MRI machine.

Because resources are limited and the departments are often short-staffed, medical students can prove to be a true asset to the medical team at Stanger. Following the “see one, do one, teach one” model, medical students are welcomed to assist with many of the medical procedures. Students will gain plenty of hands-on experience and improve their procedural skills during this elective...Read more

Name:

Alexandra Tatum

Location:

Vellore, India

Program:

Christian Medical College, 2014

During my fourth year of medical school, I completed a four-week international clinical elective at Christian Medical College (CMC) in Vellore, Tamil Nadu, India. I chose this site because of its history. The American missionary Ida Scudder, one of the first women to graduate from Cornell Medical College, founded CMC in the early 1900's. Her legacy is now a sprawling institution that attracts patients, medical students, and clinicians from all over India and beyond.

In an attempt to learn about as many facets of CMC as possible, I spent a week each with the gynecological oncology, reproductive medicine, and psychiatry teams. I also spent one week learning about CMC's community health initiatives at both the Rural Unit for Health and Social Affairs (RUHSA) and the Community Health and Development (CHAD) sites. There is a strong sense of mission among CMC physicians and staff, and what I valued most about the experience was witnessing firsthand the multitude of thoughtful innovations through which CMC is working to improve health outcomes in the communities it serves. Of note, all rounds, lectures, and other forms of formal communication are conducted in English, although the language barrier was at times a limiting factor in my communication with patients as I did not speak Tamil. For students with more time to spend abroad, I think it would be an especially valuable experience to get involved in one of CMC's innumerable research or health outreach projects. Overall, I had a fantastic experience at CMC and would enthusiastically recommend the site to other students.

Name:

William Shrauner

Location:

Kumasi, Ghana

Program:

Komfo Anoyke Teaching Hospital, 2013

During the summer of 2013, between my first and second years of medical school, I was afforded the opportunity to spend the summer conducting research at Komfo Anoyke Teaching Hospital (KATH) in Kumasi, Ghana. I worked under the direction of Dr. Adam Gyedu, an attending surgeon at KATH, and Dr. T. Peter Kingham, a surgical oncologist at MSKCC. Our project sought to characterize the patient population at KATH with hepatocellular carcinoma (HCC), the third most common cause of cancer deaths worldwide. I spent my days alternatively pouring through the patient record and spending time with Dr. Gyedu in surgery and clinics.
This was my first time working abroad, and as a newcomer to both medicine and clinical research, the experience was immensely valuable. The mentorship and teaching Dr. Gyedu offered was incredible. The lessons learned daily were further bolstered by living and working alongside Ghanaian medical students.
We were able to analyze the records of 465 patients, gaining insight into a previously uncharacterized group of patients. In early 2014, I was able to present the work at the Academic Surgical Conference, and then give a subsequent presentation at the fifth Consortium of Universities for Global Health. I am deeply indebted to both Dr. Gyedu for his guidance and mentorship and the fellow students I met for welcoming me into their home and country.