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On Being There

Ho, Ming-Jung MD, DPhil; Chen, Wei-Shone MD, PhD; Hirsh, David MD

doi: 10.1097/ACM.0b013e318257876b
Teaching and Learning Moments

Dr. Ho is associate professor, Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; e-mail:

Dr. Chen is professor and associate dean, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Dr. Hirsh is assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts, and Cambridge Health Alliance, Cambridge, Massachusetts

Even the 11.8-mile depth was too close, too shallow. The location, calculated at 30.986°N, 103.364°E, had an estimated radius of uncertainty of 3.1 miles. For the people of Eastern Sichuan, China, that uncertainty didn’t matter. They knew the time—Monday, May 12, 2008 at 06:20:10 UTC. The magnitude, beyond the 7.9, was enormous.

Shortly after this disastrous earthquake, we at the National Yang-Ming University and at the National Taiwan University sent a team of medical professionals and students to the site to offer aid. One afternoon, an elderly couple approached the station. The elderly man sighed: “We have climbed over the mountains since dawn to reach you. Is it too late to attend your clinic?” His countenance belied strength. The team leader gestured to the students to set up chairs for the exhausted couple. “Have you eaten?” someone asked. The couple shook their heads. Their smiles revealed few teeth.

The leader broke some tough-to-chew, high-energy cookies into pieces. He soaked them in water to share with the couple. “Delicious! Delicious!” The wife took a piece of cookie and reached out to the leader: “You eat too.” Her hand trembled, but her voice did not. The leader noticed the woman’s unusually worn nails. The woman seemed to need to explain her appearance: “We lost everything in the earthquake. We could not find scissors to cut our nails.” A student clipped the nails of the woman, and they spoke.

Later, the student shared the couple’s story. They had said that the young student reminded them of their grandchild. With a deliberate tone and gaze, the couple had explained—the sudden earthquake, the force, the complete loss of buildings, the confusion. Afterward, they could not find their grandchildren. They dug with their bare hands to pull the children’s bodies from their collapsed home. They dug again to make the children’s graves. The couple left these burials, walked into the mountains, and came upon our medical camp. Despite their sadness, they kept thanking the students and the team for coming such a long way to help them.

The couple’s story and their thanks resounded in the students’ memories—They felt a deep connection to the couple. This human engagement felt different than time spent in passive roles. The students described the work as a moment of clarity—an expression of the meaning of physicianship. The students understood that they provided relief by their attention and affiliation—core values of the healer’s art long before advances in medical technologies.

But we as educators are left with questions. Do transformative moments in medical education require proximity to suffering? What are the forces that help us learn the fullness of doctoring, of caring? Do immersive service experiences in less familiar cultures somehow sharpen our senses, foster perspective, or even allow enlightenment? Our students and faculty became not only more mindful of how people of diverse cultures manage illness but also more certain that humanism is the foundation of medical practice across the globe.

Although it may be hard work, we must offer safe and effective service learning, global health, or cross-cultural opportunities for students to experience these critical, transformative moments. And we must provide proper support and mentoring for those who choose to do so. To establish the foundations of professionalism and humanism in our students, there are no substitutes for their playing meaningful, active roles in patient care.

Acknowledgments: The authors acknowledge the people of Sichuan and the team of health professionals and students who participated in this project.

© 2012 Association of American Medical Colleges