Journal Logo

After the Match

After the Match

The Fullest Extent of Human Duress Can Be Found Only Beyond Our Borders

Cook, Thomas MD

doi: 10.1097/01.EEM.0000604584.43218.a4
    poverty, medical mission
    poverty, medical mission:
    poverty, medical mission

    I took my last shower just before getting on a plane to fly home. It took every Q-tip I had to get my ears clean. Twenty-six hours of riding in an open van on dirt roads in equatorial Africa will saturate every crevice of your body with a fine, reddish dust that leaks out of your pores for weeks. So why go?

    The idea that residents should travel to other countries for clinical and cultural experiences was nonexistent in the early 1990s. A resident might go to another city for a clinical experience he could not get at his home institution, but the idea of using elective time to practice medicine in a poor country was unheard of. Most of us in residency at that time just wanted the easiest elective rotation possible to have some time off. Work duty hours did not exist, and we were often desperate to slow down and breathe.

    Starting in medical school, I regularly traveled long distances to experience other cultures. I have encouraged our residents to pursue global health work since 2007, but I lacked street cred for many years. I did not participate in my initial global health experience until five years ago on a week-long mission to Port-Au-Prince, Haiti. I walked away from this experience profoundly affected.

    Since then, I have completed three similar trips, and two years ago, I wrote columns about my global health trip to Uganda. (EMN. 2017;39[11]:16,; EMN. 2017;39[12]:24, More than half of our residency graduates have participated in a global health experience during training. To date, 24 members of our program have traveled to Uganda; others have been to India and Tanzania.

    Not everyone in academic emergency medicine likes this idea. I had dinner several years ago with a program director of a prominent EM program. The topic of medical missions came up, and he said he had have never left the United States, and had no need to. “There are plenty of poor people in our state, and if residents want to take care of poor people, they can do it here,” he said. That was not the last time I heard this. With the cultural battles raging in American society today, some want to turn away from the world. But this line of thinking misses the point entirely—global health is not about helping the poor in other countries but about helping ourselves.

    This point is not lost on current residents. Unlike my generation of boomers, millennials seek out global connections. They are the genesis of the experience economy, predicated on wanderlust and activities that deepen their understanding of the world.

    A Picture of Suffering

    There are 24 international emergency medicine fellowships even though global health as a career does not generate anything close to the income that practicing emergency medicine does. (IEM Fellowships. Residents and young EPs have a strong desire to participate in deeply meaningful encounters similar to what can be achieved through global health. One of my grads recently committed to working full-time in the small African nation of Malawi. Another pending graduate is considering a similar life. You might think they are nuts, but I see this as the rejection of the self-centered behavior so pervasive in our society.

    This is not to say we do not have poor people here who need our attention. A lot of Americans have very little while battling barriers to successful lives. We see them on every shift. But comparisons with the poorest countries in the world lack any sense of scale. The picture of feet accompanying this article is of three children I saw this month in rural Uganda. They belong to three girls ages 8 to 11. None of them had shoes, and all of them had malaria. Their feet (and bodies) were covered in dirt because there was no access to water for bathing.

    Even if they found a pond, river, or lake, it would be infested with parasitic diseases. Needless to say, they did not attend school, couldn't read, had exactly one set of tattered clothes each, and had waited patiently all day in the sun for a few minutes of my attention. Still, they smiled and graciously allowed me to take this picture of their suffering. To say it was a humbling experience is the grossest of understatements.

    Is an experience like this a beneficial component of residency training? I think it is the most important. EPs often come home from a shift after a profound experience. We watch an endless stream of pivotal moments in the lives of countless people. But we are also disillusioned by the equally endless procession of people claiming victimhood without identifying that the culprit behind their misery can be found by looking in the mirror and that access to health care for nearly all Americans is as easy as 9-1-1. Global missions help us clearly understand the fullest extent of human duress, and the greatest of this can only be found beyond our borders.

    Dr. Cookis the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound ( Friend him, follow him on Twitter@3rdRockUS, and read his past columns at

    Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.