Monday, August 9, 2010

Back to School

My last summer of medical school is very quickly coming to a close. I just received emails from the administration about our new class and exam schedules, that our first day of class will begin at 7:15AM, and a very long textbook list. AHHH!!!!

School stress can certainly follow me to Ghana. The second year of medical school in the US is arguably the toughest of the four years due to the extreme volume of information there is to internalize not just for the USMLE Step 1 Board exams at the end of second year, but also in preparation for the responsibility of being on a patient care team as a third year medical student. What we learn in our second year builds on our first year and has even greater potential to be applied to save lives. However, call me crazy, but despite this thunderous load of stress awaiting my arrival back in Michigan in less than a week, I am excited about my second year of medical school because I’m moving one step closer to seeing and taking care of patients. Let me explain.

Szoa and I after 5 hours waiting at a bus station and 6 hours on a bus to Wa...we're still smiling! Photo Courtesy of Szoa

On the same day that I received these not entirely welcome emails from the administration outlining my second year, I was preparing to welcome my friend, Szoa, to Ghana. Szoa is a premedical student who was able to squeeze one week out of her busy work schedule to come visit me in Ghana and see firsthand how medicine works in a developing country. Since Szoa had just one week, I did my best to arrange for the most meaningful medical experiences while also giving her a crash course on what it is like to live in Ghana. She had to try all the food that I’ve been sampling in the last two months in just one week…and that alone is not an easy task.

Throughout the week, Szoa got to see almost every level of the delivery of health care in Ghana from the research and policy level at my presentation of preliminary results and recommendations to the health care leadership in the Ashanti region, to the teaching hospital level through the variety of OB/GYN cases that come into KATH when on call, to the most basic point of care through the interaction between midlevel providers and their communities in the rural upper west region surrounding Wa. While I can only hope that the breadth and depth of her brief health care experiences were worthwhile as she begins her career in health care, I can say with complete certainty that my week introducing medicine to Szoa has recharged my own excitement about medicine and health care.

The first year of medical school can be tough, especially as you are memorizing the seemingly neverending adverse effects of the tetracycline class of antibiotics or struggling to construct a cohesive conceptual understanding of renal physiology. Medical school students are self-selectively eager students who are always itching to hit the ground running. So, an entire year spent with books rather than interacting with patients can be very demoralizing—to the point where I even questioned if this was what I really wanted to do. But, my summer in Ghana has erased these negative feelings and my week with Szoa took the form of a reflective capstone.

Even though most of my time was spent focusing on the clinical quality and management changes an OB/GYN can make at a district hospital, the impact on maternal health, and the policy implications of this intervention, my summer in Ghana helped tie together all of the different pieces of medicine I have experienced in the last year into one entity. The connections between policy and research, process improvement, and direct patient care were not just made clearer in my mind, but were strengthened as well.

Imagine a pregnant woman for visualization purposes. In just one individual, she represents the medical acumen that physicians and midwives will provide through prenatal, labor, and postnatal care; the continuous data collection and interpretation that the medical staff must employ in order to develop innovative process improvement interventions and ensure that life-saving techniques are applied effectively, efficiently and reliably; the policies that were put into place to spread best practices which will make her access and utilization of quality health care seamless; and the joy of adding another beautiful human being into her family. Because current medical education curricula focus just on developing the medical knowledge we will need to care for patients, I used to think that these four layers of health care delivery were siloed fields. But, my summer in Ghana has taught me that these layers are all interconnected within a patient and are difficult to tease out into four separate streams.

As Szoa and I were observing a caesarean section during a night on-call at KATH, I found myself building and jumping between these layers of health care delivery as I tried to explain what was going on in front of us. This caesarean section was being performed because of the condition oligohydramnios, which was detected and managed by her care team in order to ensure the safety of mother and baby, which was probably a result of the mother regularly attending free antenatal clinic days, which are hosted by all levels of health facilities throughout Ghana in order to improve maternal mortality, which include providing mothers with nutritional supplements and regular tracking of the health of mother and baby, and so on. As I pointed out anatomical structures like the uterus, I explained the need for the uterus to contract in order to avoid bleeding complications after delivery, the regular practice at KATH to give the mother misoprostol to avoid postpartum hemorrhage, how the use of misoprostol was introduced at the district hospitals by the OB/GYNs newly posted to work at district hospitals, how misoprostol is a controversial drug because it is abused for abortions, how the regulation of pharmaceuticals in Ghana needs to be tightened, etc. It’s all interconnected!

Although my second year of medical school will most likely be busy to the point of overwhelming chaos, I know I’ll not just survive, but I will enjoy learning about the endless number of things that can go wrong in the human body and how we have developed ways of correcting and managing these complications, while continuing to muse about health care improvement through the many layers of health care delivery.

Second year, here I come!

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