Global Health

Cui Bono? Who Will Benefit?

uvmmedicine blogger Katherine Wang '17

uvmmedicine blogger Katherine Wang ’17

It was the combination of Grey’s Anatomy and Mountains Beyond Mountains that convinced me my senior year of high school to consider medicine as a career—the excitement of the operating room and the journey Paul Farmer took through Haiti and beyond. It obviously was an idealized notion of both surgery and global health, but it shaped my undergraduate experience. I chose to major in anthropology, and enrolled in an introductory writing course in the subject after reading about it in Tracy Kidder’s book. I also picked up a global health studies minor because it sounded exciting and tied into my plan to complete the pre-medical coursework.

In lectures, I learned about the tenets of public health, the basics of global health. We discussed the pros and cons of the Millennium Development Goals. Information about health disparities and social justice was presented, but I was learning only in the abstract. I then had the opportunity to study abroad in South Africa and learn about its health system more closely. During the quarter before I left, I took a class that touched on the ethics of global health, and the role of outsiders descending on a rural location. It harkened back to one of my anthropology classes in which the professor would always ask, “cui bono?” Rather than its contemporary meaning in law and forensics, she used it literally, meaning, “who is to benefit?” The combination of these two courses made me question my role in traveling abroad and learning, and how to fit it all into a career in the future.

I chose to sign up for a global health elective this year for several reasons. First, I am interested in learning about a different health care system, and understanding the intricacies of health care delivery and practice in a resource-limited country. That framework will also be supported by a greater comprehension of diseases that we do not encounter in the U.S. I also want to interact with women in Uganda and see the challenges they face, which may or may not be different in causes and manifestations from those seen in the U.S. As a medical student, I want to continue working on my clinical skills, from physical exam and technical skills to cultural competency. Finally, I want to learn more about the culture of Uganda, the “Pearl of Africa.” In doing so, I hope to foster an exchange of knowledge and culture and ensure that I am contributing as well as learning.

There are inherent challenges in working in a new place. Even during third year, switching rotations meant new attendings and residents, a different part of the hospital, or a whole different system. This will be a bigger change—somewhere that I have never been in a significantly different hospital setting. Furthermore, I’m nervous about finding my place within the teaching hospital. I don’t want to be an additional burden, although I know I’ll have to adapt. Here, I have been lucky to be in a place where resources in the hospitals aren’t limited and we run through sterile equipment like none other. I am also afraid of doing harm. I want to be there to help, and not hurt. I have heard that the wards are busy and chaotic, and I am nervous about being pulled into a situation in which I’m in over my head.  I am sure I will also encounter different cultural constructs of race and gender. In a country with one of the highest fertility rates in the world, there are bound to be a number of reasons leading to this, and it can be hard to grapple with what we can and cannot do in our limited time there.

I waited until my fourth year of medical school to participate in global health in hopes that I would have acquired skills to contribute that I didn’t have after first year. Clinically, I’ve certainly come a long way, but there are many technical skills, particularly in a specialty like ob-gyn, that I feel I am just scratching at proficient, such as delivery. Obviously I plan on reviewing the basics of what I do know prior to starting. But at the same time I certainly think knowing my limits and committing to standing by them will be equally important, as will be finding the ways in which I can be helpful,  such as helping record notes in rounds, or teaching the midwife and nursing students at ACCESS,. Finally, I feel that reflection is a key component to success – what went well in a day, what didn’t, what can I change in my behavior and how I approach things. Some things are difficult to prepare for until we encounter them. For this reason, it will be crucial to approach this elective with adaptability and the ability to take a step back to evaluate how things transpire.

Despite these anxieties, I am excited for the next six weeks to unfold, and to see the theoretical in practice. I am eager to stay with a local family, to share meals, and to learn more firsthand about home life. I am ready to be challenged and pushed outside my comfort zone, and to return to the clinical setting. My interest in global health has extended beyond my initial concept of “getting to travel and be a doctor.” It now involves the ability to attempt to reduce health disparities and inequity, and to foster a global dialogue and knowledge exchange. I’m incredibly excited to have the opportunity to learn and grow as a future physician.

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