Witness, Advocate, Exchange, Improve

Anne Dougherty, M.D.'09
Anne Dougherty, M.D.’09

The White Coat Ceremony for the Larner College of Medicine Class of 2022 was held October 5, 2018, in Ira Allen Chapel. The following are remarks from Anne Dougherty, M.D.’09, this year’s recipient of the Leonard Tow Humanism in Medicine Award. 

Good afternoon, Class of 2022

What a great honor it is to speak with you on this most important day of your medical careers.

Today, I want to tell you a story about a girl named, Gladyness.  I met Gladyness when she was eight years-old.  I was between my first and second year of medical school and had finagled my way into working in a small rural primary care clinic in Kasese, Uganda on the western border with the Democratic Republic of Congo. Gladyness had epilepsy but was not well controlled because anti-epileptic drug were hard to find and quite expensive. This time, she had a seizure and had fallen hands first into the cooking fire.  She had second and third degree burns over her both palms and forearms.  I saw her with the doctor and he prescribed proper wound care with wet to dry dressings and debridement.  Then he scurried off to see the long line of patients waiting outside the office leaving me to tend to Gladyness.

She was a beautiful girl with captivating dark eyes that followed me as I prepared a sterile field.  She winced only a bit when the debridement got to the edge of viable tissue.  I witnessed her bravery when I cleaned her wounds.  We had no shared language, only hand gestures and the raising of eyebrows that means “yes” or “I agree” in East African body language.  Though in the U.S., a patient like Gladyness might have been sent home with nursing visits to assist with dressing changes, the healthcare system in Uganda had no such provision. So Gladyness stayed at the hospital.  Over the next three weeks, I advocated for her care, taking the time to un-bandage, clean and re-bandage Gladyness’ hands three times a day.  She lost her pinkie on the right hand but the other fingers fared well.  Infection was kept at bay.  The clinic doctor told me she would go to another facility for a skin graft possibly but that was going to be expensive.  We also watched for contractures as the wounds healed so that her hands would remain functional.  The long-term consequences were unimaginable to me.  I could not comprehend what life would be like for this girl if she lost function of her hands living in rural Uganda.  But I got to go back to Vermont, however, and continue with my medical school career.

But it changed me…This one young girl living in Uganda…this series of interaction over a period of weeks reshaped my path in medicine.  It sparked in me an intense desire to work with underserved populations and to learn more about cross cultural medicine and communication.

Over the next several years, I returned frequently to East Africa – Tanzania and Uganda primarily – developing lasting relationships with non-profit groups, hospitals and medical schools.

At one point, I went back to Uganda to work on resident education and faculty development at the largest medical school in the country. One day, I was invited to a journal club with the Ugandan OBGYN residents.  They had selected a paper to review, but it was ten years out of date and compared two gynecologic procedures one of which is rarely done these days.

But these residents attacked the paper, dissected the methodology and the results as no other resident group I had seen.  They were hungry for the work.  I was curious, though, how did they select the paper?  Why not something more recent?  Through this exchange, I realized that the privilege we have to go to Dana Medical Library and pull any paper we want off the internet or through interlibrary loan did not exist in Uganda.  Those residents were hungry for the latest papers, but could not access them because of the country in which they were born.  Additionally, they were paying by the megabyte for internet.  And though we are only part of the way there, with assistance from my Ugandan partners and the Frymoyer Fund for medical education, we were able to improve the Ugandan department by setting up an internet “café” with computers and wifi for the students, residents and faculty.  Still they would have difficulty accessing papers, but at least internet availability was not the main hurdle and now they had a central space in which to study and discuss clinical issues.

In the beginning, I had a picture of myself as a global health physician working in the trenches in far flung places, performing procedures with substandard equipment and saving the day. A global health mentor of mine dissuaded me of this notion. He said: ‘If you are working in the trenches, you are doing this for yourself.  If you want to make real change, look at the systems, look at the culture of medicine, teach!’  This is not true just in global health but in medicine in general.  Six years ago, on a white board in my office next to a photograph of Gladyness, I wrote the words – witness, advocate, exchange and improve.  These are my pillars of global health, my mantra, so to speak.    And as I think about it now, they are just as applicable to global health as they are to the practice of medicine in general.

Be a witness for your patients.  Use your critical eye.  Let them teach you and let them change you.  Through each patient, understand the medical system at work.  Witness where it functions well, and, just as well, witness where it falls short.  And don’t be afraid to critically evaluate the system as you move through as trainees. Your vantage point is important.

Advocate for change with the patient in front of you.  Advocate for them to change their lifestyle – to stop smoking, to lose weight, but also advocate for justice in your practice, in your hospital system, in your community. Advocate for women and under-represented minorities to have equality within the practice of medicine.

Exchange information and ideas.  This is critically important.  Talk to patients about challenges they encounter in their lives.  Ask the questions; do not assume.  Discuss challenges in the practice of medicine with colleagues.  I am convinced that in the exchange, lies the solution.

Improve the quality of medical care as well as the medical system itself.  Participate in quality improvement projects as medical students, residents and beyond.  Use your creative skills to pioneer that innovative way to assist New Americans or non-English speaking patients through cancer diagnosis and treatment, for instance.

You are at the beginning of a truly transformative journey.  Suck every last little drop out of it. And though it is not your job to save the world, I implore you to witness, advocate, exchange and improve…and you might just change the world a little bit.

Thank you and good luck to all of you.

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