4th-yr Student IH Elective Summaries

The following are excerpts from fourth-year student elective summaries, submitted at the end of a student’s international health rotation. For more info about contacting a particular site, contact Ana Bediako, abediako@bu.edu, in the Office of Enrichment.

Listed by Continent

Africa
The Americas
Asia
Europe
Oceania

Africa

Lagos, Nigeria
LOCATION: Gbagada General Hospital, Lagos; Infectious
Diseases Hospital (IDH); Massey Street Children’s Hospital. I was located
primarily at Gbagada General Hospital in Lagos, Nigeria, one of the state
hospitals in Lagos that caters to the indigent population. I also rotated
through the state-owned Infectious Diseases Hospital (IDH) and Massey
Street Children’s Hospital. My preceptor was an internist so I spent my
first week seeing patients with diabetes, high blood pressure, anemia,
and hyperthyroidism (related to iodine-deficiency). I saw many conditions
related to the low socioeconomic status of the patients: three goiters
in my first week, and several cases of kwashiorkor, marasmus and anemia
in the pediatric clinic. What struck me the most was how diagnoses were
made using little or no laboratory testing. The physicians examined patients’
conjunctiva and tongue to diagnose anemia, conducted very long, methodical
abdominal exams quite different from what I am used to since they do not
have the luxury of being able to order CT scans or MRIs. It was a huge
learning point for me to see physical diagnosis being used as the core
of medical practice. Other diseases that I saw that have been almost,
if not completely, wiped out in the US, included advanced lepromatous
leprosy, tetanus in a 12-year-old, and childhood measles. Malaria was
much more common than I realized. The IDH is the major institution for
diagnosis and care of tuberculosis and HIV positive patients. At the Children’s
Hospital infants’ ward I saw my first cases of febrile seizures due to
malaria.(one-month elective in 2003 by Khadijah)

The Americas

Antigua, Guatemala
LOCATION: Pediatrics Department, Hospital Nacional Pedro
de Bethancourt, San Felipe, Antigua. I worked and studied in the Pediatrics
Department of the Pedro de Bethancourt National Hospital in San Felipe
of Antigua in the mornings and studied Spanish in the afternoons at Probigua.
My time in the hospital was truly eye-opening, specifically because it
was an opportunity to see first hand how children suffer in countries
without adequate healthcare and social systems. On my first day, we saw
a 6-year-old girl with end-stage renal failure who had to receive daily
peritoneal dialysis. The reason from her kidney failure was not readily
know, but it could of easily been explained by a long history of recurrent
urinary tract infections that went untreated. Guatemalans generally do
not visit doctors on a regular basis due to poverty or a general lack
of healthcare providers working within the proximity of where they live.
It was a bit shocking to learn that 1 out of every 10 children die before
reaching 1 year of age, frequently due to problems of diarrhea. In the
month of January, prior to my arrival, the rotavirus spread through the
country and resulted in the death of over 60 children.My final week in
Guatemala consisted of visiting various healthcare clinics in Guatemala.
One such site was a public health clinic in the rural area of Guatemala
which was responsible for prenatal care and vaccinations (which were provided
by the World Health Organization due to lack of funding from the Guatemalan
government). It was particularly interesting to note that there were a
fairly large number of Cuban doctors working in Guatemala in these rural
clinics, fulfilling part of their requirements to practice medicine in
Cuba, which consists of working for 1-2 years in other medically underserved
countries in Latin America. Other sites visited included a program in
dumps of Guatemala City where children living there were provided school
and free meals (Safe Passage,
a program actually started by a social worker from Maine) and a midwife
who provided care in the rural mountain areas of Guatemala (which is often
the standard of care for pregnant women). My time was in Guatemala was
very rewarding. Although Guatemala has history of internal conflict and
violence, it appears that stability is improving yearly which will hopefully
result in improved health for their people.(One-month elective in 2004
by Brian)
Antigua & San
Lucas, Guatemala
This well-run course teaches students Spanish and how to care for an
underserved patient population. It also educates about the historical,
social, and health care aspects of Guatemala. There are two tracks in
the course. Track #1 is designed for students that have little or no Spanish
background (I was in this track). The first three weeks are spent in Antigua
where students receive Spanish instruction from a private tutor (one-on-one)
for 6-7 hours/day. In addition, Dr. Garcia (who runs the course) lectures
on the history, politics, and social services of Guatemala in relation
to health care. He also talks about the illnesses most common in the poor,
rural areas of Guatemala. For the fourth week, all the students move from
Antigua to the mission in San Lucas. At the mission, Dr. Garcia’s lectures
continue and students travel to different communities to provide health
care. For Track #2, students spend one week at the Spanish school and
three weeks at the San Lucas mission; these students had frequent lectures
from Dr. Garcia but worked more closely with physicians volunteering at
the mission. For more info: http://www.unmc.edu/isp.(One-month
elective in 2003 by Brian)
La Paz, Bolivia
LOCATION: Pediatrics/Rural Medicine, Homeless Children/Rural
Clinic, La PazMy elective (Pediatrics and Rural Medicine) began with two
weeks in Cochabamba taking Spanish classes after which I returned to La
Paz. For the first four weeks, I took Spanish classes in the morning.
In the afternoon, I worked with Chi Huang (a pediatrician from BMC) treating
homeless street children or those in the children’s home that Dr. Huang
operates. Having worked with homeless populations before, I felt I was
prepared to for this experience, but the large numbers of children living
in the streets and the terrible living conditions were overwhelming at
times. We would go to the sewers to visit the children and see 30 to 40
children at a time. My last few weeks were spent in a clinic outside La
Paz that provided low-cost healthcare to community members without health
insurance. Generally, due to economic restraints, the patients would only
come if they were severely ill. Due to poor sanitation, infectious diseases
were a major problem (e.g. typhoid fever, enteroparasites, and amebiasis).
Automobile accidents and dog bites were not uncommon. We also treated
a man who attempted to hang himself. Suicide, related to poor economic
conditions and lack of health care, is very common in Bolivia.(ten-week
elective in 2003 by Brian)
Lima, Peru
I spent 6 weeks practicing tropical medicine in Lima, Peru. Off the bat,
to live in Peru, one must know Spanish. I spent several months learning
Spanish on my own and then took a daily evening class with a personal
tutor at my residence. All the patients in the clinic spoke only Spanish,
although some from the southern jungles only spoke Quechwa. In conjunction
with the University of Alabama, School of Medicine, there is a tropical
medicine course offered for the month of July and August. The typical
day starts at about 8 AM with a 1 hour lecture and then students will
split into groups either to rotate in the hospital to see what came in
overnight, spend time in clinic or round within the tropical medicine
clinic itself. All these sessions are coordinated by a teaching resident
or an attending and run until lunchtime. After lunch, there is a 1 hour
lecture for all the students. This is followed by a lab session, where
one learns everything from making your own blood plates to grow leishmania.
The rest of the afternoon was spent either in clinic, the hospital or
talking to patients they saw earlier in the day. There is a great library
in the clinic with excellent infectious disease journals and texts in
English. There are about 15 students altogether, and are from different
parts of the world. Most of the attendings can speak English. All lectures
and seminars are taught in Spanish. Within one week, I was fluent in the
core diseases one sees at this clinic. Very common is management of HIV,
Tb and all its manifestations, Leishmaniasis, Malaria, Paracoccidiomycoses,
Actinomycoses, Sporotrichiasis, Brucellosis and Bartonella. The neighboring
dermatology clinicians worked closely with us and so had many cross consults
where we saw numerous chronic leg ulcers and various infected lesions
and rashes.I learned a great deal about how to use physical diagnosis
skills to work up patients. There is an affiliated clinic in Cusco that
can also be visited as well as one in Iquitos (start of the Amazon river).
Excursions from Lima are easy to organize from the local agents especially
to Nazca and Pisco. Staying in Lima can range from $4 to $20 in local
hostels per day.(six-week elective in 2002 by Jayant)
Santiago, Chile
LOCATION: Radiology, Catholic University of ChileI spent
four weeks at the Catholic University of Chile doing radiology. Dr. Carlos
Kase, a neurologist at BUSM originally from Chile, put me in touch with
Dr. Guillermo Geisse, a radiologist at Catholic University. Dr. Geisse
was happy to accommodate my interest in pediatrics by splitting my time
between adult and pediatric radiology. He described the Catholic University
hospital as an advanced, tertiary care hospital with over 500 beds and
said that they train 6-7 residents a year in a three-year radiology program.
Once I arrived in Chile, my experiences went very smoothly. The staff
in pediatric radiology were especially helpful Dr. Cristian Garcia (the
chair of the department) and Dr. Dimitri Parra (resident on pediatric
radiology during my month in Chile) were the faculty with whom I spent
the most time. I did one week of adult radiology, two weeks in pediatric
radiology, and one week in other modalities (such as nuclear medicine
(which in Chile, interestingly, is not part of radiology) and ultrasound).
Every morning started at 8 a.m. with a review of the interesting cases
of the previous day. There were a number of conferences during the day
as well that I attended. The pediatric residents welcomed me to join their
conferences as well, and there were many times when both the pediatric
and radiologic teams had joint conferences. If the conferences had Powerpoint
or other visual aids, I was able to follow the content of them very well.
However, I was usually not able to understand much when it was just one
person in front of the room talking in Spanish. All the faculty in the
hospital, however, spoke excellent English, so language was never a problem.
Dr. Geisse also assisted with housing; one of his friends – who lived
near the hospital – rented me a room for the month I was in Chile.(four-week
elective in 2003 by Josh)

Asia

Bangkok, Thailand
LOCATION: Tropical Medicine, Mahidol University Hospital,
BangkokAt Mahidol University Hospital in Bangkok we learned through lectures
and direct patient contact about tropical diseases such as malaria, dengue
hemmorhagic fever, various parasite infections, etc.. We rounded through
the ICU and medicine wards, and while we did not pick up our own patients
(our Thai was very limited), we observed attendings providing patient
care while also translating so that we could learn as well. Our second
and third weeks took us to Phayao, a small town in rural Northern Thailand.
Phayao was simply a hidden blessing. Our learning consisted of rounding
in the morning on the medicine wards, and then going to various outpatient
sites in the afternoon. What surprised me most was that many places in
Thailand, including this hospital, were unable to afford certain therapies.
Therefore, diseases such as renal failure or HIV-infection were simply
treated palliatively. It was an ugly reminder of the business-side of
medicine. During this experience our responsibilities as medical students
were minimal but the knowledge and experience gained was priceless. The
program provided the structure necessary for learning and the flexibility
to explore the country and its people. This rotation has reinforced my
interest in International Medicine and I hope to incorporate it into my
future as a physician.(One-month elective in 2002 by Sekon)
Hong Kong, China
During a typical week Monday mornings and Friday afternoons were reserved
for outpatient clinic activities and teaching at QMH. Grand rounds were
conducted on Wednesday and Saturday mornings. During Wednesday afternoons,
we were instructed to attend outpatient clinic activities at another outlying
hospital (Duchess of Kent Hospital) where pediatric cases were emphasized.
The other days were flexible and consisted of either didactic lectures
on common orthopedic topics, bedside teaching sessions at QMH, or of scrubbing
in to participate in surgery cases in the operating room (they call it
“operating theatre” out there).In the clinics: a few patients (about 4-5
per session) were selected by the instructor based on relevant teachable
findings. These patients were presented by groups of two students each,
to the rest of the student audience of about 28 students (in a larger
conference room). After the presentation (with the patient still in front
of the audience) the instructor would critique the presentation, and add
his/her input during instruction. Bedside teaching was performed in smaller
groups of up to 7 students, again using the Socratic method. I feel that
this international rotation has been a worthwhile experience. The students
and faculty have been very eager to share their viewpoints and attitudes
and to make my learning there as productive as possible. Hong Kong is
a great city with many things to do (shopping, shopping, shopping!) and
locations to explore (hiking, exploring historical landmarks such as temples)
and the food is great!(one-month elective in 2002 by Adam)
Ludhiana Punjab, India
LOCATION: Ob/Gyn, Dayanand Medical College & Iqbal
Nursing Home, Ludhiana Punjab. I spent four weeks of my Ob/Gyn elective
in Ludhiana Punjab, India. My time was split between a private medical
college/hospital (Dayanand Medical College) and a separate private hospital
(Iqbal Nursing Home). I was not prepared to encounter the attitudes of
physicians towards me as a U.S. medical student, nor the extreme paternalistic
position most physicians held in regards to their patients. The experience
enabled me to see beyond BMC and have a better understanding of medicine
in other countries. Although the essence of medical practice was the same,
variations existed in standard treatment and in the degree of safe medical
practices. I was surprised by the number of instances in which gloves
were not worn! While technique and equipment varied little from that in
the US, cost effectiveness became readily apparent. Most surgical equipment
and garments are cloth and rewashed rather than disposed of, and the same
precautions we would consider mandatory here, are quickly disregarded
there. I learned more about the social climate surrounding the field of
medicine in a developing country than I did about practicing Ob/Gyn. The
doctor- patient relationship there is not centered on a ‘good rapport’
or on educating the patient. I was disgruntled to find that too often
physicians accused, argued, or yelled at their patients in obtaining histories.
Patients also generally came to see a physician after their symptoms had
progressed or persisted, mainly because medical expenses were all out
of their own pockets.(One-month elective in 2003 by Neeru)
Mumbai, India
I worked with Family
Planning Association of India (FPAI) in Mumbai in a non-profit clinic
in India that caters to a low socioeconomic class and brings awareness
about family planning and sex education to their clientele. I worked in
two of the branches, one in Fort and the other in Mumbai Central. The
organization of the clinic seemed efficient and professional with patients
referred to as “clients.” Clients are given a financial incentive to have
a tubal ligation or vasectomy, the latter being paid more. The clinics
also offer abortion options for up to 12-week pregnancies, and clients
usually pay a “donation” for this service. The typical surgical day consists
of patients/clients being seen in the morning for preoperative checkup
and general clinic; surgeries for abortion or ligation were performed
in the afternoon. The surgeon generally performs 12-15 surgeries a day.
Most surgeries are a mixture of abortion and laparoscopic tubal ligation.
Vasectomies are very rarely done since males are very hesitant about this
procedure despite the greater financial incentive. There are two operating
rooms side by side with two surgeons and one trainee performing the surgeries.
There is a lot of support staff helping the surgeons and the whole process
of bringing the patient in, draping them, anesthetizing them, doing the
surgery and then taking them away has been mastered to the maximum. Each
case probably takes 10-15 mins. and the turnover time is minimal, so that
all the surgeries on all 14 patients are done in only about 2 hrs! Patient
care itself was variable. The doctor that I primarily worked with took
time explaining procedures to patients, she tried to comfort them when
they were actually in the OR, and she was generally empathetic and experienced.(One-month
elective in 2003 by Bakaya)
New Delhi, India
Words cannot explain my experience at the All India Institute of Medical
Sciences, New Delhi, India (the most prestigious medical school and major
referral center in India). My first day there, I went to the Ob/Gyn clinic.
There were 60 patients to be seen by each resident in four hours (before
they had to go round on the new admissions). The diseases ranged from
stage III cervical cancer to primary infertility to even endometrial tuberculosis.
With the little Hindi I knew, I assisted the residents with the immense
workload. Women were very preoccupied with maintaining their fertility;
they were not willing to get hysterectomies, even with large fibroids
obstructing their uteruses.I then had the opportunity to go to the OR
to view an ovarian cancer removal. The surgeons wore no eye protection.
The specimen dropped on the floor. It didn’t appear to be a sterile environment.
However, their statistics show that they have a very small complication/infection
rate.. I then assisted with a study on screening for cervical cancer using
visual inspection by ascetic acid versus Pap smear.Subsequently, I was
worked in the Dermatology Dept. Unlike America, India has dermatology
inpatient wards. There were patients with leprosy (erythema nodular),
systemic sclerosis, psoriasis, and pemphigus vulgaris. It was exciting
to see diseases that I had learned about (first and second year of medical
school) but had never seen. Following this, I did Pediatrics for a couple
of days and saw many patients referred from small villages. One 6 year
old girl presented with a 19 cm spleen (normal spleen 9 cm). She had been
treated by her “village doctor” with various medications, including taking
3 burning metal rods and poking them behind her ear.On the Medicine service,
I saw many different complications of TB, including TB meningitis, INH
hepatotoxicity, miliary TB, TB induced nephropathy secondary to amyloidosis,
and even an enterocutaneous fistula made by invasive TB. The ER saw over
600 patients a day. A woman came in after a suicide attempt with organophosphate
poisoning. She was intubated, then within an hour, she was extubated after
which time she left the hospital – primarily because of the huge patient
volume.(One-month elective in 2003 by Malini)
Okinawa, Japan
I spent eight weeks in the Okinawa prefecture of Japan during June and
July of 2002 working on the Okinawa Centenarian Study. This study had
been running for twenty-five years, but only in 2001 did the three principal
investigators publish a book on their findings. I read the book, titled
The Okinawa Program, and contacted one of the principal investigators,
Dr. Brad Willcox, at Harvard’s Division on Aging at Beth Israel Deaconess
Medical Center, to inquire if there was work that I could do over a period
of two months. Together with Dr. Tom Perls, principal investigator of
the New England Centenarians Study at Boston University Medical Center,
we agreed that there were two projects I could work on over a two month
period: (1) I could team up with a pathologist, internist, and cardiologist
in Okinawa and write a case report describing the only autopsy to ever
have been performed on a centenarian in Okinawa and use the report as
a springboard to research and write about normal vs. pathological aging
and causes of death in the very old; (2)I could work with Japanese interpreters
to interview centenarians, question them about their past medical history,
and then compare the data to data being generated in the New England Centenarian
Study. During my time in Okinawa, I focused on the research and writing
of the autopsy report, rather than administering the past medical history
questionnaire, because the medical team started making centenarian house
calls later than usual in the year, and there was not enough time for
me to interview many centenarians. In order to write the case report,
I relied on another student also working on the centenarian study who
spoke fluent Japanese. She translated the patient’s medical chart and
autopsy findings and communicated for me with the Japanese doctors. I
could not have completed my work without her assistance. A few of the
doctors on the centenarian study team spoke English and with them I had
little trouble communicating. A few librarians in the University of the
Ryukyus (University of Okinawa) Medical School library also spoke English
and were able to guide me to those resources necessary to write the report.
The report is nearly complete and will be sent out for review and publication
shortly. In addition to working on the autopsy case report, I spent one
day a week in a cardiology clinic working with Dr. Makato Suzuki, a geriatrician
and cardiologist and one of the three principal investigators of the Okinawa
Centenarian Study. His patients had heart failure, high blood pressure,
and valve disease. We saw 20/30 patients over a six hour period. For the
last two weeks I was in Okinawa, the team started visiting centenarians,
as has been done every summer for the past twenty?five years. Some of
the centenarians were living in their homes with children and others were
in nursing homes. The visits consisted of questioning the patients about
medical problems, diet, family history, and any changes since the previous
year. With each patient, we performed a brief physical exam, did an EKG,
and drew blood for lab analysis. Although all of the patients I saw were
deteriorated physically, nearly all were free of dementia and could converse
easily. In sum, participating in the Okinawa Centenarian Study was rewarding
beyond expectations. I was able to do independent research and write about
normal vs. pathological aging and causes of death in the very old, see
patients in a busy cardiology clinic, make house calls to conversant centenarians,
and leave some time to explore the beaches, mountains, and remote villages
of Okinawa. I felt safe on the island at all times. I would recommend
participation in this project to other students. Fluency in Japanese is
not essential, but depending on the nature of the individual student project
to be done, it will require less dependency on others for help. The only
things I may have done differently to better my experience in Okinawa
were: (1) to try to learn more Japanese before I left; (2) to visit Okinawa
at the end of the summer rather than in the beginning, so that I could
have made more house calls to centenarians (house calls start at the end
of the summer). (two-month elective in 2002 by Adam)
Osaka, Japan
I spent four weeks for my Neurology rotation working in a private hospital
that specializes in stroke care. During that time I followed my own patients,
and participated in morning conferences, journal club, and walk rounds.
Initially patients designated by the attending were introduced, then followed
daily by myself, and separately with one of the senior residents. Patients
ranged from ages 13 to 67, were mostly female, and had diverse diagnoses,
including arachnoid cyst of cervical spine, atypical meningioma, trigeminal
neuralgia, and moyamoya.As the division between the neurology and neurosurgery
services was less distinct then hospitals in the United States, I routinely
had the opportunity to assist with patients in the OR. For the physicians,
much of the technical terminology (more so in neurology than in other
medical fields) is actually in English, or at least in a Japanese pronunciation
of an English word. The technical aspects of medicine in Japan are quite
modern, but Western medicine in Japan during the last century was mainly
under the German influence, so would be considered traditional in the
realm of informed consent, patient autonomy, and paternalism when compare
to practices in this United States. Japanese physicians are expected to
make most of the decisions for their patients. However, the style of patient
education at Shiroyama Hospital is quite different. I was very impressed
at how much time the physicians would spend with patients and family,
reviewing the disease, describing possible interventions, and exploring
what would be the best choice of action for patient. I would recommend
this experience, although overseas experience and Japanese fluency would
necessary for this type of rotation.(One-month elective in 2002 by Lars)
Seoul, Korea
“I had the opportunity to start my fourth year of medical school in Seoul,
Korea [at theYonsei Medical College, Eye & ENT Hospital]. In all,
it was a wonderful learning experience, but not quite what I had expected.
I knew very little of the Korean methods of medical education. The student’s
role is very much academic in their senior year of medical school. We
had daily lectures and quizzes and were expected to do a high volume of
reading texts and journals. I never got as much reading done in all of
my BUSM third year clerkships. There was relatively little first hand
clinical experience.”"The students’ role in clinic is one of shadow in
the strictest sense. The attending and residents were happy to have me
around in clinic, but they warned me that patients, almost without exception,
were uncomfortable with student involvement.”" I would recommend this
as an international elective for future students with the caveat that
the hands on experience is limited. But the learning and opportunity to
observe an extremely high volume of observing assessments and plans was
extremely valuable.”(four-month elective in 2002 by John)
Suwon, South Korea
Plastic surgery at Ajou University in Suwon, South Korea is hard work.
There is a lot of surgery to be seen. Most of it is reconstruction of
cleft lips and facial fractures secondary to motor vehicle accidents.
I also saw a lot of polydactyly and burn injuries among other interesting
problems. About half my time was spent in the OR, the other half spent
in the outpatient clinic. Where did I stay? Well, I was fortunate enough
to have a second cousin there, but I spent about half of my nights at
the hospital. The bunk beds are more than accommodating. The downside
was I have a basic working knowledge of the Korean language. Although
about 25% of the student body at Ajou University speaks fluent English,
the same can’t be said of the faculty.I’d recommend that student to speak
at least some Korean. Otherwise it might be overwhelming. All in all,
my experience was worthwhile and rewarding. I was able to observe many
differences between American and Korean medical practice. I think going
abroad during the medical education process broadens one’s horizons. Not
only in the medical realm of knowledge, but in terms of life and living.(One-month
elective in 2002 by David)
Taipei, Taiwan
My rotation in Orthopedics at the National Taiwan University Hospital
was indeed a very educational and rewarding experience. The outpatient
clinics were a very unique experience, totally different from anything
I have ever seen in the States. The extreme volume of patients was incredible.
Each afternoon session, we would see greater than 100 patients in a 4
hour period! The patients do not have set appointment times, but wait
all afternoon to be seen. We saw pre-op, post-op care, broken bones, carpal
tunnel syndrome, back pain, vertebral fractures, etc. During this time,
I was able to gain valuable experience in diagnosis of orthopedic related
complaints. Additionally, we saw many radiographs, and I gained confidence
in the reading of them. I also spent a considerable amount of time in
the casting/splinting room. I was able to learn to apply various types
of casts according to the residents directions and instructions. The lack
of privacy was definitely a contrast to the states. At one time, there
can be 3-4 different patients in the room. Each patient is only seen for
2?3 minutes at most, and the exam and history is very focused. In the
operating room, I got to see many different types of orthopedic surgeries
involving trauma, emergent surgeries and fixations of broken bones. The
living arrangements were also very pleasant. We stayed at Jing?Fu alumni
dormitory, which was set up for visiting and foreign students. Overall
I enjoyed my experience in Taiwan and at National Taiwan University Hospital.
I was able to speak the language, so was able to use it to interact with
patients as well as doctors. Most of the doctors have a good understanding
of English (although all patient conversations and much of doctor discussions
were in Chinese).(three-week elective in 2002 by Paul)
Zhang Zhou, China
“Zhang Zhou Municipal Hospital is the largest comprehensive hospital
of the Zhang Zhou County, located in the Fujan Province on the southeastern
coast of the People’s Republic of China. It serves a population of 4.5
million within the Zhangzhou County region. The hospital has both ambulatory
care center and 700 inpatient beds. The hematology/oncology and cardiothoracic
surgery are the two strongest departments in the hospital. Since 1984,
the hospital has operated on 1000 cases of congenital heart diseases with
98% success rate. During my week on the heme/onc service, I was in the
team that took care of patients going through chemo, radiation or surgical
therapy for their cancer. There seems to be high frequency of AML among
the young farmers. The NICU/PICU was fairly new, poorly organized and
very crowded with poor air quality. Universal precautions were not observed.
However, the teachings done by the attendings were excellent. Three out
of four attendings that I worked with spoke fluent English and I was able
to learn Chinese Medical terms and started to write progress notes on
the patients that I was following. I had planned to conduct a survey on
the awareness of HIV/AIDS among the people that visit the ZhangZhou Municipal
Hospital. I had submitted a draft of my questionnaire to the hospital’s
committee but it failed to be approved. The issue of HIV/AIDS is a very
sensitive topic and the government officials have very reserved attitude
toward answering my questionnaire. I had an eye opening experience in
China during the one-month rotation in the ZhangZhou municipal hospital.
There are tremendous works in public health education needed to be done
and it will be a task with many obstacles.”(One-month elective in 2002
by Sihong)

Europe

Crete, Greece
“My first clinical experience
in Greece was in Pyrgos, a small city on the western coast of the Peloponnese.
At a small community hospital, I spent time assisting at the emergency
department. Local men and women from the main town and surrounding villages
were waiting to see a doctor. Attending physicians and residents covering
the ER were either from the departments of medicine or surgery. Everyone
was very friendly and happy to teach. They showed me the basic ways the
emergency room operates and gave me enough freedom to see patients on
my own, to make clinical recommendations and to perform minor procedures.
Together with three residents and one attending, I evaluated people who
came with a variety of problems, including lacerations, squirrel bites,
abdominal pain, kidney stones, and motor vehicle accidents. Limited resources
were available to perform diagnostic tests like CT scan and MRI so many
times patients requiring cranial imaging would simply get a skull Xray.”"After
spending ten days in Pyrgos I moved to our affiliated academic medical
center in Iraklion, Greece. This university hospital is actually much
larger than what I had expected. Almost every window looks out either
into the Aegean Sea, the soaring Cretan mountains, or rolling hills covered
with thousands of olive trees. I was impressed by the size and technological
capabilities of this hospital, which is similar to many large American
academic medical centers. Rounds are typically conducted in the late mornings
or early afternoons and residents present their patients with new data
accumulated during the day. Many of the faculty members were either educated
or trained in Europe or the United States and involved in both patient
care and research. In its 10-year history, this medical center has published
nearly 3,000 original articles in various international medical journals.
Although I grew up speaking Greek, medical rounds were sometimes “all
Greek to me”. Writing down almost every unknown word became a routine
habit, and spending some late afternoons with an old Greek-English dictionary
was a survival strategy. I helped admit patients in the emergency room
and follow interesting cases, including an AIDS patient with fever of
unknown origin and another patient with Creutzfeldt-Jakob disease.”(One-month
elective in 2002 by Alex)

London, England
The stated goal of the elective
[at St. George's Hospital] was to study British primary care by observing
general practitioners in rural, urban, and suburban settings and meeting
with a medical anthropologist to discuss cross?cultural issues. We spent
time with different GP’s. in the clinic and in home visits? We visited
an innovative out-of-hours collective for GP’s called Harmoni. The collective
handles patient problems after the clinics are closed. GP’s take turns
covering the service. One of our most interesting experiences was a day
spent with geriatricians on medical rounds at a local hospice. We also
spent a morning in the Accidents and Emergencies (the ER). I would recommend
this rotation to students who are interested in gaining a different perspective
on primary care delivery in the setting of universal access. This rotation
is not just for students going into Family Medicine or even primary care.
There is also, some room to tailor the elective to your interests. I think
that four weeks in London is necessary to do justice to the experience.(three-week
elective in 2002 by Katherine)

Madrid, Spain
Located in Moncloa (near
downtown Madrid), the Fundación Jiménez Diaz (FJD) is one of the major
private hospitals in the Spanish capital that serve both private and government
insured patients. Most of the patient population are middle class individuals
predominantly from Spain and South America. The technology and facilities
are relatively uptodate, and the hospital staff is very warm and polite.During
the first two weeks of my rotation I worked in an outpatient medical consult
service under the preceptorship of my liaison, Dr. José María Castrillo,
a well-known and respected General Internist in the Madrid area. Primary
care providers and surgical specialties would send their patients to Dr.
Castrillo both for consultation on diagnostic dilemmas as well as for
follow-up on their medical diagnoses and care. Under his guidance we would
jointly perform a history and physical exam, generate a differential diagnosis,
and order the appropriate labs and tests to help us guide our diagnosis
and treatment. During those two weeks, Dr. Castrillo was exemplary in
that he continuously treated patients with respect and compassion taking
the time, sometimes hours, to discuss with patients and families their
medical issues. Further, his knowledgebase, physical exam and diagnostic
skills were outstanding, as well as his efforts to teach me how to become
a better clinician both on a professional and personal level.The clinical
diseases that I saw and was able to diagnose were by no means less impressive.
Amongst the most memorable ones were severe classic hypothyroidism, pernicious
anemia, hereditary hemochromatosis, Factor V Leyden deficiency, ITP in
an adult, and essential thrombocytosis apart from the more common ailments
that are typically seen in an Internal Medicine practice. An interdisciplinary
conference (Medicine, Surgery and Pathology) took place every Tuesday
where interesting cases were brought for presentation and discussion.
These tended to be from an Infectious Diseases standpoint and included
Tuberculous pericarditis and HIV opportunistic infections.The third week
of my rotation was spent in a General Internal Medicine ward in a service
composed of two fourth year students, one Intern, a third year resident,
and an attending, Dr. Gomez. During this experience most of the admissions
were for pneumonia and CHF exacerbation, though we had a case of lung
cancer and a case of SLE flare in our service. Dr. Gomez and his team
were also wonderful teachers, enhancing my physical diagnosis skills.
My fourth week was spent in the Bone and Mineral Metabolism (1 day), Lipids
(1.5 days), and Infectious Diseases clinics (1 days). Of note, I saw several
cases of clinical osteoporosis in elderly males, hereditary hyperlipidemias,
and HIV outpatient follow-ups.Overall, during my stay at the FJD, several
differences with our American health system were noted. Pressures to see
patients in a given amount of time are more lax. In addition, patients
under government insurance sometimes have to wait months or even years
for elective procedures and/or surgeries (i.e. knee replacement). Ethically,
the doctor-patient relationship tends to be more paternalistic with the
physician´s assessment and treatment plan unquestioned by the patient.
The family is more actively involved in the patient´s medical management,
and in serious illness it is perfectly appropriate to discuss routine
care and end-of-life issues with the patient´s family (especially the
spouse) without the patient’s explicit consent or even presence during
the office visit.From a public health standpoint, Spain is less advanced
in hand washing practices and smoking. Though technically prohibited patients
and even doctors, smoke inside hospital grounds. Smoking is also rampant
particularly in teenagers though public awareness and changes are slowly
coming into being. Nevertheless, despite all these positive and negative
points, my experience at the FJD was worthwhile in its exposure to a different
culture and a different health system along with the tremendous amount
of teaching by superb and compassionate clinicians that took place.(Four-week
elective in 2004 by Miguel)

Paris, France
The best part of my four
weeks at Foch Hospital was getting to know the lives of a diverse group
of people, speaking their language and relearning internal medicine, with
all its complexity and intricacy, in a whole new tongue. And For someone
who will be specializing in a surgical discipline, the one last chance
to experience the ardor of internal medicine in its most extreme essence
was definitely worthwhile.I would encourage anyone who already is fluent
in French to do a rotation at any of the many hospitals in France.(One-month
elective in 2002 by Roy)

Oceania

New South Wales, Australia
Our geriatric elective was at located in the quiet, Royal North Shore
Hospital located in the beautiful suburb of St. Leonards, about 15 minutes
from downtown Sydney by train. Royal North Shore consists of a public
and private hospital, much like our HAC and ENC campuses. Geriatrics
is taught both in the public and private clinics, in addition to the
wards. If you are interested in hospital geriatric ward medicine, as
a student you will be admitting patients, caring for them, taking histories
and physicals, and rounding with the team which consists of an attending,
a “registrar” (resident), an intern, and a whole group of medical students.The
geriatrics department has many different clinics at North Shore Hospital.
We went to falls clinic, memory clinic, and osteoporosis clinic. Most
of the time, medical students in clinics are not expected to see patients
on their own. The department also offers students to go on home visits
and follow the patients in their social environment. The atmosphere
at the hospital is very relaxed and stress-free, as far as medical students
are concerned. The experience is what you make of it. Overall, I had
a fabulous time and recommend the rotation to anyone. It is a fantastic
way to learn about new cultures and to spend some time in a different
country, with some fantastic people.(One-month elective in 2002 by Sushma)

The Royal Prince Alfred Hospital (Sydney, Australia) is the main referral
center for neurological disorders in the state of New South Wales. The
role of a fourth-year visiting medical student is similar to (by not
identical to) being at BMC. As a visitor, one is allowed a wide breadth
of opportunity to learn through didactic and clinical/hands-on care
of patients on the ward. The entire department’s facilities are available
to the visiting student who may participate in the areas of his/her
interest: anything from clinics everyday (musculoskeletal diseases,
vertigo clinic, every type of neurological testing/procedure, degenerative
disorders, stroke clinic) to inpatient ward (stoke service vs. general
neurological diseases). Every type of neurological disorder was encountered,
including those that could not be explained. The resources of the Neurology
department are substantial, with excellent ancillary services and an
outstanding outpatient facility. Students are expected to work M-F,
no weekends, no call. However, patients are admitted daily and average
about 4-6/day, the census averages anywhere from 15-25 patients. The
team consists of the attending (known as “the consultant”), a senior
Registrar (aka fellow), a junior Registrar (AKA senior resident), a
resident (PGY2) and an intern. There are also 2-3 medical students on
the team but they are rarely on the wards, as they have didactic sessions
and other presentations/studying to do. The faculty, staff and residents
are all very friendly and easygoing; this seems to be the attitude of
everyone in Australia. A typical day for me was as follows: arrive at
8:00 a.m.; work rounds and round during the morning; clinic or admit
with the stroke service during the afternoon. Thursdays are big department
conference days from 1:00 – 4:30 p.m. which includes case presentations
by the Registrars in front of the faculty with patients present, and
radiology rounds. Neuro and Medicine Grand Rounds are on Friday. In
general you are given a lot of independence to pick and choose how much
inpatient vs. outpatient experience you want. Find some good Registrars
to work with and try to work yourself into their schedule. If you want
to see anything in particular (type of patient or type of test) all
you have to do is ask -everyone is very accommodating. The amount of
flexibility could be detrimental to a student’s experience if he/she
is not disciplined; otherwise, you will see and learn a lot. (One-month
elective in 2003 by Andrew)

Primary teaching affiliate
of BU School of Medicine