Family Medicine Moments
During Covid and the racial injustice protests, our grand rounds have continued covering other topics. Perhaps some days we need a moment to focus on something else for better or worse. So this week our reflection will stray as well - to global health. Dr. Laura Kaufman Minardi, an R4 Family Medicine Resident at the Greater Lawrence Family Health Center shares her experience in Ghana. On the cusp of graduation, she speaks to working with limited resources, offering compassion, and solid mentorship. These lessons can help tackle any issue.
You can respond with comment to Laura at email@example.com or to the listserv directly. Be safe and be well.
A Reflection on Ghana
“How long has he been unable to walk?” I asked the son of the patient seated in front of me, grateful that he spoke a bit of English. We sat in the corner of a hot clinic room of the rural hospital in Nalerigu, Northern Ghana, the place these two men had traveled over an hour to reach. I watched the frail man before me, appearing much older than his actual age, unable to understand a word I was saying but staring at me hopefully, with trust that the foreign doctor was going to finally help him.
He had no medical history of diagnoses but mentioned trouble breathing for years, and at some point had become too weak to walk. I was only two days into my medical mission trip to Ghana and suddenly became nervous that I would never figure out this man’s story without the familiar first-world tools that have defined my medical training. I’ve grown used to planning a patient’s treatment before I even see them, with their blood work, CT scan results, and previous records at my fingertips with a few (okay, several) mouse-clicks. Now, a possibly very ill man and his son were counting on me to simply know what to do.
As I began to examine him, I realized he had hardly any air movement throughout his lungs. I pulled out my portable pulse oximeter – a last minute Amazon purchase before my trip – and stuck it on his finger. His oxygen saturation was in the 70s! How was he sitting here calmly talking to me? And what would I do without an ICU?! I grabbed my attending from behind a sparse curtain (that was doing its best to shield the melon-sized hernia of the young man he was examining) and we agreed to hospitalize my patient and see if someone could find a working oxygen machine while I thought about what on earth we could do for him in this setting.
We turned to our other obligations for the morning. After starting the day with rounds on the crowded pediatrics ward – seeing children mostly for either malnutrition-related illnesses, dehydration from gastroenteritis, or unexplained fevers that we often treated as typhoid - we rushed to clinic. Our short journey took us past the scores of patients sitting and sleeping in the open-air hallways outside our exam rooms, waiting for their turn to be seen sometime before nightfall. This meant a flurry of surgical consults, wound checks, follow-ups from hospitalizations with minimal records, and vague symptoms that may or may not be serious. This is where I met my frail friend and his son, who were shuffled away by a nurse while I turned to my next patient – a woman who had the bad luck of only bearing two children, hoping for an infertility treatment.
We returned to the volunteer house for a home-cooked stew lunch, where we checked in with my husband who was spending his days tinkering on projects with the maintenance team such as fixing their autoclave. (I’m convinced he did more for the health of Nalerigu than us doctors during those weeks.) After a quick rest and refilling of our water bottles with ice water, we returned on foot up the red dirt road back to the hospital. We found my patient on the male ward and brought him to the room with the hospital’s “good” ultrasound machine. With the sole x-ray machine broken for the past year, and higher-level testing not even thinkable, ultrasound had become our best friend. First we gave him a thorough exam from head to toe, looking for signs of illness like tuberculosis that may explain his frailty. Then we scanned his lungs but found no clues. His heart, though, showed evidence of right-sided strain that you might see in someone with severe lung disease. It was a pretty scarce workup compared to what one might receive back home, but we decided to try treating him for COPD with high-dose steroids and whatever nebulizers we could find.
For the next few days, in between helping out with surgeries, seeing dozens more clinic patients, and trying to learn a few words of the local language, I periodically checked on my friend. He and his son were so thrilled with the medications and the oxygen machine! He was still very weak, but for the first time in a while he felt a bit brighter. While many of the patients I met in Ghana spoke to me stoically or with quiet deference, these men were quite animated. I felt a bit responsible for them – so I quickly became dejected as it became clear that the real treatment he needed would be long-term home oxygen, an impossible order in our setting.
During my three weeks in Ghana I developed a deep respect for the missionaries and local doctors who do this work every day. I felt grateful to experience a totally foreign culture and serve people with the greatest need. But I also saw that despite our best efforts, medicine has unfair limits - whether you’re in a community hospital outside of Boston wishing for an MRI sooner, or in a hot corner of Ghana wondering why a baby has a fever.
About a week into our trip, I overheard that someone had a box of donated albuterol inhalers for the pharmacy. I quickly asked if I could grab one, then slipped it into my bag. That afternoon I brought it to my patient with the unnamed chronic lung disease and told him to use it at home when he eventually left. I did not tell him that back in the U.S. this inhaler would be simply the first step of a whole buffet of treatments we’d try. But I did tell him I was not sure he would ever get completely better. To my awe, he and his son were not surprised or disappointed at this information. They were just beyond grateful to have this gift of a shiny red inhaler that might bring some relief, even if very temporary.
In any area of service to others, we will always meet barriers that we cannot surmount. We did not transform the lives of the people of Nalerigu, as much as we’d like to change the world. But through compassion and a little creative effort from everyone, we can make a difference. As I am nearing the end of my residency, I remain most grateful to the mentors who have shown me this path, especially the one who guided us through Ghana. They work tirelessly to serve others despite daily limitations, seeking to bring a small breath of fresh air to people in need wherever they can be found.
If you have enjoyed the TMM, we want direct your attention to a new UMMS medical humanities offering:
Murmurs: Stories from our Journey in Medicine is a narrative medicine podcast that explores how health providers and trainees think about their experiences in medicine, from how they relate to their patients to what makes medical professionals tick. Each episode features a member of the UMass Medical School community to discuss a poem or essay they have written about an impactful moment in their medical education or career and takes the listener through the inspiration, writing process and interview with the author. This storytelling podcast is the Capstone project of Divya Bhatia ('21) and Qiuwei Yang ('22), with Dr. Hugh Silk advising.
Podcasts will be released weekly and are available to subscribe now on Apple iTunes Podcasts, Spotify, Anchor, and other streaming platforms! Through these podcasts, we hope to build community, promote reflection and increase awareness of issues of medical education and health inequality. Reach us at firstname.lastname@example.org or through our Anchor homepage: https://anchor.fm/murmurs-podcast
This narrative medicine podcast explores how health providers and trainees think about their experiences in medicine. Not about how they make diagnoses, but how they relate to their patients and what makes them tick. Each episode interviews someone from UMass Medical School who has written a poem or essay to learn about them and their reflection. We hope this podcast inspires others to become more reflective practitioners as well. Reach us at email@example.com.
Family Medicine Moments (formerly Thursday Morning Memo) is a forum for students, residents, and faculty to reflect on meaningful moments in their care of patients, teaching or in life in the form of a story, essay, narrative, poem, haiku, 55-word story or photo. The list-serve is based within the Family Medicine & Community Health Department at UMass Medical School. Please note that all submissions, original stories or responses, must be free of HIPPA identifiers to preserve confidentiality.
If you wish to submit an item to the Family Medicine Moments, please email it to Hugh Silk. Please write the FMM as a short essay, reflection, poem or story about your clinical/teaching success (keep it to one page). Please de-identify the patient or learner. Ideally, please ask the patient or learner if it is OK to write about them.