Child Family Health International
Taken by Shannon Brennan
An elective period in the developing world has been a rite of passage for many western medical students for decades. But there is growing recognition of the ethical dilemmas associated with these experiences - in particular the extent to which visiting students act as a drain on scarce resources for clinical training and supervision. Christine Henneberg spent an elective period with Child Family Health International, a San Francisco-based organisation which aims to challenge and inspire health professional students while making a positive contribution to host communities.
March 2006: We have arrived in Dehradun by train from Delhi, snaking our way to this bustling small city through the foothills of the Indian Himalaya. As students in the Traditional Medicine program, our days are scheduled and full. In the mornings, we spend several hours in a small homeopathic clinic, where a local doctor treats middle-aged and elderly patients for mostly chronic conditions. In the afternoons, we split our time between a modern “nursing home” (a private obstetrician’s hospital) and lectures in the home of a distinguished reiki master, who reads to us from ancient-looking texts and demonstrates healing techniques at his dining room table. We also spend a week in Rishikesh and another week in the rural site of Than Gaon, assisting in CFHI’s rural clinic and hiking to remote villages for health visits.
Even with all the adventures of daily life in India, there is something protective and reassuring about sharing the experience with a small group of other international students. When the sharp edge of cultural alienation slices one of us, we have each other to turn to - for commiseration, shared exultation, or simply the discreet raise of an eyebrow. There is a fellowship amongst our group of five young women: all at different stages of our education, pursuing another angle on the medical field for diverse reasons, we share a common urge to unwind what seems bound up, to dip below the surface and emerge with our heads wet and eyelashes dripping. There is a promise of clarity amidst the muddled confusion of this foreign place.
Fourteen months later, I return to India as an alumni fellow to work with CFHI’s Infectious Disease program. New students arrive, and I am their mentor and liaison, providing answers and directions when I can, or turning their questions back to them - which is often more beneficial. I also assist with daily logistics and communication, and help incorporate feedback from students and medical partners into the program. In this role my time is less structured than when I was a program participant; my days are irregular; my work is self-directed. While I spend little time in the hospitals and clinics, I spend lots of time talking to students about the million things they see each day-a newborn baby wrapped in a dirty sari and weighed on a produce scale; a college student stricken with leprosy; an entire family infected with tuberculosis.
One thing CFHI emphasizes in its global health electives is that, while their programs are meant to be educational-for the benefit of the students-they are not intended to work at the expense of the host communities. This means that every physician preceptor is reimbursed for his or her time spent with CFHI students. Students are asked not to go into clinics or hospitals that don’t have formal partnerships with CFHI, where they might inadvertently burden the staff and patients. And to every country where CFHI sends its students, they send with them boxes of donated medical supplies to support under-resourced clinics in that community. A key component of the alumni fellowship is to see that the “Recover” component of CFHI’s clinical partnerships is being realized on the ground-that the donated supplies are making it to the clinics where they are most needed.
My work often takes me alone into the streets of Bombay as I rush to meet students at a clinical site, head across town for a briefing with our medical director, or simply take some time to myself after a long day of people-oriented work. One afternoon while stopped at a traffic signal on my way home, a small cohort of young boys flocks to my rickshaw, waving shabby flower bouquets in my face. They wear tattered shorts and dirty t-shirts, and I see the signs of undernourishment on their faces that we’ve been taught to recognize: dry flaking skin, thinned hair. They call out in broken English: “Ma’am, one flower! One hundred rupees one flower, ma’am!” The rickshaw driver turns a fraction of the way around from his front seat, half-interestedly watching my response. I smile at the boys and shoo them gently away: “Nahi chahiye, Jaao! I don’t want any. Go on!” Traffic begins to move again, and the driver revs his engine. “Ma’am, one flower le lo! Go on, take one!” Their cries grow more desperate as we begin to roll forward, “Ma’am, one flower!” … Picking up speed now…. “One flower ma’am! Goodbye ma’am! Happy New Year Happy Christmas!” In this moment, stretched out and distorted like a piece of gum under my foot, the voices fading behind me make me want to cry.
There’s a strange difference, in a foreign place, between being alone and being with others. Things that in the safety of company and likeness would seem almost comical are suddenly wretched and frightening. I think I see a hint of a smile on the driver’s face in the rearview mirror; but, like my mood, it is tinged with tragedy.
I have seen through working with CFHI that I will be part of a community of colleagues devoted to the same mission of bringing quality healthcare to the world’s poor. But being a doctor for the underserved will often be lonely work. Of this I have become quite certain. To work in a community where my presence makes a difference, where I am not simply filling a space that would otherwise be filled by another, will mean to go where other doctors do not wish to go. It will mean to face poverty and sickness without the buffer of another body, rich and healthy like mine, beside me. But it will also be social, busy, dynamic work-because to exchange skills and ideas between different cultures is to constantly re-define social contracts, evaluate the meaning behind truths that had always seemed self-evident, and to reel under the force of otherness that is so raw and assaulting when we first encounter it. Eventually, this exchange becomes a force in itself, one we can use to promote the goals of global health equity and increase health choices for poor people.
As students, taking part in this exchange can be one of our greatest opportunities to contribute-until the near future becomes the present, when the health of the all the world’s people is in our hands.
Christine Henneberg
Institute of International Education
San Francisco
christine.margaret@gmail.com