1st year of med school and community work

Little background: I’m a 1st year medical student in Uruguay, a tiny country at the bottom of South America. My country has recently had a major change in its health care system, which, although was always free, it did not reach 100% of the population, and like the majority of healthcare systems in the world, it was not based in primary healthcare (PHC) or promoting health and preventing disease. (You can read more about PHC here: http://en.wikipedia.org/wiki/Primary_health_care)

When the healthcare system changed, the medical education also changed, to adapt to the new system. And let me tell you something—it is awesome! 

Throughout our clinical years, and since the very beginning, we are divided into groups of 28-30 students and given a poor, sometimes rural community to work with. It is our entire responsibility to go to the community, get to know the people there, the clinic doctor, the schools, understand the politics, the needs, and come up with a plan to improve it. 

First year of medical school is pretty boring. We are cramming our brains full of facts, when we really got here because we wanted to work with people. Help people. Well, with this program, going to the community once a week, gives us the opportunity to do just that. We learn how to see people as a whole, to discover all the things that influence their health, not just to see their disease. We start out by doing an epidemiological survey of the population – I confess that I had no idea what that meant. I’d heard the word “epidemiology” before, but if I’m honest, I had no real understanding of what it was. Now, not only do I know what it is, and why it is important, I am actually doing it myself.

They have a pizzeria!!

My community has a population of 2,852 people, only 2 paved roads, one tiny clinic open from 8am-6pm Monday through Friday, with one doctor and one nurse. You know what? They are **happy** to see us come. They want our help. They’re also happy to teach us. We get first-hand experience, and start helping people from day one. 

This is the CAIF- "Centro de Atención a la Infancia y a la Familia" -- help center for children and families.

They get excited students with lots of energy and the desire to change the world. We’ll do health education talks, sexual education talks, we’re planning an exercise program, we want to resurrect their football team (which died last year for lack of participation), we’ll go to the youth center and help the kids there, and to the primary schools and treat the kids for parasites (apparently an appalling percentage of the kids here suffer from intestinal parasites). We get to do stuff, impact a whole community and see the results of our work. And to me, that’s what this med school thing is all about.

Bikes and a sign for a junk yard

So here’s my advice to you, if you’re in medical school or pre-med and planning on going to med school: go to a rural community. Find a little town close to where you live, go to the clinic there and talk to the doctor. Ask him if you can help. Get involved and really put your heart into it. Not only can you make a real impact in that community, you’ll get a lot of experience, you’ll be a better doctor, a better human, and if all of that weren't enough, I’m pretty sure it’ll look great in your resume.

Learn before you do

I think the most frustrating part of med school for me is the fact that there's a lot of learning but not a lot of doing. Obviously, that makes sense. You can't throw the average 1st year medical student into the deep waters of a hospital and expect them to swim. Or not kill anyone. However, I'm not your average 1st year. And please, don't misunderstand me, I'm NOT saying I'm better than anyone. I just have more experience than most 1st years. I've worked in hospitals before (on a different capacity, but I've learned a lot). I have gone to Tchad.

I don't have a lot of the book-knowledge that you acquire in medical school (and which I'm acquiring now), but I have a lot of practical experience. I know how to put in an IV, the steps for an above-knee amputation, how to poke my index finger and find an inflamed prostate inside the belly of a 60-year-old man. Those are things your average 1st year does not know. They simply had no opportunity to learn it yet.

Most 1st years, and indeed, most doctors, haven't seen refugee camps in poor African countries. It's hard to wrap your mind around a population of 140,000 people suffering from everything under the sun (malaria, intestinal parasites, typhoid, high blood pressure, tuberculosis) and one doctor with barely any supplies, to try to help them.

I'm not making much sense in what I'm writing, sorry. What I want to say is that I miss Tchad. I miss doing things and seeing the improvement of people's lives. And I want to do so much more. There are more and more people forced to leave their homes, fleeing conflicts in several African countries, CAR, Burundi, Nigeria and becoming refugees. I feel useless and powerless.

But that just motivates me that much more, to be the best student and become the best doctor I can be, to bring the best help I can give. Learn before you do. I am learning now, but I cannot wait to go back and do.

A moment of truth...

So here we go... 

I think **one** of the reasons I didn't go to med school earlier, is because I was afraid I'd never get in. I'd never make it, so I might as well not try. 

When I was a freshman in college, I was the TA for my chemistry class, and I got a C in one of the lab write ups. The teacher, an old German dude, came to me when I was working in his office and said "you think you can get into med school with C's? You can't. You'll never make it." Folks, it was a lab write up. I did NOT get a C in that class, but the damage was already done. His words stuck with me to this day, 15 years later. 

I eventually changed my life and decided to pursue a career in something completely unrelated to medicine. It was not because of what that professor said, but I am *sure* I would not have given up so quickly, if I hadn't had his words echoing in my head and that horrible feeling that I just couldn't make the cut. 

So I graduated, got a job in Germany, (one of those real, grown up jobs) and started to settle into "grown up" life. Until I realized I wasn't happy. That my job did not make me happy. That I was not making the world a better place, and if I wasn't there, at my job, nobody would even notice. 

That realization came when I was 29 years old. Not an easy moment to face, even in the best circumstances... 

So I had a mini life-crises, questioned everything, and realized that the only consistent dream I had ever had, was to become a doctor. And thought it was insane. Crazy. No way could I do it now! 

Luckily, I have a couple of really good friends, who heard my rants, held me while I cried, and assured me that yes, I could do it. That if it was really what I wanted, not only *could* I do it, but I *should* do it! 

That brings us to today. Getting into med school is not easy, and it actually took me a little while from when I made the decision to this day. I am in my first year of medical school. Until today, I wasn't really sure I could make it. Today that has changed. I belong here. I am not only going to be a doctor, I'm going to be a great doctor. Dr. F (the chem teacher)'s words may have done a lot of damage, but they weere not true. I'm here. I made it. And I'm not nearly done! 

Watch out world! :) 

There's a song that fits perfectly with this post: "Let it be" by Superchick -- check it out! 

Three weeks in...

Sorry folks, there's a bit of an adaptation to be made at the beginning of anything, and Medical School definitely requires a bit of adapting. 

But here I am. I made it through the first three weeks, and I'm happy. So far, honestly, there's nothing really difficult, there's only a LOT of stuff. They throw everything at us, and a giant bibliography for every class, that we have to read, summarize, and post on the online forums for each class. That is also graded. Then we have homework. Then we have one exam a week, on Fridays, which are a compilation of everything we learned that week in all classes. 

We're learning a lot of concepts in public health, like equality in healthcare, the right to Health, the determinating factors of Health. And bioethics. Also, communication technics for how to conduct an interview (HPI). In a week we actually get to conduct our first interview with a member of the community (not a paid actor!) where we'll be working with health education, primary care, prevention, etc. They really do throw us straight into the deep end to see if we can swim. 

But I was expecting this. And I must say, I really like that we have a test at the end of each week, because it helps me to keep on top of things with somewhat manageable amounts of material, as opposed to having thousands of pages and concepts to go through at the end of the month. Hopefully I'm not forgetting things right after the test! (I'm not, actually!) 

So, that's what's going on this side of the world. How are you all doing? How was your beginning in Med School?

The First Day of Med School

I think I mention elsewhere on this blog, that I had a different life before. I have a degree, had a different career and studied and lived in several European countries, as well as in the US, Brazil, Argentina and currently in Uruguay. 

If you add all that up, you can probably figure out that I'm not in my early 20s, much less straight out of High School (here, like in a lot of other South American and European countries, you start med school straight out of high school, but it lasts 6-7 years. Your undergrad is included into the medical training). This means I am older than 100% of my class, by at least 10 years. 

In some ways, I think this is awesome, they're all panicky, never gone to college, have no life experience and some had never even seen "the big city" before. They're lost and overwhelmed by the newness of it all, being away from family for the first time, etc. 

I, on the other hand.... well.... You can read a little about me on the rest of this blog. Suffice to say I was not overwhelmed by anything related to starting Med School. 

However, when I was getting to that amphitheater, shuffling along with the crowd of youngsters, I had butterflies in my stomach. It was the introductory and welcome talk, so no big deal, right? Wrong. 

The big deal was that I was actually here. That the dream I've had for the last 30 years is finally coming true. That after all the struggles and sacrifices I had to make, I am finally a med student. 

And it is AWESOME. 

However, being older than everyone *including the teacher* might take a little getting used to... (She's more like a tutor for our Problem Based Learning days, but still!!) 

*edit-- just remembered that in my other life, I was actually working at a University and was younger than some of my students. I guess the tables are turned! 

The *actual* beginning

Hi everyone, I'm back, and I think a slight explanation might be in order, as to the question: "she calls herself a medical student but seems like she's in a different country every other day. How is that possible?"

Well, last year I left my beautiful life in Berlin, Germany, because I was assured, after asking everybody that had anything to do with it (the med school back home, the dean of admissions, etc., etc., etc.) that I could start med school in March 2014. 

So I packed my bags, arrived in Montevideo, Uruguay (that's where I'm from), rented an apartment and prepared to start school. 

After all of that, however, they managed to come up with a stupid bureaucratic reason to find fault with my paperwork, and to rectify that, unfortunately, took months. And they did not allow me to start without solving that first. 

I was very pissed off, almost got myself on a plane back to Germany, cried, consumed massive amounts of chocolate, and then calmed down. A bit. Enough to realize that this might be a blessing in disguise and that I could use this time to my advantage. 

This is when I contacted the doctor in Tchad and asked if he wanted a volunteer. And how I planned a trip for the last 6 months, possibly the last block of that much free time I'll ever have. 

However, now I'm back, and there's no paperwork crap this time. It's actually happening. I'm T-4 days from the very first day of Medical School, a day that, if I'm honest, I've been dreaming about for at least 24 years. Seriously. You can only imagine how excited I am. I think ecstatic would be a better word!!! 

Wish me luck!! 

Tchadian Flashback

I am back to Uruguay now. That's where I live, despite my 6 months of traveling last year. I had to find a new apartment, because obviously there was no way I was going to pay rent for 6 months without actually being here.

But I did. I found a great place and I'm super happy about it. Hopefully I'll be able to stay here until I can buy my own place.

Moving sometimes is complicated though, and this time had its ups and downs. Today was the first day I really felt like I lived here, and I went to the grocery store and bought all the things I needed to stock up the cupboards and the fridge. Then I thought I'd make myself a nice little dinner. And I remembered something...

Back in September, a friend of mine took me to a restaurant in Tchad, to eat chicken. That's all they had,  rotisserie chicken. Which you eat with your hands. And they give you a metal tray, like cafeteria tray, with a bit of bread, a bit of salad, and some spices. You're supposed to dip the chicken on the spices and eat it.

I had one bite, and I was hooked. It was fantastic!! Not the chicken, the spices! Well, both. I had to know what that was. I asked, but the guy who knew what it was wasn't there, so I came back a few days later and asked him. He told me it was a mixture of several things that he made himself.... I was a bit disappointed, I had hoped it was something I could just buy and take home. He said: "Wait here. I'll be back!"

I waited for maybe 15 minutes, until he came back with a ton of little packages full of different spices. He dropped them all on a table, then started picking up one by one,  smelling it, and telling me what it was, while I wrote it down.

Then he opened them and mixed a bit of this, a bit of that, all in front of me, showing me how to do it. And if all of that wasn't enough, at the end, he put the entire mixture into a little plastic bag and handed it to me.

 Incredible!!! And so nice! And delicious!

So today, when I thought about cooking, I remembered those spices, brought all the way from Tchad. And my food tasted like a little bit of Tchad.


I miss it....