Short term medical trips and specialty choice among trainees: a personal view

Research has demonstrated that short-term global health trips have the potential to influence specialty choices among medical trainees. In her a follow-up blog post with our organization, Dr. Christine Thorne describes how her personal experiences with short term medical trips as a medical student drove her to pursue a specialty in public health and preventive medicine.

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I wrote the other month how short-term international medical work had started me on my career in medicine.  Continued work overseas during medical school helped to shape the type of medicine I decided to practice.

As a second year medical student, I traveled to Durban, South Africa where I worked on a pediatric HIV research study.  As the only American present in the department, I struggled to understand the nature of HIV in South Africa, the barriers to testing, to prevention, to seeking and getting care.  As this was a decade ago, adequate long-term HIV treatment was only rarely available in Durban and HIV was taboo.  The administration at the time was claiming that HIV didn’t lead to AIDS and their health minister was promoting beetroot as a cure for AIDS.  It seemed to me that AIDS in that area was an insurmountable challenge.

Being a lone American in my department, possibly at the University, working on HIV was daunting.  Racial strife was rampant.  Daily e-mails warned us at the University to drive different routes to work daily so that we could not be subject to a planned robbery.  We were warned not to wear jewelry or leave our car windows down.  At the clinic, which I visited frequently, I was not once allowed to sit in on a patient visit because patients and even staff I had been introduced to didn’t trust me as an unknown Caucasian.  Radio reports were warning Africans that HIV medications were poisons sent by the western world to hurt them.  These same reports told pregnant women to avoid taking the medication that might keep their children from contracting HIV.

At the antenatal clinic, fully half of the women were testing positive for HIV. Many were never returning for their results.  Of those who did, only a three-dose course of medication was available to help prevent transmission of HIV during delivery.  Many did not choose to take the medicine.  HAART (highly active anti-retroviral therapy – the “cocktail” of medication most HIV positive people take in the western world) was not generally available, even to mothers who were nursing infants.  It was not recommended to provide infants with formula because of the risk of death from waterborne or diarrheal diseases.

As I looked at a row of positive HIV tests that someday I could come back and help these people when I had my degree.  Then I looked at the room full of benches with row upon row of gravid women sitting in them and I thought, no one physician could possibly see enough people to make a dent in this problem.

This was the first thought I had that led me towards my future specialty, Preventive Medicine.  I am currently in my last year of training, training that includes not only clinical medicine, but also training in public health and in research.  I know now that many of the issues I was facing in South Africa were not only issues of individual patients, but were pervasive cultural and public health issues that require broad scale intervention.  My short-term research work in South Africa started me on the trail to finding a specialty that would allow me to address issues in medicine both as personal as an individual illness and as broad as a social ill.  Had I not taken the time to travel and work in another country, I am not sure that I would have pursued the specialty I have chosen and I do not believe I would have the skills I am now developing that will allow me to work addressing international health in a fuller measure in the future.

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Dr. Christine Thorne is a resident physician in California.