Good evening everyone! I hope that you are all having a wonderful day. As you may have gathered from my recent post A Letter to Myself, as a First Year Medical Student, I had the opportunity to travel internationally during my medical school training. On a bitterly cold January morning, we were spoken to by several faculty members arranging international pre-clinical electives. The last speaker, a distinguished family physician, discussed an opportunity she had been offering in India over the last several years. In all truthfulness, I knew very little about India; however, while the speaker was talking I felt my heart beat faster and my back straighten: I just knew I was going to India.
My trip to India would mark my first official exit from North America. I was buzzing with excitement and uncertainty. As my departure date grew closer, I tried to get ahold of any and all information that would help me begin to understand India and my role as a medical student there. I had limited understanding of the importance of responsible tourism and wanted, as much as possible, to be mindful of my biases and what impact my presence would have on those around me. I asked friends who had travelled to India and other parts of the world about their experiences, hoping that hearing their narratives would help me to avoid any intolerant comments or behaviours.
A month prior to leaving, our school offered us some didactic and group cultural sensitivity training. I was thrilled and signed up immediately. The meeting involved first-year students travelling to a myriad of places: Tanzania, Uganda, Australia, Ireland, Croatia, and of course – India. During the training, we were challenged to discuss our reasons for wanting to complete clinical activities abroad. Other students eagerly discussed their hopes to better the lives of impoverished, marginalized populations. I admired their zeal but struggled to understand their intentions. How could our travels represent anything but personal gain? We had recently finished our first year of medical school and I felt that I had learned a lot of things but still really know quite little. I thought back to our recent OSCE where I put the blood pressure cuff on my patient backwards and watched in horror as it inflated like some sad inflatable swimming aid. I came to the rapid conclusion that I could not expect that I would be helping any patients. Instead, I turned my focus towards figuring out my motives for this trip. Why did I want to go to India? Could I use this experience to benefit others as a practicing physician? How might my presence impact patient care? What does responsible tourism look like in real life and how could I practice it?
I will admit, I did not have a good answer to any of these questions prior to my departure. Boarding the plane, I felt sure that this trip would allow me to get outside of my “cultural comfort zone” and to gain a general sense of what kinds of challenges and barriers newcomers to Canada might experience. I recognized that my experience could never be the same as other individuals; however, I felt that there was a huge learning opportunity for being in an area where I could not read, write, or speak the predominant language and lacked any sort of cultural knowledge. My first goal became to use these experiences to deepen my cultural humility and to use this humility when providing care to immigrants, refugees, and non-English speakers back at home.
Some of my initial conceptions of responsible tourism began to take shape once I actually began my observership in several busy outpatient paediatric departments. I was absolutely floored by these experiences: the number of patients, the language difference, the amount of people present in the examination rooms, the heat and humidity…just to name a few. First and foremost, I felt extremely uncomfortable not being able to identify who I was and why I was present for the appointment. Understandably, I was the subject of many confused, suspicious looks from patients and family members. I felt like I was intruding in such an intimate space and desperately wished that I could ask permission to be present. I attempted to learn a few basic introductory phrases in Hindi; but after several botched attempts, I resigned myself to silence and naively hoped that my non-verbal behaviours would communicate trust and comfort.
I also struggled with how to adapt my learning process and goals to the clinical context and needs of the patients. Back in Canada, we are encouraged and expected to ask staff physicians questions about patients we have seen in clinic. In India, there were more patients waiting than I could have ever imagined. I was casually informed by a medical student that, for some patients, the journey to see a physician had been a perilous journey due to multiple road closures from heavy monsoon rains. I felt incredibly guilty asking questions knowing that taking time from my Indian preceptors to translate and answer might actually displace some needy child from having a full appointment. So I wrote my questions down and kept them with me when I had a few moments alone with a physician or resident. I had a much easier time falling asleep believing that I had not added to the already lengthy waiting times; however, I continued to think about how else my presence as a white foreigner may have distracted from the clinical process. Was this observership totally self-serving? How could I do better in the future?
Have you ever travelled abroad to complete any type of clinical work? What have your experiences been like? Where did you go and what did you learn? Do you have any advice for medical learners planning international electives?
Stay tuned for Part Two where I discuss my experience in Lucknow, a northern Indian city, where I facilitated a professional competencies workshop for first year medical students.