Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The challenges of leaving a positive impact while practicing as a physician in another country

Farrell Tobolowsky, DO
Physician
September 26, 2017
Share
Tweet
Share

He was approximately 75 pounds and appeared to be wasting away. Although he was only 43 years old, he had end-stage AIDS. Even in this cachectic state, he continued to refuse to eat the hospital food because he didn’t like it. After speaking at length with him, he said that he only wanted porridge with meat or “fat cakes,” both of which we did not serve in the hospital. He was told that his family was allowed to bring food to him in the hospital, yet day after day, the family was nowhere in sight, so he continued to starve. As a physician, how could I help this chronically ill man with the tools of modern medicine in a foreign country?

For those of us, health care workers, who are involved in global health, it can be difficult to find your role when working in another country. Where do you insert yourself in a foreign medical system without causing more harm than good? If we only spend a short period of time, such as a month in a country, will there be someone with the same skill set to take our place when we leave? If we bring antibiotics and medications to a community, what happens when they run out? If we screen and diagnose medical problems, will there be enough resources to actually treat the patient? Are we leaving the community or hospital a better place than when we came?

All of these questions travel through my mind each time I work abroad. According to the WHO, by 2035, there will be a shortage of 12.9 million health care workers. So there’s no doubt that developing countries need more physicians and other health care workers. However, this dilemma cannot always be solved by training the personnel within the country. If you force individuals to pursue medicine as a career, will they be passionate about being a health care worker and have the necessary motivation to take care of patients? And, then, if foreign physicians are still required, we continue to face the same issues. While I am working in a country, I want to make an impact and meet the community’s needs while simultaneously being culturally competent, which can be difficult when only in the country for a short period of time.

I have worked in Mexico, Peru, India, and Botswana, both working within a hospital and in self-run clinics. In my most recent experience, I worked in an inpatient setting supervising trainees who obtained their medical training in various countries as well as helping to create curriculum for their intern year. The goal was to create a sustainable system that functioned equally well even after we, as providers, left the country. This would avoid the much-too-common problem of only providing short-term assistance as we aimed to leave a long-lasting impact. However, we learned that the skills we already possessed weren’t always applicable in another country.

That day, I felt truly helpless in treating my patient’s malnutrition. Even with all of the medications given to treat his opportunistic infections, he would not improve without proper nutrition. What the patient wanted was a “fat cake,” which is similar to a donut. While not healthy at all, it was better than the patient not eating anything at all. Day after day, I bought him a “fat cake” from a local vendor outside the hospital and watched with joy while he indulged each morning. Sometimes, we struggle with finding our role as physicians in an unfamiliar medical environment. I have had the opportunity to see how different health care systems work and how cultures define “health,” which can be dramatically different even in the same region. Some of the tools we’ve learned in our training can be applied, and some cannot. Not only is the epidemiology of disease different, but the workplace culture, resources, distribution of knowledge, and overall values of the community as well. We need to be adaptable and find where we can perform the greatest good while causing the least amount of harm for our patients as well as the local health care workers. For me, it is still an ongoing process.

Farrell Tobolowsky is an infectious disease fellow.

Image credit: Shutterstock.com

Prev

So much for repealing and replacing Obamacare. What's next?

September 26, 2017 Kevin 42
…
Next

Physicians and magicians are not as different as you think

September 27, 2017 Kevin 0
…

Tagged as: Infectious Disease, Public Health & Policy

Post navigation

< Previous Post
So much for repealing and replacing Obamacare. What's next?
Next Post >
Physicians and magicians are not as different as you think

ADVERTISEMENT

More by Farrell Tobolowsky, DO

  • The irony of the “sick” caring for the sick

    Farrell Tobolowsky, DO
  • The difficulty of maintaining relationships throughout medical training

    Farrell Tobolowsky, DO
  • My experience as a patient has made me a better physician. Here’s how.

    Farrell Tobolowsky, DO

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • The black physician’s burden

    Naomi Tweyo Nkinsi
  • Why this physician supports Medicare for all

    Thad Salmon, MD
  • Embrace the teamwork involved in becoming a physician

    Nathaniel Fleming

More in Physician

  • Why don’t women in medicine support each other?

    Jessie Mahoney, MD
  • IMGs are the future of U.S. primary care

    Adam Brandon Bondoc, MD
  • The high cost of gender inequity in medicine

    Kolleen Dougherty, MD
  • Women physicians: How can they survive and thrive in academic medicine?

    Elina Maymind, MD
  • How transplant recipients can pay it forward through organ donation

    Deepak Gupta, MD
  • A surgeon’s testimony, probation, and resignation from a professional society

    Stephen M. Cohen, MD, MBA
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician
    • Why doctors need emotional literacy training

      Vineet Vishwanath | Education
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician
    • Why doctors need emotional literacy training

      Vineet Vishwanath | Education
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...