From Uganda to Haiti, UB medical students to discuss caring for the underserved overseas

BUFFALO, N.Y. -- A diagnosis of acute appendicitis, based solely on clinical observation. A mother’s reluctance to undergo Caesarean section based on cultural beliefs about going through labor. An interest in birth control methods that don’t require a husband’s approval.

These are a few of the dramatic clinical experiences that University at Buffalo medical students will discuss on March 13 from 6 to 8 p.m. in Room 125 (Lippschutz Room) of the Biomedical Education Building on the South Campus.

The event, “Global Health Electives and Medical Relief Projects,” aims to promote volunteer medical opportunities available to UB medical students and to educate them about some of the situations they may encounter overseas.

“Interest in global health is definitely up at UB,” says David Holmes, MD, director of global health education and clinical associate professor of family medicine in the UB School of Medicine and Biomedical Sciences. He says that about a quarter of all UB medical students participate in an overseas medical program, up from the teens a few years ago.

At the March 13 event, four UB medical students will show slides and describe working at clinics in the Democratic Republic of Congo, Uganda, Lebanon and Peru. Two residents in UB’s family medicine program who recently staffed clinics in Haiti and Mexico also will make presentations.

In her first year at UB, Julie Garchow, now a fourth-year medical student, became co-president of UB’s International Health Interest Group, working with several like-minded classmates to help facilitate overseas rotations.

“We wanted to make it as easy as possible for medical students to do global rotations,” she says. Members also gather regularly to discuss issues in international health.

The value of these overseas rotations is hard to overstate, she explains. Last month, she returned from spending four weeks in rural Uganda.

Garchow and two UB classmates worked in a hospital’s maternity, pediatrics and adult internal medicine departments. Because of the lack of medical practitioners of all kinds, the medical students are called upon to play a more active role, under supervision, in an overseas clinic than they can in the U.S.

“In the U.S., a medical student wouldn’t get to do first assist on a C-section because that’s what the interns and residents will do,” Garchow says. “So when you’re a medical student you’re usually delivering the placenta, not the baby. But in Uganda, we were able to do first assist on C-sections. We had the opportunity to have more responsibility, all the time under supervision from a physician.”

The students also worked with many HIV patients with comorbidities, including malaria and typhoid. “You see diseases that you just don’t see here in the U.S.,” says Garchow. While working with HIV patients in Uganda, she developed a color-coded labeling system for HIV medications to enable patients with minimal literacy to know what to take when, even if they couldn’t read the instructions.

The experiences drive home how powerfully culture and personal experience can impact medicine. While working at a remote mountain clinic in Haiti, sponsored by Heart to Heart International, an international medical relief organization, UB family medicine resident Alisha Razack optimized an older woman’s hypertension medications and recommended some blood tests. The medications are provided for free by Heart to Heart. The woman’s adult son was so thankful he broke down and cried, sharing his story with her, how his father had died of cholera, and how he was trying to care for his mother.

Sometimes the cultural differences directly influence how receptive a patient is to medical care. “One woman needed an emergency caesarean delivery, but she didn’t want it,” Garchow recalls. “We thought she was just scared, but then we found out that in her culture, people believe that if you don’t push the baby out, you’re not a woman. In that culture, laboring is a badge of honor.”  With encouragement and support, the mother did undergo the procedure and delivered a healthy baby.

Students are expected to pay for their travel and accommodations, but student fundraising efforts at UB are helping to offset these costs. This year, a group of first-year medical students are raising funds to send a group to a clinic in Haiti; they were so successful in raising funds that they have money to spend on medications for the clinic as well. Another UB group of second-year students is going to Panama this spring to work with Floating Doctors, which provides free health care to isolated regions worldwide.

Holmes began leading overseas rotations with UB medical students in the late 1990s. Since then, he has led UB medical students on medical rotations in Haiti and the Dominican Republic; he has also done medical missionary work in Kenya, India and Costa Rica.  

“Dr. Holmes is our biggest cheerleader,” says Garchow. “When we wanted to start the International Health Interest Group, he and the Department of Family Medicine said, ‘Tell us what you need. We’ll help you.’ Karen Devlin, the department’s program coordinator, also has been extremely helpful and helps coordinate all the details.”

UB medical students interested in volunteering overseas and in the International Health Interest Group should contact Karen Devlin in the Department of Family Medicine at 829-2608, kadevlin@buffalo.edu or Holmes at 716-697-1884, dholmes@buffalo.edu.