On Our Radar Fall 2012

On Our Radar 

PA students recently returned from international rotations in India and South Africa.  These eye-opening experiences expand students' perspectives and provide them with the opportunity to practice what they are learning in challenging, under-resourced environments.  After studying at Pace, many PA students treat diverse patient populations from all over the world, and the lessons they learn abroad can be applied to their practice long after they graduate.

Jessi Oakes's international rotation focused on maternal and child health.  She spent most of her time in a city called Pune, nicknamed "the Oxford of the East" because of its large number of universities.

While in India, Jessi observed many differences, one of which is illustrated in the accompanying picture (Jessi is third from left in the photo)-- people in the operating room were not permitted to wear shoes, so they wore sterile flip flops.  Another difference she observed: in the U.S. patients' medical histories are detailed on charts that we expect our health care providers to keep for us; in India, the patients are responsible for keeping their own medical notes, so most start from scratch every time they go to the doctor.   In India, health workers are prohibited by law from disclosing the sex of the fetus, so it is a surprise for all mothers-to-be.  In addition, to help motivate women to have only two children, the first two deliveries are free of charge, but the patient must pay out of pocket for the third one.



In addition to working in Pune, Jessi also had the opportunity to complete rural rotations in a small village with limited healthcare facilities.  She worked in a clinic that treated patients with a variety of complaints from coughs and colds to snake bites, worm infections, pediatric visits, and one patient whose foot was stepped on by a buffalo!  At a vaccination clinic, Jessi saw mothers line up outside with their children, patiently waiting in relatively uncomfortable conditions for a potentially life-saving service that many parents take for granted in the U.S.

In her free time, Jessi and her peers (students from other universities) climbed mountains, planted trees, explored reservoirs and caves, rode camels, tried new foods, and learned to folk dance.

Nicholas Tarnowski, Tara Cole, Elizabeth Bailey, and Kelly Dahler completed their rotations in South Africa, where challenges included limited resources and rampant TB, a contagious lung disease that is spread through airborne bacteria.  They worked at Victoria Hospital, which took only complicated cases, providing them with ample learning opportunities in a short time.  They also worked in a clinic affiliated with the hospital.  

Some differences they observed to care in the United States: the country’s district healthcare system means residents can only be admitted to hospitals in their region, leading patients to lie about where they live to get better care; patients with contagious illnesses ranging from TB to meningitis were not isolated in separate hospital rooms; instead of health care providers having as many face masks as needed, the students were provided with one mask each that was supposed to be re-used over the four week rotation.  The clinic where they worked had very limited space and no privacy for patients.  Doctors often paid patients’ transportation costs out of their own pockets. 

The stark statistics about the patients they served include a life expectancy of just 53 years, an HIV prevalence of nearly 18 percent, a malnutrition prevalence of 23 percent and an infant mortality rate of 41 percent. 

The main lesson they learned was about adapting to the resources they did have. For example, when drawing blood, only one type of needle was available, so that was the type they used.  In addition, the hospital only had one ultrasound tech, and when she went on vacation, the healthcare providers had to rely on other diagnostic tools.

According to Elizabeth Bailey, “Practitioners used the limited number of resources they had so well, especially with their physical exam skills. We learned valuable lessons like the importance of taking a good, detailed history and not relying on lab results; when to order tests and when they weren't needed; and not wasting materials like needles, gauze, and tubes when doing procedures. We were also able to do procedures like lumbar punctures and chest tubes, which are not typically done by students in the U.S.”

Despite the challenges they faced, the students maintained a very high level of enthusiasm, working extra shifts on their time off. 

They also used their free time to attend a rugby match and explore some of Cape Town’s beautiful scenery.

From left to right: Elizabeth Bailey, Nicholas Tarnowski, Kelly Dahler, Tara Cole