See the world

Getting the most out of medical externshipsShannon Galvin, MDOctober 2013Top 10 Habits of Highly Successful Medical Trainees

"I arise in the morning torn between a desire to improve the world and a desire to enjoy the world. This makes it hard to plan the day.E B White

1. Dont dieThe major cause of death or serious disability for foreign travelers is

1. HIV2. Malaria3. Motor vehicle accidents4. Diarrhea5. Depression1. Dont dieThe major cause of death or serious disability for foreign travelers is

1. HIV2. Malaria3. Motor vehicle accidents4. Diarrhea5. Depression

Injury and illness abroadApprox 20-50% of persons report some illness-usually self limiting skin conditions or diarrheaAbout 5% are ill enough to seek medical careSerious injury and death44% from injury-MVA>>near drownings>assaultsAcute MI, angina 18%Other medical 17% GI bleed, respiratory distress, etcInfectious diseases 4%Galvin et al. Family Medicine 2012. Hargarten et al. A Medical J 1993. 1. Dont dieUse seat belts at all times (if possible)Avoid night drivingAvoid motos, backs of pickup trucksAvoid mixing alcohol with driving or water sportsOnly use certified diving instructorsUse common sense when boating

2. Dont get (too) sickImportant health hazards that may be encountered during travel include exposures to agents that cause1. Diarrhea2. Acute respiratory illness3. Malaria4. Tuberculosis5. STDs6. All of the above

2. Dont get (too) sickImportant health hazards that may be encountered during travel include exposures to agents that cause1. Diarrhea2. Acute respiratory illness3. Malaria4. Tuberculosis5. STDs6. All of the above

Pretravel preparationSix weeks before visit travel clinic to ensure needed vaccinations-may include typhoid, hepatitis A, polio boosterSome countries require yellow fever vaccination and card

Malaria prophylaxisDEET containing insect repellantsMalarone, doxycycline or other antimalarialAntibiotics for diarrheaSupply of all your own prescriptions and medical needsHand gel, first aid kitOccupational exposuresTuberculosisEnsure work in cross ventilated areaIf you bring N-95 masks bring enough to shareObtain follow up IGRA/PPD after 10weeks of return

NeedlesticksMake sure up to date on Hepatitis B vaccineIf source HIV status unknown or positive irrigate site well thenTruvada and Kaletra within 72 hours of exposure for 28 daysTopic covered in detail in the Infectious Disease lecture3. Be politeYou are easily identifiable as an AmericanYou are representing your country, your profession and your schoolYou are assumed to be rude, rich and entitled-because you are

Be polite and patient, customer service is an American conceptLearn the local greeting, use it, great everyone in the room every time you enter

4. Be streetwiseBeggingNothing to village kidsStreet children, handicapped people-food is better or small change

Touts-use good sense, be prepared when arriving at airports, train stations, bus terminalsDrinking-use local customs, women take special careDress conservatively-cover knees and shouldersBe safe, even if only out of courtesy for your hosts5. Be professionalTheir way is the right wayIf it seems different ask why things are done that waySame rules for any clinical rotation-be prompt, follow instructions, clarify if you dont understand what is expectedBe respectful of time of your preceptors-usually very busy cliniciansYour project/rotation is not nor should be the priority of the local staffTry to get a copy of relevant national or WHO guidelines prior to travel

6. Be responsibleYou should be precepted-you are there to learn-speak up if you do not feel comfortableDo not do any thing you have no business doing- surgeries, etcNo pictures of patientsWait 24 hours and reread before posting anything to your Facebook, Twitter etc accounts. Then think-what if my hosts could read this?7. Be compassionateFirst do no harmBe honest with patients-do not promise things you cant provideStandards of patient care may not be ideal-try to identify what local standards would beYou may only be able to listen, that can be very important8. ImproviseWork around resource limitationsRenal failure-can you exam urine sedimentNo echo, xray-physical examination

Follow local guidelines as best as possible-then do your best

18Chief (front row 2nd from left) and Health Center Village Advisory Committee

9. Be an ethical researcher

Every research must be approved by Northwestern and local IRBLocal IRB review can take months in some countriesConsents and questionnaires need to be in local language-English->local language->back translationBe prepared for implementation obstaclesResearch cannot deviate from the approved protocol, but you may be able to improvise in areas where specifics were not spelled outRespect for Persons, Beneficence, Justice10. Have funDelight in the differencesSpend time with your hostsIt will be normal to feel stressed or sad or angry, let us know if these feelings are overwhelming or intrusive