Reflections – Medicine in a low income country

The burden of disease in the city of La Paz has overwhelmed me this week. At times I have felt almost swallowed by the immense need and health inequity of this community. I have been reflecting on the book “Reimagining Global Health” by Paul Farmer, Jim Yong Kim, Arthur Kleinman and Matthew Basilico and wanted to share a short exempt from it’s introduction which utilizes a biosocial approach to Global Health. IMG_1411

“Five of the leading causes of death in low-income countries – diarrheal diseases, HIV/AIDS, tuberculosis, neonatal infections, and malaria— are treatable infectious illnesses that are not found on the leading list of killers in high-income countries. Tuberculosis, malaria, and cholera continue to claim millions of lives each year because effective therapeutics and preventatives remain unavailable in most of the developing world. Although effective therapy for HIV has existed since 1996, and treatment now costs less than $100 per year in the developing world, AIDS is still the leading infectious killer of young adults in most low-income countries. In fact, 72 percent of AIDS-related deaths occur in a single region, sub-Saharan Africa, which is also the world’s poorest. Diarrheal diseases are often treatable by simple rehydration interventions that cost pennies, yet diarrheal diseases rank third among killers in low-income countries.”

This point drives home the incredible divide that exists between health in low income countries and high incomes countries and it delves into the many layers of the reasons for this inequity.

Yet, the fact still remains that this inequality exists and we are faced with it as health care providers. And what do we do with it? Throughout these past two years living and working with the underserved community of Chicago at times I have felt deeply overwhelmed and subsequently uninspired that any kind of contribution could shift the scales. My experience in Bolivia hasn’t been devoid of inspiration but it has been a similar struggle to recognize what my role as a medical student could be or should be amidst such extreme adversity.

On Wednesday night, I had the pleasure of meeting with Moira Rodgers, CFHI’s new director for the Latin and South American Programs and it was during this meeting that something broke free within me. We were discussing life and medicine in Bolivia and I shared with her my feelings of paralyzed heartache at the immensity of need and she so nonchalantly said “So you will sing, porque no (why not)? I had no idea how powerless I had felt until this moment. Her openness, vulnerability and authenticity was the fuel I needed to remember the origins of my motivation to study medicine and to serve people.

Before embarking on this trip I had very high expectations for myself. And most of those expectations, to become an expert Spanish speaker, to have a profound understanding of healthcare in Bolivia and to have incredible emotional growth have fallen way below what I had hoped. And yet, isn’t that ok? I am finding that living into who we are in the moment is a much more fulfilling perspective to have. Maybe I didn’t master Spanish the way I had hoped or experienced enlightened epiphanies that fulfilled my expectations but my experiences were real and I have grown. How can anyone know what seeds are planted and how they will grow and shape our lives in the future?

I have seen extreme pain and poverty in this place. I have had days where I didn’t know what to do with what I saw but I have also had days where the beauty has overcome it and I have found peace in just being where I am. Within the present moment, devoid of judgement for yourself and others is truly where I believe the most fulfilling life exists and where we learn and grow most. That is also where inspiration exists to see the light and keep pushing through the overwhelming need that exists in the underserved (which is the majority) of our world.



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