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
131 Shares
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

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

  • The heart of a Desi doctor: Balancing emotions and resources in oncology

    Dr. Damane Zehra
  • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

    Montreh Tavakkoli, MD
  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Skydiving and surgery: How one doctor translates high-stress training to saving lives

    Alexandra Kharazi, MD
  • Don’t be caught off guard: Read your malpractice policy today

    Aaron Morgenstein, MD & Laura Fortner, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, 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

CME Spotlights

From MedPage Today

Latest News

  • How This Doctor Found Purpose After a Devastating Injury
  • House Lawmakers Squabble Over HHS Budget
  • Infant Formula Crisis Exposed FDA and Industry Failings, Lawmakers Say
  • Building Vaccine Trust Among the General Public
  • Is It Business as Usual for the Drug Industry?

Meeting Coverage

  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Children Do Well With Fewer Opiates After Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • 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...