Amy Forrestel 2017-11-08 23:45:25
I recently completed a four-week rotation in Botswana through the AAD’s Resident International Grant. I’ve had a long-standing interest in global health; however, this was my first time practicing clinical medicine abroad. Above everything, it was a humbling experience. Throughout the month, I saw hundreds of patients in clinic at Princess Marina Hospital, outreach clinics, and inpatient consults. The diversity of diseases and severity of pathology I saw in clinic were truly incredible. In one single day of clinic in my first week, I saw Sweets syndrome, pityriasis rotunda, Kaposi sarcoma, blastomycosis, exfoliative erythroderma, and plasma cell cheilitis. This was not an atypical day. As a PGY-4 resident in a combined medicine and dermatology program, I had grown comfortable in my own clinical surroundings. My knowledge and experience amounted to very little on the first day in Botswana, where everything was new — from the workflow, language, and diseases, to how to order tests and learning what medications were available. It was an intern year flashback. Patients walked in one after the other — old and young, sick and well. As follow up is often difficult or uncertain, decisions had to be deliberate, practical, and completed in real time with the patient in the room. Testing was limited exclusively to what would change management, and empiric treatment was a vital diagnostic tool. For me, finding the balance between what was therapeutically ideal and what was practical was often laced with uncertainty and second-guessing. Learning how to optimally manage patients requires longitudinal experience in the system, and I was reliant on so many people who had that experience, such as medical officers, nurses, and rotating medical students. While I was in Botswana, the first Albinism Awareness Day was held in Gaborone. Albinism carries a significant stigma in many parts of Africa. Albinos are often ostracized and are in danger of both violence in their community and health risks, including devastating skin cancer related to their condition. The event was envisioned by Tori Williams, MD, a dermatologist at Princess Marina Hospital, as a way to bring albinos together for education and social support, and provide large-scale medical interventions, including skin cancer screenings and distribution of sunscreen and hats. It was a large, coordinated effort with two albinism non-governmental organizations, health care providers, and community advocates. I worked in one of the exam tents for hours, helping to provide skin checks for hundreds of patients, many of whom had never seen a dermatologist before. It was a festive, loud, and happy day. Laughter, music, and the smell of cooking filtered through the tent walls, making it feel more like a carnival than a day in clinic. In the following weeks in the regular hospital clinics, I saw many of those patients return for biopsies and management of concerning lesions that were identified that day, most of them wearing their hats and smeared in thick, white sunscreen. The month made me a better clinician and expanded my views on the role of dermatology in the global context. I am grateful to the AAD for the opportunity, and strongly support the goal of local capacity building to care for patients and enable residents to learn and grow as physicians. Learn more about the Resident International Grant visit www.aad.org/members/volunteer/residentinternational-grant Correction! In our last edition of Aspire, we incorrectly listed the title for our AAD and Me author. The correct title is Sheena Nguyen, DO. We apologize for the error.
Published by American Academy Of Dermatology. View All Articles.