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On leaving

As the participants of the first global health pathway trip are getting ready to leave India to head back to Boston, I’m preparing to leave Boston for Liberia. I’ve really enjoyed reading about their experiences in Hyderabad, especially as I’m doing my usual last-minute final travel preparation.

During the residency application process, I remember exhaustively researching the global health components of various internal medicine training programs. Was there a formal global health track? Was there a large immigrant and refugee population in clinic? During an interview in New York, I asked about opportunities for global health electives. My interviewer stared at me for a moment. “But why would you want to leave?!? We have people from all over the world here!” The same statement could be made about BMC. In just the last two weeks on my ER rotation, we’ve had patients from El Salvador, the Dominican Republic, Haiti, Cape Verde, Vietnam, Albania, Bulgaria, Togo, Guinea, Somalia, Ethiopia, and-surprisingly-even Liberia.

So why am leaving BMC to spend six weeks in Monrovia? It’s true that my global health education at BMC has been truly outstanding so far, thanks to the diverse patient population, the opportunity to work in refugee primary care clinic, and the amazingly talented colleagues and faculty in my program who share my interest in global health. On any given day on the wards, our team’s differential can include pathology such as extra-pulmonary tuberculosis, disseminated strongyloides, or AIDS presenting with multiple opportunistic infections. But providing healthcare for a Liberian with TB in Boston is a different beast than providing healthcare for a Liberian with TB in Monrovia. Diagnostic and therapeutic tools, ward team structure, payment scheme, and of course the national healthcare structure are vastly different. How do clinicians make do with limited resources? How can the medical education system recover in Liberia’s post-conflict environment? What is the role of organizations (and individuals like me) who are inserted into the medical workforce for a short period of time to build educational capacity? What is the role of primary care and prevention-areas of special interest to me-in such a resource poor setting?

These are just some of the questions I hope to explore over the next six weeks at JFK Medical Center in Monrovia. The answer to the question that will determine my frequency of blogging-what is the availability of electricity and internet in Monrovia?-will probably become apparent in the next week.

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