It was a wonderful three weeks in India, filled with tasty food, amazing people, and exposure to a different medical system. The readings, discussion and medical experiences gave me so much insight into a part of medicine that I had never explored before. It may seem obvious, but the biggest alteration to my thinking regarding global health is how multifaceted and complex the topic is. I spent time at a health clinic in Uganda during medical school, enjoy staying up to date on current events, and view myself as a thoughtful, conscientious person, but still found myself starting at square one when it came to thinking about and discussing global health. We discussed several topics that really emphasized the complexity of the subject to me, including patient values, medical incentives and doing a disservice to people by providing them with aid.
We watched a film called Poverty Inc. and one of the most interesting concepts presented was during the 2010 Haiti earthquake, the amount and type of aid that was provided to Haiti was actually detrimental to their economy and people. As a new comer to global health, it was interesting to see how by providing goods like rice for free, it made it impossible for Haitian rice farmers to compete and were thus out of work. The film also presented a similar problem with TOMS shoes, wherein local shoe makers were put out of work when TOMS donated one pair of shoes for every pair purchased. In retrospect, this concept seems obvious, but both of these examples highlight the importance of looking past what makes the donors feel good and providing people with what they actually need and what will make them sustainable in the long term. This was a really eye opening concept to me as I think most people care for others in need, but have neglected to see that by providing aid without assessing the potential consequences, can create havoc in the receiving country’s economy.
Similar to the example above, the notion of patient value is one that I found interesting and complex. During my time in Uganda in medical school, patients would come to the clinic, be seen by a provider and then be sent off with a prescription to fill at the on-campus pharmacy. At the time, providing medical care to that population made me feel accomplished and that I was part of something that was changing peoples’ lives. I’m not saying that we did not make a difference, but I am saying that I wish I had thought more about the patients’ values when we wrote the prescriptions. I should have asked myself if the patients were able to afford their prescriptions, if they were able to take the medication for its full duration, or if their families would have to suffer for the money channeled into the prescription instead of food or shelter. If I had asked myself these questions, I would have provided better long-term care for these patients.
In sum, I learned many things during my trip to India, but probably the most notable is just the complexity of global health.