"Global health connects us to people of diverse perspectives and colors, and upon reflection, to ourselves and the lived experience...We are invigorated by the fortune of understanding others through their histories, strengths, weaknesses, fears, and failures. We learn about ourselves by reciprocating that vulnerability, by being exposed openly. In that openness we discover weaknesses, impurities, prejudices, and deficiencies in our own substance."

- Majid Sadigh, M.D.,
Director, the Global Health Program at Western Connecticut Health Network, now a part of Nuvance Health,
and
the UVM Larner College of Medicine

Established in 2012, the Global Health Program at Western Connecticut Health Network, now a part of Nuvance Health, and the University of Vermont Larner College of Medicine provides multiple opportunities for students, residents, and staff of both institutions to participate in global health experiences both at home and abroad. For nearly eight years, the program has hosted trainings for international partners, conducted impactful community health and development research projects, hosted renowned lecturers, and created a global health curriculum with an optional global health elective for medical students at the College.

Through the program, first and fourth-year medical students at the College have the opportunity to participate in a global health elective. In addition to a 6-week clinical rotation at one of the program’s partner hospitals in Russia, Uganda, Vietnam, Dominican Republic, Thailand, and Zimbabwe, students also attend language seminars and historical presentations, participate in optional research projects, go on field trips to notable landmarks, and, in some locations, live with host families associated with the hospitals.

The experience not only broadens their clinical medical training, it’s also a time for self-reflection and growth. First year medical students document their experiences, thoughts, and emotions over the course of the 6-week in-country rotation through reflections that take shape in poems, short stories, diary entries, and essays. They write about patients who became teachers, chance encounters, and perceived highlights and pitfalls of healthcare systems around the world. Some of the students unpack their thoughts in an almost schedule-like recounting of each day. Others write as third person narrators of scenes that range from inspiring to tragic. Many of their reflections are deeply personal — explorations into their own substance and the lessons they learn about themselves through their reflections in the eyes of others.

This summer, 12 students traveled to Uganda, Dominican Republic, and Thailand. Here are some of their stories.

UVM Larner College of Medicine Class of 2022s Kathleen OHara and Elena Martel sit with two pediatric patients Uganda summer 2019

A Positive Aura

Jose Calderon, Class of 2022 | Hospital PAP, Paraíso, Dominican Republic

Class of 2022's Jose Calderon with patient in the Dominican Republic

Even if I had the option of a warm shower, I wouldn’t do it.

Cold showers are best given the climate here in the Dominican Republic. It’s a lovely home where we’re staying, and the best part is the host family and how welcome they make us feel. This past Sunday we attended Zoe’s (my host families’ granddaughter) fourth birthday party. It was a Beauty and the Beast theme and it was lovely. It reminded me of all the Spanish birthday parties that I’ve been to and I was glad I got to sing along as they wished her a happy birthday.

My main experience with the local people has been through medical home visits, which we perform mainly for the elderly and those who physically cannot make it to the community clinic. I’ve met with Clara, an 87-year-old patient who suffers from malnutrition. Yet despite her fragile body and apparent weakness, she does everything on her own. She cooks, cleans, and takes care of all household responsibilities with a smile on her face.

I’ve also met Miguela, an 85-year-old patient with what appeared to be woody edema on her legs. She has suffered occasional depressive episodes, and her struggle to walk around the house has led to many falls. Despite it all, she received us with a bright smile as soon as we walked in the house. There was this positive aura about her that made me feel an instant connection with her. Maybe she reminded me of my own grandma, who despite her own personal medical issues is a constant source of positive energy for the entire family.

I also reflect on another patient with diagnosed sensorimotor polyneuropathy and sickle cell disease…

Read the remainder of Calderon’s reflection on the Global Health Diaries blog.

Read Calderon’s reflection “This Week I Met Anthony” on the Global Health Diaries blog.

The Gate

Isaac de La Bruere, Class of 2022 | Walailak University, Thai Buri, Thailand

This poem came to me after our visit to the Phud Hong Leprosy Community near our town in Thailand.

It was an incredibly powerful experience to see how its members have adapted to life within their community. All the residents are elderly, as there have been very few new cases of leprosy in the region in the last couple of decades. Many members have been there for the past forty years, sharing with us stories about how they were isolated and cast out from their families and communities when they were first diagnosed. It is a disease with a terrible stigma, especially back in the 1960s and 1970s when many of the people we spoke with first contracted it.

For many years, members of the Phud Hong community were not allowed to interact freely with the surrounding town, and very few people came to visit them. Today, however, modern medication has eradicated the bacteria from their bodies and made them non-contagious, allowing them to come and go as they please. Many, however, have found that they still prefer life within their community compared to the outside world. I wrote this poem from the imagined perspective of an older member in the late 1990s or early 2000s when the community was still gated, and based on some of the testimony we heard during our visit.

In Thailand, the family unit comprises an extremely strong bond. Having that broken, as some members described to us, and being disowned by the very people that are supposed to love and support you unconditionally is something that really hit home for me. I first imagined rage and fury as the predominant emotions. But many members spoke of feeling an indescribable sadness rather than anger. Here, I’ve imagined what someone who has gone through this thinks about when they are alone with their thoughts at night, and the emotional rigidity of daytime gives way to the melancholy cover of darkness.

I am 63 years old
If you asked me, I would say that I am happy
I have friends
A new family
A gate.

I pick mangoes with my neighbors
And we help each other cook meals
We play cards
And gamble with rambutans
Behind the gate.

We yell at the futbol players on the old tv during matches at lunch
And sit together as the sun turns the treetops to gold
I help some of the older residents walk home in the dark
And say good night when it gets late

Sometimes
Before sleep claims me
I remember my mother
And how she looked at the floor when my father told me I had to leave
I was 18
When I became a leper
And first saw the gate.

During the day I miss my fingers
And try to recall the ease of twisting a door knob
But at night I remember her
And try to recall the feeling
Of my mother’s arms around me
On the other side of the gate.

We Are In This Together

Irene Sue, Class of 2022 | St. Stephen's Hospital, Kampala, Uganda

UVM Larner College of Medicine Class of 2022 medical student Irene Sue with patient during summer 2019 global health elective trip to uganda

She lies there in a corner of a ward reserved for adult female patients, clad in a beautiful red embroidered cloth, the fabric rising and falling, following the uneven rhythm of her labored breathing.

Her concerned daughter looms closely nearby, next to the oxygen tank which has not seemed to help, anxiously awaiting Dr. Lenard Okello’s instructions as he begins presenting the patient.

St. Stephen’s Eddwaliro boasts of services including surgery (theater), general medical, dental, laboratory, radiology, maternity health, and family planning. There are two wards which, segregated by gender, contain beds partitioned by thick, heavy, purple and white curtains embroidered with “SSMH.” There are also four private rooms tucked deep within the compound. An x-ray and an ultrasound machine man the radiology department. Phlebotomy and laboratory abut each other, parted by a thin wall, the former occupied by a lone chair and centrifuge machine flimsily situated on the floor, and the latter a narrow, cramped working surface on which stands a light microscope and an outdated-looking machine apparently designed to analyze blood samples. The results are transmitted to an adjacent printer that resembles a slight step-up from conventional typewriters. These rooms, including the theater, are ventilated by one or two windows which are never closed to the outside world, buzzing with flies, fruit flies, dragonflies, mosquitoes, and various other aflight creatures about which I am somewhat afraid to learn.

Yet sometimes learning is not a choice, but an inevitability. I have learned that Ugandans speak rather softly, especially the women, as they are expected. Autonomy is not prioritized as a fundamental ethical pillar, as we have been taught in texts and classrooms. Within a consult room, patients are uninvolved with the decision-making. In fact, they are often silent, delegating the clinical reasoning and entrusting their healthcare decisions entirely in the hands of the clinician across from whom they are sitting. Privacy is not the cardinal rule; rooms are often entered into and left without minding the metal doors which clang so very often and so very loudly, obscuring any conversation my colleagues and I are straining to hear.

The hours stalk, instead of sprint. Rounding through the wards seems to move slowly and lightly. Conversations are carried out in hushed tones and without much eye contact, though a reassuring smile and/or some physical touch are sometimes dispensed by the clinician.

As I stand with Amelia and Andrew by the patient mentioned above, I begin to wonder at Dr. Okello’s furrowed brows…

Read the remainder of Sue’s reflection on the Global Health Diaries blog.

Week Two at Walailak University

Collin Montgomery, Class of 2022 | Walailak University Hospital, Thai Buri, Thailand

Week two really saw us begin to get down to business with Walailak University.

On Monday, we toured the university campus and enjoyed a welcoming reception with the Office of International Relations, where we had the opportunity to meet a group of French medical students, which was really nice. On Tuesday, we took part in a Problem-Based Learning exercise with Walailak medical students, which served as a fantastic review of hypersensitivity reactions and contact dermatitis! Wednesday entailed an experience in an outpatient clinic with a family medicine physician. I was blown away by the speed with which the doctors here have to work – we saw more than fifteen patients in about two hours and fifteen minutes. On Thursday, we went to the community hospital in Tha Sala and shadowed in the Tuberculosis Clinic. Finally, I spent Friday in psychiatry to observe electroconvulsive therapy, nephrology rounds to learn about dialysis, and then pediatrics where I had an absolutely amazing time seeing many patients with dengue and shadowing in the Neonatal Intensive Care Unit.

Meanwhile, Thai hospitality continues to impress me. Everyone we have interfaced with – students, nurses, doctors, administrators, restaurant owners, etc – seems to have a genuine interest in ensuring that we have an educational, enjoyable, and fruitful experience in Thailand. They all have a tremendous amount of pride in their community and serious goals about what they want for the future of Walailak University. Almost every night, students have offered to take us to the market and out to dinner, and help us plan out weekend trips, all with the utmost sincerity. One could be forgiven for thinking that maybe they are just pulling out all the stops because we are the first group from UVM and they want to ensure that the program can continue for years to come; however, the interactions do not feel forced. We get along with the students and faculty incredibly well, and it just feels like going to dinner and the market with old friends.

Two other things from this week have made a significant impression on me…

Read the remainder of Montgomery’s reflection on the Global Health Diaries blog.

Collin Montgomery Class of 2022 at Phud Hong Leprosy Community in Thailand

Week One

Prasanna Kumar, Class of 2022 | Hospital PAP, Paraíso, Dominican Republic

Prasanna Kumar from Class of 2022 with patient

It has been an incredible first week in the Dominican Republic, although it has taken some time to get adjusted.

A few things immediately caught me off-guard. I was not expecting to walk out of the airport and be swallowed by air as hot as the sun, nor was I expecting our host (the father of the family we are staying with) to speak Spanish as quickly as he does. Although I almost fell asleep on the car ride from the airport to our home - I only slept for four hours the previous night - the welcoming meal they prepared for us was some of the best food I have had in a while.

I was taken aback by our host family’s hospitality and their excitement for hosting us and showing us their country. Upon meeting them, I realized that any of the challenges I may experience while here will be worth it because it will make me a better doctor who can deal with varying forms of adversity in the future. Additionally, I will be spending the next six weeks with my friend and classmate, Jose [Jose Calderon, Class of 2022], experiencing everything the country has to offer and also learning together from our clinical experiences.

The clinic has been very welcoming of our presence. Afternoons are sometimes slow, but we make the most of each busy morning by shadowing the doctors, accompanying nurses on house visits, practicing taking blood pressure, and learning about vaccines. Being in the clinic has also given me the opportunity to improve my language skills. I feel marginally better at understanding Dominican Spanish after spending so much time listening to the doctors speak with the patients and also by having small conversations with the doctors whenever possible.

It has been wonderful having Ben [Benjamin Clements, MD, UVM Assistant Professor of Family Medicine] around because we've been able to discuss interesting cases and learn about the pathogenesis, diagnosis, and treatment behind several health conditions. In addition, we've been able to compare and contrast the medical system in the Dominican Republic and the United States. Sometimes, I also catch myself making connections between the healthcare system, culture, and way of living in the Dominican Republic and India. Spending so much time with Ben, during and after clinic hours, has made me consider Ben not only as a professor and mentor, but also as a friend.

I am excited to spend another week at the clinic continuing to improve my language skills and learning more about the health conditions that affect this population. I am also glad to have Monica here not only as another resource, but also as a friend who Jose and I will get to know better in the next few weeks. There are many places still left to explore in Santo Domingo, especially seeing as we have not yet made it to the famous beach nearby!

Finding Home

Ray Mak, Class of 2022 | Walailak University Hospital, Thai Buri, Thailand

Where is home for you?

If I had to pin a physical location, I consider Southern California my home. I only lived there for four years in college, but those were the best years of my life where I can truly say I felt at home. For some, home isn’t the same as where you grow up. It’s not determined by how long you’ve lived in a particular place or where your parents chose to settle down, but rather, it’s measured in the love and safety to nurture your authentic self. In reality, home for me is not a physical space, but within the circles of people I hold close to me. It’s true when they say that home is where the heart is and unexpectedly, I left a piece of my heart in Thailand this summer.

Upon arriving at Walailak University in Southern Thailand, we were welcomed with open arms and treated to an abundance of food. Thai hospitality is incredible; there was always somebody to show us around and take us out for food. Here, there is a culture of giving and looking after one another, even if you are a complete stranger. As I was leaving a roast duck shop, one of the cooks ran after me to hand me a bag of mangosteens, a common tropical fruit in Thailand. At first, I didn’t know how to respond; her generosity caught me by surprise and I had done nothing to deserve any of it. At a loss for words, all I could say in the end was “khàawp khun krap,” or thank you, one of the few phrases I picked up in Thai. Although it felt isolating at times not being able to speak the local language, it was touching to see the kindness of random strangers.

Walking into a restaurant near the university, a woman who the students refer to as “Auntie” came out to greet us and take our order. As a Chinese-American, I grew up with a similar custom of calling everyone my parent’s age, “Auntie” or “Uncle,” even if we were not blood-related. In terms of student-professor relationships, I learned that it’s normal for students here to text their professors, and even the dean of the medical school, whenever they need anything. The dean wants us to call him “Pee Menn,” meaning “big brother Menn,” implying that we are all family and here for each other despite the differences in our background and upbringing. In the States, it’s hard for me to imagine normalizing this level of comfort. I remember being hesitant in college to even email my professors, fearing that I would be a bother and take up too much time in their busy schedules. There’s a sense of closeness and connectedness in rural Southern Thailand that doesn’t exist as prominently in the U.S., where things are more “everyone for themselves.”

In American culture, independence is valued and it is much more acceptable to settle down far from home, but maintaining strong family ties is a common theme in Asian cultures. From talking with the Thai medical students, I found that they often felt homesick while studying at Walailak. However, one reason why many choose to study here is that the school strives to train doctors from underserved areas of Southern Thailand, so that graduates can return to their hometown and serve the community they grew up in. To cope with being away from home, the Thai students say that they treat their peers and mentors like a second family. As someone who found chosen family in college, I can deeply relate.

The summer before college, home was a foreign concept to me and my parent’s house was not the place for me to live as the person I wanted to be. When I told my parents that I was transgender, they expressed their disapproval and an already-difficult relationship turned into four years of estrangement after moving out for college.

I remember sitting in my pediatrician’s office, trying to verbalize why living with my parents was becoming unbearable...

Coming Soon: Read Mak's full reflection at the Global Health Diaries blog.

Class of 2022's Ray Mak a Phud Hong Leprosy Community Thailand Class of 2022's Ray Mak with Classmates in Thailand

Week One

Kalin Gregory-Davis, Class of 2022 | St. Stephen's Hospital, Kampala, Uganda

Kalin Gregory-Davis with students in kampala uganda UVM Larner College of Medicine class of 2022's Kalin Gregory Davis poses with classmates from the College and Dr. Naomi Hodde during Summer 2019 global health elective trip to Uganda

We have been in Uganda almost a week and already have done so much!

It was awesome to have this time at Dr. Samuel Luboga and his family's home [our host family] to get settled and acclimated before starting our time in the clinic. We saw a lot in Kampala - the Bahai Temple, the Mosque, a few restaurants, an orphanage, the Luboga’s beautiful farm, the public health school, and a craft market - just to name a few. Although it's been a bit of a whirlwind, we've had a good amount of downtime, and it's been a fairly smooth transition. The Luboga’s are amazing people - so kind, informative, and hospitable. While I am excited to see what Naggalama holds, I am also sad to leave the Luboga’s. But, I'm sure we'll be back.

This country is incredible - so vibrant and stimulating. I love the lush greenery contrasted with the red dirt. It gives the whole city such a beautiful backdrop.

I have learned that Uganda’s population is relatively young compared to the aging population of the United States, and it is growing quickly. Due to my interest in reproductive health, I have been asking around about family planning practices. I have learned that because abortion is illegal, desperate measures are sometimes taken, as is the case in many places around the world. These can result in complications that end up in the ER. It sounds like a very tough situation for a woman with an unwanted pregnancy. Furthermore, at the orphanage, I learned that it is a relatively common practice for women to hide a pregnancy and then leave the baby once it is born - either at a hospital, an orphanage, or even, in some dire cases, in a trashcan. These babies end up at the orphanage we visited. There are so many babies. They were adorable, but I couldn’t help think about what their future might hold. It sounds bleak. Not many are adopted. However, when the children are about five years old, the orphanage tries to find family to take the child. This approach occasionally works because Ugandan culture is committed to family and a relative will sometimes agree to take a child they had no previous knowledge of, if they find out the child is a family member. The approach sounds promising, but I am curious how many times this practice of finding and placing babies with family members actually works.

I learned that at Mulago Hospital an average of 100 babies are born per day! I can’t imagine that - it feels incomprehensible to me. I would love to shadow in the labor and delivery ward so that I can see how it is run. I can’t imagine the kind of staffing the ward requires and the amount of stress such a high volume of deliveries puts on the mothers and the providers. It sounds like such a tough situation - the high fertility rate, the lack of abortion access, the growing population, and the lack of resources that so many families likely face with so many children to care for.

At the public health school, I learned about initiatives to spread family planning education throughout Uganda. Efforts have been successful and there has been an increase in the access to and use of birth control, which has somewhat mitigated the population growth. There is a current public health project focused on bringing education initiatives about birth control to rural Uganda. I am curious to learn more. I wonder if birth control use is most inhibited by lack of access or if there are also cultural/religious norms that make people resistant to using it in the first place. I learned that Ugandans value large families and that historically families found worth in how many children they produced. This, I am sure, continues into the present, although perhaps ideology is shifting. I wonder if public health workers educating about birth control are met with resistance due to cultural ideology in addition to lack of access.

It has been an informative week and I am excited to check out the hospital tomorrow. It feels both exciting and a little nerve wracking - the best kind of anticipation!