International experience opens eyes and minds of medical students
May 08, 2015
By Joe Stumpe
From universal health care in Europe to an epidemic level of AIDS in South Africa, students at the University of Kansas School of Medicine-Wichita found themselves in unfamiliar territory during their one-month international rotations.
And that, of course, was the point.
Thirteen fourth-year students took part in clinical elective rotations under the program known as International Education Experiences. Three of those students - Stacey Kraus, Armando Villanueva, and Armand Heyns - gave vivid accounts of their experiences to classmates when they returned to school.
Stacey Kraus: Ireland
Kraus spent February working in the pediatric ward of a hospital in Wexford, a small town on the southeast coast of Ireland. "It was a town where everybody walked everywhere," she said, including her own 15-minute stroll to the hospital each morning.
The hospital offered only general services and had few computers, but Kraus was impressed by much of what she saw there. For one thing, she said, public health care meant that "there usually wasn't any worry about cost. When parents brought their kids in, they knew the kids would be covered."
She contrasted that with the situation in the United States. "Here, we're always worried about insurance and who's going to pay."
However, Kraus said some care in Ireland "could be slower" as a result, noting that it might take up to a year to see a specialist unless a patient paid privately.
Kraus traveled abroad with the goal of understanding the Irish health system, identifying the challenges facing it, and investigating a possible solution. She found a high prevalence of rotavirus, a severe form of vomiting, diarrhea, and fever. Children in the United States are routinely vaccinated against rotavirus - an approach that some Irish physicians believe would be cost-effective there as well. But the vaccination is expensive, and because death from the virus is rare, Irish health authorities have not moved in that direction, Kraus said.
Kraus' favorite day was spent in a clinic for children with developmental issues. "They very much stayed away from medicine," she said of the care providers, instead using therapies such as deep touch and sensory rooms.
The take-away from her medical training in Ireland was simply the idea that good practices can be found anywhere.
"I want to keep my thinking open to things that are being done, and not just in the United States," she said.
Armando Villanueva: Germany
Villanueva spent his month at a radiology department in Magdeburg, Germany, a city of 200,000 about an hour and a half west of Berlin.
"We were in the basement, like every other radiology department," he joked.
The unit had a reputation for innovative treatment that drew patients from across Europe, he said.
Like Ireland, Germany has universal health care. Villanueva said there are two differences between it and private care, which is also available. First, the latter entitles a patient to be treated or at least seen by the chief of a department, which a German counterpart told him "could be a good or bad thing." The other perk is a private room.
"Otherwise, you have basically the same care," he said, with a hospital stay amounting to about $4 in out-of-pocket costs per day.
Villanueva said the German multidisciplinary approach to treating liver cancer included different specialists actually rounding on patients together, something we don't see here in the United States.
He described its localized treatment for liver cancer, for which he said clinical trials are still underway. Based on the chief researcher's preliminary data for one group of patients, the approach improved prognosis by up to three years. He noted that the treatment is only considered appropriate for certain patients.
The biggest lesson Villanueva took away from the trip was something he acknowledged he could have experienced right here. A Russian woman was brought into the center with what turned out to be appendicitis. But it took the German equivalent of an intern to finally breach the language barrier: compassion, and a bit of knowledge, saved the day.
"Every country struggles with the language barrier," he said.
Armand Heyns: Manguzi
Heyns' trip to Manguzi, on the northeast coast of South Africa, was actually something of a homecoming. He was born in Johannesburg, South Africa, and lived in Canada before moving to Kansas.
Manguzi was "as different as you can get" from bustling Johannesburg, he said. It's a small town close to the border of Mozambique, known mostly to European tourists drawn for its wildlife and beach.
It's known for something else, too: With an HIV rate estimated at 38 percent of the population, Heyns said, "it might be the highest rate in Africa."
Heyns was interested in the effect of HIV and AIDS on Manguzi's culture and medical care.
The government-run Manguzi hospital has 11 satellite clinics. Heyns said he was told that most of the clinics' HIV and AIDS cases were being successfully treated as chronic diseases, because the patients received managed care and were taking their medications as prescribed. Alternatively, the patients who came to the hospital "were dying in front of us" despite the best efforts of the staff.
As in Ireland and Germany, physicians in South Africa go straight to medical school for six years after high school, with subsequent training in specialties.
"They were very well trained," Heyns said. "They could handle a lot of things. It was impressive."
Heyns spent time in several hospital units, stitching up a stabbing victim in the emergency room and assisting in several C-sections. A British physician, Dr. Jack, made a big impression on him.
"He was brilliant with his physical exam," Heyns said. "He could start diagnosing just by watching the patient breathe."
Some of the hospital's standard practices - like stretching skin grafts over a piece of wood - "were kind of freaky," he said.
As for the effects of AIDS on the general population, Heyns said it was less than he expected. "Overall, they just keep going with their lives."
"They view death as just another stage in life. They don't try to prolong it beyond what they think is necessary."
The hospital experienced shortages of first-line HIV medication and anesthetics, but the physicians were held to high standards. Heyns saw one young physician lectured severely for failing to anticipate the possibility that a child might react negatively to a certain anesthetic, which in fact happened.
Most of the hospital's doctors lived in a guarded compound on its grounds. They were good at leaving work behind after hours, "but during the day, they really suffered" for their patients, Heyns said.
Kimberly Connelly, director of international programs for the University of Kansas Medical Center in Kansas City, said those kind of fish-out-of-water experiences are just one of the benefits of training abroad. "By being a minority in another country, you develop better empathy as a practitioner," she said.KU School of Medicine-Wichita