Global Health and Underserved Communities: Challenges and Rewards

From May 29 to June 9, I traveled on a medical relief trip to the Dominican Republic.  Below is the text of an e-mail I sent the team, which I include here because I believe it states my position on the challenges and rewards that one can attain for working with underserved communities in the US and overseas.


--------------------

I wanted to send this note to thank everyone for their hard work and for making the trip successful.  For those new to global health projects such as this, I realize it is a difficult adjustment to make: the long hours, the constant work, the uncertainty around schedules and plans, and the constant feel that we should, somehow, be doing more than we are.  The recognition that the need is greater than our ability to respond to it, and how we can come to terms with that without necessarily accepting it, and how we can use our resources and skills to do our part in helping the patients we work with. 

This is a heavy task: in healthcare, we all would like to think that we can make big differences through our profession, when the humbling truth is that often the best we can do is to be a small part of a larger process.  I believe we are obligated to help our patients to the extend of their needs and to the best of our abilities, but this means that there will always be someone who we could not reach, or for whom our skills were not sufficient. 

This is not a comfortable place to be, whether in the US or overseas.  I think working in developing nations makes this gap between resources and needs more evident, but as you continue your training in Richmond you will start to notice more and more examples of the mismatch between what people need and what we can offer. 

The best approach to help as many people as possible is to determine where you can have an impact, and to work as a team to get the most out of what we have.  We chose to put a lot of focus on diabetes and high blood pressure because, as medical and pharmacy professionals, this is where our greatest skill set lies.  However, our summer clinical work fits into the larger picture of our ongoing community development work in the Dominican Republic: work that aims to address sanitation, flooding, and other broad social determinants of health.  The fact that our ongoing commitment to the community leverages our skills and matches them to with community development project allows us to address health on many more levels than if these two initiatives were separate.  We may have only done a small part, but it is a small part of a greater whole.

At the same time, our part was not especially small.  In the community, we provided healthcare to nearly 500 people: people who would have lacked care if we were not present.  For some, this involved treating blood pressure and other chronic illness.  For some, this involved parasite medications and vitamins to enhance nutrition.  For some this involved coming to get medications to use if problems such as back pain or stomach pain developed in the future.  However, I was taught that the role of a healer is to "cure sometimes, relieve often, comfort always" and, as with that as a guiding principle, I believe that there is value in doing our best to care for everyone regardless of the objective severity of their illness.

It would have been impossible to have seen the over 600 patients (when both clinical sites are added up) without teamwork, collaboration, and a unified sense of mission.  Despite the challenges noted above, you responded brilliantly.  Whether working registration, vitals, pharmacy or seeing patient, everyone willingly stepped forward to do what needed to be done to make sure that we met our commitments to our patients and to each other.

For all of this, I thank each and every one of you for being part of this exceptional team.  I look forward to working with some (many? all?) of you again in the future.