Jessica Otte is a medical student at The University of British Columbia in Vancouver, Canada. In 2006, she worked with a mobile clinic in northern India and at a small health center in rural Nepal, learning about cross-cultural care and the importance of sustainable solutions for international health. Her official blog is http://jaotte.wordpress.com.
TM: Jessica, you are a med-blogger. Why do you blog? What is blogging all about?
JESSICA: Although I started my blog as a way to collect and share information, I had an ulterior motive: fundraising. I worked very hard to compile various resources about the culture and language I would encounter on my journey to the Himalayas and to think critically about the local politics, ethics in cross-cultural healthcare, and other ’sticky’ issues I was about to be in the middle of. I had never done a trip of this magnitude before, and developing the blog was a great way to prepare. I was lucky to have a lot of traffic and managed to raise over $500 from friends, family, and strangers interested in my trip.
Blogging is a different experience for everyone that tries it. Generally, it’s a way for one person to communicate with many, and for people with common interests to unite and share knowledge. For me it was a learning tool, a way to make contacts and raise funds, a venue for sharing my stories, and it now serves as a personal record of my experiences.
TM: Your blog is called To the Himalayas, and you in fact recently completed a trip to the Himalayas. Why did you travel there and what was your experience like?
JESSICA: I travelled to Ladakh in Northern India, and then to central Nepal last summer, in between my first and second years of medical school. I’ve always had a fascination with Eastern religions and recognized the area as a hot-bed for Buddhism and Hinduism. I knew I wanted to do some international healthcare work, so I searched high and low for a program that was well-organized, sustainable, and which was designed for individuals including those with the (limited) level of training I had. The organization happened to work in Northern India. Talking to a senior peer about his past experiences overseas, he mentioned that the Nepali people were the most generous of heart; I had time to add a few weeks in Nepal to my adventure, and found some contacts there who were happy to receive me.
TM: During your trip you provided care to underserviced areas of Northern India, yet you were only a first year medical student! How prepared were you to treat patients and did you have any reservations about these aspects of the trip (especially with the langauge barriers you faced and limited resources available to you)?
JESSICA: I was a little nervous heading into the experience due to my low-level of training. Thorough history taking, basic physical exams, and CPR were about the only clinical tools I possessed. We were lucky to have a few local translators through most of our time in India, but we had to learn to communicate without them. We worked in groups of 4 students to 1 physician, and would see 2-3 patients in each group at a time. Slowly we fell into a routine. As we as students became more comfortable with a focused exam and physical for the most common illnesses - GERD and arthritis - we were able to do the majority of the work. We charted, sent patients for lab work (at our crude portable laboratory), wrote prescriptions and then went to our supervising MD to approve our suggestions.
The time in India really prepared me for work in Nepal. I had become familiar with commonly used drugs and common ailments in that population, had honed my physical exam techniques, and had gotten used to language barriers and scarce resources. I was able to learn some basic medical Nepali so that I could examine patients well and help with history taking in the native language. I spent a lot of my time studying how a sustainable health care center could be run, and used the clinic I worked at as a case study for progressive ideas such as capacity building and micro-insurance health schemes.
TM: What is your stance on global health? What are some of the most pressing global health issues to you and how do you address them?
JESSICA: I don’t know if one can have a ’stance’ on global health, exactly, but there are a few key things that concern me regarding this topic. Primarily, I think we have a tendency to think of ‘global health’ as something you have to go overseas and do. That’s what I did - but it’s not the only way. Global health includes our own backyard; practicing it can be as simple as offering services in another language or being culturally sensitive when dealing with patients’ special needs. Even thinking about how our own actions affect the health of those in other countries can be important. Which coffee we drink, how often we drive our cars, what aid groups we support, which news we read and react to, or which diamonds we buy can all make a change in the health status of someone half-way around the world.
TM: Would you encourage medical students and premeds to travel abroad and work in clinical settings like you did? What does the experience offer them?
JESSICA: Travelling abroad and being engaged in the community through work in it is an excellent way to get to know the culture. One has to be very careful about expectations before travelling. As a pre-med or junior medical student, there may not be a lot of positive change you can leave behind. If you want to save the world, stay home.
If you want to explore other cultures, test your limits, improve your clinical and communication skills, and see medicine in an entirely different context, a trip abroad may be for you. I just don’t think it is realistic to believe you are doing a lot of good for a community if you are only there for a brief time; however, what you take away will be invaluable for your personal development and for the patients that you interact with in the future.
To make sure you do more good than harm, select a program that is sustainable and supported by the local community. You can also work on the periphery of medicine; helping to build a school or a clean water source, developing an agricultural or micro-lending program, or being an instructor in hygiene or HIV/AIDS awareness are all ways to influence the social determinants of health.
TM: What was your most memorable moment during your trip to the Himalayas?
JESSICA: There were many amazing times with patients and even after work when we hung out with the locals, playing cricket or dancing to our homemade music. Getting caught in a riot on the day I left Nepal was exciting, however, the most other-worldly experience was in Northern India on the Chang-la pass.
We were driving from Leh to Tangste where we would camp and hold clinic. We drove all day on rough mountain roads, enjoying the view but always a little worried on those hair-pin turns. Finally, we reached the highest point: The Chang-la pass at 17 300 ft altitude. Stopping briefly to marvel at the idea, we had to move on quickly.
We continued down the extremely steep road. All the cars stopped and everyone got out. A snowball came flying at me! I was in the middle of a snowball fight with glacial snow, near the top of the world (as I knew it).
Being so high up, we quickly ran out of breath from running around and had to collapse back into the Jeeps so we could descend and avoid altitude sickness.
TM: What will Jessica Otte be doing after she’s graduated from medical school? Do you have any future plans to travel abroad again?
JESSICA: I have no idea what I’ll be doing once I graduate! Many fields including Family Medicine, Emergency Medicine, and Neurology are currently of interest to me, but this changes as I experience new things on my clerkship rotations. I’ve spent some time doing rural medicine and working on fly-in reservations in Northern British Columbia recently, and I could see myself making that a part of my career.
I do hope that whatever specialty I choose will be portable so that I can take my skills overseas again. I would like to spend at least a year on this but I’m not sure yet where my travels will take me . . .
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