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Admissions Essay - An Internship and My Interest in Medicine

 

How does a hospital run without adequate water to develop X-ray films? What are the signs and symptoms of malaria? What is the most common cause of infant mortality worldwide? These are all questions to which I learned answers during my six-week clerkship in rural South Africa. That a well-rounded education is the mark of a true scholar is a belief I acquired from my high-school education, and in that spirit I flew off to try and understand some of the important issues in the changing South African health care system.

 

I learned more than I had anticipated was possible and can easily conclude that studying abroad is one of the quickest, most memorable, and most enjoyable ways of broadening one's education. Furthermore, it teaches lessons that are not possible to learn at home.

 

Tinswalo Hospital, where I worked, is small. The number of hospital beds is approximately 92, and the faculty (consisting of doctors, nurses, pharmacists, translators, and administrators) is fewer than 200. The population that the hospital serves, on the other hand, is large - approaching 200,000. Although Nelson Mandela has been increasing government funds for this and other public hospitals, diagnostic and treatment supplies are scarce. Deciding how to distribute scarce resources among a large population is a common, complicated topic in African discussions, as is the efficient use of these resources after distribution.

 

As technology gets more expensive and the struggle to balance the budget continues, discussions on resource distribution and improved efficiency are also becoming prevalent in the United States. Although American physicians tend to be interested in the science and not the administration of health care, the two go hand in hand. In South Africa, one has the chance to work with and learn from other medical students whose curricula include rotations in health care administration as well as in scientific study. I feel fortunate that, by studying abroad, I have been formally and practically introduced to some of the politics that influence health treatments and distribution. I expect that this will likely influence my thinking later in my career as well.

 

In addition to the influence of politics in health care, I was exposed to the importance of culture. Treatments and etiologies of sexually transmitted diseases (STDs), HIV/AIDS, and contraception contain cultural components. When working with women about family planning in South Africa, for example, Depo-Provera shots are the most effective option. The explanation for this lies in the strongly patriarchal and agricultural nature of the indigenous society. A traditional rural family includes many children (preferably male). With many children, however, nourishment and supervision are usually insufficient. Consequently, an interest in contraception has arisen. Although oral contraceptives were available at first, this option led to wife beating by angry husbands if the pills were discovered. This can be avoided with contraception using intramuscular injections.

 

Cultural ideas influence HIV/AIDS patterns through the practice of "inheritance;" a brother or other male relative of a recently deceased married man inherits his widowed wife and proceeds to engage in intercourse with her (even if the cause of her husband's mortality was AIDS!).

 

Other types of STDs are also influenced by culture. It is a common belief of most rural South African women that it is not normal if one does not itch or burn during micturition. Also, most believe to some extent that the "cleansing" of a STD in a man can be accomplished by his practice of intercourse with a virgin or young girl. Still, it is difficult for a woman to refuse any man the act of intercourse, regardless of his relationship to her, his disease status, or her desire.

 

These conditions obviously make the spread of STDs an immense problem in Africa. A medical student studying abroad quickly realizes that to treat patients effectively or to prevent many diseases, cultural contributions also need to be addressed.

 

Of course, when studying away from home, one also has the opportunity to meet patients with diseases only read about in school. I will never forget my patients with severe tetanus or "Chicken Gunya." And I will always remember the ubiquitous malaria and tuberculosis bulletins throughout our hospital.

 

The knowledge one acquires when studying abroad, however, is not strictly in infectious diseases. Kwashiorkor and dehydration were far too common in our outpatient clinics. I doubt I will ever forget to recognize, treat, and consider the possible political and cultural etiologies of these conditions in the future.

 

The world is becoming a smaller place. People are increasingly communicating across cultures and discovering how similar their problems are. These experiences encourage broad-mindedness. In addition to the traditional education, a physician studying abroad may become naturally interested in health care politics and the cultural aspects of disease developments, and may obtain a general global perspective. He or she also will learn that doctors bring their personal water from home to rural hospitals for developing X-rays in times of drought; that the most common symptoms of malaria are fever, nausea, and diarrhea; and that diarrhea and dehydration are the most common causes of infant mortality in the world.