By: Maureen C. Ries, MD, obstetrician/gynecologist, Global Health Service Partnership, and clinical instructor, Sengerema Hospital & Bugando Medical Center, Sengerema, Mwanza, Tanzania
This past year, I have encountered the most challenging, gratifying, haunting, and meaningful experiences of my medical career. I have seen and treated clinical scenarios that I had only previously read about. Pathologic presentations that UpToDate calls “unlikely” or “uncommon” are sequelae I see every month.
I am one of the 15 physicians sent to serve as faculty in the inaugural year of the Global Health Service Partnership (GHSP), described in Mullan and Kerry’s recent article. I have spent this last year working and teaching in rural Tanzania. The critical shortage of health care workers they mention is quite real and poignantly felt by the millions of patients who do not receive the medical care they deserve. It takes three days for some of my patients to reach the hospital, as transport may consist of an ox-cart or a small rowboat if they live on a small, remote island in Lake Victoria.
Medical school enrollment is up, and faculty numbers are down. During the academic year, weekly major ward rounds in our hospital reach a Where’s Waldo? level of congestion—forty students will attempt to pack around each patient as they strain to catch clinical pearls from the doctor of the ward. During final examinations, students are required to demonstrate competency in physical exam skills that no one teaches them how to perform. In the year preceding the GHSP’s arrival, 65 of the 123 third-year clinical officer students failed their practical exams. When I am out running and I ask the local kids running alongside me what they want to be when they grow up, 3 out of 4 children tell me, “I want to be a doctor,” which is an incredibly admirable and integral response in a country whose doctor to patient ratio is 1:100,000. But who is going to teach this fledgling group of health care workers? Who is going to foster their clinical development so that they not only become doctors but become great ones?
It is challenging for me to sit on my hands and teach in an environment where workers are so scarce, but I believe in the capacity-building paradigm for international aid. Showing a student how to perform a procedure has a more significant, lasting benefit than doing the procedure on my own. One of my students sent me an email when he graduated that included a quote: “A candle loses nothing by lighting another candle.” “You were that candle to us,” he said, “and I will light another new candle someday.” New models in sustainable global health, like the GHSP, have the capability to help answer the health care workforce shortage.