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Guest blog by Dr. Kathleen White
Good afternoon to the dedicated and therefore, to me, fortunate fellow Health in Harmony volunteers.
Michelle and Rosevan asked, because I am both an ASRI volunteer and member of the Health in Harmony Board of Directors, would I write the ASRI final volunteer story of this series to both tell my story as well send a personal thanks to all volunteers from the Board? And I said of course! So first I would like to extend a heartfelt thanks to you all.
Chris, Andrew, and Bethany all recently sent you their stories of ASRI through which you most likely drew vivid images of birds, bikes, and botany in West Kalimantan. My story will not be as colorful, but my life has been altered with my progressive involvement in our organization, beginning with my six-week stint ASRI as a teaching physician in the fall of 2010.
My enchantment with global health goes back to a verbal marriage contract with my husband, Bob, many years ago – a contract that we WOULD share a “medical mission” before Bob started his full-time medical practice. I was a nurse then. Our summer in Haiti with our 2 small sons only whet my appetite… and resigned Bob to my future forays!
I went through medical school and residency with a few “international health” experiences and then two “medical missions” while in Internal Medicine practice, and found myself a dissatisfied clinician. These trips to three continents were always interesting and rewarding. I always was able to take time to give high-quality patient-centered care, if not high-technology care, but I took back more than I left behind. Very short-term medical global healthcare has few long term effects other than those occasions when we might say the right words that may impact someone’s life. Also, we never know how negative an impact we may make with not truly understanding patients’ cultural concepts. But I then thought if I could take a medical-trainee along, at least that educational experience would have some sustainability.
Then I heard about Kinari Webb. Now, this is really emotional, but it is sincere when I use the following quote by Edith Wharton to describe my relationship with ASRI and Health In Harmony:
There are two ways of spreading light: to be the candle or the mirror that reflects it.
And I know you all share my gratitude that Kinari has lit this fire and we get to fuel it with her.
As a physician I firmly believe that in assisting our patients to achieve health it is necessary to address sustainable and productive lifestyles and livelihoods. As an “environmentalist” and a very enthusiastic grandmother I feel a deep responsibility to a sustainable world.
I must mention that my passion for teaching medical trainees in a longitudinal setting with underserved patients has driven all my major career decisions. I am fortunate to be the site director for our local medical students going to ASRI, and I was able to share the experience with one of them at ASRI on my second trip to Sukadana.
I now have the opportunity to be working on a scholarly project in global health medical education as part of a one-year Medical Education Fellowship. My project is to establish an explicit curriculum for our medical students and residents going to ASRI. I hope this will enhance their experience in culturally sensitive patient-centered care, and even, my dream, to ignite their spark in replicating the model being put into practice at ASRI.
At first I didn’t think it was possible to enhance trainees’ experiences. But medical education has neglected Learning Theory until recently and I have found in my study thus far - and have been reassured by our former students who have assisted me - that there is always more they are capable of taking back from the riches at ASRI. The cultural sensitivity they gain is invaluable in caring for patients in the developed world, just as in the developing.
With advances in technology, medical care in the developed world has become more fragmented and specialized; and EXPENSIVE. It is now a well-known fact that the most patient satisfaction is achieved when care is patient–centered. Medical schools worldwide are turning their attentions back to bedside care. This involves great skill in the patient’s history and physical exam, and competent patient-centered clinical reasoning. What is not well appreciated is that approximately 30% of costs for diagnostic tests are unnecessary or may even be physically or psychologically harmful. This can happen when the testing directs the diagnosis, instead of clinical reasoning directing the testing.
There are few technical tools at ASRI in providing patient care. But that is what makes it most valuable as a learning experience. And lab tests, few as they may be, are only employed when the results will change the plan of care. And the Indonesian doctors - who are extremely bright - benefit not from our western technologies, but from our sharing our clinical reasoning skills. The collegiality is delightful.
With the research I have done as I have been working on my medical education project and assisting trainees in global health, I have found no other project like ASRI. What Kinari has achieved, and what Health In Harmony is allowing ASRI to manifest, represents the first replicative model for exchange of healthcare and a commitment to preserve the environment. But in addition to the successful re-foresting and growing environmental awareness of local people, ASRI is also a venue for re-capturing the excitement of bedside medicine. Thank you for sharing this “conceit” of saving lives while saving the planet. It has tremendous benefits for us all.
You can support the cause by volunteering, or by giving to the volunteer program - you know as well as I do how important that support is to continuing to shine our light together!
About Kathleen White
Kathleen serves on the Board of Directors of Health In Harmony and has volunteered at the ASRI Clinic multiple times. She works at Yale University and is based in New Haven, CT.