Second Year PA Student Blog: Yaying Wang
Friday, May 31, 2019
When I was applying to PA schools, one of the more important traits for me was the opportunity to have a clinical rotation abroad. Receiving my acceptance to the Duke PA program was one of the most joyous moments of my life, and having the opportunity to go on an international rotation was icing on the cake. Duke offers training sites in Sri Lanka, Tanzania, Bolivia, Ecuador, and possibly the United Kingdom in the future.
Recently, I spent four weeks in Machame Hospital in Tanzania, a Lutheran-based community hospital built by German missionaries. The health services offered include general surgery, obstetrics and gynecology, orthopedic surgery, HIV testing and treatment clinic, pediatric clinic, outpatient clinic which also serves as emergency department, and community outreach. I spent most of my time in orthopedic surgery, OB/GYN, outpatient clinic, and outreach.
Even though I have had my general surgery and women’s health rotations in the U.S., this was a drastically different experience. Observing major amputations, clubfoot deformity corrections, fracture reductions, and Cesarean sections were incredible learning experiences, especially in a low resource setting. I also helped deliver six babies, four natural births and twp C-sections. The mothers rarely get epidurals and first-time mothers receive prophylactic episiotomies. The deliveries are done under dim lighting and most of the time with a nurse and a senior clinical officer student (their equivalent of a PA student). I was astonished at how strong the new mothers can be. Only 15 minutes after we finish suturing, they were up gathering their belongings in buckets and ready to walk themselves to the OB ward.
During outreach days, I worked with a social worker, a nurse, and sometimes a clinician. We went out into the nearby villages to see palliative care patients, mostly to offer comfort and pain relief. There was one outreach where we visited a village and welcomed anyone to come to our “pop up” clinic. That day, we saw 180 patients! The turnout was so overwhelmingly high that we ran out of prescription pads and medications to give out. We were so busy that none of us had time to even stop and drink water or use the restroom for seven hours. At the end of the day, the village representative gave each of us a glass bottle of Fanta. It was the most refreshing drink I have ever had.
I met many incredibly friendly and hospitable nurses and clinicians who taught me the ways in which they practice with what little they have. Sometimes during surgeries, the power would go out, but everyone remained calm and carried on with the natural lighting that’s there. The surgeon simply put down the electric cautery he was using and picked up the scalpel instead. I never heard a word of complaint.
Other than the clinical side of my experience, I was able to witness the majestic nature and wildlife in Tanzania through my weekend hikes and trips to lakes, hot springs, and the safari. There is great value in understanding and personally experiencing health care globally. Witnessing medicine practiced in a low-resource setting ingrained in me not only the absolute necessity to practice evidence-based medicine, but that it can be practiced anywhere as long as higher quality patient care is the goal.
At Machame hospital, their post-op infection rate is 10-12% vs. the 18-22% on average in Tanzania. The surgeons there believed in uncompromising sterility of instruments and proper training of all staff, which in turn instilled a culture of higher standard of care. I hope that I have shared at least a fraction of it with anyone who is also interested in a global clinical experience.
Yaying Wang is a second-year student with the Duke Physician Assistant Program. Email firstname.lastname@example.org with questions. Editor’s note: Duke Physician Assistant Program students blog twice a month. Blogs represent the opinion of the author, not the Duke Physician Assistant Program, the Department of Family Medicine and Community Health, or Duke University.