In her final post for the blog series, Perelman School of Medicine student Hayley Goldbach reflects on what she learned during her trip with the Botswana-UPenn Partnership and how the experience has changed her life. We’re glad to have Hayley back on Penn’s campus and thrilled that she shared her adventure with us!
Leaving Botswana and Wrapping Up
Hayley Goldbach
I really didn't want to leave Botswana. Like REALLY didn't want to leave. To the point where I was scheming up ways that I could change my plane ticket (turns out if I didn't fly home on the 10th the next available flight was on the 31st so that was a no go).
But alas, resistance was futile and I had to say my goodbyes. My flight was in the evening but I insisted on a full day at clinic/lab. We had a celebration with the path lab people (complete with a cake we brought to say thank you for putting up with us), hugged all the nurses, checked that the VisualDx was running OK and promised everyone I'd come back as soon as possible. My flight was uneventful and I was home in no time (and by no time I mean a full 26 hours later) Le sigh. I miss Botswana already.
Since I’ve been back, I’ve been trying to synthesize my Botswana experience and decode what it meant to me, what I learned, and how I wanted to grow as a result of my time there. Sheesh. Talk about biting off more than you can chew. This sort of experience, unsurprisingly, doesn’t take kindly to attempts to categorize, contain or label it in a concise way but as per usual, I’m going to try my best.
What I Learned
Patience, perseverance and the delicate combo thereof: It can be incredibly frustrating to work in a developing country.
I frequently felt like one of those dolls that you punch but they keep springing back up. Whenever I wanted to accomplish something (fix a microscope, check on a patient, get a photocopy, install software etc), I would get rebuffed or redirected almost instantly: “why don’t you talk to Mr. So and So, come back later, we don’t do that here etc etc.” I'd call it getting PMH-ed. The trick was not to get annoyed by that or respond by being pushy. I would simply write down the information I needed and say “What is Mr. So and So’s phone number? I will be here tomorrow at 8:00 and I hope to find him here.” Do this enough and people realize that you are serious and they will help you. Remarkably effective actually.
When all else fails, use junk food: It is important to remember that you are a guest. While you should never compromise when it comes to an issue of patient care, it’s still important to be polite and respectful. Bringing offerings of food never hurts.
Let go of your elitism: It would be really easy to leave Botswana disgusted by way some things are handled. And it’s true- there is no excuse for letting patient care fall by the wayside. It was hard to stomach sometimes: I met doctors who seemed not to care about their patients, nurses who would routinely use Facebook during clinic etc etc. Patients weren’t generally handled with deference and I saw some things that really horrified me. It would be easy to emerge from this experience smug in the knowledge that many of these issue would be better handled in the US….BUT let’s remember that the US fails on patient care in other ways: we order unnecessary tests, practice defensive medicine, don’t spend enough time with our patients and we are participating in a healthcare system that is unsustainable. So coming from a place of judgment not only limits what you can learn from a place, it also is sort of hypocritical.
Try not to generalize: Many of the physicians I met did not take initiative at all, many would try to shunt responsibility whenever possible. In some ways, this colored my experience at the start of my trip especially because the nurses I worked with in Malawi were dedicated almost to a fault. However, for every lazy lab tech, sullen nurse and irresponsible doctor- there were 3 other people who would go above and beyond for patients, their colleagues etc. I was blown away by the microbiology lab worker who let us look at crfptococcuc under the microscope just so we could learn or Bonnie, the nurse who looked up a patient’s phone number (I still have no idea how she did that) so we could ask if they got treatment for a DVT. And these are just a few examples.
Most importantly...secure the door to your room on safari: or a monkey will come in and steal your coffee...duh!
What I’m taking back from Botswana
A love of dermatology: I can't wait to get more involved now that I'm back at school. We’re doing cardio now so I've started a game with a friend where I email her the disease we are learning about and she replies with the skin problems that go along with that disease. Luckily, I was bequeathed a large pile of derm books so I'll have plenty of opportunity to keep learning. I know, I know...I'm a huge nerd.
The knowledge that I want to make international work a part of my career: I felt so at home in Bots and I felt the same way in Malawi. I can't wait to find out how my career evolves to include this passion.
The opportunity to be re-acquainted with my own competence: Medical school isn’t kind to everyone and although I’ve been very successful grades-wise, I’ve been struggling with my own version of the imposter syndrome common to medical students. I keep waiting for someone to “find out” that I am not as smart or as hardworking as my classmates. I am not great at sustained periods of memorization and that is the key to med school success in many ways. Fears about not living up to my potential made it hard to be proud even though I did really well in terms of external markers like grades.
Botswana was the antidote to that feeling. I wanted to go to work...wanted to stay longer at work... wanted to find projects that would give me more work and I did that work well enough that people started giving me more and more responsibility. Positive feedback is always great but feeling proud of myself was the best feeling in the world. So basically, I had the opportunity to re-ignite my passion for medicine while meeting and working with some truly amazing people. I will echo my first post....am I lucky or what?
The biggest gift I got in Botswana was the chance to work with an amazing group of people. This experience would have been nothing without them. I was blown away with their generosity in teaching me and I am hell-bent on “paying it forward” at every available opportunity. So thank you to Dr. Kovarik, Jen, Doug, Kari and all of team derm for a truly amazing summer. I can’t wait to go back!