I shadowed an OB/GYN physician at a ‘family planning’ clinic financially supported by an international NGO with religious roots. He wore a tie, a nice watch, and was educated in the country. Patients were triaged by the nurse, this included weight and information gathering about family history, last menstrual period, etc., and then seen by the doctor who re-checked all of the information handed him. One of his patients was a 15 year old who came in twice a week for him to apply medication to treat her STI (STI is currently the more accepted term for sexually transmitted infections). He didn’t trust that she would remember, have clean application materials, or even a private location to apply herself. The rest of his patients came for a free pre-natal visit during which he performed a breast examination, pap smear, and gave financial planning strategies to save enough money for a taxi when the time came to deliver. When patients told him that a sister or friend was going to get them to the hospital, he continued to question for exact details of this plan.
We found a breast mass in a 32 year old 4 months pregnant. He told me uterine cancer was a big problem amongst his patients and he looked at me frustrated when a patient asked what a pap smear was. He told me that the only time he sees most women is for this prenatal visit, and he therefore feels, “not doing a pap smear or breast examination is a missed opportunity to catch these things.”
I left out a detail of his prenatal visits that I found fascinating; he introduced the topic by asking how many children the woman intended to have and then cut to the chase: “And what type of birth control will you be using to prevent future pregnancies?” I pictured a couple in the US going to their first prenatal visit together and getting a lecture on birth control. “Doctors in Haiti are not just doctors, they are public health workers,” he told me between patients. I was struck by his energy and compassion to work on the big picture while sweating away in his tiny exam room. I thought about what a great physician he was and what a role model he had been for me. This made me think of the distinct fields public health and medicine have become, unfortunate when considering their emergence as one and similar intentions. I thought about Tuesdays when I leave the School of Medicine building where I have Biochem and Pharmacology, and walk across the street to the School of Public Health to take Introduction to Policy and Epidemiology for my masters. It goes without saying that the US has innumerous resources and technology to offer medicine in 3rd world countries. Physicians seeing themselves as public health workers is an important lesson we can learn from those practicing in less privileged environments.