Last week I took a test that I have been preparing for the last 2 years. No, I am not talking about the USMLE Step 1 board exam that I took in June. Though the countless hours I spent reading textbooks, memorizing mechanisms, and studying diagrams certainly helped me to (hopefully) pass my board exam, I now realize that it is not the test I have been preparing for since June 2008. If I have learned one thing these past couple years, it is to look at the bigger picture. As medical students, we are constantly bombarded with exams, ethics assignments, standardized patients, and much more. Each task brings with it its own level of trepidation and stressful preparation. But what we often fail to appreciate in the midst of all the hours spent in the library is how important the process is to preparing us to be good physicians.

People, including myself, often wonder what makes medical school so difficult. Some will tell you it’s because of the massive amount of information that one must learn in a relatively short amount of time. Others might say it’s because of all the seemingly unnecessary activities that one is required to participate in ranging from ethics discussions and biochemistry small groups to laboratory demonstrations and clinical simulations. I, however, believe that medical school is made to be difficult and stressful because that is the life that one is signing up for when they decide they want to be a physician.

Being a physician is not a choice of careers but a choice of lifestyles. A choice which for the first time in my entire life– since I was a 6 year-old boy wearing scrubs 8 sizes too big walking the halls of a small hospital in Florence, SC with my dad, a young, ambitious cardiologist—that I seriously doubted this past year. I struggled at times learning the intricacies of all of the various pathologies we covered this year, and like anybody who has ever been in a “slump”, I began to doubt myself just a little bit. Over time, as the doubt lingered in my mind, it became harder to concentrate on my studies and my ultimate goals, which led to more doubt and so on. I am convinced that the only thing that kept me going was the constant and unwavering support of my amazing family, friends, and fellow students. Even as I doubted myself at times, not once did they ever let me think for a second that they did.

As many of you know, in March of this year I returned to Masindi, Uganda with the Palmetto Medical Initiative to provide healthcare to those who need it so badly. You might also know that we cared for a patient there on our first day who will always hold a special place in my heart as she almost died after presenting at our clinic with a severe infection before returning home after a week and a half in the hospital. Working with the remarkable group of young healthcare professionals, and witnessing the positive impact that a group of strangers can have on people’s lives gave me a renewed confidence in myself and reminded me why I have such a passion for medicine.

I returned home with a different outlook on my studies and my life. I felt revitalized and for the first time in a while, I was excited about the prospect of taking my boards and embarking on the next step in my path to becoming a physician– clinical rotations. So on Wednesday, when I showed up for my first day of antepartum rounds (my first rotation is obstetrics and gynecology) at 5:00 am, I realized why we study so hard and push ourselves so much throughout the first two years. Its not for the “Honors” score you might get in a class, or the coveted 250 boards score that many students only dream about, but rather to prepare us to join the talented and caring team of professionals that care for patients and to one way or another hopefully make a difference in their lives, no matter how small.

I recently discovered this article regarding the pentagon’s interest in developing a method of assessing cognitive states of individuals. The proposed idea is based on using electroencephalograms, or EEGs, to monitor an individual’s brain waves as they respond to various stimuli, make decisions, and perform certain functions. They would then use this information to assess how an individual processes information and eventually manipulate the learning and decision-making process to maximize that individual’s cognitive potential.

Some might argue that training the brain to respond in a particular manner is something that has been going on for centuries. After all, techniques based on behavior analysis and operant conditioning, including methods like punishment, reinforcement, and chaining (linking discrete behaviors together in series) have all been used to encourage a brain to respond in a desired and predictable way. I tend to agree in the sense that training the brain is not a new concept. However, as the saying goes “the times, they are a changin’”. As the world’s best and brightest continue to push the barriers of modern technology that were unimaginable even 15 years ago, by necessity we will also have to change the way we educate and train ourselves.

In terms of the military, the things we demand from troops in today’s increasingly complicated world are simply too much for many to handle. They are expected to not only be familiar with combat tactics, advanced weaponry, and engineering, but also various cultural intricacies, the complexities of human interaction, and methods of gathering intel in a hostile, foreign environment. The fact of the matter is that many of the brave men and women that join the armed forces and are on the “front lines” so to speak do not necessarily have the mental capacity– for lack of a better word– to learn the proper skills vital to ensure both success of a mission and their own survival. That is at least not in the short amount of time that is spent training these individuals, a mere months before they are thrust into unknown and unpredictable territory.

I think that is why we continue to invest in new technologies and innovative ways of teaching individuals. Not necessarily because the ultimate goal of “training the brain” has changed, but because the complexity and the urgency of the situations have evolved. By continuing to gather data on the way people think and the cognitive process involved in learning and decision-making, we will be able to increase the efficiency and effectiveness with which we train individuals. Consequently, they will be better prepared for when a complex situation arises and a difficult decision needs to be made under often stressful circumstances.

As an example of traditional learning, take a medical student or nursing student interacting with a patient on the wards. Traditionally, students are taught initially from a book or through lectures about how to approach patients, effective language and gestures, methods of driving the conversation, and techniques for gathering information. They then move on to interacting with actual patients with, to be perfectly honest, often little clinical knowledge or useful skills! This all works well because we are in a relatively controlled environment and there is time to make adjustments if mistakes are made or difficulties arise. However, in the heat of battle, when performing special operations, or when interacting with combatants, the opportunity to correct one’s errors and learn from one’s mistakes is rarely afforded without the direst of consequences. You don’t always have time to check the manual or google the proper technique.

Now imagine if something as simple as EEG analysis could pinpoint why one makes particular decisions. Imagine even further that it could identify predictable factors that influence one’s quick decisions, the so-called ‘going with your gut’. Call it genius or fate or blind luck, but the fact of the matter is that some people are better at making these snap decisions than others. If we could identify who those people are and what in their cognitive processes might contribute to their ‘gut decisions’, perhaps it could be possible to teach others to make better decisions when it counts. In other words, to maximize their cognitive potential by teaching them to use the information they have learned more efficiently and more effectively.

The nervous system (whose deepest secrets and phenomena I believe may never be fully understood by man) is an extraordinary one. I embrace a continued attempt to understand intuition, cognition, and the human psyche. However, I also hope that in our attempt to further our understanding we do not become so lost in our own ambition as to attempt to manipulate the amazing gift that God has given us in the human brain. It is as many have mentioned a topic for much debate and one which I look forward to being a part of in the future.

Just before yesterday evenings historic vote on health care reform, Nancy Pelosi delivered a speech to Congress. She noted the following:

“It is with great humility and with great pride that we tonight will make history for our country and progress for the American people. Just think–we will be joining those who established Social Security, Medicare, and now tonight health care for all Americans.”

Two things from that statement are quite worrisome to me. First, either one or both of Social Security and Medicare are likely to be bankrupt within 10 years once the baby boomers surpass age 65. Frankly, I’m amazed they have lasted this long. And second, at what cost are we ensuring “health care” for everyone in America. Are people going to be any less likely to abuse our emergency care systems? Will our physicians really be as concerned with the quality of patient care when there are fewer incentives to provide it?

While this health care bill does take some important steps to begin to rectify a broken system, my greatest fear is that Democrats are looking at this as the “be all, end all” of health care reform when they have really just barely begun to scratch the surface. It is great that the majority of Americans will be insured, and it is about time that pre-existing conditions and unethical coverage termination practices will be disallowed.

However, not until reform is passed for such travesties as tort law, medical malpractice, prescription drug costs, and medical reimbursement procedures and incentives will we truly be able to make progress to our system as a whole. In the mean time, it is going to be a rocky road. As a future physician I for one am concerned about the future impact that this bill will have not only on the quality of our health care system, but also on the roughly 90% or 275 million Americans who are presently satisfied with their health insurance coverage.

One of the key components of this bill soon to be law is companies of more than 50 employees will have to pay a “per employee” penalty if they do not provide coverage. Yet, when you look at the average cost of providing employee coverage, which by some estimates is as high as 10-12% of payroll, the fact of the matter is it may very well be more cost-effective for businesses to pay the $2,000 per employee penalty than to ensure coverage for their employees. If that becomes the case, then once these practices go into affect over the next 5 years, we will begin to see more families having to shop around for their own insurance plans and as individuals will have less bargaining power than as corporations.

The bill attempts to counter this obstacle with state-based health insurance “exchanges”, basically pools of individuals and small-businesses joined together for the purpose of negotiating reasonable insurance premiums. There is much doubt, however, whether these exchanges will be able to maintain the same purchasing power as larger corporations do now. The difficulties which will be manifested very early on will be due in part to the limited number of individuals, small business and self-employed that join the exchange. Additionally, there is concern that the businesses and individuals that choose to buy into the exchange will be sicker and at higher risk, which could drive up the cost. The success of the exchange rests on its ability to maintain a large membership pool where the risk is spread out evenly among individuals, as often occurs in a typical large business with more than 100 employees.

Don’t get me wrong, I am a capitalist at heart and am all in favor of competition. The problem I see arises when you start applying the same economic driving forces to what is essentially becoming a commodity in health care. We allowed the pharmaceutical industry to thrive based on competition and ingenuity alone, which the foundations of our free market system, but now look at where that has got us. Prescription drug costs are at an all-time high, and companies are not willing to spend the time and money into researching new life-saving drugs unless they can ensure a significant return on their investment. After all, by many calculations the estimates of what companies spend on marketing range from 9 – 16 percent of revenue as compared with 13 percent on R&D.

Take this special prescription shampoo a family member was using to treat seborrheic dermatitis, a condition that affects the skin and can cause drying of the scalp with itching, scaling, and hair loss. She was originally paying a co-pay of about $30 per bottle. When we switched prescription drug plans with our insurance provider, my father inquired about the actual cost of the shampoo which was just under $250 per bottle! Once you catch your breath, consider that later he found out that there is another generic version of the shampoo that can be substituted and costs but about 60$ less of that. So why was the physician prescribing for the more expensive brand?

There are numerous reasons why physicians choose to prescribe one medication over another. Most commonly, there are randomized controlled studies that show one to be more effective than another or there are various side effect profiles that determine which is best for a particular patient. Still, in some cases it comes down to simply what the individual physician is most comfortable with and has the most experience prescribing. I don’t know why this particular shampoo was being prescribed for my mother instead of the substitute. By best we can tell, the efficacy and side effect profiles are quite similar and not cause for preferring one to the other. Had our original prescription drug plan not covered the majority of the cost, I’m sure it would have sparked some concern and led her to using the generic much earlier.

How did the maker of this shampoo come to charge what might seem to the lay person an exorbitant cost? Most likely, months or years were spent into researching, developing, conducting trials, gaining FDA approval, and finally marketing the drug all the while getting absolutely no income in return. This is the basic process for the production of any new product.

Take high-definition televisions for example, the companies that invest in the technology are able to reap the benefits by charging higher prices down the road when the product is released. The problem with health care and prescription drugs is that many consider the final product should be guaranteed available to them. Imagine if anyone who “needed” an HD-TV but couldn’t afford one knew they could still walk into any Best Buy and obtain one at a fraction of the cost as anyone else. What would happen then? Well of course the cost of HD-TVs would go up for those who could still afford it. That is what has happened with our prescription drug programs across the country.

While I know I may have digressed a bit, the point I was trying to make is how difficult it is to approach the American health care system as we do every other industry because it is a unique and complicated institution. For better or for worse, we have become a society where health care is considered a right, a belief that I share to an extent. I also feel strongly, however, that the American people have an equally important responsibility to take that right and use it appropriately. I believe in the freedoms that our country is founded on, but I also believe that if you choose to subject your body to harmful substances and situations, then you should also be responsible for paying for your care if such need arises.

As I mentioned before, there are some good things in the bill that passed last night. But it is sitting at the top of a very steep and slippery slope. We must continue to strive for improvements in other areas of the health care system, to encourage responsible use of our resources, to employ preventative medicine practices, and to take responsibility for the things that are within our control such as diet, exercise, and modifying unhealthy lifestyle choices. Without the aforementioned changes, it is going to be difficult to continue driving American companies, hospitals and individual health care employees to improve upon existing therapies, equipment and techniques, the very foundation that has made our system the best in the world.

It is hard to believe that a year has passed since my first trip to Uganda with the Palmetto Medical Initiative. I have definitely been pushed to the limits this past year in terms of my desire and dedication to pursing a career in medicine. I have good friends, a loving and supportive family, and have been so blessed throughout my life. Still, as I look back at what I have accomplished and look ahead at all I still wish to achieve, I can’t help but wonder if I have made all the right choices for myself. Throughout the course of my trip, I heard countless stories from other team members about how the most meaningful and special events in their lives were unexpected. I think that is why this return trip to Masindi was so important for me. I was experiencing a confusing and chaotic time in my life with all of my academic responsibilities, volunteer work, the looming boards, and trying to maintain anything that resembles a social life. I knew that it would not necessarily be the most practical decision to take 10 days “off” and travel thousands of miles to Africa to spend a week working nonstop with little sleep.

I am beginning to realize, however, that logic cannot always be the guiding light by which we make all of our decisions. Sometimes we must let our hearts take over and point us in the right direction when we lose our way. I think that is ultimately what this trip was about for me. It was a chance to return to a country that holds such a special place in my heart, to share with the amazing Ugandan people, and to use my skills both medical and otherwise to help whomever I could in whichever way they needed it. As I sat there in the same chair in the Masindi hotel looking out at the same beautiful landscape I marveled at a year ago, I can proudly say that whether by choice or by destiny I was where I was supposed to be and I wouldn’t have traded the opportunity for anything in the world. And just like last year, even though we again saw over 1000 patients in our 5 days of clinic, one patient in particular will stay with me for the rest of my life.

photo courtesy of Joshua Drake (www.joshuadrakephotography.com)

Around noon on the first day of clinic, I was walking outside when I was approached by Andrea, one of our two Physical Therapy students. She asked me to take a look at 75-year-old Regina who had been referred to our PT clinic for osteoarthritis and painful joints. In talking with the patient and through physical exam, Andrea had astutely noticed the elderly woman’s left knee to be painful and swollen. When I got to the patient, I too observed similar findings and Regina’s entire left leg from her knee proximally up to her pelvis was inflamed, edematous and warm to touch. The moveable, painful fluid mass just superior to her patella bone along with her other symptoms led me to suspect suprapatellar bursitis as the most likely culprit. Given the extent of the infection I decided to consult Dr. Richard Monk, a 2^nd year Internal Medicine resident, on the case. He agreed that the best course of treatment would be a needle aspiration of the likely purulent fluid in her knee. At that time her blood pressure was 72/58, pulse 120, respirations 18, and her temperature was 99.5 degrees Fahrenheit. She also had an elevated blood sugar of 348 mg/dL.

After we cleaned the area with an alcohol swab, I carefully inserted a 24-gauge needle into the infected area and withdrew about 5 cc of brownish pus mixed with some blood. We also gave her an injection of Diclofenac for pain and Ceftriaxone, a broad spectrum antibiotic, to aid her ailing body in fighting off the infection. Over the next 20-30 minutes as Regina was recovering from the procedure, she became progressively lethargic and exhibited signs of severe dehydration. After all, this 72 pound, frail women had walked a couple miles under the Ugandan sun and stood in line all morning in the scorching heat with little access to food or water to see our team.

We decided to start an intravenous line and gave her one liter of normal saline solution. One of the nurses Mandie, despite having only recently graduated nursing school, was able to start a very difficult line while minimizing pain to an already distressed patient. As her body consumed the bag of fluid almost as quickly as we could give it to her safely, her mental status continued to deteriorate until she became unresponsive to voice. Her pulse continued to race at a rate of 125 beats per minute and her blood pressure hovered around 70/45. Things were looking grim for a woman who only 90 minutes ago was awake and describing the relenting pain in her leg.

Over the next 30 minutes, we continued to give her fluids and monitor her status. As we hung a second bag of normal saline, Regina had become completely unresponsive and was essentially in a coma. A hundred things were flying through my mind at this point. What was the source of our patient’s sudden deterioration? Had she gotten to us too late and become septic from the prolonged infection in her knee. Had her longtime battle with diabetes finally put her into diabetic ketoacidosis (DKA) or was she in a non-ketotic coma (HHNK)? Were her kidneys functioning adequately or even at all? Could her heart handle the volume of fluids that her body demanded? and the most difficult and troublesome question for a young medical student, had our decision to treat Regina contributed to her current status or had I missed something that could have prevented this?

At this point, Dr. Monk and I attempted to explain to her daughter and nephew via a Runyaro translator about the possibility that Regina might not wake up. It was clear that the family was distraught about their mother’s sudden decline. As we presented the family with the various options, it was all I could do to fight back the tears and wealth of emotion weighing on my mind and soul. Just days earlier, I was sitting in the MUSC library reading about diseases in a textbook, and today I was helping make treatment and quality of life decisions with a Ugandan family. We slowly and as clearly as possible informed the family that Regina could either be admitted to the local hospital in Masindi, or be taken home to live out her potentially short remaining time with her family and loved ones. I was touched by the compassion and empathy with which Dr. Monk gently reassured the family that there was no wrong decision and that they should do what feels right in their hearts.

We soon learned that the main concern plaguing the family was that if Regina passed away at the hospital they might not be able to afford to transport her body home for a proper burial, a process that might cost only $25 USD. Upon realizing this, Richard, myself and other team members acknowledged without hesitation that we would help support any such costs incurred in the hospital or for any other services related to her care. After the decision was made to transport her to the hospital, we carefully crowded around our unconscious patient with family members, translators, and team members as Richard said a prayer for Regina. I will never forget how everything else around us seemed to fade away as all of our hearts and souls were focused on praying for what at the time seemed like an unlikely recovery.

photo courtesy of Joshua Drake (www.joshuadrakephotography.com)

As a group of amazing volunteers carried Regina to the van, I prepared for our short trip to the hospital during which I would be the only healthcare provider accompanied by Rachel a psychologist at the VA hospital in Charleston, Janine a local missionary in Masindi, and the patient’s nephew. We departed down the bumpy dirt road, all the while I was trying to monitor the patient’s vital signs and hold her IV bag. Rachel was busy consoling the young nephew and reassuring me that we were doing the right thing. As I could feel the hope fading inside of me, Rachel helped give me the strength to continue working and believing in the direst of circumstances. About half-way to the hospital Regina awoke from her coma, became uncooperative, and was fighting the IV. As her worried nephew tried to relay her jumbled words to us, it seemed as if Regina was stating her wish not to go to the hospital. Now I was being looked at to decide if this extremely ill, 75-year-old woman was competent to make such decisions, a job that is difficult enough for anyone with 20 years of experience let alone a 2^nd year medical student in a bumpy shuttle van in the middle of Africa. Amongst all the commotion, Regina’s IV infiltrated so Rachel and I were left there trying to control the bleeding and assess Regina’s mental status at the same time. As I tried to explain the severity of her situation, we realized that Regina was not scared of the hospital or even death itself. She simply did not want her family to bear the financial burden of her care and would rather die than lead them further into poverty because of her illness. After assuring Regina that her bills would be taken care of, she agreed to go to the hospital and soon slipped back out of consciousness.

When we arrived at the hospital, we carried our patient directly to the women’s ward. While Rachel stayed with Regina and her family, Janine and I walked about a quarter-mile up the road to try to find the superintendent of the hospital. After walking from house to house and knocking door to door for about 20 minutes, we finally found the administrator. As he stood at the doorway holding his youngest child, I explained our patient’s situation and gave him a full report of her present illness and course of treatment. He agreed to look after Regina over the next couple days during which time she would need careful monitoring of fluid levels, blood sugar, renal function and the very real risk of life-threatening sepsis. We returned to the wards and prayed once more for Regina before departing to meet the rest of the team at the clinic. While I prayed for a safe and healthy recovery, there was a part of me that didn’t expect her to live through the night.

After a long day of clinic on Tuesday, Jordan another physician on our team accompanied me back to the hospital to check on Regina. She was still alive and had improved slightly from the day before. Her BP was 84/45, her blood sugar was still elevated at 311 mg/ dL, and she was receiving IV fluids and antibiotics. As I sat down beside her on the bed to feel her pulse, she looked up at me and I felt her squeeze my hand as if to tell me that she was not ready to give up and that I should continue to fight for her. She continued to improve slowly over the next several days. She began sitting up in bed and by Thursday was able to use the bathroom. She was started on Metformin, a diabetic drug, and continued to fight. By Saturday evening, we received an update from Janine that Regina was ambulating well, her IV had been discontinued, she was taking oral medications, and she was most likely going to be able to return home within a week’s time.

To think that this woman who only 4 days ago was staring death in the face might be able to go home and live out the remainder of her life with her family and loved ones is nothing short of a miracle. It is a testament to how unpredictable medicine is and how fragile life can be. It reminds us that while our knowledge and skills are a great gift, they can only get us so far. Ask any doctor, nurse, PA, or other healthcare provider and they will tell you about the patients that had no chance, the patients that were circling the drain, and the patients that modern medicine would deem unsaveable. But, I guarantee they will also tell you about the countless patients who despite all odds recovered from their infection, who went into remission or survived the risky procedure.

While I have barely begun my lifelong dedication to helping others I too now have my own story of a patient who, guided by faith and an amazing team of selfless care providers, overcame the insurmountable “odds” and reminded me of why I wanted to go into medicine in the first place. It is a testament to God’s will and the fact that no matter how much we think we are in control of our destiny, we are all part of something greater than our individual selves. As I continue with my education and a never-ending commitment to learning I pray that I never lose the compassion and concern I feel for my patients, and I hope that the passion I have for medicine and helping heal others will continue to guide me to back to Masindi again and again.

As I recently wrapped up my 2nd year of medical school, I briefly reflected on everything I have been through in the past 2 years and all of the various thoughts and emotions I have felt. If I learned anything it is that we all need an outlet, a place of our own to express our thoughts and opinions. For some that is a spouse or a close friend but many choose to also post their reflections in the blogosphere so that others may listen, learn and hopefully provide some helpful feedback or respectful criticism. Well, I have finally decided to join the party. I look forward to sharing my thoughts on certain topics concerning a variety of subjects and personal experiences, and I hope to in return gain some interesting feedback from my readers.

Special thanks to my good friend Bill D’Alessandro for helping me get Monkeying Around up and running.

Enjoy!
Brian

There are times in life when we all feel helpless. It may be due to the stress of school or work, the inability to overcome addition, or the tragic loss of a loved one. I most recently experienced these feelings when I travelled to Masindi, Uganda as part of a medical initiative to provide healthcare to an area which currently lacks any system of care comparable to what we are privileged to in the United Sates. In fact, many Ugandans will go through their entire lives without ever visiting a healthcare facility or receiving any sort of medical treatment. After treating over 1100 patients in 4 days, there are countless illnesses and life stories that I could recall to depict the unfathomably difficult circumstances in which the Ugandan people find themselves. However, the case of one 6-year-old boy, in particular, struck me in a way which I will never forget.

I met this young boy on the fourth and final day of clinic. He was not one of the 250 patients that we had pre-registered that morning to receive care. Rather, he was thrust into the hands of fellow student Day Burruss by his friends who were playing outside. At first she wasn’t sure what to make of the boy. She thought maybe they were just playing and were interested in the mazungo (meaning “white people”) who were visiting their town. Many of them had not seen a mazungo before our trip. But as she took a closer look, she noticed something just wasn’t right. She called me over and we began to examine the young boy, who at this time wasn’t talking and looked very scared and unsure of his surroundings.

photo courtesy of Josh Drake (www.joshdrakephotography.com)

We first took his temperature and found it to be 104.5 degrees, a temperature that surely would have warranted a visit to the pediatrician or possibly the emergency room in the United States. We immediately got some children’s Tylenol from our make-shift pharmacy and gave him a dose to help lower his temperature. As we took his vital signs, we found that his heart was racing at an astounding, irregular rate. His lungs had crackles on both sides, a pretty good indicator of pneumonia among other things. His lymph nodes were swollen in his face and his abdomen was distended and his liver was enlarged. By now we had realized that this was not a child playing with his friends who accidentally ended up in our clinic. Rather his friends, many of whom were peering in at us through the metal bars on the windows, realized that we were there to help sick people, and had pushed him into our clinic because they recognized that he needed help.

As we fed him fluids and oral rehydration salts, we began trying to communicate to the boy through a translator. We eventually found out that his 7-year-old sister was also there with him. They had both been at school that day, to which they walked 2 miles both ways in the 90 degree heat from their home. He had been sick for several days, but his mother couldn’t help them because she too was home sick with malaria. Cody Carpenter, the only pediatrician who was with us, was able to examine the boy and agreed with our assessment that he most likely had the Mumps and an associated pneumonia, which would normally warrant close monitoring and possibly hospitalization. However, no such facilities or appropriate high level of care was available in Masindi.

photo courtesy of Josh Drake (www.joshuadrakephotography.com)

I spent the next hour or so with the boy, trying to reassure him and his sister that we would do our best to help them and going over the various possibilities in my head. Did we have the medicines to help him? What could I do to make sure they would get home safe? How could we convey to the mom what was wrong and how important his treatment was? As dusk set upon us and the clinic was packed up, I came to the tragic realization that there wasn’t much more I could do to help. It was not safe for us to be out past dark and we had no idea where the child lived or the conditions there. So, ultimately, we ended up giving the boy 2 medications to treat his infection and the symptoms. The next 10 minutes were spent explaining to his 7-year-old sister the course of treatment in hopes that she might be able to relay the information to their ailing mother.

After some group pictures and loading the vans, we began to leave down the same bumpy, dirt road we arrived on 10 hours earlier. As I looked out the window, I noticed the two siblings holding hands walking down another dirt path. They were carrying a couple school books and the medications and water bottles we gave them. After feeling like we had helped so many people on my short trip to Uganda, this was truly a shocking realization for me. It was one of the most difficult feelings to know that this sick boy had a 2 mile walk home in the dark with his sister. I kept wondering about what kind of home he had to go to. Did he even have a bed or a safe place to sleep? Would he be able to get the fresh water or nutrients he would need for his body to fight the infection? And the most difficult question, which I will likely never know the answer to, will he survive another week?

As I continue to struggle with the feelings of helplessness and sadness I felt at that moment, I have tried to sift through the experiences and the people I met in Masindi: the gracious hosts of the church, the hard-working translators who helped us 10 hours per day with little food or water, and the incredible patients who will never know the impact they had on my life and my outlook. I first decided to go to Uganda because I like to travel and I wanted to gain more experience for the medical education. Now that I have returned, I realize that I gained so much more than I could have ever imagined. In addition to the pain, sorrow and harsh conditions there, I witnessed an unparalleled compassion, humility, love, and generosity that will forever remain in my heart and soul.

Some might wonder how I could feel helpless when we did so much good and helped so many people during our short stay in Masindi. I do not take for granted the amount of aid we were able to provide. But rather I wanted to tell this story because of the humbling impact it has had on me. It reminds me that while we were able to do so much good, our mission is by no means complete. I get excited thinking about the future when I might be able to return to Masindi, and I hope that others will be inspired to help in whatever ways they can.

As we continue to experience difficult economic times and change here at home, we must remember that there are people so much worse off than us. We must recognize and be thankful for the values that are truly important in life: love, compassion, and generosity. As I readjust back to the stressful life of a medical student, I remember the young boy whose face is ingrained in my memory, and I am overcome by emotion. I can take solace only in the fact that we gave him a chance and hope that God will take care of the rest.