Medical School in El Salvador
February 2008

Ingrid Cherrytree - OHSU, 4th year medical student
 

“Dew drops on a rose petal!” I exclaimed excitedly to myself as I repeated the classic description of chickenpox. I leaned in closer to examine the rash on the lethargic child. Due to widespread vaccination in the U.S., as a fourth year medical student I had only seen chickenpox in a textbook. Sweat was beginning to form on my brow as the rising sun shone through the open air porch into the makeshift clinic. Around me, the noise level was increasing as more patients began to line up for care. The setting was appropriately simple, if not chaotic, for this moment of turning book knowledge into clinical experience. Before calling over the pediatrician to confirm my discovery, I quickly reviewed other common history and symptoms of chickenpox with the mother. She concurred and we quickly sent the mother and child on their way to avoid further exposure to the crowds of people waiting to see the brigade.

Having the opportunity to participate in the El Salvador Brigade is a dream come true for any senior medical student. The large volume of patients provides endless opportunities to see pathology and gain experience in one week that might take a month in an academic institution. Instead of being one of the many medical students pursuing the expertise and attention of one attending physician, I worked along side five different physicians, all eager to show me an interesting case.

However, the experience was not limited to gaining clinical and technical skills. The phrase the “art and science” of medicine is often used to describe the skill set needed to care for a patient, and during this trip the “art” of medicine meant communicating well, empathizing, learning the historical context of the patients’ suffering and educating.

El Salvador provided the context to work on all these principles of good medicine.  Some of my greatest challenges came in the areas of communication and education in gynecology, where Dr. Hacker and I completed xx Pap smears, pelvic and breast exams.  Never did I imagine that I would be explaining to a 50-year-old woman with 10 births under her belt, what a Pap smear was and how it could improve her health. Nor was I prepared when another woman asked in response to my explanation that during a Pap smear I will remove cells from her cervix, she wondered, “What are cells?” Good question I thought to myself, what the heck are cells?!

One of the most appreciative responses from a patient that Dr. Hacker and I got was from a female patient who wanted to know why she was unable to become pregnant. After carefully investigating her birth and medical history we surmised that her previous pregnancy, a 5 month old ectopic pregnancy that ended in an emergency operation to save her life, was the most likely cause. We concluded that it was unlikely she would become pregnant again. She considered the news carefully, her eyes gazing down; we paused respectfully, not quite sure if tears would be in her eyes when she looked up. Instead, she stood up and smiled gratefully. Now she knew why she had not become pregnant again. She squeezed us both tightly in her arms and left unceremoniously. Working in an environment that is resource poor, it is satisfying to know that sometimes, knowledge is the best medicine.