I went to Lady Willington Hospital in Manali, India during my third year of residency for 4 weeks. Manali is a rural hill station (small town) in the state of Himachal Pradesh in north central India. The Lady Willingdon Hospital is a Christian mission hospital that has been serving the local community since 1935. The catchment area is extremely broad, serving patients up to 10 hour drive on poor quality mountainous dirt roads since there is minimal medical infrastructure in the this area (Himalayan Mountains).

I stayed on the hospital campus (they have small rooms available for rotating trainees) and there were several students from the UK also doing an elective rotation. In the morning we did hospital rounds on infants and children, patients hospitalized for medical conditions, and post-surgical patients. In the late morning and through the afternoon we did outpatient clinic, which was essentially an acute care clinic. There is very little chronic disease management or focus on health prevention. Basic laboratory testing and X Rays were available when absolutely indicated. There is also a labor and delivery room (which I did not participate much in, given that I was an Internal Medicine trainee) and an 24-hour Emergency Department.

I saw a wide variety of illnesses, including TB, Scrub Typhus, Entamoeba histolytica, dysentery, a variety of worm infections, and typical bacterial pathogens. There was a high number of accident-related injuries, primarily from MVA’s and unsafe work conditions. Older people presented with respiratory symptoms, probably from some form of obstructive lung disease from smoke exposure from cooking fires and inhaled dust/dirt from hard labor.

Throughout my elective, I was impressed that the staff at Lady Willingdon Hospital were able to provide excellent care with minimal resources by our standards. I did experience a degree of ‘culture shock,’ but overall it was a very valuable experience and I am thankful for the opportunity to travel to India during residency. I felt safe throughout my time in Manali, the scenery was amazing, and I had the opportunity to meet many wonderful people.

I spent 2 weeks in the village of Agbozume, Volta Region in Ghana in the Spring of 2017 during my 3rd year of residency. This was my second time visiting and providing healthcare to this community of mostly farmers and traders. It was very positive experience for exposure to clinical work, community education and understanding disparities in healthcare access. I was exposed to multiple array of interesting pathology and medical cases, some with very limited resources for further evaluation and management. I had to make grasp of whatever limited options I had to pursue care of these people. Exchanging ideas with local physicians and people in the community was also very educative. I plan to continue to visit Agbozume.

I am thankful that the medicine department could support me in many ways for my trip to Ghana. I will encourage many others with interest in International Health to consider this tremendous opportunity.

I spent the last 3 weeks and a half in Niamey, Niger. Niger is a landlocked country in West Africa. I worked under the supervision of Dr. Susan Beebout in the Clinique Olivia, a clinic in a poor part of the city associated with Evangelical Church of Niger. During my time in Niger I had the unique opportunity to work with an underserved population and with limited resources. I had the opportunity to see and help a broad spectrum of patients with a broad spectrum of pathologies, including diabetes and hypertension, typhoid, tuberculosis, sickle cell disease and many more. I would see around 10-12 patients daily with the help of a medical assistance that will also serve as translator. Most patient speak only their native language (Hausa, Zarma) and only around 20% speak French. Only very limited labs were available and most patients were not able to afford extensive diagnostic work up.

Practicing in an environment where laboratories test and imaging are not readily available I learned to trust my history taking and physical exam, and to formulate a clinical assessment with just limited information. Having to serve a population with limited resources strengthen my resourcefulness and taught me about cost-effectiveness in a very direct and practical way.

During my rotation in Niger I had the opportunity to spent one week at the National Hospital of Niamey, where I was part of the team taking care of 32 patients in the women general ward. I learn about the logistics of patient care and education in a teaching hospital and the day to day life of my colleagues residents in Niger. Even though the National Hospital is one of the main three hospitals in Niamey, the capital of Niger, there are no ventilators, angiography or MRI, and most medications routinely used in US are not available there, at all. Being able to see the highest level of care that is available in one of the poorest countries in the world, compared with United States, was a humbling and enlightening experience that I feel fortunate to have had and I m positive it has enriched me no only professionally but personally.