Med School Without Borders

by Isaac Arnsdorf:

On a routine home visit in South Africa, Yale medical resident Scott Heysell found his patient—malnourished, dehydrated and suffering from AIDS—sprawled on the ground outside her hut, where her sons, powerless to help her, had left her to die.

He helped evacuate her to the hospital, where she was resuscitated with intravenous fluids and given medications to treat her infection and HIV. Before Heysell left South Africa, he saw her again. She was walking and smiling. Her hair, which had been matted and caked with insects and mud, was clean and combed.

A classroom building on Yale's campus. (Courtesy Manning)

Now a chief resident at the Yale School of Medicine, Heysell was working for over a month in a remote hospital in Tugela Ferry, South Africa, as a Physician Scholar in International Health. The program, co-sponsored by Yale’s medical school and Johnson & Johnson, aims to provide medical residents from Yale and other universities with international health experience while improving health care in under-resourced communities worldwide. Living in hospitals or with host families, physician scholars perform inpatient and outpatient care and staff clinics, emergency rooms and intensive care units.

Over the years, the program has adjusted its focus from simply sending residents to various destinations worldwide to establishing a sustainable presence at five primary rotation sites: Uganda, Honduras, Eritrea, South Africa and Vietnam. “We focus on capacity-building at those sites,” explained Laura Crawford, the program’s administrator. “You don’t get that from sending someone over for just six weeks. You need a sustained presence that helps fit the needs of the community.”

The Uganda site, established last August by a memorandum of understanding signed between Yale and Makerere University in Kampala, is the newest community that will partner with the Physician Scholars program. The new partnership exists largely thanks to the vision of Yale School of Medicine Professor Majid Sadigh, who was disturbed by the decrepitude of Uganda’s patient care services.

“Their medical education was fantastic, no question,” Sadigh observed. “But the health care was very frustrating and depressing. They were deeply involved in medical research, but I did not see that translate to medical care.” Sadigh also observed that hospitals built to treat only 1,500 patients have been pushed to accommodate as many as 5,000.

As the scholars in Uganda, like elsewhere, try to help the overburdened medical infrastructure deal with the AIDS crisis, their direct contact with patients immerses them in the more human dimension of medicine, removed from the MRIs, CAT scans and high technology that tend to dominate American medical practice. “It gets back to the basics of helping patients and not just looking at a scan,” said Michele Barry, the program’s director and co-founder. Sadigh agreed: “In Mulago, it’s just you, your patient and your stethoscope,” he said.

Though it predates Yale President Richard Levin’s “global university” initiative, the program represents the extension of Yale’s internationalization process to the graduate schools. Moreover, according to Heysell, it presents a global image of Yale that is a major draw for many medical school applicants. Between a quarter and a half of all Yale residents go abroad on the program over the course of their three years.

“Most of the people who go abroad aren’t interested in communicable diseases as a career, and will spend most of their time in the U.S. practicing traditional medicine of all forms,” Heysell said. “But it changes their consciousness and awareness and contributes to a much more complete education.”

Yet is the program simply, as Heysell himself termed it, “medical tourism?” Some doubt whether the program really makes a difference in the communities it purports to serve as much as it just allows the American participants to have an exciting international experience. This sentiment motivated administrators to emphasize building a sustainable presence at primary rotation sites rather than scattering interns across the world, Barry explained.

For Heysell, his service in South Africa was more than just a one-shot adventure. He and his wife, also a medical professional, plan to return to South Africa next year to work in an HIV clinic, where they will help teach the next round of scholars.