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03 May 2019

Reflections on my journey into global health

By Maryam Soomro

In early 2018, I travelled to Pakistan to visit my relatives for the first time as a medical student. In a country with a vibrant and welcoming culture, I found that the news of my career choice spread quickly. In no time, I was invited to attend, observe and participate in a number of learning opportunities under the guidance of my aunt, a GP who mentored me through a new medical culture and my first encounter with global health.

Of the many differences I saw in medical practice, the commonalities that struck me most was that the ideological approaches to health are shared by healthcare providers worldwide however the challenges we face differ from country to country, creating a subculture in each country’s healthcare system. The time I spent in Pakistan became my stepping stone into the world of global health.

My initial impression of Pakistani healthcare providers was that their emphasis on patient histories and examinations and in-depth understanding of infectious diseases was more pronounced than I had previously encountered in my rotations in Victoria, yet it seemed to stem from the seemingly universal healthcare ideologies we all share.

The way medicine is practised in Pakistan follows a similar model of patient-centred care that we have in Australia; however, given the challenges faced by the general population, it manifests in an entirely different way. Patients there face poverty, a lack of public health awareness and inaccessibility to health care, due to both distance and cost. I soon understood that many investigations bore out-of-pocket costs that patients in Pakistan often could not afford; as such, doctors honed their history-taking and examination skills to perfection.

From GPs who analysed the individual aspects of the JVP waveform to formulate a differentials list, to interns who performed ascitic taps without ultrasound guidance, watching doctors practice medicine without resources was a humbling and awe-inspiring experience. I also saw doctors addressing the rising challenge of bacteria that was resistant to a multitude of antibiotics – a challenge that our public health system is soon likely to face. I find I am eager to learn more from my overseas colleagues and share what knowledge I have learnt from my mentors here in Australia. The colleges seem to be amenable to this, with RACP, RANZCOG, and ACEM all offering accredited supervised overseas rotations.

My first global health venture was a very holistic one; alongside gaining knowledge and experience in different medical settings, I gained greater appreciation of the history and culture of the region. From trekking the Himalayas to yoga at the beaches of Karachi, I found myself in a country of stark beauty and immense history. Buildings from the Mughal era rubbed shoulders with their British colonial counterparts, and Buddhists poured into Taxila to recount the Buddha’s steps, while the Sikh pilgrims came to Lahore to visit the birthplace of Guru Nanak.

By culturally enriching myself in this way, I found that on returning to Australia, I can now build rapport with patients from the subcontinent about several aspects of their cultural backgrounds, from poetry to food to their opinions on Ayurvedic herbal remedies. Learning from a hospital outside of Melbourne had the added adventure of cafés and brunch spots being replaced by chaiwallahs and hawkers selling samosas, parathas, and all manners of meat on skewers and curry. Breaks between lectures for me soon became a (very cheap) culinary affair. I found myself living and learning medicine, food, culture, philosophy and art, with subtleties revealed beyond the confines of tourism in the humdrum of every day life.

One of the greatest gifts I brought back from my global health journey is one that I only appreciate just now in my current elective rotation, namely the understanding of the nuances of culture, and how it influences the patient-doctor relationship. Despite my own experiences growing up in a Pakistani family, I had never really realised what a Pakistani patient-doctor relationship looked like until I had entered that setting as a healthcare provider.

The relationship does not just involve the doctor and the patient but also their family, which is often just as, if not more, invested in the health of the patient as the patient themselves. In one case I recall a young patient with renal failure whose older sister had attended a GP appointment instead of him to discuss the implications of renal failure – he had been too busy attending a wedding to attend his appointment.

I found that I had grown in my understanding of collectivist cultures and the way they shape decision-making, a soft skill that is not covered by most medical schools in Australia yet is vital in bridging the gap for our migrant and Aboriginal communities. I now look forward to my next overseas placement, not just for the sake of travelling, but also for the opportunity to learn more about the backgrounds of my migrant patients and the practice of medicine by my colleagues across the world.

Since my venture into Pakistan, I have completed rural rotations and rotations with an Aboriginal health focus. My current rotation will involve me in refugee health here in Victoria. As I grow in my skills and capacity as a doctor, I cannot help but reflect on how a global health perspective has molded my abilities and pushed me beyond my comfort zone, at times even allowing me to meet my patients in theirs. I find myself wondering where my passion in global health will take me and what it will teach me. For all I know I could be doing obstetrics next to the pyramids, psychiatry in the Pyrenees mountains or paediatrics in the Amazon.

* Maryam Soomro is a member of the Australian Medical Students’ Association



Published: 03 May 2019