Of the experiences I had in residency and the stories I tell over and over again, my time in Karatu is the one I reference the most. I cannot even truly enumerate all of the things that I learned there, which ranged from clinical skills and reasoning, to the business of medicine and public health. The rotation I spent there was truly formative in my style of practice, making me a better neurologist, teaching me the importance of healthcare quality and safety, and allowing me to contribute to social good through teaching and clinical care.
Learning to practice in a resource-limited environment was a test of clinical skills including physical exam, localization of lesion, triaging of problems and prioritization of testing. We could not simply rely on other experts or advanced diagnostic testing. For the patient with hand weakness that came in, with large burn scars covering his right arm, we were forced to think carefully and ascertain the localization of his lesion based on examination alone, without the assistance of imaging or EMG. In the realms of treatment, we had to consider the whole patient carefully, including the social context in which they lived, and tailor treatment accordingly — what is the distance this patient would need to travel to obtain their medications? Do they understand that they need to take this medication every day? Every patient came with a piece of critical thinking, rather than rote protocols to follow and panels to order.
The frustrations of local healthcare delivery were educational as well. In an environment like this, it can be very easy to slip into a learned helplessness, an apathy of "well, we did what we could." I have been in other resource-limited areas of the world in which this is true, but not at FAME. FAME embodies the true spirit of quality improvement and patient safety initiatives, which is quite simply asking the question repeatedly, "What can we do better?" I felt that at FAME, I learned more about the best ways to approach healthcare quality and safety improvement from the ground up, and doing so in a cost-effective fashion. I think that these larger systemic initiatives in trying to deliver quality care to patients may have the most impact on the region, perhaps even more so than just seeing individual patients -- it sets a standard for the area which other local hospitals will try to emulate in order to compete.
Seeing patients in this way, carefully considering each case one-by-one, and maximizing resources to do the most good for each patient, enabled us to feel like we were truly doing the best we could for each patient. Often times in residency, one can lose a sense of personal accomplishment -- there is always another consult to see, another call night, another rotation. However, at FAME, the mission of education and patient care, put into perspective by our medical leaders Dr. Rubenstein and Dr. Artress, made all of us who went feel like we had truly done good in the world, that we had made a difference in the lives of the people living in and around Karatu, and made a difference in the lives of the staff working there. That sense of shared mission is clearly evident in everyone there, and it renewed my sense of hope and ambition in my chosen profession. If there is a solution to residency burnout, this feels like one of them.
Global health opportunities were one of the reasons I chose to train at Penn, and my time at FAME with Dr. Rubenstein and Dr. Becker went above and beyond my expectations. What FAME has been able to accomplish in its community has been nothing less than remarkable, and the visiting resident rotation is a program that I feel strongly should be nurtured and expanded as we continue to serve that community and build up a standard for neurologic care in such areas.
