This week marks the third week of our stay in Zimbabwe, and as such, this amount of time has allowed sufficient introspection regarding the culture of medical practice in Zimbabwe and the people themselves. As we spend more time with the medical system here, I find myself becoming more in awe of the students and medical faculty.
Let me preface this by acknowledging that the financial and resource limitations surrounding the medical system is an issue which does exist and can manifest in many ways. For example, there are patients unable to get the procedures they need, maybe due to a lack of equipment, instrumentation, medications, staff to administer treatment, or, most commonly, money. Interestingly, this financial limitation is often on the hospital’s end, but rather related to the ability of the patient to afford the next test or treatment.
One of my first thoughts upon viewing the medical system was that I incorrectly thought that a system without money needed for an adequate number of resources could not maintain prompt and effective continuity of care necessary to treat patients. Though some of these limitations can be a barrier to care, what I have learned is that the word “adequate” is truly relative, a term that is redefined within the context of Pari. In the vein of “necessity is the mother of invention,” the medical practice here at Pari has developed many ways to combat the limitations that they seemingly face. The medical system has evolved its strengths in a way unique to Zimbabwe, which is what I feel makes this system inherently special and a pleasure for international students and faculty to visit.
For example, the most common day-to- day patient presentations at Pari are respiratory, gastrointestinal, or neurological issues that might require extensive imaging (e.g. TB, COPD, strokes, etc). However, I was lucky to partake in a tutorial with fifth year medical students this week in which students practiced their respiratory exam on a patient to formulate a diagnosis. The instructor called upon the students one by one to practice a component of the exam, such as examining fingertips for asymmetry, general appearance for signs of respiratory distress, lymphadenopathy, etc. It was a meticulous process in which students were assessed on their ability to be specific and recall information with precision. The students ultimately progressed to diagnose the patient with a pleural effusion and its location, solely on the basis of auscultation, chest movement upon respiration, and tracheal shift. The professor emphasized to the class that there was really no need for imaging in this case if the physician had conducted a proper physical exam, upon which the diagnosis would essentially present itself.
This type of comment embodies the philosophy of the teaching system here at Pari, where students are indeed taught how to utilize and analyze imaging modalities when possible, but are taught first and foremost how to use their hands, eyes, and ears to conduct a thorough physical exam which guides their diagnostic thinking. Also noted and emphasized by numerous instructors is the value of thorough history taking, in that, along with the physical exam, it can often elucidate the diagnosis.
There are aspects of this approach that resonate with the clinical philosophy at UVMCOM. For example, we already know history taking to be a critical part of making a clinical decision. Nonetheless, throughout the next few weeks at Pari, I recognize that I have a unique opportunity to really build upon my ability to use my hands, eyes, and ears to understand patients, simply by acting as an astute observer of the skilled medical faculty.