Aaron Becker ’17 – I recently had the privilege of taking part in a medical internship for the month of June in the Philippines through Child Family Health International. CFHI is dedicated to providing community-based global health education programs, which focuses on empowering local communities. The entirety of my trip was focused on global health, the Philippines’ healthcare system, public health, and community health. For the first week of the program I had the opportunity to visit a number of different healthcare facilities in Manila, the capital of the Philippines. I was joined by two other undergraduate students, Sara and Zoe, from New York and New Jersey. We were guided by two doctors, Dr. Paolo and Dr. Joel, through places such as the Department of Health, World Health Organization, University of Saint Thomas medical school and hospital, Philippines General Hospital, University of the Philippines medical school, and even the smallest volcano in the world at Tagaytay. The time that I spent in Manila was incredibly eye opening. I was able to try all kinds of different Filipino foods, visit a number of different malls, ride in Jeepneys, see historical sites, and of course visit the different health care facilities. Perhaps the most memorable part about seeing the different healthcare facilities was the stark contrast between different wards in Philippines General Hospital. On one side of the hospital there were wards that were only for patients covered by PhilHealth, their national healthcare coverage. These had no air conditioning, heavily crowded rooms, and insanely long lines. We met one patient that had been there for five hours and was only just getting seen to have his x-ray examined to be cleared for work. Yet, in another section of the hospital, there were wards for patients who paid higher premiums for their coverage. These had air conditioning, nicer waiting rooms, shorter lines, and smaller room for greater privacy. It was shocking to see such obvious differences in provided facilities for those who were able to pay versus those who could not; especially considering that the wards were in the same hospital where those who couldn’t pay could see.

After the first week in Manila I spent the next two and a half weeks in the remote island town of Quezon, Quezon. We were guided and instructed by Dr. Jana and the group of nurses and midwives that she worked with. Our time was spent shadowing Dr. Jana and the nurses as they handled consultations, emergencies, and child births. We were able to travel throughout the island by motorcycle/tricycle with the nurses to visit smaller health stations and reach even more remote regions. A typical day consisted of shadowing the nurses from 8 AM to 5 PM at the Rural Health Unit (RHU). However, we also took trips to Barangay Health Stations (BHS) with one or two nurses to reach patients even closer to their homes. These are smaller stations that are located within every Barangay, which are smaller sections of the town. Patients presented with a variety of different health concerns but some of the most common concerns included: high blood pressure, high cholesterol, cough, cold, fever, and prenatal checkups. However, the most interesting thing that I was able to witness was a live birth. The RHU has a side building dedicated to births and caring for mothers before and after they give birth. The room itself has no air-conditioning and no windows making it the hottest room I have ever been in. Fortunately, even in the extreme heat, Dr. Jana and the nurses were able to deliver the healthy baby without any incidents. Seeing a baby birthed did not make me want to be an OBGYN, but it was certainly an amazing thing to witness.

Another highlight from my time in Quezon was being a part of their first ever dengue virus school vaccination. Like malaria, dengue commonly spreads through mosquito bit, and can cause intense fevers and rashes. Dengue has just begun to emerge in the Philippines and the vaccination has only recently been developed. We went to three different schools to administer the vaccinations and ensure that each of the students received a card detailing their follow-up dates. Though the three of us were not able to actually give the vaccinations we were still able to assist the nurses in preparing them and interact with the children. This was my first real taste of having to honor medical ethics outside of the United States. Though I likely could have easily administered the vaccinations I agreed with CFHI’s stance on having us not administer them. It made me feel a bit useless at times not being able to perform the regular tasks of the nurses, but it was certainly an important lesson in ethics and humility.

The trip has transformed me in a number of ways. First, it has given me confidence in the kind of medicine that I want to practice. I am much more certain that I want to be a family physician and that I want to work in a community setting. It was incredible to see how influential Dr. Jana was on the island. Everyone recognized her as the town’s doctor and trusted her to care for them to the best of her ability. They knew that she was a part of their community and had a genuine concern for their health; that’s the kind of setting that I want to be in. Second, this trip has taught me a lot about the influence of religion. The Philippines has a majority of Catholic followers and it has a strong effect on government policy. The church had recently shown its disapproval of a healthcare bill that would have provided greater access to contraceptives and lobbied to have to bill blocked. The bill did end up passing, but the budget for the bill was slashed, making it nearly ineffective. Whether or not this decision is morally right, it is interesting to see how great an impact the Catholic church has on the Philippine’s government in comparison to the United States’ government. My religious studies at Wabash have mostly covered religion’s impact relative to America and seeing its effects on the Philippines has broadened my understanding of its impact. That leads me to my third take away: perspective. I have never had the chance to see healthcare, culture, and life in general outside of the United States until this trip and it gave me an entirely new outlook on all of them. My perspective on global issues and topics had been fairly shallow due to my lack of global experience. However, now that I have had the opportunity to live in and experience another country I feel much more prepared to consider global issues. In particular, this trip has made me consider our healthcare system, what can and should be done to improve it, while also giving me a better appreciation for the strengths that it has. My experience in the Philippines will be one that I never forget and will take with me no matter what career path I end up taking.

Anthony Douglas ’17 – In a recent New York Times article, a list of the 10 worst/hardest places to live in America was created. Out of the 10, 6 of those places were in Eastern Kentucky. If you’re a movie lover, you’ve likely seen a show or two that depicts the stereotypical rural Eastern Kentuckian as a moonshiner, drug addict, poor, hillbilly, and uncivilized person. “You better keep both eyes open,” “Be careful around them mountain folks,” “Don’t go anywhere by yourself,” “You’re going where? Oh, we will definitely pray for you.” This is just a small portion of some of the things I heard prior to my internship in Eastern Kentucky.

The road to Kentucky was a pleasant change from the flat lands of Indiana. The Appalachian Mountains are a sight for sore eyes, and make for a beautiful sunset. The first culture shock I received was the extremely narrow and windy roads that allow for “easy” transportation between hollers (or what non-Appalachians would call hollows). If visiting, don’t be surprised if you see equal amounts of ATV’s and 4-wheelers as cars, especially during the winter because it makes for efficient transportation and short cuts across the mountains. Make sure you take it easy going around the curvy roads, as veering off the road for a slight second may send you tumbling down the steep mountain hills. Appalachian Kentucky is a very special and unique place‑-one of the best things about it to me is how peaceful and simple life is in the mountains. Being from the city, I’ve realized how caught up we get in the hustle and bustle of city life, and how a lot of times we can become so self-absorbed that we don’t enjoy the simple things, like the people around us. You’d be surprised how much you learn about yourself, and life in general, when you’re able to come to a place like this. As I’m typing, I find myself outside of my room on the swing looking up at the mountains enjoying the sound of nature.

Douglas interacting with children from Eastern Kentucky.

More often than not, stereotypes are unreasonably large generalizations of a group of people. The negative stereotypes that exist of Eastern Kentucky have been very inaccurate from my experience thus far. All the preconceived notions I had about this place quickly dissipated within the first few weeks of interacting with community members. Eastern Kentucky folk are about the nicest people you’ll ever meet. Everyone knows everyone, last names are repetitive because generations of family stay put due to their love for their home, and people are genuinely interested in knowing who you are and developing a relationship with you. It’s honestly one big family. Poverty exists everywhere, and although certain areas of Eastern Kentucky are poverty-stricken, I would venture to say it is not significantly more prevalent than in other areas in the country. However, the difference lies between urban and rural poverty, each of which comes with its own set of issues. For instance, in rural Eastern Kentucky those living in poverty differ from the urban impoverished based on access to clean water, safely built homes, safe transportation across the mountains, and diversity in healthy foods (beans and cornbread make up the common diet of Appalachians). Much of the poverty that exists can be linked to the mono-economy that this area is heavily dependent on: coal. As federal regulations increase, the coal industry is seeing many contractors going out of business and laying off many coal miners. This reality has been detrimental to the economy and quality of life of many rural Eastern Kentucky areas. Additionally, advanced techniques in mining like stripping (blowing the caps off the mountains to retrieve coal) pose a threat to the environment and can lead to public health issues. The topic of coal mining is a very sensitive subject in this region, especially after incidents within the last two decades of miners losing their lives in explosions.

This summer has been very informative because I’ve been able to witness these problems first-hand, and understand the societal factors that are involved due to the shadowing and volunteering opportunities I’ve had. It has also been very helpful for me to see what rural health care is like. Rural health care here in Eastern Kentucky is plagued with a lack of primary care doctors. There’s a shortage currently in general of physicians going into primary care, which is alarming because primary care doctors are often the first line of defense in terms of treating and recognizing health ailments. With the shortage of primary care physicians in this community, nurses and nurse practitioners are taking on much larger responsibilities in the clinic and hospital. Many procedures/services that you would expect to be available in the hospital like labor and delivery aren’t offered because there’s either a lack of physicians, or lack of funding to have units that cater to those needs. For certain procedures, patients must travel to Lexington, KY or other hospitals miles away.

As this past week marked the halfway point of my internship, I can’t believe how much I’ve learned and grown. In a typical week, I’ll shadow and volunteer at the Hospice of the Bluegrass in Hazard, KY, lead activities and lessons at Mountain View Elementary School about nutrition and exercise, or volunteer and participate in community engagement activities. This summer I’ve shadowed nurses and doctors, sat and talked with patients daily, worked at a local café and food pantry, collected data for community surveys, led sessions on nutrition and proper exercise, assisted in running health fairs and fundraising events, and the list goes on. My summer has been very rewarding, and has given me the space to grow spiritually, emotionally, and mentally. There has been points in this summer that have been very frustrating for me. Sometimes the feeling of wishing I could do more to help discourages me. However, I’ve come to realize that this summer experience is not about making a major impact on the community I’m serving–that’s unrealistic and naïve. This experience is about learning, gaining skills in servant leadership, and interacting with a different culture in order to effect change in my community, and future communities I find myself in. As the time approaches for me to return to Indiana, I’m very excited to take advantage of every opportunity I can to learn, and possibly spark a partnership between the Wabash Democracy and Public Discourse Initiative’s own Democracy Fellows. Through conversations with local county leaders in Eastern Kentucky, there may be an opportunity for the Fellows to come to Appalachian KY and lead conversations concerning community issues plaguing the counties.

In conclusion, I think it’s very important to keep in mind that life is very short, and can bog us down if we allow it. We must learn to appreciate the simpler things in life like kin (family) and friends, the beautiful green earth God has blessed us with, and good food. That’s the Appalachian attitude. I’ve thoroughly enjoyed my time in Eastern Kentucky, and I’m strongly considering the possibility of returning to practice medicine here one day.

Bilal Jawed ’17 – When imagining a hospital, you may picture a physician or nurse at the bedside of a patient. Working in the administrative offices of Indiana University Health has made it clear that this image is only the outer, most visible layer of a hospital. Behind each white coat there are hundreds of layers: nurse practitioners, lab technicians, pharmacists, social workers, chaplains, students, and volunteers, all playing their role magically in unison, just so that doctor can send a patient home after a successful surgery or treatment. In reality, it’s not magic; it’s health care administration hard at work in the background. As health care administration is not limited to a single department or task, my role at IU Health is not either; I spend my days researching in medical staff affairs, attending hospital leadership meetings, or helping provide a safe standard of care with the Infectious Prevention Team.

One of the most pressing issues facing the IU Health hospitals is the challenge of hospital-acquired infections (HAIs), particularly central line infections. HAIs are illnesses acquired from simply being exposed to the environment of the hospital as a patient; they are estimated to kill more individuals than motor vehicles accidents, breast cancer, and AIDS combined. Approximately 1 in 25 patients develop a HAI and 1 of 9 of those patients will die from their infection. The place where people go to heal, the hospital, can actually be one of the greatest killers. The death toll for such a problem that is theoretically completely preventable is absurdly high.

Jawed getting real experience at IU Health.

Working with the Infection Prevention Team, one of my main focuses is to act as a driving force to reduce HAIs at the hospital. Because IU Health is such a massive, intricate, network of hospitals and facilities, the best approach is not on the front lines with patients, but often behind a computer screen or in the meeting room. For example, one of my projects is to write, edit, and streamline the IU Health policy and procedure for central lines. Central lines are catheters placed in veins that are often the greatest HAI offenders. A new standardized policy will eliminate erroneous and careless health care choices and help physicians and nurses make more scientifically based decisions.

As an Infection Preventionist, your job is often defined by its failures rather than successes. It is much easier to measure a life lost by a mistake than one saved by a novel health measure. This doesn’t, however, stop the Infection Prevention Team from doing whatever necessary to possibly save a life. There is the conventional: currently I am helping implement a central line curriculum to educate incoming medical interns; and then there is the unconventional: passing out mints to doctors who forgot to wash their hands with notes attached that read: “I’m sure you mint to wash your hands”.

Whatever the case, IU Health’s many moving parts never allows for a dull moment. I was fortunate enough (or misfortunate enough) to be witness the Joint Commission unannounced inspection –an event that usually only happens once every few years. Joint Commission is the national accreditation body responsible for assessing hospitals and confirming they meet good practice standards. Licensure is on the line when Joint Commission visits, which means absolutely everything. Although IU Heath is one of the leading facilities in the nation, with so many rules and regulations, it is easy for a few items to slip through the cracks. And when Joint Commission visits, a little crack sealing is required, such as buying all plastic containers larger than 3’x2’x0.5’ in the downtown area and racing through the hospital and placing them to meet a forgotten health code. I am currently serving on the task force addressing the recommendations left by the Joint Commission in hopes of making the hospital as safe as it should be.

I have been fortunate for this opportunity to peel back the layers of this amazing network of healthcare. I would like to thank the IU Health Scholars program, Mrs. Jill Rogers, and Mr. Steven Jones for making this opportunity possible. I would also like to thank Dr. Ryan Nagy and the entire Infection Prevention Team for being so warm and welcoming to their work and projects.