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Extending The Mission: Family Medicine And Global Health

Practicing low-resource family medicine in developing countries revitalizes this family doc's love of his specialty. He encourages other family docs and trainees to take part in international medical trips because of their close alignment with the scope and values of family medicine.

By Mark Ryan, M.D.

I was born in the Dominican Republic, but only lived there for a few months. As a child, I lived ten of my first 16 years in Latin America: four in Venezuela, four in Argentina, and two in Panama. After graduating from VCU School of Medicine in 2000 and completing my family medicine residency in Blackstone, VA, in 2003, I joined my first international medical trip. From my experiences growing up and my interest in returning to Latin America as an adult, the opportunity to work overseas as a physician—in a profession focused on service and on providing care for those in need—was exciting, and the experience was fulfilling. 

On the first day of clinic, I looked out over the rugged hills of rural Honduras stretching to the highway and saw our patients lining up for care, having arrived on foot, on horseback, or in shared vehicles. I was both anxious and excited about medical care in this setting: no x-rays, no labs beyond urinalysis or pregnancy tests, no specialists or specialized diagnostic equipment. We took care of patients by taking a good history and completing a careful physical exam. The history and physical exam, our clinical judgment, and help from colleagues were our only resources. As a just-graduated resident, this was thrilling and validating. Thrilling because I had to rely on my skills, and validating because my family medicine training from a rural residency program allowed me to provide the care these patients needed.
Since that first trip, I have led 14 medical trips to Santo Domingo, the capital of the Dominican Republic. The first trip, in 2005, included undergraduates from my undergraduate alma mater, the College of William and Mary. I would now call this trip a “duffle bag medicine” project. We had put little thought into how we would fit into the local health care system, and we had little consideration of sustainability or our long-term impact. After that trip, we regrouped and returned to the Dominican Republic with a long-term commitment to provide medical care and work to improve community health in a sustainable manner. I have continued to lead medical trips to the Dominican Republic since then, in collaboration with the Dominican Aid Society of Virginia (DASV), William & Mary’s Student Organization for Medical Outreach and Sustainability (SOMOS), and VCU’s HOMBRE organizations. We now travel to the DR twice a year to provide direct medical care and work with the community to address underlying challenges to health and wellness.
These medical trips are highlights of my year. Despite being a lot of work to organize, I return from these trips renewed and invigorated by practicing medicine without regard to CPT or ICD-9 codes, billing sheets, and required documentation. On these trips, medicine is returned to its essential components: the dyad of patient and physician within the setting of the patient’s family and community. Beyond the personal value, though, I believe that participating in global health projects extends the mission of family medicine to communities overseas and to medical school and residency trainees who travel with us as part of our team. The way I see it, global health work aligns with the following key components of the specialty of family medicine:
  • Thoughtful and appropriate medical care: We provide care for acute illnesses and chronic disease; we address with mental health issues and provide preventive check-ups; and we help identify patients appropriate for our outreach clinic and those who need formal care and follow-up within the local health care system.
  • Community development and social determinants of health: As explained in the bio-psycho-social model of care that is at the center of family medicine, illness and disease do not exist in a patient in isolation. Rather, health, illness, and disease exist in the context of the patient’s surroundings as well as their own individual risk factors. On these trips, as physicians and other health care providers provide direct health care, SOMOS and other team members work with the community to identify its health care priorities and develop community-driven, sustainable solutions.
  • Teaching: Whether we are teaching our patients or our trainees, teaching is at the core of what we do in family medicine. Each of the medical trips to the Dominican Republic incorporates trainees at multiple levels, including undergraduate pre-med students, medical students in the pre-clinical and clinical years, medical residents, pharmacy students, and pharmacy residents. These trainees have experiences that resemble my first trip to Honduras. Cast loose from technology and readily available resources, they learn to listen to patients, to focus on the clinical setting, and to work through difficult situations with limited resources. These experiences stand to make them better physicians and providers in the future.
  • Research and scholarship: In the process of providing clinical care and working on community development projects, we have the availability to engage in research and scholarship that will improve our ability to provide medical care for acute and chronic illnesses in the community as well as better understand the organization of the community itself. Our experiences can inform others, and we readily share our knowledge with others doing similar work.
Global health projects are both well within the scope of family medicine practice and aligned with our specialty’s goals and vision. At the practical level, family medicine residents and physicians are ideal participants global health trips. With our community focus, our scope of practice and our whole-person orientation, family medicine physicians can take on any role on these trips without regard to patients’ age or gender – no accommodations and no restrictions needed. The alignment of the project’s needs with family physicians’ abilities is notable, and it makes leading and participating in these trips rewarding and renewing, and continues to validate my choice to enter family medicine 13 years ago.

Mark Ryan, M.D., is a family physician working with medically underserved communities in Virginia and in the Dominican Republic.  He has been recognized for his teaching and community service, and divides his time between clinical practice and teaching.  Dr. Ryan blogs about health care, social media and health care communications, and he is interested in exploring how social media can improve health care for physicians and patients.

This post first appeared on STFM's blog and later on Ryan's own blog. It appears on
Progress Notes courtesy of the author.

Further reading
Posted by Sonya Collins on Jul 15, 2014 9:47 AM America/New_York
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