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Student medical experiences in developing countries drive passion for primary care

(ATHENS, Ohio – Jan. 28, 2015) For years there has been a decline nationally in the number of medical students choosing to practice primary care, which has contributed to a physician shortage in rural and underserved areas. However, interest in primary care among Ohio University Heritage College of Osteopathic Medicine students has remained strong. The reasons vary.

The decision to go into primary care could be influenced by growing up in an underserved medical area, a poignant moment in a student’s own health history, a positive encounter with a doctor they’ve known, or a life-changing experience halfway around the world. That was the case for Heritage College graduates Sarah Simpson, D.O., and Amy Simpson, D.O., who spent time in a remote, dusty village in Kenya where people walked miles to see a doctor and silently endured painful procedures without anesthesia. What the Simpsons saw in Africa changed the course of their lives.

Early on, Sarah and Amy Simpson rejected medicine as a career, although their parents were doctors and faculty members at the Heritage College. Dinner table conversations focused on health care and science. But Sarah and Amy wanted something different.

Sarah pursued a degree in political science, intending to go to law school. Amy majored in French. Late in their undergraduate education, the sisters, who are two years apart, started to question their career choices. Struggling for direction, the two agreed to tag along with their dad, Christopher Simpson, D.O., Ph.D., on a Heritage College-sponsored medical rotation in Kenya.

For years, Ohio University students and faculty traveled to Kenya with the goal of improving health conditions. More than 75 percent of Kenya’s population lives in rural areas; more than half of them subsist on less than $1 USD a day. Medical equipment and personnel are in short supply, and illnesses like dysentery, malaria, tuberculosis and malnutrition kill more than 7 million children under five years of age each year.

Having grown up in Kenya, Heritage College graduate Benson S. Bonyo, D.O. (’98) knew firsthand the public health crisis facing the country. His mother died from malaria and his sister died from dehydration. So, in 1995 he started the SHARE (Student Health Assistance Rural Experience) Kenya program, which the university officially began sponsoring in 1997. The university stopped sending students to Kenya after a surge of violence caused safety concerns, and in 2006, SHARE Kenya became Bonyo’s Kenya Mission, a nonprofit organization. Bonyo recruits medical professionals who would like to volunteer their services in Kenya.

Other opportunities exist for medical students seeking a global healthcare experience. Ohio University sponsors several summer programs in other countries, such as Botswana and Ecuador. The application deadline for most of those programs is Feb. 1 (click here for more details).

When the Simpson sisters were Ohio University undergraduates, SHARE Kenya was still sending teams of doctors and medical students during winter break to a small farming village in Kenya. The sisters accompanied their father and were introduced to medicine at its most basic level, where limited supplies and unusual ailments challenged even the most experienced doctors.

Their days began with breakfast and an educational lecture. Then Amy, Sarah and the rest of the group were loaded sardine-tight into the back of a truck, a canvas top protecting them from the hot sun and dusty road. For an hour or more, the truck lurched through giant potholes and herds of cattle, stopping every so often to let the radiator cool. Amy thought it was the most dangerous road she’d ever seen. But Sarah enjoyed the adventure inherent in the daily trek.

Sometimes they’d travel to Masara, a village where crowds of children ran up to the sides of the truck clamoring for candy or to have their pictures taken. Other times, they were taken to a remote location and set up the clinic under a tree. No matter where they went, hundreds of people would be waiting, often having walked miles, sometimes through the night, to be seen by a doctor.

At the clinic, medical students rotated with different doctors. There was a triage station where vitals were taken, a wound care area where physicians often pulled teeth or gave injections, a pharmacy, and an eyeglass station for people who needed glasses.

People of all ages with a range of health issues, many of which are rarely seen in the United States, visited the clinic. The medical team saw patients with malaria, malnutrition, cholera and parasitic diseases. They also dealt with dental abscesses, miscarriages and births. But it wasn’t the medical complications Amy and Sarah remember most; it was the people.

A young girl, gored by the horns of a cow, bicycled to the clinic with a stream of blood running down her leg. She remained calm as a doctor cleaned and sutured the giant gash in the back of her thigh.

A man walked into the clinic with a hand so infected it had swollen to four times the size of his other hand. With no numbing agent, the physician cut into the man’s flesh to drain the infection. He didn’t make a sound.

“Having teeth pulled, stitches without anesthetic … they didn’t cry or moan. They let us do our work and were so thankful,” said Sarah.

“I was amazed at how tough all the people were,” said Amy.

The Kenyans may have endured pain stoically, but the Simpsons witnessed many instances of raw emotion, especially involving the eyeglasses station. Sarah saw a woman cry when she received glasses that allowed her to see clearly for the first time in her life. She also saw an older man, who had walked miles to reach the clinic, break down in tears after learning they’d already given away the last pair of glasses.

In the United States, eyeglasses are fairly easy to come by, but that’s not the case in rural Kenya. A 2009 study found that the ophthalmologist-to-person ratio in sub-Saharan Africa is one to 1 million. Most causes of blindness in Kenya are preventable, but the lack of resources makes eye health a significant problem.

“It’s amazing what a simple pair of eyeglasses can do,” said Amy. “One of the most rewarding parts of the trip was the eyeglasses station.”

It was these and other experiences that solidified Sarah’s and Amy’s decision to become osteopathic physicians and to practice primary care.

“I realized I can be doing more in my life to help people,” said Amy.

“Being there and seeing medicine at a raw level, it was amazing,” said Sarah. “It helped me realize that I wanted to be a doctor to help people, which is the most fundamental reason people should become physicians. To help people and understand what that feels like, it’s gratifying.”

Although Chris Simpson, D.O., Ph.D., and Martha Simpson, D.O., M.B.A., who have since retired from the Heritage College, never pressured their daughters to become physicians, they are proud that Sarah and Amy have chosen to follow in their footsteps. They call the trip to Africa the “big event” that changed the course of their daughters’ lives.

“They were on the front line,” said Martha. “It was an impressive cultural and medical experience for them.”

According to Global Health Initiative Director Gillian Ice, Ph.D., M.P.H., associate professor of social medicine at the Heritage College, numerous studies have shown that global health experiences (GHE) often influence students to become primary care physicians.

“Data from the Heritage College show that students who participated in GHE are more likely to work in underserved communities in the US. It is hard to know why they are associated, but if students get to experience the importance of primary care in low-resource settings, that may inspire them to provide such services at home,” said Ice. “As the Simpsons note, GHE allows students to see how very basic health care services make a dramatic difference in people’s lives. Additionally, GHE helps students improve clinical skills, including communication skills required for the delivery of culturally competent care.”

The passion to help others and meet the health care needs of people in underserved communities are goals Executive Dean Kenneth Johnson, D.O., hopes to continue fostering among Heritage College students through programs like the Global Health Initiative, a joint program of the Heritage College and the College of Health Sciences and Professions.

As a doctor, Johnson understands how the experiences students have with patients can shape the kind of physician they will become in the future.

“Our many programs, including the global health experience, give our students a unique skillset, which makes them highly sought-after at clinical sites. They learn how to build bridges to patients and become more confident during patient interactions. The end result is that our graduates are exceptional physicians who focus on providing comprehensive, patient-centered care,” said Johnson.

In May 2014, Amy and Sarah graduated from the Heritage College in the same class. Of that class, 58 percent entered a primary care residency of family medicine, internal medicine, pediatrics or traditional internship. The high rate of students choosing primary care is not unusual for the college, which has long been a leader at the state and national levels in promoting the value of primary care.

Sarah is serving a residency in emergency medicine at Grandview Hospital and Medical Center in Dayton. Amy was accepted into a family medicine residency program at Ohio State University Medical Center. On the Kenya trip, Amy realized that she enjoyed seeing people of all ages and with different conditions. It’s one of the reasons she chose family medicine. “It fits who I am,” she said.

But Amy also remembers being discouraged about halfway through the Africa trip. She wondered if they were making a difference since many of the health conditions were caused by other systemic problems. Then, a young mother about 19-years-old came in with a baby who was lethargic, had a puffy face and didn’t interact with others. With extremely limited testing and treatment options, Amy feared the baby would not live. However, days later, at a Sunday church service in the village, she turned around and saw the mother. In her arms, the baby was smiling and laughing.

Amy had her answers. She thought to herself, “We helped people today.”

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Last updated: 01/28/2016