Henrik Sjövall was impressed when medical students presented their project work recently. Many projects focused on Global Health, located in countries with completely different conditions than ours.
Henrik Sjövall gives us a personal report:
“Today I was on hand to watch our medical students present their project work. I may be getting a bit sentimental in my old age, but wow! How impressed I was! I took in one hundred posters covering an enormous range of subjects: from cell biology, genetics, the mechanisms of heart attack, and how to reduce the risk of dementia in old age to how patients feel after a stroke—you name it! My task was to monitor projects dealing with global health, and in the morning we listened to the first oral presentations. The first student had visited Cameroon to investigate what pregnant women know about HIV/AIDS. Quite a lot, as it turns out. Probably a lot more than what pregnant women in Sweden know. If the HIV epidemic is ever to be stopped, we have to begin by educating the population, a goal that has obviously been reached in Cameroon. Well done!
The next presentation was about disease patterns and treatment outcomes for pneumonia in Kyrgyzstan, a former Soviet republic some way to the east of the Caspian Sea. Kyrgyzstan is a poor country, but the results achieved were actually quite good. There were only a few deaths even though those affected were also those most at risk (i.e., poor and living in overcrowded conditions). Our take away should be that, in reality, we can accomplish quite a lot for a lot less money than we do. It’s important not to forget the concept of “good enough”.
After a room change we traveled on to Sri Lanka, where two students had reviewed 9,000 forensic records to find around 400 cases of domestic and non-domestic violence against women. They then tried to identify specific patterns of partner violence and other violence (community violence). This is quite unique material in that, in Sweden, much of this never even comes to the attention of authorities.
The next student’s project was sad but also very interesting; namely how the Rwandan genocide has affected the mental health of men and women, respectively. A methodological problem was the lack of any real control group (that is, how much of what was observed reflects what it means to be a woman or a man in Rwanda?). That is to say, as a group, women in poor countries are generally in a very bad state. In fact, suicide is close to becoming the leading cause of death among young women from a global perspective. The student concluded that women and men seemed to have different strategies for coping with their horrific experiences. The relative impact of the genocide period, in particular, on mental health was actually greater in men, while women felt bad for a lot of other reasons besides, meaning that they were not as clearly affected by the genocide period specifically. I came to the sad realization that a person must be living under very miserable conditions indeed if genocide doesn’t further impair their mental health.
Next, we moved on to northern Tanzania, where a student had identified risk factors for lower respiratory tract infections in adults. Unsurprisingly, the patient group had a much higher HIV prevalence than the general population. The student also discovered an interesting difference between urban and rural areas: in urban areas, TB-associated infections dominated, while classic pneumonia was more common in rural areas. That seems reasonable somehow, doesn’t it?
Next came my very favorite presentation. A brave student had packed her bags and headed to Tashkent in Uzbekistan to determine the quality of their treatment of cleft lip and cleft palate in infants. In Uzbekistan, there is only one specialist plastic surgeon operating on these children. Other surgeons providing treatment have no training in the field. It turned out that there were no functioning quality-control systems in place, however. Consequently, it wasn’t possible to find out how patients had fared because no proper records exist. Many patients obviously had problems with their bite and speech, and our team-based system of specialist dentists and speech therapists is an impossible dream in Uzbekistan. As I understood it, the student had calmly informed her colleagues that there is such a thing as long-term follow-up, and that this is necessary to be able to assess long-term results. I can see in my mind’s eye how they must have stood scratching their heads as they waved her off at the airport: “Maybe we should do something about that…What do you think?”
The last student (by this point I was beginning to tire) had traveled to northern Tanzania and attempted to map the resistance pattern of pneumonia bacteria (pneumococcus) cultured from the noses of young children. The findings were alarming: penicillin resistance was very common and there was basically total resistance to Trim Sulfa, which is considered quite a dependable option here in Sweden. Apparently, Trim Sulfa (sulfamethoxazole) is used as a prophylaxis during HIV treatment, which may explain the finding.
The presentations were held during parallel sessions, so I wasn’t able to attend them all. Other students had visited Nepal to map wound infection frequency in different types of abdominal surgery or the outcomes for acute pancreatitis, a condition that patients sometimes die from even with the best intensive care money can buy. Certainly, results were worse than in Sweden, but considering the resources available, they weren’t that bad at all, actually. A project with a similar message looked at elbow fractures (a common injury sustained when falling with an outstretched arm), which always involve the risk of disabling neurological and vascular trauma. Here, too, local doctors were using thoroughly modern surgical techniques and achieving excellent results.
Back in Africa, two students had visited South Africa to study the monitoring of HIV and the usefulness of a simple new urine test to detect active TB before initiating HIV treatment, respectively. Unfortunately, the test turned out to be quite useless. Another student had traveled to Cairo to map antibiotic use. As might be expected, people there seem to do as they see fit (and can afford), a reality far removed from our system as governed by the National Board of Health and Welfare’s guidelines.
After listening to seven talks I was completely exhausted, yet also elated at the extremely high quality of the presentations. What excellent students! I also reflected on the fact that 19 of 27 global health projects had been conducted by women, a figure that seems slightly higher than the percentage of women studying the course as a whole. Could it be that young women are braver than young men and are more ready to leave their comfort zones? That could very well be the case, in fact.
The posters were presented in the afternoon, and my task was to award a prize for the best global health entry. It wasn’t an easy assignment. All of them were either good or very good. Ultimately, I chose to give the prize to the student who had traveled alone to Uzbekistan and informed the country’s only specialist in cleft lip and -pallet surgery that his results don’t measure up. That was worth a prize, don’t you think?
The day concluded with a brief talk held by me to explain why it’s important to spend an entire semester writing a thesis about something you’re unsure of. My argument was that dealing with uncertainty is a key element of a doctor’s everyday life; a doctor who can’t handle uncertainty is a poor doctor. Certainly, a doctor should know as much as possible, but even very well-read doctors rarely have all the facts necessary when making clinical decisions. Being able to handle that—weighing the degree of uncertainty against the consequences of being wrong—is something you never fully master, which is what makes our profession so fascinating. Being forced to spend an entire semester on the outskirts of understanding is very instructive and fosters respect for both the need for concrete knowledge and the ability to navigate unfamiliar waters.
In other words, a doctor must know what there is to know, and learn to deal with the rest.
Finally, tired and with my head crammed full of information, I lumbered off to the tram thinking about what amazing medical students we have. Despite the “miserable” state of Swedish schools (according to the media, at least), these students are clearly better than the best students of my time (1970s). First and foremost, they have much broader knowledge. And helping, in some way, to prepare these incredibly talented students for the world’s most fascinating profession is a privilege and a trust that I believe we fulfill fairly well, in fact.
It seems so after today, at least.
BY: HENRIK SJÖVALL
