Attending Dr. O, curbside consulting Dr. P, our infectious disease specialist via phone…
Dr. O: hey Dr. P, I’ve got a resident here who has done some traveling recently and has come back with fevers, severe myalgias and arthralgias, and marked distal muscle weakness. Reflexes are still normal. His CBC and CMP are normal, but his CPK is sky high. I’m checking him for Rickettsial diseases, West Nile, and Lyme disease. Do you have any other suggestions?
Dr. P: (Charlie Brown teacher noises)
J, the sick resident: So Dr. O, what did Dr. P suggest?
Dr. O: He’s stumped. He said we should google it.
After crawling under my house on my day off…
Attending: I saw your adventures under your house video on Facestagritterblr… Pretty hilarious.
Me: Yeah except it was pretty terrifying.
Attending: It looked pretty clean down there though.
Me: It was cleanish, except it was super dusty so I was coughing and sneezing a lot down there. And pretty much the rest of the day.
Attending: probably from inhaling mouse poo.
Me: Exactly. So if I get some weird lung disease, please take care of me and know that I’m a DNR.
Attending: What diseases can you get from mouse poo?
Me: Are you pimping me? I could have hantavirus right now and you’re pimping me!
Today, as I study about dengue and typhoid for my global health online course, I found out that a family friend who is a missionary is currently in the hospital with dengue. Small world.
#testespouringpus #wouldbeeasiertotreat #thanwhatyouhavesir
Patient with immune deficiency and serious bacterial infection, refusing antibiotics: I know about antibiotics. I’ve read the PDR and Taber’s medical dictionary…well, maybe a fourth of Taber’s. Probably like a tenth of Taber’s. But I know what’s best for me.
Me (thinking): Maybe I should loan you my immunology book too…
**Fellow student (and weekend strong man competitor) downs a suspicious looking jar of whitish yellow goo in a few giant gulps.**
Student #2: Dude, what was that?!
Student 1: 4 raw eggs and raw goat milk.
Student #2: Um, Salmonella… Heard of it?
Certainly, an MD/MPH would be a great choice, but not a requirement for working in third world countries.
As I mentioned before, Tulane is the only school I know of that has a combined MD/MPH that focuses specifically on Tropical Medicine.
I don’t know of any clinical tropical medicine fellowships (time after residency) off hand, but I’m sure they’re out there. The American Society of Tropical Medicine and Hygiene offers some research fellowships, though. Also, many residency programs (in ER, IM, FP especially) will offer tropical medicine or global health elective courses. Those would be short (2 weeks-2 months), but would be better than nothin.
The ASTMH offers a travelling fellowship in tropical medicine for medical students. It looks competitive, but super awesome. Check out their website. It has lots of useful info. And you can become a student member when you’re in med school so you can stay updated on the world of Tropical Medicine.
If you were really interested in infectious disease, you could do an ID fellowship after an internal medicine residency. But that’s a lot of years and a lot of debt racked up before going to work in the third world, so keep that in mind. Personally, I’m taking the shortest route—a family medicine residency program that offers a global health elective. I won’t be an expert by any means, but I’ll at least get my feet wet. And really and truly, 2 years of ID/TM research isn’t going to teach you how to treat AIDS in Africa or TB in India, you know?
GREAT Question. I’ve been meaning to make a post about this stuff for a while.
Most people I know who are going into medical missions are either doing Family Medicine (with an optional extra year of OB) or general surgery. There are a few others doing OB, Peds, and Internal Medicine too. Family medicine and General surgery can be extremely useful because of their broad nature. If you plan on doing career missions, it’s a good idea to do something broad so you can be of the most help to the community you work in.
That’s not to say there’s not room for specialists, though, especially if you are thinking more toward short-term missions. Lots of specialists will do 2 week - month long trips and see huge numbers of patients who need specialty care.
Tropical Medicine would be something you would have to focus on more in residency. I’m sure some schools have stronger infectious disease curricula than others, though. Tulane University in New Orleans has a Tropical Medicine program that is supposed to be really good, and they offer an MD/MPH&TM (Master’s of Public Health and Tropical Medicine) combined degree program. Of course, you could also go the Internal Medicine / Infectious Disease route if you wanted to focus just on that.
As for residency programs, I did a good bit of research on family medicine programs that were missions-friendly. Below is a list of my favorite ones (these are all distinctly Christian and are all excellent programs), and you can check out a complete list of family medicine programs that offer international rotations here.
Christ Community Family Medicine/UT St. Francis - Memphis, TN
In His Image Family Medicine - Tulsa, OK
Via Christi Family Medicine - Wichita, Kansas
Valley Baptist - Harlingen, TX
DISCLAIMER: Below is my opinion of homeopathic “medicine”. It is an opinion. I am a student in allopathic medicine, so you can probably guess that I believe in medicines that have been tested extensively rather than medicines that someone’s uncle said helped them feel better. I am not here to argue with anyone over the merits or possible benefits of homeopathic remedies, so please don’t start. This is an anonymous internet rant about people who take chances with their own health and safety rather than trust the miracles of modern medicine.
When I was in India in 2009, I stayed in a hut in the Himalayas (yes, for reals) for my first 2 weeks with a missionary family. They had another girl staying with them who had come a week or two before me. This chick was an extreme homeschooler from West Virginia (maybe regular Virginia) studying midwifery who ONLY took homeopathic remedies. The only vaccine she had taken in her whole life was the yellow fever shot REQUIRED for entry into India.
The day after I arrived she got dysentery. The family we were staying with had a very good water filtration system, but sometimes things slip through the cracks. Most likely she had brushed her teeth with water that hadn’t been filtered yet. It’s also possible she got it from drinking raw buffalo milk even after being warned not to (because she drinks raw goat milk all the time at home, duh!). Anyway, she got diarrhea somethin fierce.
My doctor had prescribed me enough Cipro to get through 2 bouts of dysentery. She did this on purpose in case anyone else on my trip needed it and didn’t have any of their own (smart lady). So I offered the girl my Cipro. She refused it, saying she would just take her Grapefruit seed extract and a few cloves of garlic. I argued with her, saying that her homeopathic stuff might have worked for her in the US, but these were germs her body hadn’t seen before. I mean, would you want to get extremely dehydrated and super sick if you were 4 hours up a mountain from civilization with no electricity, phone, or clean water? Seems to me that a reasonable person would go with the Cipro in such a situation.
Developing bronchitis and keeping my cough at bay with lemongrass green tea.
Add “Infectious Disease Rotation” to the list of times a med student is guaranteed to get sick.