Family medicine, and medical missions.

Today we had a lecture series all day at Lutheran General Hospital. One of our family medicine faculty is the great doctor who is married to an OB/GYN oncologist. They took their young family (2 kids) and moved to Nigeria for 7 years to work there as medical missionaries. He had also done several medical missions in South America as well. This guy is so interesting and has so many stories and experiences that are amazing. 

Basically he ran a hospital as one of the few doctors and as family medicine doctor did nearly everything from GI to neurology to dermatology. His wife did lots of surgery and pioneered a technique for treating / curing VVF (vagino-vessicular fistulas) and RVF (recto-vaginal fistula). VVF and RVF are conditions where there is a hole that allows communication or passage  connection of the bladder and the vagina (VVF) or a hole between the rectum and vagina (RVF). As you could imagine, this type of condition causes many different health complications. How does one get this condition? In the USA this is fairly uncommon but in Africa some have said that it is an epidemic. A common cause in Africa is young women have babies when their body is still very small and not completely developed. Often at 10 - 12 years of age they will be married and become pregnant. They will go into the brush to go into labor and have the baby. If the baby is too large for their small body it will get stuck and they may be in labor for several days. The baby will often die in the birth canal and eventually pass. However when this occurs the vaginal wall will slough off leaving a hole (fistula) between the vagina and bladder or the vagina and rectum. Another cause of these conditions is a complication related to female circumcision. 

Culturally in Nigeria, the females have their clitoris removed. This procedure is done with a scalpel by a faith healer. Due to the lack of a sterile field and the sloppy manner of which this is done, commonly a VVF will occur. 

If left untreated these young women can die from infection and complications. The wife of doctor who taught us today, essentially developed a treatment / repair for these conditions and then trained other healthcare providers how to do it. She has made a huge impact in treating this problem and decreased the related mortality throughout the country. 

The lectures were very interesting and I found my mind fantasizing about medical missions and all the adventures I could have with my family as we traveled around the world trying to provide healthcare to undeserved populations. I do want to do at least one medical mission and maybe several. I think that one of the exciting things about medicine and being a doctor is the ability to help regarding healthcare in undeserved areas. This can be done almost anywhere. Rural areas, inner city populations, many other areas within the United States are in need of medical services. Outside of the United States the amount of locations that need this assistance is overwhelming and never ending. 

Family medicine is a great specialty for the medical mission type doctor. Any specialty and all specialties are needed in these areas but because the family practice doctors have such a broad training and many skills in nearly all areas of medicine they can provide a great number of services. Since the need is so great as a medical mission doctor your ability to practice / perform procedures is only limited by what you are willing to do. These situations also create doctors who become adept at many different procedures that they would never learn or perform in the USA given their training. However in these under served areas, as the only doctor in the area, if you do not do / master these procedures they will not be done and patients will suffer from the lack of care.

This concept of being a medical mission doctor is very intriguing to me. There are so many areas in medicine that I find interesting, yet ultimately I have to choose an area / field of medicine and train accordingly. I think it could be exciting to have the opportunity to practice a wide variety of medicine and at the same time have the opportunity to provide a much needed service that will have great impact on the individuals who need the treatments. 

Who knows where / what I will do as a physician but I am going to try and keep an open mind throughout all of my rotations so that I can try to determine the field that I want to go into by giving all of them a trial run. If the past is an indicator of the future, then the only thing I can predict about my future is that, whatever path I ultimately choose it will a circuitous route filled with circus like excitement. Bring on the bearded ladies and the goat boy.