Pande, Chetna

Medicine - Pediatrics

Residency

Guyana

In Guyana, I will be part of a team from the pediatric emergency medicine department at Johns Hopkins. We will work with local physicians, residents, and medical students to hold workshops on common pediatric emergency case presentations. We will also work in the emergency room to see patients in order to gain exposure to tropical medicine and medical cases we would not see in Baltimore. Additionally, we hope to have outreach programs to the more rural parts of Guyana with medical supplies/equipment and trained professionals treating patients in need of medical attention. 

With the generosity of funding support, I was able to travel to Guyana in South America for 2 weeks during my second year of pediatrics residency training. This trip afforded me invaluable experiences and opportunities for personal and professional growth.

My time in Guyana was unique to my medical training due to the autonomy we were afforded, as well as the creativity that was required to practice medicine in a low resource area. As a physician in the US, I have the luxury of having all information about a patient at hand to make well educated decisions, as well as every possible specialist, form of imaging, and lab test available to guide my management. In Guyana, I had only the patient and my physical exam. For example, a mother brought in her 8 year old child with the complaint that he had been coughing for months. I had no other information, no capacity for imaging or other testing. Upon chest auscultation, I heard diffuse wheezing. I was able to create a spacer with albuterol out of an old soda bottle. Two puffs and 20 minutes later, she was running around without difficulty and mom was hugging us. My medical abilities and knowledge were stretched, which allowed me to grown as a physician.

We spent much of the trip providing medical care, with minimal supplies, to children in orphanages and families in villages. We acted in whatever capacity was required – doctor, specialist, nurse, pharmacist, friend. Although we were diagnosing and treating, we also provided medication, inserted intravenous lines, and providing sedation for surgeries, many skills that I do not have to opportunity to master in the US. By doing this tasks, it has only enriched my understanding and appreciation all the different roles of specialists required to provide adequate care to a patient.

Each of these experiences forced me to stretch my medical capabilities to learn to be flexible, be resourceful, and be open minded. Many patients have medical needs, few receive the care they require. This was the most logistically and emotionally challenging aspect of the trip: determining how to offer care with minimal supplies in a low resource area, and who gets that care. I learned that even if care can be administered, there are so many other social determinants of care that affect whether a patient can be treated, such as cost, transportation (especially in the jungle when it takes multiple forms of transfportation to get to the city), who can watch other children in the home, etc. In dire situations, we took children with our team back into the city and arranged for their transporation back. It was remarkable the changes we could affect when we worked together and got creative about using our limited resources in the best interest of the child.

Since I studied abroad in Uganda in college, I knew I wanted to practice medicine in low resource areas.

This trip only solidified that desire. This trip allowed me the opportunity to develop my medical skills and expand my repertoire of creative options for treatment, especially in low resource settings. I also learned that global health is a spectrum – you have to meet a community’s needs, rather than imposing your own cultural expectations on them. That could mean teaching hand washing, teaching basic life support (BLS), or setting up an intensive care unit. I am grateful for the opportunity that this grant afford me.

People

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...
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June 2018

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