When I hear somebody sigh, "Life is hard," I am always tempted to ask, "Compared to what?"
- Sydney J. Harris
I recently was privileged to hear Dr. Claire Wendland describe two groups of medical trainees.
The first was a group of medical students from the United States spending time in the sub-Saharan African country of Malawi. Each day, the students learned from their American professors and African colleagues. The students were surrounded by patients with diseases that they had previously encountered only in textbooks and lectures — malaria, untreated HIV/AIDS, the late stages of tuberculosis. Many patients had very advanced disease or long-neglected illness. The students were immersed in a medical system that relied heavily on improvisation. The medical facilities had inconsistent electricity, limited imaging studies and bare-bones laboratory testing. The students also noted that the Malawi hospital had none of the American obsessions with billing and record keeping.
The second group she described was the Malawi interns working at the institution the American students were visiting. The interns were very bright and, compared with their African peers, most fortunate. Because of the lack of technology, they had very well-developed physical examination skills. Their hard work and long hours were rewarded with a salary of $11 per day.
The next phase in the lives of the American students would include residency interviews to prepare for their careers. Many hoped they would eventually be able to pay off their burgeoning educational debts, some of which approached $200,000.
The next phase in the lives of the Malawi interns would include assignments in rural health clinics and a slim possibility of obtaining a residency. Many would be willing to accept any opportunity to train and work in America or Europe.
The students from America envied the Malawi doctors their finely honed skills and their chance to practice medicine “closer to its roots,” free of bureaucracy and paperwork.
The doctors from Malawi envied the American students their unlimited opportunities and the chance to practice medicine with the latest in technology, devices about which the Malawi doctors had read but had never actually seen.
Both the American students and the Malawi doctors thought that the other group was very fortunate. You see, each group wished that they could spend their working lives in an environment where they would always be able to have the “real doctor experience.”
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