STUDENT INTERNSHIP & EXTERNSHIP REFLECTIONS
(continued from page 17)
on my own personal ex-
periences. He was our
third patient of the day,
a 16-year-old boy who
was complaining of chest
pain when standing from
a seated position. On
appearance, he seemed
weak. I went on to check
his vitals, starting with
blood pressure. The first
reading was so strange
that I thought I made a
mistake, 145/35. I took it
twice then asked a fellow
student to double check.
I went on to check puls-
es, his were bounding. As
only a first-year medical
student, I recognized
that I knew next to noth-
Clinic health outreach team: Local clinical officers and UofL medical students. June 19, 2019. Kabale, Uganda. (Author,
Alexandra Pflum, fourth from the right). Photo credit Alexandra Pflum.
ing about cardiology, but
upon listening to his heart,
closer inspection. I hold an enormous amount of privilege and
it was obvious that there was
there are people not just in Uganda, but also in my own country
a very loud murmur. The attending physician decided it would be
who experience life-threatening disadvantages. There will be times
best for him to be referred to the public hospital for an EKG. I wish
when I’m not going to be able to give someone the best treatment
I knew what the diagnosis was, or if even he decided to go to the
available because of money. It breaks my heart and makes me angry
hospital. This young man came from a very poor family and had
all at once. That’s the unfortunate reality of the health care system I’ll
never received any medical care for this condition, or any other.
be working in. Of course, I didn’t need to travel across the world to
Patient after patient, I kept thinking back to this case because
be confronted with this issue, but this was the first time it affected
it makes me think about my own privilege in a new way. Growing
a patient I felt responsible for. I took the history, I did the physical
up, my family had never been well off. In fact, I would say that I
exam. I was involved, which makes everything more personal and
feel like an outsider amongst my medical school peers, most of
real. I’m not sure if there will be a solution to this issue anytime
whom seem to come from wealthy families. I’m the first one in my
soon, but I know that I’ll be more prepared to face this in my third
family to go to college and have always had to support myself. Even
and fourth year of medical school because of this experience.
before this trip, I recognized that I am very privileged as a white
I learned a lot about medicine in my month in Uganda. I was
cisgender person, but I’ll admit that I’ve had a bit of a chip on my
introduced to rare tropical diseases, I was able to see malaria under
shoulder regarding my financial disadvantages. This patient made
a microscope, I used my hands to determine the gestation age of
me reevaluate all of that, because his condition reminds me of an
a pregnancy and many more amazing experiences. Despite this
experience that I went through as a child, with a vastly different
eye-opening jump into real medicine, I feel I learned the most
treatment and outcome.
about myself. I saw and felt how the social determinants of health
I was born with a mild heart murmur and it was detected right
really impact people’s lives. I’m confident that this global health
away. As a child, it seemed as though every single year I would have
experience has focused me more on reflection, and more on cultural
to have it checked out. Even with my family’s financial difficulties,
sensitivity - both vital to becoming a better physician.
I had modern medical care. This patient had a problem so obvious
Alexandra Pflum is a second-year medical student at the University of Louisville
that a first-year medical student could detect it. It took sixteen years
School of Medicine.
to be discovered and the unfortunate reality is that he will probably
go on without receiving treatment. All of my self-pitying ideas of
what I thought it meant to grow up without money thus required
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LOUISVILLE MEDICINE