I wish to visit and volunteer at Georgetown Public Hospital Corporation (GPHC) in Georgetown, Guyana on a medical mission trip for 4 weeks, in January 2019. GPHC is the largest and only public referral hospital in Guyana with approximately 400 beds. It serves as an excellent example of medical training in a tertiary care, resource limited hospital in a developing country. They have a single general medicine service, that serves as the primary care team for all adult patients admitted to the hospital, and also their own residency training program for internal medicine. Indeed, they have strong collaborations with many international institutions such as University of Pittsburgh, McMaster University and the University of Calgary, and routinely have many visiting residents, fellows and faculty on site. The main language spoken by both staff and patients is English.
The trip would essentially be structured as a 4-week general medicine rotation at the host hospital. Briefly, it would involve
• 5 days a week of clinical work, for approximately 40-50 hours per week
o Daily coverage of inpatient wards in the morning, and outpatient clinic in the afternoons
o Ward coverage would include care for about 80 patients by a total of 8-10 residents; and 5-15 admissions over a 24-hour period
• Additionally, work 2 of 8 weekend days: coverage of the inpatient wards and admissions.
• One optional night shift per week for cross-cover of the inpatient service and admissions, with the following day off
• My responsibilities would include case discussion and clinical supervision in the capacity of a senior resident, to work along with a team of one senior resident and one junior resident from the hospital
• Teach the basic principles of quality improvement and help the residents at GPHC develop and start a quality improvement project as part of their training.
In this unique setting, I hope to view and understand the state of medicine and health care delivery in a developing nation, with a vastly different and under privileged patient population.
Some of the medical cases that they routinely see include rheumatic heart disease; sickle cell disease; tropical infectious diseases such as tuberculosis and malaria; and advanced HIV. These diseases, are major burdens globally, represent examples in internal medicine that we get limited experience with, at my home institution - the Cleveland Clinic.
My goals and objectives for the proposed trip are:
• Learn how the practice of clinical medicine is different and challenging in a resource limited setting. Without a multi-disciplinary team of such as pharmacists and specialists closely available, it is a rare and educational experience to learn from a system that is used to managing all medical issues for a patient as part of one primary team.
• Be a part of a cross cultural team from different backgrounds and experiences, that includes residents, fellows and staff from Guyana as well as different institutions in the USA.
As the largest referral government hospital of the country, Georgetown Public Hospital Corporation provided completely free (except for advanced imaging modalities or non formulary medication) healthcare to the population of Guyana. Therefore, the patients are all from various strata of their society - including, the poor, the immigrant population, and the middle class. The common diseases that we saw and learnt from included diverse presentations of pathologies, that included text book 'bread and butter' cases as well as tropical diseases that we do not encounter much of in the USA.
Furthermore, with their own residency programs in several specialties including internal medicine, and a unique setup wherein the house staff are GMOs (general medical officers, who are recent medical school graduates before they enter a postgraduate training program), and medical students from nearby schools, the hospital is also an excellent environment for medical teaching.
