Medicine and Dermatology in Mirebalais, Haiti – Part 2

Emily Baumrin MD

Resident in combined internal medicine and dermatology at Brigham and Women’s Hospital and Harvard University, PGY4

February 16, 2019

This week marks the end of my second week in Mirebalais, Haiti serving both a clinical and educational role as a senior internal medicine and dermatology resident. This week was focused on education in which I gave a series of case-based seminars on topics in complex medical dermatology and dermatologic manifestations of systemic disease. The internal medicine residents have a set curriculum with lectures in each medical specialty including pulmonary, cardiac, renal, endocrine etc. These lectures are given by a combination of Haitian specialists from Port-Au-Prince and from ex-pat specialists who visit Mirebalais on a rotating basis. While they have two Haitian dermatologists, the dermatologists are focused on providing clinical care given the limited time they spend in Mirebalais. This lecture series was the first dermatology focused didactic curriculum given to the residents.

The seminars were extremely rewarding but provided unique challenges compared to similar lectures that I have given to internal medicine residents in Boston. Dermatology uses a large lexicon of very technical terminology. Medical education in Haiti is taught in French, care is provided in Creole, and most students and residents speak English. Navigating dermatology terminology between the three languages was difficult and led to confusion at times. After the first lecture, I found that modifying the cases to focus on descriptive language and clinical reasoning, using photos to reinforce principles was more effective. There was a wide range of familiarity with the subject matter and I found that facilitating the more knowledgeable residents to teach the other residents and students in language and terminology familiar to their educational process was the best strategy. I will take these teaching principles back with me for medical education in Boston since I think it increased learner participation, engagement, and application of reasoning to a wide spectrum of dermatologic processes.

At the end of the week, the residents told me they were excited to use the physical exam of the skin to help diagnose internal disease and asked me to share dermatology textbooks for further self-directed education. Skin for the win!

Case based lecture to Haitian medical students and residents at Hospital University Mirebalais.