Lara Vogel, M.D.
Resident, Harvard Affiliated Emergency Medicine Residency
MGH/BWH,
PGY4
08/28/2019
In my work prior to medicine, I lived and worked in East
Africa for multiple years, focusing primarily on education and the ways the
HIV/AIDS epidemic impacted children in Kenya. Working on public health projects
in rural Kenya through my twenties pushed me toward medicine, so now that
residency was nearly finished for me, it was time for me to go back to the
place where my interest in medicine started. Or at least get closer. Through
attendings in the BWH ER Trish Henwood, Alice Bukhman and Regan Marsh, I was
able to connect with the new Rwandan attendings running one of the first EM
residencies in Sub-Saharan Africa. The Centre Hospitalier Universitaire de
Kigali (CHUK) is about to graduate its second class of residents, and the ER is
currently run entirely by its prior graduates. There are three of them. They
work a lot.
 |
| Nyungwe Forest National Park |
I technically know that EM is a relatively new specialty in
the US but seeing a new specialty establish itself is a fascinating process.
This process at CHUK is relatively far along and I had the smallest glimpse, but
watching these residents navigate their own hospital system, the ambulances,
the insurance system (they often have to wait for proof of payment before they
can treat), and the consultants’ understanding of patient care was an education
in itself. Unsurprisingly, the medicine was the same between the two countries
and the residents were exceptionally well trained—their comfort with trauma far
exceeded my own, and their ability to make do with much less support from
consultants, supplies, and patient’s understanding of disease was
incredible—but ultimately, they had many more fights everyday to define the boundaries
of their ER to themselves, to their patients and certainly to the hospital
system. Their actions were always defined by the best interests of the patient,
but when ICU patients spent weeks boarding in the ER, when the orthopedists
could not operate or admit and yet would not stop accepting transfers, and when
social services did not exist to support patients unable to care for
themselves, the question of what was best for the patient became extremely
complex and well beyond the scope of what I expect from an ER physician.
Needless to say, they all managed it with grace and I was the one left
confused.
