Linda Lee

Medical students and medical residents are attracted to Mayo Clinic for a variety of reasons. There are some obvious reasons — the institution's reputation for excellence in virtually all medical specialties; its state-of-the-art facilities and research programs; its high faculty-to-student/resident ratio.

Linda Lee, M.D., a third-year resident in pediatric and adolescent medicine, found each of these attributes attractive. But she was drawn to Mayo Clinic for another reason: the Mayo International Health Program, which offers financial support to residents and fellows who wish to provide care in medically underserved areas.

"I chose to continue my education at Mayo in part based on the opportunity to provide care in places where it is desperately needed," says Dr. Lee. "Not many residency programs offer that."

Giving and receiving

In 2004, Dr. Lee and her husband, Sung Lee, M.D., spent a month caring for patients at Tenwek Hospital, a mission hospital in Bomet, Kenya. The experience humbled and inspired the couple.

"In Africa, we worked beside local medical staff who worked 120-hour weeks and never complained," says Dr. Sung Lee, a fourth-year resident in neurology. "Their dedication and devotion was humbling, and reminded us of why we went into medicine: to provide care for people in need. We believe that when you're given a talent, you have a responsibility to use it where it is needed."

Since the Mayo International Health Program's inception in June 2000, 83 participants have cared for nearly 30,000 patients in 31 countries. As the Lees and other program participants have discovered, Africa and many other areas need the talents of medical professionals. And Africa has much teach these professionals.

"Providing care in developing countries gives you an opportunity to gain experience in procedures that are rarely, if ever, practiced in the United States anymore,"says Kristin Chrouser, M.D., who traveled to Jos, Nigeria, through the Mayo program. "It also shows you how much it is possible to accomplish even with very limited resources."

As a senior urology resident, Dr. Chrouser traveled to Nigeria to help care for patients at Evangel Hospital VVF Center. The center provides surgical treatment for girls and women diagnosed with vesicovaginal fistulas, an injury sustained during childbirth that results in urinary and fecal incontinence.

The availability of cesarean sections and prenatal care make vesicovaginal fistulas almost unheard of in the United States. But in the developing world, where very young girls often become pregnant, and many women labor and deliver their children at home, the condition is common.

Unable to access routine maternal care, women in obstructed labor may struggle to deliver for as many as five days before expelling a dead fetus. In addition to losing a child, these women must contend with extensive damage to the tissues of the vagina, bladder and rectal wall. Some also experience nerve damage, which can make walking difficult. Many are abandoned by their husbands and become outcasts. Often they are told they must have offended God to be subjected to such punishment.

Though she had been "headed toward a very comfortable career in private practice," Dr. Chrouser says her experience providing care for these women has altered her career path. She now plans to earn a public health degree and work to find efficient, low-cost solutions to problems in the Third World — solutions she will share with local providers.

"I don't think you can provide care in a developing country and not be changed,"says Dr. Chrouser, whose work in Nigeria was supported by the Mayo International Health Program. "To go somewhere where people have nothing is profoundly disturbing. You realize how very, very blessed we are in the United States. And that ups the ante — you realize we have a responsibility to help."

Care and compassion

The lack of resources available in the developing world can be "dumbfounding," says Dr. Linda Lee. At Tenwek Hospital in Kenya, where she and her husband worked, diapers were nonexistent, and the same sets of sheets were often used throughout a patient's hospital stay. The 30 infants in the neonatal intensive care unit lay naked in cribs, wiped repeatedly with the same dirty cloths. Dr. Lee eventually adjusted to the overwhelming smell. But she never adjusted to the overwhelmingly frequent loss of life.

"At Mayo, I'd only seen one patient die," she says. "At Tenwek, babies were dying left and right. And dying of what would be, in the United States, treatable conditions. It's very difficult to accept people dying simply because of the unequal distribution of resources."

Dr. Lee confronted that inequity on her first day at Tenwek Hospital. An infant who had pneumonia needed respiratory support, but another infant was using the hospital's only neonatal continuous positive airway pressure machine. Having been appointed head of the pediatric team, Dr. Lee was expected to make a wrenching decision.

"Essentially, I was being asked to decide which life was more important," says Dr. Lee. "How do you decide something like that?"

Though the lack of resources at times made her work difficult, Dr. Lee recognized that she was armed with one tremendous resource: her medical training.

"When I arrived at Tenwek and was told I was to lead the team while the main pediatrician was on vacation, I was sure there had been a mistake," says Dr. Lee. "But then I realized that our training in the United States prepared us well to be able to care for these sick children and also share what we've learned with the Kenyan trainees who were so eager to learn."

In Nigeria, an erratic power supply forced Dr. Chrouser to operate by sunlight and flashlight. Other challenges included dull instruments, staff shortages and a scarcity of clean water.

Despite these difficulties, most girls and women who come to Evangel Hospital are cured. Their transformations are celebrated during weekly dismissal ceremonies. "The dismissal ceremonies are incredibly powerful," says Dr. Chrouser. "Each patient is given a new dress to symbolize her new life. The women are also given soap and lotion to remind them that they can smell pretty even after months or years of leaking urine and feces."

To illustrate the hope the procedures offer, the preoperative patients are invited to attend these ceremonies. "You can see their eyes light up when they look at the women leaving and realize, 'Wow, that could be me,' "says Dr. Chrouser.

Valuing all patients

At Mayo Clinic, new physicians are taught to diagnose and treat disease. They also are taught to value the needs of their patients above all else. And in the view of the Mayo International Health Program, those patients aren't just the people who walk through the doors of Mayo Clinic.

"Dr. Will Mayo said, 'The best interest of the patient is the only interest to be considered,' and you take those values with you wherever you go," says Dr. Chrouser. "You also learn from each encounter with a patient, whether in the U.S. or abroad. And that makes you a better caregiver."

Dr. Sung Lee agrees.

"In many ways, patient care is the same regardless of location," he says. "That's one of the most powerful lessons I learned in Kenya. In the U.S., we can get lost in technology and tests. In many parts of the world, the practice of medicine is limited to what a physician can detect with his or her senses. But wherever you are, patients want the same thing: to be treated with dignity and compassion."

That compassion can be a balm to both patients and their caregivers. Their first days at Tenwek Hospital were extremely difficult for the Lees as they struggled to make sense of the poverty, disease and death around them. As physicians practicing in the United States, they were used to being able to prolong or save the lives of most patients. In Africa, many of their patients died. A missionary serving at Tenwek Hospital explained to the Lees how he came to terms with the limits and possibilities of care in Kenya.

"The missionary told us that he was initially frustrated because he couldn't save everyone coming to the hospital," says Dr. Linda Lee. "But then he realized his purpose was not simply to provide medical care, but to provide the comfort that Jesus would. Though his care might not save every life, the way he delivered that care could make a tremendous difference in people's lives. Your approach to care can leave patients with hope beyond the consequences of their illness."

Making a difference

For many physicians-in-training, participating in the Mayo International Health Program is a life-altering experience.

In 2004, Harrup Kaur, M.D., then a second-year resident in ophthalmology, traveled to the West Indies to care for patients with debilitating cataracts.

"Patients came in for surgery virtually blind from a treatable disease," she says. "Because they had no access to routine opthalmologic care, cataracts had completely obstructed their vision. We saw that the impact of blindness was especially debilitating in a country with limited social services. Yet the relatively simple surgery we performed allowed these patients to resume active roles in their communities. Seeing that need and the impact we had has reaffirmed my commitment to working in underserved populations. And I think that anyone who participated in this type of rotation would have a similar response."

That's why Dr. Chrouser believes rotations in developing countries should be requirements rather than electives for medical residents.

"Every resident should step out of their comfort zone and see how medicine is practiced where the majority of the world's people live," she says. "We have a duty to the developing world to share our knowledge and expertise. Institutions like Mayo are setting the standard. If every residency program in the country required this type of rotation, we would change the face of medicine in the Third World."