Robbie Sparrow is a medical student in the Class of 2019 at Western University
For individuals facing deep personal struggles, the path to recovery is often daunting and overwhelming. Support from others who have overcome similar challenges can be extremely beneficial. For example, the best people to help heroin addicts are those who have fought to stay sober for two years, and women facing domestic abuse are best aided by women who have escaped it. Doctors who care for patients living through crises are often disadvantaged when trying to empathize with them because they themselves haven’t faced the same struggle. Difficult experiences throughout a physicians’ life can help them approach this ideal of empathy and improve the care they offer patients.
I’m three days into my surgical elective at Black Lion Hospital in Addis Ababa, Ethiopia. I’ve spent each morning thus far in the OR, which consists of three dingy, green-walled chambers each holding a thin black bed and 1980s era anaesthesia equipment. I peer over the shoulder of two surgeons as they perform a lung resection on a teenager. Only hours earlier I had watched, dumbfounded, as surgeons performed a craniotomy on a toddler using nothing but a hand drill and coarse metal wire. The day before, I witnessed urologists perform a cystoscopy on a 13-year-old boy without anesthetic, cringing as the patient writhed in pain for 45 minutes.
Up on the surgical wards in the afternoon, I try with difficulty to interact with the residents and medical students. Each of the four rooms in the ward are packed with 16 patients, all waiting quietly to be seen by the medical team. The cultural differences are vast, and at first the physicians and students regard me with suspicion and avoidance. Although the doctors all speak English, they use Amharic for casual conversation — a language so difficult it took three days of memorization just to learn “thank-you”. Everyone speaks in low, hushed voices, as is typical in Ethiopian culture, and during afternoon rounds I strain from the back of the large crowd to hear what the doctors are saying.
After rounds end, I walk through the beige, run-down halls of the hospital, trying to weave my way through the throngs of people still waiting for their appointments. I look around and it hits me: I’m the sole white person in the hospital. There is a sea of black faces staring uncertainly and inquisitively at me, and I’m struck by a profound sense of isolation. I always sense that I’m being watched, judged, and analyzed. Nobody is ever rude, but the continuous feeling of intruding on another culture weighs on me during the trip, and I yearn for a fellow Canadian to share my experiences and anxieties with.
Outside the hospital, the streets of Addis Ababa are controlled chaos. The air is thick with smog from the 1980s-era cars that jam the streets, and the sound of honking is constant because stop lights are few and far between. Lining the roads are all manners of people, from those selling bananas out of wheelbarrows to others asking for money or simply loitering around. People will openly stare as I walk by, and I learn rapidly to put defenses up every time someone yells, “My friend!” and offers to sell me a trinket, tea, or tour.
Throughout my time in Ethiopia, the repeated experience of being an outsider and attracting attention because of my skin colour was difficult. Never before had I experienced life as a minority. As a Caucasian Canadian male, I came to recognize how few challenges I had faced in my life, and that I had grown up seeing people who look and talk like me lead society. In Ethiopia, I was suddenly thrust into a country where I didn’t belong and into a medical culture that was foreign to me, and had to struggle to adapt and find meaning amidst the isolation.
Each day on the street corner outside the hospital, an elderly woman missing all her fingers and toes sat begging. I never saw anyone with her, and often wondered how she reached her spot each day and where she returned to each evening. I would walk by that woman every time I entered or left the hospital, and felt sick and embarrassed each time I ignored the woman’s pleas and walked past without giving her money. One time I resolved to buy bananas for her, but soon realized shamefully that she had no way to peel or hold the fruit. Many times I gave her and others spare change or food, but the sheer scale of homelessness in Ethiopia numbed my empathy and made it seem hopeless to help any one individual.
Seeing the suffering and hopelessness of this woman, along with many others, moved me deeply and brought me face-to-face with the vast, unfair differences that exist in peoples’ lifestyles and opportunities. I had spent a few thousand dollars to reach Ethiopia, and each day had the privilege to learn and progress towards my dream of becoming a doctor. Every single day, this woman faced the same bleak routine and crushing poverty, and these stark inequalities made me disgusted at how myself and others could care so little for the suffering in the world.
In many instances, physicians care for the most desperate, ostracized members of society, and empathizing with their struggles is critical. Because most North American doctors inhabit a high socioeconomic class, they rarely experience life as a minority or outsider. When people suffer in North America, it can often go unnoticed by mainstream, wealthy society. Injection drug users shoot up while hiding under bridges, and homelessness and prostitution are confined to “rough areas” that can easily be avoided. Doctors come from a world of success and opportunity, but many patients only know pain and despair. This chasm of life experiences can make it difficult for doctors to understand the struggles of their patients.
While in Ethiopia, one of the biggest things I learned was how crushing the feeling of isolation and being an outsider is. Before my trip, when I heard people speak about feeling lonely and abandoned, those emotions were quite foreign to me. Now when I hear people talk about isolation, my mind returns to the deep loneliness and isolation I experienced in Ethiopia. It is important for physicians to understand their limitations, and by travelling to Ethiopia I realized that my medical education has limits, and a well-off lifestyle limits a physician’s ability to care for the emotional needs of certain patients. Because of this limitation, it is imperative that physicians work hard to understand the emotions and lived experiences of people different from themselves, and not gloss over or dismiss their suffering.
Note: All characters in this work are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
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