International Health Rotations

As told by Ramin Ahmadi, MD, MPH

It is the end of the twentieth century, and I am walking among the ruins of what used to be a vibrant downtown. This desolate place is the capital of the newly independent East Timor. It is two months since the Indonesian-backed militia, rampaged the streets to punish the locals for exercising their rights to self-determination by voting for independence from Indonesia.

I make up a small group of international guests brought to this site by East Timor’s independence leader, Jose Ramos Horta, the 1996 Nobel laureate. Jose is making his way home after 25 years in exile, and we are accompanying him. What should have been a joyous homecoming is, instead, a return to a country ravaged by hatred, the inhabitants greatly in need of what little medical attention we can give them. In the eastern corner of the island, we visit the only hospital in town.

I see a two-year-old boy dying from starvation curled up motionless –with swollen belly and wasting extremities– and hooked to an empty IV bag. All of my training can render only a soul-wrenching tenderness. I approach his bedside, hold his hand, but cannot help any more than that. No one can. He is alone in a world in which his little body is the very document of this world’s terrifying inhumanity. Overcrowded facilities, the bullet hole–riddled walls, poor hygiene, filthy needles, broken tubes, dirty water, and a hospital out of basic medications–a slow and melancholic decay are all around us and I cannot tell Jose what I, a North American physician, truly see. I cannot tell him, nor can I tell the people who attempt to care for his people, that modern medicine, in a place of such distorted humanity and such violated basic dignity, seems a cruel and irrelevant joke.

At home in my daily life, I am a physician living in the United States, specializing in Internal Medicine and employed by Griffin Hospital in Derby, Connecticut. I came to this country in 1982, after living through the Iranian revolution where, as a young boy I saw my friends killed, and many others suffer. From these experiences, an interest in human rights developed and has informed all of who I am. As a physician, I strive to aid those caught in the crossfire of oppression and human rights, and as a human rights activist, I created the Center for Health and Human Rights at Griffin Hospital. Through coordinated efforts with other nongovernmental organizations, I and other members of the Center work with leaders of these war-torn countries, as I did with East Timor’s independence leader Jose, to bring medicine where it is needed.

International practicum sites, with designated preceptors, provide students with the opportunity to research and implement public health and human rights projects within the context of a regionally balanced program. Administered by the Griffin Center for Health and Human Rights, international health projects promote appreciation for health as a question of social justice and as a guaranteed human right. The intense experience of working in a developing country successfully develops residents' professionalism, ethics, and communication skills as part of the ACGME competencies. The sites for previous projects and preceptorships have included: East Timor Guyana, Nicaragua and Uganda, and additional rotations are currently under development. Participation in at least one international health rotations is highly encouraged by the program, and residents are allowed a considerable amount of flexibility in the design and objectives for the rotations. Selection of sites is based on both the skill level of the resident (clinical, research, language) and the appropriateness of the project for the setting. International research projects and rotations are often used as an opportunity to develop a resident's thesis as part of the requirements of the Yale School of Public Health.