Uganda clerkships inaugurate a new foreign electives program

After six weeks in Uganda last summer, fourth-year medical students Allison Arwady, Lily Horng and Rachel Laff said the clinical rotation at Mulago Hospital was the best they’d had in medical school. The three were the first students to travel abroad with support from three new fellowships endowed by alumni donations. The fellowships marked the beginning of an ambitious program to support international clerkships for students.

“This is different from anything that has ever happened before,” said Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs. Students have long traveled abroad for clerkships, but at their own expense. For the first time, the medical school is offering financial support. Angoff believes the experience in a foreign hospital will have a lasting and positive influence on the students’ development as doctors.

Arwady, Horng and Laff joined an existing medical exchange led by Majid Sadigh, M.D., associate professor of medicine. This was the first time that the exchange, which has brought Yale residents to Uganda since the summer of 2006, hosted medical students.

“It was hard,” said Arwady, who had previously been in South Africa and Botswana, working on projects as a medical student. “It was also one of the most intense and thought-provoking experiences I have had in years. You are out of your comfort zone in every way.”

“I learned a lot, thanks to the residents and most of all to Dr. Sadigh,” said Laff, who had previously spent three months in Gabon. She said her time in Uganda reinforced her decision to pursue internal medicine. “I want that broad training,” she said.

“It was the best rotation I’ve had, hands down,” said Horng, who had previously traveled to China and Chile.

On Mulago’s wards they saw the limitations of medicine in a developing country and marveled at the skills and knowledge of their Ugandan colleagues. They came away with a heightened appreciation of the importance of the physical exam, which they saw their Ugandan and Yale colleagues relying on for diagnoses. “It’s something that we don’t do that well here,” said Arwady.

Also in Uganda was Matthew S. Cook, PA ’07, then in his final year of the Physician Associate Program, which provided partial support for his rotation. Like the medical students, he said his experience in Uganda left a lasting impression. “I definitely have a commitment to do medicine overseas,” he said. Cook began a two-week rotation on the Community Health Care Van on his return to New Haven. Coming on the heels of his Uganda clerkship, the van rotation made him more aware of health disparities in this country. “The health care system is broken and flawed. The problems are so widespread there is no easy fix,” said Cook, who is now on the hospitalist service at Yale-New Haven Hospital.

Robert M. Rohrbaugh, M.D., associate professor of psychiatry, and administrator for the clinical elective program that has brought foreign students to Yale for electives, said the success of the Ugandan program bodes well for future foreign electives. “Despite the difficulties that everyone that goes there encounters, it was confirmatory for them that this is what they want to do,” he said.

Foreign electives will be open to students who have completed their third year. In addition to the six-week clerkships, students can apply for the year-long Yale-China Medical English Fellows Program. Nancy Chapman, executive director of the Yale-China Association, said the fellows going to China would teach medical English and study Mandarin, the official modern spoken language of China. They would also have clinical and research opportunities. The association will pay travel expenses and provide a stipend and housing at the Xiangya School of Medicine in Changsha, Hunan.

Wherever they go, students would be expected to learn about the host country and learn something of the language. “They have to be prepared,” Angoff said. “They will also have an opportunity to debrief afterwards, as these experiences can be emotionally charged.”

Rohrbaugh said students will benefit in several ways. “They’ll be able to practice what they’ve learned at Yale in different settings. They’ll be seeing patients with different presentations of illness. They’ll develop an awareness of the social and political factors in health and disease,” he said. “There is a basic cultural competency that you learn.”