should pursue. However, most of those who feel
compelled to undertake such a project do
so in order to contribute to improving health
care resources of underserved people.
Medical students considering an overseas stint
should be prepared to be flexible so
far as living conditions are concerned, both in
terms of accommodations and diet. Also,
they should not consider their project a
sight-seeing trip and they need to take time to
learn about the culture of the elective country.
They must be aware that there are nega-
tive aspects to service abroad. Some residency
program directors view such an activity
as time off from medicine. Frustrated by the
inability to improve conditions in underde-
veloped areas, some individuals may fail in
their efforts to study and help overseas
health care providers.
Obtaining permission from a medical school to
study abroad should, in most cases,
not prove difficult, since more than 90% of the
schools allow third- or fourth-year stu-
dents to do so for up to two months. However,
only about 25% of the schools provide
training in international health. This is
regrettable, since preparation is the key to a suc-
cessful overseas stay and typical
university-based clinical training is inadequate for
preparing students for service in
underdeveloped areas. The University of Arizona
Health Sciences Center in Tucson, Arizona,
offers a free summer international health
course that is held in high
regard.
Medical Assistance Program International,
Brunswick, Georgia, funded by the
Reader's Digest International Fellowships,
provides funding for 50 senior medical students
to serve in overseas missions. It is one of the
few programs offering overseas study support.
The following additional advice can be useful
in trying to secure an overseas elective:
1. Seek an established program to ensure that
it will be well organized.
2. Start the search for an elective country
early; overseas correspondence is time
consuming.
3. Get to know people in your elective country,
since this can provide for mean-
ingful future relationships.
4. Be prepared to deal with communication
problems, loneliness, and frustration.
5. Consider yourself a collaborator for health
improvement, rather than a savior.
6. Travel lightly, but be sure to take pure
chlorine for water purification and a non-
leaking water bottle in which to store
it.
7. Respect the ways of the people you are
visiting; in all likelihood, they will then
reciprocate.
8. Before departing, read Cross-cultural
Medicine: What to Know Before You Go
(AMSA International Health Task Force) and
Where There Is No Doctor: A
Village Health Care Handbook (Chesperian
Foundation, Palo Alto, California).
For an in-depth discussion of foreign medical
study, see Chapter 13.
Community Service Activities
In the 1950s medicine emphasized the patient as
an individual, rather than as part of a
larger group. In the 1960s patients were
introduced to students early in the educational
process and medical ethics became a part of the
curriculum. Currently, new concerns
have emerged, such as the impact of technology
on the terminally ill and the spiraling
cost of and accessibility to health
care.
In recent years there has been a growing
awareness among health care professionals
of the needs of the disadvantaged, which
include nearly 40 million uninsured
Americans. This has resulted in students
volunteering their services, and some of these
activities are gaining medical school
recognition.
Service programs that students have initiated
and led involve a very wide range of
activities such as work in soup kitchens for
the homeless, helping to build low-income
housing, serving as health educators in local
grade schools, or assisting in medical clinics.
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