EARLY CAREER EDITORIAL
Jennifer Hong, MD
University of Mississippi Medical Center, Children's of Mississippi
From the time I entered the medical field, I longed to be involved in medical mission work. In my youth, I participated in several domestic service projects and assumed I would continue my volunteer work in the States. However, when given the opportunity to serve in American Samoa, I discovered a passion for serving abroad that continues to this day.
As a third year Pediatrics resident, I had the opportunity to serve in the Pediatrics Department of the only hospital in American Samoa: the Lyndon B. Johnson Tropical Medical Center. While American Samoa is a US Territory, access to medical care is extremely limited, posing a common point of frustration for medical providers and patients alike. For example, providers are unable to consistently obtain pediatric echocardiograms. They rely on visiting cardiac teams, few of which are pediatric trained, to obtain limited echocardiograms. I remember the frustration expressed by my supervising attending for not having the ability to diagnose a newborn with a persistent murmur. More gut-wrenching was the feeling of helplessness surrounding the lack of prostaglandins available for those with suspected ductal-dependent lesions. A particularly memorable case was a profoundly cyanotic four-year-old girl suffering from transposition of the great arteries – not just an atrial septal defect as previously diagnosed via limited work-up! This first experience gave me an immediate appreciation for access for children in the US.
Another consequence of limited access to medical care in American Samoa is a high rate of rheumatic heart disease. Medical providers stress the importance of monthly penicillin injections in the hope that it will reduce progression to severe heart disease. There are no consistent options for surgical care on the island and getting a patient accepted and transported to an off-island location is often a Herculean task. Since my time there, forged partnerships with US programs have led to screening, education, diagnostic protocols and follow-up for rheumatic heart disease.
After completing my critical care fellowship, I returned to the mission field to provide pediatric cardiac intensive care. I have had the opportunity to participate in several international cardiac trips through both Caribbean Heart Care (Trinidad) and Tenwek Medical Hospital (Kenya). Both programs were developed from a need for pediatric cardiac surgical care in their respective countries. During each trip, we performed nearly a dozen open-heart cases a week and followed them through transfer to the pediatric wards. Medical mission trips are most influential when the visiting team not only comes to address immediate needs, but also leaves behind something long-lasting: education and skills for self-sustainability. For both programs, an integral part of the trips has been working alongside the local physicians, nurses, medical students and staff to educate and empower the home team to provide some services independently.
Illness is the great equalizer. We all develop ailments of various degrees and have fears when it comes to health. After each trip, I leave knowing we made an impact on the lives we came across. More importantly, I take away an appreciation for the resilience of the people and the resourcefulness of the providers. My trips have greatly shaped the way I approach my current practice in an under-served area in the United States.