PA Elective in International Medicine

Maggie is a McMaster Graduate who currently works in Physical Medicine and Rehabilitation. She completed a 4 week clinical rotation in her second year PA School in the Western Himalayas arranged through an organization called the Himalayan Health Exchange.

Watch or listen to the interview with Maggie about her experience doing an International PA elective during PA school!:

The following is a transcript of the interview modified for readability. 

Deciding to Do a Rotation in International Medicine

Maggie: I’ve always had an interest in international medicine, but I first had to figure out if doing an international elective during PA school was feasible for me. A couple of considerations included: financial feasibility, timing, and if the PA program would approve it.

“My motivation for obtaining experience in international medicine was to not only get that experience practicing and learning medicine abroad, but to see what health care is like in other areas of the world.

And I wanted to allow that to benefit my PA practice coming back to Canada. I found that really opened my eyes to what we do have here in Canada.”

Maggie, McMaster PA Graduate

This experience doing a rotation abroad also really tested my clinical skills, because there were  so few resources in these remote areas in the Himalayas, we had to rely on our hands-on clinical skills + acumen including history taking and physical exam  in order to diagnose and treat patients over in these areas.

Setting up the International Elective

The Organization

I went through an organization called the Himalayan Health Exchange. This is an organization that was established to provide cross cultural learning and community service focused on improving the health and wellness of locals in underserved areas in the Western Himalayas.

The Himalayan Health Exchange does  have a partnership with McMaster University and PA students had gone in the previous year.

A screenshot of the applicaiton form. There is also a Medical HIstory Questionnaire.

Setting the International Elective involved:

  1. Contacting the organization to express my interest
  2. Sending in the Application
  3. Coordinating with the PA program
  4. Receiving acceptance to go.

About the Elective

Length: 4 weeks
The Expedition I choose: Western Himalayas – although there are options to do other countries such as Ghana
The Team: We were with 30 other medical students and PA students, four residents and two supervising physician who had experience in travel and tropical medicine. These were broken up unto teams for the mobile clinics.

Through that organization, there only the one expedition that fit my elective block. So I was limited in that way. There is other organizations that I think are active in ghana, and other areas, but that one fit the time that I could do it.

A screenshot of a sample list of different expeditions. Maggie’s was in the Himalayas.

Packing for the Rotation

Actually in my year, 3 of us from my class did an elective there, so it was really nice to have the group of us.

It was a matter of reaching out to those who had gone previously and other students that were going with us, from the UK and from the United States.

Packing was challenging, we had one back pack for the whole month.

We had to be very strategic when it came to clothing – in terms of quantity and types of clothing we were bringing.

We also had to bring medical supplies over – so we had to budget for that in our backpacks.

It was quite minimalist living for that month.

Medical Resources

We brought texts that we could use and review together – a lot of tropical medicine textbooks which I would not have had otherwise, but they were very useful.

Patient Access Challenges in the Himalayas

We were doing mobile clinics in the Himalayas. So we actually trekked in between our clinic days. It would be 1-2 days of trekking and then we would setup mobile clinics with four different tents, setup all of our equipment. Then people of the village would come to that area because they knew we were there.

“These patients only receive care once a year. So in 365 days we are the only medical services that go through because of mountain access it is very difficult for them to get to the hospital.” – Maggie, McMaster PA Grad

Photos of patient care above from Himalayan Health

Experience during the Rotation

A lot of preventative medicine, education, screening, well-child exams, and a lot of treating common conditions. There were the eyes, oral dental abscesses, those types of things.

We were quite limited in the medications that we had with us. There were a lot of ethical decisions as well.

Day in the Life during an International Elective

Our days would either be trekking or doing clinics. So we would spend 8-10 hours a day hiking to the next location. We slept in tents.

We had a team of sherpas and mules that would care our bags and equipment – because we had quite a lot with us. The team was amazing, and we got to know them well over the month.

We would do anywhere between 5, 8 to 10 hours of hiking. Rest that night,  either hike the next day, or setup the clinic for the next morning for patients to come to (Photo from Maggie)

Clinical Teaching during the International Elective

“We did large group sessions covering topics on tropical medicine. We focused a lot on mountain medicine, as well as taking care of yourself while you’re providing care to others.” – Maggie, McMaster PA Grad

There were two supervising physicians who were very experienced in tropical and travel medicine – both from the United States.

We also had four residents as well, so we broke off into teams where the med students and PA students were working with a resident. The supervising physicians were circulating around.

Meeting with PA and Medical Students from the US, UK and Canada

It was a really nice team dynamic as a clerk at the time, because we were learning from our other students that practiced or came from the UK and the United States and the best practice and health care models in those different countries.  We were able to review with the supervising physician and residents if we had any questions.

Photo from Himalayan Health

What I learned

Medically I learned a lot about conditions that we would really never see over here in Canada. So certain conditions of the eye, skin conditions, other things that we don’t come across here in Canada.

Giving care in an ethical way, we had a lot of discussion around what vs “Help vs. Harm” is especially in such an underserved area. We had to struggle with prescribing Tylenol for a two week course for this, when this is a really osteoarthritic patient. That really has allowed me to bring that into my practice as a pA, and I found it very beneficial about that experience.

Challenges of an International Rotation

The overall journey of being in the mountains for a month was quite challenging.

There is no access to the internet or technology. 

We were at very high altitudes, and they warned us we had to train before going to prevent altitude sickness. We were all taking medication for altitude sickness, and we had quite a few people get sick and that is quite a risk of going at high altitudes

“I would say it was very physically challenging but rewarding. And the team that we were with allowed me to get through the tough times.” – Maggie, McMaster PA Grad

Final Tips

The most important attribute is being passionate about travel/internal medicine and passionate about the experience, because you are committing a month to being there and it can be challenging with few resources.

Also think about why you want to do the experience and what you want to take away from the experience – Whether you want to continue to be involved in international medicine in the future – or you want it to shape your PA practice back home.

It’s important to also have resiliency and be flexible. There were times where unexpected things or events would happen and you had to go with the flow, or  for example, it would be raining while hiking for the entire trekk (which can span several hours), and you really had to be resilient to the challenges you come across.

My recommendation would be to speak others who have done the rotation before. I think that’s the best way to truly understand what the experience is like and see if its a good fit for you.