As the blood pressure cuff tightened, the petechiae blossomed like a cherry tree in spring, its petals shaking down the teen's arm. His face flushed with fever and winced with discomfort.
"Dengue," the resident said definitively.
I'd read about the tourniquet test in textbooks, but watching it before my eyes created an entirely different impact, one I could never appreciate without studying abroad.
I had left my medical school in New York City for an international medical rotation in Bangkok, Thailand, a similarly cacophonous and hurried city, yet with tropical foliage interspersing the high rises, golden temples glistening in the sunlight and night markets glowing with light, smoke and enticing smells.
I lived amidst the market near the hospital, winding my way through the stalls each morning, stopping for a breakfast of mango and sticky rice. I strolled through the gardens of the hospital courtyard to meet the residents in the ward, its windows wide open to the hot, humid air for rounds.
While many of our patients were suffering from the same illnesses I saw each day in my New York City hospital — cancer, kidney failure, emphysema — others were afflicted with pathologies I'd only read about — dengue fever, congenital syphilis, severe thalassemia and Burkitt's lymphoma.
I spent half of my fourth year of medical school studying abroad in Scotland and Thailand. While international medical rotations are sometimes seen as only for those planning a career in global health, I find them invaluable for all medical students. All of us learn from seeing the pathologies more common in other places; the more we see ourselves, the better our training. Furthermore, the COVID-19 pandemic has shown us that global is local and local is global.
So pack your bags and get ready. Here are some tips for international medical rotations.
Plan early
International medical rotations require more advanced thought to ensure they comply with your own medical school's requirements and can fit into your third- or fourth-year schedule. Applications usually need to be completed more than a year ahead, so start considering your study abroad options at the end of your second year. Speak with more senior students, residents, faculty and your medical school's global health program for ideas. Explore online resources such as the Association of American Medical Colleges, American Academy of Family Physicians and the American Medical Student Association.
Investigate widely
Your medical school will often have existing relationships and rotations; this was the case with mine and the medical school in Bangkok. Take advantage of these, as credits, logistics and the quality of the experience are already established. Your medical school may also offer spots to a few students to go together, and having a classmate by your side can help bring some of home with you.
Just as you can set up an away rotation at another U.S. medical school, you can do so with many international medical schools. This is how I was able to go to Scotland as a visiting student at the University of Edinburgh School of Medicine. The application process often isn't more complicated than that of a more local away rotation.
Remember your own health
Get your own health in order before you leave. Visit a travel medicine specialist to get the right vaccines and prophylactic medications for your trip. The Centers for Disease Control and Prevention's Travelers' Health website provides excellent information by destination. You'll need travel insurance, special health insurance and perhaps malpractice insurance; your medical school administration can help in this area.
Learn beyond the hospital
While you're studying abroad, pay attention to the differences not just in pathology but in the diagnostic measures, treatment styles, healthcare systems and cultural factors affecting care. Explore the neighborhoods outside the clinic or hospital. See if you can live with a local family or participate in home visits to patients. Ask other students or residents if you can join them on local excursions. A resident I befriended took us to a different lunch spot each day — places I never would have found on my own and so much more delicious than the tourist traps.
Learn some of the local language
My rotation in Thailand involved a weekly English practice lesson. Together with a Thai-American attending, we helped the Thai students and residents become more fluent and broad in their English vocabulary. In turn, I learned some rudimentary Thai. It's a welcome surprise to the occasional patient of Thai origin I see now in the U.S. when I can start our visit with "Sà -wà t-dii-khâ" (hello).
Take advantage of your time off
Residency doesn't provide much time for vacation, limiting your international travel for a few years, so seize the time in your last year of medical school. Most international rotations don't require work on weekends, so hop a bus, train or short flight to a great beach or a new city. I was in Thailand during the Thai New Year celebration, providing a full week off to explore other parts of the country. Ideal rotations will be six to eight weeks, but see if your schedule can accommodate a bit more time. I was able to stay a week after my rotation, allowing visits to Hong Kong and Cambodia.
Keep in touch
You will meet and learn from other amazing doctors on your international rotations. Be sure to nurture those connections and maintain your communication after you've left. Your relationships with them may lead to future academic collaborations, helpful consults or simply meaningful future vacations. I am grateful to now have lasting friendships from my time in Bangkok.
I have since had several patients here in the U.S. with concern about dengue fever after returning from endemic areas. My visceral understanding of the disease has allowed me to reassure and diagnose such patients in a way that would have been impossible if I had kept my learning local.
