Perspectives

Mohammed Mustafa finds a different kind of enlightenment in the East

Perspective is an interesting word. It has currency among medics, and, terrifyingly, it has influence in defining what a good doctor should be like. How often has a stay in hospital, sleeping in a bed lined with sheets that make plastic look sensuous and covered with a blanket as welcoming as a Siberian salt mine, meant that--and this is the defining experience--being on the receiving end of administrations from a medical team that embodies paternalism and hierarchical pride has motivated someone to get into medicine and become a better doctor?

Medical students returning from their electives in developing countries use the word perspective with alacrity. They tell stories of poverty impinging upon not only health but life in general. Such seemingly irremediable destitution, coupled with the witness's associated soul searching, often proves a tonic of enlightenment to those who encounter it. What's more, it puts into perspective--that word again--where Western society is in the overall scheme of things. Those who come back from, say, Goa, with dreadlocks and then proceed to ignore current worldly affairs, maaan, probably used other means to attain spiritual enlightenment.

My parents originally came from the Indian subcontinent, and many of my summer holidays therefore didn't involve getting sand in my eyes or peeing in swimming pools. Instead, they involved plane journeys to Bangladesh that were nothing less than 400 hours of yoga (try flying economy class) and an exercise in self control as you endeavoured to peel open the sachets containing dinner. My visits showed quite clearly that hardship wasn't a title ascribed to the hardest kid in your school that losing ownership of the remote control of the television to your Aussie soap loving sister wasn't really a crisis, and that my family and I were very fortunate people indeed. We, as a country, are already familiar with such far off destinations. Courtesy of travel programmes, we know of their culture and vibrancy, smells and colours. Such descriptions of Bangladesh are not altogether inexact. Its main feature is, however, undoubtedly poverty.

On such a family holiday I once met a 12 year old boy whose lifeline was selling tea, from a flask, in the town centre. His wit and adroitness pointed to reserves of untapped potential, and it was very poignant to imagine that he would probably never go to school. An accident with a pot of boiling water one day left him scalded and burnt over his chest and abdomen. He was rushed, by the locals, to the nearby government funded hospital, whereupon his treatment consisted of cracking open half a dozen eggs onto his body to seal the wounds. Throughout, his spirits remained undiminished, and, amazingly, he was back at work within a couple of hours. Take from that what you want, but I personally was never going to complain the next time I suffered a sprained wrist while doing a jigsaw.

The exchange rate of the Bangladeshi currency (the taka) means that you need a suitcase to carry your converted sterling, thus giving the impression you are "rolling in it." But the scenes of abject poverty that greet you on entering the country are enough to dispel such conceited illusions. With my life approaching the equivalent of riding a bike with stabilisers, the visits to Bangladesh were timely reminders as to how closed my mind had become and suggested the tangible irony that developing countries have a lot to offer, not only for Western medical practice but also for its practitioners. If for you, however, "abroad" means a party island populated by 18-30 year olds from Slough wearing PVC pants, a frilly bra, and a fish net top, you may never achieve the same sort of introspection.

For medics, it would of course be handy if such perspective proved more than anecdotal, and contributed to one's professional development in becoming more empathetic. There is, however, no need for self- contemplation or despair if the only scary, remotely foreign, life changing experience you have had up until this point is being served a doner kebab. Gaining valuable perspective on the back of family holidays to Bangladesh is not the only way to gain a broader mind. A bad experience while in hospital as a patient, or even on a teaching round as a medic, may shed light on how not to practise medicine. But experience, rather like loo paper, is useless unless you apply it.

Mohammed Humayun Mustafa, second year medical student, Sheffield University


studentBMJ 2000;08:45-88 March ISSN 0966-6494