Finding Inspiration in Rural Medicine

"My family has a history of congenital heart issues, one of which is a VSD in my mom. On that day, my mother asked if she could lay down for a while. It's a good thing my father brought her to the hospital instead. 

Over the past month, my mother had felt increasingly sick, and no one could figure out why. She had seen several specialists but continued to feel fatigued and breathless. On the day my father took her to the emergency room one of the doctors figured out she had endocarditis on her VSD and started the care that would save her life. That’s one of the reasons I want to practice helping people in medicine”

From early morning shifts to late night calls, medical students in their 3rd year clerkship are preparing their stamina to be the physicians of tomorrow. 

Distributed Learning and Rural Initiatives spoke with William Kennedy on a pediatrics rotation in Lethbridge to find out what makes him tick, and why he chose to have a rural learning experience. 

1. Why did you choose a rural learning experience? Have you had any others? What was your favourite part of the rural rotation?
   
   I have a lot of family in the Lethbridge and Taber area, and I remember growing up and driving down to parts of rural Alberta. I have a large family, and some of my favourite memories are us chatting around the dinner table or visiting legion dance halls. So I was naturally drawn to rural medicine.
   
   In your first and second year of medical school you have the option to gain mentorship through rural shadowing, so I have also had experience in Olds, Black Diamond and the Crows Nest Pass. In Black Diamond I got to work with some new graduates and carried a lot of responsibility. At the site we were setting up someone for transport and I was in charge of assessing the patient's vitals and reporting back. I got a real taste for emergency medicine, which is what I eventually want to do. 
   
    
2. What have you learned during your rural Alberta rotations that you haven’t learned elsewhere?
   
   Not only are you given more responsibility, but when you’re working with a small community they get to know you and your interests. A doctor or other healthcare practitioner may pass on interesting cases based on what you want to learn. Dr. Liesl Heyns in Lethbridge pulled me aside and showed me how to go through pediatric resuscitation (especially ventilator support for babies), and how to think through and commit to labs. Seeing her decision process helps inform how I will model mine. 
   
    
3. Tell me about a preceptor that inspired you or changed how you approached something.
   
   Dr. Murray Lee runs population health in Calgary and does some work in Nunavut. I wanted to do a project for global health by creating a podcast that describes what you would do in low-resource settings like the north. While I was exploring this topic I got very invested and inspired to keep the project going. I took it to a poster presentation in Calgary and I'm hoping to publish the podcast . The project got me interested in doing an elective with Dr. Lee up north, or exploring something else in a remote location. I'm interested in the thought process that takes place when working with limited resources . You have to factor in transportation, long-term resources and availability, imaging, etc. There are different challenges that need to be considered when giving treatment and different approaches based on the location you're practicing in.
    
4. Tell me about a time a patient changed how you approached something.
   
   I volunteered for a bike race to benefit MS and ALS research a couple of years ago in Vancouver. I met a lady with multiple sclerosis and we got into talking. I asked her some of her concerns when managing the disease, expecting her to mention mobility or balance issues. She was proud of how she had endured the illness, but mentioned that her edema made her self-conscious in public. When you’re faced with someone presenting with a particular illness, you sometimes anchor on what you think are their issues, but until you really ask them, you won’t be able to give them the care that does justice to their unique situation.
    
5. In your opinion, how do we achieve quality health care for people in remote areas?
   
   By continuing to support the work of organizations like Distributed Learning and Rural Initiatives within the Cumming School of Medicine and RhPAP. Especially by involving students early in training, you get to show them the breadth and depth that rural medicine can offer!