Medicine in the Bushes

    As one can imagine, practicing medicine in the bush of Angola is quite different from what we're used to in the United States. It brings you back to the core of medicine - clinical reasoning, careful observation, and thoughtful decision-making. Here, you're constantly weighing the risks and benefits of every test and treatment. This is truly poverty medicine, where cost and burden on the patient and their family are always part of the equation. Some patients travel for days to reach the clinic, many of them on foot. They are incredibly resilient people, and the effort it takes for them to come means they are truly unwell. It's a humbling reminder of both their strength and the responsibility we have to care for them with purpose and respect.

    There are several lab tests available in Cavango that we commonly use in the U.S. - such as CBC, BMP, LFTs, TSH, creatinine, and urea - but they are only ordered when absolutely necessary. In the States, these are often routine and frequently over-ordered: once upon admission and daily for inpatients to trend the numbers. Here, we only run these labs if the results will directly impact the treatment plan. The focus is on minimizing cost for patients, as expenses can quickly add up and become a heavy burden. Every test must serve a clear purpose and offer benefit.

 

    When it comes to imaging, ultrasound is an incredibly valuable tool. It's used during nearly every patient consultation because it provides a wealth of diagnostic information in a quick and cost-effective way. A new X-ray machine has been introduced at the hospital, but it's used sparingly - only a few times a month. Like the lab tests, it's reserved for situations where it can meaningfully aid in diagnosis and alter the treatment course. 

    There is also a blood transfusion protocol in place, most often used for children with hemolytic anemia caused by malaria. Only whole blood is given, and it's collected on an as-needed basis. One of the most touching things I've witnessed is the hospital culture that Dr. Tim has cultivated - if a patient's family member is not a blood match, hospital staff frequently volunteer to donate on the spot. It's an incredibly beautiful and selfless act of solidarity. 

    With limited resources, you're constantly challenged to think creatively and make the most of what's available - especially in critical moments. Over time, this environment forces you to sharpen your clinical instincts and become more adaptable. It's a powerful kind of training that you can't get in a resource-rich setting.

My thoughts:

    This experience has deeply shifted the way I think about medicine. Practicing in such a resource-limited setting has reminded me of the importance of treating each patient as an individual - carefully considering their context, their needs, and what will truly benefit them. I've been amazed at how much can be done with so little, and how strong clinical judgment, sharpened physical exam skills, and thoughtful decision-making can go such a long way. For example, one thing that was particularly shocking to me was the availability of an X-ray machine - but how rarely it's actually used. Coming from a background in Western medicine, I'm used to seeing nearly every patient receive a chest X-ray upon arrival to the emergency department, and daily chest X-rays for those with severe pneumonia or on ventilators. Here, I've learned that many of those practices aren't always necessary and can often be a waste of limited resources. Instead, clinical symptoms, physical exams, and patient progress are used to guide treatment decisions. It's been eye-opening to realize how much you can rely on your clinical skills, and how effective medicine can be when it's guided by thoughtful judgment rather than routine imaging. It's empowering to see how confident and decisive you become when you rely more on your clinical reasoning than tests. As I return to the U.S. to begin residency, I hope to carry this mindset with me - to be more intentional, more resource-conscious, and to never lose sight of the human behind every test and treatment plan. This kind of medicine has shown me the beauty of simplicity and the power of thinking critically with whatever tools you have in front of you.