Photos by Gabriel Bensaad-Johnson, OMS III, Jennifer Daniels, OMS III, and Dominick Ruybal, DO.
Gabriel Bensaad-Johnson, OMS III, had traveled with a medical team of students, faculty, and volunteers for the better part of four hours to be able to reach patients in a remote Kenyan village. While the village was located several hours from the nearest town, it was the flooded roads that continued to prolong their journey. They had patients waiting for them, and they had to make every second on the road count. After hours of driving and building makeshift roads out of rocks and planks of wood, the team finally reached a section so flooded that the road all but disappeared into a deep lake. The patients themselves would have to walk to reach them.
The team set up tents as close to the village as possible, and they soon had a queue of over twenty patients waiting to be seen. Each patient encounter started with an interview and an exam. A translator assisted SD Bensaad-Johnson as he spoke to a woman about issues she had with her eye, which was clearly deviated and not functioning correctly. She also spoke vaguely of chest pain. For her eye, SD Bensaad-Johnson ultimately diagnosed her with temporal arteritis. The visit had taken up a good bit of time, and there were other patients waiting to be seen by the handful of supervising physicians and medical students. But the cause of the patient’s chest discomfort had not yet been determined. A supervising physician nudged SD Bensaad-Johnson to complete the exam and move on to the next patient, but something was bothering him.
“I had an internal dialogue with myself,” he later said. “Her chest pain did not seem cardiac in nature – she wasn’t in pain when I pressed on her chest or ribs – and she had never specified experiencing breast discomfort.” He realized something was not being effectively communicated. She was, after all, in this modest culture, a female patient being examined by a male student with a male translator.
The team had set up a tent for private screenings, and SD Bensaad-Johnson asked the patient if she would be comfortable undergoing a breast exam. During the exam and ultrasound, he found a mass in one of her breasts which appeared suspicious for cancer. He had a diagnosis for his patient but still felt conflicted.
“I was confident and reassured in myself for having followed my instinct with the patient, but extremely saddened knowing that she will likely not receive the follow-up care and treatment she needs.” This realization, and the skills he gained while treating patients abroad, have since reaffirmed his desire to treat patients in underserved communities and to help them manage illness that may go unnoticed or untreated.