Foundations Curriculum Student Experience Blog: Bringing the Lessons Home

When I was applying to U of T, I remember browsing the Faculty’s website and finding a list of potential summer research opportunities available to medical students. One of those was a placement at a hospital less than 10 kilometres away from my father’s home village in Sri Lanka. As a child growing up in Waterloo, Ontario, I had mostly shied away from getting to know my Sri Lankan heritage. But something inside me wanted to explore it now. This summer, I found myself on a plane to Colombo, excited to collect data as part of a global health study on therapies and complications in Sri Lankan patients with thalassemia — an inherited blood disorder that causes the body to make an abnormal form of hemoglobin, a protein that carries oxygen in the blood. Patients with this disorder often need regular blood transfusions and can also experience cardiovascular complications, diabetes and other serious endocrine disorders.                                                                                         

While I certainly learned a lot about thalassemia during our weeks of chart review in the first year of the Foundations curriculum, I was now gleaning new lessons on the streets of Colombo, the city where I worked. As people with a challenging chronic disease, thalassemia patients have many interactions with healthcare workers. The charts we reviewed had extensive documentation of the frequent visits. While reading these charts, I often discovered that I had greatly underappreciated the importance of ethnicity, culture and race in medicine. 

In the first year of medical school, the Foundations curriculum repeatedly emphasizes in lectures and small group seminars the importance of cultural safety. During my international placement, I inadvertently stumbled into a real-life lesson. In Sri Lanka, there’s a common misconception that you’re not related by blood to your maternal family. People may marry their cousins or others in their home villages who might also be related.

Thalassemia is an inherited genetic disorder and if both prospective parents carry genes associated with the disorder, they’re more likely to conceive a child with thalassemia. While I was in Sri Lanka, I learned about public health campaigns encouraging potential spouses to get genetic testing prior to marriage, so as to pre-emptively decrease the likelihood of children being born with thalassemia. It was a living example of the lessons taught in first year.

Now that I’m home, I intend to keep questioning my own assumptions about culture and learning to respect our patients’ cultural diversity.

I also found myself watching physician-patient interactions in the hospitals where I worked. To that point, much of my clinical skills training emphasized the nuances of communication. Though I often wished we’d spent extra time on more tangibly clinical aspects of medicine, my time in Sri Lanka allowed me to appreciate how far good communication can go. An unusually severe outbreak of dengue forced physicians to admit many more patients than they had space to accommodate. The physicians used masterful listening skills and nonverbal communication to comfort patients who didn’t even have a bed to themselves.

In a similar vein, one of my own goals for the summer was to improve my pitiful Sinhala. I’m grateful for the opportunity to spend so much time using my second language, though I never quite got used to mentally rehearsing everything I wanted to say in advance. Nor did I welcome the daily questions about my accent. However, this experience gave me a huge appreciation of what many immigrants in Toronto and Canada must brave on a daily basis. Many of our patients, like my parents, interact with most people in a language that isn’t their mother tongue. I have so much respect and admiration for their courage.  

I intend to keep exploring opportunities to incorporate what I learned this summer into my budding medical education. U of T has a long history of its physicians being involved in global health. Maybe global health will be part of my story, too.

This student experience article expresses the views of Sanasi Jayawardena and is not meant to be representative of the entire student experience, nor represent the MD Program.