Rewarding on every level
Dermatologist Anthony B. Mak, MD, PhD, FRCPC, DABD was so thankful to take part in the Resident International Grant Program and travel to Botswana to provide dermatologic care.
Dr. Mak’s story
Through funding from the American Academy of Dermatology and support from the Botswana-UPenn partnership, I had the opportunity to practice dermatology at Princess Marina Hospital in Gaborone, Botswana, as well as its affiliated outreach hospital sites in neighboring towns and villages. In addition to my practice, I was also a clinical teacher and examiner for medical students at the University of Botswana. Originally, my trip was scheduled for 2020 but this was cancelled due to the COVID-19 pandemic. Three years later, it was revived by the Resident International Grant program directors, to whom I am very thankful for this opportunity.
I faced various clinical challenges, ranging from treating common dermatologic conditions with limited resources to tackling complex diseases that I had never seen before in practice. What I found most challenging was witnessing the difficulties that many patients face in regard to their social determinants of health.
Here is an example: A 40-year-old outdoor carpenter travelled many hundreds of miles to dermatology clinic for consultation. On exam he had thick, red, scaly confluent plaques covering his entire face, scalp, hands, and arms. He was clinically diagnosed with generalized hypertrophic discoid lupus erythematosus, which was associated with extensive scarring and disfigurement. I was surprised when the patient stated that his dermatologic manifestations had been present for more than 10 years and that he had not seen a medical doctor his entire adult life due to financial constraints and a lack of access of medical facilities from the remote area where he lived. Although extensive scarring and disfigurement had already occurred, he demonstrated impressive insight into his condition as being photosensitive and he adapted by constructing a face mask with materials at his disposal to prevent further exacerbation of his condition.
Prior to traveling to Botswana, my focus was on improving my clinical acumen and management in complex medical HIV dermatology and global dermatology. However, as exampled by the case above, I soon realized that I had emotionally and cognitively gained more from my patients than I had initially intended. I was impressed by their resilience, persistence, and self-advocacy in a constrained healthcare system. My lasting impression was invariably their patience, warmth, and politeness. This feeling was translated to my relationship with the clinic staff in Botswana, which allowed me to integrate smoothly as a dermatologist team member. I am grateful for the knowledge, experience, and teamwork skills that I have gained, which will undoubtedly help me provide better care to my future patients.
My time in Botswana was both intellectually and sentimentally rewarding, and I left with mixed feelings. I am appreciative that I had the opportunity to participate in a defining moment in my career; however, I am also sad that I have left behind people and places that I care about. I have traveled back to Canada with many amazing memories and hope to continue a career in global dermatology.
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