Issue 20 / 28 May 2018

CONTINUING professional development remains a crucial part of medical training for doctors at all levels of their careers. It shapes the way we practise medicine, but it can lead to significant stress.

Australia has seen a recent rise in the number of medical graduates, and with that comes a more competitive arena and struggle towards specialist training. Many junior doctors find themselves in a rat race of sorts, pushing themselves to meet training requirements before their counterparts. Such a competitive feat is seldom achieved without professional and academic stress, withdrawal from the social arena, restricting time spent with family and friends, managing the possibility of failure and progressive narrowing of one’s career options. This form of medical training stress has always been present but has seen a dramatic rise with the influx of graduating medical trainees, limited training positions, postgraduate medical courses, and emphasis on being highly driven medical professionals.

Like many junior doctors, I too found myself burdened with this stress recently, but ironically, it was these stressors that inevitably were the solution to my problems.

Pursuing specialist training, I had spent the past 4 years engaging in research, teaching, charity fundraising and the development of my clinical knowledge and practice. Work had become tiring, stressful and repetitive.

One afternoon, I was approached by a colleague looking for medical volunteers for an upcoming trip to Myanmar. The 2-week trip would require the volunteers to fund their own flights, partake in busy ophthalmic clinics with limited resources and adjust to the available resources of an impoverished country. Having spent my previous holidays at conferences, sitting exams or writing papers, I decided that this would be a good opportunity to get away from it all and still contribute to my professional aspirations.

Later that year, I arrived in Myanmar. As promised, I was met with rooms filled with waiting patients, limited resources, language barriers and a wide array of pathology I had not previously encountered.

On my first night, resting in bed, the gravity of my situation began to sink in. I was out of my depth. I had limited clinical knowledge and experience in these conditions, which left me slow and requiring frequent senior input. I did not have the luxury to Google my way through, and I felt like the pace would eventually get to me. I decided to study the pathologies I had encountered in that first clinic, but the demanding day left me asleep on my texts. The following morning, I joined the team at breakfast and quickly learned that I was the only person who did not enjoy an early morning run or hike in the local community because the previous day had left me too exhausted. This cycle would repeat itself throughout the week.

With the arrival of the weekend came some long overdue leisure time. Together, the team explored local temples, markets, stalls and various tourist attractions. The burden of busy clinics, limited resources and exposure to rare conditions was shared by all. However, with the support of each other we had made it through the week unscathed.

As the second week began, I found myself feeling lightened. I soon realised that the busy clinics did not translate into increased pressure to see patients quickly. Unlike at home, the patients in Myanmar were always patient and very grateful to be seen at all. It became commonplace to receive sincere gestures of gratitude and I felt truly appreciated. My seniors continued to show me the same patience they had shown me on my arrival and my clinical knowledge and skill improved substantially.

Consultations became quicker and diagnosis easier. As the clinic became more manageable, I was offered the opportunity to participate in operative cases. Here too my seniors offered patience and teaching, leaving me reinvigorated about the practice of medicine.

By the end of my clinical placement, I had explored most of the local village with my colleagues and formed strong personal and professional bonds, greatly improved my clinical skills and I had a newfound respect for life.

Too often, in our pursuit of training, we forget why we chose to become doctors and what truly makes us happy. The greatest joy for any doctor is gained from the care they provide their patients. As junior doctors caught up in the selfish pursuit of specialty training, it is this that is often forgotten.

The selfless act of medical charity in impoverished countries has many benefits to the junior doctor and it is my belief that it should be done by all doctors, at least once, in their career. The patients I encountered during my trip were the most appreciative and grateful people I have ever met in my life. Not only were they grateful for my help, but with their actions they made me grateful. The patients and hospital staff were always thankful for the gifts we all too often take for granted.

My patients lived a very disadvantaged life. They lived in poverty, hunger, sickness and war. They were grateful for food, water, shelter and family. It is naive for us to think that these people don’t have the same dreams we do. They, too, expressed wishes for a beautiful house, a car, money to spend. They often enquired as to what it was like to live in a country with all the comforts of life – free schooling, government support, access to health care – and they wished that they too had these things for their families.

They made me humble and grateful for what I have. It left me grateful for peace, prosperity, family and my profession.

Many people go through their life without experiencing the beauty of such moments. As doctors, we have the opportunity to seize this experience and we must never allow such opportunities to be abandoned. My experience also taught me about their culture and gave me insight into the struggles faced by patients who have migrated to Australia from such countries.

This experience will inevitably allow me, and all involved, to form deeper professional relationships with patients and form a better understanding of their challenges.

Academically, this experience exposed me to an abundance of clinical entities not commonly encountered in high income countries, where early intervention is common. The high patient volume and abundance of clinical features rapidly developed my clinical knowledge and examination skills. Such learning cannot be achieved without the clinical exposure, which is comparably rarer in Australia.

Finally, this experience has given me the opportunity to work closely with senior medical staff. This close personal and professional relationship allowed me to learn from their shared professional and personal life experiences, plan my career and shape my own professional development. Such experiences draw selfless, humble, compassionate and kind people – all qualities vital for the development of junior doctors and for medicine as a profession, in my opinion.

The professional development criteria laid out by the various medical bodies should be viewed as an opportunity to develop the characteristics of a successful doctor. Engagement as a health advocate in impoverished areas, I believe, is the most rewarding aspect of this requirement, and should be the starting point for all junior doctors regardless of specialty training requirements.

Engaging in medical charity work in an impoverished area has allowed me to get away from the noise of the world, to a quiet place, where I could truly carry out the practice of medicine as I have always intended.

Dr Ajit Singh Bhalla is a senior resident with an interest in ophthalmology. His interests include charity work, ophthalmic research and computer programming. He wants to dedicate this article to Professor Peter Martin and Dr Leanne Cheung: “Professor Martin has spent contributed a significant proportion of his time over the course of the past decade providing annual free care to the patients in my clinic. Without fail, he has sacrificed his time to this humanitarian cause and has gone largely unrecognised. Dr Leanne Cheung is the director of ophthalmology training at Prince of Wales Hospital.  She has dedicated her time and resources to training junior doctors and continues to do so.  She has also dedicated numerous years in the clinic mentioned in this article”. 


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One thought on “Charity as a panacea for professional burnout

  1. Nayan says:

    Excellent take away messages for all doctors.
    Let’s hope our collective colleges recognize community/charity work as part of CPD.

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