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The warm morning air of Egypt hit my face as I took the first step out of the airplane. I was still in disbelief that I had chosen to travel so far for the first time without my parents to accompany me. A sense of fear intermingled with a sense of excitement, as I breathed in the dusty new air of Egypt. This overwhelming feeling of wonderment took me back to when I was only five years old when everything seemed so exciting and new. Not only would I have the privilege to see a country I only dreamed about, but I would also have the opportunity to enrich my journey to become a better physician. It The feeling of euphoria however could not surmount the tire I felt after over 14 hours of travel, so as soon as I fixed my new bed, sweet sleep took over. The next thing I remember is waking to the sound of knocking on our dormitory door. Dazed from overwhelming emotions and exhaustion from travel, I woke to open the door to Mohammed, our host for the next two weeks at our dormitory. He handed me a giant breakfast tray even though it was 12 in the afternoon. This was hospitality at its best, a full breakfast delivered right to our dorm doors! Mohammed knew very little English, so communication with him involved an interesting mix of Egyptian words from a tourist book in combination with sign language and a bit of English words for which a substitution could not easily be found. This was my first test of communication in a foreign land. I couldn’t help to think that this is what first time immigrants to the United States must go through. I grew up in an urban surrounding where majority of the adults were foreign immigrants with very poor English skills and for the first time I understood what they had to have gone through to adjust to In Egypt it would have been easy for me if I had gotten sick and had to see a doctor since all the doctors speak fluent English there. In the United States, majority of doctors are usually only fluent in English and sometimes Spanish, but working in a place known as a melting pot, doctors can encounter a variety of languages, especially if they work in an inner city clinic. Realizing this, I set a new goal for my stay in Egypt, which was to improve my communication skills despite language barriers. My most interesting experience communicating with patients in Egypt came during my rotation through the obesity clinic of Monsoura Hospital. The attending physician there had heard a lot about osteopathic manipulative medicine (OMM) and felt that this skill would be beneficial to her patients. She gave me a few patients and wanted me to demonstrate some simple procedures on them. I decided to perform muscle energy technique (MET) which is a benign but effective exercise of activating certain muscle groups to ease tension on parts of the back and help decrease back pain. One thing about OMM is that it requires the physician be able to communicate well with the patient to tell them when they should contract or relax a certain muscle. Luckily, I was completing this rotation with my partner, Alecia, and we both set off to see what we could accomplish. First we tried telling the directions to the physicians who would translate to the patient in Arabic, but we soon found that the directions were easily skewed during translation. Our second method was the most effective, which was to only translate key words like pain, while my partner acted out the action the patient was to perform for the MET. This was a great opportunity to introduce OMM to physicians who were not familiar with the osteopathic degree, and we learned the creative art of communication in the process. Another valuable lesson I learned during my stay in Egypt is that communication involves more than just understanding a language for a physician. It also involves understanding where the patient is coming from, such as their cultural background. It is an odd concept, but it can be best explained through my experiences in the diabetic foot The hospital had built this clinic only recently, and without a podiatry profession in the country, many of their patients had sever forms of diabetic foot neuropathies, such as large ulcers, osteomylitis (infection right through to the bone), and some amputation follow ups. I could not understand how a person could have such invasive lesions on a part of their body and not bring it to the attention of a physician. The attending explained to me that majority of their patients were poor farmers who spend most of their time on their feet and were not educated about proper care for their feet while living with diabetes. The patients would only come to the clinic once the lesion was bad enough to keep them from work, by which time extensive damage had already occurred. Having the new clinic allowed the hospital to educate their citizens on the importance of proper care for the feet while living with diabetes. I watched as the physicians incorporated the understanding of the need of farmers to work for a living into a message to instill in the patient the importance of caring for their feet, so they may better comply with seemingly minor but effective habits such as wearing comfortable shoes, cleaning their feet properly and performing routine examination of their feet before going to bed. The patients were more likely to comply once the physician managed to express how the patients’ livelihood could change if they did not follow their While leaving for lunch, I noticed a large group of patients in the waiting room and asked if they were all here for the foot clinic. The physician explained to me that the clinic was also involved in a different education forum during the weeks preceding the month of Ramadan, which is the time when Muslims fast every day for a month. These forums educated the patients on what diets would be most beneficial during this month and advised on the importance of keeping up with pertinent medication. Without proper guidance, the patients were liable to stop taking medication like their insulin shots and put themselves in danger. These forums helped to acknowledge the patients’ beliefs and simultaneously worked to educate the patient on ways to maintain their health. There are many Muslims in the United States, along with other religious groups that practice fasting and this example showed that it was possible to have a larger effect on the outcome of treatment by recognizing the patient’s beliefs and then communicating the importance of treatment so the patient can come to an understanding and take control These were only two of the encounters among many that I have learned from during my short trip to Egypt. Looking back at all my learning opportunities, I cannot help but think that the physician is only as good as his or her ability to communicate to their patients; for what good is a treatment if your patient will not comply or you have not understood the reason the patient has come to see you? The best way to improve communication is to interact with different types of people to better understand them beyond the language they speak to who they are as a person, as your patient, so you may properly guide them to better health and be assured they will do their best to comply. I will carry this lesson throughout my education and into my career as a DO and if time allows, I would love to take another trip abroad to see if I can expand my knowledge even further and meet more people along the way.



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NICE: Opportunity or threat? Ginette Camps-Walsh is an international marketer who has worked in pharmaceutical and medical device companies for over 20 years. She was formerly the UK head for a pharmaceutical and medical device company specialising in radiology and is now a director of a health care company. She founded the Chartered Institute of Marketing Health Care Group and co- ordin

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