It has been a busy week for me. I started to see my own clinic patients on Tuesday, call on Thursday, and call this weekend. This may sound silly, but I feel like I am appreciating in a very different way how underserved LDL's patients are. Let me start by saying that this global health experience is significantly different than others that I have had in the past. My first was in undergrad with Global Medical Brigades. We flew into Tegucigalpa, Honduras and would bus a couple of hours to different areas to essentially provide pop-up clinics for a single day. Those patients were underserved in different ways. They did not have access to established healthcare providers. There was a lot that we could not do in a single day clinic and we often had to bemoan our limited resources because we didn't come with specialty care. This was also a single week trip, where I served as a medical interpreter. And not even a very good one at that point in my Spanish skills. My next experience was in medical school. I went with an ENT brigade to Catacombs, Honduras to an established hospital primarily staffed by Honduran medical providers. This was again a weeklong trip. The patients we saw had been screened and selected to be seen by the brigade. And in contrast to my other trip, the providers with whom I worked were actually frustrated at times that the patients they saw weren't needy enough. I don't mean this critically, they were the specialist group and they ultimately wanted to provide their specialized services to the most appropriate patients-i.e. removing a cholesteatoma, not treating allergic rhinitis. These patients were also underserved, but I was part of the group that they had been awaiting and there weren't many pre-screened patients that we couldn't treat. My medical skills had advanced a bit, so I still served as a (more capable) medical interpreter but also participated in procedures with the excitement of an inexperienced 3rd year medical student. LDL is the first place that I have gone where I have enough medical experience to be medically useful. It is also the first place where I have filled the same role as a long term provider, though this is temporary. LDL is a mission hospital that has fulltime American staff. They have 2 surgeons, one that focuses more on orthopedics and another that focuses more on general. They have general docs and OB providers. They have a trauma/ER doc. They provide clinic hours 5 days a week and take walk-in patients as much as possible. They have a 24/7 ER. They can admit patients. They have their own running lists of patients to see visiting specialists, likely urology or ENT. There's a lot that can be done. But there are still limits. I think of my patients at Sunrise as underserved. This is true, but it is in such a different way. My patients may have trouble scheduling an appointment with their PCP. We may get frustrated that they cannot get specialty care quickly or economically. They may over or underutilize the ER. But generally speaking, their access is pretty good. There are many people that I have seen in clinic that do not have problems very different from my own patients-arthritis, GERD, rashes, neuropathy, etc. But these patients travel multiple hours to be seen, and that's not always cheap. Clinic is often wrapping up in the late afternoon because these patients are anxious to get out in time for the last bus, which is between 2 and 3. My patients have broken limbs and accidents. But they can go to an ER and be treated immediately. At LDL, they try not to call in their staff on weekends or in the middle of the night unless it is absolutely necessary. This week particularly has been frustrating because the fluoro has not been working well, so the surgeon is not even sure when he can treat certain cases. We have one patient admitted with a broken femur who is getting PO tramadol while he awaits a surgical date because this was more economical for him than trying to get his surgery at a different hospital, where the price is literally about 20 times more expensive. And some patients simply show up too late from their injury to be adequately treated. I am so impressed by the work that these long term providers have done to provide the best quality care possible. They are thoughtful about their care and reserving resources, so they try their best to make care more inexpensive and more accessible to their "local" patients (within a couple of hours of the hospital). I know that this is a constant tension for them-trying to provide high quality care with a limited number of resources. This is simply something that I just do not have to think about when it comes to 98% of patients, at least not in such a distinct way. Even though I feel like I have a global patient population with treating many patients that are refugees, I am not struggling with the unique resource limitations that come with practicing internationally.