I woke up abruptly from my jet-lagged sleep surrounded by a bed net, two fans, and the smell of the DEET bug spray I had applied before going to bed. One of my team members was knocking on the door, saying that a large group of women was already outside the hostel where we were staying and had been waiting for us to come out. I was surprised to find out they had been coming every morning, anticipating our arrival, but I also realized how different this place had already become in my mind.
This never would have happened to me in America. I wondered how desperate they were for help and realized that the aid I could provide paled in comparison to the healthcare available in first world countries. Of course, I had perceptions and visions of what it would be like before I went, but I never dreamed it could simultaneously be so similar and so different from what I had imagined. While I was primarily practicing public health, the lessons I learned transcend all medical fields.
After hurriedly getting ready for the day, we walked to a covered outdoor area where we would be meeting the group to carry out our program for the next few days. I remember the smiling but curious faces as we walked into this area. Through the interpreter, we asked some basic questions about their health and how they lived. I then discovered that all the women wanted to individually meet with us. Little did I know that this morning was going to become one of the most memorable moments of my life.
I will never forget that first conversation I had through my interpreter. She was an older lady, at least 70, and wore a traditional, bright green African dress and head covering. I had noticed earlier that she was the life of the party. Even though we did not speak the same language, her spunk and humor were evident. I sat down on a bench with my notebook and a list of questions. I wanted to learn about the women’s health issues, sanitation and hygiene, living conditions, and level of basic health knowledge. These interviews were strategically a good assessment, so I would know on what level to teach and if there were any serious issues that should be addressed.
I was surprised how much I learned from this older lady. Her countenance changed once she was sitting in front of me. Her face looked worn and tired and very serious. Maybe she felt nervous or desperate for our help. I sensed that she had lived a hard life and was resilient. For the next two hours, I listened to her discuss her physical health ailments, mental health issues, and poverty. It was evident that she was dealing with some very unfortunate social and relational issues due to her untreated and unexplained health issues. I had been expecting to experience the much talked about ‘culture shock’ at some point. This had not occurred when my feet hit the ground; I thought maybe it would happen when we went to the rural village next week. I had not expected it to furiously arrive through this seemingly simple conversation.
I remember feeling such a strong helplessness. You see, most of what I was going to be doing was prevention. I cannot stress the importance that this work be done; it can save countless lives. But in this moment, I was looking at an elderly lady who had diseases that would eventually kill her and so many complaints that I could not fix. I felt helpless because I wanted so badly to take her back to the United States with me where tests could be run and she could be provided treatment.
After two heartbreaking hours had passed, I pulled my interpreter to the side and explained that I did not know how helpful this would be. I did not want these ladies to think that we could cure all their problems; in fact, I did not have the resources or the permission to do so. I will never forget her response. She explained that even though she had known these women for so long, they had never opened up to her like this. They knew that we were not there to take away all their issues and cure all their ailments, but it was a healing experience to be able to open up and talk about their struggles. There was so much power in listening. I often come back to this moment, the moment my heart broke, the moment I felt helpless, but also to the lesson of the power of listening.
The importance of listening transcends fields, positions, and culture. It is something that all in healthcare can work on, whether it is a public health professional in Africa or a medical student in the United States. I have been a patient, but I also have worked in a medical office and hospital. Listening is in high demand but often neglected. It seems that doctors interrupt their patients more and more quickly. Staring at screens due to the demands of electronic medical records does not help either, and I understand—that was my job as a scribe. But, listening is a vital part of patient care.
It is important to listen to one’s history to properly diagnose and treat. It is also a helpful strategy to build trust and a rapport between you and the patient. Without the bonds of trust built upon understanding, it is difficult to have a helping relationship. Even when there is not much else to offer, listening can almost stand alone as a treatment. While it may not treat physical illness, it can provide much needed emotional support and convey a deeper level of care. Being heard was so important to this group of women that even after the first two-hour conversation, they were all waiting to talk to us. My Rwandan lady knew there was not much else I could do, but the best medicine I had available in the moment was to just listen.