Kendall Rease was born and raised in Gastonia, NC. In spring 2018, she will graduate from North Carolina State University with a B.S. in Human Biology and a minor in Psychology. In the following article, Kendall reflects on the lessons she learned on her Atlantis Fellowship in Faro, Portugal. 

Your First Day of Shadowing

Picture this: you are walking down cobblestone streets as the rising sun gently warms your face. The city around you is slowly awakening with a soft, distant hum, and the hospital at which you’ll shadow for the next few weeks begins to come into view. Thoughts flood your mind: “Am I prepared for this? What should I expect?”

Let’s back up a bit.

In the months leading up to my fellowship, I became uncontrollably excited as I made it through the application and interview process. After solidifying my Fellowship placement, I began to count down the days and hours until I landed in Faro, Portugal. Upon arrival, I was met with a welcoming coordinator, incredible peers, and a beautiful city. When the first day of hospital shadowing came around, I was filled with contradictory emotions of excitement and nervousness. Traveling to an unfamiliar country is already enough to make the adrenaline flow. Being in a hospital in a foreign country intensifies that feeling of wonder even more.

The first week was hard.

I am not going to sugarcoat it: my first week was a bit rocky. I spent the week in the pediatric unit, a department in which I was very excited to shadow. My attending physician was extremely personable and welcoming. When we began making rounds on the floor, we saw several patients, all in different stages of health with various conditions. To say it was awesome is an understatement.

Later in the week, I spent the day in the pediatric emergency unit with a different doctor. As she saw patients and spoke with other healthcare personnel, I became lost because I could not keep up with the Portuguese conversations and interactions. An overwhelming feeling rushed over me, and I was confused and scared to speak up. After speaking about this experience with my coordinator, she urged me to continue my rotation in the pediatric unit.

As the doctor saw patients and spoke with other healthcare personnel, I felt lost. I could not keep up with the Portuguese conversations and interactions. An overwhelming feeling rushed over me, and I was confused and scared to speak up.

The next day, I returned to the pediatric emergency department. I was still recovering from jetlag, and I quickly became frustrated and discouraged because I did not understand what was being said around me. The majority of the doctors spoke English, whether fluent or broken, but at times, the language barrier really got in the way of effective communication. Because of this, I tried my best to take notes on my notepad.

The breakthrough moment will come.

One day, a four-year-old male came in with his mother. As I watched the mother converse with the doctor, I listened attentively while observing what the doctor typed in the patient’s chart. I then watched her give a routine physical examination, and she began to perform what seemed to be a sobriety test. It was almost as if she was checking the patient’s balance and equilibrium. I wrote down everything I could understand: 4 anos (4 years old), hydrated, no febre (fever), vomited once, nausea, dizziness, asked if there was an accident/trauma (answer was yes, 36 hrs prior), and CT scan ordered. Disclaimer: All of my observations and notes were mere guesses based on what I could understand from listening, reading, and watching. After the patient and his mother left, I asked the doctor if everything I had written down was correct, and her response almost brought me to tears. She looked at me with a smile and said, “Yes, you are correct. Good job.”

Communication is more than just speaking words. I learned the invaluable importance of attentive listening, body language, tone, and context clues. I wish more people could have the opportunity to be stuck in a situation in which everyone is speaking a different language.

I felt an overwhelming urge to write down some of the emotions I was experiencing in this moment. With just one patient, my morning was completely turned around. It was becoming easier to understand some of the Portuguese language because of repetitive words and phrases.

I gained a better grasp of what was wrong with the patient and what the treatment plan would be like. However, I found it frustrating when others did not immediately translate for me. Most of the time it was because they simply did not know the words to describe something. The more I reflected, I began to understand what those in the U.S. feel like who do not speak fluent English.

Putting yourself in a situation that requires change of perspective really makes you step back and reevaluate your reactions from that point forward. During that week, I definitely refined my patience and understanding. For the rest of the day, the doctor and I worked at communicating with each other. It was difficult because I knew little to no Portuguese and her English was very broken. She often struggled with finding the right words for what we were talking about. Sometimes I could help her find the word, and sometimes we had to come up with a new approach to talking about something.

It became a fun challenge, and I felt that we both learned so much from each other.

Cultural Competency

Communication is more than just speaking words. I learned the invaluable importance of attentive listening, body language, tone, and context clues. I wish more people could have the opportunity to be stuck in a situation in which everyone is speaking a different language. It is quite difficult to even put into words, but I learned so much just from that one experience.

Putting yourself in a situation that requires change of perspective really makes you step back and reevaluate your reactions from that point forward. During that week, I definitely refined my patience and understanding.

When I reflect back on my time in Portugal, I realize the importance of speaking up and asking questions. The doctor had no idea how confused I was feeling, and she was more than willing to take the time to translate what she could for me. When we found ourselves stuck, she never hesitated to find another doctor who could help us. The open communication proved to be effective and essential.

I would urge anyone to ask questions during their hospital shadowing. Whether it is regarding the language barrier, a patient’s case that confuses you, or a procedure that you wish to learn more about, ASK. You will be amazed at what stems from the bravery to ask.

Perhaps even more importantly, be patient, understanding, and willing to learn. Most students come prepared to learn more about medicine and healthcare when they embark on their Fellowship. However, it is equally as important to come prepared to learn more about people, communication, and culture. With any international travel, I advise truly immersing yourself in the culture around you. You just might be surprised at what you can learn when you are willing to open your mind.