How International Service Shaped A DO’s Path

A few weeks in unfamiliar clinics can change a career. Emma joins us to share how three undergraduate service trips—Belize, Costa Rica, and Nicaragua—steered her toward osteopathic medicine, shaped her values in family practice, and sharpened the tools she uses daily with patients and students. We compare the realities of MD and DO training in the United States, spotlighting the additional musculoskeletal and osteopathic manipulative treatment skills that drew her to a more hands-on, whole-person approach.

We talk plainly about what global service actually teaches: resourcefulness when there are no labs, humility when culture and systems differ by country, and the power of house visits to reveal social determinants you’ll never see from a clinic chair. Emma reflects on language access—from the confidence of working Spanish in Belize to the limits of phone interpreters in residency—and why in-person interpretation restores nuance, trust, and clinical accuracy. She also explains how faith shows up differently abroad and at home, and how chaplains help patients navigate the hardest conversations with care.

For students mapping their path, Emma offers practical steps: how to seek shadowing, why rejection is part of the process, and how service—local or global—builds judgment and resilience. We explore the art of patient education in the age of search engines, the challenge of reassurance, and the grace of admitting what you don’t know while partnering with specialists. If you’re weighing DO versus MD, craving real-world experience, or seeking a more humane way to practice, this conversation delivers clarity and courage.

If this resonates, follow the show, share it with a friend, and leave a review with the question you most want future guests to answer.

Recommended Books:

1. When Breath Becomes Air - Paul Kalanithi
2. The In-Between - Hadley Vlahos

I also want to thank our listeners for joining us as it is our goal to not only share with you our guest’s introduction to international healthcare, but also to share with you how that exposure to international healthcare has shaped their future path in healthcare. As true patient advocates, we should all aspire to be as well rounded as possible in order to meet the needs of our diverse patient populations. 

As a 50+ year nurse that has worked in quite a variety of clinical roles in our healthcare system, taught healthcare courses for the past 20 years at the university level, and has traveled extensively with my students on international service-learning trips, I can easily attest to the fact that healthcare focused students need, and greatly benefit from the opportunity to have hands-on experiential healthcare experiences in an international setting! I have seen the growth of students post travel as their self-confidence in their newly acquired skillsets, both clinical and cultural, facilitates their ability to take advantage of opportunities that previously may not have been available to them. By rendering care internationally, and stepping outside one's comfort zone, many more doors of opportunity will be opened.

Feel free to check out our website at www.islonline.org, follow us on Instagram @ islmedical, and reach out to me @ DrH@islonline.org

Transcript

Emma’s Education And Career Path

Dr. H 0:11

Well hey there, I am Dr. Patrick Hickey, or Dr. H, as many of my students refer to me. I want to welcome you to another episode of the International Service Learning Experiential Medical Education Podcast. During each episode, I will be interviewing healthcare-focused students and faculty from high school to university that have had an opportunity to participate in an international service learning trip. Additionally, I will be discussing the benefits and challenges to international service with healthcare professionals that have served abroad, as well as industry leaders in healthcare, education, study abroad, spirituality, and those living in the countries being served. I am very excited to have Dr. Emma Robel as my guest today. I've had the privilege of having Emma as a former student and I'm very eager for her to share with us her unique journey in healthcare. Emma graduated in 2014 from the University of South Carolina with a Bachelor of Science degree in biology and VCOM Carolina in 2019 with her doctorate in osteopathic medicine. During her undergrad years, Emma joined me on three service learning trips and presently works in private practice while also training VCOM students. We're very excited today to have our guest with us. And I know her is Emma Robo, but Emma, I believe, might have a married name, and we'll check in with that. No, I did not say. Emma didn't. Oh, there you go. It's been uh 12 or 13 years, I believe, since uh Emma and I have seen each other. We've we've connected at Christmas and a few other occasions and kept in touch in that way. But I was uh full disclosure, Emma was one of my former students. Uh went with me, I believe, on two trips, one to uh Belize and oh, three trips. Oh, I apologize. One one to Belize, uh I believe was the initial one, then I at least one was as a leader.

Emma 2:08

Costa Rica. Okay. Yeah, the last one was a leader, the second one was Costa Rica, and then we did Nicaragua.

Dr. H 2:14

I apologize. That's that's my age, uh that's my age getting in the way right there. But but it's so wonderful to to reconnect with with Emma and and you know, the the the genesis of this podcast is is trying to reach out to students that have been on an international service learning trip and and reach out and and see where they're at now, in this case, you know, 12, 13 plus years later, and and see, you know, did that trip in itself have anything to do with where you're at in life at this point in time? And are you able to connect those dots? But before we get there, Emma, if you don't mind, just tell our listeners a little bit about yourself, where you went for your undergrad, where you went for your grad school, and and what you're doing now.

Emma 2:56

Yeah, absolutely. So I graduated from the University of South Carolina back in 2014, and I took a year off afterwards to get everything ready for medical school. So during that time, I actually worked in a family doctor's office, the same one I had been going to growing up. And then I went to medical school at VECOM in South Carolina. So it's uh one of the DO schools, so I am a DO. I graduated from there in 2019, and I went on to my family medicine residency at VCU Riverside, which is in Newport News, Virginia. So a little bit closer to home, but not all the way to the cold. Finished that in 2022. So I was I did residency during the pandemic, and then I started in private practice. So I went into private family practice just here in uh Chesapeake, Virginia.

Dr. H 3:50

Emma, one thing I encounter when I speak to students, and as you know, my niche has been working with kids trying to get them into grad school. One thing I encounter consistently is the fact that students don't know about DOs. I mean, it I mean it I mean it I mean you you probably experienced that yourself, and and and and I tell them, you know, don't handcuff yourself when you're when you're doing your med school applications. I said, you know, I I I I tend to look at at the DO programs as being more holistic. And Emma, if you don't mind, spend a little time speaking about the difference between MD DO because I think our listeners would really appreciate that. And then what was your decision process as you're coming up? And what first of all, what was your undergrad degree path? And and then what was your decision process on selecting DO versus MD?

Emma 4:42

Yeah, so I uh graduated with a degree in biology. Kind of kind of boring, running the mill, and I had a minor in statistics. So my path was kind of interesting. So a lot of it actually ties back to the service learning trips because when when you do those trips, you realize how limited your resources are. So looking at the differences between DO and MD, it's it's different in different countries, but in America, there is very close to no difference. The main difference is that we get about 300 extra hours of training in the musculoskeletal system. So the idea is that the body has the ability to heal itself. Now, obviously, not in extreme cases, you know, but for something like you you overreached your shoulders out of whack, you know, your body should have the ability to do that. But sometimes with slight manipulation, we can get it to kind of go back all the way and kind of speed up the healing process. So for me, applying it was very much so it attracted me that I would have kind of this extra tool in my tool belt, especially because I knew that service learning was kind of always going to be a part of my career. So no matter where I was, no matter what tool I had, I at least would have that ability. So yeah, that was that was kind of the main thing. It's funny, you're right. A lot of people aren't aware of the differences. They either think one that there's no difference, which is probably closer to the other end of the spectrum that I get, which is that I am kind of like a a voodoo doctor that is not trained in Western medicine, you know, and and that's definitely not the case with with the US medical schools. We're still trained in everything. And yeah, it is it is a little bit more of a focus on the whole body, the whole person.

Dr. H 6:25

Now, Emma, I don't know if this is a fair question or not, but is is there just a just as same amount of respect for MD as there is DO?

Emma 6:35

Yeah, once you start practicing, I really have never have I have not personally noticed a difference. Most people is it's funny, when you're in the hospital, you know how the badge at the bottom tells you what you are that you know ours just says physician.

Dr. H 6:47

Okay.

Emma 6:48

So they don't they don't really dissect the differences between them because our licensing is pretty much the same.

Building A Service Heart

Dr. H 6:54

Well, you've already indicated that the service learning trip kind of sort of helped you with your pathway as far as the DO and and more holistic from the service. Tell us a little bit about your service heart. I mean, you went on three trips. That's crazy. I mean, I mean, when some students never go on a trip at all, you went on three trips. Number one, what was your did you have a service heart in high school before you got to college? And then once you got to college, were you very involved in other organizations where you were able to be involved in service?

Emma 7:25

So I wasn't very involved in high school. A lot of that actually more had to do with the fact that I just I played three sports, I was doing travel sports. I just had honestly had very little time. By the time college came, it was very interesting because all of a sudden I had all of this free time. It was like the two extremes. And so then how to fill that time. So, you know, Katie and I did field hockey together and and I had other activities and passions. But when it when I was thinking about kind of what experience I wanted as far as medicine, you know, my mom was a nurse. Did I did I want to be a doctor? Did I want to be a nurse? What did I want to be a PA? Kind of where where within healthcare did I want to go? Because I kind of figured I I really liked biology and I I kind of had that healthcare thought. And so a lot of it came down to getting hands-on experience. So I had worked in the free clinic at South Carolina, I had done research. I think you had you had not gotten me hooked up with Dr. Camps.

Dr. H 8:23

Oh, that's right.

Emma 8:24

The the pediatric surgeon. Yeah, so I did research with him and at one point thought I was gonna be a surgeon, which is very funny now. And so I I had kind of looked all around, but a lot of it was that I really wanted that hands-on experience with patients and in a more authentic setting than a lot of times you can get in the US at for that age group, you know, in in college, and to really help me decide what I wanted to do. So, yes, I went on one and kind of caught the bug. And I always love traveling, I always love experiencing different cultures and how healthcare differs among them. So, I mean, not only did I do three trips through ISL, but I it it was such a passion of mine that even my medical school, I looked, I mean, VCom actually has three permanent clinics in three different Central American countries. So I've spent a month in El Salvador. I've I've spent time in Honduras, and and I'm hopefully gonna go on another trip with VCOM because it it just was something that I always wanted to continue doing.

Dr. H 9:25

Wow. So your experience with ISO not only helped you with your decision process on on the DO pathway, but also on your selection of school that had an international opportunity. That's amazing.

Emma 9:39

Yeah, yeah, that was the main reason why I chose my medical school.

Dr. H 9:42

Emma, do you do you believe that? I mean, I I I guess or anticipate you speak a lot of Spanish at this point. Is that correct?

Emma 9:50

No, I wish. I unfortunately have lost a lot of it. You know, I I remember when we were in Belize, we were short on translators. And when you're short staffed on translators, you have no choice but to figure it out. And and I did I did Spanish from the time I was third grade till 12th grade. So you would think I should be fluent. And I have never felt more confident in my Spanish than during that Belize trip. But but you know, as I went through, like when we went to Costa Rica, when we went to Nicaragua, we had enough translators, so I didn't need to use it as much. And then, you know, I knew I know enough to get by. So when I was in El Salvador living there for a month, I could go order coffee at my coffee shop. I could order for my, you know, I could do the basics, but to carry on a full conversation, I I was uncomfortable by that. It had been so long.

Dr. H 10:41

So it's interesting that you shared that when you're in college. Thanks for reminding me, you had that experience with Dr. Comps and you actually did a research project with him, I remember. And and for those that aren't that are listening, Dr. Comps is a they believe his specialty was robotic surgery at the time, the the Da Vinci program. And he was a pediatric surgeon. So um uh Emma was in great hands. So in addition to that, you volunteered at a free clinic. But it is interesting that your decision, which helped you with your med school approach, was based on going outside the United States to get a hands-on healthcare experience. And and and I still see that as being a challenge today because I still work and mentor a lot of work with and mentor a lot of uh students interested in healthcare. And the common complaint I hear from them is we can't get opportunities or experiences here to shadow because of a variety of issues, HIPAA considerations, and a lot of barriers to shadowing. So a lot of students are actually, I hate to say it, but forced to go outside the United States. And do you see that at all in your practice?

Language, Translators, And Access

Emma 11:52

I mean, absolutely. I'm in private practice, so I take I teach medical students, so I teach uh VCOM students in their third and fourth year of their clinical rotations, but I generally just because of the ties, even within the, I mean, I'm I work for a physician-owned group, which is very different, but still, even the ties within that, I really don't take high school students. I would love to, but it's yeah, it's very your hands are kind of tied. It is very difficult to have those experiences.

Dr. H 12:22

Reflecting back on on Belize as a freshman, probably, right? And and then the number I think I might have been a software. Yeah, yeah, for sure. And the next two years, I mean, it was so long ago. I hate to say that, but I mean, does does anything stand out for you as far as either the the situations, the scenarios, the patients, uh, anything in particular this many years later?

Emma 12:48

I mean, I definitely remember us going door to door because a lot of the clinics that we did in Costa Rica and later we were we really had a clinic set up and the the patients came to us in Belize. I remember we were going door to door. And so I definitely remember, I distinctly remember actually one case of meeting basically like a mentally challenged child that was in the home. And it was just very interesting because in Belize, the they that population is really sheltered from the rest of society and not integrated. And I remember being very surprised by that, just with the differences that we have in the resources that we have in America that are available and the push for more resources. And meanwhile, it's kind of the other extreme in that country. So I distinctly remember that.

Dr. H 13:40

What was there anything specific in the in the communities that you visited, whether it was your Spanish-speaking skill sets or or or the way you assess them or anything in particular that that you can relate to what you're doing now in your clinical setting? I mean, is there anything? I mean, you worked obviously with a lot of people with limited English proficiency. Do you still, even though you're in private practice and even coming up through, have you been exposed to patients with limited English proficiency? And if so, were you able to use translators like in your own practice or or coming up through? And what was that process?

Emma 14:18

Yeah, I saw it a lot more in residency. Uh, in residency, we definitely worked with the uh an even more underserved population than I do now. I think I only have one or two patients now that don't speak English. And then I, you know, it gets more into a legal requirement. So we definitely legally have to have actually an interpreter in person, is how my group does it. Most places, like in residency, we have something called the blue phone, and the phone is literally blue, you know, and you call the interpreter and they they do it all by telephone, the interpretation, which can be actually a lot harder. I I much prefer having an interpreter in person.

Dr. H 14:55

So what what is that process? Just out of curiosity, when they do it on the phone, or is it a speaker? Then you can hear everything that's going on.

Emma 15:03

Yeah, yeah. So I I it's the phone is basically on speakerphone between you and the patient, and you go back and forth, but so much is lost in translation when you have the body language, you have someone that wants to interrupt someone else, you know, just normal parts of conversation that are missed when someone's on the phone. It's it's just more difficult.

Dr. H 15:22

Well, actually, uh, I I don't know if you recall, but when I did my master's and my doctoral training, I looked at the barriers that Hispanics have when they try to access healthcare. And I I specifically looked at the interpreter process or what we call the triadic relationship. I've got one of my former students, Aubrey, who's working on her DP. She needed a project, so she's actually expanding what I started, and she's developing a module for ISL, whereby every student will have a little bit of training before they go in country because I I don't know about you, but I don't see where we are properly trained for the interpreter process. Aubrey.

Emma 16:03

Yeah, you trained me.

Dr. H 16:05

Well, thank you for that.

Emma 16:06

Um, yes, I don't know if that was sufficient enough, but it was very sufficient because I have watched other people use an interpreter, and I'm like, no, no. Well uh no, we I remember we had a class. Yeah, exactly. You had an ISL class, and that was one of the things we practiced.

Education As Care In Primary Medicine

Dr. H 16:20

Way back in the day. You're you're right. And and it's amazing where where we see providers now still not appreciating the interpreters being part of the team and and using the interpreter in the proper way that they should use interpreter. And I appreciate you saying that that your your practice is driven by the law. There is a law that says actually, if you're federally funded as a hospital, I think it's Title VI, that you need to provide an interpreter for people with limited English proficiency. Now you said you see you saw more of it in your residency coming up through because you're in an area that had a predominant Hispanic population, is that correct?

Emma 17:01

Correct. There, not not so much where I practice now, but definitely where I was in residency. It's funny, I only moved about 30 minutes away, but it's just a very different population.

Dr. H 17:10

I don't know if you can recall, Emma or not, but I I I notice that when a lot of students come back from their in-country experiences, they're they're very excited, but then after a while they they feel very down because they reflect back on their experience and they say, you know, the medicines and the treatment and everything that we gave these people is only going to probably last a week or two. And then then they're back to where they were before. And what I try to share with my students is the best gift that you could have given them was the education that you provided for them, where you tried to empower them. Can you can you speak to that? I mean, the education, I mean, in your in your own daily practice now, because you're distributing treatments and medications, et cetera, but you're also educating your patients on how to do better with their nutrition, their exercise regimen. Is is that falling on deaf ears, do you find when you are trying to educate your patients?

Emma 18:08

Well, I would have answered very differently five years ago than now. Now it's a lot tougher because people, you know, I get a lot of patients that will, you know, you have Google, you have Chat GPT, you have, you have all these things that they think are telling them the information that they want. So I think I think education is power. Absolutely. I want all of my patients to be educated on why they have the disease, the nature of their disease, what they can do about it, what they can do for prevention. I mean, primary care is all about prevention and staying healthy. I would so much rather see you for a physical and have what I call a very boring exam, and we get to talk about prevention and do all these things and may, you know, find something awful wrong with you. But I I mean, education is my favorite part of my job. I don't find that it really falls on deaf ears. I will say I think I have some patients that are that are very adamant that they it's like confirmation bias. You know, they find what they want to find online and that and that is the truth, and they are gonna stick with that no matter what I say. But those are also the patients that for some reason they don't believe me and yet they keep coming back to see me. So, you know, there there's there's something there that they're that they're getting out of a visit with me, I suppose. So, no, I think education that's that's my favorite thing to provide.

Dr. H 19:23

So, do you do you appreciate that the patients that are coming to you are pretty well versed on their symptoms and and and and their problems, much more so than 10, 15, 20 years ago when they weren't able to look it all up on the internet?

Emma 19:40

That's a good question. I think it all depends on the attitude, right? I think whether you think you know what's going on with your body or you don't know what's going on with your body, uh, you know, I hopefully am the one that you are coming to either way to either confirm or find something else. I think it's more a matter of, hey, I you got a headache and it is not a brain tumor type of a situation, and trying to reassure that for a patient that's already very worried because of what they have found on the internet. That is actually, I find, a lot harder to do. It's not so much the diagnosis aspect of it, it's the reassurance that can be very tough for some patients when they've read something and now they're and now the anxiety is through the roof because what they've read is what they've read.

Dr. H 20:25

Yep. Going back to what you said earlier about going on the three trips and and you love travel, as a leader when you went on the trip, first trip you were a member of the student cohort, but then the next trip you're a leader. Could you see the growth? I mean, I know we're we're going way back, but could you see the growth in your students on on the on the trip between day one and the final day? And and I know for the listeners, in addition to to being a leader for the trip, what my leaders do is they usually co-teach the class before we go in country. So again, with the students who went with you, that are either freshman, sophomore, juniors, maybe first time doing blood pressures, by the end of the week, do you recall seeing any growth in them at all or a level of self-confidence that they they never knew they could have?

Student Growth And Clinical Confidence

Emma 21:15

Yeah, I was gonna say the confidence is probably what you notice the most, just the level of comfort that they have and the knowledge of sometimes it's very awkward. People take for granted even taking blood pressures. It can be very awkward the first few times you do it until you kind of get a system of where you put your hands and how you get it on. And you know, something as simple as that. It does take a few tries to kind of get correctly, and you feel almost embarrassed the first time you do it. You're like, this is so simple. I should know how to do this, it should be flawless, it should look good. And so, yeah, absolutely. It's uh seeing the even from the classes to their first day boots hitting the ground, kind of you get the eyes wide, a little bit a little bit nervous, not sure what to expect. To you know, the first clinic day things start to, you know, you you kind of maybe still a little bit dear in the headlights, but by day two, you kind of get into a rhythm of things, and by the end of the week, you feel like you've been there for longer than a week.

Dr. H 22:11

Hey, speak if you can to the role of spirituality in healthcare, because especially in our trips in Latin America, you see a deep faith in the people. We, as you probably recall, whether it was Belize or or Costa Rica or Nicaragua, we go into the homes, as you've noted, and you know, we'll see that they have barely anything. But in a lot of cases, they offer you the only chair that they've got. They have one loaf of bread. I recall many times they offer you the only food that they've got, but you'll always see a picture of the Virgin Mary or Jesus or something, you know, Christianity-based. And it's very prevalent. Can you do a comparison, maybe? I I don't know if you can or not, between what you saw in in Latin America on your trips, spirituality-wise, and what you see in your daily practice now.

Emma 23:03

Yeah, in my daily practice, you know, unfortunately, spirituality usually comes up in conversations with patients when when we're having very difficult conversations. It's usually either new cancer diagnose us, it's a hospice discussion, it's, you know, kind of those really, really heavy moments. And so I don't, it might come up a tiny bit, but for the most part, unfortunately, it usually comes up in those much heavier moments. And then it becomes it's it's a crutch, it's a lifeline, it's a comfort that that is, you know, used during a lot of my visits. And, you know, and it's tough in America when you're practicing because you really don't want to bring, like, I cannot bring religion into the room, my patient can bring pa religion into the room, right? But that's not really appropriate for me to do. So there is kind of that separation. Whereas when, you know, practicing in Central America, it's it's expected, you know, it's it's different. It's kind of expected that you both match the same spirituality. And so there's there's an openness to it that is that is not really prevalent in the American system. Again, until you're in the hospital, we need to call the chaplain. And even the chaplains are not usually denominated, you know, it's not like I'm gonna, I need a Catholic, I need a Presbyterian. It's just you will call the chaplain who who is a generic religious figure, unless you ask for someone specific. So it it's it's very just different.

Dr. H 24:31

Do you feel that that that chaplain is well-versed or well trained to be able to meet the spiritual needs of the of the patients, even though they may be Catholic and the and the patient may be some other denomination?

Emma 24:45

I've never seen a situation where they haven't done a phenomenal job in meeting the the spiritual needs, you know, but uh it would probably uh yeah, not not that I have seen.

Cultural Competence Across Countries

Dr. H 24:57

I think they they have done a great job, but one thing we speak about as far as the international service learning trips is the ability to gain cultural competency. Do you feel after three trips that that helped you to understand more of where your people are coming from and and how has that been able to help you moving forward?

Emma 25:19

Oh, absolutely. Each country was different. I think I was very naive in thinking that because it's Central America as a whole, that the healthcare system would be the same, the people would be very similar, and and uh it's not. I I mean each country I I learned something new about the healthcare system and about the people, and and it was they were they were each very different. So yeah, it was I wish I had spent more than a week. You know, the more time you spend there, the more you learn. So I wish I had spent more time, but I think still uh after a week you do get a good feeling for kind of the the nature of the people, their expectations and kind of what they're looking for.

Dr. H 26:02

One seed that I've tried to plant with a lot of my students, like yourself, is you know, you can always go back. And how wonderful it would be as a practicing physician to go back and to be around a lot of young students that are 18, 19, and 20 that want to be where you're at. So that that's always an opportunity. And and ISL has done that before. I've actually encouraged a couple of docs to shut down the office, bring your whole staff with you and and and go make a difference. What an amazing opportunity that would be to try to educate and train some of those that are coming into healthcare. Is that something you've ever considered, or is that something your private practice would be interested in?

Emma 26:44

Well, it's kind of a it's a little bit different. So I am currently sent at, like I said, my medical school has kind of three clinics that are fully staffed by, you know, so the way they do it is that you get around the clock care. They hire physicians in that country, and then students come down, medical students come down to learn, the doctors come down, do the trips, and we do outreach, you know, every basically every three months, and an area has an outreach. So I I will be doing that so that I can still continue to learn.

Dr. H 27:17

Tell me about you said you went to El Salvador for a month, is that correct? How did how did how did that compare to the three countries you'd been before? Or is there an opportunity to compare them? Because you just mentioned that you felt that uh in your naivety you thought the healthcare system was the same in all of Latin America, and now you've been to at least four countries. Uh, did you notice anything different? Yes, five? Five now, okay.

House Visits And Social Determinants

Emma 27:41

Yeah, five now, yeah. No, they're all very different. So I distinctly remember when we went to Costa Rica, because we did Costa Rica on a service learning trip. I distinctly remember we were driving past on the on the bus and we saw all these pregnant women outside the hospital. And all of them were uh it, you know, you could tell they were in active labor. And with the one of our guides was telling us that those were most likely Nicaraguan women who had come down during the Civil War, and they are not permitted to enter the hospital because they they do not have health insurance, they're not covered because they have, you know, countrywide until the baby is crowning, because the baby will be a Costa Rican citizen, which was very interesting. That is interesting.

Dr. H 28:24

I'm glad you I'm glad you brought that up because I do recall on on different trips to Costa Rica that we took care of a lot of Nicaraguan refugees and that their access to health care was not similar to Costa Ricans because they were from another country.

Emma 28:38

It was not. That was why I don't know if you remember this, but after Costa Rica, when I when we went to go lead the trip, you asked which country we I got to pick the country to go to. And I said, Oh yeah, I want to go to Nicaragua now.

Dr. H 28:50

Thank you for that.

Emma 28:51

Because we yeah, because we only saw so many Nicaraguan people that I was like, well, now I want to go to Nicaragua and see what's going on there. And that was probably of all the ISL trips, that was probably my favorite.

Dr. H 29:02

Well, because of you, because of you, then we went there for five years.

Emma 29:06

Yeah, yeah.

Dr. H 29:07

Thank you. That that was that was a gift because I I I echo what you said. I love Nicaragua, I love the Nicaraguan people. But isn't it amazing that that you saw that we were taking care of the refugees and they they needed more care, probably than what they're receiving? And let's go to where they're from and let's really understand the problem. And and and that that goes back to the house visits that you mentioned earlier, you know, and I share that with students who have never been on the trip. One reason we do the house visits is to try to see if the pathology of the patient complaint is somehow somehow related to the home environment. And and I do recall when we went to Nicaragua, a few different places where the women would be cooking wood wood fires on a stove with no ventilation, and they were breathing in that smoke, and then they come to us in the clinic and they'd have respiratory. Problems. Well, if we hadn't done the house visit, we wouldn't have understood what was going on. If we hadn't done the house visit, we wouldn't have seen the sanitary conditions. And I don't know if you recall the squatters and all the other things that we saw.

Emma 30:13

Oh, yeah. ISL, that's one thing that ISL really does a phenomenal job on, are these social determinants of health. I still remember filling out that sheet front and back, and it had way uh, you know, so much detail that's incredibly important to overall health that we do not ask in America.

Dr. H 30:31

Well, and and that, and that's you know, that's always shocks students when we go on the trips that they see us doing house visits and they they share with me quite a lot. Are we able to do that here in the United States? And and as you say, we just don't do that very often here.

Emma 30:45

Yeah, the patient really has to consent for a house visit. Now, there are some home-based cares, and I do have some patients. Unfortunately, in private practice, it comes down to time, you know, the travel time to get to the house to do the visit. I don't have all the resources that I do in the clinic and then to leave. It's a much longer visit. And so I would you would see much fewer patients per day. You just don't have the ability to do that really in private practice. You still have the freedom, right, you know, to do it. I did it in residency actually, plenty of times, but it is not as readily.

Dr. H 31:17

And now we're doing virtual visits, correct?

Barriers And Workarounds For Experience

Emma 31:21

Yes, and no. Medicare just repealed it at the end of September. They won't cover them anymore for Medicare, which is probably a huge population that really needs it.

Dr. H 31:28

There we go with our with our healthcare system.

Emma 31:30

We could, we could, we could have a Yes, our our wonderful health system. We could yeah, we could have a whole conversation on our quite a few.

Dr. H 31:37

Well, you know, on our broken systems. I'm very, I'm very proud to be an American. I'm, as you know, born in Canada, and I've seen a few healthcare systems through my through the years. And you know, I I think it's up to every one of us to learn the system, then work the system as best we can. And and and that's a true patient advocate because there is a lot of red tape, there's a lot of bureaucracy, there's a lot of paperwork and things, and and it's really unfortunate that it has to be that way. But but once you get into the system, you can kind of manipulate it as best you can to better serve your patients.

Emma 32:10

You can. Sure, absolutely. I've done it many times.

Dr. H 32:14

I mean, what would you say to you know, you know, with our listeners, someone that's 18, 19, 20 and and they they want to be where you're at? You know, they they they don't know what to do to get there. I mean, your decision process was was greatly made on your service learning trips, but but what if they don't have an opportunity to do a service learning trip like like what you did? How can they how can they get their toe in the water? How can they really see what it's like to be a physician in a daily practice?

Emma 32:47

I mean, I would say that if they don't have the ability to go on a trip, then they can, I don't want to say make your own, but you can kind of make your own experience, right? And you can reach out to local doctors, uh, see if any of them would be willing to let you shadow. And not just doctors, but if there are any nurses in private practice that would be willing to let you, or PAs or MPs, you know, whatever you're you're interested in exploring or learning or going to, reaching out locally for opportunities and you're going to be told no, and that's okay. And you just keep going. You will find someone that says yes. That and it might take five, six, seven people to get there, but you will find someone that is perfectly willing. I mean, the medical community, thankfully, is we are built on training. We are built on, you know, at some point all of us were trained, uh, all of us were educated, and so you will find someone that that will be willing to help and volunteer. And it doesn't have to be medical, you know, it can be I uh you could do, you know, you can go to the food pantry, you can go help with an animal shelter and some sort of giving back so you can see what what type of service you're really interested in doing with your life.

Dr. H 34:01

One uh one fond memory of you, and I have many, was that you you loved animals so much. I I think at I think after our first trip, I I I don't know if I put it on the syllabus, but I it maybe it was an unwritten rule. Don't pet the dogs, because every dog I feel called out.

Emma 34:19

Yeah.

Dr. H 34:19

Every dog that came home. Absolutely.

Emma 34:21

I think I came home with more pictures from dogs than anything else.

Dr. H 34:23

You just loved on them. And and and through your college career, you you you adopted them. Is that correct? Oh yeah. Yeah.

Emma 34:30

Yeah, I did a foster program through the leadership. There's a Carolina leadership program, I think, that I created some fostering program. So we had something, I think it was a full-year program. I think by the end we had like 20 dogs adopted through the fostering program. It was very sweet.

Dr. H 34:44

Now you spoke to the students that could not, if they could not afford to go on a medical mission trip, you gave them good ideas and things. What about the ones that could afford to go on a medical mission trip, a service learning trip, and are maybe intimidated by the language, intimidated by travel, intimidated by the food choices, which are probably different. What would you say to those students?

Emma 35:08

Yeah, I mean, I think experiences where you become uncomfortable will only help your own growth. I think it's very, very important, especially while you're young, to purposely put yourself in positions that will that will make you uncomfortable. Your first one, it is scary, absolutely. And and you know, you're uncomfortable. You've never done it before. You might be traveling by yourself. I mean, we were lucky enough that you put on a so that all of us travel together, uh, which is very different. But if you're traveling by yourself, you know, get very comfortable with your travel plans and know where you're meeting the next person. Practice a little bit of Spanish, you know, you do frankly probably don't need a ton to get by. You'll be able to kind of figure it out. You know, someone else will always know more or less than you, and that's just the nature of life, and that's okay. And just be have a mind, go in with a mind open to learning.

Dr. H 36:00

I that that's a common theme, Emma, that I've seen coming up. It's okay to be uncomfortable. I I like that. I I mean, I don't think I don't think students hear that enough. I think they're brought up in such a protective society.

Emma 36:13

Especially, yes, and especially highly driven students. You know, when you are highly driven, you are the the people that are the your next generation of doctors, nurses, healthcare, you are told, you know, you will succeed, you should be that straight A student that you know you don't make mistakes. No, it's okay. You got you have to make mistakes to learn, you know, in a safe environment. And that's what this trip is you have people watching over you to make this a safe learning experience.

Dr. H 36:41

But I I appreciate that, you know, and I I think that's your wisdom coming through and and years of doing what you're doing to realize that that you've got to be uncomfortable and that that you learn from being uncomfortable, you learn from making mistakes, and and and we have to get away. And and one thing I share all the time, Emma, with with these students that are striving all the time to be the best they can be. And I I say consistently, don't obsess about your GPA. You know, I say don't tell mom and dad that Dr. Hickey said don't get an A. You know, I say do as well as you can academically, but don't obsess about the GPA. More importantly, keep busy, keep busy with service as you indicated, keep busy with learning another language, keep busy with volunteering or even getting a job as a medical assistant or a scribe. And and busyness makes a difference. It it helps. So yeah.

Emma 37:33

Yeah, absolutely. Yeah, to be a well-rounded student, like it's not all about academics. Academics are not are are not everything, and that's you know, just reality. I can't, I god, I was so highly driven in high school. I think I had one B and I was so mad about I still remember it to this day. Why would why would I remember that? But then college comes and it and it kicks you in the butt a little bit, and that's okay. That's a good thing. You need that to grow.

Dr. H 37:58

But but it goes back to what I was saying. I mean, I don't know if kids are getting the wrong message where they obsess about their GPA and and and they don't seem to see the value of service and and getting more involved. Right. I mean, do you see that? Is that a generational thing, or do you see that yourself sometimes?

Emma 38:15

My favorite students, my favorite co-residents, my favorite everyone, my favorite are the ones that know what they don't know and are confident in that. You know, you cannot, none of us know everything in life. I as a and I love being a primary care physician because I know a little bit about a lot. And and I do, I am the master of none, and I'm the first one to admit that. So, you know, common things are common. I can I can find, I can get on the right path, I can figure out kind of where we need to go. But then after that, you might need a specialist, and that's okay. That's because I don't know everything. Yep, and I never will. That's okay.

Knowing Limits And Using Specialists

Dr. H 38:53

And and that's that and that's great that you accept that and understand it and are comfortable in your skin because that's why they're specialists.

Emma 39:00

I mean, you can reach out to the exist, and it's okay. That's a good thing.

Dr. H 39:04

Well, they come and consult on your case and and write their orders and move on. It's great.

Emma 39:09

You ask your questions in the hospital when you see them, and and you just you can't be embarrassed about not knowing everything that someone else knows.

Dr. H 39:16

I like what you wrote, you you know what they they know what they don't know. Is that correct?

Emma 39:20

Is that yeah, you have to you have to know your limitations. Uh, and that's it's a good thing to have limits. It's okay to not be all-knowing.

Dr. H 39:29

If you don't mind, Emma, uh and I appreciate your time. Just just before we sign off, could you just for those students that are again on the fence of D O or MD, what what should they really do to to try to figure that out? Because I I meet with students all the time. I try to get them to explore, you know, the the DO role. I mean, what do you what do you encourage? Do you encourage them actually? I mean, would visiting a DO program help? Or what are the resources that would really help them to know the difference?

Choosing DO: Resources And Shadowing

Emma 40:00

I think for me, the resource for knowing the differences was looking at the two medical schools. You know, I compared side by side what the curriculum was, what the learning philosophy was. Usually those are directly on on the medical school websites. And then I would find uh one of each. I mean, I had to in order to go to DO school, I think I had I had to shadow a DO. I mean, you I had to get a letter of rec from a DO. So you kind of have to know what it is when you're applying. And I and I I still remember who I shadowed, actually. Yeah, he and he was very good because I still remember this one guy, bless his heart, he came in with horrible chest pain. And I think anyone else you see, this guy is bent over with chest pain, and I think anyone would send him to the ER. And this doctor goes, uh-huh, yeah, get on the table, and cracked his back. And he goes, Oh, okay, yeah, I feel great now. I can breathe. Thanks. You know, and you're and I and that was my I I was uh, you know, out of college at the time, and I was like, oh wow, that is so cool that we actually did something for this.

Dr. H 41:01

Well, you know, you you mentioned earlier that you take extra training on you, I think you said musculoskeletal system, is that right? So remember, I'm a little different. I would say musculoskeletal system because of my Canadian. So I go I go to my chiropractor. Where when some people say, What's the difference between a DO and a chiropractor? Do you get that very often?

Emma 41:22

I don't. I usually explain it. So it's called osteopathic manipulative treatment. That the the that's kind of the name of the treatment that we learn. So I kind of describe it like it's a mix between physical therapy, chiropractic, and massage therapy. So we kind of learn techniques and there's a lot of overlap amongst them. The difference is you have someone there, there's a lot of difference in the medical training, you know, with a chiropractor, obviously, than than a doctor. So it's just a different level to just something else, basically.

Dr. H 41:54

Well, Emma, thank you so much for your time. It's been a true joy to to reconnect with you after so many years and to see where well to see where you're at in your practice and and to know that that the ISL trips were integral to to where you're at today. And and very much so. And even though you you've not become a Spanish speaker, you've learned to use interpretation.

Emma 42:15

There's still time. There's still time.

Dr. H 42:19

Never say never, right?

Emma 42:20

Never say never, absolutely.

Dr. H 42:22

Well, you shared some wonderful lessons that I'm sure a lot of people will take to heart. And and I really appreciate again your time today and and for advocating for international service learning. So thank you, thank you.

Emma 42:34

Absolutely. It was good chatting with you, good catching up.

OMT, Chiropractic, And The Toolbox

Dr. H 42:38

I want to sincerely thank our guest, Emma, for her willingness to join us today on the International Service Learning Experiential Medical Education podcast. But most importantly, I want to thank Emma for the passion she has shared with us, specific to her own unique journey in healthcare. As a doctor engaged in clinical practice, Emma has touched many lives of patients and their families and continues to pay it forward through a role as an educator of our future healthcare practitioners.