Medical Training We Will Always Carry in Our Hearts
Michelle Berlacher (formerly Torbeck) and Mark Berlacher met during a night rotation at Eskenazi Hospital during their intern year in residency at IU School of Medicine. Three years later in 2017, they were engaged and traveled together to Eldoret, Kenya to train with AMPATH at MTRH. The couple now lives in Dallas, Texas where Michelle is an Assistant Professor at UT Southwestern Medical Center practicing at Children’s Medical Center and Parkland Hospital and Mark is a cardiology fellow at UT Southwestern.
Why did you decide to do a residency in Eldoret, Kenya with AMPATH?
Michelle: I had heard great things about the Kenya program and always knew I wanted to do it coming into IU for my residencies in medicine and pediatrics.
Mark: The program was out of my comfort-zone, and my family was pretty anxious about it. It was Michelle’s idea. But once I learned more about it and talked to people who had done it the decision became pretty easy.
What were some of the experiences you remember most?
Michelle: It was such a unique experience because we took on patients as our own and really were stretched to learn and grow. Doing residency in Indy, I’d never treated malaria before.
One of the cases that will forever stick with me was a case of tetanus in a little boy on the peds ward. I had never seen tetanus before and probably will never see such a severe case of acute tetany for the rest of my life. A 5 year old boy’s spine was extremely rigid and arched, in the shape of a U. He was one of the lucky ones and within a week he was recovering and up and walking around. One of my favorite memories is seeing him smiling with my glasses on in the hallway. That is a face I will carry forward with me in my medical career.
Unfortunately, today in medicine, a lot of the why you do medicine is gone. We spend a lot of time in front of the computer writing notes, writing orders and we spend so little time with our patients. In Kenya, we were with our patients all morning and then you’d see them again in the afternoon. I spent more of my time with the patient, forming relationships and learning more deeply about the healthcare system of Kenya. It further deepened the “why” I became a physician.
How does your experience with AMPATH affect your current work?
Mark: Even now our experience with AMPATH serves as a motivator for us. To get the opportunity to do that during our training was so, so unique. The patient-centeredness of that experience is unlike anything we have the U.S. It’s such an example of why you go into medicine, and that’s for the patients. And the patients there are just incredible. They’re very different culturally than a lot of US patients, but so, so grateful. It was such a joy to talk to them, to listen and to know what they’d overcome to get care.
Michelle: The patients and the things they’ve gone through just to get care are incredible. It’s such a fond, special place we hold in our hearts along with our time there.
I don’t think we can incorporate global health into our careers, but Dallas is a melting pot and as much as we can we’re trying to engage in local-global opportunities and support people of different cultures and backgrounds.
There are diseases and hurdles that we dealt with that we’ll never have to experience in the US. I remember going to a satellite clinic with Dr. Mamlin and an HIV patient came in with really severe nausea and vomiting. We’d probably just put them on Zofran in the US and order a lot of tests. But Dr. Mamlin examined him, and a few seconds later had me come listen to his stomach. I could hear the patient had a succussion splash, a gastric outlet obstruction. It needed no imaging, nothing. I would have done a GI consult and so much more back in the US to find this out. Unfortunately, his obstruction couldn’t be easily fixed, but adjusting his diet was enough to manage it.
Why did you decide to donate to AMPATH?
Mark: We’re so glad we’re finally able to support AMPATH monthly and give back to a program that was an incredible experience for us. Now that we both have paychecks, we’re so grateful to be supporters.
Michele: We vividly remember being in the TB ward with 3 people to a bed in open air. I’m thankful to hear MTRH is able to adjust to the pandemic and do infection control with AMPATH’s support. It was eye opening comparing medicine there and here.
Any additional thoughts to add about AMPATH?
Mark: The patient-centeredness of practicing medicine in Eldoret, once you do it, it can never really leave you. It becomes part of how you practice as a physician.
The physical exam skills of some of the attendings there are incredible. Something I will always aspire to.
Michelle: For me the Kenya experience changed how I approach a patient, encouraged focusing on minimalism, and that you don’t always needs extensive tests or imagery or labs. You realize you can practice medicine without gadgets. You can really use physical exam, use your brain, and use what you have right in front of you. These are things I think about while rounding on my patients every day. We all just need to get back to the basics sometimes.