Experiencing Psychiatry Abroad Made My Pre-Med Applications Stand Out  

Columbia University Pre-Med Student, Megan

My experiences working with SLV.Global in Sri Lanka and Bali greatly helped inform my decision to pursue a career in medicine. I’d worked in healthcare before – first as a volunteer researcher in a cognitive psychology research lab, then at a local braille center and a retirement home. So I had a strong interest in the field of psychiatry and was eager to learn more about healthcare. However, as a student, I found it hard to gain exposure to psychiatric practice from a hands-on perspective due to the significant patient confidentiality rules that are prevalent in the United States. Through SLV.Global, I was finally able to have the unique opportunity to work alongside clinicians, help patients in their rehabilitation process, and gain a valuable sense of understanding about how culture and society influence medicine and psychiatry.

I participated in two Mental Health Placements with SLV.Global, one in Sri Lanka for ten weeks and one in Bali for four weeks. In both destinations I was able to get firsthand exposure to the significant effects that cultural influences have on mental healthcare. Both Sri Lankan and Balinese cultures heavily stigmatize mental health disorders.

In Sri Lanka, where roughly two-thirds of the population is Buddhist, mental health disorders are perceived as karmic retribution as part of the reincarnation cycle. As such, mentally ill people are treated as if they deserve their conditions as punishment for something they did wrong in a previous life. People suffering from various disorders are often abandoned in mental institutions, which are typically underfunded and heavily avoided by the local populace due to societal stigmas. Many people are scared to even enter a psychiatric hospital in order to receive medications.

A similar situation exists in Bali, where the belief in black magic is strong, as is the fear that it can be used to punish those within the local community. People with mental illness are seen as being “cursed,” therefore many families engage in "pasung" – a practice that refers to the confinement and restraint of both criminals and mentally ill people. Despite a national ban on "pasung," families of mentally ill people often believe that it is the only treatment for their loved ones. Desperate families chain up the mentally ill within their communities, believing they are helping, but then abandoning them for months or even years in terrible conditions, hoping that the symptoms will go away by themselves or be taken away by the gods.

Through SLV.Global I worked directly with local healthcare practitioners who are striving to improve the conditions in psychiatric facilities and access to support within local communities, so patients can continue to receive assistance once released from institutionalized care. In Sri Lanka, I shadowed Dr. Jegan, a psychiatrist who operates clinics in temples, schools, and community centers to encourage local patients to receive care in places where they feel comfortable. In Bali, I worked alongside nurses who live and work at the Provincial Mental Hospital (RSJ) and receive training from the psychiatrists running the hospital. I also learned from other mental health practitioners who create halfway houses for victims of pasung in order to provide a safe transition environment.

Social stigma towards mental health exists everywhere; it is a global problem. Individuals with mental health disabilities are often viewed as dangerous and unpredictable, and the lack of “cures” for psychiatric disorders only magnifies the problem. While there are many medications available worldwide that can control symptoms of psychiatric disorders, access to medicine is not all it takes to solve psychiatric issues. Therapy and adequate education about mental disorders are crucial to mental healthcare and sadly; countless individuals have no access to such measures.

My experience learning about and participating in various therapeutic activities helped me understand how important non-medicinal patient care is in improving a patient’s quality of life. The therapeutic techniques we used in Sri Lanka and Bali improved patients’ memory, executive functioning, fine motor skills, physical health, and day-to-day social interaction in a way that medicine simply could not. Improving a patient’s confidence and self-esteem is often not a priority for under resourced facilities like those I experienced abroad. However, that is largely due to understaffing and general inability. All the professionals I encountered in the psychiatric facilities are genuinely doing the best they can, but with the care deficit being so great, it is obvious that the easiest way to treat as many patients as quickly as possible is with drugs alone.

Throughout the duration of my placements with SLV.Global I was able to get a true insight into global mental health treatment and what it would be like to work within the mental health field in the future. I am grateful to have had such an immersive and hands-on opportunity in the field of psychiatry and I’m eager to continue my career in medicine.