Mentorship in the mountains: lessons from a remote health center

Mentorship plays a crucial role in the professional development of doctors, extending beyond the confines of residency or fellowship in academic programs. It is equally important in private practice, where mentorship relationships can align with personal values and professional needs, fostering ethical and mindful practice. Moreover, mentorship is vital for doctors practicing in remote and rural settings where an absence of mentorship can pose significant challenges. Without the guidance of experienced mentors, physicians may find themselves with limited access to essential support and advice, which can adversely affect their ability to deliver high-quality care, particularly in complex cases. Mentorship is vital for ongoing learning and skill enhancement, and its absence can result in missed opportunities for professional development and knowledge exchange. Furthermore, practicing in remote areas can be isolating, and the lack of mentorship can intensify feelings of both professional and personal isolation, potentially impacting job satisfaction and retention.

Despite the passage of 15 years, I can still vividly remember the sun setting behind the rugged peaks of Chitral, a remote district in Northern Pakistan, just outside a modest rural health center. This was my first medical posting, having just graduated from Aga Khan Medical College, with only 5 years of formal medical education. Yet, the locals welcomed me with gratitude – I was their only link to medical care in a region where access to doctors was scarce. In this challenging environment, the mountains whispered tales of resilience and adversity. Little did I know that this remote outpost would shape my career, test my mettle and teach me invaluable lessons about mentorship – or the lack thereof.

During my initial week at the post, a distressed mother arrived, cradling her feverish child. The boy’s ear was visibly red, swollen and oozing pus – a tiny round lithium battery lodged deep within the external auditory canal had caused severe otitis complicated further by sepsis. With the village community gathered around me, I tried to extract the battery using forceps, but it stubbornly resisted, bruising my ego. I recall how I wished for the guidance of someone more experienced. While searching for alternative solutions, I discovered an old magnet in a nearby storeroom, sparking a ‘eureka’ moment. Persistence paid off as I somehow maneuvered the magnet and forceps, finally freeing the battery. Witnessing the power of resourcefulness, I marvelled. Yet, I still wonder: what if I hadn’t found that magnet or the idea hadn’t come to mind?

As I treated tuberculosis and malaria, and prescribed evidence-based medicine for heart failure, pneumonia and hypertension, my confidence grew steadily. However, practicing medicine in remote areas can test that confidence, revealing it as a double-edged sword. The combination of insufficient training, inexperience and lack of mentorship can quickly turn confidence into a liability. One snowy, pitch-black night, a woman arrived in excruciating labor. As the baby’s head emerged, the shoulders became stuck – a classic case of shoulder dystocia, though I had never encountered one in real life. My suspicions were confirmed when the humble ward orderly, with more experience than I, remarked, ‘The right shoulder is stuck; what are we going to do?’ With the roads to the main city blocked by landslides and no obstetrician nearby, I realized I was her best chance. Drawing on something I had only read about during my obstetrics rotation, I braced myself and gently rotated the infant. The room held its breath, and with a triumphant cry, the baby entered the world. That night, I felt like a hero. It was a profound reminder that education is not a substitute for experience. I often reflect on what might have happened if the baby hadn’t been born that day and how this would have affected the fragile mind of a young physician alone in the mountains.

Our old pharmacist taught me the art of suturing. When a farmer stumbled in, blood spurting from a lacerated ear, I stitched with trembling hands. Mentorship, I realized, could come from unexpected corners.

And then, the haunting case of rabies. A young boy, already in the throes of aerophobia and hydrophobia, presented too late. Despite our efforts, he succumbed. We faced the aftermath: the rabid dogs that had terrorized the village. Armed with determination, I rallied the community, capturing and euthanising the infected strays. Mentorship extended beyond doctors; it was about collective action.

I always knew that ‘failure’ would eventually come knocking, and when it did it was gut-wrenching. A boy of 13 years came to me with burning micturition, suprapubic pain and fever. As many of my colleagues would have, I confidently diagnosed a UTI and prescribed antibiotics. However, his condition deteriorated. Six agonising hours later, emergency surgery revealed perforated appendicitis. Although the boy survived, my heart sank. This experience made me realize that the lack of mentorship had left me in the dark; I needed guidance beyond my own experience, and wisdom beyond my years.

Mentorship has been a cornerstone of my career, guiding me through various stages and locations. For instance, in Singapore, I refined my skills and gained confidence in handling complex cases. Moving to London, I was influenced by a mentor who emphasized empathy and meticulous care. In Philadelphia, I was encouraged to embrace innovative approaches and contribute to research. New York and Wisconsin provided an opportunity to master advanced techniques, which have become central to my practice and I found unwavering support in my role as an instructor, helping to pass on my knowledge to the next generation. These experiences highlight that mentorship is a continuous journey, essential for both personal and professional development.

Reflecting on my journey, the bold choices I made – some triumphant, others humbling – have defined my path. From the secluded rural health center to the vibrant cities worldwide, I have carried with me the lessons of mountains and magnetism, of sutures and stray dogs. Above all, mentorship is not just an option; it is a crucial force that saves lives and shapes futures¹.