Community-based medical education: Exploring doctor-patient interactions in post-disaster Aceh, Indonesia

Abstract

People who are affected by disaster(s) often undergo significant shifts in their lives due to physical injuries, displacement, and the loss of family members and properties. These experiences may contribute to challenges in how they interact with medical doctors, who may struggle to co-construct equitable and meaningful medical encounters with disaster survivors. At present, scant medical education research has explored the means of preparing doctors to engage sensitively with patients in post-disaster contexts. This thesis focused on the potential for community-based medical education (CBME) to familiarise physicians (both current and future doctors) with the lived experiences of disaster-affected patients. By employing a postcolonial lens, the study illuminated extant power relations and foregrounded efforts to listen to the subaltern community’s voices. The research drew on ethnographic techniques to conduct 225 hours of participant observations, 23 individual interviews, and 2 focus group discussions. The research participants included patients affected by disasters, community medical doctors with considerable experience working in these communities, and medical students completing a CBME unit. The findings from interviews with patients highlighted significant problems in medical education and practices in post-disaster areas, including asymmetrical power relations and complex cultural differences. Some community medical doctors, however, addressed these challenges by engaging the broader community, and medical students’ experiences during CBME suggested that home visits and reflective practices have the potential to enhance their preparation for work with disaster-affected patients. Based on these findings, this study offers an educational model for community engagement that could reduce asymmetrical power relations and cultural difference toward improving post-disaster community engagement in healthcare program.