This American Doctor Moved to Chad (and is paying off her student loans)

Welcome to our latest Hippocratic Adventures Interview! I’m  Dr. Ashwini Bapat and today we’re *very excited* to have Dr. Sarah Silva with us.

Dr. Sarah Silva received her MD from Loma Linda University, completed her family medicine residency training in Boise, ID and then went on to a one year fellowship doing C-sections in Seattle. She has been practicing full spectrum family medicine in rural southern Chad since 2018 with her husband and their two small children. When she’s not doctoring, you can find her blogging at For the Healing of the Nations.

Watch the full video above so you don’t miss out! Below, we share the episode summary and show notes.

1. Tell us your story. How did you end up practicing in Chad? 

I started to do a few trips overseas in high school and in college I had an overseas experience on the continent of Africa. This experiences inspired me to make a career out of working overseas, so I entered medical school with this in mind.

When I was looking for medical schools, I found that Loma Linda University Medical School, has a loan repayment program where they sponsor a certain percentage of my loans for every year that I serve overseas within their network of hospitals. Once I finished my fellowship, I saw that there was an opening in Chad. I visited, and that I could be a good fit. I learned French for a few months and then in the beginning of 2018 started working in Chad.

2. Can you tell us more about the loan repayment program?

Our umbrella organization is Adventist Health International. They noticed that for many medical students, by the time the graduate from training, the huge medical school debt prevents most physicians from being able to work in low income countries. So they sponsor part of the loans for every year that a physician works overseas.

Importantly, I work alongside physicians of all different faiths for both short and long-term work.

3. What language do you communicate in?

I mostly communicate with the nurses in French, and then the nurses will translate it into Chadian Arabic or into the local language.

4. How did you get licensed to practice in Chad?

For me, it was just a matter of sending the government diplomas from all my training. And then we pay 300USD per year to have a license. Physicians who come for short-term stints don’t need a formal agreement with the government to practice medicine here.

I’ve still kept my US state license active.

5. What types of opportunities are available in Chad?

There are both short-term and long-term placements. The shortest amount we’ve had people come is 6 days. After that people can stay for weeks, or months or really any amount of time.

6. Tell us about your hospital.

Our hospital has medicine, pediatrics, and maternal-fetal, and surgical wards. Our staffing fluctuates – some times we have EM docs, general surgeons, surgical specialties that can do general surgery.

There are possibilities for primary care docs and general surgery (even for 1 month stints). We’ve done a week of cleft lip & palate surgery – the plastic surgeon came with his anesthesiologist and they did head & neck surgeries that week.

We would love to have an opthalmology team come in to do cataract surgery. We just need a physician who’s flexible and willing to work in less than ideal conditions.

7. How does family medicine in Chad compare family medicine in the US?

I do very little traditional family medicine in terms of seeing patients in clinic. Most people are illiterate, they don’t have watches, they don’t know their birth dates, so time is very different than in the developed world.

I do mainly inpatient medicine, pediatrics, and the OB ward. I do all the complicated obstetric cases, and I call in the general surgeon for uterine rupture that may require a hysterectomy.

My practice is vastly different than in the US. We have a few standard labs – hepatitis, TB, but it’s hit or miss to get a CMP. So there are many times when I have patients with unclear diagnosis simply because we don’t have the labs or imaging. We now have a functional X-ray and I’ve had to learn ultrasonography on the go. I have to go off my physical exam a lot to clue me into the diagnosis. It’s frustrating to not know whats going on with the patient. It’s also fulfilling because we have patients that come from afar to our hospital, because they heard we care for their well-being.

We also train up local Chadian physicians. The doctors are usually a mix between US-trained and Chadian trained physicians.

8. How are you compensated for your work in Chad?

I get a living stipend, travel compensation and loan repayment from Adventist Health International. So we’re able to live quite comfortably. The folks that come for short term stints are self-funded. Living costs here are minimal

9. You have a young family – how has that been?

The work in Chad is usually of a 24/7 nature, so I split the work with another doctor, but that also means we’re always on call. On the one hand my work hours are flexible so I can come home and breastfeed a newborn, but I make up for it when I’m called in for a post-partum hemorrhage at 3am.

Life is very simple and the kids play outside, free-range. When I’m at work my husband and another family help to care for the kids. I live in hospital housing right next to the hospital wards, on the same compound, so thats convenient.

10. How does malpractice insurance work?

There isn’t any malpractice insurance.

11. What were some of the challenges you encountered?

It’s hard to switch from a US-trained mind set. The patient’s family pays for every test I order, every medicine that I order. So each decision I make is weighed in the balance. I can’t just order all the tests I need to make a diagnosis, I need to really think about if this test is going to change management of this patient.

This has given me a lot of pause to reflect on medical management.

It’s also been hard to accept the loss of patients – acceptance of where I’m living, what I’m able to do, with what I have. It’s hard to lose a mother.

12. What were some of the joys?

There’s an incredible amount of satisfaction that comes from helping those who are so destitute. The little that I can give makes an incredible difference.

3 Quick Rapid-Fire Questions

We’ll ask some “Rapid Fire” type questions at the end which are meant to induce short/off the top of your head type answers. These will be fun!

a. What’s the coolest place you visited?

b. What’s a piece of advice you would give to someone who’s on the fence about trying out an experience abroad?

c. Have these experience abroad been worth it?

Watch the video to learn Dr. Silva’s answers!

Now we want to hear from you!

What’s your biggest takeaway, “aha” moment, or insight from today’s conversation? Let us know in the comments below.

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