An increasing number of medical students are choosing to do an elective abroad. While there is much in the peer-reviewed literature about curriculum development, there is very little, if anything, about preparing medical students for the ethical conflicts and emotional turmoil that working in an underprivileged setting can cause. This paper examines some common threads of conflict found in multiple countries including the role and treatment of women, the lack of pain management, economically driven medical decisions, dealing with unnecessary death, reproductive health and social taboos, bribery of physicians, informed consent and reintegrating into Western medicine. Vignettes gleaned from the experiences of the authors common to multiple disadvantaged settings are presented. These can help serve to prepare the student for situations he or she may encounter. Several suggestions are offered to mitigate the emotional conflict including setting realistic goals before going abroad, peer and family support, journaling, etc. Finally, a cognitive framework is offered tho help the student make sense of what he or she may be experiencing.
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