Reflections...

It certainly has been a fast month (alright 28 days). Some reflections if you please:

It has been an interesting and welcomed transition from “living in the future” while in Hood River for the last six months of our stay there, to “living in the past” as we left our beloved Columbia River Gorge, the Cascades, Oregon, the west, and our family to “living in the present” as we adjust to living here. The days on the wards scream by as I try to stay at least one step ahead of the diseases here and attempt to teach at the same time. My team is responsible for all the weekend admissions so, while we don’t have to actually admit the patients, the medical officers do that and do it extremely well, our service will be huge on Monday and the attendant frustrations will multiply.

This will be the first week without the on site leadership of Steve Gluckman, the clinical director of the UB/Penn partnership. So we are down to two Penn attendings, me and Nicola Zetola, with four others who are on the staff here. Together we lead the six medical services called “firms”, three male and three female. We are from all across the map; US, Cuba, India, Pakistan, Peru, other sub-Saharan African nations and of course Botswana.

Nicola is simply amazing. A guy one year older than our eldest, he grew up in Peru, entered medical school there at age 16 (it is an 8 yr program beginning at the undergrad level) where as a seventh year intern and an eighth year extern they ran the hospital, was the ONLY foreign applicant accepted to Johns Hopkins for residency (medicine) where he of course excelled, and completed an Infectious Disease Fellowship at UCSF where he published no less that 25 papers and got a MPH in at Berkeley in just one year. And is here now, a newly minted ID specialist/generalist with extraordinary clinical skills. We have become fast friends and rely on each other heavily; me on him for his clinical knowledge and skills in an inpatient environment and he on me for pace and experience from the opposite end of a medical career. He was looking pretty rough on Friday as he had been on call and had slept little in the previous 72h. So we kidnapped him at 6pm, took him to our place where he and I participated in the time honoured tradition in medicine of hepatic stress testing, smoked pipes, passed out in bed thereby properly incurring the clucking of the women staying here (yes Lynne included) and awoke new men, if not a touch the worse for wear.

I find I have moved into a more spiritual side of myself. I pray more, reflect more, fear and ask for guidance more. Lynne and I have moved away from the traditional Lord’s Prayer and are extemporaneous in our reflections and prayer, something we both find liberating, more immediate and enjoyable. I pray for the ability to demonstrate and live the love I feel from the Lord to the people here. The Batswana have been uniformly friendly (except perhaps when they are driving) and welcoming. When we tell anyone that we have moved here we are met with a smile and gleeful handshake.

About Gaborone, it is an emerging city in an emerging nation. Much of it would remind one of, say, Austin, TX, a college town and capital of about the same size. Eugene is another appropriate comparison. Botswana is blessed with abundant wealth and a large and expanding, educated, middle class. It finds itself on that ill-defined threshold between the security of the past and the blessings of a brighter, yet to be defined, future. It isn’t resource poor in the traditional sense although there are days when we have no linen, no suction, little true cooperation from other services, and no IV kits on the wards. The challenge is not only how to acquire the needed goods and services for this nation but how to distribute them equitably. Picture perhaps the Industrial Revolution in our country.

The seduction of this place at this time is that I can truly make a difference that is lasting, by simply teaching. That of course is also the challenge. It would be nice, although thoroughly boring, if life came in well outlined and clearly defined packages. I am slowly finding my feet. Writing this down helps, Lynne helps immeasurably, praying and reflecting has become a much larger and welcomed part of my life, and the challenge proceeds. I am blessed to be here with all the attendant anxiety and self accountability. I am out of my comfort zone, challenged to be in the lives of my patients and colleagues in training. For now I wouldn’t have it any other way.