Resigned to Resignation

Early in September, a Friday, I came home from a district hospital in a lousy mood. I had been discouraged all week that the MO's, with a few notable exceptions, weren't asking the right questions and therefore not practicing up to their potential. I know, I have written about this before but my toxicity meter was in the red zone. It seemed that nothing I had done to date had made any lasting difference in care. I had had a horrific Monday, involved in something that while medically necessary, decent and appropriate really shook me like I haven't been since my MSF days. With MSF I had to look through/past events and continue; "next". Here, I have been able to let my guard down and was totally blind sided. I felt depleted and ineffective and began to seriously question the true purpose of my medical presence here.

To the extent that we, or for that matter any expat organisation , make a lasting and true difference here appears to be simply out of reach. This is a young country that is in the process of emerging from adolescence and needs to find its own value system. I find it making the same mistakes, and encountering the same struggles that a more mature country has processed through. Hell, when the US was this "age" we were fighting a war, again, (1812 wasn't it?) and for what? It is generally agreed that we are at least two generations away from true reform in medicine. Were we placating the metaphorically "young teen" country such that rather than teaching one to fix the flat tire one's his bike we instead were buying one a new bike? We'll just have to wait and see I guess.

So on that Friday I found myself thinking if the above was true, what was I doing here, really, that was making more than a temporary impact? Was this just an exercise in pure narcissism and was I just collecting stories? I love the people and the primary medicine to be sure but B-UP has slowly moved away from point-of-care medicine at a primary level. We are responsible to those that fund us and it becomes difficult to quantify relationships or for that matter reliably assure that knowledge transferred makes a difference at the doctor-patient level. I had been worrying that at some level I and my organization were, perhaps, enabling.

I found myself a bit depleted and not a little frustrated. I had struggled for a while with the notion that I am different in numerous ways from my fellow faculty members; generational, primary specialty, medical terminology and priorities, etc. Even the term "faculty" is foreign, implying separation from my primary care colleagues. I have learned alot about health care in this setting and at the same time that information rarely related to my every day teaching and, with few exceptions, had little lasting impact on my those I mentor. All too frequently I found myself saying that "we have discussed this disease and its management before" and did he/she remember that? For the most part they didn't, or didn't care.

In any case after no less than two "interventions" on the part of my family ("Papa you need to get your shit together and enjoy your grandchildren and they you") and considerable introspection on our part I submitted my resignation a week later, effective 17 December. I have 5 weeks. I know, no state secret here, but I wanted to keep it quiet as it shouldn't be about me.