If you are coming to my site for the first time - welcome! Since starting medical school time for updating the blog has been quite limited. Please use the menu on the right of the screen to read my blog from my time in Haiti (Jan-July, 2009).
Enjoy and I welcome all comments, here or via email:
MATTHEWLGOODWIN@gmail.com
Thursday, November 12, 2009
Saturday, August 29, 2009
Weill Cornell Medical College
Forgive the lack of posting - medical school orientation has been quite busy. So far my classmates are a lot of fun, although a tad younger than me.
One thing I have noticed so far is the tendency for the school to shower us with praise and tell us how wonderful we are. I am not suggesting they do the opposite, and I am very grateful they seem to think so much of us (and to be fair, there are some quite amazing people here); but it does seem like the general public seems to view physicians as pompous and arrogant many times. In my view pumping our egos so much perhaps doesn't help.
Many times I have felt like I am back in middle school, but it has been refreshing to meet other people like myself in so many strange ways (can memorize lists of insane amounts of material but can't get to a meeting on time or find their way out of a room). It is also a bit surreal to don the white coat "for real" and not in Haiti or in a lab. It's a nice, exciting feeling.
All in all it has been excellent, and I am extremely impressed with what Cornell as a medical school does. More to come, I hope.
One thing I have noticed so far is the tendency for the school to shower us with praise and tell us how wonderful we are. I am not suggesting they do the opposite, and I am very grateful they seem to think so much of us (and to be fair, there are some quite amazing people here); but it does seem like the general public seems to view physicians as pompous and arrogant many times. In my view pumping our egos so much perhaps doesn't help.
Many times I have felt like I am back in middle school, but it has been refreshing to meet other people like myself in so many strange ways (can memorize lists of insane amounts of material but can't get to a meeting on time or find their way out of a room). It is also a bit surreal to don the white coat "for real" and not in Haiti or in a lab. It's a nice, exciting feeling.
All in all it has been excellent, and I am extremely impressed with what Cornell as a medical school does. More to come, I hope.
Friday, August 14, 2009
NYC
Forgive the lack of posting. We have made it to our apt. in NYC.
In New York, things are great. The people here are so much more wonderful than you may have heard. We thought this on every trip to the city to interview, etc. and it's only been confirmed for us again. People are everywhere and helpful and nice. While biking through central park I told Mandy I may never leave this place.
I may not. Back to figuring out how to get internet at the house.
If you've seen the movie In America, there is a scene where he lugs a window AC unit across the city. That was me yesterday; I'm still recovering.
I hope to get back to more meaningful commentaries when we get settled!
In New York, things are great. The people here are so much more wonderful than you may have heard. We thought this on every trip to the city to interview, etc. and it's only been confirmed for us again. People are everywhere and helpful and nice. While biking through central park I told Mandy I may never leave this place.
I may not. Back to figuring out how to get internet at the house.
If you've seen the movie In America, there is a scene where he lugs a window AC unit across the city. That was me yesterday; I'm still recovering.
I hope to get back to more meaningful commentaries when we get settled!
Friday, August 7, 2009
Difficult Times (for some)
It's almost 2AM, and I just made my fourth trip with a car full of donations to the salvation army. We managed to fill the 2,000 square-foot house we are currently in with God only knows. Actually I know - everything that we've accumulated in this lifetime, and then some.
Moving to a tiny 1-bedroom in NYC is becoming quite liberating. We are simply having to donate almost everything and store the rest. Remarkably, we find ourselves knee deep in things we have no idea why we were saving them. As a brief example, these are things I found while cleaning:
My TWO casts from when I broke my foot in 10th grade! (that was 1996!)
Love notes from my High School girlfriend as well as other casual girlfriends (including the girl who gave me mono in college)
Trophies from as far back as 1987 (soccer mostly). 1987!
Hair from when I shaved my head in high school.
Notes from members of our 1998 High School Cross Country Team (goals sheet from each individual).
Boxes of VHS tapes: everything from MC Hammer on OPRAH to the 1992 Dream Team basketball games.
Bins full of exams from high school and college (this proved to be extremely funny - in Spanish I had drawn a cartoon man holding a sign that "says Students Against Spanish (SAS): Because we just don't need it!" A lengthy note from the teacher was in red).
Unopened bottle of coke from Mexico circa 1994.
Newspapers from Duke basketball circa 91-92, Nixon dies, and Braves winning various pennants.
About 15 Literature Anthologies.
A 1992 NBA Almanac.
A Christian Laettner Timberwolves poster.
Bizarre stuffed animals from...??? (one was a brocolli-person)
Articles on everything I appeared to ever wonder about.
A Tim Briles "Bowie" running singlet.
An Adam Goucher ceramic t-pot.
Books and books and books.
The list goes on.
Why we have so much stuff I have no idea. It seems this is some sort of middle-class phenomenon. If you are rich you can always get new stuff; if you are poor you can't afford much stuff. If you're middle class though you can afford stuff, yet never feel quite like you should get rid of anything.
Of course, my problem is that I always think "man, I would love it if my dad had kept such and such for me to see (watch, bat, etc)". Of course, I can't recall ever wishing my father had produced some old moldy casts from his childhood. Perhaps it's just me!
Tomorrow I pick up the moving truck and we load for NYC - posting could be a bit spotty as we do this.
Of course, i can't believe all the paperwork I have saved (writings, etc.). Today I can post as much as I want and it all fits neatly on my laptop. Our kids won't know any different. Can you imagine "Dad, what are all these thing things with markings on them? Is this what wikipedia was referring to when it mentioned "writing"? How strange! Why not just type it and save it? Why did you waste so many trees??"
"Son, things were different then. All of our music didn't fit in our pocket, we read books from pages bound together, and to talk to someone you had to pick up the phone. You couldn't send a facebook message or twitter or text. It was a hard time..."
Somewhere some 85 year old is reading this, thinking how she should remind us all what difficult times really are like.
Somewhere else an 85-year old (or probably 45-year old) isn't reading this because she's in Haiti, and she knows what difficult times are really like; she's living them now.
Moving to a tiny 1-bedroom in NYC is becoming quite liberating. We are simply having to donate almost everything and store the rest. Remarkably, we find ourselves knee deep in things we have no idea why we were saving them. As a brief example, these are things I found while cleaning:
My TWO casts from when I broke my foot in 10th grade! (that was 1996!)
Love notes from my High School girlfriend as well as other casual girlfriends (including the girl who gave me mono in college)
Trophies from as far back as 1987 (soccer mostly). 1987!
Hair from when I shaved my head in high school.
Notes from members of our 1998 High School Cross Country Team (goals sheet from each individual).
Boxes of VHS tapes: everything from MC Hammer on OPRAH to the 1992 Dream Team basketball games.
Bins full of exams from high school and college (this proved to be extremely funny - in Spanish I had drawn a cartoon man holding a sign that "says Students Against Spanish (SAS): Because we just don't need it!" A lengthy note from the teacher was in red).
Unopened bottle of coke from Mexico circa 1994.
Newspapers from Duke basketball circa 91-92, Nixon dies, and Braves winning various pennants.
About 15 Literature Anthologies.
A 1992 NBA Almanac.
A Christian Laettner Timberwolves poster.
Bizarre stuffed animals from...??? (one was a brocolli-person)
Articles on everything I appeared to ever wonder about.
A Tim Briles "Bowie" running singlet.
An Adam Goucher ceramic t-pot.
Books and books and books.
The list goes on.
Why we have so much stuff I have no idea. It seems this is some sort of middle-class phenomenon. If you are rich you can always get new stuff; if you are poor you can't afford much stuff. If you're middle class though you can afford stuff, yet never feel quite like you should get rid of anything.
Of course, my problem is that I always think "man, I would love it if my dad had kept such and such for me to see (watch, bat, etc)". Of course, I can't recall ever wishing my father had produced some old moldy casts from his childhood. Perhaps it's just me!
Tomorrow I pick up the moving truck and we load for NYC - posting could be a bit spotty as we do this.
Of course, i can't believe all the paperwork I have saved (writings, etc.). Today I can post as much as I want and it all fits neatly on my laptop. Our kids won't know any different. Can you imagine "Dad, what are all these thing things with markings on them? Is this what wikipedia was referring to when it mentioned "writing"? How strange! Why not just type it and save it? Why did you waste so many trees??"
"Son, things were different then. All of our music didn't fit in our pocket, we read books from pages bound together, and to talk to someone you had to pick up the phone. You couldn't send a facebook message or twitter or text. It was a hard time..."
Somewhere some 85 year old is reading this, thinking how she should remind us all what difficult times really are like.
Somewhere else an 85-year old (or probably 45-year old) isn't reading this because she's in Haiti, and she knows what difficult times are really like; she's living them now.
Monday, July 27, 2009
Continuation
In light of comments I received on blog posts, I may post one or two more (or just keep this going forever).
In the midst of moving to NYC, I have little time. However, religious phenomena are never far from my mind. I recently received a religious card. Now, I am grateful and happy to receive cards, especially considering it meant some one was thinking of me; so don't mistake this for ungratefulness. However, I am increasingly surprised that people choose to send their religious beleifs to others in this form. How strange it would be if I sent out Agnostic cards for events:
"Despite the fact that current evidence suggests there probably is no higher power, I still hold that perhaps one day evidence might suggest there is. Either way, we dont know....Happy Birthday!"
I feel as if this card would upset a Christian, who might respond with "this is ridiculous, we are chilren of the christian God!"
Will there ever be a time when people recognize that the essence of faith is doubt, not knowing? People are people, despite the fact that some were born in a place that affords them a different opinion on matters that cannot be proven. In this world of ever-colliding cultures, we should be cognizant of the differences in opinion we hold over things for which there is little evidence.
Then again, perhaps I am being overly critical of people wanting to share the joy they share in their personal faiths. This I understand, for the joy I find in evidence-based thinking is considerable.
May you find joy in your heart (now this sounds like a card...).
In the midst of moving to NYC, I have little time. However, religious phenomena are never far from my mind. I recently received a religious card. Now, I am grateful and happy to receive cards, especially considering it meant some one was thinking of me; so don't mistake this for ungratefulness. However, I am increasingly surprised that people choose to send their religious beleifs to others in this form. How strange it would be if I sent out Agnostic cards for events:
"Despite the fact that current evidence suggests there probably is no higher power, I still hold that perhaps one day evidence might suggest there is. Either way, we dont know....Happy Birthday!"
I feel as if this card would upset a Christian, who might respond with "this is ridiculous, we are chilren of the christian God!"
Will there ever be a time when people recognize that the essence of faith is doubt, not knowing? People are people, despite the fact that some were born in a place that affords them a different opinion on matters that cannot be proven. In this world of ever-colliding cultures, we should be cognizant of the differences in opinion we hold over things for which there is little evidence.
Then again, perhaps I am being overly critical of people wanting to share the joy they share in their personal faiths. This I understand, for the joy I find in evidence-based thinking is considerable.
May you find joy in your heart (now this sounds like a card...).
Monday, July 20, 2009
Winning the Lottery (On Leaving Haiti)
I am sitting at the PAP airport now, leaving Haiti. Kevin told me that this would a trip of a lifetime; it was. To briefly recap, the week here was absolutely nuts. I began taking all the Pap smears and HPV tissue samples from the clinic home with me so that I would have enough time to get all of the samples labeled, entered, organized, packaged and sent. It’s interesting, because at the clinic here so much rests on human relationships in order to get things done. An example: The new medical students interning for the summer came down recently. One of them is helping us with the HPV study in HIV positive women. My role in this project consists of many things: enrolling patients in a study, performing vaginal exams and collecting samples, assisting OB/GYN guys during colposcopies, taking inventory on materials and making sure we have everything, organizing and labeling all samples, making sure samples get sent to Cornell, etc. It sounds like a normal busy clinic/lab set up, but it is extremely hard to get anything done if people don’t know and like you. For instance, we ran out of slides (we take vaginal swabs and send them over to the micro lab for analysis). I sent one of the interns to get more covers, but people just told her they didn’t have any, etc. They didn’t know her well enough yet. I went back for the same thing. I greeted them, they all know me and joke with me in Creole, and then I asked for the slides. There was some discussion and eventually a guy I know popped out of his office and told me he would help me. We eventually found a lab that lent us some. The new intern has actually done a great job of walking around and making her face “known” so that she can get materials, etc. as well. It’s hard to explain unless you go through it. It’s extremely frustrating, but that’s just how it works there. Everything is based on relationships.
In the last week we had a big push to rescreen women from last year for HPV/lesions/cancers, etc. So each day for the last 2 weeks that I was in clinic we were in the exam rooms collecting samples. Of course, this made for GREAT clinical training for me, and the OB docs I worked with are awesome. One would stay as long as I was willing to see patients. He would even take us home if we missed our ride. This doesn’t sound like a big deal, but driving up to where we live in PAP is not easy. I digress. I was also enrolling patients in a different study with MORE samples and more paper work were required (and much more time). It was a huge mess but we got so many patients seen; more importantly we collected samples on projects that could lead to better treatment for HIV/HPV patients in Haiti and worldwide.
I skipped the last weekend at the beach and a few other things to get these samples finished up. It was a pain, but it worked out really well.
Then, I had a day or two to pack. Of course I got really sick one of my last days at the clinic (last Thursday). I actually was discussing a procedure with one of my OB mentors while I was performing it, and suddenly felt like I would pass out and puke right there between her legs. I had had major gallbladder attacks that morning and had hoped they would go away. This was something else. I felt sick. I looked up at him with my hands still on the speculum and brush and calmly said “I need you to finish this one.” He looked at me like any good mentor would and said “No, you can do this, you’ve done this many times, if it’s still bleeding you know what to do.” I looked at him again and said “I feel very sick, I really need you to do this.” He immediately grabbed the instruments, gave me the chair, and finished the exam standing up. He was great. He went and got me a shot of anti-nausea stuff and injected me and then got me a coke in case my blood sugar was low. I then developed had chills and flu-like body-aches. The problem was that I had patients scheduled for me to collect samples from the rest of that day (Thursday) and Friday, my last day. I HAD to see the patients. I had to rest for 30 minutes then finished the patients. I went home that day, got in my underwear, and slept til the next morning, on and off.
By the way, it is over 100 degrees F most of the time in our house right now. This means several things: 1) This is REALLY hot, especially considering that our ceiling fans don’t do much. Turn your heat on to about 90 to 100 degrees F and try to walk around inside for a bit, it’s awful. 2) In this heat my computer only works for about 30 minutes at a time. I’m serious; it then overheats and gets really choppy/freezes up. 3) I have taken to filling the bathtub with cold water and immersing myself in it for relief and to get my core temp down. 4) It doesn’t really cool down that much at night. Besides the fact that this is weird, it sucks.
I couldn’t eat anything all Thursday. Friday I felt better and managed to eat around lunchtime. Seems I had a 24-hour flu.
I started packing Fri night, but my friends had thrown me a wonderful going away party. My Haitian friend from the streets came, along with one of our guards. And of course, all the ex-pats I like. One of my very good friends here actually created the company that makes Rara bags. You HAVE to check these out and order some for people you know! These are wallets, bags, etc made from trash off the streets. She actually employs Haitians to sew these things. It's really remarkable. Check them out:
http://klynnstudio.com/RARA.html
This is a great cause and a cool gift. You can order one of these and it goes to a project that employs Haitians and helps clean up Haiti/is good for the environment! Order something!! At any rate, she showed up with one of the wallets as a gift for me. Also, both OB doctors I work with came, and one of them brought a Vase for me as a gift. A social worker I work with brought me a Haitian Vase/Case as a gift earlier in the day at the clinic too. During the party, I was drinking beer and talking creole with my Haitian friend and the security guard, and the security guard was telling me how he never gets to do this. When I asked him "do what", he said he never has had a beer with people he works “for.” I thought this quite unusual. He said in Haiti he is just in a different class – we wouldn’t party together. Maybe I live in my own little world, but I was telling him that in the states everyone is allowed to party with everyone if they want. We had a great time. I was moved that everyone came.
On my last day of work a good friend of mine at the clinic brought me a necklace. It was touching for several reasons. For one, I talk to her every day; she is a wonderful woman. She is a peer-counselor at the clinic. I found out later that she “grew up” around the clinic; she was a victim of mother-child HIV transmission. And this girl is awesome. She comes in every day that I have time and we practive English together. On my last day she made me close my eyes and put the necklace around my neck. I love it and was very moved by the gesture.
Today I left. I drove through PAP for the last time for now, but I think I’ll be back. In customs in Miami I got the opposite treatment as Haiti. In Haiti white means rich, and you’re treated well, as if you have lots of money. Of course, I have long hair and a beard. At customs in Miami I got asked some questions about how long I’ve been out of the country and then sent through the “agriculture” checking scanners. I have no idea what this is, but later in the airport a man came up to me and was like “Man, I saw that, that’s crap. I used to have a big beard and I’d get crap like that all the time.” We then went on to speak about Haiti and what I was doing. He then asked me, “Ok, I’m sorry if this is ignorant, but how can you work with those patients? Aren’t you scared you’ll get HIV?” I explained that even if I spilled HIV blood on my arm (which happened more than once during exams) it would be extremely hard to get it. In fact, I could take a needle out of an HIV-infected arm and stick it in mine, and the rate of transmission is still less than 1%. I explained all this and he was like “oh wow, that’s crazy; when I was in San Francisco I would cross on the other side of the street if someone looked gay or sketchy.” I then joked, “Well, if you‘re sleeping with your patients, it’s a different story!”
Finally, in Miami (I am at the airport typing this now), I tried to hop on a flight tonight to ATL instead of sitting in the airport all night to take the morning flight. I was told in Haiti that there was a flight tonight that was empty that I should get on. When I tried, the lady simply told me that she couldn’t do it; it was a rule - she can’t put me on a flight for a different day even if there are openings. I was confused and tried to work her with a smile, etc. But she was having none of it. I then realized I wasn’t in Haiti, things aren’t so heavily based on interactions here…Well, perhaps I just contrasted this with what happened as I left the PAP airport in Haiti: I have 4 bags, so I had to recruit bag-help at the airport. The men took me through to “business class” check in (skipping the big line for regular people). I told them that I was not business class, they were like, no worries, we got it. An American Airlines rep asked me if I was business class..I just said no. These guys grabbed him and talked to him and he just nodded and let me stay. Then they quickly checked me in, no worries. So I obviously tipped these guys well. It was an interesting situation.
So now I am back, the journey is over, for now. I wish I had some end all, be all advice, some wise words from six short months of experiences. I don’t. In fact, all I have is a mind full of memories, good and bad, difficult and fun. I learned more than I thought I would, about people, about life, about me, about the world. I also made better friends than I ever imagined I could in such a short time – friends I will have for life, Haitian and American.
Perhaps you don’t agree with everything I say; and if you don’t, I hope you show me evidence for where I have erred. Rational dissent is always welcomed. If nothing else, I hope you became more informed and stay informed. Appreciate where you are, what you have. And even if you can’t go see for yourself what these places are like in the world, read about them, try to understand them. Try to understand that while Haiti may be “the most dangerous country to travel to” on someone’s list due to kidnappings and violence, it’s also home to millions of people that were born there and are simply trying to make a good life. They’re just like you, just not so lucky. One of our drivers is about my father’s age. He has a family, he works hard, he speaks creole clearly and slowly so the Americans can understand him, and he is funny too. If he could speak English or my father Creole, I can picture them talking for hours about things, about life, about the good, about the bad. What do they have in common? Maybe not so much, maybe a lot. My dad never has to spin his wheels and do a 180 in the car because he runs into an angry mob charging at him; then again, he also probably doesn’t get a new crop of young foreigners coming into his workplace all excited to change the world every few months. But they both love their families, they both like to laugh, and they both are kind and hard working.
If you were to travel somewhere like Haiti you would likely meet someone like this; someone that makes you realize that despite what frustrations you have, despite what people say, despite how “bad” or “dangerous” a place it is, the majority of people are good. Maybe some bother you for money; is it so wrong that they are trying to get money to eat or send their kid to school? Others will bother you about their religion because you don’t believe what they do; is this so different from how you treat people that have a different belief system than you? But most will try to help you when you’re down, will smile when you joke, will greet you when you pass them. They might not understand why you would risk coming to their country right now, but they appreciate it, because they know the ease of life from which you come. And they appreciate your understanding that a few violent people don’t make everyone that is born there “bad.”
So in closing, appreciate the US, love the US. But please understand that you were lucky, you won the lottery. They didn't. Have compassion for your fellow humans. They're just like you, just not with a winning lottery number. Perhaps one day we can all win the lottery.
In the last week we had a big push to rescreen women from last year for HPV/lesions/cancers, etc. So each day for the last 2 weeks that I was in clinic we were in the exam rooms collecting samples. Of course, this made for GREAT clinical training for me, and the OB docs I worked with are awesome. One would stay as long as I was willing to see patients. He would even take us home if we missed our ride. This doesn’t sound like a big deal, but driving up to where we live in PAP is not easy. I digress. I was also enrolling patients in a different study with MORE samples and more paper work were required (and much more time). It was a huge mess but we got so many patients seen; more importantly we collected samples on projects that could lead to better treatment for HIV/HPV patients in Haiti and worldwide.
I skipped the last weekend at the beach and a few other things to get these samples finished up. It was a pain, but it worked out really well.
Then, I had a day or two to pack. Of course I got really sick one of my last days at the clinic (last Thursday). I actually was discussing a procedure with one of my OB mentors while I was performing it, and suddenly felt like I would pass out and puke right there between her legs. I had had major gallbladder attacks that morning and had hoped they would go away. This was something else. I felt sick. I looked up at him with my hands still on the speculum and brush and calmly said “I need you to finish this one.” He looked at me like any good mentor would and said “No, you can do this, you’ve done this many times, if it’s still bleeding you know what to do.” I looked at him again and said “I feel very sick, I really need you to do this.” He immediately grabbed the instruments, gave me the chair, and finished the exam standing up. He was great. He went and got me a shot of anti-nausea stuff and injected me and then got me a coke in case my blood sugar was low. I then developed had chills and flu-like body-aches. The problem was that I had patients scheduled for me to collect samples from the rest of that day (Thursday) and Friday, my last day. I HAD to see the patients. I had to rest for 30 minutes then finished the patients. I went home that day, got in my underwear, and slept til the next morning, on and off.
By the way, it is over 100 degrees F most of the time in our house right now. This means several things: 1) This is REALLY hot, especially considering that our ceiling fans don’t do much. Turn your heat on to about 90 to 100 degrees F and try to walk around inside for a bit, it’s awful. 2) In this heat my computer only works for about 30 minutes at a time. I’m serious; it then overheats and gets really choppy/freezes up. 3) I have taken to filling the bathtub with cold water and immersing myself in it for relief and to get my core temp down. 4) It doesn’t really cool down that much at night. Besides the fact that this is weird, it sucks.
I couldn’t eat anything all Thursday. Friday I felt better and managed to eat around lunchtime. Seems I had a 24-hour flu.
I started packing Fri night, but my friends had thrown me a wonderful going away party. My Haitian friend from the streets came, along with one of our guards. And of course, all the ex-pats I like. One of my very good friends here actually created the company that makes Rara bags. You HAVE to check these out and order some for people you know! These are wallets, bags, etc made from trash off the streets. She actually employs Haitians to sew these things. It's really remarkable. Check them out:
http://klynnstudio.com/RARA.html
This is a great cause and a cool gift. You can order one of these and it goes to a project that employs Haitians and helps clean up Haiti/is good for the environment! Order something!! At any rate, she showed up with one of the wallets as a gift for me. Also, both OB doctors I work with came, and one of them brought a Vase for me as a gift. A social worker I work with brought me a Haitian Vase/Case as a gift earlier in the day at the clinic too. During the party, I was drinking beer and talking creole with my Haitian friend and the security guard, and the security guard was telling me how he never gets to do this. When I asked him "do what", he said he never has had a beer with people he works “for.” I thought this quite unusual. He said in Haiti he is just in a different class – we wouldn’t party together. Maybe I live in my own little world, but I was telling him that in the states everyone is allowed to party with everyone if they want. We had a great time. I was moved that everyone came.
On my last day of work a good friend of mine at the clinic brought me a necklace. It was touching for several reasons. For one, I talk to her every day; she is a wonderful woman. She is a peer-counselor at the clinic. I found out later that she “grew up” around the clinic; she was a victim of mother-child HIV transmission. And this girl is awesome. She comes in every day that I have time and we practive English together. On my last day she made me close my eyes and put the necklace around my neck. I love it and was very moved by the gesture.
Today I left. I drove through PAP for the last time for now, but I think I’ll be back. In customs in Miami I got the opposite treatment as Haiti. In Haiti white means rich, and you’re treated well, as if you have lots of money. Of course, I have long hair and a beard. At customs in Miami I got asked some questions about how long I’ve been out of the country and then sent through the “agriculture” checking scanners. I have no idea what this is, but later in the airport a man came up to me and was like “Man, I saw that, that’s crap. I used to have a big beard and I’d get crap like that all the time.” We then went on to speak about Haiti and what I was doing. He then asked me, “Ok, I’m sorry if this is ignorant, but how can you work with those patients? Aren’t you scared you’ll get HIV?” I explained that even if I spilled HIV blood on my arm (which happened more than once during exams) it would be extremely hard to get it. In fact, I could take a needle out of an HIV-infected arm and stick it in mine, and the rate of transmission is still less than 1%. I explained all this and he was like “oh wow, that’s crazy; when I was in San Francisco I would cross on the other side of the street if someone looked gay or sketchy.” I then joked, “Well, if you‘re sleeping with your patients, it’s a different story!”
Finally, in Miami (I am at the airport typing this now), I tried to hop on a flight tonight to ATL instead of sitting in the airport all night to take the morning flight. I was told in Haiti that there was a flight tonight that was empty that I should get on. When I tried, the lady simply told me that she couldn’t do it; it was a rule - she can’t put me on a flight for a different day even if there are openings. I was confused and tried to work her with a smile, etc. But she was having none of it. I then realized I wasn’t in Haiti, things aren’t so heavily based on interactions here…Well, perhaps I just contrasted this with what happened as I left the PAP airport in Haiti: I have 4 bags, so I had to recruit bag-help at the airport. The men took me through to “business class” check in (skipping the big line for regular people). I told them that I was not business class, they were like, no worries, we got it. An American Airlines rep asked me if I was business class..I just said no. These guys grabbed him and talked to him and he just nodded and let me stay. Then they quickly checked me in, no worries. So I obviously tipped these guys well. It was an interesting situation.
So now I am back, the journey is over, for now. I wish I had some end all, be all advice, some wise words from six short months of experiences. I don’t. In fact, all I have is a mind full of memories, good and bad, difficult and fun. I learned more than I thought I would, about people, about life, about me, about the world. I also made better friends than I ever imagined I could in such a short time – friends I will have for life, Haitian and American.
Perhaps you don’t agree with everything I say; and if you don’t, I hope you show me evidence for where I have erred. Rational dissent is always welcomed. If nothing else, I hope you became more informed and stay informed. Appreciate where you are, what you have. And even if you can’t go see for yourself what these places are like in the world, read about them, try to understand them. Try to understand that while Haiti may be “the most dangerous country to travel to” on someone’s list due to kidnappings and violence, it’s also home to millions of people that were born there and are simply trying to make a good life. They’re just like you, just not so lucky. One of our drivers is about my father’s age. He has a family, he works hard, he speaks creole clearly and slowly so the Americans can understand him, and he is funny too. If he could speak English or my father Creole, I can picture them talking for hours about things, about life, about the good, about the bad. What do they have in common? Maybe not so much, maybe a lot. My dad never has to spin his wheels and do a 180 in the car because he runs into an angry mob charging at him; then again, he also probably doesn’t get a new crop of young foreigners coming into his workplace all excited to change the world every few months. But they both love their families, they both like to laugh, and they both are kind and hard working.
If you were to travel somewhere like Haiti you would likely meet someone like this; someone that makes you realize that despite what frustrations you have, despite what people say, despite how “bad” or “dangerous” a place it is, the majority of people are good. Maybe some bother you for money; is it so wrong that they are trying to get money to eat or send their kid to school? Others will bother you about their religion because you don’t believe what they do; is this so different from how you treat people that have a different belief system than you? But most will try to help you when you’re down, will smile when you joke, will greet you when you pass them. They might not understand why you would risk coming to their country right now, but they appreciate it, because they know the ease of life from which you come. And they appreciate your understanding that a few violent people don’t make everyone that is born there “bad.”
So in closing, appreciate the US, love the US. But please understand that you were lucky, you won the lottery. They didn't. Have compassion for your fellow humans. They're just like you, just not with a winning lottery number. Perhaps one day we can all win the lottery.
Saturday, July 11, 2009
This isn't good for anyone (On Medical Ethics)
A standard medical school interview question goes like this:
Q: A woman comes to you for an abortion. What do you do?
There are several ways to answer this. For example, you perform the procedure. More likely though, you would refer the patient to someone who could do the procedure (if you weren’t trained to do that). The other answer may be that you aren’t comfortable with it so you would refer them to another physician for it. These are "correct" answers. There is a wrong answer, however. That wrong answer goes something like this:
A: I think abortion is murder. Life begins at conception. I wouldn’t do it. Period. I would send the patient home to have the baby.
Prepare to get grilled. You will get grilled not necessarily on your views (although most educated people would be very curious about these black and white views – there is no nervous tissue for about 14 days post-fertilization, we can create a “fairly” viable embryo with no sperm (SCNT), we fertilize eggs and simply fail to implant many times during attempts to get pregnant (conception is only a part of life beginning), we fertilize many eggs during in vitro fertilization yet few seem to mind this, etc.), but rather you will get grilled on failing to provide your patient with adequate care. If you feel you cannot do the standard of care that is LEGAL and asked of you, then you are obliged to find that patient adequate care. If this isn’t how things worked, imagine the upheaval it would cause in medicine: Some right-wing neoconservative doctor doesn’t “believe” in evolution and he refuses to curb his over-prescribing of antibiotics, saying that nothing is evolving (of course, it’s hard to imagine people PRACTICING medicine that is based on evolution and not understanding it, but it happens). Superbugs continue to develop. Take it a step further, a doctor fails to give a young lady the HPV vaccine when she requests it because he feels she shouldn’t be having sex. He tells her to go home and not have sex. However, her religious system doesn't ban sex. Then she gets HPV-18, which is strongly linked to cervical cancer.
Just a short time ago these things were unconscionable.
I recently had a discussion with medical students here. I was horrified at what I found out I had missed in the states. President Bush signed new “conscience” rules in December of 2008 before leaving office. I could not believe what I read. In short, the new law allows a doctor to refuse a service because of a moral belief (I have no problem with this; just make the referral) AND not inform the patient of where to get care or that care is available. In other words, a physician can now legally wrap his morals into his care to a degree like never before. In other words, a woman can ask for the HPV vaccine and essentially told not only “no” but also not given a referall to anywhere else. In fact, the doctor is now ok to say no and explain why it is morally wrong to get it to the patient.
Is this what we want? Do we want someone trained to advise us on health issues spilling their morals into care that much? One could argue that all beliefs will affect that intimate doctor-patient relationship (and I agree), but where do we draw the line? Now a doctor can refuse a legal procedure, fail to refer you to someone else, and even counsel you on why he doesn’t do what you asked. So now what?
“That ethics policy, however, from the American College of Obstetricians and Gynecologists, had less to do with whether doctors should be willing to perform abortions or other potentially controversial services, and more to do with what they should do if they were unwilling to perform them (bold mine). In those cases, according to the policy, doctors should tell patients upfront and refer them to someone who is willing to provide the services.
Under the new regulations, however, such referrals will not be required.”
The AMA and various other medical societies opposed this action.
If you are like most people that will read this, you are a Christian and are so mainly because it is the religious story of your culture/people/family. No one argues about this.
But pretend you were some other religion that believed that there was no such thing as psychiatric illness. So when you see a patient that is severely depressed, rather than giving them the standard of care, you explain to them that you don’t believe it is right to take those drugs. You send them home. To me this is disgusting. Treat the patient or find someone who will – this is your JOB! If you find something about your job that doesn’t agree with your “morals”, then work to change it or quit. But do your job. Patients should be taken care of.
Or imagine you rush your son to the hospital, short of breath and weak. You find out his heart is failing and he needs a transplant. Imagine if there were a heart available but the doctor simply couldn’t bring himself to do the transplant – he considered the heart to be the “soul” of the person. Besides this not being correct, he now wouldn’t have to refer you to the surgeon who could do it, instead being likely to counsel you on how God has a plan (or the heart is the soul or anything else) and to say goodbye.
Or imagine that you’re seeing your physician about getting rid of syphilis; however, your physician feels that STIs are punishment for wrongdoing and refuses to provide care. Now he does not have to refer you to another physician for care. Now imagine that this is the only urologist within 50 miles. You are now out of options. You will not receive the standard of care for a disease that is easily curable. And that’s legal. (I think you now see the point; this crashes right into what really is legal, the standard of care, etc.)
The whole thing is an abomination.
Interestingly, I received an email out of the blue from a good friend of mine. She just wanted to share her strange story of late. She knew nothing of this law. She told me that suddenly upon returning to her usual OB/GYN this year she has had an incredible amount of trouble getting contraceptives. Insurance has denied the IUD, and her primary care doc suddenly is making it very difficult to obtain the pill. She was baffled.
One of her friends commented to her, "maybe their religious views are getting in the way of your care."
My friend went on to tell me that she couldn’t imagine her friend was right because she has been going to this doctor for years with no problems until this year. She knew nothing about this new law. I was upset. Here I am, now hearing about how it plays out with patients, unbeknownst to them! Her friend was right on target.
People that agree with this law (perhaps you?) agree with it because they think that their views are the views that their doctor will have. Just imagine for a second that he doesn’t share those views. Now he is free to deny you care that you may need. The issue isn’t with what the doctor does or doesn’t do; the issue is with what he does in the event he feels uncomfortable. Does he uphold some professional standard of care or not?My friend is currently searching for a new doctor. Interviewers for medical school must be scratching their heads; one of the most clear-cut ethical decisions a clinician can make is now being turned on its head, and not for the good. This isn’t good for anyone.
Q: A woman comes to you for an abortion. What do you do?
There are several ways to answer this. For example, you perform the procedure. More likely though, you would refer the patient to someone who could do the procedure (if you weren’t trained to do that). The other answer may be that you aren’t comfortable with it so you would refer them to another physician for it. These are "correct" answers. There is a wrong answer, however. That wrong answer goes something like this:
A: I think abortion is murder. Life begins at conception. I wouldn’t do it. Period. I would send the patient home to have the baby.
Prepare to get grilled. You will get grilled not necessarily on your views (although most educated people would be very curious about these black and white views – there is no nervous tissue for about 14 days post-fertilization, we can create a “fairly” viable embryo with no sperm (SCNT), we fertilize eggs and simply fail to implant many times during attempts to get pregnant (conception is only a part of life beginning), we fertilize many eggs during in vitro fertilization yet few seem to mind this, etc.), but rather you will get grilled on failing to provide your patient with adequate care. If you feel you cannot do the standard of care that is LEGAL and asked of you, then you are obliged to find that patient adequate care. If this isn’t how things worked, imagine the upheaval it would cause in medicine: Some right-wing neoconservative doctor doesn’t “believe” in evolution and he refuses to curb his over-prescribing of antibiotics, saying that nothing is evolving (of course, it’s hard to imagine people PRACTICING medicine that is based on evolution and not understanding it, but it happens). Superbugs continue to develop. Take it a step further, a doctor fails to give a young lady the HPV vaccine when she requests it because he feels she shouldn’t be having sex. He tells her to go home and not have sex. However, her religious system doesn't ban sex. Then she gets HPV-18, which is strongly linked to cervical cancer.
Just a short time ago these things were unconscionable.
I recently had a discussion with medical students here. I was horrified at what I found out I had missed in the states. President Bush signed new “conscience” rules in December of 2008 before leaving office. I could not believe what I read. In short, the new law allows a doctor to refuse a service because of a moral belief (I have no problem with this; just make the referral) AND not inform the patient of where to get care or that care is available. In other words, a physician can now legally wrap his morals into his care to a degree like never before. In other words, a woman can ask for the HPV vaccine and essentially told not only “no” but also not given a referall to anywhere else. In fact, the doctor is now ok to say no and explain why it is morally wrong to get it to the patient.
Is this what we want? Do we want someone trained to advise us on health issues spilling their morals into care that much? One could argue that all beliefs will affect that intimate doctor-patient relationship (and I agree), but where do we draw the line? Now a doctor can refuse a legal procedure, fail to refer you to someone else, and even counsel you on why he doesn’t do what you asked. So now what?
“That ethics policy, however, from the American College of Obstetricians and Gynecologists, had less to do with whether doctors should be willing to perform abortions or other potentially controversial services, and more to do with what they should do if they were unwilling to perform them (bold mine). In those cases, according to the policy, doctors should tell patients upfront and refer them to someone who is willing to provide the services.
Under the new regulations, however, such referrals will not be required.”
The AMA and various other medical societies opposed this action.
If you are like most people that will read this, you are a Christian and are so mainly because it is the religious story of your culture/people/family. No one argues about this.
But pretend you were some other religion that believed that there was no such thing as psychiatric illness. So when you see a patient that is severely depressed, rather than giving them the standard of care, you explain to them that you don’t believe it is right to take those drugs. You send them home. To me this is disgusting. Treat the patient or find someone who will – this is your JOB! If you find something about your job that doesn’t agree with your “morals”, then work to change it or quit. But do your job. Patients should be taken care of.
Or imagine you rush your son to the hospital, short of breath and weak. You find out his heart is failing and he needs a transplant. Imagine if there were a heart available but the doctor simply couldn’t bring himself to do the transplant – he considered the heart to be the “soul” of the person. Besides this not being correct, he now wouldn’t have to refer you to the surgeon who could do it, instead being likely to counsel you on how God has a plan (or the heart is the soul or anything else) and to say goodbye.
Or imagine that you’re seeing your physician about getting rid of syphilis; however, your physician feels that STIs are punishment for wrongdoing and refuses to provide care. Now he does not have to refer you to another physician for care. Now imagine that this is the only urologist within 50 miles. You are now out of options. You will not receive the standard of care for a disease that is easily curable. And that’s legal. (I think you now see the point; this crashes right into what really is legal, the standard of care, etc.)
The whole thing is an abomination.
Interestingly, I received an email out of the blue from a good friend of mine. She just wanted to share her strange story of late. She knew nothing of this law. She told me that suddenly upon returning to her usual OB/GYN this year she has had an incredible amount of trouble getting contraceptives. Insurance has denied the IUD, and her primary care doc suddenly is making it very difficult to obtain the pill. She was baffled.
One of her friends commented to her, "maybe their religious views are getting in the way of your care."
My friend went on to tell me that she couldn’t imagine her friend was right because she has been going to this doctor for years with no problems until this year. She knew nothing about this new law. I was upset. Here I am, now hearing about how it plays out with patients, unbeknownst to them! Her friend was right on target.
People that agree with this law (perhaps you?) agree with it because they think that their views are the views that their doctor will have. Just imagine for a second that he doesn’t share those views. Now he is free to deny you care that you may need. The issue isn’t with what the doctor does or doesn’t do; the issue is with what he does in the event he feels uncomfortable. Does he uphold some professional standard of care or not?My friend is currently searching for a new doctor. Interviewers for medical school must be scratching their heads; one of the most clear-cut ethical decisions a clinician can make is now being turned on its head, and not for the good. This isn’t good for anyone.
On Good Things
My last day of work in Haiti is this Friday. These last few weeks have been incredibly great. Busy, fun, and with a sense of belonging at the clinic. We are really in a big push to see as many patients as possible right now. As you probably know, my job is in the OB/GYN part of the clinic here. Within the larger study of examining when it is best to start ARV treatment, we are running another study looking at HPV in HIV positive women. Then within that there is another study looking at prostaglandin levels in women with and without cervical lesions. All this translates into me being very busy in the clinic, trying to coordinate patients coming, the appropriate paper work being ready (harder than you can imagine to get copies), examining patients, giving treatment, etc. It has been very hectic. Amidst this, though, I have realized how much I love about what I do here:
1) When I walk around the clinic I always run into coworkers who I horse around with and joke with in Creole ("bay odyens"). It has really become home to me in the last few months. It's helped that I’ve had to beg pretty much every lab here at some point to let us borrow supplies of some sort.
2) Our drivers are awesome. Sometimes we have a chance to stop and buy them all beer on the way home from work. It’s a good time. These guys could ignore us or whatever (they speak little if any English), but instead they are always upbeat and friendly, joking around with us in Creole about everything. They also cash checks for us and do other minor things that must be done. (And they put up with me when I insist we need to see another patient and we can't go yet.)
3) The two OB/GYN guys are work with are fantastic. One of them has on more than one occasion stayed well past 4:30 (6:30). This may not seem like much, but the labs shut down at 4-4:30 and everyone goes home. But this guy never complains; he just is like, “yeah, this is my job.” I am going to email the director of the clinic about him. He’s great.
4) The administration. They have been excellent. Despite not really knowing the director of the clinic, the secretaries/admin ladies have taken care of absolutely everything I could need. Any time I had a problem about a paycheck or anything else, they took care of it.
5) Locals. The locals where I live are wonderful. I am friends with a few guys here. I met them both the first week I arrived. While I work a lot here, whenever I can get out to the street to eat I do. My favorite is the lady around the corner who sells this big spicy plate of spaghetti for about a dollar. When I go out and sit in the dirt street/alley and eat, I always see the local guys I know. And they’re always really nice. I invited one of them to Mandy’s going away party; he speaks little English, but I think enough people spoke some creole there that it was “anfom.”
6) Plat de jour. I couldn’t leave this off! This is my daily lunch plate of rice, bean sauce, and meat. It is awesome, and it’s huge, and it costs 1.50 US. I love it.
7) Having no car but things being possibly available just around the corner.
8) Learning how much I know about seeing patients in the clinic, although I claim to know nothing about it. Although I complain about clinic, as I began to learn more and more Creole I began to understand patients more and was able to explain the drugs to them , the exams, how important it all is.
9) The ex-pat community and other foreigners. While I miss the lab desperately (turns out not everyone is concerned with “what the answer is”, but rather are concerned with looking good or appearing smart), I have enjoyed the other ex-pats I have met here. People from all over the world and even states. Being from the US-South is a unique thing here; especially considering that I am one of the most educated science people.
10) Haiti. This place is poor, many are uneducated, many are sick, and yet there are still smiles just a few feet away. While there are many things that bother me about this place, one thing about walking around here, especially as a “blan” is that you are always greeted. There are even some kids here that always say to me when I see them “Goodmorning!” It doesn’t even matter what time of day it is!
I am sure I will be back.
1) When I walk around the clinic I always run into coworkers who I horse around with and joke with in Creole ("bay odyens"). It has really become home to me in the last few months. It's helped that I’ve had to beg pretty much every lab here at some point to let us borrow supplies of some sort.
2) Our drivers are awesome. Sometimes we have a chance to stop and buy them all beer on the way home from work. It’s a good time. These guys could ignore us or whatever (they speak little if any English), but instead they are always upbeat and friendly, joking around with us in Creole about everything. They also cash checks for us and do other minor things that must be done. (And they put up with me when I insist we need to see another patient and we can't go yet.)
3) The two OB/GYN guys are work with are fantastic. One of them has on more than one occasion stayed well past 4:30 (6:30). This may not seem like much, but the labs shut down at 4-4:30 and everyone goes home. But this guy never complains; he just is like, “yeah, this is my job.” I am going to email the director of the clinic about him. He’s great.
4) The administration. They have been excellent. Despite not really knowing the director of the clinic, the secretaries/admin ladies have taken care of absolutely everything I could need. Any time I had a problem about a paycheck or anything else, they took care of it.
5) Locals. The locals where I live are wonderful. I am friends with a few guys here. I met them both the first week I arrived. While I work a lot here, whenever I can get out to the street to eat I do. My favorite is the lady around the corner who sells this big spicy plate of spaghetti for about a dollar. When I go out and sit in the dirt street/alley and eat, I always see the local guys I know. And they’re always really nice. I invited one of them to Mandy’s going away party; he speaks little English, but I think enough people spoke some creole there that it was “anfom.”
6) Plat de jour. I couldn’t leave this off! This is my daily lunch plate of rice, bean sauce, and meat. It is awesome, and it’s huge, and it costs 1.50 US. I love it.
7) Having no car but things being possibly available just around the corner.
8) Learning how much I know about seeing patients in the clinic, although I claim to know nothing about it. Although I complain about clinic, as I began to learn more and more Creole I began to understand patients more and was able to explain the drugs to them , the exams, how important it all is.
9) The ex-pat community and other foreigners. While I miss the lab desperately (turns out not everyone is concerned with “what the answer is”, but rather are concerned with looking good or appearing smart), I have enjoyed the other ex-pats I have met here. People from all over the world and even states. Being from the US-South is a unique thing here; especially considering that I am one of the most educated science people.
10) Haiti. This place is poor, many are uneducated, many are sick, and yet there are still smiles just a few feet away. While there are many things that bother me about this place, one thing about walking around here, especially as a “blan” is that you are always greeted. There are even some kids here that always say to me when I see them “Goodmorning!” It doesn’t even matter what time of day it is!
I am sure I will be back.
Friday, July 3, 2009
Fee for service (Drs. don't get paid to think)
Recently I was discussing how surgeons will tell you whether they think they should operate on you AND then get paid to operate, and I began thinking more and more about the concept of fee for service in medicine. I am disturbed by the fact that the same physician gets paid for performing a procedure, when they are the one that decided the procedure was needed. In other words, it would strike me as strange if I went to a painter who charges 500$ per room painted to ask him if I needed to repaint some rooms in my house. Wouldn’t it be strange if the SAME person decided 1) if you needed rooms painted, 2) told you that is what they do and they will do the service, and 3) they did it for a fee you didn’t really know about until later. In my view, I would like an independent consultant to determine the need for the paint (my family – “should we paint this room?”), a separate company to do the painting, and the price to be agreed upon before starting (and having the option of using a cheaper provider).
Because many of you are medical people, I am positive I am stepping on more than a few toes here. But aren’t we setting up physicians for unethical behavior when we pay them much more for doing procedures than thorough examinations, and we financially reward them for doing as many procedures as possible? If you are a cardiologist and you get paid 3,000$ per catheterization and 80$ for talking to a patient and doing a stress test, why would you NOT take any patient you could to the lab for a cath- Especially if the cath took less time. Now you can move patients through and make lots of money. And if you have a family money is a good thing. You’ll have a better chance of protecting your family in the case of emergencies and a better chance of providing a stimulating environment for children to grow up in. Also, having money will give you a better chance of sending them to study whatever they wish to pursue in life. Making a living is a good thing.
One problem is people don’t like to talk about money. But doctoring IS a profession, and a highly regarded one. Not only this, but the best of the best go into it, and part of this is that they are well-respected and adequately compensated for their considerable gifts, talents, and sacrifices. In my view, paying doctors less is not an option. As it is, they spend a lot of money and time in training during the best years of their lives. Many of the doctors who have devoted their lives to insane working hours could devote that time and energy in the business world and make MUCH more. But they don’t. Lowering income much will only lead to our beginning to lose some of the best and brightest.
But why must we reward doctors that do many so procedures and not necessarily needed/cost effective ones? Why can’t we figure out a way to salary doctors, so they are free to practice good medicine as they see fit? Why can’t we create a system in which the reward of good medicine is a higher salary? In other words, if you were rewarded at your engineering firm for the number of jobs you did, you would plow through them with little regard for quality. (Or with an adequate understanding of the “lowest level” work you can get away with legally. Of course, you would also be cognizant of your market and whether you may lose customers for this type of low level work. In medicine, you won’t lose customers because there is a shortage of doctors and few patients are given a choice as to which doctor they can see.) However, if the quality of your work was being analyzed, and your pay was determined by how good your work was, you would slow down and do your absolute best. Especially if this meant that your future salary would be in part determined by the quality of patient care you were giving.
Doctoring is set up now to encourage unethical behavior. Luckily, some of our most altruistic men and women become doctors and resist this temptation to practice bad medicine their whole career. The problem is the system. We need to fix it before we taint medicine forever. How far away are we from an expose on this topic that hits the New York Times and turns off a whole generation to scientifically-grounded medicine? How far away are we from the public distrusting everything about doctors due to something like this? We must fix it before someone fixes it for us. If you’re a doctor, I’m not sure why you are still reading this; shouldn’t you be doing a procedure?
Because many of you are medical people, I am positive I am stepping on more than a few toes here. But aren’t we setting up physicians for unethical behavior when we pay them much more for doing procedures than thorough examinations, and we financially reward them for doing as many procedures as possible? If you are a cardiologist and you get paid 3,000$ per catheterization and 80$ for talking to a patient and doing a stress test, why would you NOT take any patient you could to the lab for a cath- Especially if the cath took less time. Now you can move patients through and make lots of money. And if you have a family money is a good thing. You’ll have a better chance of protecting your family in the case of emergencies and a better chance of providing a stimulating environment for children to grow up in. Also, having money will give you a better chance of sending them to study whatever they wish to pursue in life. Making a living is a good thing.
One problem is people don’t like to talk about money. But doctoring IS a profession, and a highly regarded one. Not only this, but the best of the best go into it, and part of this is that they are well-respected and adequately compensated for their considerable gifts, talents, and sacrifices. In my view, paying doctors less is not an option. As it is, they spend a lot of money and time in training during the best years of their lives. Many of the doctors who have devoted their lives to insane working hours could devote that time and energy in the business world and make MUCH more. But they don’t. Lowering income much will only lead to our beginning to lose some of the best and brightest.
But why must we reward doctors that do many so procedures and not necessarily needed/cost effective ones? Why can’t we figure out a way to salary doctors, so they are free to practice good medicine as they see fit? Why can’t we create a system in which the reward of good medicine is a higher salary? In other words, if you were rewarded at your engineering firm for the number of jobs you did, you would plow through them with little regard for quality. (Or with an adequate understanding of the “lowest level” work you can get away with legally. Of course, you would also be cognizant of your market and whether you may lose customers for this type of low level work. In medicine, you won’t lose customers because there is a shortage of doctors and few patients are given a choice as to which doctor they can see.) However, if the quality of your work was being analyzed, and your pay was determined by how good your work was, you would slow down and do your absolute best. Especially if this meant that your future salary would be in part determined by the quality of patient care you were giving.
Doctoring is set up now to encourage unethical behavior. Luckily, some of our most altruistic men and women become doctors and resist this temptation to practice bad medicine their whole career. The problem is the system. We need to fix it before we taint medicine forever. How far away are we from an expose on this topic that hits the New York Times and turns off a whole generation to scientifically-grounded medicine? How far away are we from the public distrusting everything about doctors due to something like this? We must fix it before someone fixes it for us. If you’re a doctor, I’m not sure why you are still reading this; shouldn’t you be doing a procedure?
Friday, June 26, 2009
Hungry
Back in the saddle at work, the poverty is wearing on me. In the house where we stay, and medical students/doctors/researchers rotate through, they say that there is an expiration date on almost everyone here. A point where you need to get out, go home, something. Usually it’s a combination of the poverty, violence, and badgering that wears you down.
Today as I took the new interns to lunch at the cafeteria I saw a lady that works in my building eating cookies while we ordered huge plates of rice. I asked her why she wasn’t having the plat de jou…She said she can’t pay for that. So I gave her the money to get that. Right, I know, Matthew is against handouts; it just got to me, this lady I work with.
Later I was walking down the hallway and I heard a yell from behind “Dokte! Dokte!” I stopped. It was a young man, very skinny. He told me he was starving and really needed food. Could I give him money to get food. I told him I didn’t really have much today, but I could give him some of the peanuts I had. I took him to my office and gave him my peanuts. Later I saw him vociferously eating them on the sidewalk. The man was quite hungry. Hungry probably isn’t the right word for that.
Today as I took the new interns to lunch at the cafeteria I saw a lady that works in my building eating cookies while we ordered huge plates of rice. I asked her why she wasn’t having the plat de jou…She said she can’t pay for that. So I gave her the money to get that. Right, I know, Matthew is against handouts; it just got to me, this lady I work with.
Later I was walking down the hallway and I heard a yell from behind “Dokte! Dokte!” I stopped. It was a young man, very skinny. He told me he was starving and really needed food. Could I give him money to get food. I told him I didn’t really have much today, but I could give him some of the peanuts I had. I took him to my office and gave him my peanuts. Later I saw him vociferously eating them on the sidewalk. The man was quite hungry. Hungry probably isn’t the right word for that.
Tuesday, June 23, 2009
What We Did (On Tourism in Haiti)
No one wants to read a full recap of one person’s adventures; however I do think (hope) some perspective can be gained by my hitting the significant areas our recent travels. I will try to write by saying not necesarily what we did, but what we learned.
On Friday, Mandy and I got dropped off at the Port-au-Prince airport to fly to Santo Doming. Wrong airport. Someone there drove us to the other one. The confusion begins.
We boarded a 12-seater to Santo Domingo, Dominican Republic. After arriving, we made it to a bus station via taxi, then via a nice bus (air conditioned!) to Puerta Plata, Dominican. A few things to note – the DR seems like a resort compared to Haiti. The roads are so nice. The people aren’t everywhere. It was a crazy shock. I expect that shock now as I travel to the US; I wasn’t ready for it just going to the other side of the island. As one friend told me, “you live in a bad part of Africa right now; you’re going to Latin America – it’s a lot different.” He was right.
I made friends with the girl next to me on the bus. She was Haitian but studying in Dominican (Medicine). As my Spanish leaves something to be desired and her English was spotty, we actually spoke quite a bit in Creole – making me realize I know a lot more than I thought. Upon arriving to Puerta Plata, this girl and her husband actually gave Mandy and I a ride to our resort. It was very nice of them. The resort was unreal. All of the sudden we ate and drank all we wanted from Fri-Sunday. It was wonderful. We even got the chance to tear up a relatively empty dance floor late one night; I had blisters on my feet afterwards. It was an unreal break from Haiti. We kayaked and snorkeled in the ocean, and I mangad to lose several ping pong games to Mandy. Also, one night a waiter was so kind as to "get us in" to a really nice resteraunt where you needed reservsations there. I tried to give him the smooth handshake with some money for getting us in (long story as to why this was such a big deal). The money exchange went well, but instead of saying "gracias" I choked and said "por favor". Luckily Mandy was behind me speaking Spanish and telling him thank you...
We had a great time. Leaving Sunday, our plan was to head to Cap Haitian (in Haiti), to see the Citadelle, then bus down the next day to PAP (6 hour bus ride). We rode on the back of motorcycles to the actual city Puerta Plata from the resort. Then, we walked until we flagged down a bus heading to the border. We took this bus, and then took another motorcycle to the actual border. We then walked up to the border (sketchy!) and it was physically locked. We were told it was closed because of the Haitian elections. Great. We immediately were hit the reality of poor haitians all around– they follow you around in the streets, eager to “help” you. In reality, they want money. We can argue about whether this is good or bad, warranted or not, but however you split it it can be a real pain in the ass. End of story. If you think I’m being harsh, come walk the streets as a white person in Haiti. It’s probably depressing or sweet or something if you’re here for a week or two. If you live here, it’s different. Imagine if every time you walked out your front door, people came up to you. NOT to say hi or greet you, but to ask for money. It's not just asking - its badgering; constantly doing things you don't need then demanding money ("Don't run in the street....give me 10 dollar"). It's different than many poor people I've been around. As if you're the bad guy suddenly. And when you say no they follow you and keep talking. You say no several times, and they still persist. Then when you finally actually don’t give them money they pitch a fit. I digress. I did give money to a man for exchanging our money for us and money to a kid for "shining" my tennis shoes.
We made it to a hotel (can you call it this?) and slept. Not before Haitian men and children wanted our money (for walking with us to the hotel, which we told them we knew where it was…). We spent a long, hot night there. What a strange border city. The next day we pushed our way through people streaming across the border. It was market day, where the Haitians come across to sell. The border was WIDE open. It was crazy. We were stopped because we were white; otherwise our passports never would have been stamped. AS SOON as we crossed the border things got nasty. Literally as soon as we crossed. It’s just different. Run down. Poverty. Like African slums. We had to search for where to get our passport stamped. We then rode another motorcycle to find a bus. We piled in a school bus PACKED with Haitians 3-4 to a seat. Not joking. They were very nice to us though, even though we were the only whites within miles. This was actually a nice ride. At one point we saw white people. We passed missionaries at one point, builidng a building. It was weird, being on the bus looking out. I felt like I was haitian, looking at them, thinking, what a strange site, all those blan.
We eventually got off and flagged another bus to the Citadelle. Here, we rode on the back of motorcycles up a ways (this was an insane ride). Then we walked up to the great historic site: http://en.wikipedia.org/wiki/Citadelle_Laferriere
Of course, things were as “Haitian” as ever. A Haitian guy insisted on walking with us – even though I repeatedly told him I had no money for him. Mandy told him numerous times as well. (She speaks Spanish, I speak Creole; we told him in both, and English.) At the entrance he still walked with us, insising on giving us some terrible tour (e.g. “this is a cannon”…). He was bothering me and Mandy. Finally, as we walked up onto a terrace, he began saying “no no, this way”. At which point I got stern. I just yelled at him the equivalent of “look buddy, we paid the entrance price, we are going to look where we want.” He was like "fine." Then he walked over with us and I was like, "look, we didn’t ask for you, we've repeatedly told you we don’t have money for you, and now you're annoying us. Go away!" He started yelling at me how he showed us the shortcut on the walk up, etc etc. I told him, "I would pay you 50 goude for that, no more, and the smallest I have is 100, and you're not getting that. You are annoying us." So I tell him to go away. He’s yelling at me, etc. We walk down to the middle of the castle, where 4 other men are sitting. Our “guide” is still yelling, and now begins yelling at them that we stiffed him. THANK GOODNESS I know some creole. I could understand what he was saying to them. I yelled to the men in creole, “Not true, we told him we had no money for him and to leave us alone; he wouldn’t”. At this point I was a bit scared. No one else was in this castle (Seriously, no one), and you can easily “fall” off any one of these ledges. (Yes, it is the sketchiest “tourist” spot I’ve ever seen in my life). And now I’m yelling at some Haitian guy. Great. Luckily, the men sided with us and also started yelling at the other guy. Side note: it’s very hard for me to enjoy vacations like this. And you wonder why Haiti has trouble attracting tourists? Who wants to get hastled like this AND fear for their life during vacation?? At any rate, I am now scared he is going to corner us in a dark part of the castle or on a terrace and try to kill/rob us. As we descended some stairs into a small alley, he was there. He had something in his hand. My heart rate jumped a bit, although I tried to look cool, and big. He had 50 goude in his hand. “Here, you said you would give me 50 goude, so I got change”, he said. I said "of course," and traded him my 100 goude for his 50. I love Haiti perhaps more than anyone, and things like this are never going to help the economic siutation. You're sitting there reading this thinking, "I would never go do this." And for good reason. And it's a shame, the Citadelle is amazing, and this could be a real money-maker for them.
I forgot to mention that at this point I am delirious, emotionally and physically spent:
(taken from wikipedia) “The Citadel is one of the most popular tourist destinations in Haiti. Directions to and history of the fortress are provided by self-appointed guides from the town of Milot. Visitors may be asked to pay a small fee at the entrance to the Citadel. Visitors are encouraged to rent a horse for the uphill trek. The first portion of the seven-mile (11 km) trail is navigable by 4WD vehicle, although infrequent landslides and construction projects sometimes make this unreliable. From the mid-level parking lot, the second portion must be completed either on horseback or on foot. The entire seven-mile-trail starting in Milot, almost completely uphill, can be walked by experienced hikers who carry plenty of water. Most of the interior of the Citadel fortress itself is accessible to visitors, who may also climb the numerous staircases to the fortress's roof, which is free of guardrails. On a clear day, the city of Cap Haitien and the Atlantic Ocean can be seen to the north.”
The view was incredible. I was also carrying 2 L of beer from the Dominican, which I questioned the utility of every minute of the hike. And the "no guardrails" on top of this castle was truly crazy (you could easily pulmmet to your death with a wrong step). As we rode on the motorcycles back down across steep, wet cobblestone, we eventually were at the base. Here, we were deciding on how to get to Puerta Plata, at which point a black SUV, with a big, heavy set black man driving, pulls up. Tinted windows, bass bumping. The ticket office guy says, “hey, my friend will give you ride,” and points to the SUV. I walk over to the SUV. His window is rolled down and he speaks broken English. “Friend, no problem, I will give you ride. Just get in.” I got closer and realized he was drunk and was holding a martini glass just below the window. Now, I’m not the smartest guy in the world, but I was quite sure this was a bad idea. This was us about to get robbed, I am sure of that. I just kept saying no and walked off. We ran into town on foot and found a tap-tap:
http://bonsamaritan.org/yahoo_site_admin/assets/images/Bus2.19173702_std.jpg
We crammed into this and found a domestic airport. It was almost 3 pm and it would take 6 hours to bus down to Port-au-Prince, then we would have to find a way across Port-au-Prince at night up to our house. No way. We needed a flight. We walked into the airport at 2:45 and managed to catch the last flight, at 3pm, down to PAP. It just so happened that GHESKIO was picking up the summer interns in from the US at the airport at 4:30 that day. They picked us up too. We returned safely with the new summer students.
I said I would not report what we did, but rather what we learned. I did just the opposite, I fear. Regardless, I will posit a few things:
1) Tourism in Haiti sucks because it’s dangerous.
2) It really is dangerous in Haiti, no matter what someone that has been here for a month or two during a “calm” time tells you (e.g. “I was there for a few months, it’s fine!”).
3) Tourism in Haiti also sucks because people bother you. They don’t get that you want to have a nice time; you don’t want to be arguing with someone to leave you the hell alone the whole time you’re on vacation.
4) Tourism in the DR is nice because they seem to be capitalizing on what they have- warm weather, beaches, safety. Haitians could learn from this. There ARE beautiful beaches and sites in Haiti.
5) Tourism in Haiti will continue to be bad as long as there is violence and instability. Why spend vacation here, even if it were at a resort, when violence is looming?
6) Despite all of this, we breathed a sigh of relief when we made it to Port-au-Prince, perhaps the most dangerous place. But to us it's home, and it felt good to get back home, where I have friends and family around to help if something goes wrong.
7) Haiti has the resources to provide a tourism industry, if only they could:
1) provide a stable enough environment, and
2) learn to recognize what tourists want (not to be hassled the whole
time, for one).
8) If you think I am being overly harsh; feel free to come on down and back pack around the country some. I love this place and many of the people here; and I’m trying to be as true to the truth as I can regardless of how that comes out. I actually think there could be a real tourism industry here, it just needs to be guided safely and made accessible to those that don't speak Creole/know how to deal with things here.
On Friday, Mandy and I got dropped off at the Port-au-Prince airport to fly to Santo Doming. Wrong airport. Someone there drove us to the other one. The confusion begins.
We boarded a 12-seater to Santo Domingo, Dominican Republic. After arriving, we made it to a bus station via taxi, then via a nice bus (air conditioned!) to Puerta Plata, Dominican. A few things to note – the DR seems like a resort compared to Haiti. The roads are so nice. The people aren’t everywhere. It was a crazy shock. I expect that shock now as I travel to the US; I wasn’t ready for it just going to the other side of the island. As one friend told me, “you live in a bad part of Africa right now; you’re going to Latin America – it’s a lot different.” He was right.
I made friends with the girl next to me on the bus. She was Haitian but studying in Dominican (Medicine). As my Spanish leaves something to be desired and her English was spotty, we actually spoke quite a bit in Creole – making me realize I know a lot more than I thought. Upon arriving to Puerta Plata, this girl and her husband actually gave Mandy and I a ride to our resort. It was very nice of them. The resort was unreal. All of the sudden we ate and drank all we wanted from Fri-Sunday. It was wonderful. We even got the chance to tear up a relatively empty dance floor late one night; I had blisters on my feet afterwards. It was an unreal break from Haiti. We kayaked and snorkeled in the ocean, and I mangad to lose several ping pong games to Mandy. Also, one night a waiter was so kind as to "get us in" to a really nice resteraunt where you needed reservsations there. I tried to give him the smooth handshake with some money for getting us in (long story as to why this was such a big deal). The money exchange went well, but instead of saying "gracias" I choked and said "por favor". Luckily Mandy was behind me speaking Spanish and telling him thank you...
We had a great time. Leaving Sunday, our plan was to head to Cap Haitian (in Haiti), to see the Citadelle, then bus down the next day to PAP (6 hour bus ride). We rode on the back of motorcycles to the actual city Puerta Plata from the resort. Then, we walked until we flagged down a bus heading to the border. We took this bus, and then took another motorcycle to the actual border. We then walked up to the border (sketchy!) and it was physically locked. We were told it was closed because of the Haitian elections. Great. We immediately were hit the reality of poor haitians all around– they follow you around in the streets, eager to “help” you. In reality, they want money. We can argue about whether this is good or bad, warranted or not, but however you split it it can be a real pain in the ass. End of story. If you think I’m being harsh, come walk the streets as a white person in Haiti. It’s probably depressing or sweet or something if you’re here for a week or two. If you live here, it’s different. Imagine if every time you walked out your front door, people came up to you. NOT to say hi or greet you, but to ask for money. It's not just asking - its badgering; constantly doing things you don't need then demanding money ("Don't run in the street....give me 10 dollar"). It's different than many poor people I've been around. As if you're the bad guy suddenly. And when you say no they follow you and keep talking. You say no several times, and they still persist. Then when you finally actually don’t give them money they pitch a fit. I digress. I did give money to a man for exchanging our money for us and money to a kid for "shining" my tennis shoes.
We made it to a hotel (can you call it this?) and slept. Not before Haitian men and children wanted our money (for walking with us to the hotel, which we told them we knew where it was…). We spent a long, hot night there. What a strange border city. The next day we pushed our way through people streaming across the border. It was market day, where the Haitians come across to sell. The border was WIDE open. It was crazy. We were stopped because we were white; otherwise our passports never would have been stamped. AS SOON as we crossed the border things got nasty. Literally as soon as we crossed. It’s just different. Run down. Poverty. Like African slums. We had to search for where to get our passport stamped. We then rode another motorcycle to find a bus. We piled in a school bus PACKED with Haitians 3-4 to a seat. Not joking. They were very nice to us though, even though we were the only whites within miles. This was actually a nice ride. At one point we saw white people. We passed missionaries at one point, builidng a building. It was weird, being on the bus looking out. I felt like I was haitian, looking at them, thinking, what a strange site, all those blan.
We eventually got off and flagged another bus to the Citadelle. Here, we rode on the back of motorcycles up a ways (this was an insane ride). Then we walked up to the great historic site: http://en.wikipedia.org/wiki/Citadelle_Laferriere
Of course, things were as “Haitian” as ever. A Haitian guy insisted on walking with us – even though I repeatedly told him I had no money for him. Mandy told him numerous times as well. (She speaks Spanish, I speak Creole; we told him in both, and English.) At the entrance he still walked with us, insising on giving us some terrible tour (e.g. “this is a cannon”…). He was bothering me and Mandy. Finally, as we walked up onto a terrace, he began saying “no no, this way”. At which point I got stern. I just yelled at him the equivalent of “look buddy, we paid the entrance price, we are going to look where we want.” He was like "fine." Then he walked over with us and I was like, "look, we didn’t ask for you, we've repeatedly told you we don’t have money for you, and now you're annoying us. Go away!" He started yelling at me how he showed us the shortcut on the walk up, etc etc. I told him, "I would pay you 50 goude for that, no more, and the smallest I have is 100, and you're not getting that. You are annoying us." So I tell him to go away. He’s yelling at me, etc. We walk down to the middle of the castle, where 4 other men are sitting. Our “guide” is still yelling, and now begins yelling at them that we stiffed him. THANK GOODNESS I know some creole. I could understand what he was saying to them. I yelled to the men in creole, “Not true, we told him we had no money for him and to leave us alone; he wouldn’t”. At this point I was a bit scared. No one else was in this castle (Seriously, no one), and you can easily “fall” off any one of these ledges. (Yes, it is the sketchiest “tourist” spot I’ve ever seen in my life). And now I’m yelling at some Haitian guy. Great. Luckily, the men sided with us and also started yelling at the other guy. Side note: it’s very hard for me to enjoy vacations like this. And you wonder why Haiti has trouble attracting tourists? Who wants to get hastled like this AND fear for their life during vacation?? At any rate, I am now scared he is going to corner us in a dark part of the castle or on a terrace and try to kill/rob us. As we descended some stairs into a small alley, he was there. He had something in his hand. My heart rate jumped a bit, although I tried to look cool, and big. He had 50 goude in his hand. “Here, you said you would give me 50 goude, so I got change”, he said. I said "of course," and traded him my 100 goude for his 50. I love Haiti perhaps more than anyone, and things like this are never going to help the economic siutation. You're sitting there reading this thinking, "I would never go do this." And for good reason. And it's a shame, the Citadelle is amazing, and this could be a real money-maker for them.
I forgot to mention that at this point I am delirious, emotionally and physically spent:
(taken from wikipedia) “The Citadel is one of the most popular tourist destinations in Haiti. Directions to and history of the fortress are provided by self-appointed guides from the town of Milot. Visitors may be asked to pay a small fee at the entrance to the Citadel. Visitors are encouraged to rent a horse for the uphill trek. The first portion of the seven-mile (11 km) trail is navigable by 4WD vehicle, although infrequent landslides and construction projects sometimes make this unreliable. From the mid-level parking lot, the second portion must be completed either on horseback or on foot. The entire seven-mile-trail starting in Milot, almost completely uphill, can be walked by experienced hikers who carry plenty of water. Most of the interior of the Citadel fortress itself is accessible to visitors, who may also climb the numerous staircases to the fortress's roof, which is free of guardrails. On a clear day, the city of Cap Haitien and the Atlantic Ocean can be seen to the north.”
The view was incredible. I was also carrying 2 L of beer from the Dominican, which I questioned the utility of every minute of the hike. And the "no guardrails" on top of this castle was truly crazy (you could easily pulmmet to your death with a wrong step). As we rode on the motorcycles back down across steep, wet cobblestone, we eventually were at the base. Here, we were deciding on how to get to Puerta Plata, at which point a black SUV, with a big, heavy set black man driving, pulls up. Tinted windows, bass bumping. The ticket office guy says, “hey, my friend will give you ride,” and points to the SUV. I walk over to the SUV. His window is rolled down and he speaks broken English. “Friend, no problem, I will give you ride. Just get in.” I got closer and realized he was drunk and was holding a martini glass just below the window. Now, I’m not the smartest guy in the world, but I was quite sure this was a bad idea. This was us about to get robbed, I am sure of that. I just kept saying no and walked off. We ran into town on foot and found a tap-tap:
http://bonsamaritan.org/yahoo_site_admin/assets/images/Bus2.19173702_std.jpg
We crammed into this and found a domestic airport. It was almost 3 pm and it would take 6 hours to bus down to Port-au-Prince, then we would have to find a way across Port-au-Prince at night up to our house. No way. We needed a flight. We walked into the airport at 2:45 and managed to catch the last flight, at 3pm, down to PAP. It just so happened that GHESKIO was picking up the summer interns in from the US at the airport at 4:30 that day. They picked us up too. We returned safely with the new summer students.
I said I would not report what we did, but rather what we learned. I did just the opposite, I fear. Regardless, I will posit a few things:
1) Tourism in Haiti sucks because it’s dangerous.
2) It really is dangerous in Haiti, no matter what someone that has been here for a month or two during a “calm” time tells you (e.g. “I was there for a few months, it’s fine!”).
3) Tourism in Haiti also sucks because people bother you. They don’t get that you want to have a nice time; you don’t want to be arguing with someone to leave you the hell alone the whole time you’re on vacation.
4) Tourism in the DR is nice because they seem to be capitalizing on what they have- warm weather, beaches, safety. Haitians could learn from this. There ARE beautiful beaches and sites in Haiti.
5) Tourism in Haiti will continue to be bad as long as there is violence and instability. Why spend vacation here, even if it were at a resort, when violence is looming?
6) Despite all of this, we breathed a sigh of relief when we made it to Port-au-Prince, perhaps the most dangerous place. But to us it's home, and it felt good to get back home, where I have friends and family around to help if something goes wrong.
7) Haiti has the resources to provide a tourism industry, if only they could:
1) provide a stable enough environment, and
2) learn to recognize what tourists want (not to be hassled the whole
time, for one).
8) If you think I am being overly harsh; feel free to come on down and back pack around the country some. I love this place and many of the people here; and I’m trying to be as true to the truth as I can regardless of how that comes out. I actually think there could be a real tourism industry here, it just needs to be guided safely and made accessible to those that don't speak Creole/know how to deal with things here.
Thursday, June 18, 2009
A Luxury You Didn't Know You Had
The ride home went smoothly. Today at work I spoke with my friend at the Embassy and my friend that writes for the AP. Those journalists - complete nuts. He has been out there in most of these riots/protests. Impressive in a strange way. Regardless, he told me about the shooting today and where to try to avoid. Unfortunately, the clinic is in the middle of the bad parts, so we have to drive out through the chaos. The streets were charred in some parts still. Our driver carefully chose his route, looking ahead down streets, etc. The only bad part was when we got to a T in one road. To the left was a crowd around a car. Some kids were in the road waving there finger "No! No!" to cars. We turned right and eventually made our way home. The chilren waving cars off brought on a strange feeling in me. It made me think of how these children knew this violence was wrong. Very interesting. They protected us.
Also, I found out that these riots are usually orchestrated. These people get paid to cause chaos. Some do riot on their own, but many get paid.
Tomorrow we leave for the DR for the weekend. Sunday are the elections (more chaos), and Monday we return. Also, three other medical students arrive monday. As fast as this country changes there is no telling what it will be like Monday.
((Finally, in case things go bad, we are flying into Santo Domingo, then bussing up to Puerta Plata for Fri and Sat night. Then Sun we will bus over to Cap Haicen. Monday we bus back down the country side to PAP.))
There is also a young woman who works at the clinic and comes in and practices Creole with me each day now. She is beautiful. I found out today that she might be one of the girls that knew the clinic cause she was a child born with HIV here. Talking to this young woman (20), I cannot imagine the implications. Who will date her? Who will marry her? Will she try to have a child? Should she??
I also treated a woman with a yeast infection today. As I was explaining the meds, i met her son. He has Strabismus (cross-eyed). We spoke about whether he's seen a doctor, etc. I ended up giving her my phone number. This little guy broke my heart. It's a treatable and curable thing, the cross-eyes, yet probably will never be treated. It made me angry that i wasn't more powerful too. I wanted to organize an optho group to get down here...I sent a few emails, but in reality i just might not have the contacts...
Amidst the chaos the people continue to walk the streets, to sell, to bathe, to come to clinic, etc. In other words, it's nothing new here, the protests. I also heard hostility toward foreingers is growing. A frenchman was kidnapped last week. 25 US citizens were kidnapped in 2008. It hit me again today - can you imagine this is the only life you know? Can you imagine being born here, with the violence every 6 months while the world watches. And yet you carry on. As they say here, "N'ap kenbe." We're holding up.
Good night, and thanks for reading. And forget about what kind of car you own; enjoy the safety of driving home from your job and knowing you won't get mobbed or killed. It's a luxury many people don't have.
Also, I found out that these riots are usually orchestrated. These people get paid to cause chaos. Some do riot on their own, but many get paid.
Tomorrow we leave for the DR for the weekend. Sunday are the elections (more chaos), and Monday we return. Also, three other medical students arrive monday. As fast as this country changes there is no telling what it will be like Monday.
((Finally, in case things go bad, we are flying into Santo Domingo, then bussing up to Puerta Plata for Fri and Sat night. Then Sun we will bus over to Cap Haicen. Monday we bus back down the country side to PAP.))
There is also a young woman who works at the clinic and comes in and practices Creole with me each day now. She is beautiful. I found out today that she might be one of the girls that knew the clinic cause she was a child born with HIV here. Talking to this young woman (20), I cannot imagine the implications. Who will date her? Who will marry her? Will she try to have a child? Should she??
I also treated a woman with a yeast infection today. As I was explaining the meds, i met her son. He has Strabismus (cross-eyed). We spoke about whether he's seen a doctor, etc. I ended up giving her my phone number. This little guy broke my heart. It's a treatable and curable thing, the cross-eyes, yet probably will never be treated. It made me angry that i wasn't more powerful too. I wanted to organize an optho group to get down here...I sent a few emails, but in reality i just might not have the contacts...
Amidst the chaos the people continue to walk the streets, to sell, to bathe, to come to clinic, etc. In other words, it's nothing new here, the protests. I also heard hostility toward foreingers is growing. A frenchman was kidnapped last week. 25 US citizens were kidnapped in 2008. It hit me again today - can you imagine this is the only life you know? Can you imagine being born here, with the violence every 6 months while the world watches. And yet you carry on. As they say here, "N'ap kenbe." We're holding up.
Good night, and thanks for reading. And forget about what kind of car you own; enjoy the safety of driving home from your job and knowing you won't get mobbed or killed. It's a luxury many people don't have.
Escalation
I've just been told that things have escalated since yesterday, violence is in the streets. It's not clear exactly who is being targeted right now. There are rumors of shootings and kidnappings now, and I am not sure how we will get home tonight.
This I won't forget
Haiti is in the midst of a bit of unrest. There are demonstrations each day in the streets right now. This consists of mobs of people marching through the city, burning cars, etc. I had heard of these things and seen some groups as we went to and from work. The issue is that parliament passed a law increasing the minimum wage from ~2 dollars to ~5 dollars a day. To become law the president must sign it. He has not. In fact, many businesses have said that people will lose jobs if they make this law. And students have started protesting in the streets over this. They want it signed. One day we saw a car in flames. Other days we have seen cars overturned and destroyed.
Today something happened that I won’t forget. I was returning from work, in the front seat of our truck, next to our driver. I was the only “blan.” As we pulled around a corner onto a street, a kid ran in front of us, pushing a tire with a stick. To the left I made eye contact with an elderly lady, she was wagging her finger back and forth, mouthing “no” to us. It felt weird. We rounded the corner at a decent speed and immediately slammed on the brakes. In front of us was a mob overtaking the streets, running right at us with sticks and poles, yelling, angry. Our driver looked a bit panicked, cut the wheel to the left, peeled his tires, threw it in reverse, and spun around. In a matter of seconds we were turned around and peeling out in the other direction. The mob turned onto the street and was still behind us as we fled. Now, if you’ve been on the streets of PAP you know that it is CROWDED. Luckily, our driver hit the gas, weaved in and out, and we made it out of there. In fact, we drove to the clear other side of town before heading up the mountain to my place.
The whole thing felt like it was straight out of the movies. Later in the day I heard that a good friend of mine here, Jonathan Katz (who writes for the AP), was there. This same day he wrote this story:
http://www.etaiwannews.com/etn/news_content.php?id=979979&lang=eng_news
Glad it wasn’t out car.
Before you get stressed out or worried, I should point out a few things (this is for you mom). First, no one died in yesterday’s car burning, so even if we had been caught, we would have fled at worst. Second, we work at the AIDS clinic in the bad part of town- this seems bad, but everyone generally knows someone who gets their medication there and leaves those doctors alone. Third, as demonstrated yesterday, our drivers are quite good.
Tomorrow Mandy and I are flying to the Dominican Republican for some R and R. It’s probably as good a time as any to get out for a few days.
Today something happened that I won’t forget. I was returning from work, in the front seat of our truck, next to our driver. I was the only “blan.” As we pulled around a corner onto a street, a kid ran in front of us, pushing a tire with a stick. To the left I made eye contact with an elderly lady, she was wagging her finger back and forth, mouthing “no” to us. It felt weird. We rounded the corner at a decent speed and immediately slammed on the brakes. In front of us was a mob overtaking the streets, running right at us with sticks and poles, yelling, angry. Our driver looked a bit panicked, cut the wheel to the left, peeled his tires, threw it in reverse, and spun around. In a matter of seconds we were turned around and peeling out in the other direction. The mob turned onto the street and was still behind us as we fled. Now, if you’ve been on the streets of PAP you know that it is CROWDED. Luckily, our driver hit the gas, weaved in and out, and we made it out of there. In fact, we drove to the clear other side of town before heading up the mountain to my place.
The whole thing felt like it was straight out of the movies. Later in the day I heard that a good friend of mine here, Jonathan Katz (who writes for the AP), was there. This same day he wrote this story:
http://www.etaiwannews.com/etn/news_content.php?id=979979&lang=eng_news
Glad it wasn’t out car.
Before you get stressed out or worried, I should point out a few things (this is for you mom). First, no one died in yesterday’s car burning, so even if we had been caught, we would have fled at worst. Second, we work at the AIDS clinic in the bad part of town- this seems bad, but everyone generally knows someone who gets their medication there and leaves those doctors alone. Third, as demonstrated yesterday, our drivers are quite good.
Tomorrow Mandy and I are flying to the Dominican Republican for some R and R. It’s probably as good a time as any to get out for a few days.
Tuesday, June 16, 2009
Drugs
I seemed to have developed a fungal outbreak on my arm and elsewhere. So I went to the pharmacy (my ride was in a hurry), and hastily tried to get anti-fungal cream. I grabbed two bottles of different things and left. One bottle was nice ciclopirox olamine anti-fungal. Great. I looked up the other bottle: Scabies cream. Not only that, but it was lindane cream, which is a known carcinogen and has not been made/sold in the US since 1976. I am not using this cream. Despite our annoyance with drugs, at least we don’t have to worry about things like this with the FDA in place.
This weekend we went to do a hash run at a beach. We sailed over 10 miles out to an island to exercise, then came back to have drinks and food and spend the night. I will try to include pictures.
This weekend we went to do a hash run at a beach. We sailed over 10 miles out to an island to exercise, then came back to have drinks and food and spend the night. I will try to include pictures.
Friday, June 5, 2009
Mr. Blan gets the white price!
While there are no Taco Bells or anything even close to that here (obviously), there is the totally random Domino’s Pizza down the hill from us (3/4 mile). So of course, my favorite American thing to do here is to walk down to it, grab a cold beer, and eat a pepperoni pizza. As you know, when you order a pizza they type your name into the computer and it pops out on a little tab that goes on the pizza box. Well here when I get my pizza the tab on my box says “Mr. Blan” (translation: “Mr. White”). This always cracks me up. I can order, go walk around for 30 minutes, come back, and they never ask for my name…Can you imagine how awkward this would be in the states….Japanese man orders pizza and it says “Mr. Jap” on the box…I need to take a picture of this.
A few days ago we stopped to buy avocados and watermelon. From one lady I successfully got Avocados for 10 goudes each (not small avocados; this is a quarter each!). Then I went to buy a watermelon. Normally they are no less than 250 goudes, and thus we never buy one (this is 6.25!). Well, a friend at the clinic said she was able to bargain one down to 100 goudes the other day. She said it’s really hard to get them down on watermelons. She is also Haitian.
So we ran up to the corner with watermelons. I asked the lady how much. She replied 250 goudes. I told her no way and that a friend of mine just got one here for 100 goudes. She said no way and put the watermelon away.
Well, everyone knows I don’t mind being a bit of a jerk sometimes (I like to call it cordial dissent). So I started yelling, “hey, you’re giving me the white price here! My friend bought one here for 100 goudes…and she’s not white!” A few people nearby were really starting to laugh. So I just kept on her, “That’s the white price; my friend isn’t white…You give me a white price! My friend isn’t white, and it’s 100 goude for her!” People were laughing and I was just going to walk off, happy to have made my point. She came back over and was like, “fine fine, you can have it for 125 goudes.” I prob could have gotten it for 100 but I was happy to have gotten the Haitian price (perhaps cause I knew enough Creole to give her a hard time in creole?). Ha – again, imagine this in the states…too funny.
A few days ago we stopped to buy avocados and watermelon. From one lady I successfully got Avocados for 10 goudes each (not small avocados; this is a quarter each!). Then I went to buy a watermelon. Normally they are no less than 250 goudes, and thus we never buy one (this is 6.25!). Well, a friend at the clinic said she was able to bargain one down to 100 goudes the other day. She said it’s really hard to get them down on watermelons. She is also Haitian.
So we ran up to the corner with watermelons. I asked the lady how much. She replied 250 goudes. I told her no way and that a friend of mine just got one here for 100 goudes. She said no way and put the watermelon away.
Well, everyone knows I don’t mind being a bit of a jerk sometimes (I like to call it cordial dissent). So I started yelling, “hey, you’re giving me the white price here! My friend bought one here for 100 goudes…and she’s not white!” A few people nearby were really starting to laugh. So I just kept on her, “That’s the white price; my friend isn’t white…You give me a white price! My friend isn’t white, and it’s 100 goude for her!” People were laughing and I was just going to walk off, happy to have made my point. She came back over and was like, “fine fine, you can have it for 125 goudes.” I prob could have gotten it for 100 but I was happy to have gotten the Haitian price (perhaps cause I knew enough Creole to give her a hard time in creole?). Ha – again, imagine this in the states…too funny.
Wednesday, June 3, 2009
HIV Crime
Today we had a criminal in our clinic. We treated her as well as we could and let her go.
She is an HIV positive patient, as all of the patients I am seeing for study I am involved in are. I did a pregnancy test for her – she was pregnant. The OB doctor then spoke with at length. Turns out she has a boyfriend of two years that she lives with. She has HIV and knows it. Her boyfriend has no idea she has it, nor does she plan on ever telling him. In the US this is criminal behavior:
http://www.thebody.com/hivmonth/thismonth1007.html
I was fired up about clinic after seeing her. I spoke “through” the OB doc about how he would need to know as she had the child because the child was going to need very special treatment. It would be a full effort to see to it that the risk for transmission to the child was as low as possible, which would entail a few drug cocktails for the child. And despite most births in Haiti taking place outside the hospital, this one needed to be in the hospital for the child’s sake. I asked the OB doc to explain to her how important this is for her child – if she wants the best for her child. It was sad. And interesting.
One interesting question that came out of this is how this plays out legally. You will only get prosecuted if you knowingly gave someone HIV. This means you have to be tested. Thus, we now have an incentive for people to NOT get tested, especially if they are engaging in high-risk behavior as part of their job (sex workers).
If nothing else this made me interested in clinic again…This presented as a challenge. And what should the law be? Hard to say.
She is an HIV positive patient, as all of the patients I am seeing for study I am involved in are. I did a pregnancy test for her – she was pregnant. The OB doctor then spoke with at length. Turns out she has a boyfriend of two years that she lives with. She has HIV and knows it. Her boyfriend has no idea she has it, nor does she plan on ever telling him. In the US this is criminal behavior:
http://www.thebody.com/hivmonth/thismonth1007.html
I was fired up about clinic after seeing her. I spoke “through” the OB doc about how he would need to know as she had the child because the child was going to need very special treatment. It would be a full effort to see to it that the risk for transmission to the child was as low as possible, which would entail a few drug cocktails for the child. And despite most births in Haiti taking place outside the hospital, this one needed to be in the hospital for the child’s sake. I asked the OB doc to explain to her how important this is for her child – if she wants the best for her child. It was sad. And interesting.
One interesting question that came out of this is how this plays out legally. You will only get prosecuted if you knowingly gave someone HIV. This means you have to be tested. Thus, we now have an incentive for people to NOT get tested, especially if they are engaging in high-risk behavior as part of their job (sex workers).
If nothing else this made me interested in clinic again…This presented as a challenge. And what should the law be? Hard to say.
Tuesday, June 2, 2009
PETA (Letter to Time, 2008)
In light of their recent terrorist activity against some of our best scientists (e.g. The Animal Research War, by Drs. P. Michael Conn and James V. Parker), I am quite disappointed that you would allow such a forum for Ingrid Newkirk, president of PETA. Contrary to what most uneducated people think, the views of PETA are quite unusual and extremely harmful. For example, on their webpage one can easily find them pushing to end all animal experimentation. In fact, they say "...animals differ from humans significantly, making animal drug tests unreliable and dangerous...computer models, cell cultures, and human studies are more accurate." Not only is this inaccurate in many ways (computer models and cell cultures are far less accurate in many ways ), it is also dangerous. Furthermore, scientists use those techniques and only use animal models to answer those questions (and safety concerns) that other models cannot.
PETA has not only been involved in terrorizing our top scientists, but their agenda is nonsensical. In the push for no animal experimentation, they forget that: 1) institutions are already in place that make sure experimentation is rigorously regulated and serves great purpose, 2) while we know different animals are different from humans in different ways, they come much closer than cells in a dish! Who among us would like to be first in line for a drug that has never been tested in a living mammal? 3) the Nuremberg Code (drawn up after the atrocities of WWII) and the Declaration of Helsinki both declare that human experiments should be based on animal experimentation, and 4) all major medical treatments can be traced back to understanding gained from animal models.
I would assume that PETA members and supporters already know this and thus practice what they preach by declining all Medicine and Western Medical Procedures, which are all with us today because of animal experimentation. As an animal lover and animal researcher, I can tell you that I would rather discover how muscular dystrophy works in a canine model so that my son never has to experience it himself. Ingrid Newkirk herself has said that if animal research led to a cure for AIDs she would not be for it. She has championed a movement (PETA) that has now unleashed terrorist attacks against scientists who have devoted their lives to curing diseases.
I suggest that if Ingrid Newkirk truly feels the way she espouses, that humans are granted no special rights from other mammals, then perhaps she should do the following:
1) explain to our top scientists exactly how to cure diseases without animal models,
2) offer herself as a test subject for new medical treatment that has been tested in cell cultures and computer models but NOT in living animals, and
3) deny any medical treatment that is offered to her, as it is the result of decades of animal experimentation.
I have found in my career that like most things, people think they support PETA only until they are educated about how it all works. All of us are in favor of minimizing suffering in animals. It's just some of us believe that our children and loved ones are more important than other mammals. Unfortunately, it usually takes having a loved one fall very ill for this reality to set in.
TIME, I hope you merely didn't understand what Ms. Newkirk stood for when you featured her. If you did, then shame on you.I would love to write more, but I have to go feed my cats.
PETA has not only been involved in terrorizing our top scientists, but their agenda is nonsensical. In the push for no animal experimentation, they forget that: 1) institutions are already in place that make sure experimentation is rigorously regulated and serves great purpose, 2) while we know different animals are different from humans in different ways, they come much closer than cells in a dish! Who among us would like to be first in line for a drug that has never been tested in a living mammal? 3) the Nuremberg Code (drawn up after the atrocities of WWII) and the Declaration of Helsinki both declare that human experiments should be based on animal experimentation, and 4) all major medical treatments can be traced back to understanding gained from animal models.
I would assume that PETA members and supporters already know this and thus practice what they preach by declining all Medicine and Western Medical Procedures, which are all with us today because of animal experimentation. As an animal lover and animal researcher, I can tell you that I would rather discover how muscular dystrophy works in a canine model so that my son never has to experience it himself. Ingrid Newkirk herself has said that if animal research led to a cure for AIDs she would not be for it. She has championed a movement (PETA) that has now unleashed terrorist attacks against scientists who have devoted their lives to curing diseases.
I suggest that if Ingrid Newkirk truly feels the way she espouses, that humans are granted no special rights from other mammals, then perhaps she should do the following:
1) explain to our top scientists exactly how to cure diseases without animal models,
2) offer herself as a test subject for new medical treatment that has been tested in cell cultures and computer models but NOT in living animals, and
3) deny any medical treatment that is offered to her, as it is the result of decades of animal experimentation.
I have found in my career that like most things, people think they support PETA only until they are educated about how it all works. All of us are in favor of minimizing suffering in animals. It's just some of us believe that our children and loved ones are more important than other mammals. Unfortunately, it usually takes having a loved one fall very ill for this reality to set in.
TIME, I hope you merely didn't understand what Ms. Newkirk stood for when you featured her. If you did, then shame on you.I would love to write more, but I have to go feed my cats.
Prayer Study (Letter to Time, 2006)
As someone who regularly looks forward to when TIME takes research I have read in medical journals and translates it into language the layperson can understand, I was quite disappointed with the recent article “The Year in Medicine from A to Z” [Dec. 4]. I regularly encourage my college Wellness students to read TIME because of the unbiased, cogent medical and health advice that is regularly reported. However, your recent article that mentions the study of 1,802 coronary-bypass graft (CABG) patients who either received prayer (and did or did not know it) or did not receive prayer and their concomitant post-operative complications seemed to offer a bit of scientific soft-pedaling. First, you mention (as does the study) as a limitation that the investigators could not control whether friends and family prayed for these patients; and the investigators did not try to control this (unethical as well as impossible). The researchers mention this because if all subjects received robust amounts of ‘personal’ prayer, then the gain from additional prayer would in fact be harder to statistically detect. However, whether the prayers were heartfelt (because they were “provided by clergy and identical”) seems a moot point – is the Lord’s Prayer that is recited in these very Churches every Sunday any less heartfelt because it is “provided by clergy and identical”? Furthermore, if Christians are having a hard time offering ‘heartfelt’ prayers for patients recovering from open-heart surgery, then I cannot help but wonder how ‘heartfelt’ prayers can be about less life-threatening matters. I was most appalled, however, by the concluding statement of TIME that “the possible confounding factors in this study made it extraordinarily limited.” I am a bit confused as to how this study is “extraordinarily limited” compared to any other study that must control for extraneous variables. Would it have been better to let subjects ad-lib their own prayers? (Limitations then become: What was said during prayer could have accounted for the differences.) The investigators designed a well-designed study to test the efficacy of intercessory prayer for unknown individuals and should not have to soft-pedal the results any more than TIME should when reporting them. As a scientist who grew up in the Church, I am appalled to continually see Americans reject data in favor of their interpretation of whatever Holy book they adhere to, be it the Qur’an, the Torah, or the Bible. Perhaps the TIME writers were persuaded by the closing paragraph of these investigators’ paper, which does its own soft-pedaling of its results. I would hope that the TIME staff and every reader would be smart enough to read the fine print on the first page of the original article: “sponsored by the John Templeton Foundation.” John Templeton, the founder and philanthropist behind the John Templeton Foundation, is quoted on their website as saying “love and prayer” are “the most powerful weapons on earth.” While I should not expect all readers to find and examine original research for themselves (although I encourage this), I do expect TIME to adequately research any data before labeling it “extraordinarily limited.” Is this research scenario so different than my telling a relative across the U.S. that my church, despite not knowing him, is praying for him daily?
Research vs. Clinic
It is with great shame that I return to my blog. The past three weeks have held so much, from frantically pulling all-nighters and analyzing data to traveling to Seattle to present those data to trying to take over a project in Haiti where I must see patients.
This has been chalk-full of strange experiences, not limited to my absolutely splendid time in Seattle. The city itself did not seem like much special to me, but how nice it was to be back amongst researchers! It was so nice to try to keep up with all the ideas and research being presented. All the "top minds" of what my research centered on (oxygen uptake kinetics of skeletal muscle) were there, and many of the major talks centered around that area. It was invigorating. So invigorating that it has me worried about med school. Worried because I am "becoming" an expert in research and a specific research area, only to put it on hold and get clinical training. The problem with that is that I haven't enjoyed the clinical part of my days in Haiti all that much. It's too much like work that a monkey could do. No real problem solving. Just doing what's called for in a clinical situation. If symptom X, give drug Y. I miss being in the lab, generating ideas, arguing about what some strange signal means. I miss discovery. I could be doing a post-doc in a top lab in the world, and instead I am going back to school. I could also be going to school in San Diego, where one of the best physiology departments in the world is, but I am not. In the end, this is probably the right move. It’s just hard. I wanted to go to med school for several reasons, not the least among them to study cancer and work with cancer patients. Last night as I was beating myself up over this, I stumbled upon an article on lactate metabolism in cancer. It was very intriguing. As you probably know if you’re reading this, my two areas as of now are Lactate Metabolism and VO2 on-kinetics. If I did a post-doc or went to San Diego, I would be working on straight physiology, not combining my areas with cancer. As it is, I will be bringing a completely unique viewpoint to studying cancer. This feels like a huge gamble right now, but I think it’s correct (I hope it's correct). In the meantime, I am hoping to continue with my love of physiology, collaborating for experiments when possible, presenting at physiology meetings, etc. I find myself up at all hours of the night thinking and analyzing our data and just trying to “get through” the days in the clinic. This work is completely fascinating. Hopefully my gamble will pay off.
Also, in digging out old data I found a few old writings I will post here. Comments always welcomed!
This has been chalk-full of strange experiences, not limited to my absolutely splendid time in Seattle. The city itself did not seem like much special to me, but how nice it was to be back amongst researchers! It was so nice to try to keep up with all the ideas and research being presented. All the "top minds" of what my research centered on (oxygen uptake kinetics of skeletal muscle) were there, and many of the major talks centered around that area. It was invigorating. So invigorating that it has me worried about med school. Worried because I am "becoming" an expert in research and a specific research area, only to put it on hold and get clinical training. The problem with that is that I haven't enjoyed the clinical part of my days in Haiti all that much. It's too much like work that a monkey could do. No real problem solving. Just doing what's called for in a clinical situation. If symptom X, give drug Y. I miss being in the lab, generating ideas, arguing about what some strange signal means. I miss discovery. I could be doing a post-doc in a top lab in the world, and instead I am going back to school. I could also be going to school in San Diego, where one of the best physiology departments in the world is, but I am not. In the end, this is probably the right move. It’s just hard. I wanted to go to med school for several reasons, not the least among them to study cancer and work with cancer patients. Last night as I was beating myself up over this, I stumbled upon an article on lactate metabolism in cancer. It was very intriguing. As you probably know if you’re reading this, my two areas as of now are Lactate Metabolism and VO2 on-kinetics. If I did a post-doc or went to San Diego, I would be working on straight physiology, not combining my areas with cancer. As it is, I will be bringing a completely unique viewpoint to studying cancer. This feels like a huge gamble right now, but I think it’s correct (I hope it's correct). In the meantime, I am hoping to continue with my love of physiology, collaborating for experiments when possible, presenting at physiology meetings, etc. I find myself up at all hours of the night thinking and analyzing our data and just trying to “get through” the days in the clinic. This work is completely fascinating. Hopefully my gamble will pay off.
Also, in digging out old data I found a few old writings I will post here. Comments always welcomed!
Thursday, May 7, 2009
Tuesday, May 5, 2009
Rad Onc
I am presenting a poster in Seattle May 28th. This poster is still not complete. Not only that, but it looks like I need to redo lots of the data that are part of it. Thus, posting might be sporadic for the next month or so.
Happy Cinco de Mayo. Interestingly, a friend of a friend wrote this Op/Ed piece. I am yet to fully fact check it, but it is quite interesting:
http://74.125.95.132/search?q=cache:CQzNAOqUdvoJ:www.utexas.edu/lbj/students/writing/nedderman.pdf+may+5,+2007+cinco+de+mayo+austin+stateman&cd=4&hl=en&ct=clnk
On another note, I find myself wrapped up in the world of statistical analyses lately. It seems that is all I do. Also, after having the opportunity to read about and discuss medical specialties even more lately, I feel very good about pursuing radiation oncology (5 years of residency after med school). When I shadowed a radiation oncologist several years ago, I decided right then and there (knowing nothing about lifestyle, research in field, pay, etc) that that was the type of oncology I wanted to practice. I was fascinated; I shadowed as radioactive seeds were planted in a man’s prostate. Then later I watched as the oncologist applied strontium directly to a woman’s eye tumor. Later, a woman was told she had roughly a 20% chance of living. This was fascinating to me. The oncologist spent a great deal of time “coaching” her on what treatment she could pursue. The specialty takes all the great things I love about teaching and coaching and applies them to medicine and oncology. I digress.
In searching for the medical specialty I want, there are many things that enter the decision. First, I need a specialty where I can pursue oncology research in a basic science lab. I have learned that while clinical research can be interesting, it doesn’t fulfill my need for investigating novel mechanisms (so far anyways). Thus, I need a specialty that allows me time and resources to research in a basic science lab. Surgery would make this very difficult, as there is an emphasis on practicing surgery a lot so that you can improve each time (after all, Michael Jordan didn’t become great by READING about how to play basketball…he practiced and practiced and practiced and practiced). Also, surgeons tend to have little time for their outside-of-medicine pursuits. Although it may surprise some, I have a keen interest in things outside just practicing medicine (family, writing, teaching, reading, politics, public policy, art, animals, international health, etc.). Surgery would leave me little time for these things.
Radiation Oncology also appears to attract more “basic scientists” than any other specialty (this is debatable). In fact, about 20% of folks matching into Rad Onc residency each year have their PhD already (way more than any other feild)! Further, the career demands a ferocious interest in basic science and being on the cutting edge of technology and new, groundbreaking science. Thus, most Rad Onc's will spend quite a bit of time outside of the clinic in research/academic pursuits. Apparently, this discipline attracts very few “phonies” that are just interested in the nice lifestyle (like dermatology, ophthalmology are prone to do) because the career demands a high interest/activity in science. I love this. Also, it is one of, if not the, top specialty for palliative care. End of life issues are extremely interesting to me, and I plan to be involved with palliative care my whole life (another post on this later?). Finally, you get to sit down and really dig into the treatment plan you are going to give a patient. No cracking chests and yelling orders in the OR (I am NOT interested in this), but rather lots more time at the desk with a cup of coffee using physics and the literature to determine what and how to zap. I love this! Also, "call" tends to be quite light (how often is a tumor going to need emergency zapping?), allowing for greater flexibility. Finally, these doctors are compensated quite well, which is important because 1) I am going to have WELL above the average student loans (because of the whole masters/PhD/post-bacc thing) when I start practicing, and 2) I want to be able to take care of my family. Like it or not, medicine is a career just like other careers, and I would like to be able to take care of and protect my family and friends. I don’t think there is anything wrong with that. Finally, I have been reading lately that in order to match into Rad Onc you need to have good grades in med school and score high on your boards (it is considered “ultracompetitive”, along with Dermatology, Ophthalmology, and Plastic Surgery), but also it is IMPERATIVE that you have published some research and it helps tremendously if you attended a school with a top Rad Onc Program. A large part of my picking Cornell was because of Memorial Sloan Kettering Cancer Center (MSKCC). Imagine my delight when I looked up “top” Rad Onc programs and saw that Cornell was considered one of the top three, if not THE TOP, Rad Onc program in the states (and possibly world). The three “top” Rad Onc programs appear to be Cornell, MD Anderson (Houston), and Harvard. So it all seems great right now….I “just” have to get in there and do really well in med school now!
On another note, I am tired of the endless haggling for money; even from people you thought were friends. One of the guys that I talk to all the time around where we live asked me 20 bucks the other day. It made me sad because I thought we had a friendship. I’m learning it’s very hard to have a friendships across perceived socioeconomic barriers. And of course I told him no.
Today I spoke Creole with the nurse I yelled an expletive at earlier this year. She got so excited that I understood what she was saying and was holding a conversation with her. This made me laugh because I haven’t had time to study AT ALL lately. And when I yelled at her before I was studying every day! Maybe it's easier because I'm just living and using it without thinking too much.
Finally, a young man grabbed me outside the clinic yesterday and spoke a mixture of English and Creole with me. Basically, he was well-dressed and never asked for money. He said he was looking for work and did I know of anything at GHESKIO (the clinic) that he could do. I was happy that as jaded as I have become I was able to speak rationally and try to help him. I told him that I was merely a research intern here, with little to no power. Further, I told him that I have no idea if there are even any jobs here. However, I told him that what he should do is put together a resume and a short personal statement saying a bit about whom he is and what he would be interested in doing. He said he would do that. We exchanged emails and phone numbers. Today, he was at the clinic again. We talked some more. He wanted to know if we could sit down and have a meeting next week. I told him yes, BUT it might not do any good. I explained again that I had no power and was merely a research intern here. I hope he understood this. He did start the conversation today by saying, “Hey, I see you around the clinic speaking Creole!” And then we spoke Creole. Bon Bagay (Good Stuff)!
I just wish there were work to give people like this and/or I had anything to do with that. Then again, I am plenty jaded to be prepared for this to be a big let-down. I hope not.
In other news, Mandy has started working at Holy Angels Hospice Orphanage. I wouldn’t do it justice to speak of it here for her. From what I hear from her, imagine commercials of sick and handicapped kids with flies in their mouths and sores on their bodies in their underwear. Imagine children with heads the size of basketballs because their hydrocephalus has not been fixed. So that’s what she gets each day. Perhaps I can eek a blog entry out of her.
Finally, one last thing about Rad Onc. To the best of my knowledge there isn’t much treatment for cancer in places like this (Haiti). I think if you have cancer you basically ride it out (unless you happen to have money to go elsewhere). Perhaps I would have the time and money to set up radiation therapy in places like this one day.
Happy Cinco de Mayo. Interestingly, a friend of a friend wrote this Op/Ed piece. I am yet to fully fact check it, but it is quite interesting:
http://74.125.95.132/search?q=cache:CQzNAOqUdvoJ:www.utexas.edu/lbj/students/writing/nedderman.pdf+may+5,+2007+cinco+de+mayo+austin+stateman&cd=4&hl=en&ct=clnk
On another note, I find myself wrapped up in the world of statistical analyses lately. It seems that is all I do. Also, after having the opportunity to read about and discuss medical specialties even more lately, I feel very good about pursuing radiation oncology (5 years of residency after med school). When I shadowed a radiation oncologist several years ago, I decided right then and there (knowing nothing about lifestyle, research in field, pay, etc) that that was the type of oncology I wanted to practice. I was fascinated; I shadowed as radioactive seeds were planted in a man’s prostate. Then later I watched as the oncologist applied strontium directly to a woman’s eye tumor. Later, a woman was told she had roughly a 20% chance of living. This was fascinating to me. The oncologist spent a great deal of time “coaching” her on what treatment she could pursue. The specialty takes all the great things I love about teaching and coaching and applies them to medicine and oncology. I digress.
In searching for the medical specialty I want, there are many things that enter the decision. First, I need a specialty where I can pursue oncology research in a basic science lab. I have learned that while clinical research can be interesting, it doesn’t fulfill my need for investigating novel mechanisms (so far anyways). Thus, I need a specialty that allows me time and resources to research in a basic science lab. Surgery would make this very difficult, as there is an emphasis on practicing surgery a lot so that you can improve each time (after all, Michael Jordan didn’t become great by READING about how to play basketball…he practiced and practiced and practiced and practiced). Also, surgeons tend to have little time for their outside-of-medicine pursuits. Although it may surprise some, I have a keen interest in things outside just practicing medicine (family, writing, teaching, reading, politics, public policy, art, animals, international health, etc.). Surgery would leave me little time for these things.
Radiation Oncology also appears to attract more “basic scientists” than any other specialty (this is debatable). In fact, about 20% of folks matching into Rad Onc residency each year have their PhD already (way more than any other feild)! Further, the career demands a ferocious interest in basic science and being on the cutting edge of technology and new, groundbreaking science. Thus, most Rad Onc's will spend quite a bit of time outside of the clinic in research/academic pursuits. Apparently, this discipline attracts very few “phonies” that are just interested in the nice lifestyle (like dermatology, ophthalmology are prone to do) because the career demands a high interest/activity in science. I love this. Also, it is one of, if not the, top specialty for palliative care. End of life issues are extremely interesting to me, and I plan to be involved with palliative care my whole life (another post on this later?). Finally, you get to sit down and really dig into the treatment plan you are going to give a patient. No cracking chests and yelling orders in the OR (I am NOT interested in this), but rather lots more time at the desk with a cup of coffee using physics and the literature to determine what and how to zap. I love this! Also, "call" tends to be quite light (how often is a tumor going to need emergency zapping?), allowing for greater flexibility. Finally, these doctors are compensated quite well, which is important because 1) I am going to have WELL above the average student loans (because of the whole masters/PhD/post-bacc thing) when I start practicing, and 2) I want to be able to take care of my family. Like it or not, medicine is a career just like other careers, and I would like to be able to take care of and protect my family and friends. I don’t think there is anything wrong with that. Finally, I have been reading lately that in order to match into Rad Onc you need to have good grades in med school and score high on your boards (it is considered “ultracompetitive”, along with Dermatology, Ophthalmology, and Plastic Surgery), but also it is IMPERATIVE that you have published some research and it helps tremendously if you attended a school with a top Rad Onc Program. A large part of my picking Cornell was because of Memorial Sloan Kettering Cancer Center (MSKCC). Imagine my delight when I looked up “top” Rad Onc programs and saw that Cornell was considered one of the top three, if not THE TOP, Rad Onc program in the states (and possibly world). The three “top” Rad Onc programs appear to be Cornell, MD Anderson (Houston), and Harvard. So it all seems great right now….I “just” have to get in there and do really well in med school now!
On another note, I am tired of the endless haggling for money; even from people you thought were friends. One of the guys that I talk to all the time around where we live asked me 20 bucks the other day. It made me sad because I thought we had a friendship. I’m learning it’s very hard to have a friendships across perceived socioeconomic barriers. And of course I told him no.
Today I spoke Creole with the nurse I yelled an expletive at earlier this year. She got so excited that I understood what she was saying and was holding a conversation with her. This made me laugh because I haven’t had time to study AT ALL lately. And when I yelled at her before I was studying every day! Maybe it's easier because I'm just living and using it without thinking too much.
Finally, a young man grabbed me outside the clinic yesterday and spoke a mixture of English and Creole with me. Basically, he was well-dressed and never asked for money. He said he was looking for work and did I know of anything at GHESKIO (the clinic) that he could do. I was happy that as jaded as I have become I was able to speak rationally and try to help him. I told him that I was merely a research intern here, with little to no power. Further, I told him that I have no idea if there are even any jobs here. However, I told him that what he should do is put together a resume and a short personal statement saying a bit about whom he is and what he would be interested in doing. He said he would do that. We exchanged emails and phone numbers. Today, he was at the clinic again. We talked some more. He wanted to know if we could sit down and have a meeting next week. I told him yes, BUT it might not do any good. I explained again that I had no power and was merely a research intern here. I hope he understood this. He did start the conversation today by saying, “Hey, I see you around the clinic speaking Creole!” And then we spoke Creole. Bon Bagay (Good Stuff)!
I just wish there were work to give people like this and/or I had anything to do with that. Then again, I am plenty jaded to be prepared for this to be a big let-down. I hope not.
In other news, Mandy has started working at Holy Angels Hospice Orphanage. I wouldn’t do it justice to speak of it here for her. From what I hear from her, imagine commercials of sick and handicapped kids with flies in their mouths and sores on their bodies in their underwear. Imagine children with heads the size of basketballs because their hydrocephalus has not been fixed. So that’s what she gets each day. Perhaps I can eek a blog entry out of her.
Finally, one last thing about Rad Onc. To the best of my knowledge there isn’t much treatment for cancer in places like this (Haiti). I think if you have cancer you basically ride it out (unless you happen to have money to go elsewhere). Perhaps I would have the time and money to set up radiation therapy in places like this one day.
Monday, April 27, 2009
Hand out
This is almost not worth the post. It’s not worth the post because it’s fatiguing and paints Haiti in a poor light. But what other light can I paint them in then my experience here? I cannot give you someone else’s experience. Only mine.
In the ongoing discussion over what is appropriate, I was recently explaining to someone how in medicine treating an “n of 1” is your job on a daily basis. A patient comes in (number in study = 1) and you must use what you know to treat them. The knowledge you know was generated from many studies in which large numbers (n>1) were used to uncover the most common responses. Thus, statistics are used to determine what the error is with which you may say a treatment works when it really doesn’t. If we just treated one person and determined medicine on that, then medicine would be in world of trouble. That one person may have been an outlier.
Thus when I go down the street and kids beg for money, I cannot escape the idea that my inclination to “give” to the “n of 1”, the child who is sitting there, is actually not based in reality. What does my giving do besides make me feel good inside? Perhaps this child eats for one more day, and then what? Westerners cannot come over and hand out money so that other countries may thrive. But we can influence their society so that they can thrive on their own. Perhaps we are still afraid of that; perhaps we don’t want that – we want to give them handouts so we can dictate how they behave. We can then throw out presidents we don’t like, presidents that are for the poor people, the oppressed.
What is wrong with Haiti? Why do tourists not visit here? The news is full of horrible stories about Haiti. A friend from home asked me if people were poor because they did drugs and drank so much. That isn’t the Haiti I know. The Haiti I know and see is full of poor people. Poor people that want your money.
There is a cute kid that always comes to my office at the clinic to play. I usually play with him. Today, I realize his speech is full of “Ba’m” this and “Ba’m” that (give me!). Today he just came in and searched through my bag. He found three packs of gum still in a larger wrapper. He asked for some and I said ok. He then proceeded to take out the packs of gum and try to leave with them. An older man (a social worker) walked in. I know this man. He is always very nice to me and speaks with me. I tell the child no, that he can have one piece of gum. I have to grab him and take the packs of gum out of his hands (actually pry them out of his hands). I give the man and the child a piece; I also chew a piece. The man talks some and then leaves. The child proceeds to grab my pens and sticks them in his pockets and says he wants them. He tries to leave. I am disgusted. I have to grab him again, dig in his pockets to get my pens. He finally pouts off, only to return and ask for money. I am disgusted. I say no. He goes away.
I sit at my desk and reflect. He blatantly tried to steal my pens when I wasn’t looking. His mom has a job here at the clinic. They eat. Just then I am interrupted by the man that was in earlier, the social worker. In his best English he says “Give me ten dollars.” I ask him for what and he cannot explain. I tell him firmly no. I also don’t feel compelled to explain myself. I am a student who is severally thousands of dollars in debt, who has decided to come here for six months to try to help, and you walk in here to ask ME for money? And with no reason? We talk some in creole; I firmly tell him no, I don’t have money for him.
I understand these people are poor. I understand that these people don’t live great lives. I don’t understand why the folks with jobs feel it is ok to ask the white students for money. The sad thing is I think many white expats here feel some “prestige” of being white here. Many here treat you like you are rich and special. It’s disgusting.
For how long have we given handouts? For how long will we give handouts? And for what? So we can be above them and dictate their moves? Own them?
Can we blame them for continually seeking these handouts when we continually give them? Is there no better way?
In Sinclair Lewis’ Arrowsmith, a physician-scientist goes to an island infected with the plague with what he is almost positive is the antidote (think penicillin for syphilis). Only he has not done a scientific study on it. His mentor preaches over and over the importance of staying strong and seemingly “cold-hearted” in his approach. There is no scientific evidence suggesting it works, so he MUST have a control group that gets placebo, for the medicine may not actually work. The young doctor struggles with this, as he knows his mentor is right, but also thinks what he has will work. Ultimately, more are saved if he can show with a well-controlled study it is effective.
I digress. I lost my train of thought. Our ride came and I had to pack up and go. On the way out a woman stopped me to ask me for money. This was a clinic employee, not a beggar. I just said no. When it rains it pours. Of course, they aren't all like this. I spent my sunday having a beautiful brunch with haitian friends from the clinic. But those aren't the things that get to you here. Those moments sustain you. I apologize for not writing more about the beautiful moments here.
As of now my opinion is that hand outs are a terrible thing. They breed the wrong attitude. What we need are Haiti-friendly policies in government; policies that support their direction as an independent nation. Policies that aren’t about making people feel good, but rather are about creating a sustainable environment in Haiti and other developing countries. That is something I can get behind. That is something worth giving money to.
In the ongoing discussion over what is appropriate, I was recently explaining to someone how in medicine treating an “n of 1” is your job on a daily basis. A patient comes in (number in study = 1) and you must use what you know to treat them. The knowledge you know was generated from many studies in which large numbers (n>1) were used to uncover the most common responses. Thus, statistics are used to determine what the error is with which you may say a treatment works when it really doesn’t. If we just treated one person and determined medicine on that, then medicine would be in world of trouble. That one person may have been an outlier.
Thus when I go down the street and kids beg for money, I cannot escape the idea that my inclination to “give” to the “n of 1”, the child who is sitting there, is actually not based in reality. What does my giving do besides make me feel good inside? Perhaps this child eats for one more day, and then what? Westerners cannot come over and hand out money so that other countries may thrive. But we can influence their society so that they can thrive on their own. Perhaps we are still afraid of that; perhaps we don’t want that – we want to give them handouts so we can dictate how they behave. We can then throw out presidents we don’t like, presidents that are for the poor people, the oppressed.
What is wrong with Haiti? Why do tourists not visit here? The news is full of horrible stories about Haiti. A friend from home asked me if people were poor because they did drugs and drank so much. That isn’t the Haiti I know. The Haiti I know and see is full of poor people. Poor people that want your money.
There is a cute kid that always comes to my office at the clinic to play. I usually play with him. Today, I realize his speech is full of “Ba’m” this and “Ba’m” that (give me!). Today he just came in and searched through my bag. He found three packs of gum still in a larger wrapper. He asked for some and I said ok. He then proceeded to take out the packs of gum and try to leave with them. An older man (a social worker) walked in. I know this man. He is always very nice to me and speaks with me. I tell the child no, that he can have one piece of gum. I have to grab him and take the packs of gum out of his hands (actually pry them out of his hands). I give the man and the child a piece; I also chew a piece. The man talks some and then leaves. The child proceeds to grab my pens and sticks them in his pockets and says he wants them. He tries to leave. I am disgusted. I have to grab him again, dig in his pockets to get my pens. He finally pouts off, only to return and ask for money. I am disgusted. I say no. He goes away.
I sit at my desk and reflect. He blatantly tried to steal my pens when I wasn’t looking. His mom has a job here at the clinic. They eat. Just then I am interrupted by the man that was in earlier, the social worker. In his best English he says “Give me ten dollars.” I ask him for what and he cannot explain. I tell him firmly no. I also don’t feel compelled to explain myself. I am a student who is severally thousands of dollars in debt, who has decided to come here for six months to try to help, and you walk in here to ask ME for money? And with no reason? We talk some in creole; I firmly tell him no, I don’t have money for him.
I understand these people are poor. I understand that these people don’t live great lives. I don’t understand why the folks with jobs feel it is ok to ask the white students for money. The sad thing is I think many white expats here feel some “prestige” of being white here. Many here treat you like you are rich and special. It’s disgusting.
For how long have we given handouts? For how long will we give handouts? And for what? So we can be above them and dictate their moves? Own them?
Can we blame them for continually seeking these handouts when we continually give them? Is there no better way?
In Sinclair Lewis’ Arrowsmith, a physician-scientist goes to an island infected with the plague with what he is almost positive is the antidote (think penicillin for syphilis). Only he has not done a scientific study on it. His mentor preaches over and over the importance of staying strong and seemingly “cold-hearted” in his approach. There is no scientific evidence suggesting it works, so he MUST have a control group that gets placebo, for the medicine may not actually work. The young doctor struggles with this, as he knows his mentor is right, but also thinks what he has will work. Ultimately, more are saved if he can show with a well-controlled study it is effective.
I digress. I lost my train of thought. Our ride came and I had to pack up and go. On the way out a woman stopped me to ask me for money. This was a clinic employee, not a beggar. I just said no. When it rains it pours. Of course, they aren't all like this. I spent my sunday having a beautiful brunch with haitian friends from the clinic. But those aren't the things that get to you here. Those moments sustain you. I apologize for not writing more about the beautiful moments here.
As of now my opinion is that hand outs are a terrible thing. They breed the wrong attitude. What we need are Haiti-friendly policies in government; policies that support their direction as an independent nation. Policies that aren’t about making people feel good, but rather are about creating a sustainable environment in Haiti and other developing countries. That is something I can get behind. That is something worth giving money to.
Wednesday, April 15, 2009
Take back your hand...
I was asked today by someone in the states how Haiti has changed my views on life, etc. There is no easy answer to this. First, it seems that every ex-pat here breaks down at some point. Not from the workload or the language or the isolation (although those things all help), but rather from the unending pressure that people put on you here. Almost everyone you meet wants a handout or something; in turn relationships take a strange twist. What’s innocent? What’s sincere? Why does it matter? And in response to this, almost everyone here trying to help feels helpless in so many ways.
One thing that comes to mind are handouts to people on the street. Every day you are asked for money. Sometimes it's aggressive, sometimes it’s nice, usually it’s awkward. Not because I feel bad about not giving money; I don’t. It’s instead awkward because the questions that you must answer in these conversations, “Come on, I have a job, but I only make 100$ a month…what do you make?” “I have no work and my mom is sick”, etc. So what to do?
If you give the handout, what good does it do? Does it not just propagate some idea that they should seek handouts rather than seeking education and innovation? What if you give a kid on the street 10 bucks? Let's say that his household brings in 5 dollars per week (about the mean income). You just gave them two weeks salary. So what do they do? Go back to school? Why? Money is waiting somewhere with the white man.
Let’s pretend that handing out cash did NOT propagate this attitude. Even so, what good does it do? I’m not sure I know. So there is money in someone’s hand; how does that help them in two weeks or next year? How does that help this economy? The infrastructure? The government?
I wish I knew.
So how has Haiti changed me? It has made me more aggressive, because this is a more aggressive society. It has also made me more willing to laugh. Without humor to soften the mood, life for so many people is just too bleak (including me); it has made me want to be funnier for the same reason.
It has also made me miss basic science, because I don’t get to do any here. And I miss presenting and teaching in front of groups. But I will get those things back. I won’t get back having no memories of seeing these people each day.
So how has Haiti changed me? I have pictures and frustrations in my head to last a lifetime. And I’ve only been here three months. Imagine how these people feel.
One thing that comes to mind are handouts to people on the street. Every day you are asked for money. Sometimes it's aggressive, sometimes it’s nice, usually it’s awkward. Not because I feel bad about not giving money; I don’t. It’s instead awkward because the questions that you must answer in these conversations, “Come on, I have a job, but I only make 100$ a month…what do you make?” “I have no work and my mom is sick”, etc. So what to do?
If you give the handout, what good does it do? Does it not just propagate some idea that they should seek handouts rather than seeking education and innovation? What if you give a kid on the street 10 bucks? Let's say that his household brings in 5 dollars per week (about the mean income). You just gave them two weeks salary. So what do they do? Go back to school? Why? Money is waiting somewhere with the white man.
Let’s pretend that handing out cash did NOT propagate this attitude. Even so, what good does it do? I’m not sure I know. So there is money in someone’s hand; how does that help them in two weeks or next year? How does that help this economy? The infrastructure? The government?
I wish I knew.
So how has Haiti changed me? It has made me more aggressive, because this is a more aggressive society. It has also made me more willing to laugh. Without humor to soften the mood, life for so many people is just too bleak (including me); it has made me want to be funnier for the same reason.
It has also made me miss basic science, because I don’t get to do any here. And I miss presenting and teaching in front of groups. But I will get those things back. I won’t get back having no memories of seeing these people each day.
So how has Haiti changed me? I have pictures and frustrations in my head to last a lifetime. And I’ve only been here three months. Imagine how these people feel.
Monday, April 13, 2009
Sunday, April 12, 2009
RAM
Besides discovering what the iTunes “genius” button does, this week has been filled with events funny and sad and great. Such is Haiti.
Thursday night we ended up going to the legendary Hotel Oloffson to here RAM play. Because RAM and what RAM is to Haiti is incredibly hard to convey, I am including a Wiki link:
http://en.wikipedia.org/wiki/RAM_(band)
This is an incredibly magical and fascinating group. Richard A Morse (where RAM got its name) is the front man, an interesting guy, born in Puerto Rico, who now lives here and owns the hotel. Basically, if you want to kick back OR move around to the beat, RAM is an intense mix of African drum beats and horns. Makes for a great time. My friend Paul has a blog with video clips – you should check them out:
http://paulsjourneyyoureinvited.blogspot.com/
(Please read Paul’s account of us trying to get some food from a waitress. A sad account of what we run into each day here.)
More interesting than the music of RAM is their political history. I won’t bore you with the details that you can read elsewhere, but their past has included kidnappings during the show, threats on their lives, an incident where the government made them perform at Kanaval and the driver of the truck went nuts and ran over people, etc.
Yesterday we walked down to the hotel to grab a drink and who greeted us at our table but Richard Morse himself! We spoke with him for about 30 minutes; he spoke about everything from music to politics to "ever leaving Haiti." It was refreshing; he is such a revolutionary figure here I imagined him to be more reckless with his life. Instead he told stories of being scared for his life and wanting to keep playing music. He spoke about how he was “simply a musician”, with a twinkle in his eye. It was refreshing to hear such a figure talk about how he merely has a good gig in Haiti and he tries to do some of the right things with the platform he does have. He told us the firsthand account of police grabbing him off stage and trying to take him away, of band members being arrested at midnight during a show, and of the 1998 Kanaval accident, in which his chief security man was killed. He joked that nowhere else in the world would offer him a job. “I mean, I asked a friend about teaching elementary school in the states – you gotta get a teaching degree for that now, which would mean more school! I’m just a musician man, and I have a decent gig here in Haiti. Just a gig man, just a gig.”
To return to my struggles with Creole, I’ve learned that I get along well if I just accept what people say in Creole and try to get the overall meaning from a few of the words and the body language. For instance, today I was playing with two dogs outside our place. A man walked by and asked me something. I thought he said the word friend, pointed to the dogs, and was smiling. I thought maybe the question was “are the dogs friendly?” I just said “oui” and he smiled and called the dogs over to him to pet them. Beautiful. What’s so hard about that?? Now flashback to work. I was going to make copies in a backroom and I stopped to ask the guy who works in that wing (the door was shut) if it was ok for me to go in. Apparently he told me in too-nice a way NOT to go in there. What did I do? Oh, I smiled and said “merci” and barged into the room. Bad idea. I barged into a sensitive meeting with a few patients and the psychologists. They gave me the death look. Ooops. As I walked out the guy I spoke with on the way in looked at me like I was an idiot. (Imagine this in the states, Me: Can I go in back here to make copies? Boss: No, there is a very sensitive meeting with big-wigs and sick patients going on back there, Me: Oh great, thanks! (Barging in.))
I digress. Last story. I bought chicken off the street the other day while walking around. They chopped it and cooked it for me. We couldn’t eat it there because a guy was harassing me to buy him a coke. (This guy wanted a coke, and 10 kids were standing there behind him. “What about them?” I asked. “I buy you one and not them?” “Forget about them man, just me.”) So I ended up eating my chicken on a bridge. As I ate it, I put the chicken bones on the bridge, figuring that a dog would be able to easily get them and chew on them (as opposed to my throwing them into the trash below). So a pile of bones was sitting on the railing next to me. Next thing I know a man is yelling at me from behind, grabs my discarded bones, and bites into a bone! He continues to yell at me as he walks off. From what I gathered this was some form of “you wasteful America.” He was not happy that I wasn’t eating the bone. The act itself, grabbing someone else’s chicken bones and biting into them, sums up the situation here.
Thursday night we ended up going to the legendary Hotel Oloffson to here RAM play. Because RAM and what RAM is to Haiti is incredibly hard to convey, I am including a Wiki link:
http://en.wikipedia.org/wiki/RAM_(band)
This is an incredibly magical and fascinating group. Richard A Morse (where RAM got its name) is the front man, an interesting guy, born in Puerto Rico, who now lives here and owns the hotel. Basically, if you want to kick back OR move around to the beat, RAM is an intense mix of African drum beats and horns. Makes for a great time. My friend Paul has a blog with video clips – you should check them out:
http://paulsjourneyyoureinvited.blogspot.com/
(Please read Paul’s account of us trying to get some food from a waitress. A sad account of what we run into each day here.)
More interesting than the music of RAM is their political history. I won’t bore you with the details that you can read elsewhere, but their past has included kidnappings during the show, threats on their lives, an incident where the government made them perform at Kanaval and the driver of the truck went nuts and ran over people, etc.
Yesterday we walked down to the hotel to grab a drink and who greeted us at our table but Richard Morse himself! We spoke with him for about 30 minutes; he spoke about everything from music to politics to "ever leaving Haiti." It was refreshing; he is such a revolutionary figure here I imagined him to be more reckless with his life. Instead he told stories of being scared for his life and wanting to keep playing music. He spoke about how he was “simply a musician”, with a twinkle in his eye. It was refreshing to hear such a figure talk about how he merely has a good gig in Haiti and he tries to do some of the right things with the platform he does have. He told us the firsthand account of police grabbing him off stage and trying to take him away, of band members being arrested at midnight during a show, and of the 1998 Kanaval accident, in which his chief security man was killed. He joked that nowhere else in the world would offer him a job. “I mean, I asked a friend about teaching elementary school in the states – you gotta get a teaching degree for that now, which would mean more school! I’m just a musician man, and I have a decent gig here in Haiti. Just a gig man, just a gig.”
To return to my struggles with Creole, I’ve learned that I get along well if I just accept what people say in Creole and try to get the overall meaning from a few of the words and the body language. For instance, today I was playing with two dogs outside our place. A man walked by and asked me something. I thought he said the word friend, pointed to the dogs, and was smiling. I thought maybe the question was “are the dogs friendly?” I just said “oui” and he smiled and called the dogs over to him to pet them. Beautiful. What’s so hard about that?? Now flashback to work. I was going to make copies in a backroom and I stopped to ask the guy who works in that wing (the door was shut) if it was ok for me to go in. Apparently he told me in too-nice a way NOT to go in there. What did I do? Oh, I smiled and said “merci” and barged into the room. Bad idea. I barged into a sensitive meeting with a few patients and the psychologists. They gave me the death look. Ooops. As I walked out the guy I spoke with on the way in looked at me like I was an idiot. (Imagine this in the states, Me: Can I go in back here to make copies? Boss: No, there is a very sensitive meeting with big-wigs and sick patients going on back there, Me: Oh great, thanks! (Barging in.))
I digress. Last story. I bought chicken off the street the other day while walking around. They chopped it and cooked it for me. We couldn’t eat it there because a guy was harassing me to buy him a coke. (This guy wanted a coke, and 10 kids were standing there behind him. “What about them?” I asked. “I buy you one and not them?” “Forget about them man, just me.”) So I ended up eating my chicken on a bridge. As I ate it, I put the chicken bones on the bridge, figuring that a dog would be able to easily get them and chew on them (as opposed to my throwing them into the trash below). So a pile of bones was sitting on the railing next to me. Next thing I know a man is yelling at me from behind, grabs my discarded bones, and bites into a bone! He continues to yell at me as he walks off. From what I gathered this was some form of “you wasteful America.” He was not happy that I wasn’t eating the bone. The act itself, grabbing someone else’s chicken bones and biting into them, sums up the situation here.
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