Sirens and Lights

(1) I’m still sorting out the semantics of my reaction to the Samantha Power’s resignation from the Obama campaign, and more to my general weariness/wariness towards the way this race seems to be going these days. My siblings and I had a fairly intense discussion yesterday morning regarding the Democratic primaries and the danger of so much passion with its resultant polarization. This is, of course, not a new topic, but one that took on a little more reality to me when I saw a link to a Times blog discussing Power’s slip and the consequences (You can read the article for the full story.) . She, for those of you who haven’t heard of her, is someone who is actually really inspirational on her own, with her intelligence, boldness, principles and hard-work….not to mention incredible writing skill (please please go read A Problem from Hell: America and the Age of Genocide, if you haven’t) and passion. My reaction, quite honestly, was a mixture of sadness/foreboding combined with a somewhat paradoxical sense of relief. For as much as it concerns me that these kinds of comments appear to be spreading and kind of think Power is a good enough influence that she maybe shouldn’t have resigned, I really respect Obama for wanting to keep this a clean fight, and respect that he has supporters who believe in and abide by those principles. Everyone makes mistakes, especially passionate individuals, but that there are consequences (and discouragement of others following down the path) represents more to me that most of the increasingly suspect rhetoric that makes up the campaign season these days….

(2) I wrote a post a few years ago talking about a program in Brazil intended to incentivize keeping children in school and out of the labor force. A fellow Fogarty scholar emailed out a comment from The Lancet (a medical journal) discussing this type of program, Conditional Cash Transfers (CCT), which is described as:

During the past decade, countries with transitional and middle-income economies have introduced programmes that transfer money to poor households on the condition that they comply with a set of requirements, including attendance for health care, food and nutritional supplementation, and enrolment of children in school. Conditional cash transfer (CCT), a type of social contract, is both an alternative to more traditional social assistance with handouts and a complementary strategy to the provision of health and education services.1 Because poor families usually face the greatest barriers to health interventions, CCT helps to redistribute resources and thus reduces health inequities.2 For very poor families, cash provides emergency assistance, while the conditions promote longer-term investments in human capital.

The author goes on to discuss the numerous known benefits of programs such as this one, including evidence from a “systematic review of six CCT programmes in Latin America and Africa showed a fairly consistent picture of the effects of such programmes on the use of health-care and education programmes and, to some extent, growth and health outcomes for children early in life, despite some methodological concerns.”

The accompanying concerns are not too surprising, dealing with a need for a better understanding of which aspects of programs such as these (eg, health interventions, food supplements, and cash transfer) truly affect health-outcomes and the expense of programs such as these– particularly with regards to low-income countries for whom the program may not be cost-effective, let alone feasible without appropriate health and education services.

Conditional cash transfer: a magic bullet for health?
The Lancet 2008; 371:789-791
Kenji Shibuya

So…. did you vote (if you had the opportunity)?!? Pennsylvania’s primary isn’t until April, so I haven’t had the opportunity yet….but it doesn’t mean that I’m not following the proceedings closely from my little house in Peru. It seems like many of the undecided votes are going to Obama, and judging by Georgia, we might be in for a more decisive election than I had thought possible…

In any case, this might be a bit premature, but I keep flashing back to the last election (not primary, actual election), when I had just returned from a year in many countries listening to such a diverse and yet harmonious collection of voices. As I will be this next election, I was in Hershey, feeling overwhelmed by the beliefs of those around me, and yet still rebelliously and naively, it turns out, hopeful.

We are lucky to be where we are. Go out and vote to make the change you believe in.

Flashback Post…

What it feels like to be so wrong
Posted by: sural in Back in the U.S.A 2005

*note: not everyone i met expressed the opinions below; there was certainly quite a range, and almost always appreciation of some facet(s) of our country…and almost never were these opinions given in a hostile or threatening way, just critically. The vast majority of these opinions came from friends.

In today’s NYTimes, there’s an op-ed on President Bush’s inauguration, and more significantly on the world view on our country’s re-election of this man. Reading the opinions written by the author, I found myself nodding in agreement and even murmuring “yeah” and “exactly” to myself (it’s 2:30 am and I’m the only person in the library’s entire computer lab right now…so, i suppose the behavior is a little excusable!). Long ago (or so it seems…really about 18 months ago), I found myself in Switzerland working at the World Health Organization. As one might imagine, my co-workers in many cases were either (a) European (and thus particularly likely to be more left than the average American); (b) not American (and thus likely to be more left than the average American); (c) interested in health and human rights (and thus likely to be more left than the average American); or (d) some combination of the above. Suffice it to say that they were generally strong opposers of Bush and, in many cases, of Americans as a whole….variations on the theme of “I dislike America” included:

“I dislike America.”
“I dislike Americans.”
“America(ns) is/are selfish, materialistic and/or arrogant .”
“I dislike your country, but not the individual people–I love you!”
“I dislike your government.”
“I dislike Americans because they do not think about others. The whole world should get to vote in your elections.”
“I dislike your government, but I realize that people only have so much control over their governments and so I do not dislike you.”

Observation: The comments often strongly reflected the individual’s own background. For example, those in countries where people have a stronger influence on their government were much likelier to avoid the last phrasing and to select “I dislike Americans” as their argument of choice, often directly associating Americans with the then current American administration. However, people in countries such as India and Brazil, which are both embracing capitalism and addressing corruption in their own countries, almost always expressed themselves with the last phrase.

I’ve never been one to wave the flag of patriotism with much vigor, but after a number of rather sharp attacks on my American background and the country’s politics despite my openness about my own criticisms, defensiveness began to creep in… Rather than blindly defend our actions, however, I began to consider the actual matter at hand.

So…how to defend/explain away America/the American people’s selection of Bush and condoning of his behavior? Well, I tried several of the usual methods: the fear factor, the ignorance card (most Americans don’t pay attention beyond their own lives, let alone the lives of people by whom they may even feel threatened 1000’s of miles away–this encompasses lack of awareness, lack of depth of understanding and even lack of concern–depending on the day), the “big country/government with small individual [perception of] influence” theory…. in the end, I think I opted for a combination of the final explanation and the idea that we, the Americans, didn’t know what Bush would do. We hadn’t anticipated 9/11 upon electing him, and certainly not his response to the attack. I settled on this explanation, delivered in soothing, empathetic tones designed to both calm the inquirer and head off further discussion as well as to express my own sympathy to their frustration with my government’s actions. Perhaps surprisingly, it generally worked…particularly in countries like Brazil where the distinction between the government and its people is well understood.

Even more surprising, maybe, is that the explanation began to work on me, as well. The silent message to all of that was as follows: “just wait, we’ll redeem ourselves when we get a choice to express how we feel about the last four years–we’re good people and we agree!” In November, I had been home for approximately 3.5 months and for all of my efforts to support Kerry, I don’t think I ever changed my belief that we would right our wrong and elect Kerry. I believed that America would redeem itself. A few friends from abroad sent me emails half-jokingly commenting on how the Americans had better come through for the world, and that I’d better have done my part to ensure a Kerry victory, especially in my own home swing state of PA (yes, people abroad are aware of the intricacies of our election process), and I laughed, certain we would. When PA went blue, I nodded silently, “of course PA went blue,” despite the fact that where I attend medical school was very red…perhaps that should have been my first sign. When it all came down, I was stunned, much more so than those European/non-American/justice-seeking friends who had been suspicious of Americans all along. And instead of me being the one nodding knowingly, it was them, not just silently, but also vocally confirming their opinions of not only our country’s government, but of its people.

Perhaps a bit ineffectively, I sent apologies for the significance of the election (because, as the article’s writer says, it affects them as much as us–only they don’t get a say), but this time I didn’t offer explanation. I know I’m not anti-American…I know many of these people who turned the Hershey area red; they are friends, mentors, colleagues. They are not ignorant or materialistic or arrogant people. And perhaps for this reason, in my letters, I didn’t broach the topic which was so bothersome to me… less of how had I been so wrong about my fellow Americans– countless people have discussed this idea since well before the election even occurred– than of what being wrong means…

….thoughts for the next entry (for now, there’s an exam in 27 hours and I need to study… :-P)…

This isn’t going to be profound. I’m just a little annoyed. As someone who gets most of her news via on-line newspapers rather than TV, I think it’s easy to select the reports to which I’m paying attention (i.e. reports on world leaders getting assassinated-worth reading, story about a presidential candidate female or otherwise showing emotion- not so interesting). Yesterday, though, I took a break and was watching CNN en espanol’s coverage of the primary in NH. I’m sure this is surprising to those of you who are subjected to the inane prioritization of news as offered by most television channels, but it was the first time that I came across the clip of Hillary Clinton tearing up (not even crying), as well as all of the to-do about how this must be the reason she won the primary in NH despite her loss in Iowa (something like 47% of female votes went to her). Last night, I clicked on a few more of the links on nytimes.com and cnn.com following the “story.” All I can really say is that I almost feel bad adding more writing on a subject that is complete speculation (for really obnoxious writing, no matter your candidate preference, try reading Dowd’s editorial in the times….not that I should be encouraging its popularity).

We’re finally at a point where we have at least 2 very viable Democratic candidates that would probably do a good job as President. For all of the personality traits that one has versus the other, the differences are quite often relative instead of absolute. As voters in the primaries seemed to have been prioritizing, they’re both “electable.” What that means is that we are left free to focus on their policies, which do differ a bit, including on health (will have another post later on that).

Regardless of whom we ultimately choose, I wish we didn’t have to cheapen Clinton’s candidacy by harping on this factor as more important than her politics, especially in a woman who has done little to “exploit” this characteristic herself.

A good op-ed by Gloria Steinem was sent to me by Payal, linked here. The interesting quote, in my mind, though, was the following: “What worries me is that male Iowa voters were seen as gender-free when supporting their own, while female voters were seen as biased if they did and disloyal if they didn’t.”

The article brings up a few ideas I didn’t bring up here. Steinem says, “What worries me is that some women, perhaps especially younger ones, hope to deny or escape the sexual caste system; thus Iowa women over 50 and 60, who disproportionately supported Senator Clinton, proved once again that women are the one group that grows more radical with age.”

Despite graduating from an all women’s college (as Hillary Clinton did), I think it would personally be hard for me to vote along those lines alone, as much as I want to honor the path. As Steinem acknowledges, “This country can no longer afford to choose our leaders from a talent pool limited by sex, race, money, powerful fathers and paper degrees. It’s time to take equal pride in breaking all the barriers. We have to be able to say: “I’m supporting her because she’ll be a great president and because she’s a woman.”

Overheard giggles. I’m sitting in this cozy twin bed in my family’s house, having just finished a lazy conversation on the usual subjects with a friend of the growing-up-together-variety…an exchange interrupted by my twin asking my friend via IM if she was talking to me, because she could hear me giggling in her room (taken over from my brother in 1992) down the hall. I feel like it could be 1990 or 1999 or 2005 or any year in between, breathless -or snorting, as the case may be- bursts of laughter interspersed with empathy, encouragement and discussions on books/relationships/the next time we’ll get to go dancing together in Philly. twin interruptions required (though at least I can roll my r’s these days!).

Forgive the sappy. Heading to back to Peru entirely too soon…

Scuffed walls, white sheets imprinted with a hospital’s name, a bookshelf lined with review books and Spanish lessons, fragrant fuschia flowers on the windowsill and my red backpack spilling over with clothes on the utility carpet.

Homeless once again… I’m literally living in the hospital these days, similar to how residents/house officers did years ago. The ORs are directly one floor below my room, the cafeteria and library are two levels down. On my floor, two computers, a treadmill and a wood-paneled TV mounted on the wall complete the set-up. This existence has a surreal feel, as I could easily never step foot outside for days, nor spend time changed out of my baby blue scrubs. There’s luxury in the simplicity of it all- life physically centered around a stairwell, theoretically around surgery- the thought of coffee and a bed somewhere nearby, even if there isn’t really time to dwell long with either one. The sensory deprivation outside of the OR will likely inspire me to resusciate neglected projects in the few hours between clinical responsiblities and bed. The isolated humming of the air conditioner beside my desk screams function! productivity! focus!

The comfort will be short-lived. It won’t be long until I hike out to my car, stranded in a distant parking lot, needing mindless music, open windows and indian food and family weekends to balance me out. Enjoy the blog entries until then…

I’m in Allentown this month for the final rotation of my third year of medical school.

sujal recently redesigned this blog for me in anticipation of another year long departure from the u.s…. I thought i’d add a post this morning to celebrate that. those crazy swirls at the top of the screen are oddly inspiring.

i actually woke up on time today, which is a shocking first, and stumbled to the hospital while watching the sun rise, sipping needily at my scalding black coffee. on the list of things for which i am grateful on these too early mornings, having chosen to do my Surgery rotation in months with lots of daylight is currently at the top. Hershey’s a quiet place, with quiet sunrises, and the walk is a quiet reminder of why it’s sad to be leaving this home for a year.

So…a friend from my Watson year (and beyond) recently commented on this blog and I realized that it still comes up when someone Google-searches me. I haven’t written here in quite a while (since October???!), and I thought that maybe this was a good time to resuscitate “Sirens and Lights,” especially as I’m finally going to be seeing patients as a “student doctor” rather than as an observer with a slightly more than passing knowledge of medicine (i.e. has slaved over cadavers and observed a handful of lumbar punctures while interviewing patients for studies)!

Here at PSU, we have the Student-Clinician Ceremony for incoming third year students to officially commence the clinical portion of their medical education. I have to admit that I was slightly dreading attending another ceremony in stiff white coats, but the ceremony turned out to be nice. In particular, one fourth year reflected on her experiences transitioning to third year. In the course of her speech (which was both funny and insightful), she commented on the degree of intimacy patients bestow (that’s not the right word…it’s been a long week) upon their physicians…and it reminded my of my pre-med days, and what brought me to medicine in the first place. I was a Psych major once upon a time, and always loved the idea of being able to not only share a window into others’ lives, but to be able to do it in a way that would be helpful to the other person–not just feed my love for hearing people’s stories! Her speech reminded me of that, and I found it reassuring to remember how much I love that feeling, particularly now amidst the all of the minor anxieties of debuting on the wards (which basically come down to (a) will I enjoy it? and (b) will I be good at it?, with the obvious overlaps in even those two questions).
The reason I’m writing this now is that I think I have a “new” use for this site, though in reality I suppose it’s a continuation of what I had meant to be doing during the Watson year; I want to use it as a way of documenting my patients’ stories. I realize this is tricky in terms of confidentiality and will do my best to respect those I meet as professionally as possible…we’ll see how it works out as I try out this new project.

P.S. Thanks to all of you who thought of me last month as I was studying for the boards*, including those of you who just thought of me randomly (despite not having seen me in over a year!!!)… I’m slowly catching up on emails and voicemails now (especially those ones for which I’m attempting to revive my Portuguese and French!), and it’s wonderful to realize how much support I have out there, good vibes from just about every continent (still missing Antarctica…someone move there just so I can get good luck emails and feel special ;)). In the end, the month was long and taxing, but also very gratifying having so much time to focus on what it is I need to be my best. It’s a rare opportunity, and I’m certain it’ll help out over this next crazy crazy year. Força (Portuguese for “strength/power/effort”) was my motto for boards time, and I think I’m going to maintain it through third year.

*the “boards” usually refer to the first part of the U.S. Medical Licensing Exam. There are three parts, the first of which is taken between second and third year of medical school.

Keeping Quiet
Pablo Neruda

Now we will count to twelve
and we will all keep still.

This one time upon the earth,
let’s not speak any language,
let’s stop for one second,
and not move our arms so much.

It would be a delicious moment,
without hurry, without locomotives,
all of us would be together
in a sudden uneasiness.

The fishermen in the cold sea
would do no harm to the whales
and the peasant gathering salt
would look at his torn hands.

Those who prepare green wars,
wars of gas, wars of fire,
victories without survivors,
would put on clean clothing
and would walk alongside their brothers
in the shade, without doing a thing.

What I want shouldn’t be confused
with final inactivity:
life alone is what matters,
I want nothing to do with death.

If we weren’t unanimous
about keeping our lives so much in motion,

if we could do nothing for once,
perhaps a great silence would
interrupt this sadness,
this never understanding ourselves
and threatening ourselves with death,
perhaps the earth is teaching us
when everything seems to be dead
and then everything is alive.

Now I will count to twelve
and you keep quiet and I’ll go.

-from Full Woman, Fleshly Apple, Hot Moon
Translated by Stephen Mitchell

This is the longest I’ve gone without writing on here, and i know it’s surprising seeing as how I was abroad from May-August. I can’t say that I have a particularly good reason for ceasing my updates, perhaps the good fortune of having had wonderful companions somewhat nearby in both Rio and Durban, perhaps enjoying a few months of relative introspection/lost-in-thought-whirlpools again. I’ve been back in the U.S. and in Hershey for a little over a month now, which in med school terms means 2 exams down and a third looming in a week.

How do I sum up the summer? If I were the type to say so, I would say that “It was the most amazing summer of my life, transformative and inspiring.” I’m really not, though ( )….and so I think my more verbose description would be: these three months brought me the opportunity to actually deal with the dreams I created for myself over the last 24 years (and particularly during my watson year)…and I know that the phrase “deal with” doesn’t seem like it’s positive, but trust that for me, it without a doubt was/is.

In some ways, particularly on this weblog, I think this summer seems almost like a continuation of the Watson year, phrases separated by the hyphen of a year of medical school. It’s not that there isn’t some truth to that perception, but the reality is that even medical knowledge aside, last year contained a type of education all its own, a remnant of my Watson year that no amount of biochem and anatomy managed to beat out of me (thank goodness). Those of you who’ve spoken with me about the last two years have heard me say that a lot of what I learned last year was what I should have known before I left, about politics, human rights, poverty, justice, activism, “making a difference” etc. And so, leaving this time seemed a little bit like a chance to turn my vague interests and experiences prior to and during my year off into a more concrete contribution to both the areas in which I was working and to my own education (obviously always always still looking forward to all that accompanies [transient] immersions in other languages and communities, which is generally anything but concrete).

Background: I ended up spending the first 6 weeks of the summer working in Rocinha (described below), a large favela precariously perched on the hills of Rio de Janeiro, Brasil, on an evaluation of the Community Health Agents program that works with those infected with tuberculosis in the community (WHO’s DOT program, for those who are familiar with it). After a quick weekend return to the U.S., I headed off to Durban, South Africa for 5 weeks to work at the Nelson Mandela School of Medicine. There, I participated in a handful of small projects, but most significantly on a study looking at the impact of a Global Fund funded formal training/support program for home based carers, who serve as the backbone of AIDS care in much of the province (well, much of Africa, but for the purposes of the study…). I spent a lot of time working in the office in Durban preparing everything for the study, but I did have the opportunity to spend a little bit of time visiting Tugela Ferry, one of the rural sites supported by an incredibly large group of home based carers. There, I spent most of the day driving out to different tiny settlements in the area and interviewing the home based carers (with a translator of course! The people there speak Zulu), and then the remainder of the time in the HIV clinic where a med student friend (hi, jason) from the U.S. was working.

…..ah, out of time. I really will finish this post later….promise.

School’s out for the summer (let’s just ignore the fact that this is the last official summer of my life, and I’ll be spending it in the Southern Hemisphere, where it’s technically winter)!!!!!!!! I haven’t updated on here in an extremely long time, I realize. That will soon change, I promise….because my life is once again going to be interesting and not simply the sagas of a med student in central PA! Tonight, I’m heading out to Brazil to begin my work in a favela in Rio. Summer schedule:

May 14-May15: Philly (home!)
May 15-June 8: Rio de Janeiro (research)
June 9-June 12: Washington, D.C. (AMSA Global Health Action Committee Board Meeting! www.amsa.org/global)
June 13-July 1: Rio de Janeiro (research)
July 2-July 4: NYC (visiting fun people)
July 5/6-Aug 12: South Africa (volunteering?)
Aug. 13: Philadelphia (home!)
Aug 14: Hershey
Aug 15: Beginning of second year

Ok, back to packing and the usual (much missed) frenzy of preparing to leave…. talk to you next from Rio de Janeiro!

Beijos!

The United Nations
Commission on Human Rights
April 15, 2005

In a resolution (E/CN.4/2005/L.28) on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, adopted as orally revised and by a roll-call vote of 52 in favour to one against, with no abstentions, the Commission urged States to take steps, individually and through international assistance and cooperation, especially economic and technical, to the maximum of their available resources, with a view to achieving progressively the full realization of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health; and called upon the international community to continue to assist the developing countries in promoting the full realization of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, including through financial and technical support as well as training of personnel, while recognizing that the primary responsibility for promoting and protecting all human rights rests with States.

The Commission encouraged States to recognize the particular needs of persons with disabilities related to mental disorders, as well as their families, including by reflecting their needs in national health and social policies, such as national poverty reduction strategies; and called upon them to place a gender perspective at the centre of all policies and programmes affecting women’s health. They also called upon States to protect and promote sexual and reproductive health as integral elements of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and decided to extend, for a period of three years, the mandate of the Special Rapporteur on the right to everyone to the enjoyment of the highest attainable standard of physical and mental health.

The result of the vote was as follows:

In favour (52): Argentina, Armenia, Australia, Bhutan, Brazil, Burkina Faso, Canada, China, Congo, Costa Rica, Cuba, Dominican Republic, Ecuador, Egypt, Eritrea, Ethiopia, Finland, France, Gabon, Germany, Guatemala, Guinea, Honduras, Hungary, India, Indonesia, Ireland, Italy, Japan, Kenya, Malaysia, Mauritania, Mexico, Nepal, Netherlands, Nigeria, Pakistan, Paraguay, Peru, Qatar, Republic of Korea, Romania, Russian Federation, Saudi Arabia, South Africa, Sri Lanka, Sudan, Swaziland, Togo, Ukraine, United Kingdom and Zimbabwe.

Against (1): United States.

David Hohman (United States), speaking in explanation of the vote… said the United States believed that while the progressive realization of economic, social and cultural rights required government action, those rights were not an immediate entitlement to a citizen.

http://www.unog.ch/unog/website/news_media.nsf/(httpNewsByYear_en)/0DC62B805E191CF7C1256FE40050A75D?OpenDocument

from a journal entry 3 months into medical school, sort of a progress report i never quite got around to posting….new update coming soon….For now, I’ll just say—YAY! Going back to Brazil and then to South Africa this summer! Details to come on those two events, as well….suffice it to say that I’m ecstatic!

Nov. 5, 2004 What kind of doctor do I want to be? Being in medical school has been an experience so far. We’ve muddled through hours in anatomy lab, log hours in the case rooms and library, and of course the obligatory celebrations following a long test (hopefully) well done. The 134 of us in my first year class at PSUCOM spend the better part of our lives locked up in well-lit rooms, shivering in the artificial air trying to convince ourselves to power through another hour of the subject du jour. Looking at us from the outside, we must be quite a sight, marching en masse between lecture hall and cadaver lab, slamming shut our teeny yellow, anatomy lockers and surreptitiously changing in the hallway into gumby-green scrubs before snapping on gloves and heading up to the partially dissected human bodies three floors above. As we run up the steps (we’re not allowed to take the elevator because the administration doesn’t like the smell), and race into the laboratory to vie for the attention of professors carefully navigating us through the body parts, our eagerness is probably a little disturbing. And during exams, as we dutifully rotate through the 25 bodies (2 people per body) to the beep of an alarm that sounds every 90s, prodding and poking in an attempt to identify the tagged structures, it is perhaps an odd dance, but one that has been well worn by our predeceesors in medical community.

When I first arrived at medical school, fresh from my year abroad, the entire “experience” of it all really surprised me…in an email to a friend, I wrote the following:

“It’s interesting- when you interview for medical school, people always ask you why you want to attend medical school and so many of us answer having translated the question into, ‘why do you want to be a doctor?’ Medical school, however, is more than just learning to practice medicine, to helping people. It’s four years dedicated to transforming you- all young, unprofessional, idealistic you- into a physician, someone who attacks problems in certain ways, looks at people in certain ways, treats information in certain ways, has dissected a dead human being. As one doctor joked yesterday, ‘you will be processed like sausages by the end of this!’ They constantly refer to the “community and brotherhood of doctors” that we have recently joined through our commencement of medical school, and even talk about the price of initiation (tuition and long hours of cadavers and libraries). We will be ‘doctors,’ and it’s more than a profession; it’s an identity. I think that when I was in frosh and sophomore year of college, I found a lot of comfort in that, in not having to figure out who I was right away because I would have an identity through my profession. I’m not sure when exactly that changed, though I guess it must of been before senior year of college because I was already a little frightened of going into medicine then. Somewhere along the line, though, I think that’s the part that’s started to scare me most- losing my identity. It’s one thing to become a physician with the skills and experiences involved, but I entered medicine as the person I am now with the reasons I have now and I’m a little worried that if I turn out like many of the doctors I’ve seen this year, I’m not sure how I’m going to be happy- and almost scared of the person I would be if I was happy that way. I don’t even think I’m that mutable a person, but who knows….I’ve met so many people that have changed their entire value systems during their twenties and thirties.”

Looking back now, three months into this endeavor, I’m happy to say that I haven’t lost any of the passions I developed while on my year away. In fact, I think that this time has truly reaffirmed to me not only that I want to become a physician, but why this is the right path for my life, and most likely will continue to be. What I have realized, though, is an idea of a completely different stream—as I observe my peers in our matching green scrubs at work, it strikes me how diverse we, in reality, are. Medicine means so many varied and even conflicting things to each individual who pursues it, and even the seemingly innocuous “Why do you want to be a doctor?” is a question fraught with personal priorities and expectations– quite in contrast of the perfunctory, “To help people,” with which most prospective students dutifully respond. I was worried about losing myself, but I’m realizing how unlikely it is that this will happen–and that if it does, it’ll likely be with good reason. For now, I’m happy to have reaffirmed my rationale for being here, and to have begun to find a community in which to maintain my passion for my dreams–and to be finally done with anatomy!

http://www.npr.org/templates/story/story.php?storyId=4512366

Safety of Medical Residents’ Long Hours Questioned
by Rachel Gotbaum

Summary of Findings from the Harvard Work Hours, Health and Safety
Group:

– Average number of consecutive hours worked by interns in 2002-2003
on extended-duration shifts: 32 consecutive hours*

– Average number of hours worked per week in 2002-2003: 70.7 hours**

– When interns drove home from an extended (longer than 24-hour) work
shift, their odds of a motor vehicle crash were 2.3 times greater than
when the same interns commuted from work after a shift that, on
average, was less than 12 hours long. Interns’ odds of a near-miss
crash (in which bodily harm or property damage were narrowly avoided)
were increased nearly six fold after an extended-duration work shift.

– In a prospective analysis during the 2002-2003 academic year, every
extended work shift that was scheduled in a month increased the
monthly risk of a motor vehicle crash during the commute from work by
16.2 percent. (The new ACGME regulations allow eight 30-hour shifts to
be worked per month.)

– In months in which interns worked five or more extended shifts,
their odds of falling asleep while driving were 2.39 times greater;
their odds of falling asleep while stopped in traffic were 3.69 times
greater than in months when they did not work extended shifts.

– Interns were awake 96 percent of their work time in U.S. hospitals
during the 2002-2003 academic year. They reported that their patient
workload did not allow them to make much use of the “on-call” rooms
that hospitals provide for them to sleep.

February 27, 2005
NYTimes
EDITORIAL
Thousands Died in Africa Yesterday

When a once-in-a-century natural disaster swept away the lives of more than 100,000 poor Asians last December, the developed world opened its hearts and its checkbooks. Yet when it comes to Africa, where hundreds of thousands of
poor men, women and children die needlessly each year from preventable diseases, or unnatural disasters like civil wars, much of the developed world seems to have a heart of stone.

Not every African state is failing. Most are not. But the continent’s most troubled regions - including Somalia and Sudan in the east, Congo in the center, Zimbabwe in the south and Ivory Coast, Liberia and Sierra Leone in the west - challenge not only our common humanity, but global security as well. The lethal combination of corrupt or destructive leaders, porous and unmonitored borders and rootless or hopeless young men has made some of these regions
incubators of international terrorism and contagious diseases like AIDS. Others are sanctuaries for swindlers and drug traffickers whose victims can be found throughout the world.

In many of these places, poverty and unemployment and the desperation they spawn leave young men vulnerable to the lure of terrorist organizations, which, beyond offering two meals a day, also provide a target to vent their anger at rich societies, which they are led to believe view them with condescension and treat them with contempt. Training camps for Islamic extremists are now thought to be sprouting like anthills on the savanna.

“America is committed not only to the campaign against terrorism in a military sense, but the campaign against poverty, the campaign against illiteracy and ignorance.” Former Secretary of State Colin Powell said that. Well, America launched its war on terror after Sept. 11, but did not bother to look at some of the deeper causes of global instability. This country is going to spend more than $400 billion on the military this year, and another $100 billion or so for military operations in Iraq and Afghanistan. But that amount is never going tobuy Americans peace if the government continues to spend an anemic $16 billion- the Pentagon budget is 25 times that size - in foreign aid that addresses the plight of the poorest of the world’s poor.

For decades, most Americans either have preferred not to hear about these problems, or, blanching at the scope of the human tragedy, have thrown up their hands. But in terms of the kind of money the West thinks nothing of spending,
on such things as sports and entertainment extravaganzas, not to speak of defense budgets, meeting many of Africa’s most urgent needs seems shockingly affordable. What has been missing is the political will.

This year, there is a real chance of scrounging up, and then mobilizing, this political will. Prime Minister Tony Blair of Britain, who has stood resolutely by President Bush at Mr. Blair’s own political peril through the war in Iraq, has staked Britain’s presidency of the Group of 8 industrial nations this year on tackling poverty in Africa. Mr. Blair wants his ally, Mr. Bush, to stand beside him at the coming G-8 summit meeting at Gleneagles in Scotland this July. After the G-8 meeting there will be a United Nations summit meeting in New York in September, where the world’s leaders will examine progress made toward reaching the Millennium Development Goals of cutting global poverty in half by 2015. Chief among those goals was that developed countries like America, Britain and France would work toward giving 0.7 percent of their national incomes for development aid for poor countries.

If the progress made so far is any guide, it is going to be a short meeting. While Britain is about halfway to the goal, at 0.34 percent, and France is at 0.41 percent, America remains near rock bottom, at 0.18 percent. Undoubtedly, President Bush will point to his Millennium Challenge Account when he attends the summit meeting. He will be correct in saying that his administration has given more annually in foreign aid than the Clinton administration in sheer dollars. His Millennium Challenge Account was supposed to increase United States assistance to poor countries that are committed to policies promoting
development. This is a worthy endeavor, but it has three big problems.

First, neither the administration nor Congress has come anywhere close to financing the program fully. Second, the program, announced back in 2002, has yet to disburse a single dollar.

Most important, relying mostly on programs like the Millennium Challenge Account, which tie foreign aid to good governance, condemns millions of Africans who have dreadful governments (Liberia, Congo, Ivory Coast) or no government (Somalia) to die. No donor nation is, or should be, willing to direct money to despotic, thieving or incompetent governments likely to misspend it or divert it to the personal bank accounts of their leaders. Strict international criteria of political accountability, financial transparency and development-friendly social and economic policies need to be established and enforced, not just by outside donors but by prominent and influential African leaders, like South Africa’s president, Thabo Mbeki.

Help for people living under governments that fail these criteria will have to be channeled mainly through international and nongovernmental organizations. Bypassed governments will not like this, but they cannot be allowed to stand in the way of outside help to the victims of their misrule. It is not the fault of Africa’s millions of refugees that warring armies have burned their villages and fields and driven them into unsafe and disease-ridden camps, like those in the Darfur region of Sudan. And no fair-minded person would blame the victims of callous and destructive governments, like Zimbabwe’s, for the economic and
social misery they create.

In the next few months, Mr. Bush could take a giant step towards altering the way the world views America by joining Mr. Blair in pushing for more help in Africa. It’s past time; the continent is dying. In the Democratic Republic of Congo, which is anything but, some 1,000 people die every day of preventable diseases like malaria and diarrhea. That’s the equivalent of a tsunami every five months, in that one country alone. Throughout the continent of Africa, thousands of people die needlessly every day from diseases like AIDS, tuberculosis and malaria.

One hundred years ago, before we had the medical know-how to eradicate these illnesses, this might have been acceptable. But we are the first generation able to afford to end poverty and the diseases it spawns. It’s past time we step up to the plate. We are all responsible for choosing to view the tsunami victims in Southeast Asia as more deserving of our help than the malaria
victims in Africa. Jeffrey Sachs, the economist who heads the United Nations’ Millennium Development Project to end global poverty, rightly takes issue with the press in his book “The End of Poverty”: “Every morning,” Mr. Sachs writes, “our newspapers could report, ‘More than 20,000 people perished yesterday of extreme poverty.’ ”

So, on this page, we’d like to make a first step.

Yesterday, more than 20,000 people perished of extreme poverty.

A Path to Cheaper AIDS Drugs for Poor Nations

Excerpts: “The Food and Drug Administration has approved the first generic triple-therapy AIDS cocktail, opening the way for American taxpayer dollars to be used to buy cheaper medicines for use in poor countries.

Assuming the drugs made by the approved company, Aspen Pharmacare of South Africa, are priced at a third to a half of brand-name ones, charities and poor nations getting Bush administration money will be able to treat two or three times as many patients. ”

“Dr. Paul Zeitz, director of the Global AIDS Alliance, which pushes for cheaper AIDS drugs and frequently criticizes the administration, said that the approval was “a step in the right direction,” but that he was “waiting to see if this is going to open the door to all the drugs that are needed, or if it is just a token gesture.”"

ok, so still some reservations on the ethics of insisting that FDA approval is necessary when WHO pre-qualification standards are essentially the same as the FDA’s, and still wondering what this means for other drugs, but this is incredible news for now….

the story

I spent much of my time in Brazil living in Porto Alegre, a southern Brazilian city known for being progressive and hospitable. The first World Social Forum was held there, and when I was there, the woman I lived with, among others, eagerly shared books on microcredit and other ideas with me from the talks she attended at the Forum. I don’t know how many of you read my final posting on Lula and Brazil, but the reality quoted below still makes me sad…especially when you think that the last time the forum was there, Arundhati Roy marked the occasion by saying, “Another world is not only possible; she is on her way. On a quiet day, I can hear her breathing.” Those words particularly resonated with the Brazilians who had just elected a president that was not only supposed to represent the people, but to many embodied the people. I suppose the last few posts have demonstrated the idealism and naivete that are still a part of me, even after the time I’ve spent away…and perhaps my belief in Roy’s quote does as well, but I do still believe….

“So many people thought that Lula’s election meant change was on its way, but instead we’ve been disappointed,” said Francisco Whitaker, one the founders of the forum and a member of the Brazilian Commission for Justice and Peace, a nonprofit group linked to the Roman Catholic church.

“It’s sad, but the big lesson that we learned from these last two years is that it is an illusion to think you can change the world by taking political power,” he added.

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Antiglobalization Gathering in Brazil Sees Little to Celebrate

PORTO ALEGRE, Brazil, Jan. 25 - The last time this prosperous city in southern Brazil was host to the World Social Forum, an annual gathering of antiglobalization activists organized as an alternative to the World Economic Forum in Davos, Switzerland, the mood was jubilant.

That was 2003, and Luiz Inácio Lula da Silva, a former metalworker and union leader, had just been sworn in as Brazil’s first working-class president, fueling hopes on the left that the new government would break from mainstream economics and spend heavily to ameliorate the country’s vast social disparities. For many of the globalization critics that flocked here at the time, Mr. da Silva’s administration was to be a shining example of how a left-wing government could buck the capitalist establishment and get away with it.

But two years later, as the World Social Forum returns to its original setting in Porto Alegre after a sojourn in India, the mood is more somber. Instead of steering Brazil off its free-market course, Mr. da Silva has embraced the so-called neoliberal economic policies that he so harshly criticized while in the opposition. And while that stance has won the president fans on Wall Street, it has put him at odds with the far left of his own Workers’ Party and with many of the founders of the social forum, which is to open here on Wednesday.

“So many people thought that Lula’s election meant change was on its way, but instead we’ve been disappointed,” said Francisco Whitaker, one the founders of the forum and a member of the Brazilian Commission for Justice and Peace, a nonprofit group linked to the Roman Catholic church.

“It’s sad, but the big lesson that we learned from these last two years is that it is an illusion to think you can change the world by taking political power,” he added.

Whereas in previous social forums Mr. da Silva was cheered like a rock star, at this one he will be the subject of academic debate. In the six-day event, delegates will participate in panel discussions with titles like “The neoliberal reforms of the Lula government,” “The Lula government and the future of the left,” and “Two years of Lula: where we were, where we are, and where we are going.”

Well aware that the economic course that he has charted does not sit well with his old cronies on the left, Mr. da Silva had initially planned to skip this year’s event to accept an invitation to the World Economic Forum, where he hopes to persuade foreign investors to help finance much-needed infrastructure projects in Brazil. But the president reconsidered at the urging of his advisers, who argued that such a move would only irk his longtime supporters even more, and he is scheduled to speak here on Thursday at a seminar on poverty and hunger before heading to the Swiss Alps for the economic forum.

Still, there is no guarantee that Mr. da Silva will be the crowd pleaser here that he was in the past. In October, the president angered the forum’s organizing committee when he said in a speech that the event should focus on “one or two” specific issues or run the risk of “becoming a bazaar of ideological products, where everyone buys and sells whatever they feel like.”

“That kind of criticism was totally out of line,” said Emir Sader, a member of the forum’s steering committee and a prominent left-wing intellectual. “The whole point of the forum is to discuss alternatives to the current world order, and that means discussing a variety of issues,” added Mr. Sader, who also directs a research center on public policy at Rio de Janeiro’s State University.

Mr. da Silva’s remarks also reverberated in the mayoral race in Porto Alegre, which was heading into a runoff vote at the time. Raul Pont, the candidate from the more radical wing of the Workers’ Party, had made the social forum a key part of his campaign platform, arguing that the event might no longer be held in Porto Alegre if another political party was elected. But by criticizing the forum in public, the president appeared to be taking sides with the opposition candidate, José Fogaça of the left-leaning Popular Socialist Party, who in the past disparagingly referred to the forum as an “ideological Disneyland.”

In the end, Mr. Fogaça and a coalition of center-right parties won the election, putting an end to the Workers’ Party’s 16-year reign over City Hall. Because the Workers’ Party had long been one of the forum’s main sponsors, Mr. Fogaça’s victory set off a fierce debate about the event’s future in Porto Alegre and even prompted some members of the steering committee to argue that the forum should be moved to another Brazilian city where the left remained in power. Hoping to seize on the chance to generate tourism revenue, officials in Fortaleza, Belo Horizonte and Salvador all quickly offered to be host to the event, which is expected to draw more than 100,000 visitors this year from all across the globe.

Once elected, Mr. Fogaça sought to mend fences with the forum’s organizing committee, saying that his government would fight to keep the event in Porto Alegre, a city of 1.5 million people. But Mr. Fogaça has also been careful to highlight his differences with the forum’s founding philosophy, stressing that his government will embrace globalization and seek to attract the multinational corporations that many of the forum’s participants so forcefully scorn.

“I, too, am one of those that still believes that there is a difference between the left and the right,” Mr. Fogaça said in an interview. “But I also believe that an elected official has to have the wisdom to know when to cross the line.”

For a left-wing politician, he added, that means knowing when to use “orthodox policies” to guarantee stability and generate economic prosperity. “Whoever doesn’t realize that doesn’t belong to the 21st century,” he said.

Media That Matters Probably some of the most inspirational stuff I’ve seen in a while, particularly the first two….

on the uninsured and what we can do

jeffrey sachs…the millenium development goals and ending poverty

(Health Professional) Student AIDS Advocacy Network retreat….

*note: not everyone i met expressed the opinions below; there was certainly quite a range, and almost always appreciation of some facet(s) of our country…and almost never were these opinions given in a hostile or threatening way, just critically. The vast majority of these opinions came from friends.

In today’s NYTimes, there’s an op-ed on President Bush’s inauguration, and more significantly on the world view on our country’s re-election of this man. Reading the opinions written by the author, I found myself nodding in agreement and even murmuring “yeah” and “exactly” to myself (it’s 2:30 am and I’m the only person in the library’s entire computer lab right now…so, i suppose the behavior is a little excusable!). Long ago (or so it seems…really about 18 months ago), I found myself in Switzerland working at the World Health Organization. As one might imagine, my co-workers in many cases were either (a) European (and thus particularly likely to be more left than the average American); (b) not American (and thus likely to be more left than the average American); (c) interested in health and human rights (and thus likely to be more left than the average American); or (d) some combination of the above. Suffice it to say that they were generally strong opposers of Bush and, in many cases, of Americans as a whole….variations on the theme of “I dislike America” included:

“I dislike America.”
“I dislike Americans.”
“America(ns) is/are selfish, materialistic and/or arrogant .”
“I dislike your country, but not the individual people–I love you!”
“I dislike your government.”
“I dislike Americans because they do not think about others. The whole world should get to vote in your elections.”
“I dislike your government, but I realize that people only have so much control over their governments and so I do not dislike you.”

Observation: The comments often strongly reflected the individual’s own background. For example, those in countries where people have a stronger influence on their government were much likelier to avoid the last phrasing and to select “I dislike Americans” as their argument of choice, often directly associating Americans with the then current American administration. However, people in countries such as India and Brazil, which are both embracing capitalism and addressing corruption in their own countries, almost always expressed themselves with the last phrase.

I’ve never been one to wave the flag of patriotism with much vigor, but after a number of rather sharp attacks on my American background and the country’s politics despite my openness about my own criticisms, defensiveness began to creep in… Rather than blindly defend our actions, however, I began to consider the actual matter at hand.

So…how to defend/explain away America/the American people’s selection of Bush and condoning of his behavior? Well, I tried several of the usual methods: the fear factor, the ignorance card (most Americans don’t pay attention beyond their own lives, let alone the lives of people by whom they may even feel threatened 1000’s of miles away–this encompasses lack of awareness, lack of depth of understanding and even lack of concern–depending on the day), the “big country/government with small individual [perception of] influence” theory…. in the end, I think I opted for a combination of the final explanation and the idea that we, the Americans, didn’t know what Bush would do. We hadn’t anticipated 9/11 upon electing him, and certainly not his response to the attack. I settled on this explanation, delivered in soothing, empathetic tones designed to both calm the inquirer and head off further discussion as well as to express my own sympathy to their frustration with my government’s actions. Perhaps surprisingly, it generally worked…particularly in countries like Brazil where the distinction between the government and its people is well understood.

Even more surprising, maybe, is that the explanation began to work on me, as well. The silent message to all of that was as follows: “just wait, we’ll redeem ourselves when we get a choice to express how we feel about the last four years–we’re good people and we agree!” In November, I had been home for approximately 3.5 months and for all of my efforts to support Kerry, I don’t think I ever changed my belief that we would right our wrong and elect Kerry. I believed that America would redeem itself. A few friends from abroad sent me emails half-jokingly commenting on how the Americans had better come through for the world, and that I’d better have done my part to ensure a Kerry victory, especially in my own home swing state of PA (yes, people abroad are aware of the intricacies of our election process), and I laughed, certain we would. When PA went blue, I nodded silently, “of course PA went blue,” despite the fact that where I attend medical school was very red…perhaps that should have been my first sign. When it all came down, I was stunned, much more so than those European/non-American/justice-seeking friends who had been suspicious of Americans all along. And instead of me being the one nodding knowingly, it was them, not just silently, but also vocally confirming their opinions of not only our country’s government, but of its people.

Perhaps a bit ineffectively, I sent apologies for the significance of the election (because, as the article’s writer says, it affects them as much as us–only they don’t get a say), but this time I didn’t offer explanation. I know I’m not anti-American…I know many of these people who turned the Hershey area red; they are friends, mentors, colleagues. They are not ignorant or materialistic or arrogant people. And perhaps for this reason, in my letters, I didn’t broach the topic which was so bothersome to me… less of how had I been so wrong about my fellow Americans– countless people have discussed this idea since well before the election even occurred– than of what being wrong means…

….thoughts for the next entry (for now, there’s an exam in 27 hours and I need to study… :-P)…

An interesting article…. commentary hopefully forthcoming…(exam on Friday, so I’m a bit busy this week).