Friday, December 5, 2008

food, choice, and the brain



I just discovered WNYC's Radiolab, which I can't believe I've never heard before. It is now tied for my favorite podcast with the BBC World Have Your Say, which I adore also. Podcasts: little joys of the world.

So the episode I caught was about choice, and how our brain manages to give us enough information to let us get through every day -- especially the cereal aisle. My friends know that choice is an especially sore spot with me. The whole episode is fascinating and provides enough interesting thought points for the next five or so dinner parties you might attend.

All of it is interesting, but the part I really love discusses the work of Baba Shiv, a professor at the Stanford School of Business (natch), who gave participants in a study either 2 or 7 digits to memorize. They were then instructed to walk down the hall, but were stopped before they got to the supposed second part of the experiment by someone offering them compensation for their participation -- either a slice of cake or a bowl of fruit. So, turned out that, consistently, the people with seven digits in their head took the cake. Those with two took the fruit. The reason, Shiv thinks, is that with the reasoning side of the brain occupied, people chose what looked tastiest to the emotional brain. Those with some extra space in their rational brains used it to make the healthier decision.

So now I know why I gain anywhere from 2-5 pounds during finals.

Wednesday, December 3, 2008

Answers (or: Zen and the Art of Medical School)

For better or worse, I took a personality assessment last year, as a participant in a study that another student in my program is doing. The test told me I'm an INTJ, which I like to refer to as the "evil mastermind phenotype." The description tells me that I look to put the world into logical frameworks (and am not so great on the personal relationship side of life -- oh well).

While, yes, this lends itself to scientific thought and exploration, it also produces some problems within the study of medicine. Because medical problem solving is all about finding the logic behind the mysery -- but when push comes to shove, something is still unexplained. I would much rather be the person writing the textbook than reading it, because the authors have the liberty to pick what they know and gloss over what they don't.

Scientific study continues with an aim towards explaining the unexplained, but there's also a point of complacency -- a point at which physicians seem content to know that a symptom is caused by a certain disease, and know which treatment works. How exactly the symptom occurs may never be explained, and may never need to be explained, practically speaking.

But for the med student, particularly one who craves answers, this is a continual source of frustration. The structural framework for explaining the disease is almost complete, but is missing a few blocks in one corner. You can drive yourself crazy looking for answers that you'll never find, or trying to reconcile contradictory theories.

So, apparently, there's an additional skill you need to learn in med school: learning when to give up. When to accept that the answers aren't there, and be at peace with the ambiguity. The first battle is with the material, and the second with the frustrated brain. For an INTJ, the second may be harder to win.

Wednesday, November 5, 2008

History and the Emergency Room

Someday my grandchildren will ask me what I was doing on the historic night when the United States elected its first African American president, and I will tell them I was sitting in the Alta Bates emergency room.

Here's what happened:

Yesterday evening, I was staffing our student-run medical clinic, run out of a local church. We keep our medications in two big hardware carts. The drawers are labeled and the meds always have some degree of organization, but the staff rotates and the clinic is always chaotic, so there's often a bit of a scramble to find what's needed and see if it's within the expiration date and functional. Near the end of our clinic session -- when the election had already been called and the streets of Berkeley were erupting with celebration! -- a client with risk factors and possible symptoms of diabetes came in. We rifled around in the drawers and tried to find the equipment to take his blood sugar. I picked up a device that looked promising, started to open it to load it with a lancet... and felt a twinge of pain as the already-loaded lancet stuck me in the left index finger.

There's a strange moment when your mind moves from the mundane -- does this gadget work? Which strips do we use with it? -- to the profound, which, in this case, was, "have I just done something that could endanger my life?" Dumbstruck for a few minutes, I then picked up my bag and walked to the ER.

Where I waited for about 1.5 hours until the doctor saw me, asked questions about the needle and the exposure, and finally decided I was so low-risk I didn't need any post-exposure prophyllaxis. But they did take my blood for testing now and instruct me to come back for follow-up in a few months. Overall I was calmed, glad for the experience to be on the other side of the door, and totally grateful to my two classmates who stayed there with me until midnight. If you're going to spend a historic night sitting in an ER, it's best to have company.

Saturday, October 4, 2008

Call it

I saw my first patient pronounced dead today. He probably came into the ER dead already, so I might not have witnessed him die. But I did get a very unsteady feeling as I heard the resident who'd been giving orders say the words, "Time of death: 2:31 PM." The resident was impressively poised and calm as he shouted tasks to the group of students, interns, and nurses (the attending was in the room but remaining hands-off). But even he was visibly shaken as he had to pronounce a human being dead, and, as I stuck around to listen, call the coroner.

Earlier in the day, the patient's son had taken him out from his residence for a hamburger. It turned out that the patient was on a puree-only diet, and the hamburger directly precipitated his death.

"Wow," one of the nurses commented, "that son is sure gonna feel guilty."

Or, I wondered, did he know exactly what he was doing? Did he and his father talk about the emptiness of a life of institutions and puree? Did they decide a hamburger would be the perfect way to go?

Doctors don't get to know the answers to these questions.

Sunday, September 21, 2008

Shared Histories, National Cultures

I've been really fascinated by the idea of shared cultural heritage for awhile. Culture is, of course, always interesting, but culture in general more often connotes an age-old (albeit changing) model of thinking and acting. The idea that I keep turning over in my head is personal history and how that shapes regional culture.

For example, my close college friends, all Californians, and I, an East Coaster, have had several conversations about the '89 earthquake. They can all name where they were and what they were doing when it hit, and their feelings and fears that loved ones might be affected. I can vaguely remember hearing about a big earthquake and thinking it had something to do with the World Series that year, but it didn't play a big role in my childhood.

Or, there's this cartoon:

I know I will always remember the moment when I learned what had been done to the World Trade Center and the people within them, and how the world changed for me after that. But a whole generation of younger people is growing up without that moment in its history; and it is probably wondering what the big deal is.

I was comparing Peace Corps experiences last week with someone who had served in Armenia. He was telling me that Armenians are a chronically depressed people, and when I asked him about it, said he thought it had to do with the post-Soviet economic downturn associated with being instantly cut off from Moscow's support and resources. The country to this day hasn't recovered, leading to a national sadness and a difficult service for an optimistic American volunteer.

I spoke about Mozambique, about how although the people there are shockingly poor, they manage to stay happy. I told Mr. Armenia that I thought this was because of the disasters -- man-made and natural -- that Mozambicans are constantly having to deal with. If they don't figure out how to pick their lives up and go on, they won't survive. So they've developed an incredible resiliency that, to the casual observer who doesn't prod about civil war or cyclone stories, seems like a happy-go-lucky attitude towards life.

So it occurred to me that most of the conflicts in the world arise because of differences in shared histories. And they continue because of our inability, or unwillingness, to see things from another perspective. Israelis, for example, are often portrayed by the American Left (I love you Left, don't get me wrong; but you'd be even better without the blinders) as cold and heartless. I agree that Israelis are tough, sometimes intimidatingly so; but they're tough because they have to be. They've witnessed suicide bombings near their neighborhood grocery stores; they've heard stories about gruesome murders on their local news stations; and they send their kids off to school on buses that could be hijacked. If they want to keep living day-to-day, they have to toughen up.

Palestinians, too, have personal histories which include having their rights stripped, hearing stories from their parents and grandparents about being driven from their land, and seeing walls put up to keep them out of economic and social opportunities.

It's not really fair to end this post just encouraging each side to see the others' perspective. That's a really difficult thing to do, when everything in your memory and everyone in your social sphere tells you otherwise. Maybe what I'm encouraging is that the rest of the world, those who would be mediating conflicts or sending aid, try to understand personal histories and the difficulties that can accompany them. Before we label Armenians as sad-sacks, Mozambicans as stupidly happy, Israelis as bellicose or Palestinians as uppity, we need to try to incorporate into our thoughts a sort of international empathy.

Sunday, September 7, 2008

Triage

One of my favorite aspects of getting a medical education is how medical concepts and images seep into everyday thought and parlance. So, for example, exposed wiring at the base of a telephone poll begins to look like the brachial plexus. Or the sites of complicated road intersections can only be described as anastomoses.

My current imported concept is triage, which is mostly about prioritization, but connotes a sense of urgency, of impending disaster if not executed correctly.


Triage is becoming my mantra because I have a sense that the world could implode very soon. As faceless stormtroopers crush protests at the RNC and journalists are crushed to the ground screaming, our possible next vice president seems to be fond of burning books, and Roe v. Wade seems more threatened with every passing moment, choosing how to spend one's time is of the utmost importance.

In that vein, today I took an hour to phonebank for Obama. There are countless ways to spend your time, many of them worthwhile and productive. But to me, this is what is urgent now. If this election is lost -- the patient's death, by my analogy -- I don't want to know that I didn't do everything I could to save it.

Monday, August 11, 2008

Dessert with no dinner

The way HIV/AIDS-related programs are executed in Mozambique often reminds me of the episode of M*A*S*H in which Major Winchester donates gourmet chocolate to the Korean orphanage, only to learn that the head of the orphanage has traded the stuff on the black market for food staples like rice and beans. "Forgive me," he says, when he's realized his mistake. "I have given dessert to children who have had no dinner."

You'll see what I mean when you read this. When the magnitude of the HIV/AIDS epidemic became known, the international community flocked to the aid of affected countries, pouring money into programs for prevention, treatment, and impact mitigation. This is most definitely a good thing: helping sick people, and preventing people from getting sick, is a valid goal, particularly in the case of AIDS, which affects people of the age who otherwise would be earning money for their families and taking care of children.

But whether it's because of these ties to economic development; or because of the threat of AIDS spreading from Africa to our own safe and cozy homelands; or because of the ability of this disease to capture the imaginations and hearts of donors, AIDS has unfairly taken top priority on the international aid agenda. It's not uncommon to visit a hospital in which the beautiful, new areas dedicated to AIDS care sit beside the other wards, which are overcrowded, crumbling, and understaffed. Or, teenagers' curricula on STIs and sexual health, often NGO-run, are fine-tuned based on international best-practices -- but the students have had no adequate preparation in areas like the germ theory of disease or population biology, which are essential to their understanding HIV's transmission and spread through populations.

Or, like in the article linked to above, people with inadequate nutritional intake are given expensive and potent medications to treat their illness. I work in HIV/AIDS research, and I believe that it is indeed an international emergency. But we in the international development, research, and health communities need to ensure that dinner is provided before dessert.

Friday, August 8, 2008

Validation; or, The Next Level

It might be that it's Friday night, and that I get to hang out with some old Peace Corps friends later, and that I get to spend some lazy, pampered days in New York soon, but I'm happy right now.

I had an extremely validating conference call this afternoon. For the past two weeks or so I've been poking away at my computer, forcing myself to generate code that might work to turn out numbers that might be vaguely relevant or useful or correct. If this sounds like the wrong way to do research, welcome to data triangulation. We look at lots of numbers and try to pull out something meaningful from them.

Problem is, I've never been trained in triangulation -- I'd never even heard the word in this context before my first meeting with my thesis advisor. I figured someone would clearly explain to me how the process works in time for me to present the findings of said triangulation to a high-level group of researchers here.

So far nothing has become a whole lot clearer, and I'm on my own for the presentation, which is next week. The main higher-up on the project, though, R, always seems to have something in his head. He's said several times that we'll need to "take it to The Next Level" with the help of analysts at UCSF, which drives me crazy because this project, as my master's thesis, should mostly be done by me. Which is why it was so nice to speak to said analysts today, in a call that R missed, and learn that "The Next Level" appears to be a nebulous area existing only in R's head. The first few minutes of the call went something like this:

UCSF: "So, did you and R get a chance to talk on Wednesday?"
Me: "Yeah, we went over some scheduling issues and he gave me some tips for the presentation, but I was hoping he'd be on this call. He wants your help in taking it to the Next Level."
UCSF: "Yeah, so about that Next Level... do you have any idea what he's taking about? Because, the level you're at now... that's about the level we can work at."

Which is so great to hear. Because after 2 weeks of battling it out with Stata (and constantly checking friends' blogs and celebrity blogs), it seems that maybe I do have good instincts in this whole data analysis thing. Not that a trained professional couldn't do it 10 times faster, but I think I'm coming out with about the same results that an MPH on the project might, via the same logical routes that my thoughts have been taking over the past 2 weeks. I may not have the organization or confidence or refinement of a seasoned professional, but at least I feel that I could someday.

So I'll let you know when I've reached The Next Level, but for now I'm happy on this one.

Thursday, August 7, 2008

Procrastination, the brain, and celebrity fluff

So it's down to the wire in my time spent working in Mozambique, and all I can do is watch bad romantic comedies and compulsively update my useless celebrity expertise on perezhilton.com. What I should be doing, and what I can press myself to do for vast, uh, minutes on end, is analyzing the 9 datasets that make up the material of the triangulation project. But it seems that my brain has become overwhelmed. With each passing day spent staring at the computer screen, my fingers are getting clumsier, my mind slower, and my capacity for concentration shorter.

I put a romantic comedy on as I fell asleep last night, because my brain's craving for them is like a late-night ice cream craving. There was a moment when I drifted off to sleep and was only conscious of a stream of numbers.... 40.0, 11.1, 12.5 -- of the type I'd been endlessly keying into an excel spreadsheet earlier that day. The number streams seem to be causing stress on my neuronal connections, causing these poor cells to beg for Jennifer Aniston and her sister's wedding. I've even started watching the second-rate American shows that a Brazilian channel here broadcasts; shows I had never heard of and would never watch in the States, but which make it here maybe because of low syndication fees, because they give my mind the idiocy fix it needs.

I've never had such severe concentration problems, but then again I've never required such heavy, numbers-oriented concentration before. Another problem may be that I'm on my own with the work here, and I'm never sure if what I'm doing is productive or even correct. So there's probably some fear of failure mixed in with the cognitive overload, conspiring to put my mental output at about zero. I don't know whether to push on or give in and raid my roommate's DVD collection.

Monday, July 28, 2008

Onde está a coração

Yesterday I went to another home -- I think I've probably blogged about at least two other "homes" by now. This home is where I stayed during my two month-long Peace Corps training: a cozy, woman-headed household in a little town about 45 minutes outside of Maputo.

It's remarkable how much it did feel like home: the kids ran out to greet me, my mom scolded me for not keeping in better touch and told me I should get married soon, and I was fed a big, greasy plate of spaghetti. I had brought a lot of toys for the kids, so we all played in the yard after lunch and got our hands covered in the red dirt that characterizes the village. I let the kids take some pictures with my camera, which they couldn't get enough of. They were too excited and impatient to learn the rules well, so there are a lot of pictures of torsos with no heads and ground with no figures, but there are a few that are surprisingly poignant. Here are 3 of mine followed by 2 of theirs.


In case you were trying to figure it out, frisbees, Silly Putty, and harmonicas all make great gifts for rural African kids. Trust me on this.



Mozambican girl plays frisbee: the dream realized!





Saturday, July 19, 2008

+ Jovem!



A colleague at the National AIDS Council invited me to his TV show, a talk show for youth, because this week's show would be about multiple concurrent partnerships -- the topic of my current research. Fantastic! I thought -- though I made sure he meant *in the audience* and not *as a guest speaker* before I accepted. Him being what I thought was your average beaurocrat, I assumed "+ Jovem" was a toned-down, government-run show. I was envisioning Charlie Rose set in Mozambique and focused on HIV/AIDS, with a live audience who would get the chance to ask some questions.

Well. So last night we arrived at the studio, I and a colleague from UNAIDS whom I had invited. The guard waved us in the front door, past a long line of young people; VIP treatment! A few other production aids walked us through the halls to the set, where we climbed onto the risers where the audience was seated. The youth started rolling in, raucus and excited, many dressed to the nines for their opportunity to be seen on TV. Jorge, the National AIDS council beaurocrat/TV host, started describing to all of us how the show would go. The special invited guests were the second-in-command at the National AIDS Council, and a representative from N'weti, an HIV/AIDS communication-oriented organization. There was also a woman from the Ministry of Health who would make a plug for a good hygiene campaign that was to start the following week. And, a DJ and a rap group... and two groups of Marrabenta singers... and another duo of scantily-clad female singers... and there would be T-shirts given out, and there was a large display of "Klin" detergent and two girls wearing Klin t-shirts which would have some camera time as a sponsorship deal. So, as with all things Mozambican, there were surprises, there was chaos, there were things happening which it was better to just take in and not question.

The show started with Jorge and a group of guys wearing sparkly blue vests doing a little choreographed dance, which completely cracked me up. Imagine yourself meeting a work colleague to discuss contacts and resources useful to your project. Then imagine that same colleague, a few days later, breakin' it down with a posse of sparkly-vested dancers. Classic.

The HIV-related conversation wasn't fantastic, especially because of the straight-laced, academic tack taken by the interviewees. The kids in the audience were more concerned with gossiping with each other and sending text messages. But they did have a chance to share their thoughts about multiple partnerships -- always poorly defined, but in their context meaning having more than one boy- or girlfriend at once -- and they seemed to be getting into it. I hoped the youth watching at home would have similar conversations with their families and friends.

One of Jorge's assistant approached my UNAIDS colleague, Katia, and I, and told us we would be asked questions. Despite our impassioned protests to not have to speak on national TV, Jorge insisted. Katia almost forgot the name of the special guest, but pulled it together to make a point about how we are trying to bring what have been private conversations into a public debate in order to confront the HIV emergency in Mozambique. Then the question came to me, as a foreigner, what were my impressions of what was going on here with all of these multiple partnerships?

Putting the question like that, there was really one answer I could give: Well, this isn't just Mozambique, and it isn't just Africa. It happens everywhere in the world, and it's a problem that the global community will have to tackle together. Despite this being the in-vogue theory as to why AIDS has taken such a hold on Africa (previous theories being unsafe blood supply and high rates of STDs), I do believe it happens everywhere, and, moreover, I believe it creates a culture of inferiority when the debate is framed as, "what is wrong with these Africans?" I've already met a sort of cultural defeatism when, as a Peace Corps volunteer, I told people that I had friends who were virgins at 23 because of their strongly-held beliefs. The answer I got was, "Well, maybe in America you can do that. Here, among us Mozambicans, it's not possible."

So, that's the story of my 15 minutes of fame in Mozambique. A statement about global unity on + Jovem, and I think the Portuguese grammatical errors were minimal!

Tuesday, July 15, 2008

I was a lonely teenage broncin' buck....



These were anonymously left at my doorstep last night... Thing is, there are three women living in my house, and none of us has any idea who they might be from. At least it provides us with some entertainment.

Points if you can sing the line following the title!

Thursday, July 10, 2008

Update: spontanous cure!

Good news: As of this morning, my phone is demonstrating complete, spontaneous cure! All the names are coming back. Phew. Old age will be put off for awhile yet. No word as to what triggered it, but perhaps it was the certainty of knowing its diagnosis. :)

And, just to make sure I haven't offended anyone, this wasn't meant to trivialize dementia, which is no doubt an extremely difficult thing to deal with for patients and their families and loved ones. It was more to demonstrate how warped a med student's view of the world is, when she looks at a phone and thinks neurology.

Wednesday, July 9, 2008

Diagnosing

I guess you know you're a med student when it's all about the diagnosis. Lately I've been trying to diagnose everything: I diagnosed my roommate's ear pain (bacterial otitis media resulting from URI), my cold (mostly URI symptoms with some GI -- I think it was a coronavirus), my everlasting psychological angst (still up in the air).

Today I found myself diagnosing my phone. I guess the case presentation would go something like this:

7 y.o. phone presents with lack of memory recall. Symptoms appearing gradually over the last week, easily noticeable to owner. No significant past medical history, aside from some possibly damaging drops on the ground. Family history unknown (any registered problems with basic Nokias?). Memory recall impaired only when calls or messages appear, in which case number is correct but appropriate name not matched. Name appears without problems in stored list.

Diagnosis: phone seems to be experiencing declining memory consistent with dementia. Oh, my poor phone.

Friday, July 4, 2008

Development ideals and master's theses

Earlier this week on a conference call, my co-investigator on the project we're working on shocked me into embarassment. He spoke of the importance of involving the National AIDS Council in all steps of our project, adding that we should avoid conference calls from Americans to Americans -- calls like, well, the one that was taking place right then.

The reason this embarassed me so much was that I had been totally preoccupied with fighting for my own place in this project. As a student, it's hard to have one's voice heard against those with more experience, more letters after their names, and more publications under their belts. I never wanted to carry out a project on my own, because, let's face it, those letters and publications do mean something, and whatever project I worked on singlehandedly would be bound for disaster.

But I didn't want to end up anyone's research assistant, either. With so many high-profile scientists on the project, I could picture myself relegated to a position as someone's errand-runner, reporting back every day, until my job was done and the real, higher-level analysis fell onto someone else's plate. So I'd begun to assert myself, to think of the project as "mine", to plan out the next steps quickly so that I could retain some control.

The problem was, any project that has as its goal improvements in the health or well-being of a population really should belong to that population, and not to some ambitious master's student. In my determination to make this project "mine", I'd lost sight of the fact that the problem, its study, and its eventual solution, is all theirs. This project belongs to the people of Mozambique, and to claim otherwise is to do the Mozambican people, and the entire ideal of international development, a huge disservice. If any interventions, and the research they are based on, are to be successful, they must come from within.

And so I am learning to be at peace with a master's project that has two levels: one, the research itself, which I am aiding in the execution of; and the other the process of working with individuals within governmental and non-governmental institutions, of understanding people's concerns and interests and finding solutions together. It is both a great challenge to find the time and energy to work with others on their terms, and a relief to know that the burden of this research is not on my shoulders alone. I am learning to love my role as consultant to Mozambique, and whatever happens with the research, I know there will be good stories to tell at the end of the process.

Wednesday, July 2, 2008

Unbiased reporting?

Look closely at the pictures of the candidates in this story, published in one of the largest-circulation newspapers in the country, about Obama leading polls in a few key states.



If this were the NY Times, there would be international outcry. Seeing as this is Mozambique, the main implications were my roommates and I laughing about it in our kitchen.

What would grandpa say?

I couldn't resist this when I saw it in the grocery store.



My grandpa, a connoisseur of Jewish deli corned beef, would roll in his grave.

Thursday, June 26, 2008

Five reasons why I appreciate the Peace Corps

1. Being part of the community
My return to Mozambique as a researcher working on a national level has really brought home how unique the Peace Corps experience is. Living abroad isn't unique -- I meet expatriate foreign service members, aid and humanitarian workers, and some industry folks, every day. But the expatriate existence is nothing like being a community volunteer. As a volunteer, even if living with email and working in an office, you are a part of the community in which you live. Your friends are nationals, your recreation is sitting at the corner bar with your colleagues and sharing one of the 750 ml bottles of beer, or maybe gathering for a party in which all the women bustle about cooking fish stew and corn meal xima while the men sit on plastic chairs and talk. As a born outsider, you may never be able to completely fit in, but as a peace corps volunteer you come pretty close.

2. Experiencing poverty
Every person who is born into privilege should somehow experience poverty. Peace Corps volunteers aren't completely poor, as they have their medical and emergency expenses fully covered, but our salaries are pretty darn low. Below the lowest tax bracket low. And it's a powerful experience to walk down a street and know that most shops aren't accessible to you, and to find yourself making friends with people whose company you don't necessarily enjoy, just because they can provide you with fancy food or rides in their car. It goes a long way to understanding how people without means end up putting themselves in risky situations.

3. Being different
As a white person in rural Africa, I got stared at everywhere I went. Babies sometimes looked at me and began to cry. Children begged and yelled "mulungo", white person, every time I passed. Men gave me endless attention and quite a few marriage proposals. My male friends were always approached by women trying to marry off their daughters. Being so different starts to weigh down on you, and you begin to expect the worst from everyone. I'd never experienced this kind of overt prejudice, nor the hardening of spirit which is produces, living in the States -- although many do.

4. Comraderie
Every time I meet a Returned Peace Corps Volunteer (RPCV), I know we share much in common. Even the volunteers from different continents or working in different sectors can understand my experience, and I theirs. Having been in the Peace Corps is almost like being inducted into a secret society within which there are few rules but much good will. It is an automatic feeling of acceptance when I meet other RPCVs, and the sense that we could talk for a long time, sharing stories from our volunteer days.

5. Self-sufficiency
There is much I'm still learning about, well, everything. But being in a strange place, speaking a strange language, and dealing with completely unforseen ups-and-downs as a volunteer has given me a sense that I can generally handle things. There's a certain "wait-and-see" mantra that volunteers need to adopt if they are to do well at site, which has also served me well back at home and at school. If I don't know how to do something -- well, I'll figure it out. Or, I won't, and I'll see where that brings me.

Sunday, June 22, 2008

Sports, pride, and poverty



Sunday night of a football-filled weekend. Last night was the Russia-Holland match of the Euro Cup, a match which might have slipped by as one of the less important of the tournamet, if it weren't for the strong Dutch expat presence in Maputo. As it were, there was a rowdy, happy gathering of Dutch and others in one of the popular expat bars in the city, which I somehow stumbled onto. I don't watch soccer as a fan, but I do get caught up in the games when I watch with a dedicated crowd. And I have to say, the Dutch in their bright orange shirts won me over, and by the end of the game, an upset loss, I was almost as disappointed as the rest of them. I said almost.

Today, I had the opportunity to see a live game between the Mozambican national team, the Mambas, and the Madagascar team. Again, I had never watched a Mamba game before -- but it was impossible not to get swept up by the thousands of cheering, dancing, heckling, celebrating fans in the stadium. Here are some pictures:







Guys carrying Mozambican flags -- and dressed in Mozambican flags -- watch the band play the national anthem.




Goooool!




Peanuts!



The guards were carrying batons, guns, and gas masks. Good thing everything stayed calm.


The game made me so happy, as it clearly made everyone else so happy, that I got to thinking about sports and their importance in our lives. Sports bring out feelings in us that are basic and universal: pride, competitiveness, and comraderie. Athletes around the world, whether footballers in Mozambique or baseball players in the States, inspire these emotions in their fans.

Money, of course, can confer advantages, like fancy equipment and trainers. But an athlete is an athlete, a game is a game, and a fan is a fan. Sports provide an even playing field, as it were, for civic or national pride, and pride in the athleticism of men and women. In a place, like Mozambique, where it is hard to be carefree -- hard to forget about the difficulties facing life each day -- football provides a pure sense of pride and competition. Becoming enveloped in a game and infected by the enthusiasm of the crowd feels like freedom.

Friday, June 20, 2008

You can't go home again

(Fine, I'll admit it... this blog is driven 90% by fun titles.)

For the last few days I've been traveling up to Vilankulos, the town in Mozambique which I called home for two years. I was happy to come home to the States after my service ended, but ever since coming back here I've been dying to get back there.

I knew there would be some changes: about 6 months after I left, Vilankulos was hit by a devastating cyclone. The pictures my friends sent me almost drove me to tears, and probably would have, if they weren't accompanied by words representing the characteristic Mozambican attitude of, "Eh, we've been through worse and we'll get over this too". It's easy to underestimate this Mozambican resilience, especially before hearing the stories -- everyone has one -- from the civil war. But that's for another day.

In Vilankulos, there were indeed signs of the cyclone, even more disturbing because it is now a year-and-a-half later. The brand-new marketplace, almost finished when I left and functional for only a few months, was still roofless and empty. The hospital buildings that my organization worked hard to help the Ministry of Health erect also showed signs of enduring damage, and also weren't functioning normally. And, unrelated to the cyclone, the high school was holding classes in tents, because the public university had taken over half of the beautiful, new, World Bank-built structure that was supposed to be Vilankulos's new high school. I wondered, could someone just call the World Bank and let them know that their project was being so misused? Could I? "Hello, uh, World Bank...?"

Good things were apparent, too. A new bank and a cell phone store had sprung up near the center of town. A new market in one of the outer neighborhoods. New paint jobs, mostly the yellows and blues of the two leading cell phone companies, shined in the brutal midday sun of the tropics. But mostly, there was just the sense that people were continuing to live their lives. The buzz of the central market and the shuffle of the feet of women wearing colorful wrap skirts as they carried baskets on their heads and babies on their backs.

And for me, this was the saddest part. Life had moved on past me. My former colleagues greeted me with smiles, and we exchanged pleasantries and enquired about family members, before they moved on to their tasks at hand. Two new volunteers have replaced my sitemate and I, and their house has a familiar Peace-Corps-volunteers-live-here comfort. There are new babies, new relationships made, old ones broken. Life has moved on.

When I left Vilankulos this time around, yesterday, I didn't know if I'd ever return. I love the place. But what was once home no longer is; the home I have in my mind is not a place but a spot in time -- a time now past. I don't think I believed it before now, but you really can't go home again.

Thursday, June 19, 2008

Notes on the Underground


Five hours in London between flights, and I decided to ride The Tube. There really wouldn't be time for anything much beyond that, but wouldn't that make the trip worthwhile? Living the life of a London commuter, minding the gap with the best of them?


It was actually a little bit of fun, even if I did get some funny looks because the quaint voice of the announcer kept making me spontaneously smile. But the experience was also a little worrisome: the smallness of the Underground car couldn't help but make me realize that Londoners too, not just their modes of transportation, are smaller than we are.
Every time I ride the NYC subway, I become worried because of how large we've gotten: large enough that only a small percentage of riders seem to fit within the confines of one seat. Even with my sample size of 2 hours on the tube, it seems clear that Londoners are managing the challenges of life with supersized fast food and little time for exercise better than Americans.
Maybe if we shrink down our public transportation we'll force ourselves to shrink too...?

Tuesday, May 13, 2008

File under: depression, poetry, the Pacific Northwest

Patient: It's like it's always cloudy, always raining.
Me: Wow, that's a really poetic way of putting it.
Patient: Yeah, it's like... have you ever lived in Seattle? It's like that.

Finals

It's finals week, and I'm almost finished with my first year of medical school.

Do I feel any closer to being a physician? Sometimes I think yes: my vocabulary has changed such that I now refer to heart attacks as "MIs" and pulmonary embolisms as "PEs." I even shocked myself by using that last abbreviation in front of a patient, and not catching the mistake until maybe 20 seconds into the blank stare that I got in return.

But most of the time, no. The experience is still providing me with my weight in comedy gold, from all the newby-meets-the-medical-world flubs. Last week, when our suitcase clinic physician asked me to describe a patient's rash, I had several "rashy" words fly through my head -- pruritic! maculopapular! -- before I realized I didn't actually know their definitions and had no idea if they applied to our patient's rash. So I was left with: "Uh, it's red. And dry."

But I think I'm doing ok. Enough of the basis for understanding is there, such that I'm beginning to see how the diffrerential diagnosis process works -- even if I can't use it myself yet. More importantly, I'm still fascinated by it all, something which keeps me wanting to learn every day.

However, that doesn't actually mean I'm motivated to do the work I need to be doing. Finals week is an interesting thing: time ceases to have any meaning, day blends into night which blends into day again, and the real point of anything is totally lost sight of. It's a uniqueley academic thing -- although maybe analogous to armed combat, albeit on much lower level of unpleasantness. I don't think you can get PTSD from finals week, but I'm not positive.

Finals is also unique for its characteristic sine-wave of procrastination, which goes something like this: work hard for 2 hours, get bored and burnt out, waste time for 2 hours, panic that no work is getting done, work for 2 hours, and so on. Easy access to the internet has opened up new worlds of procrastination. Worlds which include emailing, chatting, watching videos, and, yes, blogging. Which reminds me: I really need to get back to work.

Tuesday, April 29, 2008

YouTube and Reproductive Health

The crazy world in which we live never ceases to amaze me.

Today in my reproductive health class we debated whether or not women should be granted asylum in the United States to be able to have abortions. It's a really interesting and nuanced question that involves not only issues of human rights and unsafe abortion, but the U.S. asylum process, historical precedents, and U.S. politics and public opinion. It was really a fascinating thing to be a part of.

Also fascinating was a mini-lecture afterwards from an ob-gyn working to expand abortion access. She spoke of two recent and completely mind-blowing initiatives: Women on Waves and Women on Web. Women on waves is a boat of professionals who bring on board women facing unwanted pregnancies in countries in which abortion is illegal -- and then sail into international waters to perform a medical (Mifepristone/Misoprostol) abortion (or to decide to continue the pregnancy after a counseling session). Women on Web is even crazier: women in countries where abortion is illegal can order, over the web, and from an anonymous source, misoprostol/mifepristone doses sufficient to abort the fetus. How do the women know how to use these medications, or when to seek help? Well, there's an instructional YouTube video.

YouTube, to me, is a time-waster, somewhere to go when I'm not thinking about anything serious. The idea that a woman could be relying on YouTube to ensure her health is, well, crazy. But in a crazy world, where all the official rhetoric touts a woman's individuality and the validity of human rights, and yet we get closer to overturning Roe v. Wade everyday, and women in the U.S. military are not allowed abortions, the solutions must be crazy too. People have an endless supply of ingenuity, and will use every resource at their command to address the problems with which they're faced. YouTube included.

Tuesday, April 1, 2008

Wouldn't it be nice

Sometimes I wish doctors didn't have to solve problems.

The patients I've had the opportunity to speak with are fascinating people. Really, everyone has interesting things beneath the surface, to be discovered if you ask. In a medical interview, the questions scrape the surface, but only barely. We hear about family and social support, difficult aspects of a life, and daily habits -- but only for a few seconds. Only what's especially relevant, and what there's time for.

Sometimes I would prefer to just sit and chat, without having to worry about getting at the medically relevant information. This is particularly true of the geriatric patients we see: a lifetime of stories, and all we hear is "I eat a balanced diet" and "I had a hard time when my sister died last year." I want to hear about the family, what they did for fun when they were kids in the 1920s and 30s, and which sister he was closest to.

Maybe this means I should consider psychiatry, if what I like about medicine is the sitting and chatting. Or maybe that means I have a naive view of what psychiatry is -- I'm sure the psychiatrists have their own vital data that they need to gather through leading questions. But at least there's more time to sit and talk.

Monday, March 10, 2008

Politics and Heartbreak

I have midterms to study for, but all I can think about is Eliot Spitzer. When I saw the headline, it felt like hearbreak.

What does it mean to believe in someone you've never met so much that finding out about his moral transgression breaks your heart? For one thing, it means I'm less jaded than I thought I was. Two years of working for the Federal Government and experiencing first-hand the egos, petty power struggles, and hierarchy systems; and another two of working in HIV prevention in Africa, seeing nothing work and hardly anyone notice or care. I thought I was rough enough around the edges. I must've been wrong.

It also says something about electoral politics. It says that through our elected officials, who operate in the public sector on behalf of us, we express our voices. We want to believe in what our representatives are saying and doing because it makes us believe that we can say and do those things. It makes us believe in humanity, and in our ability to come together as a community to build better lives for us and our children. And when one politician who has succeeded so spectacularly in affirming these beliefs falls from grace, it shatters our hopes.

Disillusionment with politics is nothing new. Richard Nixon infamously disillusioned an entire generation of voters. George W. Bush has done it again, more recently. But W. never represented half of the country, the half that voted blue and wore t-shirts with W.'s picture that proclaimed, "Not my President." Spitzer was the voice of the reformer, the underdog, the idealist. The person who believed the world could be different. Now he has let us all down; he has broken our hearts.

Tuesday, February 26, 2008

Reaching Out

This past Sunday, I volunteered at a blood pressure screening event organized by the Ethnic Health Institute (EHI), an outreach group associated with Alta Bates Summit Hospital. The first thing I came away with, after a long morning of measuring blood pressures at two large, African-American churches, was a complete love of outreach work. Some people whose pressures I took hadn't been to see a doctor in years. It's not that people aren't concerned about their health; it's just that they don't have the time, don't have the insurance coverage, or don't know the best way of navigating to HMO system to be able to see someone who can respond to their concerns in a respectful manner.

Which is where outreach comes in. In this revolutionary service, the health care providers go to the people, instead of the other way around. People who haven't been able to receive services suddenly find them stepping on their toes.

Outreach services have some added bonuses, which I discovered this weekend. One is that the sites where outreach services is delivered -- churches, in this case -- are much happier places than hospitals. I loved chatting with folks as they came out of church happy, talkative, and full of the music of their choirs. It also allows the providers a glimpse into the worlds of their clients. The biological world has intimate linkages to the psychosocial world, and any deeper understanding a physician can gain into this latter world will help her understand her patients' medical conditions.

Finally, I came away with a little excitement, and maybe some fear, at being looked at as a professional. I hadn't anticipated that, sitting on the other side of the table and wearing a name tag, I would be treated as an expert. People hung on every word I said, clutched the pamphlets I handed them, shook my hand. It made me think more about how I phrased my words and what I emphasized. It's not every day that someone listens to what I'm saying.

Wednesday, February 20, 2008

I got an A?

Yesterday, my patient gave me an A. My preceptor (the doc whom I shadow/help/learn from every few weeks) had left the room and given me the chance to interview the patient. On coming back, my preceptor asked the patient, conspiratorially, "So, how'd she do? An A-? B+?"

My patient, a lovely woman, and now one of my favorite people ever, gave me an A. Which, of course, made me really happy. It also has limited value, because I didn't actually have to produce any results -- the patient's treatment didn't depend on me, and the patient wasn't familiar enough with the history-taking process to know what questions I'd forgotten or not followed up on thoroughly enough.

But, I don't think it's meaningless. It says something (albeit small, I know, you don't have to remind me) about how I interact with patients. I actually do think I've gotten better at speaking with and listening to patients, at turning the "patient interview" into a "patient conversation."

But, a few minutes later, as my preceptor and I examined the patient's heart, I completely failed to hear what turned out to be a quite distinguishable heart murmur.

So, the point: medicine contains within it a huge set of skills, and a whole lot of information. It's so different from anything I've studied before because it has a well-defined end-point -- to be able to effectively treat patients -- and yet is so vast. A first-year who has improved in one area is likely miserable in a whole lot of others. And not only is it difficult to learn everything, but it's also hard to know how fast you should be learning. It's as if the "fire hose" that is medical school has created a puddle around you, and you're now trying to figure out if it's best to tread water or drink yourself to dry land. And how much you can drink at once without making yourself sick.

Tuesday, February 5, 2008

Our faces, ourselves

We recently had a basic clinical neurology lesson, in which we learned that the human face is among the most captivating objects with which to lure someone's eyes. When a patient is minimally responsive, moving your face from side to side and observing his or her eye movements can give you valuable information about the patient's mental state. Faces are the first objects that capture a baby's attention.

And yet, when I was told that a faculty candidate looked like me, I had no real basis for agreeing or disagreeing. I could objectively say that yes, her hair and skin colors looked like mine, so sure, there might be a chance that she looked like me. But could I really say if there was a "resemblance"? Could I "see it"?

No. Which is often the case with people who are told they look like celebrities or relatives or friends. Somehow, despite having a finely-tuned mechanism for picking out human faces, and telling one face from another, and years of experience with our own faces, it's very hard for us to compare these faces to others'. Is it precisely because of this extensive experience with our own faces that prevents us from seeing it as others do? Or is it a projection of our desired or possessed characteristics onto our physical aspects (as in, "I can't look like her because I'm more youthful-looking than she is")? Or something entirely? What does this mean in terms of our concepts of who we are, and our relationships to our physical appearance?