Dispatch #1 from Cox's Bazar
November 30, 2018
I finished residency 5 months ago. I have worked approximately sixty shifts as an attending. Let's call it roughly six hundred patients treated (though maybe a few more). And I'm already bored. Not bored like, "why the hell am I doing this?" but bored like "fever, cough, abdominal pain, for more than two months? yeah, you'll be alright." Now my job has some awesome pathology. Good sick folks who really need an ER doc, and the thought of that gets my heart pumping! But there's plenty of pathology as well where there's nothing acute, nothing emergent that I can reverse, nothing that acutely needs an ER doctor and may be better treated by a PCP. I'm always happy to listen, happy to help as best I can, and try to do what I can with what I got, but it's time for an adventure.
And so that maybe explains why I find myself cruising along at 35,000 ft, with the Himalayan mountains out the left side of the plane and the Indian Ocean somewhere far out to the right. It doesn't really explain why I volunteered two weeks of my time to work in a refugee camp or how I ended up going to Bangladesh of all places. So let's do a short backstory. When I finished residency, I knew that I wanted a community job that would push me to become the best physician I could be and one that would give me space to grow and stretch myself professionally before having residents/med students/NP students paying for me to educate them. But I also didn't want to become a soulless, any work so long as you pay me by the hour, mercenary ED physician; someone who works an 8hr shift, does no more and no less than is asked, who doesn't know the nurses names and they don't know mine, who is simply checking days off the 10+yr retirement calendar with no intermediate goals in sight.
And so when I took my job, I negotiated two periods during the year where I could take up to 4 weeks off for international work. Initially, the goal was to teach abroad during this block - start building an academic portfolio, gain experience outside of Ethiopia, and buffer my credentials. But I'm hoping to do some international teaching later this year and in the meantime thought there was still a lot of international medicine that I hadn't seen yet. In the grand scheme of international emergency medicine, I think it breaks down into 4 buckets: 1) Missionary ; 2) Education; 3) Disaster; 4) Refugee
1) Missionary Work
There's a nice location to which you have some connection (may be as remote as your next door neighbors great aunt's sister's daughter is from there and knows they have a hospital with an ER). You fly in for 1-2-3 weeks. Maybe they know you're coming, maybe they don't. You're not integrated into their systems, you do the best you can but more times than you end up pissing off the local staff, getting in everyone's way, providing good care 1x but leaving all patients scratching their head(s) asking why this Gringo is here and what is he/she doing to me and why?
2) Education Work
Arguably the most sustainable work. Use my prior education and training to teach the local healthcare staff. Whether teaching hand sanitation, triage modules, or advanced care, if you teach a man to fish, hopefully he'll never go hungry, enough so that they never need you to come back, effectively eliminating your own job.
3) Disaster Work
Man-made disasters, natural disasters, war zones. May be really exciting with a large role for EM physicians (i.e. earthquake, building collapses, war zones). May not need much in the way of Emergency Care but need oodles of logistical help to provide basic health services (drought, famine, forest fires, flooding). Unpredictable, variable impact, huge need but rarely needs ED doctor after first few hours-days.
4) Refugee Work
Captive population with chronic (and acute) health needs and very limited access to health services. Ideally, this is a standalone bucket but I am anxious to see how it differs from the first bucket (if at all).
So why me and why now? Why am I on a plane, sipping Johnnie Walker and Ginger Ale halfway around the world, praying that the combined bubbles and alcohol stave off permanent cankles that I could have avoided all along by staying home in Atlanta and jogging/throwing a ball for my dog who thinks I'm the greatest creation on two legs? Let's start with the second question. Why now? I'm done with EM Boards, I have relatively few commitments at home other than to provide for my amazing wife and lovable dog, and I was able to get the time off work. Why me? Because I can. Because I am fortunate enough to be able to take the time off work, I am interested in paying back the blessings I have received through no merit of my own, and because it doesn't matter who goes to do the work as long as someone does it. Based on my prep work and calls with former volunteers, I don't think most of this work requires an ED physician. But it requires someone who has the time and the inclincation to serve, and my professional skill set can hopefully help. So that's why I'm here, cankles and all, filled with the "what the f* have I just signed myself up for?" jitters, and ready to bear witness and try to give back/pay forward just a little bit.
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Nighttime on 11/30/18
Just finished the orientation session for this week and I'll working with a group called MedGlobal alongside a retired pediatrician from Houston, a family medicine hospitalist from rural Pennsylvania, a nurse/midwife from outside Newcastle, Australia, and a group of local physicians. Founded in 2017, MedGlobal works with a partner local organization (OBAT Helpers) to staff a medical clinic that provides outpatient care to 150-300 patients DAILY. The current refugee camp(s) in Bangladesh is comprised of 27 different sections with an at-risk population (refugees + the Bengali who were living in these towns before the camps arose) of 1.3-1.5 million people. I'm heading to the clinic tomorrow morning for the first day of work so should have more to report back after that.
Until then, here's a music video we shot while enjoying that grad-student life at HKS
I finished residency 5 months ago. I have worked approximately sixty shifts as an attending. Let's call it roughly six hundred patients treated (though maybe a few more). And I'm already bored. Not bored like, "why the hell am I doing this?" but bored like "fever, cough, abdominal pain, for more than two months? yeah, you'll be alright." Now my job has some awesome pathology. Good sick folks who really need an ER doc, and the thought of that gets my heart pumping! But there's plenty of pathology as well where there's nothing acute, nothing emergent that I can reverse, nothing that acutely needs an ER doctor and may be better treated by a PCP. I'm always happy to listen, happy to help as best I can, and try to do what I can with what I got, but it's time for an adventure.
And so that maybe explains why I find myself cruising along at 35,000 ft, with the Himalayan mountains out the left side of the plane and the Indian Ocean somewhere far out to the right. It doesn't really explain why I volunteered two weeks of my time to work in a refugee camp or how I ended up going to Bangladesh of all places. So let's do a short backstory. When I finished residency, I knew that I wanted a community job that would push me to become the best physician I could be and one that would give me space to grow and stretch myself professionally before having residents/med students/NP students paying for me to educate them. But I also didn't want to become a soulless, any work so long as you pay me by the hour, mercenary ED physician; someone who works an 8hr shift, does no more and no less than is asked, who doesn't know the nurses names and they don't know mine, who is simply checking days off the 10+yr retirement calendar with no intermediate goals in sight.
And so when I took my job, I negotiated two periods during the year where I could take up to 4 weeks off for international work. Initially, the goal was to teach abroad during this block - start building an academic portfolio, gain experience outside of Ethiopia, and buffer my credentials. But I'm hoping to do some international teaching later this year and in the meantime thought there was still a lot of international medicine that I hadn't seen yet. In the grand scheme of international emergency medicine, I think it breaks down into 4 buckets: 1) Missionary ; 2) Education; 3) Disaster; 4) Refugee
1) Missionary Work
There's a nice location to which you have some connection (may be as remote as your next door neighbors great aunt's sister's daughter is from there and knows they have a hospital with an ER). You fly in for 1-2-3 weeks. Maybe they know you're coming, maybe they don't. You're not integrated into their systems, you do the best you can but more times than you end up pissing off the local staff, getting in everyone's way, providing good care 1x but leaving all patients scratching their head(s) asking why this Gringo is here and what is he/she doing to me and why?
2) Education Work
Arguably the most sustainable work. Use my prior education and training to teach the local healthcare staff. Whether teaching hand sanitation, triage modules, or advanced care, if you teach a man to fish, hopefully he'll never go hungry, enough so that they never need you to come back, effectively eliminating your own job.
3) Disaster Work
Man-made disasters, natural disasters, war zones. May be really exciting with a large role for EM physicians (i.e. earthquake, building collapses, war zones). May not need much in the way of Emergency Care but need oodles of logistical help to provide basic health services (drought, famine, forest fires, flooding). Unpredictable, variable impact, huge need but rarely needs ED doctor after first few hours-days.
4) Refugee Work
Captive population with chronic (and acute) health needs and very limited access to health services. Ideally, this is a standalone bucket but I am anxious to see how it differs from the first bucket (if at all).
So why me and why now? Why am I on a plane, sipping Johnnie Walker and Ginger Ale halfway around the world, praying that the combined bubbles and alcohol stave off permanent cankles that I could have avoided all along by staying home in Atlanta and jogging/throwing a ball for my dog who thinks I'm the greatest creation on two legs? Let's start with the second question. Why now? I'm done with EM Boards, I have relatively few commitments at home other than to provide for my amazing wife and lovable dog, and I was able to get the time off work. Why me? Because I can. Because I am fortunate enough to be able to take the time off work, I am interested in paying back the blessings I have received through no merit of my own, and because it doesn't matter who goes to do the work as long as someone does it. Based on my prep work and calls with former volunteers, I don't think most of this work requires an ED physician. But it requires someone who has the time and the inclincation to serve, and my professional skill set can hopefully help. So that's why I'm here, cankles and all, filled with the "what the f* have I just signed myself up for?" jitters, and ready to bear witness and try to give back/pay forward just a little bit.
==================
Nighttime on 11/30/18
Just finished the orientation session for this week and I'll working with a group called MedGlobal alongside a retired pediatrician from Houston, a family medicine hospitalist from rural Pennsylvania, a nurse/midwife from outside Newcastle, Australia, and a group of local physicians. Founded in 2017, MedGlobal works with a partner local organization (OBAT Helpers) to staff a medical clinic that provides outpatient care to 150-300 patients DAILY. The current refugee camp(s) in Bangladesh is comprised of 27 different sections with an at-risk population (refugees + the Bengali who were living in these towns before the camps arose) of 1.3-1.5 million people. I'm heading to the clinic tomorrow morning for the first day of work so should have more to report back after that.
Until then, here's a music video we shot while enjoying that grad-student life at HKS
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