I am a second year student at UCSF Medical School. Health care policy and reform fits into the fringe of our basic science curriculum, which focuses on clinical diagnosis and patient care. My classmates and I are about to graduate from the basic science part of our curriculum and move into the clinical years of our education.
As we progressed through various organ systems over the past year and a half, I imagined myself in various roles as a physician; could I see myself practicing as a gastroenterologist? Neurologist? Cancer surgeon? Infectious disease specialist?
Our current course is called, “Lifecycle,” and has covered principles of reproduction, embryology, pediatrics, childhood development, and geriatrics. I have again been moved to think about myself in various practice settings. In recent exercises, about a dozen classmates and I have discussed neonatal emergencies and even simulated the resuscitation of a high-risk infant. We discussed the trajectory of a fetus born with a hole in the septae of the heart and instances in which the fetus is deprived of oxygen and sustains brain damage early in life or even in utero.
We discussed the ethical implications of the cases. Less than 25% of neonates born at 24 weeks survive without brain damage. Hospitals vary in their willingness to resuscitate neonates born between weeks 23-26 of gestation. Who makes the decision about resuscitation? Who represents the fetus? What happens if the parents disagree among themselves or with the doctor?
I threw in the question, how much does it cost? No one really talks about that. According to our discussion leader, one of the chief residents in pediatrics at UCSF, a day in the neonatal ICU can easily run between $20,000 and $30,000. As I understood it, sick babies can walk out of the hospital with million dollar bills, with no improved prognosis, and with the likelihood of returning for more costly care in the early years of life.
We talk about the ethics of neonatal resuscitation and who gets to make tough decisions, but what about the ethics of cost? The burden of cost on the hospital and society is not trivial. Most families wouldn’t have the resources to cover such a hospital bill, so either a government program or private insurance would end up paying.
The government, as we know, is broke. And health care spending is helping break it. National health spending totaled 17.3% of the national economy last year. Health spending share of the GDP increased 1.1% last year, which was the greatest increase since 1960. It is estimated that by 2019, health care spending will make up a full fifth of the national economy.
Could resuscitating preterm babies be responsible for underfunded education? Deteriorating infrastructure? Cuts in other social programs? If the parents of the child could pay the bill in full, then by all means, they can decide how to spend their money. But it the government is paying, shouldn’t there be some ethical consideration of the other beneficiaries (stake-holders?) of its service?
Saturday, February 6, 2010
Tuesday, July 7, 2009
Independence Day...Sierra Style
For the second year in a row, I spent the night of July 4th under the stars and well away from any airport security lines, barbeques, or fireworks. With my friend Justin, I climbed Stately Pleasure Dome, Lembert Dome, Cathedral Peak and Matthes Crest, which are all near Tuolumne Meadows in Yosemite National Park.
At this time last year, I had just joined the local rock climbing gym, Mission Cliffs. I started going a few times a week. At the end of July, 2008, I went with Justin and his friend Zennard to Yosemite. Still too novice to climb with them, I hiked to Echo Lake while they climbed Cathedral Peak.
This year, I was ready to climb. Our trip started with a traffic jam leaving San Francisco on Thursday evening, but after we crossed the Bay Bridge, traffic had thinned, and we made good time to our camping spot that evening.
We woke up early on Friday and drove into the park. By 9 am, we arrived at Tenaya Lake. We walked up some low angle slabs to the beginning of Hermaphrodite Flake on Stately Pleasure Dome. I led the route--my first trad lead! The highlight was shimmying up the chimney that formed behind the namesake flake on the second pitch.
I also led the first pitch of the route above it called Boltway. The second pitch had a 5.8 slab move right of the belay ledge, so I turned the lead reins over to Justin. We topped out around noon and rapped/walked off the side of the dome.
After a nap on the beach of Tenaya Lake, we dumped our stuff at our campsite (Tuolumne Campground) and headed back out to Lembert Dome. We climbed Northwest Books, which started with a fun mantle move followed by an awkward lieback. Three people flew by us free-soloing the whole thing. Oh well, so much for being hardcore! The second pitch began with a two parallel cracks in a corner and mellowed out at the end. We topped out by climbing up some 3rd class slabs and then walked off the northwest side of the dome.
That evening, we organized our packs for the main event of the weekend--Cathedral Peak (10,940 depending on who you ask) and Matthes Crest. At 5 am on Saturday, we got up and drove to the Cathedral Lakes Trailhead. I'm guessing our packs weighed close to 40 pounds, loaded with our camping gear, two ropes, and a full rack of climbing gear.
We followed Budd Creek and reached a patch of pine trees below Cathedral Peak around 9 am. We dropped our big packs, took our climbing gear, and scrambled up a steep slope covered with scree and small boulders. We could see a few other parties on the upper pitches, but nobody was at the base. We began climbing almost immediately. Justin led the first pitch. He ran the rope out, and then we simul-climbed for about 15 feet until he reached the top of what was marked the second pitch on our supertopo map.
From there, we climbed variation routes to the summit, making four more pitches out of it. The highlights were a chimney, a splitter hand crack and another outward flaring crack that were all lots of fun. The summit was about nine square feet in area. We took pics and then downclimbed around the back of the spire to 4th and then 3rd class rock. The path wrapped back around to the east face, and we descended on a trail from there. With the help of Justin's GPS, we walked straight back to our stashed backpacks.
At this point, I felt like I was crashing. I had a bad headache from being in the sun all day, my throat was sore for some reason, and I was really sugar-low. It was after 6 pm; we had been on the move for over 12 hours. I made it clear that I needed to stop. Every step was jarring to my entire body and exacerbated my headache. Call me weak, but I needed food, drink, and rest. I proposed that we stop and hike to the climb from this point in the morning. Justin sensed the urgency (desperation?) in my voice, and agreed.
At this time last year, I had just joined the local rock climbing gym, Mission Cliffs. I started going a few times a week. At the end of July, 2008, I went with Justin and his friend Zennard to Yosemite. Still too novice to climb with them, I hiked to Echo Lake while they climbed Cathedral Peak.
This year, I was ready to climb. Our trip started with a traffic jam leaving San Francisco on Thursday evening, but after we crossed the Bay Bridge, traffic had thinned, and we made good time to our camping spot that evening.
We woke up early on Friday and drove into the park. By 9 am, we arrived at Tenaya Lake. We walked up some low angle slabs to the beginning of Hermaphrodite Flake on Stately Pleasure Dome. I led the route--my first trad lead! The highlight was shimmying up the chimney that formed behind the namesake flake on the second pitch.
I also led the first pitch of the route above it called Boltway. The second pitch had a 5.8 slab move right of the belay ledge, so I turned the lead reins over to Justin. We topped out around noon and rapped/walked off the side of the dome.
After a nap on the beach of Tenaya Lake, we dumped our stuff at our campsite (Tuolumne Campground) and headed back out to Lembert Dome. We climbed Northwest Books, which started with a fun mantle move followed by an awkward lieback. Three people flew by us free-soloing the whole thing. Oh well, so much for being hardcore! The second pitch began with a two parallel cracks in a corner and mellowed out at the end. We topped out by climbing up some 3rd class slabs and then walked off the northwest side of the dome.
That evening, we organized our packs for the main event of the weekend--Cathedral Peak (10,940 depending on who you ask) and Matthes Crest. At 5 am on Saturday, we got up and drove to the Cathedral Lakes Trailhead. I'm guessing our packs weighed close to 40 pounds, loaded with our camping gear, two ropes, and a full rack of climbing gear.
We followed Budd Creek and reached a patch of pine trees below Cathedral Peak around 9 am. We dropped our big packs, took our climbing gear, and scrambled up a steep slope covered with scree and small boulders. We could see a few other parties on the upper pitches, but nobody was at the base. We began climbing almost immediately. Justin led the first pitch. He ran the rope out, and then we simul-climbed for about 15 feet until he reached the top of what was marked the second pitch on our supertopo map.
From there, we climbed variation routes to the summit, making four more pitches out of it. The highlights were a chimney, a splitter hand crack and another outward flaring crack that were all lots of fun. The summit was about nine square feet in area. We took pics and then downclimbed around the back of the spire to 4th and then 3rd class rock. The path wrapped back around to the east face, and we descended on a trail from there. With the help of Justin's GPS, we walked straight back to our stashed backpacks.
We started off the slopes of Cathedral and headed southeast towards Echo Peaks. Snowfields were still melting, and we crossed meadows that were oozing with water. We walked south up into a saddle, which Justin aptly named Echo Flats. We followed the shoulder of Echo Peaks first to the south and then southeast until Matthes Crest came into view. The imposing razorback of granite towered over the backcountry bowl. I doubted my abilities for a minute.
At this point, I felt like I was crashing. I had a bad headache from being in the sun all day, my throat was sore for some reason, and I was really sugar-low. It was after 6 pm; we had been on the move for over 12 hours. I made it clear that I needed to stop. Every step was jarring to my entire body and exacerbated my headache. Call me weak, but I needed food, drink, and rest. I proposed that we stop and hike to the climb from this point in the morning. Justin sensed the urgency (desperation?) in my voice, and agreed.
We stopped, pitched our tent, and ate chili and rice for dinner. I was laying down by 7:30. I faded in and out of sleep and tried some restorative yoga moves. My headache lingered on. I got up after a few hours. The moon was rising over Matthes, and the evening alpinglow on the mountains was spectacular. We heard two people walking by who had presumably come off the crest. Justin ran after them and got some route beta. We had been concerned about a snowfield that appeared to be at the base of the last descent rappels, but we learned that there was room to pass around it.
We packed out bags for the next day. A climbing rope and a tag line, a full rack of gear, some food, and two liters of water each. We planned to go on belay to gain the ridge and then simul-climb over to the south summit. I set our alarm for 5 am and went back to sleep.
The sky was just turning pink with morning light when we woke up. We boiled some water for oatmeal, took down the tent, stashed our big packs under some rocks and headed crosscountry towards to the south end of the crest.
It took us about an hour to get over there. The last 15 minutes, we scrambled up steep slabs to a notch marking the south end of the crest. The sun was not yet on us, and the wind was blowing. My teeth were chattering as we started climbing around 7:30. Two pitches, and we were on the top of the ridge. The climbing was incredibly fun. Knobs, cracks, corners, all combined in a haphazard, choose-your-own-adventure fashion.
Once we gained the ridge, we each wrapped about 50 feet of rope around us from our respective ends so that only 100 or so feet of rope remained between us. Justin began advancing along the ridge and placed pieces of protection when possible. When the rope was taut, I began climbing and removing protection as I came to it. We continued in this manner for a few hundred horizontal feet before we came upon a sketchy downclimb. Instead of proceeding forward, we went down a south facing ramp, which dumped us out on another north-facing ramp. There, we had to traverse north and pull a roof move to gain the ridge again. We were definitely off route, but it was fun! Except for the part where I fumbled and dropped my belay device off the side of the cliff...not good for morale.
The exposure was as mind-blowing as the guide book said it would be. In fact, I only took brief moments to absorb the spectacular surroundings; I focused mainly on my feet and the rock. Another party passed us. We continued to simul-climb the undulating granite until we came to the South Summit.
We took a breather and then planned our descent. There were slings and a rap ring on the South Summit, so we decided to rap off the east side into the notch below. We had two ropes, which we joined together to make one long rope and hoped for a single rappel. We managed to not get the rope caught in the maze of flakes and cracks in the rock. Once in the notch, we crossed back over to the west side of the crest and scrambled down to a pine tree with slings around the base. We rappelled from there to one final rappel station. Since I had lost my belay device, Justin went first and then tied his belay device to the rope, which I then pulled up to get the device. I then lowered the rope and rappelled down.
There was a snow field below us, but we were able to scramble to the north of it. We scrambled down the last scree field of the trip, and then booked across the bowl to where we had camped the night before. A brief rest, a bite to eat, some water, and then some repacking of our big packs, and we were all loaded up again for the walk out. We had to climb a few hundred feet to get back around the shoulder of Echo Peak, and then it was a smooth three miles back to the trailhead...downhill all the way... The mosquitos were enough motivation to keep the pace up. We reached the car at 7:45 pm. The smoke from the fires had gotten a lot thicker; the smell of smoke was obvious and the air scratched my throat.
We turned on Doc Watson and hummed to some Banjo music as we drove out of the park. No traffic to speak of. Most everything was closed as we drove home. We made one quick gas stop in Oakdale, and made it back to San Francisco in about 5 hours.
Once we gained the ridge, we each wrapped about 50 feet of rope around us from our respective ends so that only 100 or so feet of rope remained between us. Justin began advancing along the ridge and placed pieces of protection when possible. When the rope was taut, I began climbing and removing protection as I came to it. We continued in this manner for a few hundred horizontal feet before we came upon a sketchy downclimb. Instead of proceeding forward, we went down a south facing ramp, which dumped us out on another north-facing ramp. There, we had to traverse north and pull a roof move to gain the ridge again. We were definitely off route, but it was fun! Except for the part where I fumbled and dropped my belay device off the side of the cliff...not good for morale.
The exposure was as mind-blowing as the guide book said it would be. In fact, I only took brief moments to absorb the spectacular surroundings; I focused mainly on my feet and the rock. Another party passed us. We continued to simul-climb the undulating granite until we came to the South Summit.
We took a breather and then planned our descent. There were slings and a rap ring on the South Summit, so we decided to rap off the east side into the notch below. We had two ropes, which we joined together to make one long rope and hoped for a single rappel. We managed to not get the rope caught in the maze of flakes and cracks in the rock. Once in the notch, we crossed back over to the west side of the crest and scrambled down to a pine tree with slings around the base. We rappelled from there to one final rappel station. Since I had lost my belay device, Justin went first and then tied his belay device to the rope, which I then pulled up to get the device. I then lowered the rope and rappelled down.
There was a snow field below us, but we were able to scramble to the north of it. We scrambled down the last scree field of the trip, and then booked across the bowl to where we had camped the night before. A brief rest, a bite to eat, some water, and then some repacking of our big packs, and we were all loaded up again for the walk out. We had to climb a few hundred feet to get back around the shoulder of Echo Peak, and then it was a smooth three miles back to the trailhead...downhill all the way... The mosquitos were enough motivation to keep the pace up. We reached the car at 7:45 pm. The smoke from the fires had gotten a lot thicker; the smell of smoke was obvious and the air scratched my throat.
We turned on Doc Watson and hummed to some Banjo music as we drove out of the park. No traffic to speak of. Most everything was closed as we drove home. We made one quick gas stop in Oakdale, and made it back to San Francisco in about 5 hours.
Tuesday, May 6, 2008
Exit Stage Left
On March 31, I left Sierra Leone after ten intense weeks of living with Dr. Barrie and working on two health care projects. I hoped that my final day in Sierra Leone would be both stress- and sweat- free, but Freetown was relentless until the moment I boarded the plane.
My flight out of Lungi airport, located across the bay from Freetown, was scheduled for midnight. Just before 7:30 p.m., I finished washing up and zippered my bag. The last light was disappearing over the hills, and Dr. Barrie and his family were praying by candlelight in the common room. I stood by discreetly for a few minutes and then paced on the balcony a times. Ten minutes passed, and the traffic outside looked menacing. They looked deep in prayer, but I wanted to say goodbye. Finally, their prayers ended. I hugged everyone—Dr. Barrie’s wife, mother, mother-in-law, grandmother-in-law, son, daughter, cousins, and sister-in-law. Many aspects of Sierra Leone would be easy to part with, but I was truly sad to leave these people.
Dan, Dr. Barrie, and I hopped into our vehicle for the short ride to the ferry terminal, but we could not even pull out onto Mountain Cut. The traffic was gridlocked, and the last ferry was scheduled to depart in twenty minutes. We got out of the car, each of us carrying one of my bags, and started walking. With sudden inspiration, Dr. Barrie hailed a passing motorbike. Dan did the same, and soon, with heavy bags on our backs and across our laps, we were weaving in and out of traffic and riding down the center line between immobilized vehicles.
By this time, I had completely sweated through the clothes I would be wearing for the next forty-eight hours. Otherwise, traffic had finally opened up and we were zooming towards the ferry terminal. Our three motorbikes arrived one after the other, and we all laughed in relief. But three men shouted that we would miss the ferry if we didn’t run.
We left Dr. Barrie behind and ran through the terminal and out the other side. The ferry was backed up to a concrete loading ramp leading into the water. The boat was inching away from the ramp, and the boat’s loading stand was lifting. Dan ran ahead to get on the boat, and I struggled with my bags. I watched Dan jump three feet up to the platform and thought I’d never make it. I got up to the base of the ferry and was looking up in defeat when three young men from above grabbed me, bags and all, and lifted me effortlessly onto the boat. They let me catch my breath before demanding a small token for their deed. Then they disappeared into the crowd on the lower level of ferry.
The ferry was completely full of people and their goods and belongings. We sat down on the only empty bench, but soon found out why it was empty. A crazy man stood by and shouted about ice cream for the entire ferry ride. We finally arrived on the other side of the bay, and I caught a local taxi for the last ten kilometers to the airport. For a little extra, I got the front seat in the car. Four other people piled in the back, and we were on our way.
At the airport, generators were running, check-in was smooth, and my flight left on time. I wrote my own baggage ticket, making sure that the letters S-F-O were crystal clear. A man took a picture of my passport with a digital camera. After a completely manual security check, I walked out onto the tarmac in the humid darkness. I was sweaty and exhausted. Culture shock began when I stepped inside the airplane: air conditioning, magazines, light. We were all disinfected with a light aerosol spray, in accordance with WHO regulations. And with that, we were hurling down the runway. I slept all the way to Heathrow, and it was the best I had slept in three months.
My flight out of Lungi airport, located across the bay from Freetown, was scheduled for midnight. Just before 7:30 p.m., I finished washing up and zippered my bag. The last light was disappearing over the hills, and Dr. Barrie and his family were praying by candlelight in the common room. I stood by discreetly for a few minutes and then paced on the balcony a times. Ten minutes passed, and the traffic outside looked menacing. They looked deep in prayer, but I wanted to say goodbye. Finally, their prayers ended. I hugged everyone—Dr. Barrie’s wife, mother, mother-in-law, grandmother-in-law, son, daughter, cousins, and sister-in-law. Many aspects of Sierra Leone would be easy to part with, but I was truly sad to leave these people.
Dan, Dr. Barrie, and I hopped into our vehicle for the short ride to the ferry terminal, but we could not even pull out onto Mountain Cut. The traffic was gridlocked, and the last ferry was scheduled to depart in twenty minutes. We got out of the car, each of us carrying one of my bags, and started walking. With sudden inspiration, Dr. Barrie hailed a passing motorbike. Dan did the same, and soon, with heavy bags on our backs and across our laps, we were weaving in and out of traffic and riding down the center line between immobilized vehicles.
By this time, I had completely sweated through the clothes I would be wearing for the next forty-eight hours. Otherwise, traffic had finally opened up and we were zooming towards the ferry terminal. Our three motorbikes arrived one after the other, and we all laughed in relief. But three men shouted that we would miss the ferry if we didn’t run.
We left Dr. Barrie behind and ran through the terminal and out the other side. The ferry was backed up to a concrete loading ramp leading into the water. The boat was inching away from the ramp, and the boat’s loading stand was lifting. Dan ran ahead to get on the boat, and I struggled with my bags. I watched Dan jump three feet up to the platform and thought I’d never make it. I got up to the base of the ferry and was looking up in defeat when three young men from above grabbed me, bags and all, and lifted me effortlessly onto the boat. They let me catch my breath before demanding a small token for their deed. Then they disappeared into the crowd on the lower level of ferry.
The ferry was completely full of people and their goods and belongings. We sat down on the only empty bench, but soon found out why it was empty. A crazy man stood by and shouted about ice cream for the entire ferry ride. We finally arrived on the other side of the bay, and I caught a local taxi for the last ten kilometers to the airport. For a little extra, I got the front seat in the car. Four other people piled in the back, and we were on our way.
At the airport, generators were running, check-in was smooth, and my flight left on time. I wrote my own baggage ticket, making sure that the letters S-F-O were crystal clear. A man took a picture of my passport with a digital camera. After a completely manual security check, I walked out onto the tarmac in the humid darkness. I was sweaty and exhausted. Culture shock began when I stepped inside the airplane: air conditioning, magazines, light. We were all disinfected with a light aerosol spray, in accordance with WHO regulations. And with that, we were hurling down the runway. I slept all the way to Heathrow, and it was the best I had slept in three months.
Tuesday, March 18, 2008
Posting!
I've had problems accessing this site from Sierra Leone, so please see my postings at www.povertyhealth.org in the lower right hand corner in the community blog box!
Thanks!
Anne
Thanks!
Anne
Monday, March 17, 2008
Let There Be Light, Please
Even as I watched from the plane during our descent into Freetown, I took notice of the darkness below. Dim lights lit the runway as we landed, and the roar of a generator took over the roar of the plane when we disembarked and stepped off the tarmac into the airport. As we made our way from the airport, we passed houses with single kerosene lamps marking their doorways. Drinks stands and food vendors used small generators and candles to do business.We arrived in the early hours of the morning to the home of Doctor Barrie, our Sierra Leonean host for the next few months. We hauled our suitcases up a dark stairwell and lit candles once inside. Dr. Barrie's wife brought us some rice and we ate a late supper in the darkness. From my room, I could see the outline of the mountains out the window, and I watched pedestrians loiter in the dark streets below. The roar of a few generators persisted throughout the night. Sometime in the early morning, I noticed the light bulb in my room was illuminated. The electricity was on for two hours before going off again. Last night, when we arrived home, and the electricity was on yet again. I thought I'd take a quick shower while the lights were on, but the minute I sprung to get my towel, the lights went off again. It was shower by candlelight for me. The generators create their own problems. They burn on gasoline, which costs just under five dollars a gallon here. One gallon will burn in a small generator suitable for a house for five to six hours. The generators do not burn cleanly or efficiently, and produce palpable heat in an already-balmy environment. The lack of power dictates every aspect of life here. Factories cannot be built, stifling local economic production and growth. Food is not easily refrigerated in stores or in the homes of local people. Streets are not lit at night. Conducting communication and business are difficult.I'm told that the electricity situation has actually improved in the last few months. A few changes might be responsible. Most noticeably, a new government came to power in November. However, probably more importantly, the World Bank and International Monetary Funds recently cancelled some of the country's debts incurred during the civil war. Before, the government was spending two thirds of the GDP each year to pay off the debt. Now, the funds are free to spend on development, and one result is that Freetown buildings have electricity for at least a few hours on most days.Today there was no electricity, though, so Dr. Barrie turned on the generator for the evening. One reason was so we could get some work done, including financial planning for the next year and the creation of a baseline health survey for 196 households of war amputees in Kono. A second occasion for light was that his mother just arrived home from a pilgrimage to Mecca, and many family members congregated in his apartment.In the evening, it's an odd state here in Freetown. Sounds of generators, car horns, and loud music compete in the street, and people hang out in the darkness. The hiking headlamp I threw into my backpack at the last minute might just turn out to be the most useful item I packed.
Saturday, January 5, 2008
Next Stop Sierra Leone
In October, 2007, when I saw Dan Kelly for the first time in three years, we had a lot of catching up to do. I had worked in China for two years, first as a teacher then a travel guide. I decided to apply to medical school and moved to San Francisco to pursue that goal. Dan had finished 3 of 4 medical school years and started a non-profit organization to fight extreme poverty. He had spent six months in Sierra Leone putting two projects in motion.
We started where any old friends would start: pints of beer. Questions, stories, insights poured forth for hours. The conversation continued over the next month, as Dan completed his internal medicine sub-internship in San Francisco.
Meanwhile, I finished up my own medical school applications and considered the timing of a spring trip to Sierra Leone. In fact, ideas about Africa had taken seed almost a year ago when, in an email, Dan casually suggested I come out to help with the projects. Dan doesn’t say anything casually, though.
While Dan was in San Francisco, I asked question after question until I realized that there were a lot of details that I wouldn’t grasp until I went. Just before Thanksgiving, Dan returned to the Bronx to complete his medical school work. I booked a plane ticket to Sierra Leone with a January 11th departure date.
Now, that date is a few days out. My parents’ raised eyebrows and lack of comments on my trip has turned to enthusiastic support as they have learned more about the projects I’ll be working on. I’ve enlightened many United Airlines ticketing agents about the location and pronunciation of the small West African country, population 6 million. And I’ve learned much about the people, culture, and history of a nation that ranks last on the United Nations Best Countries To Live In list, published in November, 2007.
Next week, these conversations and articles will fade into the shadows of reality. Sierra Leoneans face a host of development, health, and reconstruction issues following the recent civil conflict that ended in 2002 with thorough disarmament by a UN team. I will be working in the Kono District to turn four cinderblock walls with a roof into a community clinic, with clinical and public health programs for farmers and their families in the area.
All my experiences are shaped first by my own nationality and culture, but second, and more prominent in my mind, my experiences in China. I’ve done endless comparing in my mind between the place I know and how I imagine Sierra Leone might be. I imagine I’ll gain even more perspectives on development issues in China by having a new example for comparison. The two countries are so different, yet face similar problems: disease, infrastructure issues, corruption, lack of venue for change, widening gulf between rich and poor. In short, both countries face problems of development, and I hope to gain radically new perspectives on poverty and development in Sierra Leone.
I’m also nervous about my personal health and safety. I deeply want to help others, but I also have a healthy sense of self-preservation. I will be exposed to a host of diseases. Will my malaria drugs do their duty? Will my face mask and gloves protect me from tuberculosis or typhoid? If I’m sick, can I get help? Everyday life will pose a challenge as well. Www.weather.com rated the daily UV index as 10+/extreme. My pale skin says ouch. Vegetables are difficult to come by. There are about 600 miles of paved roads in the whole country. All the while, these hardships are likely to be trivial compared to those faced by the people who live there. I expect perspective to be powerful.
As far as safety goes, the media doesn’t bring much good news back from Africa to the United States: genocide, election riots, AIDS, mobilizing warlords, famine, and the winter 2006 Leo DiCaprio flick, “Blood Diamonds.” Currently, Sierra Leone is touted by Lonely Planet as one of the safest places in West Africa, though that can’t be a tough title to claim with the Ivory Coast and Liberia for competition. I’m packing copies of my passport, bringing what little street smarts I have, and kicking the confidence I had in China to explore remote nooks and crannies of the country--at least until I get my bearings.
I also have high expectations for this experience from a different perspective. Whether I’ve been exploring careers, lacking direction, indecisive, whatever it’s called, I’m not anymore. I believe I will be able to unite my varied interests, and that my range of experiences will be an asset to the projects we work on. Furthermore, I hope that I will gain motivation and clarity that will shape my medical education, which begins next fall.
Those are personal expectations. But what about project expectations? I want to alleviate the suffering of individual people. As a teacher, I want to empower people to help and sustain themselves. I want to make a difference. I want to leave in April with a sense that the clinic operation is sustainable. As Jeffrey Sachs notes in his book, “The End of Poverty,” there is a latter of development, and many countries in Africa can’t even get a foot on the bottom rung. For three months, I’m going to join the ranks of others working like crazy to get Sierra Leone’s first foot off the ground.
References in this post:
www.go-act.org
http://www.alertnet.org/thenews/newsdesk/N26420967.htm
Lonely Planet, West Africa
Jeffrey Sachs, The End of Poverty
We started where any old friends would start: pints of beer. Questions, stories, insights poured forth for hours. The conversation continued over the next month, as Dan completed his internal medicine sub-internship in San Francisco.
Meanwhile, I finished up my own medical school applications and considered the timing of a spring trip to Sierra Leone. In fact, ideas about Africa had taken seed almost a year ago when, in an email, Dan casually suggested I come out to help with the projects. Dan doesn’t say anything casually, though.
While Dan was in San Francisco, I asked question after question until I realized that there were a lot of details that I wouldn’t grasp until I went. Just before Thanksgiving, Dan returned to the Bronx to complete his medical school work. I booked a plane ticket to Sierra Leone with a January 11th departure date.
Now, that date is a few days out. My parents’ raised eyebrows and lack of comments on my trip has turned to enthusiastic support as they have learned more about the projects I’ll be working on. I’ve enlightened many United Airlines ticketing agents about the location and pronunciation of the small West African country, population 6 million. And I’ve learned much about the people, culture, and history of a nation that ranks last on the United Nations Best Countries To Live In list, published in November, 2007.
Next week, these conversations and articles will fade into the shadows of reality. Sierra Leoneans face a host of development, health, and reconstruction issues following the recent civil conflict that ended in 2002 with thorough disarmament by a UN team. I will be working in the Kono District to turn four cinderblock walls with a roof into a community clinic, with clinical and public health programs for farmers and their families in the area.
All my experiences are shaped first by my own nationality and culture, but second, and more prominent in my mind, my experiences in China. I’ve done endless comparing in my mind between the place I know and how I imagine Sierra Leone might be. I imagine I’ll gain even more perspectives on development issues in China by having a new example for comparison. The two countries are so different, yet face similar problems: disease, infrastructure issues, corruption, lack of venue for change, widening gulf between rich and poor. In short, both countries face problems of development, and I hope to gain radically new perspectives on poverty and development in Sierra Leone.
I’m also nervous about my personal health and safety. I deeply want to help others, but I also have a healthy sense of self-preservation. I will be exposed to a host of diseases. Will my malaria drugs do their duty? Will my face mask and gloves protect me from tuberculosis or typhoid? If I’m sick, can I get help? Everyday life will pose a challenge as well. Www.weather.com rated the daily UV index as 10+/extreme. My pale skin says ouch. Vegetables are difficult to come by. There are about 600 miles of paved roads in the whole country. All the while, these hardships are likely to be trivial compared to those faced by the people who live there. I expect perspective to be powerful.
As far as safety goes, the media doesn’t bring much good news back from Africa to the United States: genocide, election riots, AIDS, mobilizing warlords, famine, and the winter 2006 Leo DiCaprio flick, “Blood Diamonds.” Currently, Sierra Leone is touted by Lonely Planet as one of the safest places in West Africa, though that can’t be a tough title to claim with the Ivory Coast and Liberia for competition. I’m packing copies of my passport, bringing what little street smarts I have, and kicking the confidence I had in China to explore remote nooks and crannies of the country--at least until I get my bearings.
I also have high expectations for this experience from a different perspective. Whether I’ve been exploring careers, lacking direction, indecisive, whatever it’s called, I’m not anymore. I believe I will be able to unite my varied interests, and that my range of experiences will be an asset to the projects we work on. Furthermore, I hope that I will gain motivation and clarity that will shape my medical education, which begins next fall.
Those are personal expectations. But what about project expectations? I want to alleviate the suffering of individual people. As a teacher, I want to empower people to help and sustain themselves. I want to make a difference. I want to leave in April with a sense that the clinic operation is sustainable. As Jeffrey Sachs notes in his book, “The End of Poverty,” there is a latter of development, and many countries in Africa can’t even get a foot on the bottom rung. For three months, I’m going to join the ranks of others working like crazy to get Sierra Leone’s first foot off the ground.
References in this post:
www.go-act.org
http://www.alertnet.org/thenews/newsdesk/N26420967.htm
Lonely Planet, West Africa
Jeffrey Sachs, The End of Poverty
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