whose addictions

2010-07-03T19:16:00.000-07:00

an oppressively hot and muggy 4th of july in hong kong, tempered by the life-saving air conditioning; feeling of sadness, uncertainty, and regret leave me feeling, for whatever reason, light-headed; i am so sorry, but words and thoughts seem so empty since they cannot undo deeds; life is what it is, for good and for ill; what will things be like, 6 months from now, i muse

vegetables

2010-06-28T07:57:00.000-07:00

for quite a long time, i've wanted to be a vegetarian, or at least reduce my meat consumption form the currently exorbitantly high levels to normal, dietician-recommended levels. now why would an almost carnivore like myself want to do this? upon much pondering, i've come up with three reasons

1) Health - generally, eating heaps of vegetables is healthier than eating heaps of meat, both in terms of reduced sodium (and I do have some mild hypertension, due either to poor eating habits or secondary to my daily dose of NSAIDs) as well as fat
2) Environment - meat is REALLY REALLY bad for the environment. It takes thousands of liters of water to produced just a kilo of beef, and while cow seems to be the most egregious culprit, rest assured vegetables always leave a smaller footprint.
3) Ethics - sometimes i wonder if a thousand years from now, humanity will look back and say that the people of this generation were barbaric for eating animals that clearly can suffer and feel pain. at the moment, such thinking is probably concerned crazy for non-PETA members, but i've read enough sci fi (haha, geek i know), particlarly a book called K-Pax (good read!) that i wonder. another way of looking at it - if we've got heaps of laws preventing cruelty to animals (most often domestic animals), how is it at all okay to kill cows and pigs and chickens by the thousand? is there not some sort of deep moral incongruence there?

now, i've tried to hop on the veggie-train in the past, but this has usually ended in me going to the deli and buying a pound of cold cuts and just gobbling it down within a week. i'm not sure if my self-control has improved much at all since then, but let this post be some sort of declaration of affirmed effort - when i return from china, i will look into how to convert to at least semi-vegatarianism.

so wish me luck - i'll definitely need it. it's like someone trying to quit smoking, but i don't think they have anything that i could parallel to a nicotine patch :P

transience

2010-06-06T06:29:00.000-07:00

last night we went to mahak's in lusaka, an indian food restaurant, to commemorate the departure of one of the young women who live on our floor at the nusring hostels. i had only ran into her a few times during the week that i've been here, and there were a few people there whom we had just met earler in the day visiting the museum. this happens frequently when i travel and live briefly in a new place. relationships come into existence quickly, they spark brightly, and the almost always fade utterly. perhaps our paths will cross again, but more likely than not they never will.

prior to mahak's, i skyped with a good friend of mine for almost two hours. we were lamenting about the difficulty of forging lasting relationships in a cauldron of instability. i remarked that a more effective strategy would be to learn to better live in the moment - to find random flings rather than to seek true love, so to speak. not something i find satisfying, by any means, but perhaps it is something i could grow to appreciate?

i feel that dynamism is so important, but at some point you can change so much that you begin to lose the core of who you are. so... i find it difficult to appreciate both these transient relationships and the longer-lasting ones, since they seem to be so different.

expat living

2010-06-02T09:34:00.001-07:00

there are quite a few internet cafes in lusaka, but there is one i like going to in particular - la mimosa cafe - largely on account of the fact that it has the fastest, most reliable connection i've been able to find. the biggest problem is that the place is about 70 minutes away by walking or 20,000 Kwacha away by cab ($4).

i usually opt for my walking, and boy-oh-boy what a relief it is to be able to walk again, courtesy of Schering-Plough's biologics. anyway, on today's walk i chose a different route from usual and along the waysaw a number of rather nice-looking, well-to-do homes - in stark contrast to the slums that populate the city and even my relatively cushy nursing student dorms.

i've generally noticed two things:
1) many expats living in zambia and other developing countries are here doing some sort of humanitarin work
2) many expats tend to seek a mode of living that emulates their life at home as much as possible

by 2), i mean that expats will tend to live in houses that are quite posh by local standards, frequent the expat establishments (i stand guilty, la mimosa is certainly one of those), employ helpers (cook, maid, chauffeur), etc... etc...

now, i'm personally as guilty of anyone as wanting a nice clean place, warm showers (or any showers for that matter), and a home generally devoid of bugs. somehow though, i feel that it's a tad more egregious to live a western-style life in the midst of great poverty than in a place like riverbend or millwoods. i remember last year when i was in zambia i ran into a british doctor who actively sought to live in the slums - something that i thought was fairly insane even by the standards of craziest bleeding heart liberals. now, i personally wouldn't go so far as to want to live in the slums, but living in a really pretty place out here sits somewhat uneasily with me.

i guess this all boils down to the concept of how much material sacrifice is ideal.

____________

on an utterly unrelated note, the air here smells really nice. there's this hint of smoke that permeates through everything. i'm not sure what gives the air this flavor, but it seems particularly nice breathing it in as i sit out here in the open under the nighttime sky.

2010-04-08T21:25:00.000-07:00

''whoever saves one life, saves the world entire"

http://www.youtube.com/watch?v=lPHvLtitxug&feature=related

the most moving ending i have ever seen

illness

2010-04-06T18:56:00.000-07:00

lately i have been thinking about my seronegative spondyloarthropathy:

april is blossoming, and it's been well over a month that i haven't been able to function properly. over the course of the last 12 months, i have probably been dysfunctional in some way, shape or form, for at least 3. my right elbow and my left knee have been affected, and many of the springtime pursuits i have cherished in the past remain beyond me. i want to walk and enjoy the beatuiful weather that is all around us. i want to bike, feel the wind in my face, explore the trails with my friends. i want to play squash again (admittedly not a season-dependent sport, but still hugely enjoyable). i remember when i used to run many times a week, looking forwards to the sunday morning half-marathon training runs that gave me my first glimpses of the depth of the beauty of edmonton's maze of river valley trails.

everytime i think i'm about to get better, things get worse again. i've been on my new medication for 4 weeks now, and if anything, things have been worse since i've started. this has been taxing on my mind, as i feel my hope for a cure fades a little more with each flare-up. i know this is probably irrational but i'm losing my grip by bits. i hate being weak. i feel the world has no room for weakness. again, i know this isn't true, but again, i feel the rationality slowly slipping away. but who can i help like this? again, being irrational. i don't really need to be that physically functional to work in policy etc. etc. but surely it dampens my effectiveness. i find that is very troubling. it's like there's something you really, really want to do, something you think is relatively good-spirited and noble, and then something happens to derail you. again, irrational - not derailed, just slowed down a bit. i feel like such a lame (pun!) even for writing this, since if i can aknowledge my irrationality, and am posting it anyway, isn't that clearly a sign of poor mental fortitude?

i also think about why. well, as you have certinaly learned in medical school, the type of arthritis i have is multifactorial in its etiology, associated with HLA-B27 and various other autoimmune conditions, associated with some set of environmental? circumstances, associated, associated. but 'why' in the grander cosmic sense of things. my mind, like your mind, certainly pines towards a cosmic moral order. again, irrationality - even amongst religious folk, i can see no weave that screams of karma on the fabric of reality. but you and me believe it anyway. what have i done wrong? i have a sinking suspicion that my motivations, my aspirations, have been impure. i toy with the idea that whatever darkness zings in my mind, invisible to the outside observer but blatantly obvious to god almight in heaven, has in some way made me deserving of this.

the last thing i feel is guilt. I AM SO LUCKY. what i have is nothing. nothing compared to a childhood cancer that will rob you of your limb and life. nothing compared to someone who has this condition in a poorer setting, where physical labor is demanded daily to feed onself and where drugs don't exist. i am guilty. of telling my parents they stress me out and that i would feel better living on my own when day-in-day-out all they have done is care for me. of even posting this and hoping that someone comes along and reads it and values my attempt at some semblance of genuine honesty. i am guilty of being an 'emo', the sort of person people scoff and scorn at.

these are my thoughts. what an imagination i have.

oncology applied to life

2010-03-29T18:07:00.001-07:00

borrowed from my amigo Joey:

I think we have a lot to learn from cancer.

Someday, I hope humans learn to break the gates holding them back from growth. Whether we perceive ourselves to be ready or not (we are ready), we will push ahead and realize our dreams. We will discard anyone saying we cannot, make use of our own resources, grow our own so that we may thrive. We will take the path of most resistance and push it aside and blaze our own trail.

It will be chaotic and some roads wind upon each other, the misfortunes of a charging crash of rhinos that cannot see what is more than a few feet in front of them. We have our goal in mind but not a clue what it looks like, only the raw desire to make it happen. I think that it will be well worth it in the end when we circumvent that which prevents us from falling, which wants to keep us sequestered to our suburban lifestyles, the mechanisms of life that say we cannot when our mantra should quite classically be yes we can.

So fellow cancers, let us be the tumor that offsets the diseases that plague this world. Proliferate.

bill

2010-03-28T08:21:00.000-07:00

this is something a friend of mine posted just as we were graduating in '07:

_______________________________________

Meet my friend, Bill

I wish you could have seen Bill back in the day.

In college, he was one of those really spiritual guys with a magnetic personality, a real spark plug. A person who knew the Bible inside-out, who prayed with the eloquence of a Jim Elliot. When he led worship - sans band, unplugged, just him and his acoustic guitar before the fellowship group - he brought heaven, then the house, down. He was a spiritual lightening rod; whatever ministry he led glowed with spiritual urgency. Whatever event he organized - evangelistic coffeehouse, short-term missions - seemed especially anointed. A trailblazer with a prodigious gift of leadership, his fame spread on campus. He sent girls into a tizzy with his good looks and aw-shucks humor, but he never played it up. He dated, but (so I heard) with such humility and consideration that no one spoke poorly of him after the relationship ended. While others went to exotic locales for spring break, he went (unannounced and without fanfare) to the Bowery mission in New York for a one-week internship. He had dreams to be a missionary-doctor.

I had dinner with him recently. The last time we had seen each other was at graduation, over a decade ago. We were young back then, dreams and possibilities spread out before us like the expanse of the cloudless blue sky. God had a wonderful plan and purpose for us, after all. There was a shine in all our eyes. But that was back then.

When I met Bill for sushi this past week, we talked pleasantries at first, spoke of our marriages, children, our jobs. He had gone off to medical school to pursue his dream of being a missionary-doctor. He had fallen for a girl during his first semester, and had married impetuously (his phrase), a few months later. Somewhere along the track of earning his M.D., his missionary dream derailed. He got a job at a prestigious hospital, moved into the suburbs. He works hard, he tells me, to keep up with his hefty mortgage. He likes to go fishing on weekends.

When we were in college, we'd get together for dinner once in awhile. Bill would always ask me the same question at the end of the meal. He�' ask, his voice earnest: how's your relationship with God? That night, just as we were finishing dessert, I sensed him pause. He held the spoon suspended in front of him, deep in thought, troubled. Then he lowered the spoon softly to his plate, as if it had suddenly become too burdensome

"Do you still go to church?" he asked me.

I blinked in surprise. I do, I told him. I do.

He looked like he had more to say, and even opened his mouth to speak. But then he paused. His shoulders sagged a little. "That's good. I'm glad." He nodded, more to himself than to me. "That's good." He wouldn't look me in the eye.

He seemed tired, exhausted. A shell of his former self. I thought to return the same question to him, but I knew the answer already. Some things just don't have to be asked.

We ended the meal soon after that. He insisted on paying, and I let him after only token resistance. When I got home later that night, the family had all gone to bed. I walked in the darkness of the house, letting the silence seep into me. I checked in on my kids, tussled their hair. Then I lay down on the carpeted floor for a very long time, listening to the cadence of their gentle snoring. I thought of my friend Bill - hollowed-out, brow-beaten, so different from the spiritual wunderkind he'd once been - and something like sadness filled me.

* * *

I went to church the next morning. I looked at the other men in church who, like Bill, are in their 30s, are suburban fathers with a mortgage and children. I saw them take their place in the pew, sing, clap, say hello, fall asleep during the sermon, pop in a breath mint right afterwards. Go home. Start work Monday. Mechanical and routine. I saw all that, and a grayness settled into my bones that I have not been able to shake.

Because deep down, I do not think we are so different from Bill as we'd like to think.

Santa

2010-03-24T00:27:00.000-07:00

A cute little dialogue from the movie I just watched:

"As practice, you have to start out learning to believe the little lies, like Santa Claus and the Tooth Fairy..."

"So we can believe the big ones?"

"Yes - Justice, mercy, duty - that sort of thing."

"They're not the same at all!"

"You think so? Then take the universe and grind it down to the finest powder and sieve it through the finest sieve and then show me one atom of justice, one molecule of mercy - and yet, you try to act as if there is some ideal order, as if there is some rightness in the universe by which it may be judged."

"But people have got to believe that or what's the point?"

"You need to believe in things that aren't true. How else can they become?"

salads and big macs

2010-03-22T08:26:00.000-07:00

helping

2010-03-17T17:25:00.001-07:00

as another round of med interviews are taking place, i am being bombarded with requests for assistance. i must admit that this has beeen pretty annoying, on account of it's repetitive nature and the amount of hours that i have spend helping others.

but taking a step back, i realize that being able to help others is quite a privilege, especially when those others are your friends. it means that they trust you enough to ask for your advice, and it means that you have an opportunity to (hopefully) improve their overall utility in some way.

i have an inkling that the opportunities to help my friend will diminish in the future as our lives become burdened with more responsibility, and having to say no to a genuine request for assistance would be far worse than whatever annoyance i feel now.

More theft!

2010-03-14T06:19:00.001-07:00

bittermelon

2010-03-11T22:42:00.000-08:00

i was flipping through the bible today (something i definitely don't do enough) and ran into ephesians 4. it talks about being completely humble and letting go of any bitterness and malicious thoughts.

my mind wandered to whether or not jesus ever felt bitter. as a perfect being coming into a world full of some pretty bad people, how easy it would be to feel bitter and jaded at creation - meant for the light, but so often in the darkness. and yet i don't think jesus was very bitter at all. he may have been angry, he may have been chastising, but probably more than anything he was loving and he believed, by and large, in humanity - why else give everyone a chance to go to heaven?

now isn't that something? what another interesting shade of his perfect goodness and divinity.

i love stealing from tumblr

2010-03-11T18:55:00.001-08:00

i will learn how to love a person and then i will teach you and then we will know

seen from a great enough distance i cannot be seen
i feel this as an extremely distinct sensation
of feeling like shit; the effect of small children
is that they use declarative sentences and then look at your face
with an expression that says, ‘you will never do enough
for the people you love’; i can feel the universe expanding
and it feels like no one is trying hard enough
the effect of this is an extremely shitty sensation
of being the only person alive; i have been alone for a very long time
it will take an extreme person to make me feel less alone
the effect of being alone for a very long time
is that i have been thinking very hard and learning about existence, mortality
loneliness, people, society, and love; i am afraid
that i am not learning fast enough; i can feel the universe expanding
and it feels like no one has ever tried hard enough; when i cried in your room
it was the effect of an extremely distinct sensation that ‘i am the only person
alive,’ ‘i have not learned enough,’ and ‘i can feel the universe
expanding and making things further apart
and it feels like a declarative sentence
whose message is that we must try harder’

-Tao Lin

why dota is baddddddd

2010-03-10T23:58:00.000-08:00

in the interest of trying to 'relax' more, i decided to pick up dota again. for all you people who don't know what dota is, it is basically a warcraft 3 mod that i used to play far, far too much. getting back into it, i knew i'd be very, very rusty. let me explain why that contributes to the vicious cycle that is dota.

usually, when you win a game of dota, you feel pretty happy. note a game tends to last anywhere from 20 minutes to 60 minutes, so it's not a trifling amount of time! now, when you LOSE a game of dota, i usually feel pretty upset - but more than just that, i want revenge. how does one get revenge? by playing another game and winning that one!

but... since i am such a horribly rusty player, i can't seem to win any games! it's a cycle of play-lose, play-lose, play-lose until it's bloody late at night and i have have school the next day at 8 am and i realize just how badly i've wasted my time.

so dota, it's time for you to go the way of your homonymous partner the dodo. good bloody riddance :P

2010-03-09T23:10:00.001-08:00

"The Christians are right. It is Pride which has been the chief cause of misery in every nation and every family since the world began. Other vices may sometimes bring people together: you may find good fellowship and jokes and friendliness among drunken people or unchaste people. But pride always means enmity - it IS enmity. And not only enmity between man and man, but enmity to God. In God you come up against something which is in every respect immeasurably superior to yourself. Unless you know God as that - and, therefore, know yourself as nothing in comparison - you do not know God at all. As long as you are proud you cannot know God. A proud man is always looking down on things and people: and, of course, as long as you are looking down, you cannot see something that is above you."

C.S. Lewis

relax

2010-03-08T18:04:00.000-08:00

time to chill out and love other thought-trees

on international women's day

2010-03-08T08:13:00.001-08:00

Three Proven Steps to Advance the World’s Women, on International Women’s Day

By NICHOLAS KRISTOF

Today is International Women’s Day, and in fact the 100^th anniversary of International Women’s Day. It’s a date that is much better known abroad but is beginning to get more traction in the U.S. as well.

So what interventions get the most bang for the buck in raising the status of women around the world? What is most helpful in overcoming injustices such as human trafficking and acid attacks? I’d welcome your ideas below, but let me toss out a few of my suggestions for most effective interventions:

First, I think girls’ education may be the single most cost-effective kind of aid work. It’s cheap, it opens minds, it gives girls new career opportunities and ways to generate cash, it leads them to have fewer children and invest more in those children, and it tends to bring women from the shadows into the formal economy and society. It’s not a panacea, of course. Lebanon and Sri Lanka were leaders in girls’ education, and both ended up torn apart by conflict. In India, the state of Kerala has done a fine job in girls’ education, but its state economy is still a mess and dependent on remittances. But overall, educating girls probably has a greater transformative effect on a country than anything else one can do.

Second, I’d argue for deworming and micronutrients. These may not sound like they’re “women’s issues,” but in a sense they are. For example, iodine deficiency particularly affects female fetuses, for reasons that we don’t fully understand. Insufficient iodine in the first trimester of pregnancy costs that child 10 to 15 I.Q. points for the rest of his or her life, and yet iodized salt programs that prevent the problem cost less than 5 cents per person reached. There are still tens of millions of girls out there with cognitive deficits because so much salt in poor countries is still not iodized. Likewise, women and girls disproportionately suffer from anemia, partly because of menstruation. In the United States, if a woman showed up at an E.R. with a hemoglobin level of, say, 9, she might get an immediate blood transfusion, and lower levels are rarely seen. In contrast, hemoglobin levels of 5 and 6 are routinely seen among women in poor countries – just unheard of in the United States. Deworming would help them, because worms cause anemia, and costs only about 50 cents per person and lasts a year (deworming is backed by groups like Deworm the World). So would iron supplements, which likewise are very cheap and can be given in particular to high school girls and to women expecting to become pregnant. Family planning likewise falls in this category: an intervention that is relatively cheap, pays for itself, and is vastly underfunded.

Third, we need more support for women starting businesses. These can be microsavings and microlending programs, or training in entrepreneurship. BRAC and Grameen have done great work in this area, as has Injaz in the Middle East. Such programs lead women to bring in incomes, and that gives them more weight in the home and society. Moreover, they tend to invest the income in their children, so there’s a broader effect in fighting poverty.

Lots of aid groups implement these kinds of approaches, including the big ones like CARE, Save the Children, Mercy Corps, and so on. So do small ones; Camfed, for example, is focused on girls’ education in Africa. I’d welcome your thoughts below both on what interventions are most cost-effective, and on the organizations you recommend to others. So many Americans are looking for good aid groups to support, and here’s your chance to recommend some to other readers.

2010-02-28T08:14:00.001-08:00

http://www.nytimes.com/2010/02/28/opinion/28kristof.html

random ramblings

2010-02-20T00:47:00.000-08:00

it's really nice to meet someone you get along with, and who is similar to you. making that connection is oh so special.

canada is getting slammmmmmeddddddd in the medal count compared to the usa. if things don't change fast, own the podium is going to be a big fat fail.

putting a pack of mentos in coke and throwing it off the high level bridge, while irresponsible, is quite some explosive fun.

nachos are pretty much the best food in the universe - along with bacon and dumplings :).

i am easy prey to addictive things.

choices

2010-02-12T13:05:00.000-08:00

life is full of choices. some we make consciously, others we make unconsciously. sometimes, explaining your choices don't make much sense. but at least you should explain them to yourself, i think. time to make a choice!

unicorns :)

the brain

2010-02-10T16:42:00.001-08:00

we have started learning about the brain in medical school, and what an interesting organ it is! indeed, it would seem that the reason every every other organ in our body exists is to keep this convoluted 3 pound mass alive and functioning.

i have been particularly fascinating by what strokes can teach us about the brain - knock out the blood supply to a part of the brain, that part of the brain dies, and the person is left with some sort of deficit. maybe they can't move their arm, maybe they can't speak properly, maybe their personality changes somehow.

so how many parts of the brain need to be knocked out before the soul is destroyed? if a stroke can completely alter your personality, disrupt all your memories, and take away your ability to feel - in short, if a stroke can erase who and what you are as a person, then what are you left with?

could it really be that everything we are is nothing more than a complicated network of electrical synapses? is that all love is? is that all a soul is?

i hope not! and these romantic notions of mine will take refuge in the margins of uncertainty that are formed from the gaps of our scientific understanding.

from a friend

2010-02-07T17:10:00.001-08:00

"Promise yourself to be so strong that nothing can disturb your peace of mind. Look at the sunny side of everything and make your optimism come true. Think only of the best, work only for the best and expect only the best. Forget the mistakes of the past and press on to the greater achievements of the future. Give so much time to the improvement of yourself that you have no time to criticize others. Live in the faith that the whole world is on your side as long as you are true to the best that is in you.”

self-assessment

2010-02-03T06:46:00.000-08:00

when i look back on my life over these past 5 years, how i was home and left and came home again, how this statement seems to run true. in the summer before i left for harvard, i made a bit of a commitment to try to stay as close to my friends from home as possible. what an exhilarating summer that was - the prospect of adventure, and glory on the horizon and the promises of relationships that would not recede.

alas, when i arrived in cambridge i was struck with a wretched home-sickness that, as far as i could tell, outstripped what any of my other friends had felt when they left. nostalgia - the word is a portmanteau of the greek words nostos (homecoming) and algia (pain) - a deep pain felt when recalling the past, one's home. unlike many other people who travel and leave, i was not blessed with a strong sense of adventure; i would much sooner spend my vacation time with friends and family in deadmonton rather than gallavant to far-away and exotic locales.

and so what did i do but squander my education by pining for home and squander my summers by coming back to edmonton while my friends did wonderful things. i met some very bright people at harvard, and when i first got there i was quite intimidated by my classmates. eventually, i did find a bit of a niche and managed to score a 3.99/4.00 on the economics honor exam that everyone in the class takes in the senior year. this isn't to say i was exceptionally bright by any stretch of the imagination, but i wasn't an idiot either and feel i could have done so much more. i could have done so much, but i chose to be with my friends. so perhaps squander isn't the right word to use. what i did was make a choice. a choice that has been richly, richly rewarding, but also a choice i would change if i could turn back time.

you see, i feel that enjoying my life at home with the people i love would be a bit selfish in a world where so many people even survive for want of basic needs. friends, relationships - important, vital even, but still a bit of a luxury. am i being a little dramatic? of course i am, but this is what i have to tell myself to change my underlying instincts, which is is to tend towards friends, home and comfort.

so when a friend of mine who came back this winter from his studies abroad told me about how he was desperately missing his home and his family and his friends, i wanted to tell him STOP - don't be weak like me and give up on your dreams so soon. of course, the nuances are different from mine and ultimately i want him to be happy, however that looks.

after a couple years, i managed to mostly rid myself of my deep-seated nostalgia. a round of medical school interviews, but again i somehow managed to sabotage myself - this time because i was, i think, deeply affected by a relationship and was contemplating not even doing medical school at all and moving to china to be with her.

and so here i am. one of the funny things about life is how even when we don't necessarily get what we want, things can turn out for the better. this doesn't always happen, but it happens enough to throw a wrench in our most intricately thought-out plans. i cannot say that what has happened has not been for the best - i am happy here at home, with the people i love. i have been blessed by rich and numerous relationships with people have helped me grow, that i have helped grow, that i care deeply for, and that deeply care for me. how nice it would be to be like one of my church friends and form roots here and always have your friends and family around you. but to me, this is selfish. and i will continue to tell myself it is selfish until i no longer want this sort of life. because there is so much that needs to be done, and i don't think, for me at least, that these things can be done here.

ultimately, determination is the best predictor for realizing one's goals; even if i'm not sure if things would be better had i taken a different path, i sincerely believe that failing in one's resolve in the long-run will certainly lead to failure.

another friend of mine asked me over the holidays how he really enjoyed the people both in his original home and his new home in edmonton, and how he wasn't sure how to choose between the two, and how he wished he could have the people from both. what i was thinking was that this was impossible. the choices we make in life cause us to gain one thing and lose another. my friend, he will eventually choose to live in one place, and most likely relationships from the other place will atrophy. i will leave, and as hard as i will try to prevent it my relationships at home will atrophy.

but that's okay, since we are at least blessed with the opportunity to make the choices in our lives.

protection

2010-01-29T16:02:00.000-08:00

as a semi-initiate to the world of japanese manga and anime, i have found that one of the most ubiquitous and recurrent themes is that of protection. what invariably motivates the protagonist to the next level of power, time and time again, is the desire to protect the (significantly weaker) friends and loved ones around him.

i sometimes feel disappointed and bitter when the people i know seem so much more concerned about pursuing their happinesses here while not paying too much attention to the problems raging around them. deep down, i know this bitterness is not any good, and there are several reasons for this. one i mentioned in an earlier post - that being optimistic rather than pessimistic tends just to be more effective a strategy for eliciting behavioral change. the second reason i will outline below:

what is the point of helping people meet their basic needs? i don't think it is so that people can be kept alive, because i don't think life is defined by the physiological processes that our basic needs satisfy. human life is the sum total of our experiences, our dreams and aspirations, our relationships, the truth, beauty, and goodness that we see in the world around us. we don't live so we can put more bread in our mouths tomorrow, we live so we can know the joys of success and the pains of suffering, so we can grow into the people we want to be, so we can fall in love.

so i have no reason to feel bitter. they are truly living, and that is a wonderful, beautiful thing that everyone everywhere should be able to do. and this, fundamentally, is what i really am trying to protect. all of the basic needs stuff - they are but the requisite threads that we need to weave the tapestry of our lives.

purpose

2010-01-26T22:14:00.000-08:00

what do you think the ultimate goal of life is?

security and stability?
to pass on one's genes?
happiness?
to glorify god?
to improve the lot of others?
to experience as many things as possible?

2010-01-10T07:06:00.000-08:00

is it possible that what we strain to find can be right in front of us? or perhaps i really am that blind and only stumble upon gold by happenstance or divine guidance. my confidence intervals are wide, but nevertheless, things are nice :)

i wax ambiguous

love from the archives

2009-12-21T14:15:00.000-08:00

a few days ago, a friend of mine told me that he always thought that i was 'asexual' - so interested in career that romance and matters of the heart would be of no importance to me. besides being a little surprising, these remarks really struck some nostalgic chords.

what happened almost 2 years ago seems like a dream. thank goodness for gmail sent-mail, since i have a written account of what i was emailing my friends in edmonton from when i was in china:

"...The ironic thing is, that when I first met here 4 months ago she hardly took my breath away - she was just another face at work. Even a month ago, after we had interacted much more, my feelings for here were not that strong - I merely had the sense that perhaps we had the potential to get along. Since then, however, I can only say that with every passing day spent in her company I have fallen for her a little more. The more time I have spent with her, the more I plumbed the depths of her character and person (to the extent that that can be done in a month), the more I began to appreciate her..."

"... hours flew by, as we joked about things as absurd as unicorns and made weird animal noises, discussed the latest developments in international relations, or dived into the world of religion and philosophy and spirituality. But even when no words passed between us, there was no awkwardness or boredom in the silence. The comfort and relaxation and satisfaction I felt in her company covered all our interactions, from inane chatter to the warmth of holding hands to watching BBC international to cooking up a storm..."

"...So we are confronted with what are essentially insurmountable logistical challenges - I am going back to Canada to start medical school, a process that will last the next 9 years, while she is going to stay in China..."

"...I think we will cherish the next few weeks that we have with one another as best that we can. It would be nice if things could go on longer, if circumstances were different, but I suppose you play with the hand that you are dealt. I will endeavor to enjoy the time we have and not cling to the memories after we part ways. So do I regret what I have done, getting to know her in spite of knowing the ending before even the beginning was written? I know that saying goodbye will be sad, but I think, hope that this is more than offset by meeting someone I connected so well with and who has taught me so much..."

well, things lasted a bit longer that i thought they would, and i fell a bit harder than i thought i would. i recall thinking i would give up anything to make things last: i would have thrown away every single friendship (and i value friendships very highly), to make things last; i was even contemplating throwing away the idealism that drives most of what i do too. it is astounding the degree to which rationality can be subsumed by emotion and passion.
_______________

it's almost 2010, and while i am technically 2 years older i feel so much younger. in beijing, it was as if i had a taste of what grown-up life is like; now, i am back to being a kid. but this isn't necessarily a bad thing. i feel as if there is something to be cherished from every different environment you find yourself living in.

so here i am, a 'baby asian' (my ex's nickname for me) once more. the future will come - in the meanwhile, it's good to savor the present.

an imperfect offering

2009-12-19T14:43:00.000-08:00

i'm not much for exchanging gifts over the christmas holidays, but i was very fortunate to receive the book 'an imperfect offering' from lillian (thanks lillian!). the book tracks the experiences of james orbinski, former head of of msf (aka doctors without borders) and his experiences - from somalia in the early 1990s as government and order disintegrated into anarchy to rwanda during the genocide when over a million tutsis were systematically, efficiently, and brutally exterminated over just 14 weeks; from founding the msf campaign for essential medicines initiative that dramatically brought down the prices of life-saving medications to accepting the nobel peace prize on behalf of msf for their humanitarian efforts.

i was so engrossed in the book that i finished reading it by this morning. christmas is usually overflowing with mirth and merriment, but this book was anything but - it was filled with tales of despair, suffering, and more than anything else, death. yet in the midst of its horrors, i felt that a message of hope resounded strongly. this was the story of one man's unshakeable struggle against overwhelming injustices. and at the end of it all, decades after he began his career, it is clear that while injustices remains and needless suffering persists, it is just as clear that HE TRULY MADE A DIFFERENCE.

towards the end of the novel, he writes about optimism and hope: "optimism is the expecation, based on the evidence at hand, that there is a reasonable chance of a good outcome. hope, on the other hand, is the certainty that a given action is right, that it "makes sense, regardless of how the situation might turn out."

how priviliged i am to be able to study medicine, a career that should not about career stability, good lifestyle, or power and prestige, but that is, at its essence, about improving the lot of my fellow man. how priviliged i am to believe in God, someone i can turn to for light no matter how bleak the world becomes.

this christmas, i will be thankful, and i will be hopeful.

social psychology on how to save the world

2009-12-13T08:53:00.000-08:00

From... http://outside.away.com/outside/culture/200912/nicholas-kristof-philanthropy-advice-1.html

Lessons from social psychology suggest that:

"If one lesson is the need to emphasize hopefulness, the second is that storytelling needs to focus on an individual, not a group."

"One experiment found that people are quite willing to pay for a water-treatment facility to save 4,500 lives in a refugee camp with 11,000 people in it, but they are much less willing to pay for the same facility to save 4,500 lives when the refugee camp is said to have 250,000 inhabitants. In effect, what matters is saving a high proportion of people, not just a large number of lives."

"In each case, research subjects were quite willing to help and donated generously either to Rokia or to Moussa (for argument's sake, two hungry children). But when people were asked to donate to Rokia and Moussa together, with their photographs side by side, donations decreased. Slovic found that our empathy begins to fade when the number of victims reaches just two. As he puts it: "The more who die, the less we care."

what FASCINATING stuff! if ever there was a reason not be sad about the state of the world, this would be it! and in reality, a little bit would really go a long, long way - the challenge of providing basic needs for all is far from insurmountable

let's shed those heavy boots forever :)

i <3 alliteration

2009-12-12T17:35:00.000-08:00

i have been feeling a bit down as of late: perhaps it's my nasty family history of depression rumbling, general jadedness about the human condition, being diagnosed with arthritis and AS, who knows.

whatever the reason - no more! as lillian put very it very correctly last night, there is so much to be grateful for. and what's the point of being heavy boots? it certainly doesn't do yourself, the people around you, or the world at large any good. so, let the festivities reign this christmas season. nothing like the end of school, impending yuletide cheer, and the return of faraways to herald happy halcyon hours.

friends

2009-12-12T09:02:00.000-08:00

last night two fun things happened - i had a chance to see one of my best friend's, howard, freshly returned from mit for the christmas holidays, and there was an absolutely fabulous karaoke party at at charles's place.

since september, i have definitely been spending more time with my medical school classmates - but let's backtrack a bit...

a little more than a year ago, when i started medical school, i was a mess. i could tell that my relationship was slowly disintegrating into oblivion and while i had pined to come home for years, more recently i was pining not to come back to edmonton (too much elitism, timothy, sigh). luckily, my close friends were all still in edmonton, and it really was a treat being back with them. and so, a little more than a year ago, i didn't much reach out to my classmates - because i wasn't sure what to make about being at alberta, and because i wanted to cherish whatever time i had left with my closest friends.

this past summer, four of my best friends moved away - one to vancouver, one to boston, one to hong kong, and one to croatia, the four corners of the world so to speak. i was sad to see them leave, but perhaps not that sad since i had gotten used to saying goodbye to good friends,. i didn't really expect this, but with the free time i had on my hands i began spending more time with my classmates; while this has been refreshing, enlightening, and enjoyable, i often find myself asking what is the nature of friendships?

what i'm trying to get at is that even though i value friendship so strongly, even though (i think) i try very hard to keep in contact with the friends around me, it seems almost inevitable that they disperse and leave. and when friends do leave things do change, no matter what the idealists will have you believe . all these relationships - they seem so transitory sometimes.

which doesn't mean they shouldn't be enjoyed!! life's pleasures seem so fleeting sometimes :(

24

2009-12-07T07:56:00.001-08:00

two dozen years. i suppose that is a bit of a milestone. in commemoration of my birthday (oh yes, self-aggrandizement for the win), i have compiled a list of 24 random tidbits [and pardon the delay in posting, it's been hard to put this together]

trying new and different things and lifestyles can be enjoyable and expand one's horizons, but an ounce of caution is often warranted
good shoes are warranted if you are going to run long distances
there is a class of drug that decreases mortality in heart failure in African-Americans (not in whites, not in Asians, etc...) - hydralazine/nitrates
singing can be so very, very fun
sometimes the things we value are fleeting - it is important to enjoy them nevertheless
as cute and cuddly as the platypus might look, it's venom is powerful enough to drop a grown man and cause him to writhe in pain - never trust those monotremes
best song ever: http://www.youtube.com/watch?v=mTa8U0Wa0q8
there's nothing quite like being home for christmas
the united states only spend 7 cents per day per person on its human spaceflight program - we'll need to do a bit better if we're ever going to get to mars
wouldn't it be nice if everyone loved everyone?
if you want to talk in a british accent - remember the long o - as in when you say 'gone' - and remember the short o - as in when you say 'hot'
china is an economist's heaven: sustained gdp growth of ~10% annually for almost 30 years, an absolutely precedented feat that has brought more people out of poverty than probably every aid agency and ngo put together
jia's sayings: Meow! Friend-pat! Purrrrrrr! Hugbot! Lovebot!
if i could go anywhere in the world, it would be jerusalem
sadness is woven into the tapestry of life: it's something you can't run away from and it's something that defines the human experience
bill gates is a pauper compared to john d. rockefeller of standard oil fame - he was worth around $318 billion in today's currency
i think it is sad that society equates christianity with close-mindedness, hypocrisy, and being judgemental
how is it that in recent polls the wildrose alliance blew the progressive conservatives out of the water? for shame alberta - why is it the wealthier we become, the more regressive we want our governments to be :(
pikachu may be cute and cuddly, but i'd rather a dragonite anyday - hyperbeam ftw!
we should donate more of our money to the needy - what is a new tv compared to food and water for a starving family?
"But the sun's been quite kind while I wrote this song/ It's for people like you that keep it turned on"
kfc is yumtacular
edmonton, often underrated, as
thank you - friends and family - for being with me over these 24 years

children's stories and love songs

2009-12-06T00:48:00.000-08:00

what i love about children's stories and love songs is that they always have a happy ending. tonight, on my car ride home from south edmonton common i sang through half of bsb's millennium album with my friends.

oh how happy that made me feel! the world can sometimes be a dark place, but love songs and children's stories never will be.

apathy/hypocrisy

2009-12-06T00:14:00.001-08:00

i haven't made a post in quite a while - i didn't feel as if i had anything to really post about. but, thoughts have been swirling in my mind, the night is yet young, and song's from backsteet boy's millennium is playing in the background - a perfect storm for blogging.

this post is about apathy. that and hypocrisy.

some background first - beneath all the friend-pats, unicorn love, and cat sounds, a rather more serious jia lurks. i feel profoundly passionate about issues related to poverty, particularly in a developing country setting where it is so often crippling that the most basic of human needs are unsatisfied. in the western world, we always espouse values like justice, equality, and equal opportunity, yet most of us stand by and do nothing as poverty grinds down these values and grinds down human life as if they were nothing. do we not understand that a person in africa is the same as a person in canada? they have friends they care for, families they love, and aspirations they dream towards - they are human beings, as much as you who are reading this blog is a human being, and they deserve a right to life as much as we do. what i find particularly horrendous is that we have more than enough resources to end poverty. many experts believe we could meet the millennium development goals if rich countries contributed a mere 0.7% of their GDP as aid to developing countries.

and yet we do not do this. we stand idly by as thousands upon millions die needless deaths. this is society's apathy.
_______________________________

but what right do i have to pontificate? if i look at my life, am i doing much more than the people i disparage in the above paragraph? is my life really that different? i am not leading a movement, heading an ngo, raising awareness for critical issues. instead i am in medical school, ostensibly to increase my capacity to make a difference in the future so that i am not someone who is 100% good intentions and 0% capacity. but perhaps i am just rationalizing away a desire for wealth and security in a cloud of false idealism. ultimately, if i ask myself 'what have you done?', i can only say 'very little'. i have been particularly critical of christian people (including my christian friends) in regards to how little they seem to care about these issues. the bible is absolutely rife with commands to show love to the poor, and yet over and over again i find that it is my non-christian friends who care more about making the world a better place than my christian ones. but as i pause to think, and once again ask myself "what have you done?", again i can only say 'very little'.

there is a rather fitting bible verse for this (Matthew 7:3)

"Why do you look at the speck of sawdust in your brother's eye and pay no attention to the plank in your own eye?

if i care so much, and yet do so little, i am far guiltier than someone who doesn't care at all. this is my hypocrisy.

if only i could be more like jesus

bacon

2009-11-29T02:32:00.000-08:00

There is nothing better than waking up beside someone you love and then making a breakfast that is full of bacon :)

spending

2009-11-28T08:55:00.000-08:00

Amount Americans spent on cosmetic surgery (2007): $13 billion
[http://www.cosmeticplasticsurgerystatistics.com/statistics.html#2007-NEWS]

Amount Americans spent on pets (2007): $41 billion
[http://www.businessweek.com/magazine/content/07_32/b4045001.htm]

Amount Americans spent on cosmetic products (2006): ~$57 billion
[http://www.google.ca/url?sa=t&source=web&ct=res&cd=1&ved=0CA4QFjAA&url=http%3A%2F%2Fwww.marketresearch.com%2Fbrowse.asp%3Fsortby%3Dp%26categoryid%3D1547%26g%3D1&ei=cloRS4WjMYiUnQe5hrTVAw&usg=AFQjCNGFuft3kDgChdjSMRYuih8XZyKGwA&sig2=Sb0vAfSz1p0YibcGISaS9Q]

Amounds Americans spent on net official development assistance i.e. foreign aid (2007): ~$25 billion
http://www.globalissues.org/article/35/us-and-foreign-aid-assistance#ForeignAidNumbersinChartsandGraphs

Not to knock on Americans per se, I think the patterns are reasonably consistent around the world

sleepy

2009-11-25T21:53:00.000-08:00

earlier this school year, i tried to subsist on five hours of sleep a day - my rationale being it was possible to train oneself to sleep less and less.

let's be honest, as nice as sleep is, we waste a huge chunk of our day doing it. productivity could increase by 30% overnight (pardon the pun) if we didn't need to sleep. people who get around on less sleep have more time to work, to see friends, to pick up a hobby, to do all those things that make us human. since really, if we liken being awake to being alive, then a similar parallel can be drawn between sleeping and being dead.

i succeeded at doing the five-hour a night routine for a few weeks, but then i crashed. crashed in the sense that my autoimmune arthritis was potentially triggered by this. now, i struggle to stay awake at 1030 after sleeping for five hours the night before. whether this is because of my medications or because i am just weak, i do not know.

alas, what a failed experiment :(

luckily, different people surely respond differently to sleep deprivation. even though i was unable to succeed, you may be able to! i highly recommened trying this little sleep-less experiment if you foresee a busy future.

heresy

2009-11-24T20:57:00.000-08:00

religion is a strange creature. there are parts that are so appealing, so enlightening, so divine and then there are parts that are so ???

i often feel that my ideas are balanced between opposing influences - rational vs. faith-based thinking, christian friends vs. non-christian friends (this means associated differences in lifestyle), church vs. scientific establishment. i just realized that in comparing the 'religious' vs. the 'scientific' ideas, the diction intrinsically favors the latter - food for thought for another day.

so, if i could ask God to clarify a few things, this is what my list would look like:

1. why is there a hell? and related to this - why do religions often think that everyone not of their own faith are going to that rather unpleasant place?

2. what's with the prohibition on sex - very rarely is there an exchange that leaves both parties rather (intensely) satisfied?

3. why is there always some killing/smiting/general violence going down?

4. why does God want us, amazingly insignifcant little humans, to glorify him and worship him?

now, don't get me wrong - i think religion can be a very good thing. in fact, i am christian and i think it is absolutely wonderful. but being christian doesn't mean i shut off parts of my brain (a common criticism leveled against those of the faith, i think) and so the questions remain...

yan yan returns

2009-11-23T21:31:00.000-08:00

tomorrow my mother is returning from china. she has been gone since early september, an absence of almost 2.5 months.

since she has left, my dad and i have been eating rather unhealthily (i swear i go to macdonald's at least twice a week), her plants that i promised to water (and that i do!) have been slowly dying but have hopefully not passed the point of no return, and the house is drifting slowly into a state of dilapidation (i exaggerate, but we haven't even vacummed since she left).

my mother and i have an interesting relationship. i often can't stand her incessant nagging and her frequent bouts of irrational fear (jia! don't go out in the rain, you get hit by lightning!). i probably shouldn't make fun of her when she is incapable of defending herself so i'll stop now.

it is interesting how difficult it can be to love those that are the closest to us. i wonder if it's because we become so familiar with them that we take them for granted. or perhaps it's because we know them so well that the bad parts of their character outweigh the good in our minds. or maybe we just lose the veneer of politeness we maintain in the day-to-day for strangers, acquaintences, and even friends. i must confess i find it very difficult to love my mother, in spite of all that she has sacrificed for me; and she has sacrificed eons more than i could imagine sacrificing for another single human being. if ever i need to be reminded of the darkness of my soul, then i need look no farther than how i have treated my mother. i could make a list of the reasons why, but at the end of the day, do they really matter?

so tomorrow yan yan will be back. for once, though, i find myself awaiting her return. i am sure i miss the food she cooks and the general order she brings, but i think that i might just (fingers-crossed!) miss her lively presence in my life.

soleil x 2

2009-11-22T20:16:00.000-08:00

(1) i think about the future too much - how to make a meaningful difference in the world, how to balance relationships with travelling, how to find true love (i'm a sap i know)

it's time to stop thinking so much and start having fun! hedonistic lifestyle of drugs, alcohol, and women here i come. just kidding. maybe. there's no sense in letting abstract thoughts get in the way of present happiness, right?

(2) http://www.theglobeandmail.com/news/national/researchers-labour-of-love-leads-to-ms-breakthrough/article1372414/

I don't know a whole lot about multiple sclerosis (MS), but from what i understand it is an autoimmune neurodegenerative disease that can be dreadfully difficult to treat. enter a scientist who wants to find a cure for his wife. this fellow finds that MS is strongly correlated with chronic cerebrospinal venous insufficiency, essentially making it a vascular disease and begins treating it accordingly - by dealing with strictures (narrowings) in patients' jugular veins. the results are apparently astoundingly positive! much more research needs to be done, but it's nice when you hear about a medical breakthrough that maybe, just maybe dramatically improve outcomes for many people

rhodes musings

2009-11-22T19:58:00.000-08:00

this weekend i travelled to regina for a rhodes scholarship interview. suffice to say, i didn't win.

this outcome has left me with rather mixed feelings. a part of me is sad - winning something like the rhodes would be rather nice - great experience, great education, great people, great on the resume; however, i think an even larger part of me is quite relieved - let me explain why:

over the past few weeks i have been filling out-of-sorts. the spectre of potentially having to leave home so soon again was like a little raincloud sitting on my head. over the past 6 years, i've lived in a few places - edmonton, boston, and beijing. every move i make, you say goodbye to your friends and the people you care for, travel to a new place, spend time forging new friendships, and then say goodbye to them all over. the cycle gets to be a bit annoying after a while. and sometimes people say (myself included) that friendships don't change when you move far, far away - well, let me say that that's absolute bollocks. seeing people way less is change, no matter how you slice it.

i don't know why emotionally i'm such a homebody. i feel that the friends i met at harvard do not suffer from this particular affliction. i'm sure many of them have lived in more places over a shorter period of time than i have. i'm not sure if i should even be calling this an affliction...

hiatus

2009-11-22T19:54:00.000-08:00

it has been a very long time since i have blogged - i stopped because i thought i didn't have enough to say. however, after many months of vacation my mind has churned out enough ideas for me to venture back into the blogosphere (though what i do hardly consistutes blogosphere posting).

one of the challenges (at least for me) of blogging is that it is very difficult to keep the subject matter varied enough to be interesting. i will try my best to do so. i will also try my best to post at least once a week.

in edmonton

2009-06-27T09:27:00.000-07:00

i arrived home on wednesday night - wow, time really does seem to whiz by here. since coming back, i've felt a little out of place. life is very different here (naturally); to me, it is quite idyllic - a happy, safe, prosperous place where people can settle down and lead bliss-filled lives.

i really enjoy edmonton, especially my dear, dear friends. the weather in the summer is quite lovely and is paired with verdant scenery to boot. i am a frigid-loving fellow, and so even the incessant sea of white (and white-brown) that visits us every winter i find quite enjoyable. you could really settle here and lead quite a happy, happy life.

alas, i think it is important not to forget the deserts beyond the oasis. this i must tell myself as much or more than i would admonish others. when i was in zambia, i met some folks who felt that they found their niche in that society. it was a place that they naturally clicked with, that made them feel emotionally fulfilled. this isn't me: i am emotionally fulfilled where my friends are, but i am logically drawn to faraway places.

i think my travels have shifted me a few points in the direction of the latter and away from the former. i think this is something that is important to do if doing extended work in different locales is what i want to do

midnight sun

2009-06-17T16:47:00.000-07:00

i am currently in iceland at a hotel at the edge of skaftafell national park. it is 13 minutes to midnight, and it is as bright as day outside. fascinating, yet so unfortunate for one´s circadian rhythms. and to think that in winter the opposite is true, with almost 100% darkness... shudder

i find writing about social issues so much more interesting than just about natural beauty or scenery (i will leave that to facebook photos).

fun facts - iceland is one of the world´s wealthiest countries (5th) and also one of the world´s most economically egalitarian ones (4th by Gini coefficient, a means of measuring inequality). iceland also generates 70% of its power from renewable geothermal sources. iceland also has the world´s first openly homosexual head of state - and she is a woman at that.

i wonder if all this is possible only because of iceland´s unique natural heritage and it´s small population (a little over 300,000).

2009-06-10T07:32:00.000-07:00

they (they i think being stalin) say that the death of one person is a tragedy, but the death of a million is a statistic. it is fascinatingly human how we need the closeness of experience to most effectively galvanize our emotions. we try to condition ourselves to think with logic, in the abstract realm of probabilities and statistics, but to make another trite quotation, these don't speak as loud as our hearts.

the life expectancy of the average zambian is 40.9 years. the life expectancy of the average canadian is around 80 years . the per capita income of the average zambian is $395. the per capita income of the average canadian is $39183. what does this mean?

i am working at university teaching hospital, probably one of zambia's best non-private, non-expat hospitals. today as we were doing our major rounds, one of our patients started gasping for air. he had been admitted five days ago at emergency with a three-week history of headache. the day before admission, he had stopped talking. he had been in a semi-comatose state since then, but for whatever reason i don't think that the necessary tests for the likeliest diagnosis (a fungal infection of the brain and meninges - cryptococcal meningoencephalitis) was never done.

some more background - corruption scandals in the zambian government have led to widespread strikes across the public sector. first it was the junior doctors, then it was the nurses, and as of today several other government agenices have gone one strike as well. as the number of strikers has gone up, the quantity and quality of care that we provide has declined. our unit would normally be in charge of 40-50 patients; now we manage only 16 as aggresive discharging has been the modus operandi in response to manpower shortages. the hospital is manned by the few senior doctors we have and a load of student nurses and medical students.

back to our patient. i can't say i know much about him - i know his name - francis, and i know his age - 30. i haven't talked to him really, being in the comatose state that he is in. today, at around 9:50 am, francis started gasping for air. we tried to give him oxygen, but the wall attachment for oxygen was not working so we moved him beds. i think he was in fairly acute respiratory distress, so we tried to get him onto a ventilator in the ICU. alas, all of them were being used (even in our hospital's reduced state) and so we moved him to the neighbouring bed were the oxygen wall socket was working better. he was producing major secretions that were blocking his airways, so we began suctioning. we gave him adrenaline as his condition declined. we gave him cpr as his condition declined some more. we gave him another shot of adrenaline.

at 10:50, my senior shined a torch into francis's eyes to look for a reaction, and found none. he placed his stethoscope on francis's chest and heard nothing. he moved his fingers over francis's radial artery and felt fruitlessly for a pulse.

certified dead, 10:50 am, june 10, 2009.

a young man, only 30 years old. while i never talked to francis, i remember everytime we rounded we spoke to his 'collateral' - a family member that stayed with him and looked after his needs (this is very common in zambia, and practically everyone in hospital has one or two). so francis had family. i'm going to venture that francis had friends like we all do, memories like we all do, aspirations like we all do. 30 is a young age to pass away at. if any of my friends (many of whom will be 30 in a few years give or take) were to pass away, i would be heartbroken.

it is very human that over a single story we will shed tears and reflect (and maybe even blog), but we can not bat an eyelash as the most gruesome numbers

___

yet another trite quotation - we take these truths to be self-evident, that all men are created. equal. what does being born into a country with a per capita income of $395 mean? it means that your country is probably not wealthy enough to mount an effective public health campaign against hiv/aids and so prevalence rates will be high - 20%, let's say. it means you won't have the resources to be screened for hiv/aids as the disease wrecks havoc with your immune system. it means you won't hace access to the family doctor when you begin to feel troubling symptoms. it means you will come to the hospital in a semi-comatose state, your relatives desperate for care, but your doctor knowing that the prognosis is quite, quite dismal. it means being certified dead on at 10:50 am, on June 10, 2009. i am going to venture to say that this would probably not happen in canada, where our income is a tad higher.

can we truly say that all men are created equal when we are born into such inequality? can we rest with confidence on our laurels when all it took was a flip of the cosmic dice?

and let me just reiterate that university teaching hospital is one of zambia's best hospitals. i am sure things are worse in rural areas, where people are poorer and the facilities are shoddier. i am sure that things are even worse in refugee camps and war-torn areas, where a perfect storm of overcrowding, infections, unsanitary conditions, and co-morbidities can easily decimate populations.

last night i watched atonement, a movie about a woman's desire to seek atonement for the sins she has committed, sins that have caused the deaths of her sister and her lover.

if you were walking by a river and saw a child fall from the tree into the water, if you saw that she could not swim and would drown in minutes without assistance, and just walked away because you didn't want to get your new shirt wet, how could you seek atonement for this sin of omission... is there really any difference between that and the relationship between us in rich nations and our fellows in poor nations? so we add the element of distance, and differences in language and culture to the formula, but nothing has fundamentally changed: the links in the chain of causation remain lucent - we have the ability to change the outcome from death to life, but we walk on by

hahaha - too much pontification! stories and didactic examples and statistics aside, while it is true that the issues are complex and many, solutions are within our grasp :)

nurses strike

2009-06-08T07:23:00.000-07:00

the interns and PGs have been on strike for about a week and a half now, and the nurses have now joined the picket lines. the hospital is now crewed by senior doctors, medical students, nursing students, and the few interns on attachment from other countries we cannot strike.

half the wards on internal medicine are now closed. reading the newspaper, it seems that other parts of the country are being affected even more seriously than here in lusaka. the government seems slow to respond, and i'm sure many people are dying as a result. corruption - not a very good thing at all

safari

2009-06-08T07:17:00.000-07:00

this past weekend (my last in zambia) i went to a safari at kafue national park. it was pretty much what i expected out of a safari - we camped in the national park for two nights and went on a game walk and a game drive during our stay.

there were loads of hippos there - and at night they are one of the loudest creatures so staying in the tent you always think they are closer than they actually are, ready to bring the rampage down on you. there were even more loads of the antelope-family creatures - puku, impala, etc... we saw some zebras as well. someone has to explain to me how black and white striping is evolutionarily advantageous camouflage against the golden serengeti backdrop. we saw a few elephants, a few hyenas, and various smaller creatures including jannets (spelling?), hares, and civets. unforunately, we did not come across any of the big cats (lion, leopard, cheetah) and there were no giraffes or rhinos in that park.

one thing that amazed me was the moon. we had near-on full moons both night we stayed, and it was incredibly bright. the light cast by the moon blotted out many of the stars and created a permanent twilight that didn't dissipate until around 530 AM when the moon set and the starts came out to play again. perhaps its the bright city lights that takes away from the majesty of the moon at home

arrest

2009-06-04T09:34:00.000-07:00

a senior registar, dr nyirenda, and some medical students were doing a tutorial on lower limb motor exam when a nursing student called us over to see a patient who was in convulsions. dr. n asked to review the file, and about a minute later the nursing student came and told dr. n that the patient was now gasping. i believe his underlying condition was endstage renal failure

we walked over to where he was, and after listening to his heart, realized he was in cardiac arrest. dr. n started chest compressions and i was holding a facemask giving him oxygen (although i really had no idea about the timing or number of breaths or anything really about basic life support). i could feel that his neck and face were quite cold, and couldn't feel a carotid pulse. we tried to inject him with adrenaline, but after a few minutes of chest compressions dr. n said that he was dead.

a few minutes after that, we walked back to where the tutorial was (just 10 meters away in our very open ward) and the family of the man who had passed started wailing

that was the first time anyone has died right in front of me

i was quite sad and started tearing when the family started wailing. dr. n just went right ahead and did the tutorial with no apparent emotions. he must have seen hundreds of patients die like that

age

2009-06-02T10:17:00.000-07:00

yesterday night we celebrated the 30th birthday of one of our expat friends here in zambia. it was somewhat of a gongshow, and amongst over things i discovered that ethiopian food may just be my least favorite genre of all foods

i'm 23 now, and i can still quite clearly remember what happened last year, 5 years ago, even 10 years ago. 10 years ago, when i was in grade nine, i thought that 23 was a dreadfully old age, a distant specter aeons away from where i was. well, here i am. it seems that life accelerates the older we get. haha! i know i'm quite young still, but it's true that the decades will only keep piling up.

on the topic of growing old, i was watching the notebook the other day, and at the end of the movie a couple very old and very much in love die in their sleep. sorry for spoiling that ending.

i swear one of the two main reasons i am christian is that i just can't stand the idea of a love like that dying after just 80 or so years. that would be just too sad. better there is a heaven where love can continue to bloom.

in other news today i was drawing blood for some electrolytes/creatinine for an HIV patient and splashed a load on my hand. i'm glad i had my gloves on, but often i don't. better safe than sorry, though the rate of transmission from blood to unbroke skin for hiv is ridiculously low

phone

2009-05-31T07:47:00.000-07:00

i am going to shamelessly solicit phone calls now. i have a cell phone and just realized that people from abroad can call me!

the number is

+260966373945

i'm not sure what the rates are, but i think the rates on skype's phone-line calling services would be very cheap

health economics

2009-05-31T07:42:00.000-07:00

i was talking to sarah-lou the other day, and she told me some interesting things about health in britain:

1) all doctors of an equal seniority get paid the same - so the internist gets as much as the pediatrician gets as much as the plastic surgeon

2) staff docs (called consultants) don't get paid that much! apparently a starting consultant might only make something like 80,000 pounds a year

3) waiting times are much less - hip replacements apparently won't ever take more than 3 months and the maximum permissible waiting time by law in emerg is 4 hours from entry to being seen by a physician

i'm not sure how they manage the waiting times thing, since they don't spend more on healthcare per capita than canadians do, but damn wouldn't it be lovely if we had that too?

the day to day

2009-05-31T07:25:00.000-07:00

i am sitting at an internet cafe in the árcades, one of two major shopping centers in lusaka (they're both each about the size of two strip malls, so quite small)

i was post-call yesterday, and so after finishing rounds at about 10 am, i rushed over to my friend dr. sombo fwoloshi's house (recently graduated from medical school, currently an intern). she lives about a 30 minute walk from the hostel i stay out, and has these lovely couches that are so easy to sink into. we only stayed for a bit as my other friend dr sarah louise bailey (senior registrar doing some tb research for a few months here) went on a shopping marathon with some of sombo's relatives.

we went to a market near downtown lusaka that had loads of stall selling clothes, vegetables, fish, bags, shoes... oh so many shoes, but the remarkable thing was that all the garments were COMPLETELY USED! i have no idea where zambia has managed to acquire so many used products, but it was rather amazing, this veritable sea of second-hand. we walked around the stalls for 5 hours, and for all my efforts i picked up a used shoulderbag for 7 dollars and sarah-lou (as she likes to be called) got nothing. well, it was good exerercise and a novel experience. the two women we were with were monsters and were relentless in their quest for material consummation - quite, quite intense

afterwards, i went home and ordered a couple pizzas from the loca pizza shop called 'debonairs' - the two came out to 114,000 kwacha, which is about 23 dollars - not cheap by any stretch of the imagination, but it did fulfill a craving and some major hunger pangs. in the evening, i convinced the two of them to watch the notebook for me, a sappy romantic movie i've been meaning to see for quite a long time. it was decent, and i was definitely tearing up towards the end.

i crashed at sombo's place, and in the morning took a bath and strolled to the catholic church with sombo and her mom. there were several hundred people at the service, and the priest even mentioned me in his sermon (i can see lots of asians - asians mean people from india colloquially, lots of europeans, many africans, and i can even see a chinese or korean fellow over there - and then he pointed at me) - he was a good speaker, and talked about the one language that is the holy spirit and love that unites humanity.

after church, we strolled back home where sarah-lou cut my hair - yay for sarah-lou! oh, i also learned that all the braids and long hair that black women sport is pretty much fake - the way their hair grows is naturally very curly, so getting it long is almost impossible. and here i was thinking they all had such cool hair! after this haircut, we strolled over to the arcades and had a late lunch at a place called mint, a little cafe that sells lots of healthy, organic things. and then here i am now.

i just noticed they are playing celine dion in the background.

so just another saturday in lusaka

strikes

2009-05-27T07:17:00.000-07:00

news has been stirring amongts the interns and the PGs (post-graduates) that a strike is afoot. now, an explanation of the british system of medical education (the one adopted by zambians): medical school starts after high school and lasts for 7 years. after this you have a 2 year internship period, similar to the internship 3rd and 4th years have in north america. after this you have 4 or so years of post-graduate training, similar to the residency programs in north america. after this you become a 'senior registrar' and can then choose to specialize, in say, infectious diseases which will then take another 5 years. when you become staff you are called a consultant.

at any rate, the interns and PGs, which make up >50% of the hospital staff and engage in a bulk of the first-line work are seriously considering going on strike. this would be seriously debilitating to the hospital and any strike would surely lead to casulaties and deaths. there are some interesting moral issues surrounding strikes conducted by healthcare personnel...

now interestingly, they apparently go on strike about once a year in response to the chronic funding issues that are never adequately addressed, chief amongst which is housing. housing is supposed to be provided by the hospital they work at, but apparently there is a lack of funding this year and so many fear finding themselves homeless

this year, however, there is a new twist - one of the main reasons that the hospital is running out of money is CORRUPTION. a mid-level official at the ministry of health embezzled 10 billion kwacha (close to 2 million USD) and purchased several hummers, lexuses, and expensive girlfriends. this is only the tip of the iceberg, as an additional two dozen officals from the ministry are currently under invesgitation.

what is worse is that foreign donors have cut off funding until the country cleans up its act. the annual budget of the ministry of health is 1.8 trillion kwacha (slightly less than 400 million USD), of which 55% is made up of foreign aid. to lose this sum of money for any extended period of time will be disastrous for healthcare in zambia. hopefully everything is resolved quickly so that health is not too badly affected... again, there are interesting moral issues surrounding such a move

so, donor beware. let's see what happens

life skills

2009-05-27T07:08:00.000-07:00

the nurse's hostel that i live in is not the most luxurious of accomodations - there is no hot water, the shower doesn't seem to work (though there is a bathtub), there are no laundry machines, there are tons of cockroaches and other insects in the kitchen, etc... etc...

i've had to adapt a little bit along the way:

1. hand-washing clothes: now, i don't even normally do laundry at home (since my mom does it, all by hand i must add since she is reluctant to spend money on the washing machine), so hand-washing my clothes has been a new experience. throw clothes in the bucket, scrub with soap, add laundry, sit, wring, and then hang outside to dry

2. makeshift screwdrivers: earlier today, my doorhandle and its frame fell off. i managed to acquire a couple new screws, but in the absence of a screwdriver i had to use the blade end of a butterknife to screw them in and then used a hammer to finish the deed

3. mosquito nets: sleeping under an insecticide-treated bednet is highly recommended for children and traveller's to malaria endemic regions. i have to sleep under my bednet, but for some reason EVERY night there is this one buzzing insect that always gets in... we wage a constant war with one another, and last night i upped the ante by bringing into bed my bottle of bugspray and just spraying like madness whenever i heard the oh-so-annoying buzzing

4. exercise: there are no gyms here, and biking here is scarier than biking in China. since running is contraindicated in my plantar state, it's rather hard to exercise in lusaka. i just take long walks to the mall where i eat subway. i yearn for some heart-rate accelerating activity, but i suppose i will just have to live with the status quo for now

grown-ups

2009-05-26T12:14:00.000-07:00

in my travels, i think i have met the grown-up version of jessica moe. i hope it's not too impolite to blog about people (maybe it's even an compliment?), but i'm going to do it anyways

who is this person? an activist-campaigner type, very pro-working in developing countries, very pro-organic, very pro-environment (so much so that she doesn't eat meat),

/****
aside: meat is HORRIBLE for the environment - the amount of grain needed to raise a cow can feed 10 people, and it takes around 3000 L of water to produce just a kilo of beef (and you probably thought you wasted the most water doing laundry, showering, flushing, etc...) - i REALLY WISH i was vegetarian, for health and environmental reasons, but alas i also really like the taste of meat :( - it's hard to do what you really don't want to do, even if you think it's right
***/

very anti-consumerist, very anti-shopping malls, very interested in working seriously on the ground (i.e. a remote, poor village in the middle of nowhere), very idealistic, etc...

in many ways, i really wish i could be more like this. i have a weakness for toilets, showers (surprise surprise), and an absence of bugs in my room, but so many people live without these things that i wish i was better able to stomach it. i wish i was vegetarian (as listed above). i (sometimes) wish i was more activisty, although i often wonder how effective grassroots activism is say, compared to working for policy-level change from within the establishment.

i mostly wish, though, that i had as much heart as this person and as jessica moe, an old friend of mine who got me thinking about helping the most needy globally in the first place so many years ago. the world would be a better place if there were more people like this, of this i am certain. still, i personally don't think that the best way to make change is the move into the middle of nowhere and doctor - i think working at a policy-level, or donating your money to train say 10 local doctors, are more efficient uses of one's resources.

that being said, people flourish when they do what they enjoy doing - and for some people that is to work on the ground, and i must say i admire that a great deal

livingstone

2009-05-26T11:59:00.000-07:00

Ah, at last, time for a post not on medicine or careers or morality, but just plain traveling.

This past weekend I had a chance to visit Livingstone, located on the southern tip of Zambia at the Zimbabwean border. The city's biggest attraction is undoubtedly Victoria Falls, one of the largest waterfalls in the world. It's name, Mosi-au-tunya, means 'the smoke that thunders' - and indeed you can see the 'smoke' created by the water vapour generated by the waterfalls from miles and miles away. It also thunders, since waterfalls are loud. Just walking around the falls we had to rent raincoats and we still managed to get utterly and thoroughly drenched.

We spent several of our evenings sipping drinks at various restaurants/bars on the Zambezi river. This is the 4th longest river on the continent and feeds Victoria Falls. The weather was absolutely perfect - not too hot, not too cold. The scenery was absolutely spectacular - large, majestic river, nice vegetation, beautiful sunsets, the smoke of Victoria Falls, etc... I would love to spend all my evenings like that...

Another interesting thing I encountered on my trip was the Zimbabwean dollar. During our travels, we walked on the bridge over the gorge created by the Zambezi river after Victoria Falls. This bridge happens to be halfway in Zambia, and halfway in Zimbabwe (so yes indeed, I did technically set foot in Zimbabwe).

Now, Zimbabwe is one of the most messed up nations in Africa at the moment. There are many reasons for this, but one of the unfavorable outcomes has been ridiculous hyperinflation. There are numerous hawkers selling Zim dollars on that bridge. The average bill runs at 10 trillion Zimbabwean dollars. Interestingly enough, while the bills were denominated at 10 trillion in 2008, I managed to also get my hands on a 5-dollar bill that was dated 2007. INCREDIBLE HYPERINFLATION! A truly fascinating economic phenomenen that does no good whatsover for a country. I recall learning that in the post-World War I period, inflation in Germany was so bad that people would need a wheelbarrow full of money just to purchase a loaf of bread.

We also went on a river safari - taking a relatively small boat very close the the countless islands that dot the Zambezi. On this safari, our guides navigated the boat to within just a couple meters of crocodiles, a group of lazing hippos, and several rather large elephants. Fun fact: the hippo kills more people than any other African mammal - it may look slow and chubby and otherwise cuddly, but hippos have nasty temperaments and can actually run quite quickly over short distances.

Anyhow, that was just a random collection of some of the highlights of my trip. Livingstone was a lovely place, and I would recommend it to anyone :)

mosi au-tunya

2009-05-23T08:31:00.000-07:00

is the local name for Victoria Falls, one of the largest waterfalls in the world (>1600 m across, 550 million L of water per minute). i went there earlier today

i'm currently visiting livingstone, and am now at a lovely riverfront bar. the city is named after explorer extraordinaire dr. david livingstone

quite, quite idyllic :)

:(

2009-05-22T08:40:00.000-07:00

there are so many patients here who have fairly manageable conditions, if only they were not here. young people, old people... hiv, non-hiv

when i actually stop to think about and ponder how they must feel on their deathbeds, how their family must feel, i feel like crying - but what would be the point?

on another note, i used to do a lot of work for Canadian Blood Services, and i always thought that if they could ship their blood overseas it would be wayyyyy more helpful. here in zambia, people walk in with hemoglobins of 34 (normally it's supposed to be >120 or 130) and desperately need transfusions, but there's actually no blood in the blood bank - and they will die of anemia. if only there was a way of shipping some of the blood we collect.

ridiculously, the surgical ward ran out of alcohol swabs today. i'm going to ship this hospital a box of swabs and tourniquets when i get home

careers

2009-05-21T07:24:00.000-07:00

it seems all my posts are somehow related to the work i'm doing in zambia, and this one will be no different.

i was seeing a patient yesterday who was chronically wasted and anemic from HIV yesterday, and today when we went to check on him, we found out that he had passed away during the night. what we couldn't really figure out was WHY he died - he was wasted, but not that wasted... anemic, but not that anemic... he did have TB, but had no pulmonary symptoms.... at any rate, it seems that many of the deaths happen for some reason that is not entirely explicable. the fellow was also quite young - only 31.

later on, we were rounding (basically checking up on the patients we were responsible for) and encountered a young lady with dilated cardiomyopathy (DCM) leading to refractory (that is, untreatable) heart failure. yet another depressing case... there is so much DCM here, largely due to HIV; in class we learned the number one cause of DCM is idiopathic, meaning the exact etiology is unknown, but what often happens is that the DCM is associated with viral infection. with the advent of HIV, all the viral-associated idiopathic pathologies are far more common, such as DCM, and also a rare condition called guillain-barre syndrome (GBS), a polyneuritis that causes ascending paralysis and possibly fatal respiratory failure.

it is sad that so many of our patients have terminal conditions at such a young age. internal medicine in the western world is defined, more-or-less, by chronic disease affecting the elderly who have hopefully led fulfilling lives. it is just so sad. and the patients i see are certainly amongst the well-to-do. in rural areas, where the majority of the people live, things are probably far, far worse

the more i work here (and i haven't worked here long), the more convinced i am that working in policy is the way to go. it is good to be a physician in low-resource settings, but a physician can only see so many patients in a day, a year, and even a lifetime. perhaps its obvious, but it seems that working at a policy-level, either by recruiting more resources to help or by engaging these resource more efficiecntly, is a far more effective way of effecting change. but as always, it's hard to figure out the best way to go about working in policy. for the past few years, i've thought that i should go into internal, go into infectious diseases, work a few years, and then get a masters in public health. by the time all that is done, i would probably be 40 or something. now, i wonder if i shouldn't just go into community health, where they teach you policy (albeit policy as applied in a developed setting) throughout the 5-year residency and you get the MPH during your training. i also wonder if i should try and do more research (i.e. get a PhD) - something that is interesting and that can make you quite an expert in a particular area, but again takes avery long time

who knows, who knows

cold

2009-05-18T04:23:00.000-07:00

Side note: Yesterday on call, we ran out of alcohol swabs. Now, normally our 'swabs' are cotton balls that we dump a big bottle of 'methylated spirits' (ethanol/methanol) mix. We ran out of the methylated spirits, and so improvised by using normal (0.9%) saline solution. Ha! That's quite a bit more basic than not having a defibrillator.

In response to Joey's comment: There are diminishing marginal returns to healthcare (and pretty much everything else in life, or so economics 101 will teach you). What this means it that initial investments will reap the largest benefits in terms of reductions in mortality - basic hygiene, nutrition, sanitation, etc... reap the largest benefits in extending lifespan. This is why lifespan in developed countries has not changed that much since, say, the early 1900s - in spite of the fact that we spent hundreds of times more on healthcare now as compared to then. Inexpensive interventions - a clean well, toilets away from drinking water, good nutrition, HIV drugs in areas where the disease is pandemic - can thus go a long way in improving health outcomes. The more sophisticated stuff found in hospitals is nice, but compared to the basics, don't do nearly as much to extend life.

Ah - now back to the title of this blog entry...

As I wrote earlier, there are a lot of attempted suicides (called parasuicides) here. One of the doctors who has been working here for a while seems to be able to tell which are serious attempts and which are attempts at drawing attention. He laughts at / mocks / insults the latter group of people; indeed, many of the doctors here just say to their face that they are irresponsible and stupid for attempting suicide to draw attention. No apparent effort is made to deal with the mental health concerns that these patients might face. PCC (that's patient-centered care, a principle they rightly try to drill into you into med school that basically says that you must treat the patient as a whole and not just the disease) preceptors would be appalled.

Last night on call, we saw a few more parasuicides - the usual organophoshates, as well as methanol and indomethacin overdoses. I found myself joking with the interns on call that these people should just use morphine, since it just puts you to sleep and wouldn't seem to hurt as much as a failed ASA overdose. I did this while one of the parasuicide patients and her relatives were not more than a couple feet away from me (our ER is quite small). While it is true that these parasuicides are trying to draw attention to their plight, I can only assume that their plight must be sufficiently dire to ingest variouis painful, poisonous substances. I know this, and yet being in that environment, I said things that were heartless, insensitive and cold.

I have gone with one of the fellow doctors to 'certify' a couple of the patients. Certifying means doing an examination to confirm that the person is deceased. The first I saw certified was a boy - newly deceased so that if you looked at him, you would think he was okay except for the fact that there was no movement. The second and third, a middle-aged man and a middle-aged woman, with their families weeping around the bedside. I think those were the first times I saw people who were recently deceased. Maybe it was because I steeled myself before hand, but I can honestly say I didn't feel much emotionally. To the deaths of people in the prime of their lives and the grief of their relatives, I was cold.

In a setting like this, there is some sort of balance between feeling compassion and feeling nothing. When you feel nothing, you can be fast and effective. Your emotions won't overwhelm you when you see stuff that could be ameliorated if only the resources were available. On the other hand, the whole point is to be compassionate.

Call

2009-05-16T03:43:00.000-07:00

Last night was my first call shift in what is called the 'adult filter clinic' (AFC) in Zambia. Emergencies basically get sent to either surgery or medicine here, and the AFC deals with the medicine cases.

There were, again, a large number of unusual cases. You would expect lots of HIV / HIV complications + malaria + all those tropical diseases, but but you might not expect (I definitely didn't) was that there are a huge number of patients who come in to the emergency with organophosphate (OP) poisoning from attempted suicide. OPs are a common pesticide that basically act on the body in a similar way nerve gas would. It is unbelievable how many OP overdoses are seen - I would estimate 1/4 to 1/3 of the overnight emergency caseload! I've been told that rarely is the suicide attempt genuine, and that generally speaking the people who OD on OPs are doing so to draw attention to themselves. I really do hope that there is some sort of mental health follow-up for the truly suicideal ones :(

There was also a patient yesterday who came with decreased level of consciousness and a history of DM and HT. When we got the lab results back, we found that the GFR was 2 and his potassium was 8.3, and that the decreased conciousness was from uremic encephalopathy. Apparently, uremic frost is also quite common here... at any rate, my resident basically told me the following in regards to his management:

"In Canada, this fellow might be an ideal candidate for hemodialysis. In Zambia, he will not get hemodialysis - we only have a few machines and reserve them for people with reversible renal failure"

So, we gave him supportive treatment, but his prognosis is quite poor in the long run. Alas, an example of how deficient even the best-equpped hospital in Zambia is.

On that note, in our emergency room the only equipment we have for resuscitation is an oxygen tank. No defibrillator, no ventilator, no monitors, and we often run out of fairly basic medicines. I've been told that there isn't even a working defibrillator in the entire hospital.

white girls

2009-05-14T07:03:00.000-07:00

I am staying on the international floor at the nursing hostel, on currently on my floor are three Finnish nurses. They have lovely Finnish-English accents and have been telling me much about the glory that is Scandinavia. Apparently, not only do they not pay tuition, the government pays them a monthly living stipend while they are attending school that can cover their rent and then some! What an idyllic little place Finland, and probably all of Scandinavia is.

Alas, that is not the nature of my post. I remember a few years ago, a friend of mine did some work in Africa and came to the attention of a young African man, who professed love, undying devotion, marriage, etc... Well, it seem that here in Lusaka, my three pale-skinned Finnish friends receive persistent attention from a slew of Zambian men - men who have indeed professed love, undying devotion, marriage, etc... The men here definitely do seem more forthcoming when talking to the women, and I'm sure the exotic nature of the pale skin does nothing but enhance their determination. It's very different from what boys are like in North America. I'm quite sure if they were to adopt the tactics undertaken by their African counterparts, there would be many more slaps across the face, cold shoulders, and restraining orders. Oh how fascinating and multitudinous are the ways people live life.

China-Zambia

2009-05-14T07:01:00.000-07:00

I've now met two Zambian students who packed their bags and left to do their medical training in CHINA, in CHINESE! Crazy... they had to learn regular Chinese, and then medical Chinese, in a place far from home and with people who don't speak their language. I thought it was rather spectacular. One went to school in Wuhan (Sijie!) and one went to school in Changsha.

unusual cases

2009-05-14T06:54:00.000-07:00

As far as I can tell, the three most common (serious) presentations in internal medicine in Canada are myocardial infarction, lung/breast/prostate/colorectal cancer, and COPD. In Lusaka, things are a little different. I get the feeling that the internist's bread-and-butter here is TB pulmonary infection with HIV co-infection. A few of the random things I have seen I list below:

1) Cryptococcal meningitis - fungal infection of the brain that only occurs when cD4 counts drops to a certain level in the presnce of HIV
2) Miliary TB - a pattern of TB on the X-ray that looks like little nodules (millet seeds) everywhere in the chest
3) MDR TB - we went to see a patient, and before I realized it we were in the TB room. Everyone just walked in, no masks or anything. After I left, my doctor told me the patient didn't just have regular TB, but MDR TB. So much about immediate respiratory isolation when TB is suspected!
4) Chloramphenicol - a cheap, powerful antibiotic that isn't used in Canada since it causes aplastic anemia but that is quite common here
5) Peripartum dilated cardiomyopathy - we didn't ever learn about this in class... it is a variant of dilated cardiomyopathy found in pregnant / post-partum women - usually reversible, but can present with cardiogenic shock

There are also quite a few cases of hypertension and diabetes, which I found surprising. Interestingly, it seem that the hypertension here tends to cause heart failure, as opposed to MI, most often...

slow...

2009-05-12T07:32:00.000-07:00

I'm sitting at a dreadfully slow internet cafe about one km north of Zambia University Teaching Hospital (UTCH). Well, I suppose the cafe itself isn't slow - it's actually rather busy with people - but rather the internet itself is.

ANYWAYS! I arrived safely in Zambia, was picked up by my old WHO supervisor's son, Kevin Osborne, and proceeded to go on a series of adventures trying to find both where I was supposed to work and where I was supposed to live. On the plus side, I managed to sleep for about 16 hours yesterday (roughly from 2 PM in the afternon to 6 AM the next morning), with the occasional lapse into consciousness.

I am staying at the nurse's hostel - it isn't the cleanest place in the world, but has a nice and comfy bed, isn't too hot during the day, and has got decent bathroom/showering facilities. There are also apparently three Finnish nursing students on my floor, but I have yet to see them. As for work, I eventually managed to bumble my way into the care of one Dr. Nirenda (that is how I would sound out his name - I've no idea about the actual spelling). The patients that we saw had presentations ranging from the 'regular' (by western standards) to the rather bizarre. There were several cases of hypertensive diabetics, a pregnany lady with epiletic seizures, some people with HIV and associated sexual! and renal complications, a lady with suspected cryptococcal meningitis. My doctor and I encountered something a little more unusual in the line-up for the canteen: Dr. Nirenda struck up a conversation with a kid who had a swollen belly, and found that he had previously been infected by Bechozia? (not sure how that is spelt), which led to portal fibrosis leading to persistent ascites that required drainage. The conjunctiva of his eyes were also completely pale - a sign of anemia that we learned about in renal block. I didn't understand the dialogue between doctor and patient since they were communicating in an indigenous language, but their exchange did end up with my doctor giving him 40000 Kwacha (about 10 dollars) to buy a few meals with - something that I thought was rather kind. Dr. Nirenda seems like a fairly smart guy, even though he looks incredibly young (in actualality, he is 32). We start again tomorrow at 8, and apparently I will be on call both Friday and Sunday of this week.

As far as a city goes, Lusaka is very, very random. There are essentially no sidewalks, only a tenth of the traffic lights per unit area that Edmonton might have, and lots of pedestrians carrying anything from big jars on their heads to wheelbarrows dodging traffic in their quest to cross the street. I also saw a big truck with cows (the logo on the side read Zambeef - feeding Zambia) driving right into the middle of town. I am somewhat scared about walking here due to the random traffic, let alone biking - and this is saying something since I braved the streets of Beijing for hours a day on my bike with no fear of consequences. I promise to take some pictures later for your viewing enjoyment.

Another random tidbit: China is actually quite involved with Zambia as a trading partner (Zambia has loads of mineral wealth) and a donor - though the exact balance between said two factors is unclear.

OKAY - time is running up - until next time :)

Nairobi

2009-05-10T21:02:00.000-07:00

Auspiciously, internet cafes seem to abound in the places I have been (and hopefully, the place I end up in).

I arrived in Nairobi a few hours ago, and am just waiting to board an Air Kenya flight to Lusaka. The staff were very friendly in sorting out a little kerfuffle I had with my luggage. Earlier today, I had the chance to explore a bit of downtown London - an unexpected bonus from having an 8 hour layover at Heathrow. I walked around (no plantar so far, whew!), saw some sights, and had a nice little snack warp somewhere.

The most interesting thing I saw in my brief ambulations were the war memorials erected for soldiers from different countries in the Commonwealth. Their inscriptions were filled with gravitas... I took some pictures, and perhaps I will post them later. On the topic of sacrifice, on my flight from London to Nairobi, I saw Milk. It tells the tale of Harvey Milk, America's first major elected official (councillor of San Francisco) who was openly gay and his struggles in fighting for gay rights. To think that only 30 years ago, gays were such openly hated in a place like SF (and that the Castro district was nothing but a regular community)...

BAA Heathrow

2009-05-10T04:32:00.000-07:00

As the passengers of British Airways Flight 116 with service from New York to London were about to disembark the flight today, the pilot made the following announcement:

"It seems we will be delayed since the sky bridge [connecting terminal to airplane] is malfunctioning. This is rather unusual since a plane just left before we arrived and they had no problems..."

A rather happy lady sitting diagonally behind me proceeded to say, in a lovely British accent:

"Heathrow is the most dysfunctional airport ever - it'll probably take an hour to get our luggage..."

Just before I boarded this flight, I was strolling back and forth across JFK airport and it occurred to me how accessible the world really is. The radius of the planet is something like 6400 km (if I remember correctly), making for a circumference of slightly over 40,000 km. Large numbers? Maybe.... the flight from NY to London was only 5.5 hours, my friend's flight from Toronto to Hong Kong a little longer at 16 hours. Another friend of mine just moved to Toronto, which seems very far, but Air Canada will get you there in less than 4 fours! The point is, as far away as many places seem to be, they are no more than a day away on the modern aircraft. And I for one have spent many a day in routine monotony...

I will try to update as regularly as possible!

P.S. I managed to get my luggage in less than 15 minutes.