Our fellows share their thoughts and experiences....
Maile Young - An Oldie, But a Goody
My dream/my hope…
There once was a young doctor of spunky disposition. Her life was filled with HIV/infectious diseases visionaries, that is, people whose business was to monitor the state of HIV/disease in the world and pursue studies and solutions to help regulate health.
The visionary recognizes global health problems and more or less attempts to contain them by evaluating the issues surrounding these problems and aiding in the creation of solutions. All this is done of course to avoid all possible danger of an excess of disease flowing into surrounding countries. If of course the burden of disease overflowed it could soon inundate the whole world. Even the little HIV/infectious disease fellows know that constant watchfulness is required to keep the flood of disease from overwhelming a country and eventually the world, and that a moments neglect of the visionary’s duty may bring ruin and death to all.
One lovely spring afternoon, when the doctor was about (ahem) thirty years old, she obtained consent to travel to South Africa to carry some N95 masks, gloves and powerpoint presentations to the local physicians who lived in this country. The little doctor started on her errand with a light heart, and having spent some time with these local physicians, she bade them farewell and started on her homeward route.
Trudging stoutly along (in heels), she noticed how years of poor access to care, neglect, and misunderstanding had swollen the burden of HIV/TB. Even while humming her careless, childish song, she thought of the visionary’s brave accomplishments and felt glad of their strength, for thought she, “If they gave way, where would the world be? These pretty fields would all be covered with the angry ugliness of suffering and death.” And with these thoughts just flitting across her brain, the little fellow stooped to pick the pretty flowers that grew along her way.
Suddenly the doctor looked around her in dismay. She had not noticed that the sun was setting. Now she saw that her short shadow on the grass had vanished. It was growing dark and she was still quite some distance from home and in a lonely place, where even the blue flowers had turned to gray. She quickened her footsteps and just as she was bracing herself for a run, she was startled by the sound of soft moans and cries. Whence did it come? She looked up and saw a small child, a young woman, an old man…suffering from disease. Any HIV/infectious disease fellow would shudder at the thought of a leak in the system! The doctor understood the danger at a glance. That small amount of suffering, if allowed to continue and trickle through, would soon be a large one, and a terrible inundation would be the result.
Quick as a flash, she saw her duty. Throwing away her flowers, the doctor clambered up the heights until she reached the suffering. Her tiny eyes and hands examined the suffering, her brain processed the cause, and her voice recommended a solution. Almost before she knew it, the suffering had quieted (well not really, but for metaphors sake)! Ah! She thought with a chuckle of naive delight, the angry, ugly suffering must stay back now! The country shall not be drowned while I am here!
This was all very well at first, but the night was falling rapidly. Chill vapors filled the air. The little doctor began to tremble with cold and dread. She shouted loudly, she screamed, “Come here! Come here!” but no one came. The cold grew more intense, a numbness, commenced in the tired little hands/brain/voice. She shouted again, “Will no one come?” She tried to whistle. Perhaps some straggling doctor might heed the signal, but her teeth chattered so, it was impossible. Then she called on God for help. And the answer came, through a holy resolution: “I will stay here till morning.”
The midnight moon looked down upon that small, solitary form, sitting upon a stone, halfway up the hill. Her head was bent, but she was not asleep, for every now and then a new voice would cry out in pain. Her mind and heart struggled. If she drew away, the angry flow of suffering, growing angrier still, would rush forth, and never stop until they had swept over the town, the country. No she would stay till daylight. What did this strange ache mean? Knives that seemed pricking and piercing through heart and to the soul. She was not certain now that she could draw away, even if she wished to.
At daybreak a physician in the US thought he/she heard groans as he/she read this blog. Investigating further he saw, an infectious disease fellow, across the world, sharing her experiences.
“In the name of wonder, girl!” he/she exclaimed, “What are you doing there?”
“I am keeping the suffering from running out,” was the simple answer of the little doctor. “Tell them to come quick.”
It is needless to add that they did come quickly.
This is adapted (several parts word for word) from: The Hero of Haarlem by Mary Elizabeth Mapes Dodge…better known as “that story about the Dutch boy who put his finger in a hole in a dam.”
Come…quick
Maile
Winston Tilghman, 3/27/2008
While Alexis is traveling around Mozambique, I get to write a blog! I, too, am new at this kind of thing, but I’ll try. This month has been a good one. I have been working at the Owen Clinic, which is the HIV clinic here at UCSD for those of you who do not know. I have been doing a lot of work in the clinic, which is appropriate since HIV has, in a lot of cases in the developed world, become a chronic problem like diabetes or hypertension that is often managed on an outpatient basis. However, one definitely does not have to go to South Africa to see advanced cases of AIDS with opportunistic infections (although I am looking VERY forward to going there in July). One only has to walk one block to the main hospital to see some quite interesting cases, actually. Throughout the month, we have had patients on the inpatient service with Pneumocystis jiroveci pneumonia, Cryptococcal meningitis, pulmonary and disseminated tuberculosis, and intestinal perforation due to Mycobacterium bovis infection. Cases of amoebic liver abscess and Castleman’s disease in patients with newly-diagnosed HIV have also made for an interesting mix of pathology. I am also constantly reminded of the challenges with which we are faced in terms of fighting the epidemic (substance abuse and poverty, in particular) despite the huge advances that we have made in terms of development of new medications to control HIV infection.
Although the global statistics regarding the HIV epidemic are daunting, I am always inspired whenever I work at the Owen clinic, because everyday I see so many people from different backgrounds and with different types of training working hard to improve the lives of people living with HIV. There is such corroboration among doctors, pharmacists, substance abuse counselors, social workers, and dieticians, whose common goal is to help people with this infection take control of their lives, that the clinic really should be a model for HIV care worldwide. This extends beyond San Diego and the USA in the San Ysidro clinic, where I have had the pleasure of working with advocates for the Latino community around the US-Mexico border. We have also had visitors from Peru and Kenya who have shared with us their efforts to deal with the global problems of HIV and TB in their communities through patient care and research. There is also a great emphasis on education at all levels in the clinic, from basic interactions with attendings to lectures and grand rounds covering a wide array of topics. I hope to apply all of these things to my own practice both as a clinical mentor in South Africa this summer and after fellowship as I figure out my own way to make a difference, however small, in the world.
Sanjay Mehta - 3/11/08
I guess this is what happens when we get a new secretary... She gets ideas, wants to change things… and I end up writing a blog. I ve never written one… and Im not sure if I should offer advice… or just muse on the state of the world. I guess it probably doesn’t matter… as long as I don’t write anything in Arabic, or talk about any bioterror agents… probably no one will even read this.
Well I think Ill just muse… I think many medical students start out with the philosophy that they want to do something, have a career, doing something useful. Traversing the medical path, I think everyone cant escape developing a little cynicism. Are we truly improving our patient’s quality of life.. are we truly making people better, or are we just titrating snake oils to improve some vague laboratory numbers. Of course, people do get better, but in the field of medicine…sometimes it can be hard to see.
I sometimes have those same sorts of sentiments when I think about “international health”. Of course, improving sanitation, finding sources of water, and treating disease improves quality of life. Thousands of individuals will have many more fruitful years now that we are able to provide highly active antiretroviral therapy to individuals with AIDS across the third world. And slowly we are working on issues of sanitation, water, and nutrition. However, I wonder about what we don’t or cant provide. Nothing improves my quality of life like a good joke, conversation, an interesting idea. The internet to me is magic… it provides humor, news, and the information that lets the crossfertilization of ideas occur instantaneously. It is the library of Congress in a machine the size of a single book. So perhaps, in an addition to making an effort to improving the tangibles in peoples lives, health, nutrition and water… we should make an effort to improve the intangibles as well… and perhaps getting people connected to the internet is the answer.
That’s the end of my musings for today….
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