Friday 21 April 2017

lessons learned

When I was looking for jobs working abroad last year, I had a lot of ideas in my head about what this year could be.  I had worked in places before for a month or two, and always felt like I needed more time. I pictured a year as this perfect time period to have enough time to learn the ropes and then jump in and go full force, teaching, seeing patients, making a difference.

What I learned is that a year is not long enough at all.  A year is just scratching the surface.  It takes a long time to find your role, to determine what is important to the locals, to find where you can enable and not overpower and turn things into your own agenda.  It takes a lot of work to place people in a position that is only 1 year long and provide the communication and tools they need so that they can be effective and integrated into the system.

When I came to Malawi, I did not expect the department I would be working in to be primarily foreigners.  That I would sit in a meeting with the heads of department and look around the room to see only white people.  This is not to say those people are not making a difference or that their hearts are not in the right place.  But I find it hard to believe we are advancing healthcare in Malawi when I add yet another non-Malawian to the table.  Do I have the answers as to how we help transition a country that is so dependent on foreign aid away from this? No.  Do I think that what I was doing here is pointless? Also, no.  But do I think this is the place in Malawi where I could be of the most use, educationally or clinically? Probably another no.

Advice from previous volunteers, other people I knew who have worked abroad, and during our orientation seemed to reiterate that there is a pattern to your emotional stability and adjustment.  You will start the first 3 months a lost soul, finding your bearings culturally, geographically, emotionally, clinically.  You should observe. Be present. Slowly take it in.  By 6 months you should be functional.  Maybe not an efficient machine, but not useless.  Then by around 9 months, you've got it down.

Was this my pattern?  Some of it, yes. I definitely now feel more comfortable clinically.  Sadly, I have seen so much HIV and TB I can diagnose (or at least add it to my differential) automatically.  PSHD (presumed severe HIV disease) is not an acronym I thought I'd ever use during my training but here I write it daily. There are still tons of scenarios where I feel like I have no idea what is going on with a patient, still can't figure it out because there aren't any more tests we can do, still turn to my Malawian registrar or clinical officer and ask for validation because they've seen a diagnosis 75,000 more times than I have (and are a million times better at any procedure than I am). Geographically, I mostly know where I'm going.  I no longer turn down the complete wrong hallway trying to go from the inpatient unit to the emergency room. Still don't know where a lot of the secret stashes are (potassium supplements on oncology ward, heparin in one of the adult wards).  Culturally I think I could be here 10 years and still not know all the nuances.  But I can tell jokes now and get a smile from people rounding with me (who maybe have just become culturally acclimated to me and smile to get me to shut up).  Emotionally, I don't know. I think there are less days where I come home feeling completely drained.  But it still happens.  I still come home some days after seeing hoards of kids with PREVENTABLE and TREATABLE illnesses and want to punch someone (Donald Trump? I don't know who exactly) in the face.  I still feel defeated and tired and useless some days.  The main difference now I'd say, is that I have just had more time, more of a chance, to see the slivers of hope that come through when you least expect them.

Some days I feel like I should stay forever given that I finally have some things going on and have made enough connections to get a few things going.  Other days, I feel like am ok. That maybe I was mainly here to provide some of the spark, that when combined with the extremely capable locals in our department, will light a fire that they can keep burning long after I'm gone.  And maybe one day they will look around the table and see that every head of department is a Malawian.

I have another list of things I will miss and some travel recommendations, but I'll save that for another day.






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