Why do I cry?
when I think of you,
When you bring me joy
In my dreams,
make love to me, your juices
mixing, flowing, churning blood
in my veins, down
to my heart, up
to my head
One with me and separate
Who are you?
I touch your hair,
Feel it thick through my fingers
But can’t find the roots
Deep black humus threads spanning
Time and intervening oceans
I eat the fruit.
Today I died
No. I hung myself
You never quite understood me
Did you?
First I tore my heart
Then my eyes—why ?
I hung myself on the big Mango
Won’t let blood go to my brain
Remember! You told me not to hang upside down
Why did you turn me back?
What were you doing in the dark—and—light doorway?
I long for you day and night
—And midnight
Am I dead?
I know your back, the curve
Of your hips, here they are wide
there rounded
here hollowed by child bodies
The eagles nested here
Turn your face to me!
I know you, you know
I’ve climbed your back,
Sucked your breasts
Been in you.
Father calls you my Girlfriend
—you must be the One
So why do I cry?
There’s a blue veil hiding you
I’m hungry
Tell me, am I awake?
You have left my dreams
No! I’m thinking
You, I, the world
Megbona lo—I’m coming back
Your fingers sear my skin
I need
There’s an explosion in my loins
My loins turn to jelly—I want to fall
My first steps,
Steady, steady
Thank You
—for your hand.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Thursday, December 3, 2009
Sunday, November 22, 2009
Why So Poor? -- Of Minds(ets) and Men
Masitala, Malawi – According to this BBC news report, William Kamkwamba woke up one day, figured he could build a windmill out of bicycle parts to supply electricity to, and pump water for his village and did it with practically no formal education. A couple of years ago my father was working in his backyard garden. He needed to dig a shallow hole and with no tool at hand, picked up a broken piece of calabash that was lying innocently by. Before he began to dig, he looked at us and said, “Improvise”. It was the first time I had heard the word. Improvise! A blessing and a curse. I did not spend years trying to understand what he meant. No, I did not even think about it after the words escaped his lips. It was just one of the big words daddy liked to use on occasion. Like the time he said “my food is always palatable”. But I did get the old boy to tell us what exactly the word meant. I thought it was pretty simple -- use one thing in place of another. I’m not so sure anymore. I’ll tell you why in a little bit.
On many occasions, I’ve had the opportunity to ask myself why the African continent is so poor. I’m sure you have too. So why are we poor? Is it because of the many years of colonialism and the slave trade or the additional years of bad leadership, coups and counter coups, civil war and strife started by men who care for nothing but themselves? Are we still lagging in development because of neocolonialism and the strangling juggernaut of the western financial institutions or because our very minds are inferior to the best of the world and our mindsets inherently retrogressive instead of progressive? The question of whether colonialism, neocolonialism, political strife and the combined exports of the World Bank and IMF has been detrimental to the continent is a moot one and has been argued on many fronts so I will only briefly examine them here.
More than a hundred years ago, the white man landed on the shores of our beloved black continent (the Dark Continent as they called it) and proceeded to rape and ravage it out of gold, cocoa, timber, the strongest men, freedom and indeed its very soul. What this did was in essence take away the foundation on which we could build our countries and our economies. The remnants became second class citizens, strangers in their own land, told where they could go and where they could not, paying taxes to foreigners and unable to buy one imported commodity without the other – I suppose the forced balanced diet kept us healthy. After that came the age of the Strong Men of Africa, the Mugabes, Nyereres, Nkrumahs, Contes and a spate of coups with stories of US and Russian involvement as the two major powers of the world sought influence in the as yet unexplored philosophy of African neocolonialism—that would come later. And when it did, it was through the multiple protectionist moves in the World Trade Organization and the extension of loan facilities from the World Bank and IMF. They attached western imports of economic philosophy and conditions that, even with the best of intents, took no account of the peculiar economic and political climates of the recipient countries. Add to this the fact that some of these conditions require loans to be disbursed in installments from western banks with all the transaction fees applicable and stipulate that consultants be hired from the donor country on development goals in the recipient and you have, by anecdotal evidence, anywhere from fifty to eighty percent of loans going back into the donor economy while drowning the poor African country further into debt. It’s not all tales of doom and gloom, of course and I am not a proponent of the “the west is keeping us down” cacophony so I will focus on the African.
The point of this piece is to look at those two essential components of human progress, the mind and mindsets of a people, and the people themselves. The last time my mother visited the US was for my graduation from college. On a stroll through Chicago, she casually remarked on how nice it would be for the white man to build some of his skyscrapers back home. Needless to say I flew off the handle with a lecture on how we had to fight our own battles, et cetera. My mother, bless her soul, is the most important person in this world to me and the one I respect the most so this example is not to cast her in a bad light. She is also a certifiably smart lady and that is the crux of the story. In Ghana, we have brains and smarts. I read animal farm, makers of civilization, John Bunyan’s Pilgrim’s Progress and Pride and Prejudice before I was out of 6th grade. The second year college classes I took in college taught little different from what I had read for three years in high school and when I pit my brains against friends with “similar” levels of education, I find out again and again how much more theory they know than I do. In fact the truth remains that one of the main reasons I came to the US for school is because I could not gain admission into medical school in Ghana. In every medical school I interviewed for in the US, there was one Ghanaian faculty member or two and even more students from Ghana, Nigeria, Kenya and the like. There are Africans excelling in most, if not all, of the greatest institutions of higher education this country. No! The African’s mind is flexible enough to bend the most esoteric theories and to propose some himself. Even with the limited educational infrastructure, the African child rises to the top. So why is it a bachelor’s degree at a third rate university outside Ghana is enough to gain you a promotion, in Ghana, over a long term employee with multiple Ghanaian degrees?
It is not the lack of firepower that is holding us back. It must be our mindsets then. From the ingrained mindset of inferiority of everything African through our unwillingness to chance innovations to the lack of support and in fact, the PhD (pull-him-down) of those entrepreneurs who try it, we have connived to drive the continent farther and farther into poverty. The problem with improvisation is that the African has been doing it for ages and has thus become complacent and comfortable. Improvisation allows us to use inferior tools albeit with extra effort for accomplishing tasks and we are just happy that way. We are not motivated to innovate. We lose sight of that intrinsic component of the word improvise, the creation of something new to replace what is. When my father first said “improvise”, it was while using a broken calabash in place of say, a hoe. There was no progress there. However, because we were just fine digging without a hoe, we had no incentive to look for better ways to dig. We missed the chance to innovate. But the buck does not end there. If necessity is indeed the mother of invention, why is there so little invention coming out of Africa? Our institutions are ill equipped to advance science, I know but that is just the beginning. Until we move beyond that essential Africanness of coping with the hard life and start looking to get into a more comfortable lifestyle, we will be unable to progress. Have you seen the travelling Ghanaian? Poor soul has oversized carry-ons, multiple oversized checked bags and some more for the children to carry. Why? Because he is bringing gifts to family members. Why? Because they are foreign goods. It is not good enough to buy these same things in Ghana. It has to have made the flight to hold any value to the Ghanaian. The Ghanaian has to have Holland prints in textiles to wear to a funeral --in effect stifling the local enterprises that seek to compete with the influx of cheaply made, overpriced foreign goods.
As much as the Ghanaian yearns after imported milk and bread however, few can afford it thus allowing room for local inventors to prosper on their minor creations. Yet, our economies suffer the ignominy of lagging behind the prosperous ones and our people suffer from lack of access to healthcare, education, employment and clean water. This is no fault of the minds and sets of minds in corpus but of the corpus itself. It is man and the men of our various countries that drive us deeper and deeper into the ground and bring our countries, which relatively flourished post-independence to their knees groveling for western handouts. The “Strong Men” of the continent began the looting process that continued in coup after coup which promised accountability but looted the state coffers while paying lip service to higher ideals. These were followed by pseudodemocracies installed to legitimize corrupt governments with the support of countries like France all so the interests of these supporting countries could continue being served at the expense of the poor African. No matter how great the demand, it is the African, like the times past when he sold his fellow man to the slave trader, who continues to sell his country out for thirty pieces of silver. And when he is finally thrown out of office by the vote, what right does he have to demand additional graciousness from a country he has so thoroughly helped to exploit and why must we pay him to relinquish power?
Many reasons are proffered for the poverty of my people. Though they all have legitimacy in and of themselves, none of them hold as much weight as the dead weight of corrupt men that bogs the continent down. From high school, when the senior student extorts sardines and milk out of the first year student so he can protect the latter from other extortionists and where a housemaster takes money from parents so as to reserve preferential treatments for their children and the headmaster takes money to admit a bad student over an excellent one, corruption runs riot in the fabric of our countries weakening the seams and breaking the bond of unity that keeps it strong. Until we change our minds(ets) and until there arises a new generation of (wo)men willing to stand tall and move our nations forward, we will forever lag in the darkness of our skins and our soils crying out as children of the dark yearning for the light of prosperity yet running back into the darkness from the pain the light causes our eyes which are so accustomed to nothingness. Long Live Africa and on men, may there be peace, and prosperity.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
On many occasions, I’ve had the opportunity to ask myself why the African continent is so poor. I’m sure you have too. So why are we poor? Is it because of the many years of colonialism and the slave trade or the additional years of bad leadership, coups and counter coups, civil war and strife started by men who care for nothing but themselves? Are we still lagging in development because of neocolonialism and the strangling juggernaut of the western financial institutions or because our very minds are inferior to the best of the world and our mindsets inherently retrogressive instead of progressive? The question of whether colonialism, neocolonialism, political strife and the combined exports of the World Bank and IMF has been detrimental to the continent is a moot one and has been argued on many fronts so I will only briefly examine them here.
More than a hundred years ago, the white man landed on the shores of our beloved black continent (the Dark Continent as they called it) and proceeded to rape and ravage it out of gold, cocoa, timber, the strongest men, freedom and indeed its very soul. What this did was in essence take away the foundation on which we could build our countries and our economies. The remnants became second class citizens, strangers in their own land, told where they could go and where they could not, paying taxes to foreigners and unable to buy one imported commodity without the other – I suppose the forced balanced diet kept us healthy. After that came the age of the Strong Men of Africa, the Mugabes, Nyereres, Nkrumahs, Contes and a spate of coups with stories of US and Russian involvement as the two major powers of the world sought influence in the as yet unexplored philosophy of African neocolonialism—that would come later. And when it did, it was through the multiple protectionist moves in the World Trade Organization and the extension of loan facilities from the World Bank and IMF. They attached western imports of economic philosophy and conditions that, even with the best of intents, took no account of the peculiar economic and political climates of the recipient countries. Add to this the fact that some of these conditions require loans to be disbursed in installments from western banks with all the transaction fees applicable and stipulate that consultants be hired from the donor country on development goals in the recipient and you have, by anecdotal evidence, anywhere from fifty to eighty percent of loans going back into the donor economy while drowning the poor African country further into debt. It’s not all tales of doom and gloom, of course and I am not a proponent of the “the west is keeping us down” cacophony so I will focus on the African.
The point of this piece is to look at those two essential components of human progress, the mind and mindsets of a people, and the people themselves. The last time my mother visited the US was for my graduation from college. On a stroll through Chicago, she casually remarked on how nice it would be for the white man to build some of his skyscrapers back home. Needless to say I flew off the handle with a lecture on how we had to fight our own battles, et cetera. My mother, bless her soul, is the most important person in this world to me and the one I respect the most so this example is not to cast her in a bad light. She is also a certifiably smart lady and that is the crux of the story. In Ghana, we have brains and smarts. I read animal farm, makers of civilization, John Bunyan’s Pilgrim’s Progress and Pride and Prejudice before I was out of 6th grade. The second year college classes I took in college taught little different from what I had read for three years in high school and when I pit my brains against friends with “similar” levels of education, I find out again and again how much more theory they know than I do. In fact the truth remains that one of the main reasons I came to the US for school is because I could not gain admission into medical school in Ghana. In every medical school I interviewed for in the US, there was one Ghanaian faculty member or two and even more students from Ghana, Nigeria, Kenya and the like. There are Africans excelling in most, if not all, of the greatest institutions of higher education this country. No! The African’s mind is flexible enough to bend the most esoteric theories and to propose some himself. Even with the limited educational infrastructure, the African child rises to the top. So why is it a bachelor’s degree at a third rate university outside Ghana is enough to gain you a promotion, in Ghana, over a long term employee with multiple Ghanaian degrees?
It is not the lack of firepower that is holding us back. It must be our mindsets then. From the ingrained mindset of inferiority of everything African through our unwillingness to chance innovations to the lack of support and in fact, the PhD (pull-him-down) of those entrepreneurs who try it, we have connived to drive the continent farther and farther into poverty. The problem with improvisation is that the African has been doing it for ages and has thus become complacent and comfortable. Improvisation allows us to use inferior tools albeit with extra effort for accomplishing tasks and we are just happy that way. We are not motivated to innovate. We lose sight of that intrinsic component of the word improvise, the creation of something new to replace what is. When my father first said “improvise”, it was while using a broken calabash in place of say, a hoe. There was no progress there. However, because we were just fine digging without a hoe, we had no incentive to look for better ways to dig. We missed the chance to innovate. But the buck does not end there. If necessity is indeed the mother of invention, why is there so little invention coming out of Africa? Our institutions are ill equipped to advance science, I know but that is just the beginning. Until we move beyond that essential Africanness of coping with the hard life and start looking to get into a more comfortable lifestyle, we will be unable to progress. Have you seen the travelling Ghanaian? Poor soul has oversized carry-ons, multiple oversized checked bags and some more for the children to carry. Why? Because he is bringing gifts to family members. Why? Because they are foreign goods. It is not good enough to buy these same things in Ghana. It has to have made the flight to hold any value to the Ghanaian. The Ghanaian has to have Holland prints in textiles to wear to a funeral --in effect stifling the local enterprises that seek to compete with the influx of cheaply made, overpriced foreign goods.
As much as the Ghanaian yearns after imported milk and bread however, few can afford it thus allowing room for local inventors to prosper on their minor creations. Yet, our economies suffer the ignominy of lagging behind the prosperous ones and our people suffer from lack of access to healthcare, education, employment and clean water. This is no fault of the minds and sets of minds in corpus but of the corpus itself. It is man and the men of our various countries that drive us deeper and deeper into the ground and bring our countries, which relatively flourished post-independence to their knees groveling for western handouts. The “Strong Men” of the continent began the looting process that continued in coup after coup which promised accountability but looted the state coffers while paying lip service to higher ideals. These were followed by pseudodemocracies installed to legitimize corrupt governments with the support of countries like France all so the interests of these supporting countries could continue being served at the expense of the poor African. No matter how great the demand, it is the African, like the times past when he sold his fellow man to the slave trader, who continues to sell his country out for thirty pieces of silver. And when he is finally thrown out of office by the vote, what right does he have to demand additional graciousness from a country he has so thoroughly helped to exploit and why must we pay him to relinquish power?
Many reasons are proffered for the poverty of my people. Though they all have legitimacy in and of themselves, none of them hold as much weight as the dead weight of corrupt men that bogs the continent down. From high school, when the senior student extorts sardines and milk out of the first year student so he can protect the latter from other extortionists and where a housemaster takes money from parents so as to reserve preferential treatments for their children and the headmaster takes money to admit a bad student over an excellent one, corruption runs riot in the fabric of our countries weakening the seams and breaking the bond of unity that keeps it strong. Until we change our minds(ets) and until there arises a new generation of (wo)men willing to stand tall and move our nations forward, we will forever lag in the darkness of our skins and our soils crying out as children of the dark yearning for the light of prosperity yet running back into the darkness from the pain the light causes our eyes which are so accustomed to nothingness. Long Live Africa and on men, may there be peace, and prosperity.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Sunday, September 27, 2009
Brain Drain II -- The reGain
July 16, 2009 -- Dongfan Chung, a 73 yo former Boeing engineer took a look at his wife and daughter, and walked away. That was the end of a rather disinteresting trial in our age about a man who was convicted of transferring numerous trade secrets and boeing designs to the People’s Republic of China, a nation he proclaimed as his motherland. Perhaps the recession we are currently embroiled in reduced the hullaballoo that would naturally have met this news. Perhaps it’s the gentle hands of time healing the wounds of the yesteryears. You see in the years after World Wars, many nations went to extreme lengths to obtain technologies that would move their markets forward. This involved transfer of several patented technology across borders resulting especially in the 80s in rapid Japanese industrial development. More unconfirmed anecdotes include stories of professors becoming factory hands in order to study machines in the US economy. They did it for a variety of reasons. Love for country, money, notoriety, the thrill of it. For what they believed in, they sacrificed their luxuries in search of the upper hand. Of course it’s criminal and it infringes on intellectual property rights so don’t you go doing it. But at home, these people are considered heroes. Another form of espionage, the legal kind, is higher education. We leave our shores in droves for education in other countries and we head back with knowledge gained and skills built to develop ours’. But what drives us to leave and what, ultimately, takes us back?
I’ll start with the most controversial of the responses I’ve heard; “I just don't have the patience to deal with spoilt patients with an overdeveloped sense of entitlement”. Now I wouldn’t necessarily have put it that way but it is to be expected that in a country where healthcare is expensive and people are used to a certain standard of living superior to most around the world would by default expect a standard of care superior to what most around the world demand. In addition to this however, there is a more outspoken culture in developed countries with a belief in the presumed right of access to any service one’s money can buy. This is an inherent part of the medical practice in the US – patients who are proactive in their health maintenance and who can sometimes be a tad bit purposeful in their pursuit of one goal or the other. Compare this to Ghana where the average patient is only ever so grateful to be seen by the doctor, wears their Sunday best to go see her and are more willing to take anything the doctor says to take. They are forever grateful for the any respite they get from their care and are less wont to blame a physician for lapses in care. This might not necessarily be good for the patient in the long run or for the quality of healthcare delivery and providers for that matter. However, it remains a fact that draws the immigrant physician to her country.
Another reason the younger generation of Ghanaians want to practice in the country of Ghana is social responsibility. But what is social responsibility? Each individual being responsible for his community, which of course begs the question, ‘what is one’s community?’ Is it our country of birth, is it where we were raised until adolescence and where our formative years were spent – in a country where we were loved and raised where we felt we belonged and where we were beaten into or at least scared into studious little nerds or is it the country that opened its shores to us, gave us the opportunity to achieve high quality education often without paying a single dime and enables us to train at the highest levels known to man and arguably spends the biggest dollar value on our education. The answer is not an easy one and is as personal as they come. And those who go home in fact do not argue their choices along these lines. Of course a lot of Ghanaians are fiercely patriotic and believe it is and will forever be the best country on earth so not one of them is likely to tell you that they owe more of an allegiance to the US than to Ghana. More than this, however, there is a belief, born of years spent in close proximity to, if not in, poverty and experiences in the medical system to know that the marginal benefit of their services is higher in a resource deprived country like Ghana than it is in the US. Being a product of two cultures, they choose to give to the one that needs them more.
Given people care about what impact they can make though, one is tempted to ask if they might not be able to contribute more to their country by working in the US and helping back home in training and establishing health facilities or systems through the use of their income? This way, one could contribute effectively to Ghana, provide services in the US, and attain the comfortable life in terms of income for family and self that drove us to the lengths necessary to make it in school. On the surface, this seems a reasonable proposition. I was gently informed however that what impact one makes depends on the services her dollars provide, the importance of the services, their effect on the system one wants to change and of course how the provision of the services fits into the individual’s worldview of self attainment. In other words, one has to be happy not only practicing in the US but also with the decision to not practice at home. This is especially difficult for those of us who want to effect change on the ground and be a part of the movement towards equalizing access to healthcare in Ghana. Instead of money, what we need is hands on the ground; hands that work at shaping policy, lobbying for political will and heal disease. The hands might as well be ours’.
What really brings us home though, and why I made the argument in the first part of this piece that we are no heroes, is the fact the greatest thing pulling us home, is home itself. Many a Ghanaian is unable to break and more often than not, strengthens the bond she has with the country when she leaves. Family and friends are left behind and are missed by the hour. The unique hospitality of the country, the good nature of its people, the resilience they show and the food which can only be found in my mother’s kitchen and by the big gutters at the roadside appeal to our very makeup. Of course we know of the frustrations with work in Ghana. We know we cannot just transfer our knowledge into the country expecting success. We expect our lives would not be quite as glamorous as possible with practice in the US. We know this and yet, we are still heading back. Some have called us noble, others heroic. But above all, we are just creatures answering the call of the wild, heading home to the watering hole at which we first drank.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
I’ll start with the most controversial of the responses I’ve heard; “I just don't have the patience to deal with spoilt patients with an overdeveloped sense of entitlement”. Now I wouldn’t necessarily have put it that way but it is to be expected that in a country where healthcare is expensive and people are used to a certain standard of living superior to most around the world would by default expect a standard of care superior to what most around the world demand. In addition to this however, there is a more outspoken culture in developed countries with a belief in the presumed right of access to any service one’s money can buy. This is an inherent part of the medical practice in the US – patients who are proactive in their health maintenance and who can sometimes be a tad bit purposeful in their pursuit of one goal or the other. Compare this to Ghana where the average patient is only ever so grateful to be seen by the doctor, wears their Sunday best to go see her and are more willing to take anything the doctor says to take. They are forever grateful for the any respite they get from their care and are less wont to blame a physician for lapses in care. This might not necessarily be good for the patient in the long run or for the quality of healthcare delivery and providers for that matter. However, it remains a fact that draws the immigrant physician to her country.
Another reason the younger generation of Ghanaians want to practice in the country of Ghana is social responsibility. But what is social responsibility? Each individual being responsible for his community, which of course begs the question, ‘what is one’s community?’ Is it our country of birth, is it where we were raised until adolescence and where our formative years were spent – in a country where we were loved and raised where we felt we belonged and where we were beaten into or at least scared into studious little nerds or is it the country that opened its shores to us, gave us the opportunity to achieve high quality education often without paying a single dime and enables us to train at the highest levels known to man and arguably spends the biggest dollar value on our education. The answer is not an easy one and is as personal as they come. And those who go home in fact do not argue their choices along these lines. Of course a lot of Ghanaians are fiercely patriotic and believe it is and will forever be the best country on earth so not one of them is likely to tell you that they owe more of an allegiance to the US than to Ghana. More than this, however, there is a belief, born of years spent in close proximity to, if not in, poverty and experiences in the medical system to know that the marginal benefit of their services is higher in a resource deprived country like Ghana than it is in the US. Being a product of two cultures, they choose to give to the one that needs them more.
Given people care about what impact they can make though, one is tempted to ask if they might not be able to contribute more to their country by working in the US and helping back home in training and establishing health facilities or systems through the use of their income? This way, one could contribute effectively to Ghana, provide services in the US, and attain the comfortable life in terms of income for family and self that drove us to the lengths necessary to make it in school. On the surface, this seems a reasonable proposition. I was gently informed however that what impact one makes depends on the services her dollars provide, the importance of the services, their effect on the system one wants to change and of course how the provision of the services fits into the individual’s worldview of self attainment. In other words, one has to be happy not only practicing in the US but also with the decision to not practice at home. This is especially difficult for those of us who want to effect change on the ground and be a part of the movement towards equalizing access to healthcare in Ghana. Instead of money, what we need is hands on the ground; hands that work at shaping policy, lobbying for political will and heal disease. The hands might as well be ours’.
What really brings us home though, and why I made the argument in the first part of this piece that we are no heroes, is the fact the greatest thing pulling us home, is home itself. Many a Ghanaian is unable to break and more often than not, strengthens the bond she has with the country when she leaves. Family and friends are left behind and are missed by the hour. The unique hospitality of the country, the good nature of its people, the resilience they show and the food which can only be found in my mother’s kitchen and by the big gutters at the roadside appeal to our very makeup. Of course we know of the frustrations with work in Ghana. We know we cannot just transfer our knowledge into the country expecting success. We expect our lives would not be quite as glamorous as possible with practice in the US. We know this and yet, we are still heading back. Some have called us noble, others heroic. But above all, we are just creatures answering the call of the wild, heading home to the watering hole at which we first drank.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Saturday, August 29, 2009
Don’t Say Goodbye
This is a reflection on an experience I had some time ago in its raw, non-edited form. It shows a bit of what the student life is and the little joys we get from it.
There was a smile on the mother’s face as we left the room. I had been in there with my fellow second year student as part of our pediatric session for the Patient-Doctor experience (PD) and he had happened to be the last patient we saw that day.
I must first admit that I have been on e of the many students that have smirked in disdain as our preceptors tried again and again to justify the saying of catch phrases like “that must have been hard for you” to patients. I understood the need for empathy towards the patient but I also knew the patient’s primary goal was to get treated. And as a second year, my aim was to learn the ropes for survival during third year and that involved learning about diseases, procedures and doctor preferences.
The morning was rather slow this Wednesday and we saw about two patients, one very quiet and needing little persuasion to consent to procedures, the other hyper-excitable and having more fun in a hospital than I had ever seen anyone have. In both rooms, I played the game of peek-a-boo while the physician and or resident got what they needed for diagnosis from child and mother alike. In the room of the third patient, we morphed from clowns into strong men holding down a child as a venous line was placed in her vein to hydrate and nourish her. I was learning. My day was getting productive but not as productive as it would in the next few hours.
My colleague and I had been discussing how best to get out early from the rather quiet ED (emergency department) to study for the STEP I exams when the cardiac monitor started screaming in protest. The beeps got louder and the rush of footsteps past the staff room indicated a major event was happening. Before we could rush into the room, the door was closed and we were left to rue a missed opportunity.
SVT, I heard them say. And with that I went to the still complaining monitors to conduct my personal consult. It was no SVT since there was no sinus rhythm but there was tarchycardia alright, 240 beats per minute in a child and all I could think of was what a unique opportunity this was to see theory in practice. The loud cries coming from Room 3 blended into one with the beeping of the monitor in front of me and both played in sync with the ups and downs of the EKG baseline and the cluttering and smoothening of the rhythm strip as I stood intently looking for the P wave before the QRS complex and arguing with my colleague about whether the initial upstroke was the P or whether there was a bundle branch block.
Finally, we got our chance or let me say, I got my chance when the cardiologist was brought down for adenosine therapy and my colleague volunteered to interpret the Arabic that the mother spoke. I saw a little boy in obvious pain with his face buried in his mother’s bosom and the hand he could use digging into the winter coat that she apparently was oblivious to the fact she was still wearing. And in the eyes of the mother, I saw not just pain and despair, but confusion—confusion about what was going on and probably confusion from being listening to what was being discussed around her and not understanding a single word of it.
We took our positions in the far corner of the room out of the way of the hurried masses and looked on silently while the professionals went about their work. I attempted my game of peek-a-boo again but where it held the first patients attention throughout our visit to her room, it caught this one’s only for a second. I watched my colleague communicate the findings and plans to the mother and repeat her questions and consents to the attending. I did not comprehend what they said to each other but from her mannerism, she seemed to trust in what the doctors were doing and only wanted her son to be free from suffering. First, a bolus of Midazolam was administered to calm the still remonstrating child and then preparations were made to administer adenosine in the hopes of getting him out of his arrhythmia. With each dose, he looked on first in calm and then as the medicine made its way to his heart he would writhe in pain and attempt to reach for his mother who stood holding his hands and brushing his hair with the other while tears run from both eyes. I turned and whispered to my friend to tell her everything would be okay, to “do what we are told to do in PD” but he was an interpreter. Was it really his place to do that? I was of course still jesting and I was still wracking my brains on what the mechanisms of action of adenosine and midazolam were but there was something else dawning on me that many hours in my PD lectures had not convinced me about—these two people were concerned not only about the treatment being administered. They wanted hope against hope that everything would be fine.
The adenosine intervention ultimately failed and the patient had to be transferred to the surgical intensive care unit. While preparations were being made for this and an ultrasound was sought to observe heart structure and function, there was a temporary lull in affairs and I went over to hold the boy’s hand. He held my finger tightly while I said to him that he was going to be fine without knowing whether he understood me and praying that he would be alright. We stood there silently watching each other and saying nothing more but understanding that a connection had being made that was essential to the humanity of both of us. The ultrasound came and left without him letting go of my finger and another cardiologist who could speak Arabic came and left and he would still not let go of my finger. Finally, at 5:30pm, 30 minutes past our check out time and with every thought of studying for the upcoming boards out of my mind and concerns about p-waves and inverted t-waves nowhere near the forefront of my consciousness, I was able to extricate my hand and mumble a good luck to the mother. At the door, I turned and waved. Bye S., I said. With the IV lines still in place and the EKG leads hanging off his chest, he turned to look at me, raised his hand slightly off the bed, and waved in return. At that moment, a lightness descended on me and for the first time that late afternoon, I saw a smile in the mother’s eyes and about her lips. Then I realized I was smiling as well.
On my way out of the ED, I could hear the cardiac monitor still shouting its revelations to anyone that would listen. But in Room 3, a silence had descended; a brief respite from what would most likely be another frantic few hours.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
There was a smile on the mother’s face as we left the room. I had been in there with my fellow second year student as part of our pediatric session for the Patient-Doctor experience (PD) and he had happened to be the last patient we saw that day.
I must first admit that I have been on e of the many students that have smirked in disdain as our preceptors tried again and again to justify the saying of catch phrases like “that must have been hard for you” to patients. I understood the need for empathy towards the patient but I also knew the patient’s primary goal was to get treated. And as a second year, my aim was to learn the ropes for survival during third year and that involved learning about diseases, procedures and doctor preferences.
The morning was rather slow this Wednesday and we saw about two patients, one very quiet and needing little persuasion to consent to procedures, the other hyper-excitable and having more fun in a hospital than I had ever seen anyone have. In both rooms, I played the game of peek-a-boo while the physician and or resident got what they needed for diagnosis from child and mother alike. In the room of the third patient, we morphed from clowns into strong men holding down a child as a venous line was placed in her vein to hydrate and nourish her. I was learning. My day was getting productive but not as productive as it would in the next few hours.
My colleague and I had been discussing how best to get out early from the rather quiet ED (emergency department) to study for the STEP I exams when the cardiac monitor started screaming in protest. The beeps got louder and the rush of footsteps past the staff room indicated a major event was happening. Before we could rush into the room, the door was closed and we were left to rue a missed opportunity.
SVT, I heard them say. And with that I went to the still complaining monitors to conduct my personal consult. It was no SVT since there was no sinus rhythm but there was tarchycardia alright, 240 beats per minute in a child and all I could think of was what a unique opportunity this was to see theory in practice. The loud cries coming from Room 3 blended into one with the beeping of the monitor in front of me and both played in sync with the ups and downs of the EKG baseline and the cluttering and smoothening of the rhythm strip as I stood intently looking for the P wave before the QRS complex and arguing with my colleague about whether the initial upstroke was the P or whether there was a bundle branch block.
Finally, we got our chance or let me say, I got my chance when the cardiologist was brought down for adenosine therapy and my colleague volunteered to interpret the Arabic that the mother spoke. I saw a little boy in obvious pain with his face buried in his mother’s bosom and the hand he could use digging into the winter coat that she apparently was oblivious to the fact she was still wearing. And in the eyes of the mother, I saw not just pain and despair, but confusion—confusion about what was going on and probably confusion from being listening to what was being discussed around her and not understanding a single word of it.
We took our positions in the far corner of the room out of the way of the hurried masses and looked on silently while the professionals went about their work. I attempted my game of peek-a-boo again but where it held the first patients attention throughout our visit to her room, it caught this one’s only for a second. I watched my colleague communicate the findings and plans to the mother and repeat her questions and consents to the attending. I did not comprehend what they said to each other but from her mannerism, she seemed to trust in what the doctors were doing and only wanted her son to be free from suffering. First, a bolus of Midazolam was administered to calm the still remonstrating child and then preparations were made to administer adenosine in the hopes of getting him out of his arrhythmia. With each dose, he looked on first in calm and then as the medicine made its way to his heart he would writhe in pain and attempt to reach for his mother who stood holding his hands and brushing his hair with the other while tears run from both eyes. I turned and whispered to my friend to tell her everything would be okay, to “do what we are told to do in PD” but he was an interpreter. Was it really his place to do that? I was of course still jesting and I was still wracking my brains on what the mechanisms of action of adenosine and midazolam were but there was something else dawning on me that many hours in my PD lectures had not convinced me about—these two people were concerned not only about the treatment being administered. They wanted hope against hope that everything would be fine.
The adenosine intervention ultimately failed and the patient had to be transferred to the surgical intensive care unit. While preparations were being made for this and an ultrasound was sought to observe heart structure and function, there was a temporary lull in affairs and I went over to hold the boy’s hand. He held my finger tightly while I said to him that he was going to be fine without knowing whether he understood me and praying that he would be alright. We stood there silently watching each other and saying nothing more but understanding that a connection had being made that was essential to the humanity of both of us. The ultrasound came and left without him letting go of my finger and another cardiologist who could speak Arabic came and left and he would still not let go of my finger. Finally, at 5:30pm, 30 minutes past our check out time and with every thought of studying for the upcoming boards out of my mind and concerns about p-waves and inverted t-waves nowhere near the forefront of my consciousness, I was able to extricate my hand and mumble a good luck to the mother. At the door, I turned and waved. Bye S., I said. With the IV lines still in place and the EKG leads hanging off his chest, he turned to look at me, raised his hand slightly off the bed, and waved in return. At that moment, a lightness descended on me and for the first time that late afternoon, I saw a smile in the mother’s eyes and about her lips. Then I realized I was smiling as well.
On my way out of the ED, I could hear the cardiac monitor still shouting its revelations to anyone that would listen. But in Room 3, a silence had descended; a brief respite from what would most likely be another frantic few hours.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Friday, July 31, 2009
Brain Drain -- A Dead Hero or A Live Coward
I recently watched Public Enemies, the "autobiography" of John Dillinger, that most inglorious American robber of the yesteryears. In one scene, a bank manager attempted to delay the inevitable by fiddling with his keys. Dillinger smacked him upside of the head and said matter of factly, "you can be a dead hero or a live coward". The words if ever spoken by the man, most likely, did not start with Johnny and they hold meaning for more than that banker. I thought, "surely, this is no different from the choice faced by every migrating Ghanaian doctor". But is it?
According to a Ghana Ministry of Health report, there were on average (median) 3 doctors and 35 nurses per 100,000 people in the country in 2005. That made a total of 1241 physicians and 6599 nurses in a country of more than 20 million people. There were also 791 Ghanaian trained doctors practising in countries outside Ghana (NEJM 2005;353:1810-8) and that's only those trained in Ghana. The numbers were better in 2007 with reports of 13 doctors and 92 nurses per 100,000 (NEJM 2007;356:440-3). So we have advanced a bit yes? But why exactly do physicians, with a sworn oath to serve mankind leave the hallowed shores of Chorkor and Cape Three Points for the white man's land? The reasons may surprise you.
We'll start with the obvious one -- money. See there is more money to be made in the US and UK as a health professional than in Ghana. Given the current rate of production of doctors in the US lags quite far behind the ever increasing need for them, there will always be the demand for doctors from other countries. So how much, exactly, is the Ghanaian doctor making? The statistics, as they usually are from developing nations, are murky at the least and depends on who you ask. The only information I found after scouring the web is found here. A house officer, the equivalent of a resident apparently made $700/700 cedis per month in 2007 if we are to take the word of the doctors. That's half the income an undergraduate investment bank intern makes in per week in the US. Compare this to how much a community activist turned Member of Parliament makes and you can understand the agitation of the incessantly striking doctors back home.
In a country where a plate of Selsbridge fried rice cost in the range of 4 cedis the last time I checked and does not satiate me, a man's could run through that much in ehhh, 2 months. Now let's add a wife and 2 kids and we are coming down to less than a month. And you say, the average man eats kenkey anyways so why shouldn't the doctor? You are indeed right. Include this factor, rent, utilities, count the number of extended family members our young doctor must support in addition to the mother who broke her back for him to go to school and he saves maybe 150 cedis at the outside ceteris paribus. The average income of a medical resident in the partners medical system in Boston, MA, was about $50,000 annually as of '07. That's before taxes of course, rent is much higher than in Ghana at close to $1,500 depending on where you live, average meal costs $8 so no you are not living like a king/queen. But you are living. And your dollars would go a longer way in Ghana -- or used to. So, would you rather live in Ghana and make the meager income, serving your healthcare deprived people or would you rather migrate out to serve the healthcare deprived people of the US and make much more? At least that used to be the question.
Recently, a different generation of doctors have arisen, driven by a patriotic zeal to serve their country but still, looking for the way out. Why? I had a rather disturbing facebook conversation with one of my high school mates recently. He is currently a student at the University of Ghana Medical School. He, see, was in the US on an exchange program and was looking to return for medical school and eventually, work. Why, I asked, are you, a Ghanaian, trained on my mother's tax income thinking of leaving the country when my retired mother is back there? Who will deal with her medical issues? Where is the return on her investment? The government says pay a fine if you leave immediately after training but will the fine treat her if she falls sick? I was of course not talking to someone without family in the country. He gave me a laundry list of reasons why he could not stay in the country. But before that, he summed it up in one word -- Indiscipline.
According to him, there isn't only lack of equipment with which to deliver the needed care but the available ones frequently break down and are usually not fixed. Working conditions, described as hours, available nurses, are terrible and the bureaucracy associated with the teaching and delivery of the arts and science of medicine is legendary. Add into this the general laisssez faire approach of Ghanaians and the concept of African time (Case in point, months after I'd liaised with a group of philanthropists in Boston to send books to the UGMS, I am still waiting for the reply from a vice dean of the school on whether the delivered books have been claimed from the harbour) and you get the frustrations of an idealistic young man who went into the profession with the fire and brimstone spewing prophecies of a doomsday preacher only to crash with disillusion. Of course included in those ideals is the promise of riches but one cannot deny the inherent good in him. I, as expected, berated him for expecting someone else to fix his country while he leaves to prosper in another's. He was not patriotic, I said. I, I boasted, am going back to fix the country and my education was not even subsidized by the government. But is he any less patriotic than I? Am I any better for going back? Until systemic changes are made and political will for He definitely would not be a hero for staying home. It is expected that he stays. But is he a coward for leaving? I think not.
In the following posts, look out for my thoughts on the immigrant physician-trainee experience and the generational movement with every intention of going home to help change and make a living in Ghana.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
According to a Ghana Ministry of Health report, there were on average (median) 3 doctors and 35 nurses per 100,000 people in the country in 2005. That made a total of 1241 physicians and 6599 nurses in a country of more than 20 million people. There were also 791 Ghanaian trained doctors practising in countries outside Ghana (NEJM 2005;353:1810-8) and that's only those trained in Ghana. The numbers were better in 2007 with reports of 13 doctors and 92 nurses per 100,000 (NEJM 2007;356:440-3). So we have advanced a bit yes? But why exactly do physicians, with a sworn oath to serve mankind leave the hallowed shores of Chorkor and Cape Three Points for the white man's land? The reasons may surprise you.
We'll start with the obvious one -- money. See there is more money to be made in the US and UK as a health professional than in Ghana. Given the current rate of production of doctors in the US lags quite far behind the ever increasing need for them, there will always be the demand for doctors from other countries. So how much, exactly, is the Ghanaian doctor making? The statistics, as they usually are from developing nations, are murky at the least and depends on who you ask. The only information I found after scouring the web is found here. A house officer, the equivalent of a resident apparently made $700/700 cedis per month in 2007 if we are to take the word of the doctors. That's half the income an undergraduate investment bank intern makes in per week in the US. Compare this to how much a community activist turned Member of Parliament makes and you can understand the agitation of the incessantly striking doctors back home.
In a country where a plate of Selsbridge fried rice cost in the range of 4 cedis the last time I checked and does not satiate me, a man's could run through that much in ehhh, 2 months. Now let's add a wife and 2 kids and we are coming down to less than a month. And you say, the average man eats kenkey anyways so why shouldn't the doctor? You are indeed right. Include this factor, rent, utilities, count the number of extended family members our young doctor must support in addition to the mother who broke her back for him to go to school and he saves maybe 150 cedis at the outside ceteris paribus. The average income of a medical resident in the partners medical system in Boston, MA, was about $50,000 annually as of '07. That's before taxes of course, rent is much higher than in Ghana at close to $1,500 depending on where you live, average meal costs $8 so no you are not living like a king/queen. But you are living. And your dollars would go a longer way in Ghana -- or used to. So, would you rather live in Ghana and make the meager income, serving your healthcare deprived people or would you rather migrate out to serve the healthcare deprived people of the US and make much more? At least that used to be the question.
Recently, a different generation of doctors have arisen, driven by a patriotic zeal to serve their country but still, looking for the way out. Why? I had a rather disturbing facebook conversation with one of my high school mates recently. He is currently a student at the University of Ghana Medical School. He, see, was in the US on an exchange program and was looking to return for medical school and eventually, work. Why, I asked, are you, a Ghanaian, trained on my mother's tax income thinking of leaving the country when my retired mother is back there? Who will deal with her medical issues? Where is the return on her investment? The government says pay a fine if you leave immediately after training but will the fine treat her if she falls sick? I was of course not talking to someone without family in the country. He gave me a laundry list of reasons why he could not stay in the country. But before that, he summed it up in one word -- Indiscipline.
According to him, there isn't only lack of equipment with which to deliver the needed care but the available ones frequently break down and are usually not fixed. Working conditions, described as hours, available nurses, are terrible and the bureaucracy associated with the teaching and delivery of the arts and science of medicine is legendary. Add into this the general laisssez faire approach of Ghanaians and the concept of African time (Case in point, months after I'd liaised with a group of philanthropists in Boston to send books to the UGMS, I am still waiting for the reply from a vice dean of the school on whether the delivered books have been claimed from the harbour) and you get the frustrations of an idealistic young man who went into the profession with the fire and brimstone spewing prophecies of a doomsday preacher only to crash with disillusion. Of course included in those ideals is the promise of riches but one cannot deny the inherent good in him. I, as expected, berated him for expecting someone else to fix his country while he leaves to prosper in another's. He was not patriotic, I said. I, I boasted, am going back to fix the country and my education was not even subsidized by the government. But is he any less patriotic than I? Am I any better for going back? Until systemic changes are made and political will for He definitely would not be a hero for staying home. It is expected that he stays. But is he a coward for leaving? I think not.
In the following posts, look out for my thoughts on the immigrant physician-trainee experience and the generational movement with every intention of going home to help change and make a living in Ghana.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Saturday, July 25, 2009
Barcamp09 -- Healthcare Ghana
It is fitting that the first post on this blog is from Barcamp09. Barcamp is a coming together of young Africans in the diaspora. It encompasses multiple brainstorming sessions on a myriad of issues that are pseudo-generated on the go. I just left one such breakout session on the nature of the healthcare system in Ghana. As is usual at these things, there was a lot of talk about the problems and a lot of finger pointing to lack of political will. However, there were multiple pearls of solid solutions in the rubble. From teleconferencing to mobile vans to setting up a fund for contributions from Ghanaians in the diaspora and at home, we are beginning to think of effective ways to fill the gaps in healthcare delivery in our country. A group has been set up that will, through email, continue the efforts thus begun.
If you are out there, if you care, join the cause.
Prime
If you are out there, if you care, join the cause.
Prime
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