Reflecting on two months of intern year

August 15th feels like forever ago. A part of me almost wants to pretend that it also feels like the blink of an eye. But, the reality is that these past two months have emotionally and physically felt long. Starting off on Rheum was such a blessing. I’m so so thankful for the gentle usher in to this new phase of life. Similarly, I’m so thankful for one month chunks of rotations to really allow myself to actually feel prepared and better understand the work I’m doing. After how exhausting and almost all-consuming this past month on inpatient has been, I’m beyond grateful for two weeks to rest, move slowly, recalibrate and reassess my priorities.

The best part of these past two months has been strengthening my willingness to ask for help and feedback often. I struggled so much with switching presentation formats between medical school and residency. It was frustrating for the one thing I was really good at to become something that I sucked so bad at. It wasn’t a sense of imposter syndrome, but more a desire to yell, “THIS ISN’T ME. I CAN DO BETTER THAN THIS. THE WHOLE SYSTEM HAS JUST BEEN FLIPPED ON ME.” I’m so proud of myself for asking for help early and often. It really took away any shame, fear, or guilt that I had about not knowing. I am here to learn and I’m so eager to learn. Hopefully that combined with a positive attitude will continue to serve me during these next three years.

The hardest part of these past two months has been the experience of being the face of a system. As an intern, I’m the first doctor that answers questions, that relays information, and shows up. Sometimes, I show up late, or without the answers someone wants to hear, or with no further clarification as to why we’re doing what we’re doing. That’s also a part of my learning curve. But, 99% of time, they’re not mad at me. And that 1% of the time that it might be me, I’m comfortable attributing it to my own learning curve. I’ve learned through the frustrating way that I might be the person who gets yelled at when people are mad at hospital systems, other doctors, life in general, etc. But I might be the person who it gets taken out on, and that is not mine to carry. It never had to be, but from now onwards, I can make space for someone else’s emotions which are so real and so valid, without taking them onto myself as my burden to carry. That is a frameshift that I look forward to.

I start a month in the NICU on Monday. I’m definitely terrified, but also excited. There was a magical feeling to getting into your rhythm on PHM. I hope to give myself grace and kindness as I begin anew once again.

A Fresh Start

I’ll be switching this space into one that serves as my journal documenting my emotions, reflections, and experiences throughout residency. I’ve only been a resident for 6 weeks now, but have already seen and felt so much. I cannot fathom what three whole years will look like. But I’m excited to share those inner thoughts with myself in an effort to retain the lessons from beautiful, sad, frustrating, and uplifting moments. I’m also hoping to shed some of the heaviness that naturally comes with caring for kids and families through the most difficult times of their lives in this space. My deepest hope is that I’m able to retain the core of who I am as a person and health care provider by treating myself and others with kindness.

See you soon.

Making Room For The Unexpected

This piece was originally published at Aspiring Docs Diaries on July 24, 2017.

When I walked into my academic advisor’s office on the first day of college in 2010, I had in my hand a four-year plan. That’s what I called it. Meticulously listed out was every course I planned to take for the next four years, and how this path – and no other – would be the one that would eventually lead to medical school. I remember seeing her jaw visibly drop an inch or so. “We’ll work with this,” she said.

In reality, my college experience barely reflected the notes I had scribbled onto every corner of that sheet. I traveled to South Africa as a freshman, and learned about the complexities of that nation’s HIV epidemic. My interest peaked, pushing me towards a public health and policy minor. A Google search led me to FACE AIDS, a national movement of students who championed HIV activism on their campuses. Instead of checking off boxes on a list I’d written before college even began, I grew into what my experiences would be. I allowed myself to learn, reflect, and mold my understanding of the world and my place in it, as the years went on.

And then suddenly, during my senior year of college, a strange reality settled in. I’d applied but didn’t make it into medical school. Without much conscious thought, my mind would return to that day, walking into my advisor’s office with a plan. I’ve lost count of how many times I asked myself, “if I had just followed the plan, could I have avoided this?” In those moments, I’m embarrassed to admit that I didn’t care much about the incredible experiences I had had over the past few years. I didn’t think about how much stepping outside of my comfort zone and learning about how those who are completely unlike me had strengthened my resolve to become a physician. All I could think about was that the numbers didn’t quite add up. I didn’t score high enough or work hard enough to get to my destination.

Over the next year, I worked tirelessly to improve my competitiveness for medical school through graduate level course work and re-taking the MCAT. When I applied for a second time last summer, I remember thinking to myself, “Here you go, this is who I am. I hope this is good enough.” I could never have predicted what the result would be. I received more interview invitations than I thought could be possible. Every conversation at every medical school focused on those amazing experiences that I had neglected to fully value over the past year.  They were an integral part of my personal growth, and I finally realized how they will help me become the doctor I have envisioned.

So, here I am today. I am extremely fortunate and ecstatic that I will be attending medical school in the fall. Getting accepted was the happiest, most validating, lightest moment of life. Here I am again, but instead of making a four-year plan and trying to plan out every detail of my forthcoming experiences, I feel myself focusing on the destination, of what will I get out of medical school, and where it will take me. This time I know better. I consciously recognize that some of the most important and life-changing opportunities that will come my way will result from keeping an open mind, being excited about my career, and building a path for myself one step at a time. If the past is an indication, I’ll be better off for it.

Human Resources for Health: Addressing Rwanda’s Shortage of Health Professionals

Sub-Saharan Africa bears 24% of the global burden of disease but is served by only 4% of the global health workforce. (WHO)

In four short weeks, I’ll be working as a Research Intern at the Rwanda Biomedical Center in Kigali; I have never been more excited to step out of my comfort zone than I am in this moment. The efforts taking place in Rwanda are a spectacular example of what it takes to rebuild a public health system. The 1994 genocide deteriorated Rwanda’s fragile economy and health infrastructure. As a result of the widespread violence, the nation experienced a significant loss of health care professionals and a steep increase in the prevalence of HIV/AIDS. (as of 2012, the estimated HIV prevalence is 2.9%). Concern over the Rwanda’s skyrocketing AIDS epidemic led the Government of Rwanda to collaborate with Partners in Health and the Clinton Health Access Initiative in 2005. This partnership has come a long way:

  • PIH supports the Government of Rwanda’s delivery of health care services to approx. 865,000 people through 3 hospitals and 40 health centers in Rwanda’s poorest regions. 
  • CHAI has worked in Rwanda since 2002 to scale up HIV/AIDS care and treatment, contribute to health infrastructure, and promote economic development.
  • In Aug 2013, CHAI and the Government of Rwanda announced a program that will combat malnutrition through collaboration with food producers, development of local food processing industries, and increased income for small holder farmers.

However, Rwanda still experiences a significant lack of human resources — physicians, nurses, midwives, management officials. The WHO recommends a minimum level of 2.3 health care providers per 1,000 population; Rwanda has a density of 0.84 providers per 1,000 population. In an effort to strengthen the nation’s health workforce, the Government of Rwanda and CHAI invited 25 American institutions (16 academic medical centers, six nursing schools, one public health school, and two dental schools) to form a 7-year partnership known as the Human Resources for Health program.

Through this initiative, health professionals from the United States- dentists, doctors, nurses, management officials, and midwives – will partner with Rwandan health professionals to exchange knowledge and skills that will promote the ability of the Rwandan health force to sustainably and comprehensively address their nation’s health needs. Each year, approximately 100 health workers from the United States will “twin” with colleagues in Rwanda.

Human Resources for Health was announced in 2012, and I am extremely excited to monitor and watch this initiative grow. Rwanda has shown immense dedication to eventually breaking free of dependence on foreign aid, and this is evident through efforts to improve and sustain health infrastructure, medical education, and proper health outcomes.

For more information on the Human Resources for Health program, visit:

The Official HRH website

NEJM article detailing the program

 

Bringing it Back to the (Global Health) Book Worm Days!

Let’s be truthful — I haven’t been reading leisurely over the past 3.5 years at NYU. I haven’t been reading much except NYT articles, truthfully. Now that I’ve graduated and I start the process of reassessing and re-inventing myself, my first step is to engage my mind and spirit with some moving, challenging works.

And so I present…. My (Global Health) reading list! I have many other texts outside the discipline that I’ve included, and that is because everything is interdisciplinary. History, economics, politics, health – they are all related.

I’m eager to blog more, and for now, enjoy!

Medicine and Culture
Better
Will to Live
The Truth About Drug Companies
How Doctors Think
Partner to the Poor
When Doctors Don’t Listen
How to Repair the World
A Field Guide To Germs
The Origins of AIDS
The Self Regulation of Health and Illness Behavior
The Ghost Map
Six Months in Sudan
A Bed For the Night
Infections and Inequalities
Reimagining Global Health
Uncertain Suffering
Family Secrets
What to Eat
Pathologies of Power
Poor Economics
A Short History of Nearly Everything
 “War and Peace” by Leo Tolstoy
“The Rise of Theodore Roosevelt” by Edmund Morris
“The Life and Times of Lyndon B. Johnson” by Robert Caro
 “However Long the Night” by Aimee Molloy
 “The Heart and the Fist” by Eric Greitens
 “Why We Can’t Wait” and ” Where Do We Go from Here? Chaos or Community” by MLK
 “Born to Run” by Chris McDougall
Cutting for Stone by Abraham Verghese
How Wall Street Created a Nation: J.P. Morgan, Teddy Roosevelt, and the Panama Canal
The Prize: The Epic Quest for Oil, Money, and Power

Snapshot Sunday: Hungry Planet

Peter Menzel and Faith D’Aluisio traveled the world photographing everything that an average family consumes in a given week and noting the cost. Their results were exhibited in the Nobel Peace Center in an effort to raise awareness about “how environments and cultures influence the cost and calories of the world’s dinners.” (TIME Magazine)

Here are some of my favorites from the full slideshow:

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India – 1,636.25 Indian Rupees or $39.27

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Guatemala – 573 Quetzales or $75.70

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Egypt – 387.85 Egyptian Pounds or $68.53

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USA – $341.98

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USA – $242.48

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Mali – 17,670 Francs or $26.39

 

 

 

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Great Britain – 155.54 British Pounds or $253.13

Think critically about these pictures… People of which countries, in general, are eating more balanced meals? How does culture influence food choice, especially in regard to developed vs. developing nation classifications?

To kick off the first week of October right, I’ll be focusing blog posts on nutrition. These pictures of meal comparisons around the world have always forced me to think critically about why Americans make the food choices we do and how we, as a nation, can focus more on taking up balanced eating.

Snapshot Sunday: Honor A Father’s Wish

On Friday, I wrote an article about the importance of empowering women to speak up against acts of sexual violence against themselves, or others. We have the power to change how society, especially Indian society, views rapists and those who have been raped.

Today’s return of Snapshot Sunday takes me back to the start: Honor Badri Singh Pandey’s wish. Jyoti Singh Pandey, his daughter, was gang-raped in December 2012. His wish – “We want the world to know her name. My daughter didn’t do anything wrong, she died while protecting herself.
I am proud of her. Revealing her name will give courage to other women who have survived these attacks. They will find strength from my daughter.”

badri

Raise your voice, for yourself and those you care about. 

Links of interest that I highly recommend:

Sushmita Sen’s Speech at the Save & Empower the Girl Child Campaign Fashion Show

Sohaila Abdulali’s NYT piece “I Was Wounded; My Honor Wasn’t”

 

Snapshot Sunday: Inside the Mirebalais ER

I love alliteration, and I love Sundays. Here’s to the start of a new series – Snapshot Sunday.

mirebalais ER

 

The ER team was treating this patient’s complicated tibia/fibula fracture when this image was captured. As a huge supporter of PIH’s work across the globe and their model of accompaniment, I felt this was the best way to start the series. While I haven’t yet had the privilege to visit Mirebalais, I have toured the Butaro Hospital in Rwanda and I am proud to raise funds for PIH’s life saving work.

For some more info on PIH, check out the following:

“Mountains Beyond Mountains”, by Tracy Kidder

www.pih.org

 

The Growing Movement: NCD screening and care in resource limited settings

I first learned about the growing necessity for NCD screening and care during my December 2011 trip to Rwanda with FACE AIDS and PIH.

At that point, the now-functioning Butaro Cancer Center of Excellence was a a work in progress. The Butaro Center, being rural East Africa’s first comprehensive cancer center, serves a symbol of what can be done with proper funding and will. Yet, this model and the growing recognition of NCDs as a major issue in resource limited areas, has brought one central question to the forefront of this movement: why isn’t chronic illness (such as cancer) screening integrated into primary care services in a more widespread, efficient manner?

While this question is one that I don’t have a solid answer for, I am using it as a framework for further research on this topic, and I invite you to do the same or take on some of the other recurring questions I’ve seen asked: What is the role of local educational institutions in creating cancer-care providers (such as oncologists, nurses, etc.) in order to allow long-term growth in cancer care infrastructure? Increasingly, how are non-profit organizations across the globe taking on provision of cancer-care and screening services, and what does the future of public sector-nonprofit sector partnerships in provision of these services look like?

For more in-depth, or area specific information on these topics, here are some potential links of interest:

HSPH Infographic: “Global Burden of Disease: Good News and Bad News”

the link between mental health and NCD care 

the adoption of an omnibus resolution on NCDS at the World Health Assembly in May 2013

One example from Uganda of how organizations are increasingly getting involved in cancer care 

The very complex topic of NCD screening and care provision, especially in resource limited settings, is one to watch.