The Ultimate Chapter, The Final Farewell

For those of you loyal readers who have all but given up on the epilogue to this African saga, I have finally gathered my wits about me for a brief moment to at least note down a bit about the experience State-wide. As some of you know, I have begun my fellowship in Hematology/Oncology. It has been a tumultuous beginning, and unfortunately, the night is darkest before the dawn and that dawn will not even begin to peak its head for another 10 months or so. Therefore, this night will be one of the longest that I will have known.

More than just the challenges of initiating myself into a field I know almost nothing about, immersed in a caustic environment, yet again separated from my wife, is the culture shock of the medical system itself. I experienced this contrast before when I began my ER rotation after returning from my sojourn in the Himalayas in early 2007, treating and diagnosing patients w/ nothing but my physical exam skills (pitiful though they may be, but surprisingly better than that of my Kenyan colleagues), some rudimentary diagnostic instruments like my stethoscope and a single otoscope/opthalmoscope for the entire camp, and of course the collective experience of myself and my colleagues. After I returned from that experience, I was immediately thrust into the most defensive field of medicine - the ER - where $1000 work-ups for a simple headache were commonplace, where 95 year old demented folk were admitted to the ICU. At the time, it was more a curiosity than a shock because I had really been only on vacation from the American travesty of a medical system during my time in India.

Now, however this transition back to the US is a bit more awful. Here we are in supposedly the richest country in the world where we routinely condemn people to death because they cannot get their cancer care covered. At the same time, we will spend literally millions of dollars on another person so that we could possibly buy them a few more months of misery. The discrepancies are disgusting and typical of the American medical system where everyone is to do what he can, and just because we can do something it means we must do something, and when somebody protests then the full force of the academic hierarchy comes crashing down upon you to highlight your ignorance and inadequacy as a member of the team. Such is the reality that greets me after the challenges and triumphs of my time in Kenya.

Still, the choice of pursuing this field at this institution was mine. Yet, the current reality does not at all serve to be the last taste of this blog for my beloved readers; it is only to demonstrate the importance of having pursued this escapade across the world in the first place.

The accomplishments in Kenya could not have been realized without the support of so many people. Dr. Dave Leonard was the first one to have identified me as a potential recruit for Lalmba at a party celebrating our successful completion of a crash course in Global Health. He and his wife were lecturers for that course and he served as sort of a reluctant recruiter; reluctant in that he did not know if someone such as I with such a short time of commitment would necessarily be a good fit for the organization. Then Dr. Marc Seidman decided I was worth an interview after talking to me on the phone, and voila it Hugh and Marty also thought me worthy enough to send me over for what they considered such a short time.

However, thanks to Hugh and Marty and their faith and confidence in my abilities and their satisfaction with our progress at the site, they were willing to send me back a second time to ensure a stable transition for the new volunteers. As a consequence of the intervening political crisis, our evacuation from Matoso, and my missing my plane flight back to Kenya, I now have the dubious honor of being the most expensive volunteer in the history of Lalmba.

Of course the success of any project cannot be exalted without the heroes who have blazed the way prior to my arrival and who will continue building on what little foundation that I have added in my short time. In this particular case, the names of Paul and Darcie Meierbachtol will be ones to remember as those who were able to take up the mantle and pursue the smoothest transition one could hope for from one medical director to another.

The expatriates often get much of the congratulations with regards to the work. However, they are simply an instrument for movement. The actual movers are the Kenyans themselves. I try to always emphasize to them and to anyone else who will listen that it is their dedication to the clinic that really keeps it going.

And the well wishes, concern, and encouragement of my family also made this journey possible. Without Dad's ability to facilitate communications during the political crisis and everybody else's good vibes pulling for us to make it out safely, things could have been much hairier. And to go along with that, the hospitality of Tom and Marge Tucker and Holly and Tony in Arusha made our escape that much easier to handle.

And to PJ and Howard, who's compassion and generosity support the fulfillment of such adventures. Their faith in the greater good and the concept of "pay it forward" have been an inspiration to us. I plan to continue to embrace their vision.

Finally, last and arguably the most important person to make all of this possible - the establishment of a streamlined HIV/TB clinic, the initiation of a consistent teaching curriculum, the encouragement to start computer training, in short all accomplishments and even goals to be pursued - is Professor Amy Jeevan, Chair of the Modern Languages Department at the University of Indianapolis and the most wonderful woman in the world. Without her constant encouragement, her willingness to work a whole year in a new job with barely any back-up, her acceptance of my need to go back to Kenya to finish my work despite the political tumult, and her understanding that this was an innate urge of mine to fulfill this dream of international travel, health care, and intrigue, and of course her financial support as my sugar momma, none of the progress during my time there would have been made. Really, she was the the keystone of the whole operation.

It is to all of you that I dedicate this last chapter. And from this vantage point as traveling doctor, I bid thee farewell, as I now fully commit myself to the future of hematology and oncology.

Thanks for everything.