Night

5 am and we're hurtling through the streets of Soweto. Brush fires blaze in the background as shadowy figures huddle around them for warmth, thick blankets wrapped tightly around thicker waists, infants rocked to sleep on their backs. Bitter whiskey runs freely between young men patrolling the streets with bats; barely old enough to shave, they are marching with an uneasy certainty. Metallica's "For Whom the Bell Tolls" blasts from our radio. I open the car window as Francois lights another cigarette, and the wind is deafening.

'Princess' is a squatter camp rocking on the edge of chaos; it is a place of cramped shacks, raw sewage, and bullets. I wear an over sized bulletproof vest over my jacket, aware that its frayed belly is more for show than any real protection. Francois offers me a hand as we pass over a rickety bridge haplessly built on an open sewer; I do not need it, it is not the first time that I have passed through nightmares. Quietly, we make our way to a tiny shack, barely the size of a western bathroom, nestled in the heart of the camp. There is no crowd, only a small girl standing outside, lost in a dark blue blanket; a fat officer with faraway eyes idles restlessly nearby. We walk inside. There is a woman sitting on a bed. She is young and frail with high cheekbones and slightly sunken eyes; she clutches a bottle of milk and doesn't look at us. Her three month old daughter is lovingly wrapped in a blanket beside her, tiny coarse curls matted against her forehead. She wears a tiny pink hat that nearly covers her eyes, startlingly long eyelashes peeking out. We stay only briefly. We don't talk to the mother. As we leave, we ask the officer to translate for us. "Please tell her that the baby is dead", we say. We file a report and leave, drive away, faster and faster in the darkness. Far in the distance, beyond the dry hills and isolated roads, Soweto is burning.

I have written a lot about God in this past year, generally to reflect on his absence. The problem of evil haunts me: how could a benevolent God allow the horrors I see all around me? Perhaps worse, how could he blind so much of the world to the suffering that is so obvious it shakes me to the core, keeps me awake at night? There is so much pain, and for what reason? For a long time I have not believed in God. Rabbi Hillel said that most people live their lives in an easy darkness, unaware of their blindness. A few, however, are tormented by lightning: occasional flashes of realization that light up the earth and shake them from complacency. My experience this year has been one long lightning storm; sometimes it is a nightmare that I cannot wake up from, but other times I'm glad, because I am no longer sleeping.

I suppose that it would have been easy for God to make people good, to always make the right choices and create a happy world. But instead of goodness, God gave us an even greater gift: he gave us freedom. Uniquely, we have the ability to analyze and reflect, thereby making genuine choices. Those decisions will not always be right or just, and humanity as a whole has suffered for it. Greed, hatred, bigamy, ignorance... they plague us as a people, and yet most of the time we continue to walk in darkness, blissfully unaware of the evil we have allowed ourselves. But God in his wisdom has in fact given us two gifts: Free will, and Insight. I believe in God because I have seen the lightning; I have felt the truth and am blessed with the ability and opportunity to bring change, however small. It is a challenge that we all must answer, each in our own way. My time in India and Africa has been illuminating... I am coming home with enough thoughts to write without stopping until the end of my days. There is so much to see, to do, to experience and to change that it is nearly overwhelming... I take deep breaths and continue on, small steps and one at a time.

Thank you to everyone I have worked with - all of the amazing people and organizations that have made this year possible. You have enriched my life beyond belief, and I hope that in the years to come I prove worthy of the opportunities you have granted me. I have two more weeks in South Africa, mostly on holiday, but I will continue to write. After all, there is so much more to say. I am sitting here now, listening to the familiar Metallica tune that blasted on the radio a few nights ago in the paramedic response car. The deafening instruments do not drown out the original inspiration, Jon Dunne's 16th century poem in which he famously wrote that "any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee."

Pesach

This Passover, as we commemorate the Jews' liberation from over two centuries of slavery, let's not forget those who are still enslaved by unthinking foreign policies and bad government. As demands for biofuels increase and food prices rise, the frankly horribly predictable problem of worldwide hunger is growing at a faster rate than ever in the past three decades.

If Not Now, When?

What happens to a dream deferred?

There is a famous poem by Langston Hughes written around the time of the Harlem Renaissance called "A Dream Deferred"... Hughes asks, "what happens to a dream deferred? Does it dry up like a raisin in the sun? Or maybe it just sags like a heavy load... or does it explode?". Soweto, in may ways, is the answer to that question and its aftermath: What happens to a population that has been systematically repressed for so long, their dreams whittled down to aspirations for the basic human rights of recognition and equality? And, even more so, what happens when those dreams finally come true?

I went to Soweto last weekend as part of a small tour group run by Imbeza tours. The woman running the operation, Mandy, was engaging and provocative, immediately honing in on our interests and pushing for dialogue. Almost as soon as I got into the van, she started up a conversation about South Africa's politics and economic situation... she remarked that S. Africa's economy was growing too quickly. Now, this opinion took me by surprise, of course, because according to pretty much any political/ economic journal, S. Africa's economy is growing at a much slower rate than anticipated. Originally, when the ANC came to power, there was a lot of speculation about which way the country would go - would it descend into eventual chaos, like Zimbabwe, or would it putter and struggle along, eventually becoming a free democracy? Although civil war hasn't broken out, the ANC's economic and social policies, while on some level idealistically successful, haven't really panned out when it comes to market growth. Domestic companies are frustrated with the black empowerment laws that force them to hire certain percentages of non-whites for "leadership" positions, without simultaneously ensuring that the black work force is also educated enough for those positions. International companies, generally weary of Africa, seem to still be watching what happens... China is, in fact, quickly moving in to fill that gap, but the economic progress is nonetheless not as, well, progressive as it should be. Nelson Mandela, when touring Europe a few years ago and meeting with world leaders was asked why, amidst all the praises, these leaders aren't doing anything more to help South Africa develop. He replied, "they don't have any ink in their pens". The whole world seems to know that this country isn't doing as well as it should be... so why does Mandy think it's growing too quickly?

Mandy's answer touches on the frustrations that must be felt by many South Africans - when change comes, why doesn't it take them along? She reflects that the international companies establishing themselves in South Africa - opening banks, buying properties - are only benefiting those who are already part of the "white" system: in other words, only those who are educated and part of the current economic infrastructure are getting the jobs and, subsequently, an increase in their standard of living. But what about those who have been systematically excluded? During apartheid, the government made it official policy to provide purposefully poor education to the black communities - schools (shacks, really) would employ one teacher for more than a hundred students, and only the most basic materials were provided. Students would generally only study through primary school, afterwards joining the blue collar work force if they hadn't already dropped out. Only the wealthy few could afford a better education, and as a result illiteracy is widespread throughout even the most urban communities, such as Soweto. Since the ANC came into power the rhetoric has changed, but practical differences are barely noticeable. Public schools in Soweto are only improving slowly, and the funds that are supposed to be allotted to education and socioeconomic development in the poorest areas "disappear". The most frustrated seem to be the middle-class blacks: too "rich" for even meagre government subsidies, but without the resources to afford private education, how do they break into the system? What good is the end of political oppression if socioeconomic status remains the same, without any reasonable hope for change?

According to Mandy, the government should be focusing less on trying to appease foreign companies and recruiting more investors and instead put more efforts into education and housing. "But what about the tax revenues?" I asked... shouldn't the money that comes from investments be helping the poor? How else could the government get funding for the social programs she wants? Mandy paused and agreed with me that that was an interesting point... interesting, but not relevant because things aren't working that way in South Africa. Yes, taxes should be helping the poor - but they're not. They're either mismanaged, misappropriated, or simply disappear. But how could an economic slowdown possibly be the answer? Mandy pauses. "It would equal things out a little", she says after a while.

We drove through different neighborhoods, rich and poor, crossing the boundaries between million dollar houses and shacks in just minutes. We walked around, handed out food, and photographed. I saw the sights and sounds of Soweto that day - smelled chicken roasting on metal cans, tobacco wafting through ramshackle shebeens. But it is the soul of Soweto that I really wanted to see... Mandy gave me a window, but then the curtains closed and the tour was over. I got a glimpse of how the people must feel... it's unfair, things don't seem to change, when is it their turn? It's easy to say that I don't have those answers and, frankly, it's not my responsibility to know... I'm just here to stitch people up, right? As I uploaded photographs to my laptop that night, Rabbi Hillel's famous words resonated in the back of my mind "...If I am not for others, who am I? And if not now, when?".


Stark contrasts in living conditions between the rich and poor areas of Soweto, all black, ask questions that go far beyond the typical "race" dialogues


Young girl waits outside her house as a river of sewage runs past


Women cook chicken on a fire outdoors



Young girl pumps water... the poor neighborhoods of Soweto don't have indoor plumbing

Boy plays with a plastic gun... when do games become reality?


On the way to school


Elderly man relaxes in the late afternoon


Alcohol is a major problem in Soweto...

Philosophical Diversion

Recently, I shared some of Bertrand Russell's writings with a friend; scanning his essays for the most meaningful, accessible bits made me excited about his work all over again... so much so that I feel compelled to post a small excerpt here. This is the preface to his autobiography, entitled "What I Have Lived For"... it is one of the most beautiful passages I have ever read, and it speaks to me deeply. Russel was a brilliant philosopher (yes, and mathematician...) in many fields, but it is his passion for self-reflection and honesty of vision that I admire most. In my opinion, one of the greatest pitfalls of 'modern' living is the ability to walk through life blind, without contemplation; it's easy to become well-fed shells going through the motions without ever looking deeper into ourselves. Russell not only embodied the antithesis of that, he lived its principles. Now, of course, the passage below, beautiful as it may be, is brief and inevitably superficial. But, it's 11am and I haven't slept in nearly 30 hours, so....

What I Have Lived For

Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind. These passions, like great winds, have blown me hither and thither, in a wayward course, over a great ocean of anguish, reaching to the very verge of despair.

I have sought love, first, because it brings ecstasy - ecstasy so great that I would often have sacrificed all the rest of life for a few hours of this joy. I have sought it, next, because it relieves loneliness--that terrible loneliness in which one shivering consciousness looks over the rim of the world into the cold unfathomable lifeless abyss. I have sought it finally, because in the union of love I have seen, in a mystic miniature, the prefiguring vision of the heaven that saints and poets have imagined. This is what I sought, and though it might seem too good for human life, this is what--at last--I have found.

With equal passion I have sought knowledge. I have wished to understand the hearts of men. I have wished to know why the stars shine. And I have tried to apprehend the Pythagorean power by which number holds sway above the flux. A little of this, but not much, I have achieved.

Love and knowledge, so far as they were possible, led upward toward the heavens. But always pity brought me back to earth. Echoes of cries of pain reverberate in my heart. Children in famine, victims tortured by oppressors, helpless old people a burden to their sons, and the whole world of loneliness, poverty, and pain make a mockery of what human life should be. I long to alleviate this evil, but I cannot, and I too suffer.

This has been my life. I have found it worth living, and would gladly live it again if the chance were offered me.
.

Personal Statement!

Hey everyone, and thanks for reading... apologies for not updating the blog for the last week, I've been busy working (ok, just a little!), abseiling, caving, hiking, and... working on a personal statement! I need to submit a mini essay on "why I want to be an emergency medicine physician" to USC/Keck School of Medicine in order to do a rotation there... this morning I woke up with a little inspiration and finally wrote something! I pasted the statement below... please post or email comments, as I would *love* all and any feedback! I'm submitting the essay sometime Tuesday afternoon, so please send comments by then! Thanks a lot, and I promise more updates this week!

*****

Thank you for the input to everyone who emailed/ posted comments... more updates to come soon!

Sharing an Article...

I just came across this while browsing the NY Times online... as Rutgers is my alma mater, and since I graduated with a BA in Philosophy less than four years ago, I just had to post this...
http://www.nytimes.com/2008/04/06/education/06philosophy.html?
em&ex=1207627200&en=cf25c58a650590d5&ei=5087%0A

Go Rutgers, And props to the Philosophy Department. I'm thrilled that more and more students are realizing the benefits of taking a few minutes (hours? years?) out to examine life from a deeper perspective... majoring in philosophy was probably one of the best decisions I made in college.

Fun at Work?

I was dressed up as a drunk, combative car accident victim for the final exam of the ATLS course... and had a great time!

Yeah, we have a lot of fun... or, I suppose, at least I do... lodged between the long hours, the chaos, the depressing stories and the violence, there's a lighter side to things (honestly, there is!). The trick to getting through the day - in fact, the secret to loving the days - is to find humor in every situation. Some days, things seem so ridiculous that I pretend I'm actually on "Candid Camera" and am being taped for a reality TV show... often, it's the only explanation that makes any sense. I remember walking through the trauma unit one morning, coffee cup in hand... there's a guy sleeping (and snoring very loudly) in a pool of blood (his own, I hope...) on the floor... a paramedic is holding a patient's amputated foot in a plastic bag near the door. There is a woman who was bitten by her boyfriend, a man who jumped off a train, and three police officers guarding a man who is so drunk that he's asleep, half on a chair/ half on the floor, butt straight up in the air. I mean... it must be some kind of dark comedy script, right? It's weird, it's funny, it's surreal... except that, of course, it's actually real, and so then you stop chuckling and get to work.

Saturday was my last shift at the Joberg Gen. In five weeks, I've done 23 12-14 hour shifts, plus a three-day ATLS course. In that time, I've placed 8 chest tubes, 3 central lines, and assisted with two DPLs. I don't even know how much I've sutured, or how many ABGs or IV's I have placed... I lost count a long time ago. I'm exhausted. In some ways, it's hard to believe that it has only been five weeks... I have become to comfortable here, in Joberg and the hospital; I've met so many people, made friends, traveled about... it almost feels like I live here. The shifts have sometimes flown by in a flurry of activity, and other times, when the patient flow slows to a manageable trickle, long conversations about politics or philosophy break out over weak coffee and cold Nando's chicken. I have loved all of it, every last bit; I say that honestly, acknowledging that each and every terrible thing, all of the inefficiencies, the preventable morbidities, the horror of the constant violence and underlying racial tensions - everything that I have experienced here has been more than worth it. Life here is exactly what I often feel is lacking back home: it is real, so very, very real, that it's impossible to deny or avoid. In the states, particularly in the more affluent communities, it feels that life is lived in a bubble of cars, fashion, and shopping malls... here, in the hallways of 163, the frivolous concerns of suburbia couldn't be further away. I don't find myself constantly rolling my eyes... i'm too busy caring for patients, too busy learning and feeling what is real as it ebbs all around me. I suppose this is part of the reason why I chose to become a doctor, why I'm going to specialize in emergency medicine, and why I insist on practicing it in the busiest, most chaotic conditions available. Maybe this desire will pass as I get older, more tired and jaded... but for now I'm more than happy to roll up my sleeves and get my hands dirty... thank you, Africa, for giving me this opportunity. I'll be back!

After relaxing on Sunday, I will start two weeks of trauma ICU at Chris Hani Baragwanath ('Bara') Hospital on Monday. Bara is the major "university" hospital serving Soweto, a poor, historic township just minutes from Johannesburg. It is home to an estimated 4-5 million people, mainly poor black families, and is one of the most violent areas in all of Joberg. Bara hospital is one of the largest hospitals in the world, with 3,500 beds, and runs one of the busiest trauma services in all of Africa. But, more on that in the next post... for now, I want to take you on a brief , illustrated tour of the Joberg Gen. Enjoy!


Welcome to the Trauma Unit! Enter at your own risk... :)


The entrance to 163 is a locked metal gate... enough said!!


Hanging out with Nick and Marius at the end of a 14 hour shift. It's 7am and we're exhausted... why are we smiling?!


Looking at an x-ray with Colin... I honestly don't think he's capable of looking serious in *any* photograph!


Mariana, me, and Colin in one of the trauma bays.


Kids, don't try this at home!! Especially because i'm doing it wrong (there's no mask on the end of that BVM!) But it's all for the photo anyway... :P


Linh (an elective student from Germany) says that "all Asians love doing this in photos!"...


... I thought i'd give it a try too :)


Hey everyone! Thanks for reading, and stay tuned for more updates and photos! Just as soon as I get a little more sleep...

Wild Things... You Make My Heart Sing!

So, it's been a while since I posted photographs... here they are! More to come soon... This post is of the animal-friendly variety (though not necessarily of friendly animals... read on!)


Making friends in Zanzibar... I met this little guy at the night market, and babysat him while his "owner" stepped away to "do some business" for a few hours... but we had fun! Tiny monkeys love sugarcane juice, in case you were wondering...


Trying on a 50kg snake at the Gold Reef, Johannesburg. Don't worry mom, he was friendly!


So, Colin and I decided to go on a do-it-yourself safari at a local animal reserve... this is our "safari vehicle", a late 80's LaserTracer! Shockingly, he survived the ride... what happened? See below...


We drove into the "Predators" section of the park, apparently disturbing a lion and his women... the lion was not pleased... this is him sizing up our, um, not-so-rugged car...


This is the lion preparing to pounce... Colin has his camera running, and there's a video clip of me screaming for him to get moving!! The lions basically chased us out, but I was clicking photos the entire time!!


The lion is way, way too close to our car!! This is *without* zooming!


Awww, tired... an older lion yawns and basically ignores us. Phew!


Hey there beautiful... look at those eyes!!