On Being

There we sat, the room lined with orange and beige fiberglass chairs, all nervous, making awkward conversation with those sitting next to us. Most people were in suits, of course, I didn’t own a suit and had certainly never worn one in my life. (Not to mention my mother informed me years later that my acne was terrible…) A young, boisterous guy with blond spiky hair across the room wanted to let the whole room know he was different, he had a fine arts degree you know. Sitting next to me, a skinny Asian kid who appeared to be about 13 turned to me and asked me what I was studying and where I was from. I had just flown thousands of miles from Tanzania for this interview, my head was fuzzy and my guts were churning with nausea and apprehension.


Oh, I’m working in Tanzania right now. I live in a village and mostly work with maternal-child nutrition and HIV education programs. How about you?

He paused…

Um…wow…I just finished my second year of biology at U of A…I’m really good at piano though… 

It seemed his slight frame in its stiff black suit sank ever further into his chair. I felt bad, I’m sure he was a good kid and I sometimes wonder what kind of doctor he turned out to be. Presumably he was a brilliant genius and I’m sure he ended up going to medical school somewhere. The large part of the process of becoming a doctor is about portraying yourself in a certain way, focusing on all the ego-boosting accomplishments you have and saving face at all costs.

The entirety of my interview started with: “Well…this one time in my African village…” Afterwards I felt the pangs of regret of having completely blown the only chance I would ever have at becoming a doctor by boring the interviewers to death with African village stories that had nothing to do with real-life. The truth is that having just spent months and months in Tanzania with no running water, no electricity and surrounded by an overwhelming amount of human need that I was powerless to do anything about gives you an incredibly accurate idea of what real-life actually is. I had done a lot of soul-searching and although I had no suit and bad acne, I knew who I was, what my core values were and what I passionately believed in. The process had made me redefine who I was.  Everything that I had used as a crutch to define who I was had been stripped away and I was laid bare (with a lot of time on my hands) to figure out how to start anew.

Now, over ten years later this year spent in Uganda and Ecuador rings with some of the same truths of redefinition. I nostalgically think back on a time when I was self-aware and so deeply convinced of what my role in the world should be, 'doing' medicine can so easily let us forget those aspects of our vocation.  Although my roles are now very different and I feel I have more to offer on many levels it reminds me that all of life is about who you are, not what you do. In Canada, I am defined as a doctor, a baby-catcher, a joker, a runner, a snowboarder, a hiker, a biker, a church-goer, a wife, a friend, a sister, a daughter. While these continue to be true for the most part, this year I am mostly defined as a foreigner, as different than those around me, wherever I am. After a while this can be somewhat un-grounding, yet it provides a unique opportunity to question what about me is ego and pride and what is really who I am and who I strive to be. It is all too easy to define ourselves by all that we do, instead of just being. Needless to say, a shift in mindset that is easier said than done.  Who cares what you do?  Who ARE you?

Spanish Lessons and Pregnancy Culture

Here I am in Machala, Ecuador. What I'm supposed to be doing is MPH courses, designing a grant and writing a publication for my most recent work in Uganda. What I mostly do is go to spinning class, sit around and sweat while I listen to lectures, go running in the early morning, swim on occasional evenings, sweat some more, do dishes, hand wash clothes, sweat, and create fabulous dishes to cook without the use of an oven. Did I mention the sweating?

Trying to make the most of this unique opportunity of living in a rather idyllic mosquito infested swamp I'm taking some Spanish lessons to brush up on vocabulary and grammer. My teacher, Marcelo, used to be a high school chemistry teacher. Before that he studied medicine but had to stop because his wife left him with his two young daughters to take care of and well...studying medicine is expensive. Now he works in mosquito control, spraying for Dengue mosquitoes. He's a nice guy. Mostly we talk about how to describe vaginal discharge, religion, birth control, pregnancy complications and Ecuadorian culture. Its good he's not squeamish about these things.

Today was a contraceptive day and I listed off types birth control which he translated and made cultural comments on. My favourite: "Yeah, mostly its just the pill, the injection and the Copper-T that people use...well, there's also vaginal douches, but only prostitutes use those."

Good to know...

Before my Spanish class I was at one of the local health centers doing what they call 'psycho-prophylaxis' with pregnant women. It appears to be generic women's health education, so I don't know if the 'psycho' is related to the teacher or the patients, anyway... I was told to talk about nutrition in pregnancy, which I did with flare of course (with no preparation...I hadn't gone over that topic with Marcelo yet!) The health center is packed with patients and family members lining up with a garden variety of complaints. A cute, scruffy haired, ripe-smelling 2-year old screamed for most of my talk, and then happily played with my cell phone as he sat his ripe little diapered bottom on my foot. At one point the nurse wanted to emphasize a point I made about the complications of diabetes in pregnancy and having a baby that is larger than normal, she said "See what the doctor is saying? If you eat too much sugar you are condemning your baby to a life of obesity, diabetes, high cholesterol, heart attacks and early death!"

Perhaps not exactly how I would have worded it to a Canadian population...ah, I have much to learn, both language and culture.

A Hint of an Existential Crisis

The final hint of tropical moisture was removed from the air with a fine chemical mist as the flight attendants emptied their aerosol cans into the air to sterilize any hitchhiking mosquitoes. As the air-conditioned plane lifted off from the Entebbe airport I felt a mixture of relief, nostalgia and regret. I couldn’t help but feel just a hint of an existential crisis in the residual mixture of emotions left behind after spending August to December in Kampala. Although my expectations may have been unrealistic, on many levels, both personal and professional I question if there was any point to the exercise and whether the balance of good and bad, frustration and hope leveled out to a positive balance. The truth as, looking at the history of ASPIRE, a huge amount of progress has been made this year despite my questions as to the sustainability and local investment. Perhaps my goals for my time in Kisenyi were somewhat unrealistic.

After a few weeks in Europe for some much needed rumination and healing I found myself back at Hopkins, trying to drink in some knowledge from the Public Health fire hydrant. Its always an intense and exhausting experience but I found myself searching for mentors and perspective on how to direct my vocation in a way that will both be personally rewarding but actually contribute in a way other that just catching individual babies. Don’t get me wrong, I don’t need to save live ‘a million at a time’ like Hopkins claims to. As my wise spouse often quotes, “its not important to be important, its important to be useful.”

Christmas Around the World

Christmas Day finds my family on three different continents, what's new? We're in Barcelona, the sun is shining and the sky bright blue over the Mediterranean Sea. Our Christmas dinner will likely consist of tapas instead of turkey. My older sister is in the midst of an Australian summer while the younger one is on a local boat somewhere on the Amazon between Pucalpa and Iquitos in Peru, a few cows are penned on the boat deck and apparently there was potential for one of the chickens to turn into Christmas Eve dinner! Mom and dad are staying in Calgary this Christmas, celebrating with old friends while my in-laws are having a feast in a brown and snowless Manitoba...what a family it is!

Of course, Christmas in much of the world is very different than the shimmering lights, Christmas markets and designer boots we find ourselves surrounded by here in Spain. I love the public health messaging campaign below about the 'festive season'. The gift of health for Christmas is priceless but as 'cheap' as two doses of antimalarials for some!



Wishing you all the best of Christmases, may you know hope and peace, and share some of it around.

Tanzanian Nostalgia

I recently went on a rather nostalgic trip to Tanzania to climb Kilimanjaro (an epic tale told elsewhere). Let me be clear, it wasn’t nostalgic because I’d climbed the mountain so many times before! The truth is, I really like Uganda. It’s a country with a dark and violent past where (for the most part) people have chosen reconciliation over judgment and much about the nation and its people fascinate me. But I LOVE Tanzania, perhaps because I speak the language, I can interact on a different level, joking and teasing. Undoubtedly it is because I spend a very formative year of my life there. Immersed in Tanzanian food, culture, language and families. I will forever think their elephants are larger, their hearts are bigger and their language more beautiful. There’s no questions I’ve left a chunk of my heart there. The nuances of Ugandan work culture and language are to some extent wasted on me. Tanzania was my first African love, I can’t help it!

I miss Tz.

Cervical Cancer History

As we wind our way deeper into Kisenyi II past the pungent aroma of fermenting millet, down a steep alley, through a door that opens onto a dirt courtyard of children playing and women washing clothes, around the corner of a block of latrines you can see how a child could get washed away in a downpour. We edge along narrow ledges between houses, the drop-off off to deep open sewers inches from my toes. I duck my head to follow Veronica into a house, a sheer piece of cloth is the door. We are welcomed and a colouful woven mat is layed on the floor where I sit, legs bend beneath me next to Hadija, a wide-eyed 2-year old chewing on her breakfast chapatti. The morning sun glows through the curtain as Veronica explains what we're doing and asks if the woman would like to participate. She's keen to get tested only after she is reassured that she won't have to 'open her legs for an exam like they do at the hospital' unless the test is positive.

Although I am obviously deeply invested in the project and passionate about working towards preventing women dying of something so incredibly preventable it still boggles my mind that women are so open to collecting their own samples and being screened for HPV. On our first day of testing, one of the teachers at the primary school heard we were testing for cervical cancer and ran over to find us during recess so she could get tested. They take the swabs, go behind a curtain or to the latrine, and come back with the specimens for the research assistants to label then ferry to the lab for analysis. To be honest, if someone showed up at my door with a cooler full of swabs and asked if I wanted 'do-it-yourself' cervical cancer screening I might just shut the door. Although the logistics of a truly community-based screening program can seem intimidating, I can't help but be encouraged by how eager women are to be involved.

I remember an impassioned speech by Stephen Lewis at a huge HPV conference in Montreal last year. His usual topic is HIV but he spoke about cervical cancer that night, and the tragedy of something that is completely preventable, not only with screening, but with an effective and safe vaccine that is responsible for the death hundreds of thousands of women across the world. Over 85% of those deaths occur in the developing world where there is no infrastructure for effective screening programs.

I heard Stephen Lewis again more recently, on a CBC podcast interrupted by haltering internet when he spoke at the funeral of Jack Layton, previous leader of the opposition. The quote of Jack Layton's that stuck with me was 'Always have a dream that's longer than your lifetime'. Today, my dream is to make cervical cancer a historic disease, this disease that is often called a case study in health equity has no right to take the lives of young women, regardless of where they are on the planet. Check in with me in a decade to see how we're doing.

Blatantly Obvious

The sound of my feet pounding the path was the only rhythm I was aware of as I slowly climbed the incline of the Kololo hills in the rising early morning mist, past embassies and houses that would put the mansions of Shawnessey in Vancouver to shame. As I pass Kololo Heights and start my descent back home, the orange ball of the sun peaks out from behind Ntinda hill sending sunbeams shooting through the low lying clouds in a brilliant peachy fan. Running is good for the soul. A nearby mosque emanates sing-song prayers out into the waking world. Funny, I think to myself, normally their morning prayers are done by this time.

As I drink my coffee, the plan for the day goes through my head, meeting with PATH (an NGO with offices nearby at the WHO building). Then Michael (Doreen’s replacement) and I had a long to do list, check-out labs for processing cervical biopsies, buying a specimen carrier, editing and printing surveys and educational material, we had discussed it all just yesterday.

I show up at the gate of the WHO offices at the appointed time, but have an intriguing discussion with the guards at the gate. No, no one is in the office today. Why? They give me a strange look, a bit confused even. Well, its Eid.

Of course, Eid, silly me, oh well. Having not learnt my lesson I tromp down the hill to Mulago Hospital, get to the office to find the place a bit deserted. That’s funny, Mike and I had this work plan, oh well. When I call him (he’s a good Catholic boy by the way), he says: Sheona, it is Eid, we cannot work today!

I now recalled our scheduling challenges with the outreach workers in Kisenyi:

Does Monday work? No, Veronica’s church has to help distribute the World Food Program food.
Tuesday? Well, Esther is a Muslim, it could be Eid.
Wednesday? Well, it could be Eid.

Of course no one had thought to tell me, its obvious to the rest of the world, the date of the huge celebrations of Eid marking the end of Ramadan can’t be announced until the Imam sights the new moon.

It reminded my of a lovely family from Kerala, India who after recently moving to Calgary experienced their first Halloween. Of course, no one had thought to mention to them that children in their neighbourhood would be coming by, ringing the doorbell, yelling ‘trick or treat’ and asking for candy. Its so obvious, isn’t it?

So I spent the day immersed in epidemiology and statistics, catching up on courses instead. I have to say, I was grateful for Eid!