Ah, too bad

Dr. Sanjay Gupta has decided not to pursue the surgeon general post.  Ah, too bad.  We all know how I felt about it.

Gotta love the picture

I just had to post this picture as I just found it hilarious. Also, I love salt - if I ever end up with hypertension, I might as well stop eating.

For those of you interested in reading about NYC's attempts to curb high salt diets, you can read here.

It's about time

I'm very happy and encouraged that one of President Obama's first acts as President was to rescind the Global Gag Policy. 

Paging Dr. CNN

So, the blogs are all abuzz about the rumor that Dr. Sanjay Gupta, of CNN medical correspondent fame, was approached to be the next Surgeon General.  What do I think about this?  I think that surely, we must have more qualified doctors than a talking head on tv.  Am I biased against doctors on TV?  Yeah because I don't think that you can ever be a good one (don't even get my started on the show, "The Doctors"... an Oprah spinoff which no one, including Ms. Winfrey herself, should ever watch). 

 

At one point, I wanted to be Surgeon General.  I think I might have even mentioned that on a medical school admission essay or two (or at least thought about putting that in).  I still think that it'd be pretty nice to be Surgeon General, but my sights are on other positions (HHS Secretary is a good start, then WHO director or UNAIDS director - hey, maybe even throw in a MacArthur genius grant somewhere in there).  However, I think that whoever holds that post should be someone more than a (non-)talking head.  They should be ready to elevate the position to something of stature, and elevate it beyond the public health ruins in which it currently finds itself - especially with a willing and ready president, as I hope Obama will be (my hope for his first act as President, as others before him - repeal the Mexico City Policy).

 

On the other hand, I find it encouraging that someone who is merely 39 may be Surgeon General.  That gives me a chance at doing before I'm 35.

 

Bummer

If this is true, I'm totally bummed.  Leave it to me and get my hopes up that the Secretary of Health and Human Services have actual experience working in either health or human services (ahem, Howard Dean).

A nonsensical policy

When did family planning become a bad word? When I was little, we used to drive past this building with the words, "Planned Parenthood" on it. I didn't know what it was nor did I know the controversy surrounding such clinics. However, the words struck me. "How great is that? People can plan on when they want to become parents!" This was when I was in elementary school. Now that I am older, I still think the same. How great is is that people can control their own reproductive choices?

This post is about family planning. I had a friend call me the other day and we discussed family planning. She is pro-life, I think, and asked me, somewhat rhetorically, "Why wouldn't any pro-lifer support family planning?" She went on to argue (and I'm paraphrasing here) that anyone who is pro-life should be for any prevention in unwanted pregnancies, including comprehensive sex education and teaching and enabling people to use birth control. So, this in light of a recent op-ed in the New York Times highlighting President Bush's "pro-life" choice to cut off birth control funding to many international organizations, got me raging. Seriously, doesn't he get it? Not giving people condoms doesn't stop them from having sex. Giving them condoms simply gives them a way to protect themself from infection and unwanted pregnancy when they do have sex. I mean, if the President decided not to fund any programs that provided sex education or birth control in the United States, people would be outraged - wait, he already did and people are outraged. I guess we can give President Bush brownie points for being consistent.

Meanwhile, a "young woman lies in a hut, bleeding to death or swollen by infection, as untrained midwives offer her water or herbs. Her husband and children wait anxiously outside the hut, their faces frozen and perspiring as her groans weaken." [Quoted from Kristof, "Can This Be Pro-Life?"]

So cool it's hot

When I first told my parents that I wanted to get a degree in public health, they kind of just smiled and nodded. I don't think that they knew what it really was. Now, after many explanations, my dad proudly explains to other people that it deals with getting safe water and vaccinations to populations. My mom, however, is still a little confused. Er.

However, apparently college students get what it is. An article in the Washington Post focuses on how hot the public health classes and majors are on college campuses. I wish that they went into the graduate degree level as well, as those are the people likely to work in public health.

There's a lot to be speculated about why public health is so cool nowadays. In the article, Dr. Thomas Coates pointed his finger directly at HIV/AIDS, saying that it raised the public awareness. I don't know if that's entirely true (and I think he's biased - look at his bio!). Even after the HIV epidemic became large and publicly well-known, public health was still not totally cool. I think a lot of factors have helped public health become a hot commodity - the terrorist attacks of September 11th (and the subsequent nationwide discussion of chemical and biological warfare), the prominence of the Bill and Melinda Gates Foundation and other global foundations and their focus on global health, and the culmination of numerous articles on public health issues domestically (i.e. food contaimination scares, drug contamination scares, the growing number of obese Americans, etc). Regardless of the reason, I think it's great that there is more interest in public health.

As an MD/MPH, I think it's also very important for physicians to be interested in public health. My medical school class was pretty split between those who understood and were interested in public health and those who couldn't have cared less. The student quoted at the end of the article was so optimistic about public health and so pessimistic about medicine (she was planning on getting an MD). That's a sad prospect. Do public health people really think medicine is still its old, stody self? Perhaps it still is, but there is still a lot to be had for public health-minded people who want to go into medicine. I have only gotten the greatest response to my public health degree among my classmates and my attendings. It's a hot commodity in medical schools, just like in undersgrad. I think that the medical profession is slowly changing towards a more global perspective - global in the sense of geography as well as disciplines - and that, in the end, it will be better for doctors and patients.

The article just got me thinking about public health and how it relates to my career plans. I feel as though my public health mind has been put on hold while I'm in residency, as it's hard to do both. Then, I'm reminded of my public health training every time I work with patients to provide more comprehensive care.

Mind the gap

Since I have come back from traveling, people have asked me how I enjoyed it - especially India since I hadn't been there before. I have to say that I am really glad to have gone to India. I learned a lot about India and about myself. It was rewarding to see how medicine really works in "charity hospitals" (I didn't get to see much of "real" medicine in Vietnam, since I was working in an international clinic). I am still struck by my experiences and what I saw. I saw shortcuts being taken in patient care, inadequate medical supplies and equipment (and personnel) being stretched beyond their means, and diseases that I had only read about in textbooks. None of this was to the fault of the medical personnel, who were simply doing their jobs the best way they knew how. Looking back, it was a wonderful experience and I don't regret going. However, it was also a stark lesson in the gap between rich and poor in India and helped me reflect on that same gap (albeit smaller) in the United States. An article in the New York Times today brought it to my attention, so I guess that's what led me to writing about it tonight.

So, did I have a good time in India? Sincerely, I don't know. I had some great memories and met some wonderful people. I learned a lot in medicine and grew as an individual. However, I don't know if I can say that I had a good time in India. Do I wish I hadn't gone? Of course not.

Village Visits

A few days ago, I spent the day with the mobile clinic associated with the hospital that I'm working at in Vellore, India. They go to several villages in a day, put a table under a big tree, and play doctor. It's actually pretty cool and you get to see the patients in their own village, which is sometimes only 10 kilometers away, but takes about an hour to get there because the roads are so crappy.

Also part of the day, I went on a home visit with an intern. The home was a bare building, made out of brick and mud. The entire building measured maybe 10 feet by 20 feet and was divided into three rooms, one of which was the kitchen. Somehow, and I don't know how, 3 generations of one family lived there. All of this was in the middle of plots of farmland, growing rice and some other crops that I didn't recognize. They didn't seem absurdly poor, but it was still very eye-opening, and no longer will I complain about my room because it doesn't have air conditioning.

The day also opened my eyes to the possibility that I really could do this - real global community medicine. Before this, I was doubting my ability to really rough it and be able to really put myself out there. Then, today, I saw how much it is needed and more so, how much it is appreciated. I mean, I am beyond privileged to be able to help others in a way that really makes an impact. So, I'm thinking, yeah, I can do this. Yeah, I can learn to read and write Vietnamese (and speak it medically) well enough to really help my patients in California as well as in Vietnam. Or maybe I'm just being my delusional idealistic self.

Resurrected

So, I'm back from the (almost) dead. I hopped out of bed this morning and didn't feel achy, feverish, or like I was going to hack up a lung or two. I still feel like I'm in that precarious don't-push-it-too-hard-or-you-may-fall-back-down-that-cliff position, but yeah, feeling better! I feel like jumping for joy, but then my knee reminds me that I cannot jump.

So, what's new? Nothing much... I'm reminded that I have tons of stuff to do, including writing my final paper for my Master's in Public Health, writing a rough draft of an article I want to submit for publication, and getting my life in order. Little things, really.

Oh, if anyone knows of any good apartments in the San Jose area, or any tips on how to find a good apartment, email me!

Wasting away

I've spent the last few days cooped up in the house, playing Wii with my little cousin. I feel ok, but I don't think that I have ever had absolutely nothing to do. I feel like I should be outside, exploring, etc etc, but the fact that I can't ride a motorcycle and can't walk quickly puts that option out of the picture. So, I'm literally wasting away (seriously - somehow in the last 2 weeks, I have managed to lose 6cm from my waist... maybe playing the Wii really is exercise?!) and probably going to die of Vitamin D deficiency.

So, I'll comment on a few things in the news recently, as that's all I'm able to do is read the New York Times about 400 times a day.

• Public Health Risk Seen as Parents Reject Vaccines - So, I'm a big fan of public health (oh dear, that's an understatement) and vaccines are routinely referred to as the ultimate public health success. Without vaccines, we wouldn't have eradicated polio nor dramatically reduced the incidence of numerous other childhood, and adult, diseases. So, how do I feel when I see parents reject vaccines because they feel like it? I feel as though these parents are selfish. They are putting their children and other children at risk of easily preventable infections because of one study, widely discounted by scientific circles, that suggested vaccines cause autism. Now, autism is a serious matter and the hooplah over vaccines as the cause just distracts from the search for the true causes of autism. So, get your children vaccinated! (And curiously, it's always the upper middle class suburbs that end up with measles outbreaks. Why don't we quarantine them? Oh, right, that's not politically correct.)
  
• A Case of the Blues - This is a long read, but worth it for anyone watching Congressional elections this year. Basically, it explains the uphill battle the Republicans have in the upcoming election and a profile of Tom Cole (R, OK). All in all, it made me hopeful that the Democrats would get more seats in the House and Senate. However, like the Presidential election, I will not be overly optimistic because anything can happen. What do I think the Democrats need to do? Campaign in this election like any other - campaign hard, campaign lots, and get voters to turn out. Democrats can't win simply because they think they'll win.

I feel like there were more articles, but I can't think right now. Apparently, my brain has atrophied as well.

Cry baby

Anyone who knows me very well knows that I cry very easily. I cry when I get nervous. I cry when I see a Hallmark commercial on TV. I cry at "Extreme Home Makeover." I cry.

So, today I wanted to cry all afternoon. I spent the afternoon at a pediatric HIV clinic in the public pediatric hospital and all I wanted to do was cry (don't worry, I didn't). The physician saw about a patient every 10 minutes and each one was the most adorable little child ever. If anyone has any doubts as to how important it is to prevent maternal to child transmission of HIV/AIDS, you need only to meet one of these children and just imagine the life they will lead - full of countless pills, unmentionable stigma and discrimination, and health consequences that medicine has yet to fully understand surrounding the long-term effects of HIV infection.

The patient encounter goes as follows. The doctor sits at the desk, calls out the name of the next child to be seen. The child and his/her caregiver comes in and sits in the two chairs next to the physician. The physician records his observations and findings while asking the caregiver (who is sometimes the child) whether they take their medicines accordingly, whether they have any side effects, whether the child is eating, and if there is any change in health. The doctor then writes up a prescription for the meds and the child and caregiver leave. And the cycle repeats itself.

The drugs are given to the children free of charge, courtesy of PEPFAR (quite possibly, the best thing President Bush has ever done during his time in office). However, what cannot be remedied with money is the stigma that these children and face.

The most heartwrenching patient I saw was a boy, around 11 years of age. His mother and father died of AIDS when he was less than 2 years old and he is being raised by his grandmother and great grandmother. Both of them hold onto old beliefs and misconceptions about HIV. They don't allow him to go to school or the nearby orphanage because they're afraid that he'll infect the other children. He is in charge of his medicines and responsible for knowing how and when to take them. He's 11, but looks around 7 and was obviously depressed and withdrawn. I can only imagine his day-to-day, where he receives little to no stimulation, no education, and no play time. To top it all off, his strain of HIV was resistant to first and second line treatments and the only thing available to him was a salvage treatment - which was being put at risk because he wasn't taking his medications as directed. I'm tearing up, just thinking of him.

Really, in a world (and country - Vietnam has a new upper class whose income and spending rival even the wealthiest Americans) where there is such wealth, this should not be happening. We should be able to protect the weakest members of our society and provide them with basic human necessities, including love.

I have to mention that I was the only cry baby around today. None of the patients, ranging from 3 months to 13 years old, cried. Not a single whimper, peep, or scowl.

Two sides of the same coin

I spent the morning in a public surgical hospital today and, to say the least, it was eye-opening.

My friend, who is in her last year of medical school in Saigon, was so kind as to let me join her and her classmates while at the hospital. The hospital is a rather large collection of buildings, all of it open-air (i.e. no air conditioning), and full to the brim with patients. Literally. In one room about 15 x 40 feet, there were about 12-14 beds lined up, much like what you see the barracks look like in military movies. In that room would be about 20 patients - so, yes, there is sometimes more than one patient per bed. The patients and their families are responsible for food, water, and miscellaneous other things that we take for granted in most developed countries - so, in addition to the 20 patients in this room, add another 20 for visitors, 3-4 nurses, and 3 medical students and you have a very packed room. There is no patient privacy to be had (HIPAA has yet to be uttered here) and prevention of hospital-borne infections is non-existent. I had to look hard to find a sink in the entire room, and that's because it was hidden in the corner, behind a patient bed, and never used the entire time I was there.

This is dramatically different than the clinic I have been working in. The clinic I work in is an international clinic, with Western standards and both Vietnamese and Western trained physicians. You walk in and it's much like any doctor's office in the United States - except that you pay for every service up front. And pay, you do. A doctor's visit is $100 and you pay for all lab tests and medicines prescribed. Needless to say, the patient populations in the private and public hospitals rarely overlap, if at all.

No system is perfect. The private clinic has its drawbacks - it cannot be entirely Westernized because you depend on Vietnamese workers, supplies, and medicines; some lab tests are impossible to get in Vietnam; and all emergency cases are evacuated to Singapore, where the medical standards are higher. Of course, I would prefer the private clinic style because that is the one that I am accustomed to. However, you cannot leave the public hospital without thinking, "How can this become better?" Sometimes, when I leave work in the United States, I ask myself the same question.

Now, everyone's favorite past-time of late is bashing the American healthcare system (and thinking up new proposals to fix it). However, after spending a few hours in a public hospital in Vietnam, I can say that the American healthcare system really isn't that bad. It's not perfect, but it's definitely not that bad.

World AIDS Day

I think it's rather sad that most medical students are not concerned with anything but their exam grades. Really. I organized a talk about Global HIV/AIDS and women and the showing was good, but disappointing in that most people could not bother to learn about what's going on in the world. And we even had free food.

Sorry, my own griping about the apathy of medical students. I'm not saying that I'm the most worldly of all medical students, but I do make an active effort to learn what's going on. Is it too much to ask?

Inspiration

I went to an award ceremony for Partners In Health on Saturday afternoon and listened to Paul Farmer (who is a public health powerhouse in my view) and Ophelia Dahl speak about public health and social responsibility. Listening to them speak, especially Ms. Dahl, was amazing. It was inspirational beyond belief and it reminded me why I'm doing what I'm doing. It's easy to lose focus in the middle of three exams and two papers (like I had this last week), and so to see that people really are making a difference and I can be one of those people was very therapeutic.

I truly believe that everyone can make a difference in this world, and the decision is up to them as to whether they want to do it and in what capacity they will. Not to say that everyone will find a cure to cancer or establish world peace. Rather, that we are capable of doing great things - whether big or small. It's just nice to see that people are doing great things in this world. In a wonderfully strange way, it gives me a glimpse of the light at the end of this tunnel of medical/public health school.

larger ramifications

i've been up to a lot of stuff lately, and none of it having to do with the academic side of being a medical student. rather, i'm trying to get involved and informed in the larger idea of what it means to be a medical student and a prospective medical professional. several things that i have done to sort of explore ways in which i can get involved:

* attended a talk by Sheri Fink, who wrote War Hospital. she graduated from stanford medical school but never did her residency and has since worked in Bosnia, Iraq, and Africa doing medical aid stuff. she talked about the difficulties of doing work abroad, which is salient for myself because of my upcoming trip to vietnam. one of the things that i found most fascinating was her discussion of our responsibilities there. not only as medical professionals, but as members of an international community. we represent out home country but we are guests in another. i think that is forgotten by a lot of physicians who think that they can go to some poor developing country and save a few lives and return to their nice suburban life, telling their neighbors and friends of the poor people that they helped. i don't know if i effectively got my point across, but you know.

* starting a student chapter of physicians for social responsibility with a friend in the public health program. when we were talking about what we wanted to do and what our goals for the club would be, it dawned on me that a lot of my classmates either couldn't care less and/or don't want to know more in order to care more. it's so surprising to me when i came to medical school to find that it was more conservative, more sheltered, and definitely more concerned with their own practice more than their own patients. i don't know if this is everyone's experience, but it has been mine. i'm sure that the people that i am thinking about when i say conservative, sheltered, and concerned with lawsuits and money think that there are too many wackos and lilberals in medical school.

i thought that there had been more things that i had done or attended that made me think of the larger idea of being a physician. oh well. i totally forgot them now. but yeah, i've had to question what i'm doing here in medical school. yeah, i'm getting a great education, supposedly getting smarter and learning, but really, what are my responsibilities after i finish and actually become a doctor?

one of the most memorable moments when it comes to my choice of a medical career was at a conference that i attended during college. then, i was working at a very small non-profit, doing women's health work. i was speaking to another advocate in the field and we were talking about public health and medical careers. i told her that i was considering getting a masters in public health in addition to a medical degree and i asked her if it was worth it getting a medical degree if i will just do public health work. what she said to me, which i will never forget, was "though i hate to admit it, the 'MD' after your name gives you a lot of respect and esteem among people. yeah, you may not actually be talking about medicine, but if they see those two letters, you're automatically 'in.'" it's amazing how titles and degrees, though you may not use the knowledge gained from them, get you places in the world. i'd hate to admit it or even concede to the possibility that i would "use" my medical degree in order to have an "in" with someone, but that's the world we live in. especially in politics, a field that i'm very interested in, that seems to be even more applicable.

so maybe i'm idealistic and optimistic (two charges of which i freely admit i am guilty). does that mean that i'm naive? no way. though i think i will change the world, i am happy with the thought that though it's unlikely i will change the world, it's highly likely that i will change someone's life. i just need to reminded of my idealism every once in awhile, especially where my day-to-day life consists of anatomy textbooks and physiology lectures.

hmm

it's an interesting weekend. pats just won the super bowl. i studied ALL weekend. really, i did. i studied at least 8 hours today and for 8 hours yesterday. i guess this is what i signed up for when i wanted to be a medical student, but boy, it's more than i expected. also, i hope to do very well in anatomy, so we'll see what happens.

i don't know what to comment on for now, as there's not a lot going on. oh, bird flu. so, i'm planning on going to vietnam this summer as part of my public health degree. i'm very very very excited, as i was supposed to go last year but cancelled my plans because of SARS. however, this year, this damn bird flu shows up. bird flu? will i cancel my plans because of bird flu? nope. i refuse to. i've waited long enough to go to vietnam. though i did doubt this decision after i learned that a 23 year old female recently died because of bird flu. that scares me, but obviously not enough. am i crazy? maybe so, but not for just this reason (for the fact that i know the california state fossil, maybe).

sorry, that was a rather boring post. sorry to waste your time. i take input on what to post on. i have opinions, i swear. i'm just kind of brain dead right now. all i know is anatomy. i know that the common extensor tendon of the forearm originates at the lateral epicondyle of the humerus while the common flexor tendon of the forearm originates at the medial epicondyle of the humerus. does this make any sense to you? if so, you need a life. i've already signed mine away, so escape while you can.

everything's brown!

so, after the snow settles, people start stepping in it, and it gets brown and mucky. quite disappointing if you ask me, but i'm sure you're not asking me.

finals are coming up and i'm freaking out. i need to pass all my classes (duh!), but i want to honor one of them. we'll see if i can do it. we'll see how much sleep i'm willing to sacrifice to do it. i haven't been getting a lot of sleep lately, and i think that it shows. what i want for christmas: sleep.

for my public health program, we had a holiday gathering today and collected toys from people. it was nice, as we got lots of toys and people mingled. being public health is fun because you're with a lot of like-minded people who want to make a good difference in this world. you'd be surprised at how many people in med school don't... well, to be more correct, who aren't interested in the larger aspects of healthcare and disparities and such. and you'd also be surprised at how many republicans there are in this place! i mean, if you're a republican at 21, i don't want to even see what will happen in another 21 years.

well, enough about that. off to watch tv and try and accomplish some work (though you'd think that's impossible, i beg to differ).

so, i went to a residency forum today at Harvard Medical School. first, HMS is an awesome campus. everything's grand looking and all marble. tufts looks like a pile of crap compared to it. ah, but i still love my school.

so, to relay the real story. i was asking a residency program director about health policy opportunities in the residency programs at his hospital and in internal medicine / primary care residencies in general. he said not to worry about this unless "you plan on becoming head of the WHO and getting rid of worldwide malaria." i didn't say anything to him then, but i immediately thought, "well, yes, i do plan on becoming head of the WHO and getting rid of worldwide malaria." though i admit that i am wildly optimistic (my favorite phrase to describe myself right now), i will not say i'm naive...just because i say that i will do all this stuff doesn't mean that i will do it. it merely means that i have the possibility of doing it. i mean, when i heard that the head of the WHO was stepping down and they were looking for a new director, i looked at the biography of the outgoing director and wondered how i'm doing in comparison to her. is that weird? i've also done the same for surgeon generals, heads of state public health departments, people in the news, kofi annan, etc. i say that i know i'm a true nerd when kofi annan is my hero.

but the residency program director's comment reflects a certain societal expectation that as you grow older, your expectations of the world and of yourself become more "realistic." i guess no one in those high positions starts out thinking that they will be where they are X number of years down the line, but i mean, there's gotta be some thought of a possibility in their head. i'm just accepting the idea of that possibility. will i be disappointed if i don't save the world? no, because i know that i will have tried as hard as i could to become whatever i want to become and in that path, i have changed the world. even making a mark in the world, whether it's developing some trivial piece of policy or helping someone overcome childhood cancer is worth the ride. the "unrealistic expectation" of becoming an answer on jeopardy (one of my goals in life) by becoming some grand figure is helpful to me because i know that even if i don't become that person, that i will have enjoyed the journey and that i have tried my hardest to get there.

maybe this attitude comes from the fact that my parents made the "american dream" a realization by owning their own business and becoming part of the middle class. maybe it came from the fact that i believe there's still room for change in this world. but mostly, i think it's from a deep-seeded feeling that everyone is doing something for a purpose. i never felt like i was going into medicine because i wanted to make lots of money and earn a lot of prestige. i went into it because i knew that's what i enjoyed and that was one way in which i could make a real difference. my purpose is to serve others, as a physician and as a person. though that's hard to keep track of while i'm writing papers and studying biochem, it's still in the back of my head when i ask myself "why?"