If there were a 100 people on earth...

A very cool project that echos my sentiment in the note I wrote earlier "When It Rains on the World...", courtesy of Dave:

http://www.youtube.com/watch?v=rvTFKpIaQhM

As the holiday season approaches, appreciate the gifts you've been given, and please remember the less fortunate around you and around the world. You can imagine how difficult it would be when everyone celebrates and feasts while you are starved and dying.

Appreciate what you have, and do your best for a better world

Dont let murderers get away! Take action on Burma NOW!

Back in 1988, the Burmese military junta massacred 3,000 demonstraters. Since then, they have nullifed a landslide victory that elected Aung San Suu Kyi to the head of a demoncratic gov\'t and have continued to jail/kill activists. Burma is ranked 164 out of 168 countries in the Reporters without Borders ranking of freedom of press.

Back in 1988, Burma was not in the world\'s eye. We didn\'t have the internet and global communication of today see into that troubled nation. The government was not under as much scrutiny, and they got away with it.

This is a different time. Now, the Monks\' Resistance in Burma is getting coverage from NYT, MSNBC, and Time Magazine. Now is the time to tell the military junta that the world is watching and will not tolerate such repression. NOW IS THE TIME TO ACT.

Click on the links below and sign online petitions to pressure international leaders to take action about the situation in Burma (it’s fast and easy).



Online Petition to President Bush- Amnesty International

http://takeaction.amnestyusa.org/c.jhKPIXPCIoE/b.2590179/k.C43E/Take_Action_Online/siteapps/advocacy/ActionItem.aspx?c=jhKPIXPCIoE&b=2590179&aid=9315

Online Petition to UN Secretary General Ban Ki-Moon- US Campaign for Burma

http://www.democracyinaction.org/dia/organizationsORG/uscampaignforburma/campaign.jsp?campaign_KEY=5521

Online Petition to Chinese President Hu Jintao- US Campaign for Burma

http://www.democracyinaction.org/dia/organizations/uscampaignforburma/petition.jsp?petition_KEY=730&t=HomePage.dwt

When It Rains on the World...

The world is not about us.
The world is not about how awesome we will be as doctors, not about how many Nobel prizes we will win, not about when we will be chief of surgery.
The world is not about how we need a new dress for the next party, not about how we need new shoes to go with that new dress, not about how baller our cars are.
The world is not about how we need our nails done or we won't feel confident, not about how many uninspiring activities we can rack up on our resume, not about how we can best manipulate the system or other people.
The world is not about getting the biggest house and two cars for our family, not about making sure our kids are smarter than everyone else's, not about living the unsustainable American dream.
The world is not about us, because we don't need help.
The world is about them.
The world is about children who never live past 5 years old, about how they can never dream of going to school, about how they will never have a chance to win that Nobel prize because their potential cannot be realized without education.
The world is about poor people who wear one dress all their lives, about how they can never take a proper shower because they can never take off that one dress and wash it, about how they die because hospitals are too far to walk to.
The world is about how they can benefit so much from the same amount of money we spend on a can of coke, about how they don't eat so their kids can go to school, about how they will never live the unsustainable American dream.
The world is about them, because they are the world, and the world needs help.

We all do it - we all have ambitions, we all need when we merely want, we all pretend, we all search for the best for ourselves and people *we* love.

And where are we heading with that mentality?

In a few years, some of us will drown because there is simply not enough land to stand on. Even the richest cannot escape from poverty, because rich people do die from HIV, the virus that jumps over to humans because people are too poor to eat real meat, so they eat infected chimps instead.

When it rains on the world, it rains on all of us equally, without discrimination.

So if we don't help them, we're not helping the world, and we're not helping ourselves.

Feel free to disagree or argue, but I hope you will consider the possibility that this might be true.

The Craziness that is India

After months of roughin' it and no internet in the middle of India (which you can call nowhere), I now have internet for almost 6 full days! There is so much I can say/tell you about India, but all I will say is below:

1. I saw scrotums the size of basketballs every 2 days. Once we accumulate quite a few, the surgeon comes to pop the enlarged scrotums because they are filled with fluids - it's like popping water balloons. If you squish too hard the people around the surgery table get splashed, just like Songkran.

2. There's a place called Osho, where people pay to meditate in a lavish garden, walled off and smacked right in the middle of raging poverty. An entry requirement, apart from the fact that you have to pay up, is an HIV test. You will have sex either because you come to Osho to do so or because they will seduce you. I was gonna peer in for some free porn but then I remembered I didn't want free porn =|

3. I saw this 70 year old lady with cellulitis so bad they cut all the skin around her right arm off - her arm now looks like that of the mummy when he's killed almost enough human beings to be flesh-filled once again. All you see is red muscles and their tendons underneath - no skin, no fascia, and that's gotta hurt like a mother (love you Mom =D). I don't know how she's still alive with that humongous wound and that age of hers, but I'm glad she is.

4. When I was in a taxi in Bombay, a boy was running on the sidewalk to fly his kite and he fell into a sewage hole because there's no lid on it. I saw him fall and disappear into the hole while the other kids just looked on like they didn't even see it. For a while I thought I was hallucinating, although I probably wouldn't hallucinate something so horrible. By the time I realized what had happened I could no longer see or remember which hole he fell into, since every other hole had no lids either. I hope he's ok.

Tell me that's not crazy.

What do you do when you're going to India?

I'm going to India this summer - to work and in no way for vacation. I'm going to a city called Jamkhed - it's in the middle of nowhere (and I'm not exaggerating - the closest civilization is 6 hours away and it's not even that civilized of a civilization). To put it in perspective, Bombay, which is one of the most important cities in India (I'm sure you alll have heard of it) is 8 hours away by car. To be fair, there is running water, and phone line, and internet through the phoneline (very old school), and electricity, but not much else, and electricity is often out. There's a lot of cattle though, and they paint the cows since the people worship them. Should be interesting.

Of course, I like civilizations like most people. I like clean, or maybe even luxurious, beautiful hotel rooms. I like clean sheets. I like not having to deal with mosquitos (this area of India is infested with the Anopheles mosquitos that carry the protozoa Plasmodium falciparum, the most dangerous and drug resistant strain of all the Malaria protozoas). I like not having to wonder every time whether there will be parasites in my drinking water, or even my shower water (if you bathe yourself in water infested with the right kind of parasites called Schistosomes, you can get liver fibrosis which will require you to get a liver transplant - big, big deal and not fun for you). I like having a/c to run to when it's unbearably hot. And I know I won't like my living conditions for the months to come. I've done roughin' it things when I was little (sleeping in tents, bucket shower, or sometimes no shower at all - I do shower every day now though =P) and I think I'm too old for that now...but roughin' it is hopefully a small price to pay for what I will do in Jamkhed.

Check out what I will be doing at http://jamkhed.org/fundraiser.htm - I'm learning how to create a sustainable healthcare model and will investigate the effects of this program on the rates of TB in villages in the Jamkhed area. I will be living with the family who started this wonderful program and hospital from scratch - and they will cook me Indian food everyday! I will be eating on the floor with my hands, restrained from using spoon and fork like I was hoping to (I wanted to bring my own spoon and fork, but that will be disrespectful =) I will go around with village health workers, watching people take their INH, maybe scrub in on some cool surgeries, and maybe observe delivery the old school way. Read the donation page and contribute if you'd like - this is a good cause but it is not yet significant to me since I have not seen it first hand. I will not ask you to donate since I know favors are limited and I'll only ask if I really need to, but if you like what you read, it might be nice to help them out, since the doctors at Jamkhed like comfort and civilization as much as we do, but they choose to abandon it for the betterment of the world. If you can't get your hands dirty (literally), donating is something you can do =)

A blurb from the website about an experience of a village health worker who's part of Jamkhed:

In a huge conference hall in Washington DC, over a thousand participants listen with rapt attention to Muktabai Pol, a village health worker from Jamkhed, India. The listeners include officials from WHO and UNICEF, ministers of health, health professionals and representatives of universities from many parts of the world. Muktabai shares her experience of providing primary health care in a remote Indian village. She concludes her speech by pointing to the glittering lights in the hall. “This is a beautiful hall, and the shining chandeliers are a treat to watch,” she says. “One has to travel thousands of miles to come to see their beauty. The doctors are like these chandeliers, beautiful and exquisite, but expensive and inaccessible.” She then pulls out two wick lamps from her purse. She lights one.

“This lamp is inexpensive and simple, but unlike the chandeliers, it can transfer its light to another lamp.” She lights the other wick lamp with the first. Holding up both lamps in her outstretched hands, she says, “I am like this lamp, lighting the lamp of better health. Workers like me can light another and another and thus encircle the whole earth. This is Health for All.” The audience rises to its feet in a standing ovation.

'nuff said =)

The book and its cover

Today I saw a 38yo female patient at the liver clinic. All I know before I met her for the first time is that she has autoimmune liver disease (Anti SM Ab), was on Prednisone but had many complications with the medicine that required her to stop the treatment. The doctor mentioned that she cared a lot about her appearance which made her reluctant to start treatment to begin with, and now that the side effects are full blown in her unfortunate case, she decided to disown medicine for the time being, maybe forever.

We called her name in the lobby and I saw a beautiful lady slowly rising from her chair, with a confident yet in a way contemptuous smile on her face. She was well dressed, with a bandana on her head and many other accessories, like an anklet, rings, bracelets - the list goes on, she has jewelry anywhere you can modestly/femininely have one without looking like a goth.

She sat down and she was very upset with the liver doctors. She did not have any liver symptoms apart from mildly elevated liver enzymes before the treatment, but after the treatment she has alopecia and neutropenia that led to her cellulitis and vulva ulcer, causing her to be unable to walk and admitted to the hospital for infection treatment. In a way she blamed the liver doctors for convincing her to get treatment. In her words, she felt that the doctors was trying the medicine on her normally functioning body and damaged it - now her body and her life is ruined.

In the doctors' defense, they were simply following protocol. One out of ten patients will have side effects as bad as this lady does - it's simply random and unfortunate, and there's no way to tell in advance before the treatment is administered. In the long run, without treatment she will succumb to liver cirrhosis requiring transplant, and that is a much bigger deal than alopecia or minor infections. However, one can argue that lifelong alopecia can be worse than one transplant or even death, and this seems to be the case with this lady who cares immensely about her appearance.

In my head I tried to understand that for some people, beauty and maybe dignity that comes with it is more important than life itself - people just have different preferences and I'm in no place to judge, but as hard as we try not to, doctors, or human beings for that matter, do judge. For example, a baby had an inborn-error liver disease and after many surgeries to no avail, she needs a transplant to save her life. However, her mother will not let her go through it. The doctors were very upset but there's nothing anyone can say to change the mother's mind. The doctors suspected that because the baby looked normal (with some jaundice), the mother does not see how quickly death is coming to claim her baby, or maybe she's simply afraid of the procedures. I don't know the reasons, but I understand that sometimes people simply want to die with some dignity. I'm not upset with the mother and I don't judge her - I just simply don't know what to say. Maybe the mother knows best what is best for her baby, but is she entitled to taking away her baby's fighting chance at life? The baby can't speak for herself - what if she wants to fight?

(Back to the pretty lady) From a scientific or economic efficiency point of view, life with side effects is better than no life at all. When you consider life in agony or indignified states like brain death, alopecia and infections seem a small price to pay. As doctors we want the best for our patients, or what we think is the best, and when patients choose not to listen to us, we cover our eyes in sorrow because we know what will happen to them and we don't want to watch.Once it happens, there may be nothing doctors can do at that point, and any regret won't turn back time or change the outcomes of their choices. Death rarely gives you a second chance.

I didn't have to struggle for long. When the doctors came in, the lady let out her anger and frustration. She did not break down and cry - there were no streams of tears - only big, heavy drops falling quickly to her clothes, like she's trying her best to hold it in with her dignity but it is simply overcome by what she suffered. She said she lost her job because she's a hostess, and a hostess simply needs hair to be hired. Every time she brushes her hair and a bunch fell to the ground, her son was frightened. She tried to convince him that the hair will come back, when she herself doesn't know for sure it will, and her son was not convinced, maybe because she did not believe it will to begin with. She said that without her son she wouldn't care so much about her hair, but now that he's freaked out and she can no longer support the family financially, the treatment is not acceptable. The economic efficiency argument above now falls to pieces, and what you thought was an easy choice is not always clear cut. Remember not to judge anyone but yourself.

Poor lady.

Has nothing to do with anyone

If you will forget most of the things you learn in school and most of the knowledge you will retain through life comes from on-the-job training, then what is the point of trying to remember what you learn from class in order to do well on exams in a pass/fail system? If you think that's such a stupid question, then give me a convincing argument of why I should study for an exam when classes are pass/fail. True, remembering will help me become a better doctor, but there's no way to retain any detail of what you learn in medical school (it's simply not possible for a human brain to retain all these details when new information is poured in every day to replace them). As a result, the only thing you can take from medical school is the fact that you have learned everything once and learning it the second time for your future job will be faster. Humor me, and believe for the sake of the argument that the above observation is true, then is there a point to studying for medical school exams when they are pass/fail?

Since I'm inclining towards no, the above paragraph is simply a result of procrasination and disbelief in studying for exams. Have you ever crammed your head with so much information that you want to dump it somewhere and move on with life? Well, you really can't because you need to know these things for your job but you will, since there is not enough space in our brains. So WHAT is the point?

The answer is there is NONE!

You're in a room with Hitler, Mussolini and a lawyer. You have a gun with two bullets. Who do you shoot?

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The lawyer...TWICE!