The GTF - Over - Yourself - Puppet

Ever have those days when you feel like patting yourself on the back for things like doing the dishes? Or your past accomplishments seem good enough?  Your ego is swelled, and your trophies are what keeps your chin up?

Well then, have I got the thing for you!

You, my friend, need to go out and make yourself a GTF-Over-Yourself-Puppet.

Step 1: Find a pillow, a duffel bag or whatever.
Step 2: Decorate is with your A papers, your medals, your trophies, and whatever else that makes your nose stick up (a picture of yourself might be a good idea if you've ever found yourself buying yourself a drink).
Step 3: Play a ridiculously awesome 80s song.
Step 4: Jump over your puppet over and over until you've worked up a sweat.

Congratulations.  You have successfully gotten over yourself and are ready to get back to work.

This is what I do on those days when things don't feel like they're working out, when things just aren't going MY way, and when I feel down because maybe it's been a while since I've received a gold star.  This is what I do when I feel myself plateau and when I feel flat.  This is what I do when my own thoughts are so annoying with praise for so-called "good deeds."

I mean seriously, these are the days when I desperately need my mantra to be, "Get over yourself, and remember you're really a total dork...and don't you forget it!"

The trend is common in medical students.  We get smarter, we think we should get some kind of praise, we start to look down on others who might not be as smart, and we can lose perspective.  We can become comfortable with our state of knowledge.  We can think, "Well I did well on that one thing that one time, so I'm great and there's no reason to improve."

Ever have those days when you start treating others, maybe even patients, a little differently because you've accomplished something or won something? You get a little smug? Your identity is now linked to a medal?

You need to GTF over yourself.

And here's why.  Sure, you should be proud of your accomplishments. What you did is important, and hard effort deserves some acknowledgement, but when we link our identities to accomplishments, we're setting ourselves up for failure.  What if you didn't have the trophy? Are you still better than your neighbor? Does that prize you won make you a better human being? Really?  I don't think so.

Incentives for striving to do our best are great to motivate us into producing product, but it comes at a price if we don't keep ourselves and our motives in check.

Remember the scene from Titanic when the passenger could no longer buy a seat on the lifeboat? Money didn't matter anymore just like our silly papers and awards don't actually mean anything.  When you die, your accomplishments don't go with you.

All you can strive for is to leave a legacy that has made the world a better place.

Your trophies? Who cares? Your medals? Will they save you against a tiger in the jungle? Nope.
You know what does though: character, hard work, and commitment to making the world and our communities better (note: I probably exaggerated; I'm not really sure if these things will actually save you from a tiger).

Regardless, your spirit is what touches people, moves people, and has the ability to change people.  Trophies, awards and empty compliments don't move anyone.

Incentives might catalyze action and cause motivation, but it's empty if the incentive comes without purpose.

So today, if you're looking for credit, a pat on the back, get out the GTF-Over-Yourself-Puppet, start making a fool of yourself and get out and serve somebody.

DISCLAIMER: The only reason I know so much about this topic is because I need it.  I think I was born with an extra gene for arrogance, so I have to practice this technique.  I'm not claiming to be some saint of humility.  I'm just a human who sometimes just needs to find creative ways to stay humble.

P.S. Please feel free to leave your own GTF Over Yourself songs in the comment section below!  Maybe we can make a GTF over yourself soundtrack...stay tuned...

Shit works

It's moments like right now when I get really excited.  

I'm working on my routine work for my favorite class: complex emergencies and forced migration, and this video is assigned.

Simultaneously, I'm attempting to put together an IRB protocol for a trip to India this winter that addresses child malnutrition through a women's empowerment program.

The overall theme here is:

Step 1.) Focus on women

Step 2.) Solve problems

As my favorite OMM professor said to a doubtful group of students, "Shit works."  Then the crack was heard 'round the world.

(Shout out to PCOM Class of 2014 who helped raise over $1000 for CARE in the Live Below the Line Campaign in 2011.)

Where the girls at?

I had the privilege of going to one of those important doctor conferences last weekend in sunny SoCal. It was honestly a fantastic experience in many more ways than I expected it to be.

Although, I still have some lingering unfinished business with the said conference, and it starts with answering the question, "Where the girls at?"  Seriously, I walked into the opening plenary and 5/5 leadership positions are white men?

Research conference winners are 7/8 male students?

What year is this again?

I'm not saying I know the exact reasons for this occurring; however, a recent study out from Yale did just find that gender bias is occurring even in academic science, possibly explaining the lack of women rewarded for their research efforts.  But there are other reasons of course.  There are the choices women make and the same old excuses always made for the unbalanced scales in leadership. But, as Anne-Marie Slaughter points out in "Why Women Still Can't Have It All," the rules and culture need to be changed so women actually have a chance and are not forced to make the decisions most men simply don't.

I'm sure there are many more reasons, but the reasons don't matter as much as the lack of action taken to rectify the situation and the poor outcomes resulting from the shortcomings.  Less women means less female perspectives.  It means the balance in an organization is tipped.  It means nothing becomes easier for young professional women in the future because there are less women role models to look up to.  It means there are less women role models for even younger girls who aim to be doctors, or spokeswomen or whatever profession they aim.  It means the decisions world leaders are making lack female perspective, and I think history shows us what the world looks like when it is only run by men.  Grim is an understatement.

Granted, I was honored in more ways than one this weekend.  Our team's project may actually make a difference, which is the aim (I think) of all research.  Our goal is to stretch the status quo, and I think we may have planted a few seeds which is really all we can ask for, for now.

We dressed up, presented, put on the professional game face and delivered. We were poised, and we really did have it going on.

Regardless, there's still something lacking.  One can't help but feel a little bit like she intruded on a secret society of men... with their boy jokes and their male bonding. I won't mention egos because I know I have one too...but still... where the girls at?

There's something to be said about small talk when networking.  In Eastern countries, when you sit down to do work, you have tea, ask about the family and maybe a half an hour in, you start to discuss the project at hand.  In the US, small talk is said to be important.  I have to say, I think I'm damn well decent at small talk with women.  But with boys? Epic fail.  No, I don't play golf.   Football? Too many rules. No, I don't even watch sports...besides ice skating of course.

To be frank, I think I got stuck in that awkward adolescent stage, and I still stumble over my small talk with middle aged men.  This is inconvenient because they tend to be the majority at these kinds of conferences.  The result is that I'll talk only about the work because I have nothing else to relate to.  Unfortunately, women who are in the same position are accused of being abrasive, cold and dare I say, bitchy.  It's a catch 22 really.

Now, I'm sure I did fine. I put on the face and laughed at the jolly old jokes.  Luckily, I also had some good company too in order to bear the weight of my awkwardness, and my cynic hat really didn't come on until the way home.  Additionally, I am extremely grateful for the female trailblazers already in the field and will be sure to keep them close.

But, it is good to be home,  to take off the game face, indulge in the fall, and figuratively (I wish literally) play in the dirt and hang out with the worms as today became a baking/puzzle/reading day.

I know I will love the profession I have chosen once I'm actually in the field and talking to patients.  Until then, I feel like a large component of being a female in this profession requires having the game face on at all times, regardless of how draining it can become, and playing the game to get along in the boys' club.

To fix, to heal, to love

A tough lesson to learn for the medical student with the hero complex: to heal is not the equivalent to fixing as only one of them truly requires love.

They don't teach about this silly "love" concept in medical school.  As a matter of fact, it's a concept that is easily put out of the mind as the tables and graphs compile into a heaping mound of ways to fix.  We have choices as we go through this large pile of evidence.  We can fix at point A or B or C, never mind if the patient wants it.  I have followed the guidelines, I am fixing, no lawsuit for me!

It is easy to become fixated on the fixing.  It is what we learn how to do in medical school; unfortunately, the art of healing is often forgotten and left to a student's own pursuits and drive during and beyond their formal education.   It's selfish really.  It can become a sense of control for us.  We must be the saviors of the world! If not us, who?  It is narcissistic even.  We are the martyrs of the world giving up our young lives to pursue saving lives.

And how dare you sick patient for not accepting the fixing I am practicing on you! Don't you know how lucky you are to be blessed with such an educated being able to fix you?

Sounds real loving, right?

I learned this lesson deeply this past weekend.  Sometimes the most loving and the most selfless act might be to let go and not intervene because in order for healing to truly occur, patients must choose it.  So often we forget that healing is a choice.  The physician can open the door, but opening the door is the majority of our role in the healing process.  Ultimately, it us up to the  patient to walk through it when they are ready.  Until then, we must wait and relinquish our neurotic compulsion to control the world.  We must let the love and healing start within the patient, for only when one learns to love oneself, can she find herself worth getting up and walking through the door.

Only then, and only when they feel moved to do so, will they walk through, and then we must be waiting on the other side with open arms, without judgement, and without the question, "What took you so long?"

The truth is everyone has their time, and it is devastating to know that some people are self-destructing when the door is open right in front of them.  We can sell the attractiveness of what awaits patients on the other side until we are blue in the face, but we also have to understand that what lies on the other side can be scarier than death to patients. It is the unknown; it is anything but the status quo.  And even though the status quo might be deadly, it also might be comfortable.  It is a form of disingenuous identity they have adopted, but it is theirs, and it is only theirs to change.

This is the hardest thing to do as a friend, a medical student and as a daughter: to let go and relinquish control, to love without the compulsion to fix, and to wait for the healing to begin from the inside.  We know the risks.  We know what can happen when people hit rock bottom, but sometimes it's that rock bottom that propels people to move through the door.  We have to be patient.  I have to be patient.  To love without fixing in order for healing is one of the hardest lessons I'm learning, and I only pray that the work done on the inside to get my loved ones and future patients onto the other side happens before rock bottom becomes a death sentence.

Justice is Health

As a doctor in training, we often hear “horror stories” of the patient or patient’s loved one, who goes a little off the deep end when they receive an unfortunate diagnosis or a fatal prognosis.  It’s a defense mechanism.  It’s the patient’s way of trying to comprehend, “Why me?”  They urgently seek an etiologic agent and subsequently try to bring it to justice.  “It must have been that thing I ate that day when we ate at that picnic 7 months ago...it must be because the government poisoned the air in my neighborhood...I just read a study linking lightbulbs to my condition!”  Absurd as some of this sounds, when anyone tries to answer the question, “ Why me?” we all come up with an amusing at times, but limitless array of answers.

However, as physicians we know that definitively pointing at a cause for a disease is nearly impossible and takes years of study. (For instance,  it took decades to definitively link smoking to lung cancer.)  Therefore, for the majority of suffering seen in the clinical setting, there is not one guilty culprit that we can lock up and ensure never causes harm again.  On the contrary, there are usually many suspects, and sometimes these suspects even intersect on their path to causing disease.  While this makes epidemiology pretty interesting (for epidemiologists), it is frustrating for patients.  Similarly, in the court system, trials are long, and any suspect which leaves reasonable doubt of guilt is acquitted.   While the suspect may be watched more closely, the victim cannot be prescribed an intervention to simply eliminate it.

This poses a problem for patients and all providers.  This means illness is not just; by definition, it is not fair.  Justice, or the concept of fairness, is what patients seek out though.  They immediately ask themselves, “Why me?” “What did I do to cause this?” Numerous cultures blame disease on other factors that do not fit into the Western bio-medical model.  Health is sometimes defined by you and your family’s good fortune and social status while disease might be caused because you dishonored your god or family.  They link disease to a specific cause, and they explain symptoms as something you might deserve. They seek a way to explain it and make it fair.  While we in the U.S. might not agree, what stands true is that across all cultures, we instinctively strive to pin down the cause of disease because we desperately want it to be fair. We want to lock the culprit away or at least prevent any reason for a disease-causing agent to get us.  Furthermore,when both patients and providers feel  justice is unobtainable, we can become anxious, depressed, angry, isolated, and suicidal.  

Alternatively, I have also seen the lack of fairness surface as symptoms just as I have seen symptoms manifest in a quest for justice.  I saw it in court when I was 12.  One of my family members suffered GI symptoms, headaches, lack of sleep and anxiety when things were just not fair and out of her control.

I wanted to understand this, and maybe that experience propelled me into attempting to understand social justice and its effects on health.

Why do some places get Tb, HIV, and cholera, while other places do not?  Why do poor people get certain diseases, and rich people simply don’t?  Why in the U.S. are some areas healthy and some not?  What unfairness happened to this person that made their health so poor?  

Granted, I understand there is personal responsibility involved in health, but that goes for people with the education, resources and belief system that certain behaviors do in fact increase your health and prevent disease.  Most importantly, people who take personal responsibility for their own health know they are worthy of good health in the first place and know they are capable of leading healthy lives.  For those that do not lead healthy lifestyles, poor education, lack of resources, poor self-efficacy and lack of feeling worthy all contribute to poor outcomes.  Lack of resources and poor education is what we can control to a large extent at a population level, where self-efficacy and self-worth can be targeted at an individual level. Either way, isn’t it just unfair that someone might not know about clean water and have access to it, and is subsequently why they are exposed to cholera? Isn’t it just as unfair that an adolescent might not have anyone to reinforce their self-worth and teach them healthy habits so that they might learn to lead healthy and happy lives?  It is this basic unfairness leading to poor health that sets me off.

To summarize, social justice determines health outcomes on a population level, and fairness at an individual level heavily influences the health of that individual.

At the Survivors of Torture and Trauma Project, a project of a refugee resettlement agency I am currently interning at, I see this everyday. For example, both mental and physical health symptoms are not alleviated until a rapist is put to justice.  For my clients, symptoms will not go away until they fully realize asylum, and they feel safe from the treacherous circumstances of which they fled.  Sometimes asylum is granted, and an ounce of fairness is reached, although it really does little to compensate for the trauma endured.  However, healing must progress otherwise, despite the lack of fairness.  In some cases, clients can at least find refuge, a place where healing can start while true justice might never be achieved.

Today I went to court again - flashback from half my life ago.  I was sitting as the case manager with my client’s three adolescent girls.  I could see it.  The mother’s testimony through the interpreter, the roundabout questioning common for those fluent in the legal system and foreign to me. 

In medicine, if I want to know something, I look it up or I simply ask what I want to know from a patient.  In the courtroom, if you want to know something from a respondent, apparently, the “best” way is to fire twenty questions that kinda not really narrow in on what you want the person to say, and if they don’t say exactly what you want to hear, well...we will see what happens when the verdict is made.

Confusion, unfairness, trauma, tears.  No one should have to see the strongest person you know, your hero, your mother, go through that.  It’s not fair.  It’s not fair to the mother,  and it’s not fair to the daughters, but it happened today.

As future physicians, we encounter injustice everyday, and we must fight it.

How do you fight injustice? You advocate. 

Because reaching justice by finding criminals and removing them alleviates symptoms and disease, whether it be the pneumonia causing bacterium, poverty (an etiologic cause of numerous ailments), or a trauma- causing suspect. You advocate for disease causing agents' removal so that they cannot cause more harm and damage. 

However, while we must advocate, we also must strive to heal despite lingering injustice.

For those whom injustice has already violated, we need to build that patient or population up stronger and help them develop their own resilience so they can find their own justice within themselves and begin to heal.

World Malaria Day!

Progress...

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...I think we can do better

Why do we need that overseas aid anyway?

5 Ways YOU Can Help Fight the Disease

Finals Anthem

...started making a checklist but it got too long...so please enjoy my 

abstractfinaltermpaperfinalpresentation anthem while I figure it out...

it's good to be a 90's kid

Fundraising Friday!

I'm passing the message on from Emily Stanley, Program Director or Edge of Seven, from Heather Mansfield, "the blogger/entrepreneur of Non-profit Tech 2.0."

Heather has committed to donating to one of her favorite causes each Friday in 2012.  You can check out her blog here, and if you decide to donate on a Friday, comment and share your story!

I decided to add 10$ to the fund today to get things rolling, and if you decide to donate to the Phoenix Fund, click here and in the comment section give a shout-out to Fundraising Friday!

The Biggest Obstacle

"Vicki, your biggest obstacle is going to be convincing people you're not crazy and that you actually know what you're talking about," Dr. A, my adviser in life, medicine and career (I guess that's just about everyhing, huh?).

Me: "I know"

The World with a Bright Future

'Nuff said...

As Yuwa Concludes, the Phoenix Fund is Born

This is the final part of my reflection from my time with Yuwa.  This organization reinvigorated my convictions and reminded me of how much a difference one individual can truly make.  Not to mention, the stories of the girls are what inspired this fund and blog.  After reading, please feel free to contact me if you'd like to get involved.  


This week, I dove straight into Yuwa's daily operations and attempted to figure out how exactly this tiny organization has been able to galvanize the community into lifting up the status of girls.  Obviously, the process of transforming the girls' situation has not been an  easy feat, and at times has seemed like an uphill battle met with resistance from brick wall after brick wall.  Even to this day with a national superstar coming from Yuwa and the successes they have had,  moving things along and making progress is still met with obstacles. Changing the culture to truly appreciate girls' potential and capabilities is not as easy as having one accomplishment known by the country; on the contrary, it is met with reluctance to change and opposition at the grassroots level. This was evident on Monday when I went with Franz to practice at 5:30 in the morning in Satu village: the problem village.  The brothers of the girls have a long history of harassing the girls and trying to kick them off the football field. Apparently, the boys are jealous and use intimidation tactics often.  While we had been at TATA during the weekend, a few  of the boys destroyed footballs and threatened the girls at practice.  These threats are common and represent the ongoing struggle for establishing gender equality in the community and for creating the understanding that girls are just as capable and hold equal value as boys.

Although dealing with the daily obstacles can seem draining, the successes seen in other pockets of the community shined through at each practice, each English class in the morning and through small increments of increasing confidence that rippled throughout the community and created change.

An example of this occurred when, Quinn, the English teacher volunteer, and I taught English in the Salidri village. This was without a doubt the highlight of my week.  Leading up to it, Quinn had told me about a girl named Sita, who  longs to be a doctor.  Salidri is an amiable village, as the families have been supportive of the girls and let the children participate in English class before school or before morning chores.  Furthermore, the boys and girls tend to practice together harmoniously, and the kids I got to know were bright and motivated. 

Class took place in a small dusty "living room" where about fifteen kids crowded in and plopped on the floor; they all brought their donated notebooks and pencils they took overwhelming pride in. Quinn led the lesson with compassion and ease, and the kids were all eager to participate.  We decided to turn the second half of class into a Science/English class. I wasn't sure many of these kids had ever been to a doctor so I had decided to bring my stethoscope and ophthalmoscope to see their reaction. Just seeing these tools left the kids in awe.  We started the science portion by having all the kids take their pulse and then listen to each other’s heart and lungs.  I then asked them what sound the heart makes.  They all said simultaneously, “tuk-tuk, tuk-tuk”  with enthusiasm that echoed throughout the room.  It turns out, tuk-tuk translates to lub-dub, lub-dub in English.  I never realized heart sounds were different in other languages! After the stethoscope was put away, I feebly attempted to explain the accommodation reflex with the ophthalmoscope.  These kids are seriously bright! I showed them that as you shine the light on the right pupil, you can see the pupil shrink, and then after briefly taking the light away and replacing it,  you can see the left pupil match the right one.  They were fascinated.  They passed the ophthalmascope around and made each other's pupils change sizes, and as the information passed from one to another, everything was slowly translated into Hindi and I could see all of the children light up (literally) as they began to understand one by one. The last activity we did was to find the uvula! This was a great way to wrap up class as "AAAHhhhhs" reverberated against the mud walls.  The good news was that no one's was deviated.


Oh, and Sita’s eyes were just glistening.

The second day, we brought an atlas of the human body from the Yuwa house, and I had a couple of the kids try and read aloud the paragraph on the cell. It was challenging task - not only to read in English but to comprehend the biology - but with Quinn’s Hinglish skills combined with Sita’s understanding of the cell, the class (I think) began to understood the Golgi apparatus, mitochondria, nucleus, and Endoplasmic reticulum.  Knowing how our own bodies work is such an incredible tool, and it is so empowering.  It opens up numerous doors when you think about it.  It allows you to make educated decisions regarding how you want to treat your body when you’re both sick and healthy and about whether or not you will go to a healthcare provider or choose to suffer because of a belief in karma. This practice along with a general mistrust of healthcare providers occurs in the villages in India and in most of the developing world, so seeing Sita light up when she explained how something in the body worked was incredibly moving. I reminded her to study really really hard.  She just finished 10th grade (although she looks like she could be 12) and she now has college to go and then medical university.  I think it would be one of the most incredible things if she made it to becoming a physician. 

After finishing Poor Economics (Abijit Banerjee and Esther Duflo - highly recommended for anyone interested in fighting poverty),  and after staying at Yuwa for about a week, I was incredibly challenged to contemplate the traditional way 'aid' is given, development is carried out  and health interventions are created.  After racking these issues around my brain with regard to ethical and cost/impact considerations, I have been left, as any humanitarian,  in a complete mental bind.  Here's the thing about development and about figuring out the best way to help.  If you ever think you have figured it out or ever become comfortable with your methods, you're doing it wrong.  Development is a mind-(insert expletive 4 letter word of choice here). There are political and cultural sensitivity issues and serious ethical concerns to consider, and all MUST be considered even if one is merely trying to "help out."  The first rule of thumb is always, just like medicine, to do no harm.  You may think you're providing an education to girl, but maybe you're driving a family into further poverty by taking away an economic asset if you don't compensate the family for allowing the girl to be educated.  


But, there's a second rule of thumb that parallels medicine as well; it is the rule of beneficence, or doing good.  Just because the issue is complex and draining at times, it is not an excuse to do nothing.  


So with this mental bind for doing something but without doing harm came my idealistic and dreamy solution.

Here was my thinking process:


1.) There needs to be more girls.
2.) There needs to be more girls who know their worth and who know they have the untapped potential to be the most powerful person in the world.
3.)  These girls need higher education. This untapped potential needs to be plugged in! They need skills to reinvest back into their communities!
4.) A girl physician arising from a rural village in India or Nepal or anywhere might be one of the greatest assets for the community, for any developing country, and the entire world. 


Often, as westerners observe and judge the social injustices that prevail in developing countries, it is so easy to think of ways it could be better as we compare the situation to our privileged position.  It is easy to become obsessed with the idea of being the rescuer, of being the one to save the day.  But, because we really don’t and really can’t fully grasp the situation at hand, it would be absolutely incredible if someone from the community in need, could rise above and return to intervene and be a leader for their village or larger community.  (One of the most marvelous women who have done this is Somaly Mam, who is responsible for the rescue and advocacy of thousands of girls trafficked in Cambodia.  With the help and support of westerners, it has been able to grow into what it is today.)


Physicians on the other hand, are community leaders by nature of their profession.  Combining the fact that girls from the developing world invest back into their communities 90% of their earnings compared to boys who typically invest 30-40%, with the skills and knowledge physicians have at their disposal along with their respected role within communities has given rise to this idea.  A girl physician coming from regions like Salidri, Hutu, or the Lower Everst region of Nepal, that are typically isolated from traditional development aid might be the best tool the world has for fighting poverty.  This solution doesn't take westerners to come in and save the day, no credit will be given to us, but rather, it grants the opportunity to a girl to be her own community's hero.  Using the infrastructure already there, this girl can have the opportunity to receive all the credit.  Maybe this idea sounds implausible, idealistic and naive, as the odds are stacked up so highly against girls in the developing world, but I truly believe girl physicians who are motivated to make their communities better might be the best ally the humanitarian field could have.  This girl will be able to fully understand the complex nature of health problems in her community and be able to do something, to do the right thing, about them.  That girl will understand why the community makes decisions the way they do, how to change social norms and how to target the social determinants of health.  That girl can be an educator, role model and advocate for her own people.  

Hence, the Phoenix Fund was born. The details are still being worked out.  The idea is still a bit clumsy right now as I balance two degrees and in actuality, I really have no idea how to do this, but with the help and encouragement of the Leap Year Project, LittleWhiteCoats, and friends and family, it's starting to take shape. 

If this sounds like a good idea to you, or if you’d like to get involved, feel free to contact me at victoriala@pcom.edu or Donate here!

Football: Yuwa Part 2/3

Upon arriving, and on thirty minutes of sleep, I plopped my stuff down at the Yuwa HQ house, met a couple of the girls, and got to work in the fields planting ropa.  Ropa, while being a source of income and food, is also the noose choking the girls from opportunity.  To plant it, you basically have to remain at a ninety degree angle bent forward, and plant one seed at a time by hand for acres in straight lines.

The plots of land were outlined by narrow "walkways" of mud. I  reluctantly stepped heel-to-toe to the plot of land the girls were working on where I decided to leap in: into the 1-2 foot deep mud under the Indian sun.  I was so overtired. I had not had thirty seconds to come to grips with what I was doing or where I was.

My trip to Yuwa was pretty impromptu.  I had made the arrangements about three weeks prior while virtually unreachable in the mountains adjacent to Everest. I really had no idea what to expect, who Franz was, or what the organization was like.  I was just a floating semi-expat, who had wandered herself into a small village in the rice fields.  While that may have been the case, there was really nothing to think about. That's the beautiful part about traveling.  I was too tired to think, too tired at that point to care.  I just wanted to jump in the mud and start planting.  There was nothing really to think about - just do, just be.

My lines of rice were certainly not up to par, and the girls were pretty keen on letting me know.  They made planting rice almost look elegant, except that there's nothing elegant about it.  Throughout the week, I witnessed the girls not going to school to plant ropa five-six hours a day while their brothers headed to school, goofed off at school, and returned only to stop and stare at the girls planting.  Ropa, a forced and meager opportunity at livelihood, is just one of the obstacles the girls face.

That first afternoon though, I was informed we were heading out.  About twenty of the girls were given the rare opportunity to take an overnight field trip to the TATA steel football stadium for a match on Sunday. 

Getting twenty girls around in India is not an easy feat.  It begins with arranging about 4 rickshaws and multiple negotiations as to not get ripped off to head to the bus station.  Then there's the cautious bus ride.  Remember, Jharkhand is the state with the most girls trafficked in the country, and Franz is justifiably extremely protective over the girls. 

During the bus ride, Bollywood videos blasted, my hair was braided multiple times, I dozed in and out of sleep, and I had told half the girls that I was indeed not married...only ten more girls to go, I assured myself.

The weekend was similar to a sleep-away camp....except Indian style of course. The girls were restless and excited for the match the following day, they took turns borrowing my camera to take their pictures, and I finally finished letting everyone know I was not married. 

The next morning was game day.  The field was nothing like Yuwa has, which are generally scraps of land in which Franz has tirelessly negotiated to be allowed to use.  The TATA athletic director, a very nice guy who seemed truly dedicated to the cause,  attended with some various self-proclaimed important people promoting corporate social responsibility to greet the girls and show them support.  

The match left me in a trance.  You would absolutely never believe where these girls come from by merely watching them play football.  The raw talent was unbelievable.  The scissor kicks, crossovers, headers, passing, the strategy - just a fantastic game.  The girls ended up losing 4-3, but they still had a fantastic match.   At the time, they needed a little work on anticipating and positioning, but that was something they would continue to work on.  

What left you glowing on the inside was watching Anand, the head coach, so passionately encouraging these girls.  Anand is a twenty something year old guy who, for what I could tell at the time, had no reason other than his passion to dedicate himself to Yuwa.  He was up at HQ at 5:00 AM at the latest to prepare for practice every single morning.  He was always present, always full of vigor, and reliably full of compassion for the girls.  He cheered those girls on at the match with more fervor than I had ever witnessed after playing the game for ten years as a kid in the States.

It was safe to say by the end of the weekend,  I had a decent grasp on the potential for the organization, but more importantly on the organic authenticity of it.  It was critical to understand that if it would grow, it would do so because of the girls, by the girls, and for the girls, and only directed by the game - not by an outside source who would want to take credit for such a social change.  Yes, unfortunately while development and non-profits can hide inside an egg-shell of idealist humanitarian principles, inside the field, it can be just as messy and full of greed as any for-profit sector; except in this case, there's so much more at stake: not financially of course, but  there are real lives on the brink of something great here.  Football as a change agent might be the most powerful of them all, and it's critical to protect its integrity for these girls' sake at minimum.

Yuwa means youth! Part1

Today, I stumbled upon a friend's TED talk in Ranchi, the capital of one of the most deplorable states in India, Jharkhand, to grow up in as a young girl.


Meet Franz Gastler.

I had the privilege to get to know him and the girls at Yuwa-India for about a week and a half this past summer.  His conviction is inspiring, and his practice of humility and patience in order to change the social norms of a society that generally doesn't think twice about the role of girls has stood unwavering while tested against frustration, doubt, and sometimes hostile cultural differences.


I've written about Yuwa before, but this reflection (first of 3 parts) is what I wrote while there, and I think it's critical to share the raw experience that began the Phoenix Fund. Read, check out the site, share the cause, and donate if you're moved. Thanks.


I flew from Kathmandu to Delhi to Mumbai to Ranchi.  Upon arriving in Ranchi, I had been traveling for twenty-four hours, had slept thirty minutes and stood bewildered at the brink of filthy exhaustion. My last flight, from Mumbai to Ranchi, was half empty and filled with Indian business men.  To say I looked out of place may be an understatement.  I was a disheveled white girl with a backpack twice my size. Not to mention, no one goes to Jharkhand.  


Per exiting the plane with my oversized backpack dangling with scarves and a village teapot (my prized collections from Salleri, Nepal) I trudged on to meet my ride.


In the sea of Indian business men inquisitively staring stood a lone white guy in his late twenties, sporting a white motorcycle jacket and who exuded an overall bad ass swagger.


This is Franz Gastler.


Franz got on his motorcycle, I got in a cab, and we took off to Hutub, about thirty minutes outside Ranchi to Yuwa's headquarters.


The first think one should know about Jharkhand is that no one goes there besides business men. It is the leading state in India for sex trafficking and has a literacy rate for women that hovers around 50%. 


Yuwa is a "small" NGO that uses football as a platform for girls' development in the areas of health, education and livelihood. I say it is small as compared to the typical Indian NGO (although there are good ones if you now where to look) that falsely attempt to save the world by hoarding government money.  However, what Yuwa (meaning youth in India) lacks in organizational size and big international organization funding, it more than delivers with social impact and heart that oozes out of the girls it serves and is mostly run by.

There’s virtually zero overhead as Franz, the executive director, and one or two unpaid interns at a time guide the organization.  However, while the interns and Franz run the logistics, the real director of the organization is the game itself.  As someone who has visited rural India and Nepal, one expects to find girls in the fields, and if they even possess the confidence to say hello to a Westerner, it is merely a brief "Namaste" with a small bow of the head and timid smile.  Essentially, it is the “Namaste” of a servant.

Not Yuwa's girls.


On the contrary, timidness, an attitude of servitude, and weakness have been transformed into confidence, bright smiles and strength. And, although they have all the odds in the world stacked against them, you would never know their roots by judging their play on the football field.


Check out the TED talk and stay tuned for Part 2/3 next time!

Kony 2012

Kids say the darnest things...

I think this is important.  This represents how the younger generation feels about social movements and global humanitarian crises in general.  

Neat stuff...back to policy...

ACA

I know what you were thinking.  The animal lovers thought I would be talking about the  Alley Cat Allies, fellow expats thought I would be talking about American Citizens Abroad, and my fellow medical students thought I would give a nice discussion on CVAs in the ACA.

Sorry to disappoint.

But indeed no: this is merely a little note on the Affordable Care Act.  If you're having trouble figuring out what that huge "Obamacare" debate is all about, or if the ACA's more than 2400 pages seem a little intimidating, check out this map as it breaks down the Supreme Court decision nicely and also adds a touch of humor.  You can read up on the different aspects being debated here.

Want some more information? 

Here are some other sources I like that target different aspects of the bill.

Anyway, onward march to finishing a mid-term... 

Condoms

This week is looking pretty nuts (pun intended).

Research, reading articles, writing articles, grants and papers, searching/applying for the "one" (internship of my dreams this summer), surgery cases, diabetic ketoacidosis, rounding in the AM, the daily debate: trauma surgery or academic family, keeping up with the Affordable Care Act decision, and I'm hoping to squeeze in some run time for the half marathon coming up.

So, with that said,  I'll try to keep the blog updated with some links/videos of either current events I find important or stuff like this: inspiring and exciting solutions to global health problems :)

Problem: Not enough condoms in the world--> Bad public health outcomes (increase in unwanted pregnancies, increase in STIs, increase in stress and mental health problems) PLUS poor economies! (Yes, poor health--> poor people-->poor health--> poor people!) It's a terrible cycle and EVERYTHING is related.

Solution: Meet Sir Richard's Condom Company, a company of the 21st century.

30 years ago, hey, 10 years ago even, anyone who would have tried to do this would have been looked at as utterly insane.  This is only the beginning of solving never before thought solvable problems.

It's a pretty cool time to be studying medicine and public health. 

Speaking of, study time.

Ecstatic

Dr. Jim Yong Kim,co-founder of Partners in Health, has been nominated by Barack Obama to lead the World Bank.

To describe me being ecstatic might be the understatement of the year.

His career has been an inspiration to my entire generation, as it has driven the field of global health toward innovative and down-right smart solutions to problems never thought solvable.  To have him lead the World Bank will further inspire but importantly, hold those with a stale platform accountable to the ethical legacy Dr. Kim's career symbolizes.

Read more at the NY Times...

Strive

"There will be times when you're at your lowest point.  You are the ash of a phoenix with clipped wings that will never rise.  You are a broken levy unable to control the drowning of your household.  STRIVE."

I can't say enough good things about this performance. Miles and Carven effectively clench at your soul by grabbing your shame and taking it on ride through hope, joy and inspiration.  The cure to shame is empathy: the willingness to listen, and to go with people to their darkest places and to feel suffering with them.  Then, once you're there, you can inspire, but you can't do that of you're simply talking down.  You have to be willing to go there, to understand that all places of darkness are places where all humans are capable of going and even living for long periods of time.  You have to replace the otherness mentality with one of oneness.  If you're suffering, I am not separate, I can feel that too, I have felt that too.  Then we can grow together.

These fine gentlemen do just that.  They move, they inspire, they make suffering a common place - a place shared by all human beings only to remind us we all have the potential to STRIVE anyway.

And just a note on the performance: I am loving the blue lighting.  It reminds me of Picasso's blue period, a very dark and somber period of his life.  Many of the paintings from that period make you feel a sense of solidarity with the people he painted and with Picasso himself.  Most people look at the art and think, "Oh, that's not very pleasant, that makes me sad," and move on, but another powerful feeling the art evokes it empathy.  When artists paint scenes of sadness, they have found common ground with their subjects, and want to take you there too.

Forward

Abrupted. Definitely not a word, but for some reason abrupt seems too abrupt and the ed gives the non-word a feeling of |

A one month unexplained hiatus for transitioning into a new trimester while balancing a well in route public health semester, shifting priorities, tying up loose ends, deciding future plans and assessing new goals went a little something like this.

Week 1 goes by. The thought: "I'll get to it next week, big neuro exam and application due dates are coming up."
Week 2 goes by: "I'm sure I haven't disappointed too many, I have a new grant to write."
Week 3: "Does anyone read it anyway? I have meetings and research this week"
Week 4: "Busy, busy, busy, big paper due plus a debate."
Today: Sit down, can't write anything.

Notice how as the excuses pile up, the self-doubt trickles in and paralyzes any progress.  On my daily things to do, I will consistently write the word blog, but consistently "something" comes up.  That something is usually anything and everything: all worthy things to do (at least by my standards), but they're excuses nonetheless.  My vigilance against such matters need to be improved, but there's no need to worry. The few dedicated readers find quite the creative ways to keep me in line, so thank you and I'm sorry.

I like change.  I've always been open to it, but progress - that's a different story.  I have met numerous encouraging professionals the last month, continued two fantastic projects that are both innovative and inspiring, yet I frequently stop in shock when the progress and encouragement come so fast at me.   It's almost like the feeling of panic one might get when they're right about to get hit by a train.

The thought: "Really, I think I can do this?"

My thought process is due for a tune-up and some re-wiring.  Rather than any step in the right direction being met with a halt and week-long thought process about how I can maybe reach my goals, it's time to write and do.

When the progress comes so fast, I become a little dizzy.  I roll it over in my mind, contemplate over it, and analyze all possible options. But often while I'm contemplating, the train comes.  While reflecting is important, maybe riding the wave and seeing what happens might be a better option to move forward.  I haven't landed in a toxic wasteland yet, so I might as well trust my own abilities and see where I end up.

Progress: the process of striving for and taking steps to reach your dreams, and doing them!

Enough self-berating though. Going on and on about it won't accomplish anything.  Time to shift gears.
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I had wanted the phoenix tattoo since I was 15 years old.  To me, it symbolizes my roots, transformation and is a motivator for my future.  My older brother, Jack, took me to get it when I was 18 during Thanksgiving break my first semester at college.  I had only three months prior, left home in the Midwest to begin "young adult-hood" on the East Coast.  You know young adulthood. It's that awkward stage in life where you're figuring out your identity, you can be whoever it is you want, start over, explore new freedoms; oh, and there's a lot of beer.

Jack and I had planned it out all semester.  During my last visit, the artists came up with a sketch, and we had sent color schemes to each other back and forth until the big day.  I was hesitant, anxious, and shy.  I was a naive white girl from the suburbs of Chicago walking into a tattoo parlor outside Baltimore full of tattooed, bearded and pierced men.  I looked like a wide-eyed foreigner, curious of the artistic genius under the harsh facade.  Hidden under my timidness though, sparkled a tiny ounce of excitement and a secret bad-ass.  

The first etch shocked me.  I remembered cutting off my sister-in-law's wrist circulation as I squeezed her hand in angst.  I was still unsure, but it was too late to back-out.  The only way to endure the 3 1/2 hours of droning vibration and bleeding was to lean into the discomfort and breathe.

When I looked in the mirror, I was in shock.  I obsessed and looked for hours, nit-picked at any ill-conceived imperfection.  I was in disbelief at its permanence.  I had this mystical bird that took up 1/3 of my back on me permanently. I hated it, initially.  I didn't regret it, but I definitely hated it. It was so big, it was huge. Gradually though, the loathing dissipated, and after the initial shock wore off, I embraced it and remembered the care and detail both the artist and I put into it as well as the story.

I rolled over the tattoo in my mind and contemplated it for a few years.  While they were young years and some might criticize immature, I still weighed the pros and the cons, but they didn't really matter as the vision never changed. It was like this powerful drive that existed at my core: still yet to change.

Seven years later (wowza), I'll walk by a mirror and catch a glimpse, smile, and be reminded of the backstory, the reason, but most importantly to take the right steps forward that day, to strive for the future.

I took a good hard look at my tattoo this morning and reminisced of that moment walking into the parlor.  I had saved money from my summer Lifeguard position for it, agonized over its details and built up the moment in my head like I was about to change the course of the world.  While it didn't turn out so dramatic, the tattoo holds a dear purpose: to remind and to motivate.  Today, it also led me to want to smack myself on the head as I compared the project to my tattoo: something you can't stop once you start.

The Phoenix Fund is a project in which regardless of circumstance, exams, papers and career plans, the fulfillment is a part of my core and will only annoyingly itch at me, much like a droning, vibrating needle, until complete.

"A mythical bird that never dies, the phoenix flies far ahead to the front, always scanning the landscape and distant space.  It represents our capacity for vision, for collecting sensory information about our environment and the events unfolding within it.  The phoenix, with its great beauty, creates intense excitement and deathless inspirations." Fen shui Master Lam Kam Cheuen

- a thing of the past.  It's a new day.

Happy Generosity Day!

Valentine's Day giving you the blues? Are you single and alone and two steps away from a bag of chocolate...yes, I'm talking to you.  The chocolate coma is not worth is, I promise.

Let's change angles.  Let's shift our perspectives.  Instead of, "What a sh*tty Valentine's Day this is for ME," let's make it about someone else - anyone else.

Today is Generosity Day.  It is the day we have put off far too long. It is the day we have told ourselves time and time again, "I'm going to help out that guy on the street one day.  I'm going to give to a charity or cause one day.  I'm going to be the generous tipper at a restaurant one day.  I'm going to be the brave person who talks to the lonely security guard one day. I'm going to reconnect with that long lost friend or family member one day." Well, today is that day.

Today is the day.  Today is the day we can choose to feel sorry for ourselves and to throw our very own self-pity party.

Or, we can choose to act out what Valentine's Day is really about: love, compassion, empathy, generosity, connection, vulnerability, belonging, and courage.  That's right.  No where is Valentine's day about chocolate, self-pity, self-doubt, candy grams, and plastic hearts.  It's true.  Wal-mart, Target, the convenience stores, grocery stores and commercials have all been lying.  I promise.

Today is the day. Meet someone new.  Give a little more.  Stretch your mind and your heart.  Feeling nervous? Never done anything like this before? That's okay.  There's a first time for everything.

Furthermore, I promise you really can't fail at it!  All you have to do is be human and attempt as best you can to feel what someone else feels, practice some genuine empathy, give. You will surprise yourself.  You will do these things with raw and genuine generosity without any contrived superficiality.
Remember you really have nothing to lose.  On the contrary, you only have joy, connection and a deeper understanding of the human condition to gain - if you dare to go that far.

V-Day

This weekend I had the privilege of participating in the 3rd annual Vagina Monologues at my medical school.  I wrote in my bio that I was inspired to try-out after watching KC Baker's TED talk on women claiming the public stage.   In the talk, KC referred to the Dalai Lama's comment, "The world will be saved by the western woman." KC responded with, "The world will be saved by the western woman who speaks up."

For those of you who have not seen or heard of the Vagina Monologues, it is a play based on over 200 interviews with women about all sorts of vaginal topics: ranging from orgasms and the art of finding the clitoris to rape and abuse.  The themes from  the interviews were consolidated into monologues that are performed throughout the country to raise awareness of the ongoing violence against women.  Valentine's Day was dubbed V-Day as the official day to campaign and protest.

Each year, the Vagina Monologues also spotlights an area of the world where the violence has been escalated, and a monologue is performed to commemorate the women affected.  This year, the campaign focused on the devastated post-earthquake region of Haiti, war-torn Congo and post-Katrina New Orleans. While they are three very different areas of the world, the monologue tied the themes of oppression, racism and sexism together to highlight issues of which women all throughout the world can relate and stand in solidarity.   I was lucky enough to perform that monologue.

All aspects of the show impacted me.  I befriended fourteen other courageous and strong future female physicians, healed immensely through connection and bonding,  overcame nerves to claim the public stage and finally delivered an important message.  Heck, I even learned things about my vagina I had not previously been taught-no, not even in anatomy class.

The spotlight monologue was technically focused on other regions of the world, but the slam poetry could pull on a heartstring of any woman.  I could relate to it, the women of Philadelphia could relate to it, and by the end of two months of rehearsal, I could literally feel my life story with the life stories of all women being told in that poem.

While Saturday and Sunday's performance were delivered smoothly and moved the audience to both laughter and tears, today's performance at a local women's shelter, The Sheila Dennis House, left an imprint on me of gratitude, humility and fellowship.

We had never had an audience as animated at the Sheila Dennis House today.  At every mention of the word vagina or clitoris, they gasped, their eyes bulged out, and finally and without any inhibition, they let out roars of laughter.

My monologue was supposed to take the audience on a journey.  It started in chaos as I delivered the scenery of garbage, animals and rubble.  We then barged right through a wall of frustration as the audience and I realized no - no one was coming to help- even though help was promised.  Then, there is the line where the mood changes.

"Dances churches fields abuse centers carrying possibility bellies beings words."

At this point, my voice changes and I am moved.

It happened consistently, each time I practiced and performed the monologue: while running, in the shower or at rehearsal.  But tonight, during that line, I gazed into the eyes of a seven month pregnant twenty-something year old in the front row.  The entire audience let out an awe of relief as we all gathered our compassion and strength for her alone.

It is this line where the mood shifts.  It is this line where every single woman can relate: black, white, American, Haitian, Congolese, broken, rich, poor...

It is this point where the woman overcomes adversity, recalls her inner strength, finds enough courage to connect with others and remembers nothing can stop her.  It is this line when women band together, decide to dance regardless of circumstance, and realize that the world's destiny is up to their attitude, resilience and courage.

When the women were brought into my story, into chaos, they nodded in empathy.  I could feel their thoughts, "mmhmm, I've been there." They sang "Amens" during the frustration as they all knew what it feels like to be in a situation where they did not have control and to yearn for a helping hand that would never arrive.  But then, simultaneously with the inflection of my voice, they eased into the optimism of that line. From that point on, shy smiles gradually peaked out because we remembered, we all remembered, that we must carry on as the mother earth does.  We must carry on, for it is us that carry all possibility.

"What women carrying on outshining filth, outshining odds
What happens now New Orleans Haiti Congo women
Now or never
Women claiming what they carry claiming carrying
Now women colored brightly carrying everything, everything
Carrying on I tell you
Carrying on."

The 118

Enter the elevator. I am here waiting....like a creep.

Excuse me.  If you had to decide who in the world would save it, who would it be?

Reply...hmm a superhero...my precocious daughter...definitely not Obama, he had his shot...not the UN...Morgan Freeman?...that's a weird question with my 9am coffee...

Well I have an idea who it might be.  See, in my spare time I follow the field of global health and development.  In essence, I study the best way to help.  You know, the first rule of thumb in medicine is, "Do no Harm."  Well, the same goes for public health and development.  So often, people from the western world go into communities to try and be a superhero, but they can really only go so far.  Even when we study the best methods for helping, there usually comes a roadblock at some point. If you think about our heroes, they are  generally ordinary people doing the extraordinary in their communities.  I think the best way for communities around the world to really come out of poverty are to have more leaders come out of their own communities.  Are you following me?

"Sure, I see what you're saying."

Okay, but here's where I get a little more specific.  New leaders can't be just anyone. Right?

"Sure."

The leader has to be a girl, and not any girl.  It has to be a girl who is educated, knows what she's worth and makes her community realize her worth as well.  It's a tough thing to sell in communities that traditionally oppress women, but already there has been some major strides in communities in Nepal, India and all throughout Africa.  It's been said the realization of women's equality is the moral issue of our time.  We know that when you educate a woman, you educate - at minimum - the rest of a family, but also entire communities and even nations.

"Okay, that sounds pretty cool."

So, here's my idea.  Because we know that investing in women and girls has huge economic implications for countries, I am starting a higher education scholarship fund for girls in the Lower Everest region of Nepal.  The scholarship is available to the forty most talented girls in the region who are currently attending high school and live in a hostel I helped build this past summer.  At the hostel, they have leadership training, vocational workshops and English lessons.  My dream is to grow this fund into an opportunity for one of these talented girls to continue her education at the University level.  Currently, I'm working on the application process.  Maybe even one day, the girl will become a physician like me and return to her community and show the world what can be done if you give a girl a shot.

So, what do you think?  You seem like you're pretty good at ... (insert personalized compliment here such as making money).

Well, I'm pretty good at creating social change around me. Want to help?

Special shout-out to Val for donating to the cause!