Academia in Reduced Circumstances

[Photo: Cowherd on the lower slopes of Dedza Mountain.]

7 May 2017

I was just getting ready to settle in for some contemplation and program-building, perhaps even plan a small research project for next year. The last student rotation is completed and the cycle doesn’t re-start until the end of August. But after a meeting with one of the leaders of the new Family Medicine Residency in Mangochi—Presto! We have a 4-6 week block of teaching the Family Medicine Residents. To begin before the end of May.  Aha!

It will be fun, I am sure, to teach some here and some in Mangochi (just a few days) and since Family Medicine was my first completed specialty training, I have a certain feel and sympathy for it. When I found myself trying to keep abreast of all the specialty journals—-Orthopedics, Ob-Gyn, Pediatrics, Internal Medicine, ENT, Dermatology—you get the point. I think at that time in my life I was too worried about missing something or not providing the most up to date treatment, which is a terrible ground on which to stand if you are in Family Medicine.  You need a certain, and growing, knowledge base and a fine sense of when to refer to a specialist. And more confidence, or at least courage, than I had. I marvel at reading William Carlos Williams and his practice of medicine in New Jersey.  At any rate, since 75% of my patients’ issues were primarily psychological, despite whatever physical complaints they had, and that was the most interesting to me, I retrained in Psychiatry.

Being faculty in Psychiatry here means that your desk will never be clear. I think it is important, especially in this resource-deprived setting, that the generalists have a basic grasp of what is delirium, anxiety, depression, mania, schizophrenia, the result of trauma, etc. and how to “manage” them. “Manage” is a strange word, suggesting more control than we have. But we talk about “Management” of this and that illness. It really is “Our Plan for You”. It can be thoughtful and helpful and thorough, even perceptive. But the bearer of the unwellness must be the real Manager.

Linda and my “bed” was two twins pushed together. They’d slip apart. I tied the legs tightly. The mattresses drifted like tectonic plates. No earthquakes. Just discomfort with that firm line of mattress binding down my side or back or shoulder.  Our landlady brought us a queen. (The twins are in the spare rooms so we can sleep 6 in beds here, should you drift by on your ramblings.)  But it was a kind of cheesy one with a slippery rayon covering and a cheap, uncomfortable mattress. Couple that with the clingy polyester sheets provided by Peace Corps, too small to tuck in securely, and you have a recipe for dreams of sliding around in warm mud pulled by a horse with no rider.

Determined to remedy it, I measured the bed, biked to GAME, and located cotton sheets (200 thread count! Isn’t Motel 6 up to 600 by now?), one fitted and one flat. Home again then off to find a foam pad. Two stores later, it is clear that I cannot get a queen-size foam pad. I can go to the factory, in some distant location of Blantyre, and buy a queen mattress.  Ok.  I bought two twin-size pads and, thinking we had rubber cement at home, didn’t buy glue. We had wood cement. Back out to town, pumping up my tires between runs for less drag on the road, and bought a can of rubber cement. Anyway, cutting foam with a bread knife leaves a ragged edge; sharp scissors are better, at least for 2’ foam. Measure, glue, approximate and press tightly. Voila, a 2” thick pad with rounded corners. Add 200 thread count cotton sheets, and it was bliss.  Although a faint smell of organic solvents tainted my dreams; I hope my liver is intact. It is nice to complete a project, since my work here will never be, or even feel, completed. I see why surgeons like it; the appendix is ready to burst, the appendix is out. Done. Or midwives, the mother’s in labor, the baby is in transit, and then the baby is nursing. [My father completed his training in Internal Medicine, found it “too depressing” according to my mother, and re-trained in Ob-Gyn. He loved it, most of it.]

Linda walked to Kamba Market and returned with pork from The Lord Is My Savior Pork Butchery, ran it through our new meat grinder, and spiced it up. The sausage is remarkably good. I can see we’ll try many and varied recipes for spiced ground meat. Indian, Middle-Eastern, Greek. Even Arkansas.

Morning glories adorn our front porch and the small fence behind the house which surrounds the garbage can, etc. Our gardener is a perfectionist and the place looks like no garden I’ve ever had. Or seen. We have beds of carrots, lettuce, tomatoes, sweet potatoes (Yes, Mr. Quale, there is an “e” for the plural.), cucumbers, butternut squash, pumpkins, hot peppers, green bell peppers, forests of basil and parsley, and peas that only grow about 2 ½ feet tall, covered with blossoms. I’ll take some of the pea seeds home to try. Our iridescent green, yellow-breasted, black and violet Collared Sunbird and his Ms. were flitting about this morning in the tall bushes with lavender flowers. We need lion and lamb to lie down together—-it looks like Eden.

But it doesn’t sound like it. The College of Medicine Sports Complex is directly visible about 500 yards away. Every weekend night is party time; it is rented for weddings, Bar Mitzvahs (maybe not), and gatherings of all sorts, as well as all the COM functions. There is even an exercise group on the lawn in the middle of the track that sets up with huge speakers and blasts exercise music (not Bach—like dance-hall music, not sure if it isn’t all electronic, strong beat) all afternoon Saturdays. Like all else, you get used to it so it isn’t such a bother.

Still, in the early morning it is lovely here as the world awakens; the birds move with eagerness and precision, unlike yours truly who is stumbling about trying to make two cups of tea. It will be similar when I get to Beach Island this summer.  Mornings are paradise there, the quiet unbroken by chain saws or weed whackers that don’t get started, when they do, until after the second cup of coffee.

The contrast for me, between hard work, both physical and mental, and restful being, is simply delicious.