Not Quite the Start You’d Expect…

8 June 2018 – I have hesitated a lot in writing this blog. Much of the other recent posts were ones I had worked on over a period of time and just recently finalized to publish. This one, however, I never started – for many reasons. I’ve debated about opening up here; being honest about my experience – holding nothing back – and I am finding that it is good to do so. As public as a blog may be, I have been trying to use it not only as a place to share my experience, but also to create a space in which I can process all that has been going on this year for me.

So, content warning before I begin – just to go ahead and put it out there. During my first week in Tanzania, I found myself in an unfortunate place. What unfolded on May 10th involved me being taken by four men in their car, held against my will, and robbed of the possessions I had on me. The bottom line is this: I am okay. I walked away safe. And thats really all that matters.

I feel as if I can’t write this post and update you all on the past five weeks without first having had to be open about that. If you are up for it, then read on with me and see what I’ve been up to. What I have learned – about my project, about this place, but likely of most importance, what I have learned about myself.

Tanzania Week 1: 5 May – 11 May

I arrived on May 5th in the Dar Es Salaam International Airport. It felt like one of the first times in recent flights that I had finally arrived at a normal hour. Applying for a Visa on arrival and receiving my luggage, arrival came and went without a hitch. Meeting a driver I had previously scheduled, Mzezele helped me with my things and drove me across the city to where I would be staying. During my sophomore year at Sewanee, I roomed with a fellow EMT, Dylan. It turns out that Dylan’s dad lives here in Tanzania working with USAID. I guess you could say I now have lived with two generations of Greers (and they’re both great!). Arriving and settling in, the week began well. I got to see George’s Yacht Club where he sails on the weekend and begin to get myself acquainted with the town. Living not to far from the center part of Dar, I spent a day exploring the downtown streets and felt like I was once again starting over – but at the same time feeling confident and excited about the opportunity to do so. I had set up a meeting at the main National Hospital and was just filling some time in the early days until that meeting came. On the 10th of May, I was out on a walk after lunch and ended up communicating with a few guys also walking nearby me. Through a process of deception, building trust, and a bit of my own drive to embrace newness I found myself in the back seat of a car I should not have been in. The following hours are not worth writing out in detail except that I once again walked out of that car, away, and safe. I had to make the hard phone call a parent never wants to receive – and was met with grace on the other side of that line. I don’t know what you did after you hung up that phone, but you did exactly what I needed when I needed it. I am still thankful for that. George too was a saving grace. His experience, accessibility, contacts, etc. are really what have allowed me to feel confident enough to remain here. A trip with him to the police, a report filed, and a slow following day – my first week in Tanzania came to an end not quite in the way I was expecting.

Tanzania Week 2: 12 May – 18 May

Welcoming in the weekend, I joined George at the Yacht Club and joined him on Jammy Dodger, his small Sail Boat that fits about four people. Though a bit rainy, there were others up for a race, and so we went out to the boats for a day on the water. Having just mentioned in the last post that I drove a boat for the first time, this Saturday brought a whole new level of newness as I helped crew a sailboat for the first time. There were definitely moments I thought we were going under…but I had a blast and it served as a good place for me to put my energy. We spent Sunday again at the club, this time on the beach, I would soon find that this is how my Friday – Sunday’s would work, and I looked forward to them. Having postponed my meeting from the first week – I met with the two directors of the Emergency Department at Muhimbili National Hospital. JP, who I had previously been with in the UAE had worked with these two men and I was excited to meet them. We discussed some of the different levels of emergency care within Dar es Salaam and greater Tanzania and further about opportunities I may have to engage with the system. Much of my other time I spent back where I was living. I began a bit of re-orientation for myself, covering my bases, and preparing to begin again. I used the time to do what I like the most – to run. It’s hot here, and the rainy season was in its final week, so the humidity was quite high, but I was glad to be getting back into the routine of it. Through a contact at the U.S Embassy, I learned about a first responder training scenario the embassy was sponsoring for local police and first responders. I got to serve as an actor in the scenario, and got to see some training in action, which was a great and unexpected addition to the week.

Tanzania Week 3: 19 May – 25 May

With a sunnier day – George and I went back out for another race on Jammy Dodger. The opening weekend of Race Season was fast approaching and everyone wanted to get in some practice. Although there were still moments I felt I was about to fall in, it was cool to see how much I picked up the second time around. We went that night to a dinner party in where we acted out a Murder Mystery. With about 30 guests, everyone played their parts (in full costume), but none of us found the killer. I had never done an event like this before. It was quite elaborate, well planned out, and fun! I was a great variable because most people at the party knew others, but as I was new here, most did not recognize me. On Sunday, I wandered the low tides looking at all the sea urchins tucked against bedrock and was glad I didn’t step on one! During the week, the hopes I had had for work or observation at the hospital seemed to be falling short and so I was forced to begin a bit of a re-approach to my project here. I tried to fill my time meaningfully, focused on my training, and began reading much more. What I began to find (and still as I write now), is that leaving the confines of my living space, especially without having much direction or plan for where I need to be or why, has grown to be pretty hard for me to do. Trust can be a hard thing to build.

Tanzania Week 4: 26 May – 1 June

This weekend marked the opening weekend for racing, which meant that the Yacht Club was full of people, and full of boats out on the water. It also happened to be George’s birthday! Having a good race in some big waves, we popped some champagne as a toast and enjoyed the sun out on the water. We ended up in 2nd place! That evening, George and I went to watch the the Liverpool vs. Real Madrid Championship final. During the week I was able to met with a private security group who also employs ambulances in the area. Hoping to gain a little more access than I did, I was still able to have a good conversation with those in charge and be able to speak to a few medics who work there. Later in the week I met a former Peace Corps Volunteer who now works as a trauma nurse at one of the local private hospitals. I joined him at the end of the week to join in a meeting with other doctors and nurses as they discussed prospective ideas for their hospital. Later, again with Luke, I met others involved in Basic and Advanced Life Support Training classes who aim to raise the level of medical education for those who live in Tanzania. They are called the Emergency Medical Services Academy.

Tanzania Week 5: 2 June – 8 June

In my fourth full weekend in Dar, George was out on a smaller sailing race, so I joined the rest of the Jammy Dodger crew for the larger Yacht Race. This time we came in 1st! All four times I went, I had moments I thought I was going in, but each time I walked away having gotten the hang of it a little bit more. In the following day, I became so wrapped up in the book I was reading, I practically didn’t move from that one spot on the beach all day long. Two days later I turned the last page and raved about it in text messages to family. So I will do it here too. If you haven’t read Beartown, by Fredrik Backman, you should. If you have, I’d love to hear your thoughts! I’ve spent much of the rest of this week doing a bit of online research, finishing up these blogs and preparing for a move on Saturday! I am headed to Arusha! (For Kilimanjaro, and I am so excited!)

Pictures!

This is my Sunday reading spot, and it makes me very content! Sea Urchins! Very cool, but not comfortable to step on… Low tide and sunset

Happy Birthday, George! A great day and a great race on Jammy Dodger My last race on Jammy Dodger. The red sail is called a spinnaker, used to keep the boat moving with a downward wind. Counting down to the finish line – so that we can stop our watches at the right time! (…for first place!) The Yacht Club is one of the few places on the Tanzania Coast that looks back out west, and the sunsets are quite rewarding.

Project!

Well, over the course of 5 weeks, I managed to secure a few meetings, but as I have faced elsewhere, access to the medical field as a foreigner has proven to be a challenge. Coupled with some increased latency on my part to fill my down time exploring, going out to meet new contacts, etc. I found myself often feeling as if I was waiting for the next thing – the next meeting – the next email response, etc. etc. During my time in Dar, I met with doctors at Muhimbili National Hospital, had good conversation with people working on establishing an “Uber for Ambulances” through the local telephone company, met with more doctors at an international private hospital who were discussing new ideas for creating a Trauma Registry here for the city of Dar, further engaged with a group called the Emergency Medical Service Academy, and lastly met with a private security company, who also offers ambulance response as a part of their subscription package. I valued every meeting and was glad to have had the time to speak and join in on the conversation here. Where I struggled was seeing these meetings through to the next step – which would have been a more direct line of access to observation as has been done elsewhere. Below you will find a mix of all the things I took away from these meetings and the ideas I connected along the way.

To start, there essentially is no organized Emergency Medical Services in greater Tanzania, at least not recognized by the government here, but that does not mean you wont find an ambulance on the street or at a bay in a local hospital. They exist, but are not organized or regulated by the government. Often you will find inter-facility transport vehicles within hospitals and privately employed ambulances on the street. Positions such as Paramedic are not a recognized field of practice. The existence of private ambulance services here is similar to other places I have been; however, what differs is that these private services are the only ones that exist. While we have 911 in the U.S, Denmark has 112, Chile 131, 132, and 133, and Thailand has 1669 for health emergencies. Tanzania only has two numbers – for police or for fire. It’s a hard realization to come to, but people essentially live here without rapid emergency response care. We discussed this first and foremost at Muhimbili. The two doctors I met with are hard at work training others while also working towards developing a sustainable and efficient system. The World Bank has recently donated money for infrastructure development. In agreement with local authorities, the money comes with a caveat: if road development improves, people will drive faster, and thus more accidents are likely to occur. With this funding, the World Bank also required the implementation of better system of emergency response. To start, this will only cover the main roads in development, and will thus only be a “highway unit,” but I think its important to start somewhere.

Later meeting with Knight Support, a private security company, I spoke with a lead coordinator and paramedic. Knight Support Ambulance technicians are trained under the British Model of EMS and receive training from international instructors every six months. This company works both here in Dar and in Arusha, a larger populated city in the north. Their services come at a price. Either by subscription or immediate call, it it will cost you. Pricing for transport and care are often hard to afford for much of the local population, and circumstances are made more difficult as the security company are unable to accept payment via the national health care system. Since the local government does not recognize these ambulances as a true profession, citizens are unable to use their national insurance. Knight Support is not the only service that looks like this. Other names I found, but was unable to successfully make contact were the Dar Flying Doctors, and the Tindwa Medical and Health Services. What this goes to show is that these services do exist, care is being reached to those who call upon it, but it isn’t accessible to everyone.

It was in my final meeting here at the International Hospital, Aga Khan, and the subsequent meeting with the Emergency Medical Services Academy (EMSA) that these thoughts began to really be pieced together. At Aga Khan I got to sit in on a conversation about different ways to develop a trauma registry for the hospital. I thought this was a cool idea – it was similar to the cardiac registry idea found on the Global Resuscitation Alliance’s 10-step plan and seemed like an excellent place to start. The idea was met with a good bit of pushback – which was, “Well, we don’t really see trauma here. People don’t come to this hospital for trauma, they cant afford it and unless the trauma happens around the corner, here isn’t the easiest place to access.” I found this to be a really interesting point. Doctors and nurses echoed the fact that national insurance wasn’t accepted at Aga Khan, meaning many people won’t bother to come because they cant pay. It is incredibly hard for me to see such a big facility, with good technology and highly trained personnel, and know that only a small fraction of the population here can access it. I also know how often this occurs back home in the U.S., and that too is just as hard of a realization.

Moving to my conversation with the EMSA later that day, I met trainers who were finishing up an “International Trauma Life Support (ITLS)” Class, which is a training class for doctors, nurses, EMTS, and even bystanders that is recognized by the American Heart Association. It was here in my conversation with Faya, a doctor in his later years, who has practiced medicine here in Tanzania and elsewhere in East Africa, that I was inspired about the future of EMS here. He and others behind the EMSA movement, have the intention of first bringing up the knowledge of the local population around the ideas of pre-hospital care. So many times this year, I found myself in conversation about the types of ambulances involved, the tiers of training, etc., but what Faya and others at EMSA were focused on was pure education. He said to me, “ If I could change one thing before I die here in Tanzania, it would be for that person on the street who sees a motorcycle crash to stop and call an ambulance instead of tossing them in the back of a random car with no help. People treat the dead with more respect than the severely injured sometimes!” Faya further went on to explain that much of this “treatment” isn’t out of disrespect, but rather, a lack of knowledge of what to do in such an intense moment. EMSA seeks to change that. The idea is that in time the technology will come: the equipment, the structure, the ambulances – all of them will come, but if they come without a population who is knowledgeable about their service, it just will not work. A second piece of information that stuck with me from Faya was when he said, “For most of the people I train here, I show them things, machinery, that they have never seen before and likely will never see in real practice here in Tanzania, BUT…if I can give them the knowledge that it exists, then I will have done something good. Because one day, they may see it, and when they do, they will know how to use it.” It was a strong message for me to hear and take away for my time in Dar. Knowledge is a powerful thing, and it goes with you a long way in life. My mind was often brought back to the conversation I had about the different myths surrounding EMS in the developing world. I was able to see some of the barriers mentioned more clearly after having learned them. The chain of survival looks quite similar from one place to the next; however, it is the “frame” that often differs and poses new and different challenges for places around the world. I am looking forward to some time in Arusha were I can explore these questions in a new light. Arusha is also another big city in Tanzania, but likely is supported by a much larger tourist industry given its proximity to Kilimanjaro and the Serengeti. It will be interesting to see what part, if any, that plays.

What else am I learning, you ask?

Well, a lot, and much in ways I didn’t expect to have to confront this year. I have thought a lot about what happened to me during my first week here. Often thinking about it much more than I wish to have done so, but some things are easier said than done. I tried to tell myself I was good, that it happened, that it was over, and that it was time to move on. In a lot of ways, I did that. I got back into a routine, I kept my mind busy and focused on running, reading, and researching online. What I didn’t do however, was get out much besides my runs or times out with George in the evening. To be quite honest, I hold a fair amount of shame regarding that – my lack of desire to engage, my readiness to be done, and my latency towards seeking out new discoveries. Much of what has fueled me this year has been exactly that – the possibility of something new, something unseen, and I sort of felt like I lost some of that fire while in Dar, at least temporarily, but I know it isn’t gone either. Sitting in the airport for Arusha today, taking off down the runway, I was reminded of that same exciting feeling I have had before and will feel again. Perhaps I should have moved earlier, realizing that my stagnancy was only further perpetuating a sense of solitude, however, my new Bank Cards only arrived this week (thank goodness they did at all!). As I continue to discover this year, the way it happens, is well, exactly as it should. Of course, I think all of us can agree we could have done without what had happened, but through it I have had to confront new questions about myself, about my future, and about how I see the world.

My aunt said it well to me in saying that, “it seems that [my] journey this year has shown [me] the best in people around the world in innumerable ways. And for that we are all so grateful. Unfortunately yesterday showed you some of the worst. Hopefully the memories of the day will fade and just be a blip on the radar.” Shout out to you, Aunt Kelli, and thank you for encouraging words. I am so grateful for all I have seen, it has truly been the best. I’ve seen new things here in Dar now too, and am reminded of the enormity of the world, and also my smallness within it. There are an incredibly large, diverse amount of stories that make up the lives of people here in Dar, in Tanzania, in Africa, back home in Charlotte, in North Carolina, in the U.S. And there are also an incredibly large amount of those stories that are shared across cultures, boundaries, and borders. In medicine, you confront many of those stories. I would like to say that a hospital doesn’t discriminate, but I know that wouldn’t be entirely accurate; however, we all face the world’s health issues, together and as individuals. As patients, parents, family, or friends, we experience it for better or for worse. Atul Gawande, who wrote Being Mortal, a book I loved so much, recently gave a commencement address to a new class of doctors. In it he discusses the difficulty one faces in treating patients of different stories – yet leaves clear emphasis that anyone who walks through those doors should be given the same right to treatment as the next. A patient should be a patient no matter the race, gender, creed, or origin. Read it here, if you would like. What I am taking from that is this: I met some people early on in Dar I wish I hadn’t, and I really don’t see at the moment quite where my story and theirs is shared, but it does not negate that their story does exist – just as much as mine. Some day they may get sick, go to the hospital, and be treated. Some day I may get sick, go to the hospital, and be treated. Half the world away, but health care all the same. All of this makes me excited for the day I will get to be on the side of giving treatment, working together with others, living shared stories with some and others not. It’s not to say there are not still times I am angry, scared, or wishing I had done one thing different that day, but I’m also trying to keep the right mindset about it moving forward.

Trust is a hard thing to build. It is a beautiful thing when it comes innately, as I often think it should. We all deserve the benefit of the doubt, but it is hard thing to re-build. That’s an internal strife I think we all face at times through our different relationships and experiences. This experience will likely for some time mark a significant moment of struggle for me. I will have to continue to re-open myself to new situations and new experiences that I may now be more hesitant towards, and through it, I suspect I will learn – just as I did before. The world is definitely a beautiful place in that way. It isn’t perfect, anywhere, and you will find that too as you see more and more of it, but we do get to share it. I’m grateful every day for having the chance to have seen so much of it.

Whats up ahead? Can you believe that there are just three (well now two as I proofread and post…) more weeks?!

Well I am off to Arusha today. I am meeting up with a guy named, Samson, who previously lead my sister up Mt. Kilimanjaro. He has been an incredible friend to me even before we have met. On Monday we set out together to tackle the mountain. He told me that he was going to make dreams come true, and get me on top of that mountain, together. Safe to say I am pretty excited about that. When I finish I will just be under two weeks remaining – Samson is going to help me with a short safari trip and I will be spending my final week in Tanzania wrapping it all up. In bonus news, there are four Sewanee faces I may get to see along the way. A few old friends are leading Moondance trips this summer in Tanzania. Our dates seem to align and I am excited to see some familiar faces once again in a place I would not have expected! Fingers crossed.

As always, thanks for sticking through to the end. Here’s to summer hitting full swing and good times ahead.

Cheers,

Mark

P.S. I made it to the summit! 19,341 ft above sea level – It was amazing. More to come about my trek, a future safari trip, and my upcoming final week in Tanzania.

April Hiatus: Weeks 3 and 4 – The United Arab Emirates

April Hiatus Week 3: 21 April – 27 April

Hopping on a plane in the afternoon of the 21st, I was on my way to the Middle East. I arrived in Dubai, UAE late night/early morning on the 22nd and did my best to make it to my hostel as quick as I could…on the 66th floor! After catching some sleep, I embarked on my first day in the UAE to explore Dubai. First going to the old city and wandering through various Souks (old city markets), I enjoyed conversing with locals (who were mostly trying to sell me things), nevertheless, they were fun to speak with. Late afternoon I made my way over to the Burj Khalifa, the world’s tallest building, and ventured up to the 125th floor to see the sun fade away and the city light up at night. Making my way back towards my hostel, I spent the evening hours walking along the beach. On Day 2 I soaked up some sun on that same beach, alternating between reading, and dipping into the cool, blue water. It was a pretty good way to spend your second day in Dubai. That afternoon I traveled to Abu Dhabi to meet up with JP and Karen McBryde, a Charlotte family, now living over here. JP is an Emergency Room Doctor at the Cleveland Clinic and welcomed me for about a week and a half to join him and try to get involved with some of the EMS organizations there. To begin my time in Abu Dhabi, I checked out the Sheikh Zayed Grand Mosque, a tremendously big Mosque that can hold more than 40,000 people when necessary. The intricacy and design within the white walls were astounding. Having a nice evening out with the McBryde’s and their friends ended my first day in Abu Dhabi quite well. We headed out on a boat the next day to explore the coast line and spend the afternoon on the water. It was awesome (and I drove a boat for the first time!) As my first week came to a close, I worked on setting up some meetings and contacts here in Abu Dhabi and later in Tanzania.

April Hiatus Week 4: 28 April – 4 May

The week started off well as I joined JP on Saturday at the Cleveland Clinic Emergency Room while he was on shift. As it has been elsewhere, it is always fascinating to see the design and implementation of care in different places around the world. The UAE is a diverse place, full of ethnicities from around the world, which also means full of different cultures too. To see health care involved in such a diverse place was also a unique perspective I had not yet seen to this extent while abroad. On Sunday, I joined a colleague of JP’s involved in Search & Rescue to learn a little more of the system here. We toured his facility and went over to the Abu Dhabi Police HQ, who runs the Ambulance Service. I was able to speak to a few paramedics, tour their ambulances, and hopefully set up the right steps to ride with them a few days before I leave. I find myself now typing away as I update the many weeks having gone by since last posting a true blog update. As the week progressed, I enjoyed a little bit of continued R&R, and joined JP at the hospital two more times before leaving, and got to meet some EMT’s who worked at the Cleveland Clinic as part of the Critical Care Transport Team.

Unfortunately, as the Ambulance Service is run by Abu Dhabi Police, I would need a security clearance to ride along (although we tried, there just wasn’t enough time!)

View from above, Burj Khalifa, floor 124Just a bit higher at floor 125 looking down on the Dubai Fountain belowBack on the ground, the Burj Khalifa is truly enormousMade it just in time for a dazzling water showCan’t complain about a day on the beach!Sheikh Zayed Grand Mosque in Abu DhabiSo much beauty in the simplicity of colorI mean, look at that!Drove a boat, didn’t crash! JP, Karen and I on the boat on the shores of Abu DhabiCurrent views from the bedroom, plenty of sunshine, and plenty of heat, but most definitely plenty of beauty found in a new city, in a new part of the world.

Project Update:

All that being said, here are some ideas and observations that came to me during my short stay.

A brief overview: The UAE is broken up into seven Emirates. Much like the five regions of Denmark, each region varies in their governing body, while still largely being under one national system. There are three different EMS agencies across the UAE. In the Emirate of Dubai, you have the DCAS – Dubai City Ambulance Service. In Abu Dhabi, emergency services are run by the Abu Dhabi Police. Elsewhere, in the other five smaller Emirates, the National Ambulance Service are the primary response units. Hospitals here, much like I have seen elsewhere also have transport teams – such as the CCT (Critical Care Transport), who is a part of the Cleveland Clinic of Abu Dhabi. Each EMS Agency was designed and created under the U.S model of emergency services, which focuses on paramedics in the field and doctors on call in the hospital. Historically, the UAE has been developing their EMS since the early 2000’s. It was noted in a few who I spoke with that there is clearly still much room for improvement (such as advancements in dispatching, updated training centers and better licensing); however, I have found that almost everywhere you go will say this as well. We all have places where we can improve, and its good to be in the position where you can recognize them.

A common conversation I have had across borders has been about the difficulty in engaging the public with a relatively new system. As EMS is still relatively new in its development in the UAE, a lack of knowledge around the purpose and use of paramedic services still exists. Not only is it important to create a system of care, but it is equally, if not more important to teach the the greater community what that type of care means and what it can do for them.

While I was with JP, I joined him on three different occasions to the Emergency Room at Cleveland Clinic Abu Dhabi where he works. I was able to shadow him as he worked with other doctors, nurses, and translators to provide the best level of care possible. It was a pleasure to have that time, not only to spend it with a familiar face, but to be able and witness someone who has developed in the field of emergency care and seen it grown. I was reminded in this Emergency Room as I have been in others, that “emergencies” are broad in scope. The people you see range from seemingly perfectly healthy to near death. For some, its obvious: a puncture wound to the hand, some sort of sickness like the flu, but for others its hard to tell – decreased vital signs, altered mental state, and the table of differential diagnoses is till wide open. I was thankful for the time to have spent there – to picture myself in those shoes one day – and to be reminded that medicine at the end of the day is largely based on communication, a smile, a simple gesture of the human in another that creates an open and welcoming space for treatment to begin.

Thanks for sticking around – some updates form Tanzania coming shortly!

Cheers to the start of summer,

Mark

April Hiatus: Weeks 1 and 2 – Mainland Europe and a Danish Return

April Hiatus Week 1: 7 April – 13 April

With some time and culture change adjustments to be made, Cindy and I began my time in Vienna slowly. Sleeping in, and a walk around the old part of the city, we wandered over to a Spring Festival that had just begun. Springtime had hit in Austria and locals were soaking in the fresh change in weather. In the evening we ate local food and called it a night (early). On my second day, we met up with other friends of hers studying abroad and continued to soak up the sun on an large island in the middle of the Danube River. They were all relishing in the warmth and I was loving the opposite – the cool breeze I hadn’t really felt in months. It’s funny how people can come to appreciate the weather for entirely different motives. We cooked dinner in and tried to catch up on all we could since having last seen each other. Soon enough, Monday rolled around and I was on a train to Budapest. I was picked up by two friends, Tim & Mirsci, who are both Hungarian, but had spent their summers with me working at Camp Rockmont. I got to spend a few days enjoying their lovely city and learning about life for them there. Mirsci and I went on a Walking Tour, and Tim and I hopped on a boat to see the city by the water. I got to meet Tim’s family and spend time with them as well. Just as quickly as I was arriving, I was on a flight three days later to Berlin. It was special to get to see so many new places in Europe that I had not seen before. I hopped on a few more walking tours and enjoyed beautiful runs along the river.

April Hiatus Week 2: 14 April – 20 April

Finishing my last day in Berlin with a bike rental to see more of the city, and a delicious dinner outside in the cool spring air, I caught a flight the next morning to Copenhagen. Wow. The emotions that filled me as I passed through the clouds and descended on the runway were so full. It really felt like a return home, and to have that as my first emotion is so special. These feelings were only heightened as I saw Morten, Karen, Iben & Rune once more. Similar feelings washed over me when I went and ran my typical route along the Amager Strand beach, and sat down at my seat at the dinner table. I was home; not the one I had left in Charlotte, no, but a new one created in place I once did not know. I went to my favorite coffee shop, and walked through the city feeling full and happy. The next three days were a blur as I spent them at the Tivoli Hotel and Congress Center with the EMS Europe 2018 Conference, where over 1,400 from 40 countries came together to collaborate and pave the way into the future of Emergency Services. I will detail more of my time at the conference below. It was so cool to listen to leaders in the field of Emergency Medicine speak about things which I had seen abroad. Talks given throughout the three days helped me begin to piece together the dots from each place I had been, and I began to see the narrative form within me about all I have seen and done in the first three quarters of my year. With just two more days in Copenhagen before leaving, I made sure to spend as much time with the family as I could. Iben and Rune had been working on a play with their school for the past two weeks, and they performed it for family and friends. It was wonderful (even though it was all in Danish). We spent the afternoon in the sun with other families from the school eating pizza, having a few drinks, watching the kids play, and of course, ice cream. You cant beat it. Rune was off for a weekend away, and Morten and I took him to the train station to say goodbye. I enjoyed one final evening with Morten, Karen, and Iben at the house and prepared for another flight.

Getting a tour of the city by the Austrian herself!Cindy and I found a Spring Festival – it was fitting to then buy some RoséA second day relaxing in the park on the Danube RiverReunited with Mirsci in Budapest – Selfie at St. Stephan’s Basilica Tim & I on the river outside of the Parliament BuildingLook at how magnificent this is!Found Gelato…they shape it into a rose! (Coffee, Chocolate & Raspberry)Walking through the Powerful Holocaust Memorial in BerlinEast Side Gallery – walking along remanants of the Berlin WallNow in the city you will find inlay stones marking the former border of the Berlin Wall. It’s interesting to walk right over it an reflect on how different this city would have looked 30 years ago. (Fun Fact: the wall, this year, has now been torn down for more years than it stood!) Taking the bike out on my last day in Berlin, I made it out to the Charlottenburg PalaceReunited with family, first stop Vild Glad, Ice Cream!!!We didn’t just make one visit, let me tell you. Beautiful days in Copenhagen full of Pizza, friends and sunshine. Tough to say goodbye, but how wonderful it was to be able to returnA pretty fantastic send-off from above as I make my way to the Middle East. This is the bridge that connects Denmark to Sweden.

How perfect for me for the conference to feature a giant Lego ambulance!The theme of the Conference was, “It takes a system to save a life.” Check out the medic drone to the left of the photo currently in development to carry medications and equipments to scenes. The conference included the EMS World Championships, where teams from all over compete for the most effective scene response.

Project Update:

What a period of two weeks that was! With a little pause since feeling like I was really working on my project, I was excited about the time I had in Copenhagen to attend the conference. Over the course of three days, over 1,400 people from more than 40 countries convened in Copenhagen for the 3rd annual European Emergency Medical Services Congress. After six keynotes, six seminar, breakouts, and lecture sessions, one European EMS World Championships, and a parade through the city, there wasn’t a moment that was not filled with enlightening and new information. During my time at the conference, I attended short Ted Talks hosted by fellow attendees, conversations about interactions with Patients and Bystanders while on scene, learned about a comparative study between Scotland and Australian EMS systems, discovered an incredible organization called the Global Resuscitation Alliance, discussed topics of patient transition, and listened to various topics covering EMS in the on a global health level. There was so much to take in and all of it happened in such a short time. Here are some highlights and key ideas I took away.

The theme of this years conference was, “Next is Now,” calling on all of us to think towards the future of EMS, and what it means. The accompanying slogan was, “It takes a system to save a life,” which is something I latched on to during the time and reflected on all the very different systems I had seen already this year. When you convene a conference of over 1400 EMTs, Paramedics, Nurses, Dispatchers, Doctors, and Administrators all connected to the EMS world, one of the most common things you will hear is this, “If you have seen one EMS System, well, then, you have seen one EMS System.” This is a running joke I have heard since I was training to receive my license in Sewanee, and throughout my time since, I have heard it repeated. And the joke has a point, there really is so much variation. In the U.S alone, there are differences from one county to the next, and that doesn’t come close to comparing one state from the adjacent one. In the U.S, my Advanced Level Training in Tennessee was only good for a Basic License on the National Scale, and thus Basic in my home state, North Carolina. So, the joke is true, and then again it isn’t. There is so much shared between systems – so much shared experience, stories, trials and tribulations, there is camaraderie in the act. Sure, the bureaucracies differ, and the guidelines are written and directed in various degrees of differentiation, but at it’s heart, there remains much to be considered similar in the world of EMS.

To begin our time at the conference, we listened to a leading Danish entrepreneur in Health Tech calling on us all to think beyond our current scope of practice, to think about where we are going, and where we could go. Offering examples of “buzzword” esque ideas such as EMS Drones (which were on display at the conference) to showing new ideas of how Artificial Intelligence and Machine Learning may help dispatchers, through voice analyzation, detect stress levels of emergency calls based off of variations in voice, tone, and speed. We were offered to reflect on the progression of EMS today: from its root slogan “Load & Go”, to the more current consideration of “Stay & Play”, to the fringes of today’s practice toying with the idea of “Treat & Release”; however, to offer just one more idea to kick off our time, we were called to think about one more step beyond – Predict & Prevent. Load & Go, as well as, Stay & Play became staple components to scene assessments during my EMT Training, and it was quite interesting to think how both of these phrases may one day fade away as new practices take center stage.

Later in topics discussing the inequalities in access to health care, Dr. Susan Neirmeyer, a neonatologist and leader of the Helping Babies Breath Project discussed where we still need to improve in providing better access to healthcare worldwide. Using my future project country, Tanzania as an example, Dr. Neirmeyer discussed the three delays that perpetuate such inequalities around the world . 1) Deciding to seek care. 2) Actually reaching that Care Center. 3) Once arriving, obtaining the appropriate level of care needed or required. This led me to reflect about how much emergency medicine expands beyond the actual transport on the receiving facility, which admittedly, I have focused on heavily throughout this year. The second delay points to the necessity of transportation for those in need of emergency care, and the third delay points to the necessity of those receiving facilities being properly trained to receive and treat the patients who arrive. Of particular interest, is the first delay, which reflects back towards the community and a population’s general education and understanding about the needs of others. It is a well known fact that there are disparities in education throughout the world. You will find that in rural Appalachia as well as rural Tanzania, but education goes beyond the primary and secondary educational subjects such as reading, writing, and mathematics. Education also includes teaching an awareness of our bodies, the needs of our bodies, and the needs of those bodies around it. This too is something that is not a difference between the developed and developing worlds, it is a disparity that exists worldwide, and is of major importance if we are to make strides in providing better access to health care for all. She left us with three points to commit to which were:

  1. Advocacy: by all, for all, everywhere.
  2. Systems: transportation, communication, and regionalization.
  3. Education: multiple care providers, life-saving basics, and prevention.

This keynote speech ended our first day well and positioned my thoughts well to begin the second day when I listened to a talk focusing on “Myths About EMS in Developing Countries,” given by a doctor from Singapore, who works closely with communities throughout South East Asia and the Pacific. They are as follows. Below are the myths and truths given by Dr. Gayathri Nadarajan, of Singapore, and her research.

  1. Developed Countries equate to Developed EMS. The truth is that this is false, a country’s growth doesn’t reflect the state of their EMS.
  2. EMS/Emergency Care Systems has a limited role in Global Health. The truth is that EMS is a crucial element of Global health and thus needs support and adequate funding.
  3. There is minimal financial gain from EMS systems development in low, middle income countries. The truth is that a good EMS system improved burden of the disease on the community, leading to long-term economic benefits.
  4. Resources are scarce in developing country; its crazy to talk about developing an EMS system with all else that’s going on. The truth is that resources are available, but there is a lack of an efficient system in utilizing those resources.
  5. If the basics are not sorted, we cannot talk about improving the EMS systems. The truth is that we can concurrently seek for cost effective or innovative solutions while sorting out basic necessities. Collaborative and transparent systems can help this process.
  6. International standards to improve out of hospital cardiac arrest (OHCA) survival rates apply to developing EMS systems. The truth is that these standards are a huge leap for many developing countries and thus we need to bridge prerequisites for developing EMS systems to help achieve the 10 OHCA steps.

All of these myths and their subsequent truths helped illuminate a lot for me in the goals I have had for this year, as well as what it means for me after. What I have really been most intrigued by is the role that the community plays in both providing and accessing emergency care. What I began to find at this conference is that this idea is shared amongst many and recognized as one of if not the most important pieces. Dr. Nadarajan went on to elaborate about the 6th myth, which I will discuss below.

The Global Resuscitation Alliance has published a 10-Step Guideline in a 2016 “call to Action” to increase OHCA survival rates. Areas must have:

  1. A Cardiac Arrest Registry
  2. Telephone CPR Capabilities
  3. High Performance EMS CPR
  4. Rapid Dispatch
  5. Measurement of professional resuscitation using defibrillator
  6. First Responder AED Program
  7. Smart Technologies AED/CPR
  8. Mandatory Training for CPR/AED
  9. Accountability
  10. Culture of excellence

In discussing these 10-Steps, Dr. Nadarajan discussed the barriers Developing Countries face in achieving these goals. To first understand where the challenges are, the concept of “chain of survival” must be understood. Excuse the photo quality, as it was taken from afar, but they are as seen below:

  1. Recognition and Activation of the Emergency Response System
  2. Immediate High-Quality CPR
  3. Rapid Defibrillation
  4. Basic & Advanced Emergency Services
  5. Advanced Life Support & Post-Arrest Care

Now, having understood the five links in the chain, we can move forward and discuss the “Frame of Survival,” which includes topics that help contribute to supporting and maintaining this chain. They are, in no particular order:

  • Strong EMS Leadership
  • Cost-Efficient Leadership
  • Good Samaritan Laws
  • EMS Specialty Development
  • Culture of Excellence
  • Relationship with Government, Police, Fire, & Hospitals
  • Quality Improvement
  • Emergency Care Network
  • Field-to-Facility Communication
  • Motivation of Staff
  • Ambulance/Population Ratio
  • Research Projects
  • Health Seeking Behavior
  • A Willing and Competent Pool of Bystanders
  • A Practice of Giving Way to Ambulance.

Now that is a lot, some of which may make sense to you and other parts perhaps not; but the driving point here is that there are a lot of different factors that play into maintaining that chain of survival. What was discussed in the talk I attended was that in order to maintain the chain of survival, and hold fast to the 10-Steps outlined by the Global Resuscitation Alliance, you must also think about the frame that allows for it to take place. Take a look at this graphic below which details the”Chain” and the “Frame.”

You may notice the larger, more clear, Blue Frame around the fainter, Gray “Frame of Survival.” As Dr. Nadarajan discusses, in developing countries and developing EMS systems there exists barriers, a wall per-say, around this frame. Things such as:

  • Political Commitment
  • Healthcare Expenditure
  • Legislative Environment
  • Basic State of Preventative Health
  • Traffic Congestion Solutions
  • Cultural Views of Death and Resuscitation
  • Cultural Willingness to Help Strangers
  • Research Environment
  • Road Conditions
  • Reliable Telecommunications

All of these things listed are contributing factors in the prevention of these systems developing, and I think it is extremely important that we pay attention to them and take note of their presence (or lack thereof in our own communities). If I think about where I worked as an EMT in Sewanee and the experience beyond as a student, bystander, and community member, I can say that we too, fail to meet every point on the World Resuscitation Alliances 10-Step Plan; we fail to meet all the criteria outlined within the “Frame of Survival, and the greater Sewanee area must combat against their own barriers that block this frame. What this is to say is that the challenges facing EMS is not a site-specific incident, which refers to the first myth we discussed at the conference – that Developed Countries = Developed EMS. Remember, this is false. There is room to improve in many places, and where I was so inspired during the conference was the times I got to see the work being done by people from all over the world. When you take into consideration the 5 links in the Chain of Survival, you begin to realize that only one of those links include a Hospital, while the other 4 have to do with Bystanders, Community Resources, Dispatchers, Field Technicians and Transport Capabilities. At times it truly feels as if EMS is on of those “Final Frontiers” within medicine and healthcare, even though the whole scope of Prehospital Care is an incredibly large field. This does not negate the frontiers we are fighting in disease prevention through research; however, the bottom line is that EMS is still developing in much of the world and there are a lot of opportunities that we can take to improve it – from education and community resources, to the roads we use and the behavior we have towards those who work in the field – it is a large scope, but of critical importance. I left the conference inspired, having received a new frame of mind, (based of off another “frame” outlined for me) one which I have taken with me to new locations and know that I will continue to carry with me next year as I start school .

(Excuse the excessive lists and bullet points, but I hope that you were able to find these topics as fascinating as I have, and as always, thanks for reading and check back again soon for more! If you are as interested in this topic as I am, I encourage you to take a look at this. Published Just before the Conference, the Global Resuscitation Alliance met to create a document called “Acting on the Call” which details case studies around the world and the opportunities we may have as a global team to improve and follows up from their 2016 Call to Action.)

Bali, Say What? Hey MK!

24 March 2018 – 6 April 2018

Spring Break! Or at least, what felt like a wonderful one.. read on for a pause in time as I trekked further south to Indonesia and back to Thailand for one final week with my sister.

Week 12: 24 March – 30 March

March 24: Im in Bali. What?! Having arrived quite late night on the 23rd / early morning on the 24th, I caught my first true glimpse of the island late morning, as hot and humid sunshine came through my hostel window. I had met up with a good friend I made in Thailand, Alex, who happened to be there for similar dates. We planned the first half of my time in Bali to travel around together – soaking up the sun, climbing mountains, and enjoying the beautiful landscape. Having been able to save some on my budget during the first half of the year, and finding an awesome roundtrip ticket, I started my spring break a little early. We began with a day on the beach in Canggu. Crashing, strong waves of the South Pacific kept us mostly on shore; however, a few refreshing dips were needed with the heat and humidity (and I thought Thailand was hot!). Alex and I met up with other friends she had made while here, and enjoyed a night meeting new people from all over. A second day in Canggu consisted of a failed attempt at surfing. Caught a taxi towards Badung, at the base of Mt. Batur, one of the active Volcanos on the Island. Stopping along the way for a coffee break and view of the surrounding rice terraces, we inched along winding road and arrived at our next hostel, including a natural hot spring at its center. Early to sleep, we awoke at 3:00 am to begin our climb up to the top of the Volcano for sunrise. Powering through the hundreds of others (it wasn’t quite your moment alone on top of a mountain experience) we made it to the top, bundled up due to the vast temperature change and waited on the sun. It came, in full force, dazzled in a beautiful assortment of colors that ignited the green slopes around us. After an early start, a long morning in the sun and hot spring followed. Leaving that afternoon we headed for Ubud, a city centered I the heart of the island, and surrounded by rice terraces and jungle. Alex and I parted then as she was reuniting with old friends from home. Having two final days before returning to Thailand, I rented a bike on my first day to explore the land on two wheels. A full day on the bike took me to an ancient temple built into the side of a mountain, a temple of holy water, and beautiful rice terraces at sunset. Biking along, including a chain that fell off three times, I smiled back at the hundred of smiling faces that greeted me along the road, met local farmers in the terrace and loved every minute of that day. I finished the day by giving a quick FaceTime hello to Mary Kate’s Fourth Grade class to explain what I am doing and answer a few questions! With one final day, I tried out for the second time in my life a Yoga Class – and met an instructor who had taught my sister while she was there leading a Moondance. I explore the Monkey Sanctuary in Ubud, freaked out when a Monkey jumped on my back, and made it out without any items stolen. Having found a favorite restaurant with delicious Nasi Gorung Special, I went back one last time for a meal at sunset and packed my things for an early flight the next morning. The best part of all about this flight was that my return to Bangkok included welcoming my sister, Mary Kate, to Thailand! Woohoo!! Arriving at different airports, the two of us converged to the center of the city and finally reunited – running in a full embrace practically in the middle of the street. We checked into our room that was literally a bed and enough space for our door to open, ate Pad Thai and went for a Thai Massage – a perfect thing after long flights. The highlight was Mary Kate blurting out, “Oh Baby” as her back cracked about 100 times and the two masseuses laughing out loud afterwards. Having saved the experience until MK arrived, we traveled to the 64th floor of a skyscraper in the City, spent far too much on cocktails, but most definitely enjoyed our time above the clouds. With one day left in Bangkok, we traveled into the old city, explored Wat Arun Temple, the Temple of Dawn, and Wat Pho, the Temple of the Reclining Buddha. Taking Boat Canals through the city, MK got a glimpse at the Venice of the East before loading our things and catching a plane to Krabi, Thailand, in the south.

Week 13: 31 March – 6 April

After I had incorrectly booked our hotel in Krabi, we lucked out in finding an even better spot in the center of Ao Nang, where I had previously spent my time during the beginning of my time in Thailand. Waking up early enough before the heat truly hit, we went on a run along the beach, and then cleaned up for a day out by the ocean. Taking a long boat over to Railay Beach, we trekked up a muddy and root filled cliff and back down into one of the most pristine sports we both had ever seen – Princess Lagoon. Climbing down into the lagoon revealed a beautiful emerald lagoon surrounded by likely over 200 foot cliffs all around us. It was a spot in paradise. Climbing back out, we hit the beach, ordered local food on a boat and did our best to not get sunburned. Checking out a night market, we got caught in a down pour, ran in the rain and sat soaking wet listening to groovy music at the Boogie Bar. On Day 2 in Krabi, we trekked up along the Tab Rai Hang Nak Nature Trail to soak in the sights of the south from above. Rains changing our evening plans, we enjoyed a calm afternoon at our hotel and a trip into Krabi Town to check out the Weekend Night Market. Time moves quick when you’re always on the move and sure enough we were already on a plane the next day to Chiang Mai, back north! Arriving, we were picked up by a friend of Gig’s and surprised by Gig herself who was hiding in the back seat. Since Thunderbird was full, we stayed at a place nearby owned by her friend, and it was absolutely perfect! We took bikes out to explore some of the city and the temples within the old city walls and met up in the evening with friends at Thunderbird for a few drinks and dinner out. It was special for me to not only show my sister a place that had left its mark on me, but also the people who contributed so much to my time being as good as it was. On our second day in Chiang Mia, we were picked up early and driven out to the Hug Elephant Sanctuary. We were going to spend a day with ELEPHANTS! Mary Kate saw some on the drive over and already began tearing up. As it was only four of us on the tour, we had a really good opportunity to spend time with the elephants. We fed them sugar cane, took them on a walk, covered them in mud and then splashed around in the water below – it was like a dream. That evening, Mary Kate and I played a family favorite, Spite & Malice, then met up with friends for Pizza and Jazz. On our third and final day, we took our bikes around Chiang Mai University and went on a jungle run/hike up to Doi Suthep to see the temple on the mountain. Trying to soak in all we could, Mary Kate and I tried to fill our time with some final shenanigans and an evening wandering the local Night Bazaar for some shopping, and lastly, one final goodbye to all those amazing friends. We headed back to Bangkok on the 5th, wandered a bit more through the city, and made our way over to the airport for our departures – her back home to the U.S., and me over to Europe. Mary Kate made her way across the pacific while I spent 14 hours in the New Delhi Airport and lastly arriving in Vienna to meet up with a Sewanee friend studying abroad, Cindy!

Photos Pt. 1 – Bali

Not a bad view from you doorstep! Badung, Bali.

The view at sunrise, Mt. Batur.

More Sunrise ViewsSafe to say I was pretty happy. Alex and I at the peak!Morning glow at the top.Parent and Child, looking for stray bananas.Good view for your first time doing yoga!Mary Kate’s instructor, Sheila, in Ubud, Bali!Temple in the Mountain, Gunung Kawi Sebatu TempleMore at Gunung Kawi Sebatu Holy Water Fountains at the Pura Tirta Empul TemplePhoto taken just before dipping in the water for the ritual. A friendly man who helped show me the proper way to perform the ritual.Portrait of the bike that carried me 25+ miles. Mid-bike break to run off through some rice fields, because…why not?

Selfie at the Tegallalang Rice TerracesJust your average monkey business.

One final hike to eat delicious Nasi Gorung Special

Photos Pt. 2 – MK takes on Thailand!

You just cant beat a good massage after a long flightDrinks and wind and smiles on the 64th Floor Sky BarStanding beside the Reclining Buddha at Wat PhoCheck out this Lagoon! Princess Lagoon, Phra Nang BeachWe were pretty excited about it. Making our way back to mainland after a day on Railay BeachDrinks to-go + walks at sunset are hard to beat! Pano-selfie at Hang Nak!Taking crazy photos (mainly to annoy our mother! … Sorry, Mom!)MK meets Chiang Mai friends + Delicious food by the river A day with beautiful elephants!Picture that probably most accurately describes my emotions that day!Taking a bath with the elephants at Hug Elephant SanctuaryOne final evening out after the best week you could ask forWe ordered fish! Saying your goodbyes is never easy, but you can never forget how thankful you are for having the chance to meet. Turns out the older Swedish Gentleman I had a 14 hour layover with snagged this pic of me mid-slumber…Reunited with Cindy from Sewanee in Vienna, Austria!

Chiang Mai, You Have My Heart

3 March 2018 – 23 March 2018

As this post follows my recent quarterly report, you all have already seen the story people reflecting on how all of this. is. so. good. However, I will post the photo again, because it is important to not only read it once, but to return to it as a reminder of just how good it all is. It was in these three weeks described below that the emotions expressed through these words by Brian Andreas began to read true. I got the email of this photo, titled “Crazy Life” on the 9th of March, and it all clicked. I said to myself as I read it, “THAT, is how I feel right now, and how I have been feeling. This. Is. So Good.” Enjoy an update of my final weeks in Chiang Mai, the photos, and ideas that came to me in this time about my project.

Week 9: 3 March – 9 March

I began Week 9, with new orientation with the Chiang Mai office of Friends for Asia. Much of what was covered in Bangkok was re-covered there, but it allowed me time to 1) practice the Thai words I had been trying to learn and 2) meet the new staff and fellow volunteers/interns. It was my 4th week within the Thai Hospital System and it was spent at Ratchavej Hospital, a private hospital within the Chiang Mai District. We began our time in the Emergency Room, but throughout the week rotated around through various surgeries, and the Department of Physical Therapy too. Having spent my previous weeks in public, government-run hospitals in Bangkok, it was nice to get a glimpse at the private sector and begin to understand the differences there. Our German friend, Tilman, was leaving, so we celebrated with him on his last night around the city – eating delicious food, exploring cool bridges, and a bit of dancing to top off the night. Later in the week I went with Morse, Gig, and Aor to a market near the Chiang Mai University and then to watch Red Sparrow at the nearby movie theater. Thursday night, Gig, T, Aor and I found a fun beer house with craft beers and listened to T share stories about his singing (and his performances on Thailand’s The X-Factor! I feel like I know a celebrity). We also raised a little toast towards crossing over the 8-month barrier – an accomplishment in itself, and one that felt so good and full of joy to celebrate. Throughout the week, I had been discussing with Gig and others at the Friends for Asia House about the volunteer rescue services around the city. Gig took me to one service corps and Imm, a FFA coordinator, got in touch with another on my behalf. We worked it out for me to join the Pingnakorn Rescue Team Friday night. After the hospital, a run and some dinner, I joined a group of Volunteers who suit up every weekend to provide first aid, fire, and rescue operations for the city at no cost.

Week 10: 10 March – 16 March

To begin Week 10, I hopped on a bus early Saturday morning towards Chiang Rai. I had signed up for a half marathon and needed to pick up my race gear the day before. Arriving in Chiang Rai, I wandered through the city streets briefly and over towards Wat Phra Kaew Temple, but shortly took a taxi towards my Bed and breakfast that I had reserved nearby the race course. Chiang Rai was very pretty and reminded me a lot of Chiang Mai, but smaller and less busy. To an extent, the city felt like what you may find when you drive through and older, smaller American town. Life continues as normal, but as you walk or drive through the city, you can feel its age, almost as if you too are in a different time. Arriving at the Bed and Breakfast I was blown away. Apparently being the only guest there, my single, twin-bed room was upgraded to a larger double with an awesome porch. At the back of the house was an incredible view of the Northern Thai Mountains and I could tell that looking west, I would get an amazing sunset. To top it all off, there was a big, blue pool that also looked out towards the sunset. It felt pretty close to paradise to me. I went to pick up my race gear and then spent my day having a fun time documenting my one-day vacation. Some pool time, an easy run, sunset and beer, delicious food, phone calls with my sister and good sleep in a comfy bed made out for about as good a day as you could get (all for the price of $15!!). Starting early on the 11th, to arrive at the course for the 5:30am race start, I made my way through the dark streets to begin the race. I was anxious. It had felt like a long time since I last raced and I knew I had not trained exactly like I have done so in the past. The race started fast, with a few guys getting far out in front early on. I decided to hang back – knowing I am all too tempted to start too fast and fall apart later. As the race progressed, I fell into my groove, passed others, and was cheered on by many as we had a long out-and-back section of the course. Coming across the finish line in 1:18:53, I snagged 6th place and 1st in my age group! How exciting! I had so much fun and was reminded, again, just how much I love racing. I spent the rest of that day back at my Bed and Breakfast where I quickly fell asleep in the sun, and later cooled off in the pool. All too soon it was time to head home and return to Chiang Mai. Gig and T welcomed me at the bus station and the three of us grabbed dinner together. On Monday, I switched to the Pediatrics Department at Maharaj University Hospital – one of the largest hospitals in the north of Thailand. I spent two days in the Pediatric Out-Patient clinic and three rotating around different wards in the In-Patient Department. I continued having fun evenings out with friends: we went to new restaurants, saw another movie, went back to the jazz bar and sometimes just hung out at Thunderbird since some had to work their evening shift. I went on a long-run with some friend I met previously at the race and spent my Friday evening with the Pingnakorn Rescue Team again. It was another great week in Chiang Mai, just as every one before had been. Each day fits so well: mixing time for me to explore new contexts of health and my project, time to run and do what I love, and lastly time to spend my day in good company with people I care deeply about. It’s hard to believe I get to fit all of that in one day, and I am so thankful that I do.

Week 11: 17 March – 23 March

Having worked into the wee hours Friday night/Saturday morning I began with some needed sleep, a stop at a delicious breakfast spot and later more good iced coffee – a perfect set-up for a day of blog catch-up (however, as you can see, it clearly didn’t last long enough!) I was entering what really felt like my last week in Chiang Mai, and this also meant my last week I would spend with the special friends I had made up north. As the week progressed, the realizations of this began to take hold. As it was also my last week in the Hospital, I switched gears to another department, Orthopedics. During the week, I was able to rotate around with various students, residents, and doctors to understand a little more about the educational process of medicine that occurs in Thailand. I awoke early on the 20th, (my Birthday!) To be picked up by Gig. The two of us, along with Morse, were heading to a temple to make a birthday offering, which is something done by many in Thailand on their Birthday, among other days. Arriving earlier than opening hours, we placed our offering and received a blessing on a table outside (while a very large labrador decided it would be good to stand on top of the table between us and the monk!). A half day at the hospital was followed by treating myself to another wonderful Thai Massage, a wonderful long run around the local University and an evening out with my friends. We made drinks, ate cake, went out for good food and danced ourselves far into the night. It was a special day, while the days after my birthday were a blur. I finished my final two days at the Hospital, did my best to soak up all I could while beginning my packing endeavors. I had a flight to catch…to Bali! On the 23rd, I boarded a plane to Bangkok, grabbed lunch with a friend there, and then went back towards the airport for a flight over seas towards Indonesia.

Picture Time!

I told you about these awesome people, check them out. Pictured Left to Right: Tilman, T, Morse, Gig and Aor.

We go out to eat delicious food.

We like to take far too many selfies.

Some nights you sit at the bar, and on other nights you take over.

And sometimes we have to say goodbye to good friends. See you someday, Tilman! Pictured Left to Right: Me, Morse, Koh, Aor, Tilman, Gig, and T.

On March 8, we cheers-ed to 8 months away from home, and new friendships made along the way. It was fitting to be wearing my new Watson “W” hat and my Sewanee “S,” as I wouldn’t be here without either of them.

After one week at the Hospital I made my way to Chiang Rai. First step was getting all the Race Gear ready.

Followed by some Pool Time.

After a quick shake out run, I returned for a second dip in the glassed over pool just before sunset.

Pausing as the sun faded, I couldn’t: 1) stop smiling, and 2) being so grateful for all that lies before me

I had a BLAST racing. And I was reminded I still can’t get a good photo while running.

But I sure do love repping my Sewanee Gear in each race!

Post Race, I grabbed some fun photos with new friends…

Made my way to the podium…

And got a good picture with the CRRU Mascot!

The view from the temple Gig, Morse, and I went to on my birthday.I’ve started making a habit of running long on my birthday – this year’s did not disappoint.

Happy about cake!

Friends & Fun! A wonderful birthday celebration.

Project Thoughts:

All of the time I spent in the hospitals while in Chiang Mai were great, and I was thankful to have had the opportunity to see a larger variety of hospital systems than I had been able to previously. As my previous two Thailand posts have already covered much of the work and thoughts originating out of the hospital, I want to finish this post focusing mainly on the volunteer ambulance services I got to take part in.

Sometimes it seems like plans and new opportunities fall right into your hands, literally. Getting in touch with these services began during my first week in Chiang Mai. After a late night out, a foreigner had fallen from the third floor of the hostel I was staying in to the ground below. Unbeknownst to many, this traveler made their way back into their bed and went to sleep only to be found by friends the next morning in poor shape. Waking up in a different room, I walked out that morning to see the commotion that ensued following his discovery. I went in to check out was going on and stayed with the person until medics arrived. Miraculously, this patient walked away without a single broken bone. Having seen ambulances of various forms in and around Bangkok and now Chiang Mai too, I still wasn’t sure who was who: private, public, volunteer, etc. I had walked out that morning to hear Gig say, “Don’t worry, I called the ambulance. They are the volunteers; they’re free and faster!” As she was trying to reassure this person in need.

As the chaos settled, and the week progressed, Gig and I talked a lot about the different services here and we started working on getting in touch with them. Turns out, in addition to the various hospitals (private and public) that staff their own emergency crews, there are also multiple volunteer rescue services. After receiving the equivalent of licensure by the province of Chiang Mai, these services were legally allowed to operate and respond to calls; although, none would receive any monetary compensation for their service.getting in touch with these services and communicating the options before me with the time I had left in Thailand, I managed to work out time on both of my weekends in Chiang Mai to work with a team on the Pingnakorn Rescue Civil Defense Volunteers.

A brief history of the origins of volunteers like those I worked with. If you have the time, I encourage you to go read an article found on The Guardian about the rescue services in the Country. The accompany short film is also worth the time. You can find both here. In it’s origins, volunteer response came out of the efforts to make merit, a component to the Buddhist Tradition, much like that of Karma. Do good and good will come to you. Often responding to fatal car and motorcycle crashes, these services did the hard work of transporting already deceased patients; however, in time, these services began to arrive before some patients had passed. Learning basic life saving interventions and equipping themselves with rudimentary and donated equipment, these services grew from a basic “pick-up crew” into the first responders they are today. Many, if not most, of these volunteers are self supported, devoting their time off from work to responding to calls.

The Pingnakorn Rescue Team was no exception to the above. On my first night with the team, I made my way across the river to the nearest gas station and met the crew I would be working with. Sitting and standing around the back of a pickup truck, about 4 or 5 people were there waiting for calls to go out. In the back lay a spine board and a rigid leg splint made out of sawed off plastic. In the back seat was an AED, a medical jump-bag with an assortment of gauzes, bandages, and saline wash. Also present were more serious mechanical equipment, rope, a few helmets and a plastic bag full of assorted latex gloves. Arriving, there was only one other who really spoke English, while the others had a few basic words. Waiting around the truck, the man who I would soon find to be the head of the crew would intently listen to his radio receiver for any call that came out. Knowing only my numbers and a few other Thai words I was able to make out that dispatchers were giving out calls based off of regions in the city delineated by numbers, but I had no idea which number we were. Soon enough the truck started, and I heard a quick, “get in, we’re going,” and we were off. Two in the front and three of us in the back of the truck holding on to the edges, we raced down the street as a second car followed us with their lights on as well. We arrived first on scene to a man with a gunshot wound to his foot. Within seconds of arriving, sirens from every direction descended upon our location and soon enough there were 2 other ambulances, 3 motorcycle medics and 2 police cars. The neighborhood was awash with blue lights. Having only rudimentary transport, we passed the patient to the truck that had a stretcher and closed rear. Everything in front of me had happened quite fast, but I was amazed to see the coordination of all these different rescue teams. When I was applying for the Watson, I had a professor ask me in a preliminary interview, “do you think you’ll be able to get involved? Is there some sort of fraternal/brotherhood of EMTs around the world?” I wouldn’t quite say this service was a brotherhood, but they sure did act like a well oiled machine and were happy to see their friends who had also responded. As the night continued, I would see this again and again on different calls until lastly we stopped for the night at their friend’s street food cart and sat watching Muy Thai, eating Tom Yum soup, and waiting for the next call. For me, it was an incredible way to start my time with them.

I went back the next weekend for two more nights and continue to run calls in the back of that flatbed. As I would learn, this team works only weekends because of their weekly work schedule, and everything on the truck is self supported. The husband and wife in charge shared with me through the English they knew, “we do it, because it’s the right thing to do, and we can.” In the world of EMS, people often say that if you’ve seen one EMS system, then, well, you’ve seen one EMS System; however, I suspect the mentality and mission expressed by those I worked with is shared among many of the volunteers in Thailand who devote their time to this work. The majority of our calls were in response to motor vehicle accidents, while others were non-patient related, mechanical aid that our team also knew how to work on. At times too, they would don firefighting equipment and respond to the nearby fire when more help was needed. The truck that they worked out of sort of became a jack of all trades – ready and willing to respond to whatever sounded off over the radio waves. So to were the people inside it.

Of all the ambulances and services I had communicated with thus far along my year, this was by far the most rudimentary I had seen; however, the spirit filled within those who worked for the service were on par, if not rivaling many of the other services. There was such clear devotion to their work, a desire to improve, to learn more, and be better. As I have come to find this year, when I ask about how systems of emergency care provide for and create community, I find more and more that it is really, in fact, the community themselves that play an integral part in this creation and support. The volunteer rescue workers I was with were a perfect example – the community committing themselves to service in the service of others. To those at Pingnakorn Rescue, thank you for giving me the opportunity to work along side you.

While at the Pediatric Outpatient Department, I had a great time with the Nurses who showed me around and let me work with them.

Working with the Pingnakorn Rescue Team for the first time reminded me that as long as you’ve got your hands with you, you can get involved and help.

One of the coolest parts was seeing just how many personnel arrived on scene

A large majority of the calls we respond to were motor vehicle related incidents.

On call, we wait at a nearby gas station and wait for dispatch to send us out.

Thanks again for stopping by and reading on about my time and work abroad. More coming soon.

– Mark

Winding Down and New Adventures

17 February 2018 – 2 March 2018

May 1, 2018: Welcome back! As I have been trying to catch up with all that has been happening, here is another update for you to read on. Below details my last week in Bangkok, and the incredible week I spent exploring Chiang Mai and the surrounding nature. In my last post, I detailed how good I felt, much of that feeling originated in that time of exploration and learning in Bangkok, but the feeling of confidence and wellbeing was reached a new level in this third week at the hospital and as I transitioned to Chiang Mai. I wanted to share a portion of a journal entry that comes from the thoughts and emotions I have been having. For reference, when I was in Spain for only a few short days, wandering the streets, I turned and looked at my brother, Rob, saying, “there are so many people in this world.” We both laughed a bit, as it is kind of a silly observation to make; however, I keep having these feelings where in immediacy, that is the thought I have: there are so many people in this world. But as the feelings sinks deeper, it expands as I begin to think about the lives and stories of all those people. When you really take the time to think about it all, it can be quite overbearing (in the best of ways).

“One of the greatest things I am learning this year is the magnitude of life itself. Have you ever thought about a beating heart? I am sure you have felt yours before and perhaps one of those you love – a parent, a child, a friend, a significant other. But what about the one of the person in the coffee shop beside you or in the car at the red light? I saw one two weeks ago, open, beating, and then not. Two hours later, that heart started beating again, pulsating, rhythmically. Have you ever thought about ten of those hearts beating? That entire coffee shop? 1000? The pulse of a city, a real pulse. The collective hum and drum, beating. How about an entire province’s, a state’s, a nation’s? Have you ever though about every beating heart heart in this world? 7.5 billion of them, beating 60 to 100 times every minute? Can you think of that? I can’t, but I like to try. The world is pulsating, rhythmically. The magnitude of this thought, the magnitude of life itself increases when you begin to think about which one of those just stopped? Which one of those just begun? The ones that ache in pain, and the ones that burst with joy. We all ‘march to the beat of our drum,’ but at times too, those beats align, and there is power in that synchronization. It’s quite hard to put into words, and it sometimes feels as if this expression is a bit over the top, but these are the thoughts I am filled with more and more this year as I travel, as I meet new people, as I look out into the crowd across from me. It is feeling the enormity, of this world all at once, and I absolutely love it. ”

Week 7: 17 February – 23 February

As it was the last day for other interns (I was continuing on for one more week) I trekked back with them by train to Ayutthaya. Although I had already seen much of the city, I was happily surprised to be able to see new parts of the ancient city I had not seen before. We all hopped in a Tuk-Tuk and explored the city a little more calmly than my previous bike trek! That evening, after a long day out in the sun, I went back towards my favorite Massage Studio, got an hour and a half Traditional Thai Massage and couldn’t have left more content! In my third week of interning in Bangkok, I switched to a new hospital called Sirindhorn Hospital. This time a bike taxi, BTS Skytrain, Airport Rial-Link and Car taxi would be my mode of transport (simple, right? -haha!) To say the least, the week was awesome. I was stationed mostly in Internal Medicine, rotating around with the different Interns who were working there. I began my mornings in the In-patient Ward, even getting to experience a few surgical procedures, mid-day in the out-patient ward, and afternoons in the ER. Pausing halfway through the day, all the interns, doctors, and myself from Internal Medicine ate together and it was through this time that I really was able to get to know people well. The week left me asking new questions about how I want to pursue medicine in the future and the relationships I wish to make through that time. I spent my evenings that week with new Thai friends I had made and one evening out with the interns after shift to share a traditional meal, incredible dessert, and teaching a new word to them: “Food Coma.” With all that happened that week, it was hard to believe that it was already over and that I would be flying out of the city the next day.

Week 8: 24 February – 2 March

With an evening flight to Chiang Mai, I had plenty of time to pack in the morning and say a few goodbyes to the friends I had made while in Bangkok. My departure there was a reflection of what has often occurred. This Watson Year has taught me many things, among them being that i get the opportunity to say hello to so many new and amazing people, but also that I have to at some point say goodbye, and hopefully a see you soon; however, in this practice I have also learned to better focus on the experience that WAS shared, rather than the experience that comes with the departure. To have had the opportunity even in the first place to meet these amazing people is a gift, and although I do have to say goodbye, I give thanks for having had the chance and the time to meet them.

I checked into Thunder Bird Hostel (which I give a shameless plug to it being the best hostel I have stayed in to-date). Originally planning to stay two nights, and perhaps go else where for a few days before settling down in Chiang Mai, I ended up extending my stay for the week mostly due to the amazing staff that I was able to befriend. I spent my first day solidifying a few plans for Europe and the United Arab Emirates (exciting!!) and the afternoon wandering the city to explore some of the ancient temples here. Living in Chiang Mai, you can very clearly feel both the new and the old as you walk through the streets. Ancient pieces of the city still stand on street corners next to newly built houses and apartments. There is a coffee shop, hostel, and art store on every corner. There are plenty of tourists, but interactions among locals and foreigners seem friendly and welcomed. Coming from the hustle and bustle of over 8 million people in Bangkok, its nice to downgrade to just a few hundred thousand! You really can feel the difference. One of my favorite parts of the city is the moat/old city wall that separates the technical “old city” from the “new”. Each side spans a mile, and is a perfect spot for an evening run as the heat fades away into the night. I booked a trip on my second day to Doi Inthanon National Park. Originally hoping to camp, but not really finding the right options to do so, I settled on a tour that would take me to some of the highlights. Doi Inthanon is the highest peak in Thailand and is at the very base of the Himalayan mountain change. Climbing up high, I welcomed the slight temperature from down below. The park has many great sections to it, but two of the most beautiful were the twin pagodas constructed in honor of King Rama IX and the Queen.

As the week progressed, I began to get to know the Hostel staff a bit more and enjoyed sitting in with them at night having good conversation and learning about their lives. The following day, I unexpectedly got to experience some EMT work as a foreigner needed help as we waited for an ambulance to arrive to the Hostel. In the afternoon I embarked on an adventure run to a few waterfalls I had read about. Originally miscalculating the distance to my final destination I was graced by a free ride from two guys in my hostel to the top of Doi Suthep for an awesome view of the city and a beautiful temple. The three of us spent the evening meeting fellow travelers and going to a Jazz Bar. You quickly learn how many awesome people you meet and then say goodbye to within a span of 24 hours – and in this too, you learn to give thanks for the time you did spend, not the time you didn’t. The next day, I trekked out to Bua Tong Waterfalls, otherwise known as the “Sticky Waterfalls.” The limestone formation of the falls create a sticky surface for you to walk on. As water rushes over the rocks, your feet have no problem scaling the falls upward. It was surreal to be doing such a thing! On Thursday, I travelled with T, one of the Hostel Staff who had a day off to the Grand Canyon Water Park – an old quarry now filled with beautiful clear blue water. Fairly regulated now, we were still able to have some fun in the sun with a few cliff jumps as well! I made a second attempt in running to Doi Suthep, made it to the top for sunset, and enjoyed an adventure run down the mountain in the dark. Later that night, I met with the hostel staff who were off from work and joined them at Wat Chedi Luang for a ritual as it was a special Buddhist Holiday called Wian-Tiane. It was special to get to walk beside new friends as they practiced a special part of their own religion, and to be welcomed to join them in that walk. On Friday, I moved to the new volunteer house, and spent the day at Huay Tung Tao Lake with Thai friends from the hostel. We had a bamboo bungalow to ourselves and were able to swim, relax, and eat good food.

What was so special about this week was the people I met through Thunderbird Hostel. It’s hard for me to keep calling these people the “Hostel Staff”, because very quickly they became much more than that to me. They are my friends, my very close friends. As you will see in the posts to come, most of my days end with them – on a new adventure to find good food, going to see a movie, playing games, or just sitting together and enjoying our time together. These people: Gig, T, Aor, Morse, Koh, Sander, (and Tilman who has now left) made and continue to make my time in Chiang Mai so special.

Picture Time!

Back in Ayutthaya with Jessica, Bryant, and company, I got to return to some old sites and some new, like this one at Wat Yai Jaya Mongkhon.

The five of us posed one more time at Wat Maha That.

Arriving in Chiang Mai, I took my first day to tour the old city and some of the temples within it, like this one: Wat Chedi Luang, which had partially collapsed after an earthquake.

The Tha Pae Gate, or East Gate, at the edge of the old city in Chiang Mai lights up at night, especially on Sunday, as it is the beginning of the Sunday Walking Street Market.

My trek to Doi Inthanon, Thailand’s highest point, stopped first at the Wachirathan Waterfall.

Wachirathan Pt. 2

Near the peak of Doi Inthanon are two enormous pagodas in memory of King Rama IX and the Queen.

The Pagodas overlook an incredible view.

Posing at the highest point, there wasn’t much of a view, but awesome to say I was there! This is one of the few places it ever gets cold in Thailand.

The last part of the day included a hike around the surrounding area. We were greeted with stunning views.

Stunning Views and Me, Pt. 2

My Adventure Run later that week brought me back to one of the things I love most, trail running. (Kinda looks like Sewanee!)

Finishing at refreshing waterfalls was a nice plus!

Later in the week at Bua Tong Waterfalls, or the Sticky Waterfall, Tilman and I raced to the top!

The falls were an awesome playground.

T, Tilman, and I spent one morning at Grand Canyon Waterpark, a water-filled quarry. It was a great place to relax and make a few awesome jumps!

A second Adventure Run that week brought me all the way to the top of Doi Suthep, for an incredible view of the city and mountains below at sunset.

After that run, I joined T, Morse, Tilman, and Gig at Wat Chedi Luang for a ritual around the Pagoda. We carried Lotus flowers, a candle, and three pieces of incense.

To close out an epic first week in Chiang Mai, T, Morse, Tilman and I relaxed at Huay Tong Tao Lake underneath some bungalows

I couldn’t resist a dip in the water though!

Project Thoughts:

After what now seems like ages ago, I spent my last week in Bangkok at Sirindhorn Hospital in the Internal Medicine and Emergency Departments. Having been strictly in surgery during the weeks before, I was excited for a change of pace and the opportunity to see a different hospital than the one I had previously been in. Sirindhorn hospital is situated a little more centrally within the greater Bangkok metropolitan area and differed mostly in that it is not a teaching hospital; rather, it is just a government public hospital within the city.

Some highlights and key things that stood out to me in the week are as follows. On my first day, I sat with a doctor in the Internal Medicine Outpatient Ward and saw over 30 patients in the first two hours. (I was later told that she, the doctor, was behind schedule on how many she should have seen in that time. Doctors in the various outpatient clinics sit in a room, all lined up along a wall, and hit what is essentially a “next” button on their computer that rings out the ticket number associated with a patient outside. Within a few seconds the patient walks in and sits down to discuss what is going on with them. Some come in with specific complaints, whereas others come in for a general Well Check-up. I had a hard time justifying this practice in my head. Well Check-ups included a chest x-ray, a short conversation, but nothing else. No physical exam, or anything of the sort. One could argue that the ability to see so many patients is beneficial in that they DO see the patients; however, I have to ask to what point does it benefit the patient when there is not even as much as a physical exam and routine checklist of questions to go through. Some of these wellness check-ups lasted under 90 seconds.

Seeing this on repeated accounts led me to begin asking a few questions about how it came to be that so many people come to the hospital on any given day. One response I received was the fact that there is universal coverage for anyone who visits. Sometimes a patient would walk in to the doctor’s room and state that they had a headache or symptoms of the common cold. The doctor more often than not would prescribe ibuprofen or something similar and send them out the door. This system of health care, as I previously mentioned, will cost the patient no more than one U.S Dollar. Thus, a visit to the hospital for Ibuprofen will cost less than a personnel visit to the local drug store to pick it up over the counter. Because this is the common practice, many doctors I worked with believed that it has caused there to be an increase in patients who come to the hospital.

One of the difficulties I saw firsthand with the 30-Baht system, was with a man who had come to the Emergency Room for a broken hand. Under the current health care system in Thailand, individuals are zoned to a certain hospital, and thus have to pay out-of-pocket when they go to any other hospital. A worker who had been injured while on the job in the city came to the nearest hospital for an X-ray. We learned that the patient lived about 3 hours north of the city, and was therefor not zoned for this hospital. He would have to pay out of pocket for any treatment offered, including the X-ray. The doctor I was with signed an “emergency treatment” form to overrule this, but noted that not all doctors will due so, which makes it difficult for some patients in need. Patients in rural areas are zoned within their rural area, and can only received covered care at a larger hospital if they are referred to it by their zoned facility. It was little restrictions like these that frustrated me when it came to thinking about a patient’s free right to health care.

On some days I joined a senior doctor in the Inpatient Ward of Internal Medicine. With windows open, fans blowing, and AC only flowing within the doctor and nurse fishbowl room, the ward was stifling, and it was hard to see so many people in recovery who were sitting there. Some patients needed procedures done on them, such as draining fluid from their abdominal cavity, or placing a temporary catheter for dialysis. The doctor I was with wanted to teach me these procedures, and I nervously accepted being sure to check that as long as he was okay with it then I would be willing to learn. First watching both procedures on different patients, I was guided by a confident voice and gentle hand and successfully performed both procedures. (See below for a photo of this!) I was grateful for the trust this doctor gave me, and was reminded that no matter where we are in the world, there are those who are willing to teach as long as you are willing to learn. It was moments like these during that week at Sirindhorn that made me really feel like I had a place there and was welcomed. I ate each day with the doctors, and even on some occasions joined them in the evening for dinner. They seemed to understand that I was truly there to learn from them, and because of it, were welcome to share.

A lasting thought that stood with me was when a nurse said, “I get to make people happy, and that makes me happy.”

As I was ending the week at Sirindhorn, I wrote this in transit, “The ebb and flow of an emergency room mimics to an extent that of an ambulance station on the street. Often times it is quiet. Staff talk, eat, look on their phones, touch base on the past case, or tell a story about a crazy call they worked a while back. And then at times, all alarms sound at once without a moments notice. Everyone is ready, on standby at all times. This is life for them day in and day out, but is hidden behind closed doors, not only from the rest of the hospital, but the outside world too. Ambulances are the same. We see them and we see their sirens, but we rarely know their stories. I find this to be a unique practice of medicine. In other practices, you can generally predict whats going on, where — to a degree: Heart Disease in Cardiology, pregnancies in Obstetrics, etc., but not in the ER. Too often, not even the staff knows the general subject of the next case to be wheeled in – nor do the medics who respond to a house call, a motorcycle crash, a fire – theres no telling the extent of trauma they may find, but still they stand, ready. I keep coming back to the central question of my year – how do systems of care create space for community to live? It can be hard to see how this cares for the community in an outward practice, especially given that all of it occurs behind closed doors. But I think to a large degree, it is the reassurance that lies in knowing that those doors do exist and are always staffed on the other side. I am inspired that this exists in all the places I have been. I know that I haven’t always found myself in the absolute most rural environments that you can find, but to see these practices continue, at whatever measure a place has the capacity to do so, is inspiring to see.”

The nephrologist on call at the Internal Medicine Inpatient Ward guided me as I placed a temporary dialysis catheter in the internal jugular vein. Thankful for his trust and willingness to teach.

Some of the medical Residents at Sirindhorn Hospital took me out to eat at a local spot they love.

Finishing my last day at Sirindhorn, we grabbed one more photo with the Internal Medicine Nurse Team and the Dr. Niracha, who I had worked closely with.

Dr. Patiwat (center), Dr. Niracha (right), and two other interns I worked with in that week took me out for one last meal. It was a great week at Sirindhorn.

More updates (aka catching up) are coming! Stay tuned, and happy May!

A First of Lasts; My Third and Final Quarterly Report

April 19, 2018 – Day 284 of 371. I have crossed the threshold of nine months, moved through three new countries and returned to one old in two weeks, and have officially bought my return ticket home. All throughout this time, I have been continuously riding the wave that is this year and being sure to soak up every last drop. Below you will find my last reflection sent to the Watson Foundation prior to returning home. In it I describe my ever-growing deeper understanding of what this Watson Year truly means for me and what is coming up in my final chapter abroad.

“I was happy and knew I was happy, the happiest I’d ever been. Not blissful, joyous, angels-coming-out-of-the-clouds happy, but happy as in ‘a feeling of great pleasure or contentment of mind, arising from satisfaction with one’s circumstances.” Happy from hap, as in what happens—things as they turn out to be.” – Victoria Sweet, excerpt from God’s Hotel: a Hospital, a Doctor, and a Pilgrimage to the Heart of Medicine.

Watson, if there was a way to quantify how many times I have found myself walking down a street in Thailand, a Soi (alley) for that matter, feeling a grin creep across my face, bursting into a smile I literally cannot contain – emotions overflowing to the point where I can do nothing more than to raise my hands jubilantly in praise, admiration, and most of all, thanksgiving, this letter would not end. Rather, I will leave it to your imagination the imagery of a very blonde-headed Farang (foreigner) wandering the back alleys of Bangkok and Chiang Mai doing such things. That was me. I have walked these streets, whispered to myself, “I love this life” and realized again, and again, and again that, this. This life. This year. This World. Is. So. Good. Although I leave Thailand today, the emotions which grew inside me there will undoubtably continue as I transition onwards, along this rich and full life given to me. Watson, does it have to end? I mean this, this life, all that this year holds. I do not want it to end. I have asked myself these questions on numerous occasions in the recent weeks. I think the most beautiful thing I’ve learned in this past quarter is first, the realization that I do not want this to end, and second, the subsequent answer to myself, that no, it does not have to. In fact, it is quite the opposite: it will not end, but continue, as the movements and experiences of this year weave themselves into the life that is to come for me. It will permeate all walks of my life – within myself, my relationships, my career. I will be moved, just as I am now, by what has come (and thankfully what remains to come in these last three months). During my Third Quarter, I read God’s Hotel, by Victoria Sweet, who accounts her career at Laguna Honda Hospital, the U.S’s last Almshouse, a long-term patient-care hospital. In the process of her writing, she accounts both the historical origins of medicine, as well as the journey in which she undertook during her career, both personally and with patients. Finishing this book in the midst of all the emotions described above could not have been more perfect, and thus I am choosing to share a few of her quotes – not only has her writing stuck with me, but I deeply resonate with her words, finding the descriptions and the emotions of her experiences reflections of my own.

First, a brief recount of all things Thailand. Arriving to Bangkok, I gave myself a few days to adjust to the drastic time change, while finalizing future internship plans within the city and in the north. Soon after I took a trip to Krabi, Thailand to first see the southern part of the country. I wasn’t sure whether my future plans would bring me back south, and thus I tried to see all I could in the time I had. I had just written in my last report that I had been finding the importance in separating my life from my project; however, arriving in Krabi, I came to realize what I had just written was indeed the opposite of what I was experiencing. My eyes have slowly been tuned to look towards my project – of course in the hospital and in the ambulance, but they too have attuned themselves to the streets, the passer-by’s, the clinics advertising themselves to foreigners rather than to locals, the families of four all positioned on one motorcycle: daughter in front, dad’s arms wrapped around driving, mother holding with one hand, cradling their baby in the other. “Care.” The relationship I have with to that word, that people in these communities have to it, that this country as a whole has to it is no longer separated to a project day or not, a “project activity” or not; they are both, simultaneously. Each day I am called to the opportunity to both seek out the questions I hold within my project and the questions I hold within myself. Returning from Krabi to Bangkok, I had about two weeks on my own before starting an internship with a local organization. Having hoped to set up a few contacts with emergency services in the city, I continued to face a few setbacks and had to reorient myself. These two weeks turned out to be time for much needed preparation – intermixed with sightseeing and learning about beautiful Bangkok and beyond. As I would soon find, time to do both of these things would soon come to an end.

At the very beginning of February, I started working with a local organization that provided access to, among other things, hospitals within Thailand as a form of Medical Internship. Beginning in Bangkok, I spent two weeks in the Department of Surgery at one of the larger teaching hospitals in the country, named Thammasat University Hospital. Following those two weeks, I transitioned to the Department of Internal Medicine and Emergency Medicine at Sirindhorn Hospital, where I felt I really began to come alive in my comfort in seeking out new opportunities to learn from the doctors on call. Ending all too soon, I was able to get to know the local Thai coordinators, spend good time with them and their friends. It was during this time I felt like I was not only starting to meet people from here, but building relationships with them as well. Near the end of February, I traveled north to Chiang Mai – having first a few days to explore the city and surrounding mountains (boy, did I miss them!). I stayed at the most incredible hostel and met the most incredible people, who also would soon change my Thailand experience into what it is today. Later, I spent a week in a private hospital through the same organization; I got a glimpse of the private sector of health care, and then transitioned to a fourth Hospital in Thailand for my final two weeks of interning. During that time, I spent one week with nurses in the Department of Pediatrics and one more in the Department of Orthopedics. Throughout my time in Chiang Mai, and with the help of the new friends I created, I learned more about the rescue operation services, namely the various volunteer organizations who operate in the area. On two weekends, I joined the Pingnakorn Rescue Civil Defense Volunteer Corps. Waiting at a gas station, beside a friend’s stall of street food, we relaxed by a pick-up truck and waited for calls to sound off over the radio waves. I celebrated my birthday by making an offering at a local temple with good friends, spending a day at the hospital, getting a massage, running through beautiful landscapes, and taking a pause for some fun celebrating in the evening with new, now eternal friends. It all came and went so quick; I took a surprise trip to Bali, Indonesia, getting to see the sights of the islands, and really loving the brief, yet significant interactions I had with those who lived on the island and returned for one final week to welcome my sister on her spring break. Blasting through the north and south of Thailand, we were adventuring non-stop, but most significant was the opportunity to show her those who have imprinted something special on my heart. It meant so much to be able to share a large piece of what has made Thailand the way it was, and for her to see me “in my element” was a perfect way to close.

I had mixed feelings going into my internship. I was weary of being “stuck” with one organization for too long, as has been encouraged by you all, but was comforted in knowing I had set plans in the time ahead of me. What would I learn through a surgical room about patient care? And the community? That was tough, but soon I was able to find new opportunities in the ample access I had to health care personnel. My time in the hospital not only allowed me to see new aspects of health care, but it also gave me time to communicate with those who work on the “receiving” end. Ambulances bring patients, hospitals receive. Care doesn’t end in the ambulance, nor does it when the transfer to the Emergency Room occurs; it permeates into the hospital, throughout it’s corridors, back out the door, and far too often back in again. These weeks in the hospitals have also revealed a huge, but exciting new avenue of pursuit for me. Public health, specifically, with a global focus. I cannot wait to get started on my medical degree upon returning; however, the sights and questions that have come to me along this year have caused me to also seek out a deeper understanding of our Public Health, and the relationship we have to it. It excites me to be coming out of this year, with a new piece to the puzzle that I aim to fit into the journey ahead.

“A pilgrimage is a journey for spiritual reasons, but with a material goal—a shrine, a church, a mountain. It comes from the Latin word for pilgrim, peregrinus, from per ager, meaning ‘through the territory.’ A pilgrim, therefore, is someone who leaves home to travel ‘through a territory’ that is by definition, ‘not home,’ and so has the wider meaning of alien, foreigner, stranger…The pilgrim leaves home in order to experience being a stranger—speak a different language, eat different foods, encounter different expectations—to experience otherness as the other.”

Reading this first, the only word I could find was, yes, a thousand times, yes. Each day brings a new journey. I have learned that there are days I plan to be great, but turn out the opposite, and there are days that I expect to be long and slow, yet they turn out to be absolutely wonderful. On a Pilgrim’s Journey, or on a Watson, there is no telling what the day will bring – yet I do know that the next day comes, and the one after that too. Each day brings something new. At times that newness comes in the form of direct involvement with my project, and sometimes it shows itself to me in new friendships – some of which I long to return to. Still on other days, I find that quiet solitude I have come to know and love, perhaps via biking through back alley streets of Ubud, Bali seeing every smiling face look at you while you smile back at them, or on a solo trip north to run a half marathon and high-fiving other runners as we pass each other in opposite directions. How am I growing? Well, I think I am learning to live into this year for what it is – much more for what it is than what I want it to be, and it is through this that I find myself walking down that street smiling and throwing my hands in the air. My eyes have been increasingly opened wider to the people around me. To the man on the street I always go to for delicious food – the friend who affectionately calls me More (Doctor) as a nickname, or the other who says I am Uncle Marky-Marky after her pregnancy reveal. This quarterly report feels a little different than previously; there is no long list of the things I’ve learned, or numerous new questions that have come to mind. Perhaps that is because those initial things I was learning, I know I still am, and those questions I first posed still remain, but it’s the synthesis of it all that I am finding within these three months. A Pilgrim’s Journey indeed brings new truths, and leaves you with more questions, but as one continues, I think the Pilgrimage also teaches you to at times just move “through the territory,” “to experience otherness as the other,” but most importantly to live into the idea of hap, the Latin root of happy, “as in what happens—things as they turn out to be.” As the third major leg on my Watson Year closes, the third leg of my pilgrimage closes too. I walk away having learned to live into this, this life, this world. Perhaps too that will be one of the greatest gifts of all. The future will not always include plane flights to new, unforeseen destinations, to new cultures, new food, and new people. No, this life will include long hours in the library and hard nights in the hospital, but how wonderful it is to know I can carry this mindset with me as I continue along this year. To know I do not have to leave it at the gate when I cross back over to Europe now, or Tanzania later, or home in the now not so distant future. To have had my eyes opened to this, I am grateful, to you, Watson, for the opportunity, and to Thailand, and her people, who I believe truly helped open my eyes to see these things.

So, whats up ahead? Well, it looks pretty jam-packed to me, and that is so exciting! Leaving Thailand was one of the hardest goodbyes I have had to make, but I leave knowing I also get to return to a familiar place, and a family who helped begin this year for me. I am in transit now towards Copenhagen. With Visas ended in Thailand and the conference not beginning until next week, I have a few days in Transit through Europe as I make my way North. Landing in Vienna, Austria, I will see over a few short and sure to be fast moving days Vienna, Budapest, and Berlin, ultimately arriving in Copenhagen on the 15th of April and staying until the 21st. Leaving then for the UAE, I will first stay in Dubai and later to Abu Dhabi to get to know one of the major Emergency Rooms and Ambulance system within the city. On May 5th, I will depart for Tanzania, where I have planned the remaining two months of my time as a Watson. Beginning first in Dar, I will be involved at the Emergency Department at the National Hospital, and hopefully tap into the rescue services there as well. As time grows, I will move outwards through the country and north towards Arusha. There really are a lot of great things in the works – much of which I have reflected upon and wondered how so much has come together all at once. Thinking first that I just had better “luck” than the slower paced days of Denmark and some of Chile, but realizing more now it is the experiences from both of those places that taught me to pursue what I have in Thailand and what I am soon to do so in the countries to come.

The Watson is not only a Pilgrimage, it is a Way, a clear Way of life that pulls on the things you once knew, drags you both willingly and unwillingly all the same into the thick of it all, and yet still posits you on the cusp of something truly, inexplicably great: that is, everything else – life and all that it has yet to hold. Through these nine months I have ebbed and flowed between highs and lows, and just about every emotion in between. In the last three months, I have awoken each day with an energy I once did not know I had; I have, glanced at the world and wondered what the heart beat sounds like of my neighbor across from me, I have gazed out upon beautiful landscapes and asked myself how we all got so lucky to have this Place, and I have looked inwardly to myself and discovered more about myself than I could have ever thought.

“But no matter what the interior quest, the Way was a way of life, and what he wished for us was that, with the sound of our footsteps, whatever we were seeking would fill us to overflowing.…The thing about a pilgrimage is that there is no way to experience it except to do it. In that way it is very much like life….So nothing went by us too quickly; we were not tourists but actors in a landscape made to the measure of our footsteps.”

“We were not tourists, but actors in a landscape made to the measure of our footsteps.” My experience as a Watson could almost be entirely summed up into that final sentence. On some days those steps are quite small, sometimes they do indeed look like a tourist, but on other days they are big, they bound, even leaping at times into this world with people I never thought I would meet, with sights I never thought I would see, with questions I never thought I would ask. Watson, This. Is. So. Good.

Happy Spring from Copenhagen. I wish that you may be well wherever you find yourselves. Thanks for checking in.

-Mark