Medicine, the book Overtreated, the path forward with an eye on the past . . . .

I just finished reading, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. Shannon Brownlee is the author.

I read most of this while I was in Fiji. The reading of this book and my experience in my last position has convinced me that I need to do primary care, have a long-term relationship with my patients (if at all possible), practice in a community setting with an organization that has ties to the community and is part of that community and not solely there to extract money for services without adequate follow up. Shannon Brownlee has written an eminently readable book and I highly recommend it.

So I am out looking for this kind of organization, one where I can use my medical background but also my Masters in Psychology. I have a lot to contribute but want to use ALL of my talents and education and especially to be appreciated. I also want to be in a learning organization (however small). Maybe I will just have to end up in a Doctor's Office, who knows.

Yet at the same time I am looking to get back overseas with the Loloma Foundation (a link is to the right under medical work in Fiji) doing medical projects and other health related / learning development projects.

Thanks for reading. Leads and thoughts appreciated.

David

Future of power

Every little bit makes sense, no? This is a wind farm on Highway 12 in Northern California. Admittedly not a great shot (my Iphone at about 60 miles per hour!) but they are many stories tall. I would love to be able to have one of these or its smaller cousin on my family ranch on Seaview Ridge. Someday perhaps we will.

David

RN's at Colonial War Memorial Hospital, Suva, Fiji

 

These folks were kind enough to show us around and let us take some photographs. Love the uniforms!

United States Department of State

Aloha . . . a long time ago, at least for me, I graduated UCLA in Political Science and took as many classes as possible in International Relations. After graduating the Peace Corps gave me more experience on a very basic level. While I plan on staying in medicine I am going to take the State Department examination this March.

I have friends with State, currently in Reykjavik. There are a lot of great people in State - I have met many of them over the years and it would be a difficult job especially in todays climate. Nonetheless, it might be a way to make a difference in some way. I'll do my best to pass the test although I know most people do not! International Service calls to me though.

At times I almost feel desperate to make a contribution, a lasting contribution to make things better. I am working on it.

David

A fine day

A fine day to ride at Annandale State Park. I know you can't see a lot
here but at least there is some light and clean blue sky. On this day,
life continues, world orbits, people love, we learn, babies are born.
Life is exactly what it is in each moment. I'm not too profound today
but while we strive to change it, it is busy changing us. Wisdom is
learning that, and just maybe each day I get closer to it? At the very
least, I make the attempt.

Moves, Movies, Movies

Aloha. Last night I saw Atonement and this evening, There Will be Blood. Two very different movies but both thought provoking. One wistful, memories tinged with sadness, shame, guilt. The other full of mystery, questions of birth, death, endless anger. I enjoyed both of them but there was such sadness in each and perhaps in only one, redemption.

See them.

David

Robin Taylor, Academic, Entrepeneur, intellectual and great friend

 

Taken February 4, 2008 in Suva, Fiji at Robin's wifes shop. They also own a Hair Salon directly across the courtyard from this. Robin recently started a new Primary School in Fiji - once I get the web address I will be sure to post it! I am very happy to be in touch with Robin and his great family. More of the wonderful crowd I know in the South Pacific.

Thanks for reading,

David

Friends in Germany

Aloha and Guten Tag . . . just spoke with my friend Benno in Germany. I grew up there as a kid for three years. I met Benno at the University of Hawai`i over 17 years ago now and we have remained close. We just spoke and I am reminded of the meaning of true friendship and love that we have with our friends.

In addition, I had a friend from Hamburg recently get in touch with me also after some 20 odd years. She flies for Lufthansa and lives in Hamburg. I am getting them both in touch with each other.

Someday, and I hope not at my death, I hope to have a meeting of all my friends at once from all around the world. How many languages would be at the table? How many cultures and customs would we add up? Damn that would be fun!

I miss all of my friends right now, where ever they may be in this world.

Tschuss, moce, malama pono,

David

Sometimes Change is a Forceful Gift.

Sometimes change is forced upon you. At times, if you are lucky or as you get more experienced, you begin to recognize that the change being 'forced' upon you is actually the best and most correct thing. You may not like it, I know that I don't, but lessons are learned, sometimes in the most difficult ways.

Needless to say I am at that point now. It is even more difficult for me right now because of my recent return from such a fantastic trip to Fiji, filled with kind and giving people, welcoming in the extreme and coworkers that nurture and teach, instead of searching for fault, micro examining and laying blame. I take this lesson upon myself, no one else but damn, it sure is a rough go.

But then I must think of the positives, clean water, hot water, too much food, shelter, peace and no one threatening to kill me. I keep those in mind and it helps a great deal to retain perspective. My heart still aches but good to be humbled and forced to accept that give of learning. ACCCKKKKK! I still want to scream though!

I am sorry I cannot lay this out in detail. Perhaps someday? Thanks for reading and as ever, I remain grateful.

David

Final Approach

Design

The ceiling of a bure (house) at Navutu Stars Resort. Note the
symmetry & beauty.

Return

Bula & yes I have returned. Got into Los Angeles an hour ago. I'm
waiting for my Horizon Air flight now. Tired, sad, but happy too that
I am back to change course and carpe diem.
Thanks for reading.
David

Morning Reflections on Tropical Sunday Morning

February 3, 2008 @ 1115
South Pacific Dispatch / Suva Motor Inn, Suva, Fiji

Yes, I do love being able to write from a faraway place that I am not from. I am having coffee (from Papua New Guinea) and watching the BBC World News that absolutely puts CNN to shame most of the time. I do like CNN International and the special reports.

Things look on track for my departure. Weather is good and no cyclones on the horizon at this point in time. I’ll confirm with Air Pacific today or tomorrow and set up the transport to Nadi which is about a 3 hour drive. I have seen the bus and it is a huge and comfortable bus . . . a far cry from ‘back in the day’ (1985 – 1987) when it took 4- 5 hours in a cramped open air bus. The old buses are still around and I love the fact there are no windows. If it rains you simply roll down a vinyl tarp and everyone helps hold it inside.

That cooperation, at least for the most part is much of what typifies Fiji to the outsider. Some of this is of absolute necessity, i.e., it is a must to cooperate when unloading a container in the rain and mud and you do not have a forklift and a paved road to use it on. So when we unloaded the container of medical supplies in Nausori, we had to use the ‘human forklift’ and lift the pallets with people.

Some may find it interesting (others terribly boring!) or surprising that I am tired and yes, am actually looking forward to going home. I do have a deep love for Fiji but it is not my home and my mission here this time is complete for all intents and purposes. I have a life that needs tending to back in America, people that I love, mail being saved and my love for and addiction to the New York Times and other news. I can easily envision a life where I can live in America yet spend months at a time overseas doing medical work in different places. I could work at a hospital while in America and then work overseas too.

I just heard the BBC news call Indonesia’s ex-president a great leader. What a joke. The CIA and other various U.S. government agencies were completely complicit in assisting Suharto in a reign of terror. He was a joke to many Indonesians that I have spoken to. He personally enriched himself, his family and many of his cronies from the brutal repression of his people in the name of anticommunism. I don’t think he was an American puppet but probably very good at survival and manipulating the Americans into giving what he wanted. Much of my knowledge is based on a recently published history of the CIA. I would like to read a more specific history so eventually will have to look one up.

Thanks for reading.

David

Postscript: I remember sitting with the Fijian guys from Lalati and hearing them sing around the tanoa (the kava bowl). There was a song just about their island of Beqa and each village was mentioned in the song. Fijian songs are usually about connections, to their village, to each other, to the land. It is not usually songs about anger, or alienation. There may be sadness but it is about a broken heart from love, separation from a loved one, departure from home, an island that you have come to love. Other songs are simply about fun.

Back in Suva Second Go Around

February 2, 2008 @ 2350
South Pacific Dispatches / Suva Motor Inn, Suva, Fiji
I just returned from dinner at Fong’s Chinese which is a great place to eat. Still have to disconfirm the use of MSG or not at this point as I did not think to ask at the time. I was too hungry as all I had today was tea in Suvavou with biscuits or as the Fijian say, bisketi. I much prefer the sound of bisketi! I took some of my ex-in-laws to dinner with me and afterwards went to see No Country for Old Men. I loved the movie, especially the soundscape which was very distinct, spare and beautiful. A bit of a confusing movie at times and I shall have to see it again to deepen my pea brain analysis of a very complex bit of filmmaking. Overall however, I loved it despite the violence.

How normal it seems does it not? Dinner and a movie? Yet I treasured the normalcy of that for myself this evening. I am sleeping where and when I want, eating what I wish, I am very clean after a long hot shower and have been quite happy in my nest of a hotel room. Lonely a bit but great for introspection, reflection, review and analysis and most of all the silence, the space to do nothing, think nothing.

I bought a few groceries this evening for tomorrow so I could enjoy a nice breakfast and coffee for tomorrow. I shopped at MH’s which stands for Morris Hedstrom. The old store burned down over 10 years ago and it just reopened about one month ago. Fiji time anyone?

I attempted to get online at the Tanoa hotel but the internet there is down, both the wired and wireless. I tried Skynet Internet Café, logged in through my U3 Sancruiser Titanium USB drive. It runs a shell on the machine and protects the key data behind a virus and malware shield (Avast). It worked as advertised, warning me of a trojan horse, probably a key logger program so I terminated the session immediately. I don’t have a lot of valuable data but I protect it. The USB drive was an excellent purchase. The frustrating thing is that I have a lot of blog entries written and pictures to be posted yet finding reliable access is a great annoyance. I caught a whiff of a network in Suvavou Village on my Iphone last time I was there about two weeks ago so if I visit tomorrow will try to hop on the network – I was shocked to find it there. Isa Fiji, how it has changed! Even this morning, waiting for my commuter boat for the one hour crossing to the mainland I saw children and adults go to the seawall to text and / or call people. People text a lot! Saves money over a phone call. You can add minutes at almost any store – I bought additional minutes with my groceries this evening.

Another big change is the level of supposed sophistication in the way people are talking, dressing and acting in the city. More nightclubs and I was even blatantly propositioned by at least 3-4 prostitutes on the walk home even though it was obvious I was trying to avoid them like the proverbial plague.

Less than two days left in Fiji. I will spend Sunday and most of Monday here. I want to get another Bula or Aloha Shirt, maybe another sulu, Fijian Music CD’s and so on and so forth. I bought some nice curry supplies today so I am looking forward to making curry next week.

It just turned February 3 so I will sign off here. Thank you for reading.
David

The classic Kava Photo

 

Drinking Kava at Rukua Village two days ago. Drank till 12, up at 5 a.m. to catch the commuter boat to the mainland. Good fun!

Back in Suva

February 2, 2008 @ 1340
South Pacific Dispatch / Suva Motor Inn, Suva, Fiji

So roundabout I have come once again to the Suva Motor Inn. It is funny to me, perhaps to be expected however, that this is the loneliest part of my trip. Neither coming nor quite yet going I feel I am just at that in between place, hovering, waiting and suspended. My short term course is set and clear yet the long-term is uncertain, full of longing, excitement, sadness, doubt, and unknowingness. Being comfortable with that part of it is what is hard for me at times. I wonder about others.
The rest of the Loloma Foundation ‘gang’ are all home in America, save our stalwart leader, Linda Kwasny. They have all been a joy to work with and to spend luxurious time with them after our work day is complete.

I left Lalati Resort on Beqa Island yesterday and spent the night in Rukua Village on the other side of Beqa. My friend in Santa Rosa, Sailasa Rogogo is from that village. Interestingly enough, my fellow Peace Corps Volunteer, Chris Schorn (now in Seattle) lived in Rukua and as I was drinking kava with the boys last night it was a full on reminiscing of Chris and Sai stories over the years. I even saw an old foto of Chris and that brought back many memories.

It seems that everywhere I have gone brings back a rush of memories. I drank kava till 1200 pm last night, got up at 0500 and left on the boat at 0645 for an hour’s boat ride to Navua. From there I caught an ‘Express’ bus (read slow and maddening into that but some things never change!) and got off in Suvavou Village just past Lami. Suvavou is where my ex-in laws live so it was good to see them again. Now I am so tired and lonely that I am just going to take a shower and a long nap. I am so exhausted from working, the constant travel, and the emotional demands from memory and by just being alone in what is still to me, in the end, a foreign culture. I slept on the floor last night with a bit of foam pad but out of deference to me the boys lit mosquito coils but I was eaten up anyway. I usually travel with my mosquito net but had left it behind in Suva because I have not needed it. They also closed up the windows so I was dead of the heat and sweated all night.

So why write this? This is what it is like when you have to travel so much here. You lack control over your immediate environment to a large extent and are subject to the whims and vicissitudes’ of those around you and the travel gods. I could have stayed at Lalati Resort which is unbelievably comfortable and beautiful but I had to spend at least one night in the village. I did this not only for myself but for my friend Sai. Resorts insulate you so much from the people and this was my first time to experience resort life. I loved spending time with the staff, drinking kava and so on and so forth but also enjoyed the great food, service and other benefits of resort stays.

The last four days we just worked in the clinic. I drained an abscess on an eight year old that had been ‘drained’ in December. It was still very infected and very painful. One of the primary challenges here is keeping things clean so it is very possible that they let it get dirty and it healed over without sufficiently draining and the infection being stopped. Sterility is a joke in the tropics, in the bush with insufficient control over the environment. We called a Doctor in San Diego (or emailed him) about what antibiotics might be best for this foot abscess.

Plan for today and tomorrow is to simply rest. I have a few small things to do, recharge my phone with more minutes (I simply love the pay as you go plan they have with Vodaphone Fiji). I might buy a few more shirts since the three I brought got trashed since they were so old. On Monday I catch the 1630 bus to Nadi and my flight leaves at 1030 that night. I arrive into Los Angeles, wait for a bit and transfer to Horizon Air (Alaska Air) for my flight to Santa Rosa.

Although I have loved my trip I am so very tired and look forward to seeing those I love once again and fold them into my arms. Sometimes not knowing what to do is a blessing. I have a day to recover, unpack, clean and then off to work at MS II if I still have a job, if the Hospital is still open and on and on, ad nauseum (sp?).
Thanks for reading this far. Will try to get to a computer and post this with a few fotos later or tomorrow.

David

Work

Now this is what I call going to work in style! Need more of this and
not less. Taken in the Yasawa Islands last week. I'll be seeing most
of you soon!

Ratu Tevita, na Vu ni Wai!