Sunday, June 3, 2012

Final Reflections from Botswana

“How do you pick up the threads of an old life? How do you go on, when in your heart you begin to understand, there is no going back?”
            Perhaps my experience this past 5 months has not been quite so dramatic as the epic Tolkein tale, however I find it fitting to conclude this exploration of my experience in the same way it began. Despite the degree of drama, there is no doubt that the last 5 months have been some of the most important of my life. They have helped me to better understand myself, and my place in the world. But how can I describe to you what I have learned? There are 3 areas in which I believe I have greatly grown through my experience abroad. These include: career, personal, and spiritual.
            I will begin with what was the initial stimulus for choosing to study abroad, career goals. I set off for Africa thinking that I needed to understand medicine and healthcare better, and in a much broader sense in order to truly understand if this was where my calling lay. My doubts about this were perhaps answered most emphatically of all my doubts in entering this trip. In living with other Americans who had similar doubts and similar ambitions as myself, I was able to have some of the most in-depth conversations about medicine in which I have ever been involved. In addition, observing and being involved with care in the setting of Botswana, and being immersed in the Public Health issues of the country was of an almost indescribable benefit to me and to my fellow students.
There was a point, I would say somewhere around half-way through the semester, where I decided that I wanted to be a doctor. I decided I am ready for medical school and I wanted to be the one treating patients, not simply watching. Unfortunately, I also realized that I still have another year of undergraduate school left, and the stress of applying and interviewing for medical school, and choosing a school before I can think about this truly becoming my life path. However, I know now more than ever where my conviction lies. Especially when I compare this experience to my time in the lab at UNL. For much of my time at UNL I have been fairly immersed in the research branch of science. I have spent 3 summers working full time in a lab, while spending the semesters working part-time. My experience in Botswana was the first time in my life that I have truly been immersed in medicine, at least to an extent that I have never before experienced. This has allowed me to compare my interest in the two. I found that my passion is in medicine. My passion is in talking to suffering patients and helping them to relieve that suffering. My passion is in being intimately involved with the emotions of people, while understanding my right place in guarding myself against that intimacy. My passion is to be a doctor. It has become more and more clear to me that the fulfillment of these passions will come, at least in part, in medicine. While I have found this to be true, my experience in research remains as one of the most valuable of my college life, and will surely be of vital importance as I begin a career in medicine.
            How should I be in relation to others? What is my place in the world? Ultimately, I guess this question is ‘who am I?’ While I am still in search for the true answer to this question and perhaps a final answer is unattainable in this life, I believe I have moved forward in my search for the answer. The writings of Thomas Merton and James Orbinski were perhaps two of the most influential authors I have read in my life, and ironically their books happened upon me during the most influential experience of my life. Thomas Merton lived during the 20th century and grew up in the absence of religion or spirituality. As he realized the emptiness of his life, he grew to understand the importance of spirituality and eventually entered a Trappist monastery and took a vow of silence. While I don’t believe I have the same calling as Merton, his writings helped me to understand the importance of spirituality in forming your true self and in being true to those around you. While I have always understood that doctors carry a great responsibility due to the immense power that is put in their hands, I think this fact became explicitly clear during my time in Botswana. This was not through any specific experience, but through the composite of my experiences, conversations, observations, and studies. Because of this power, I have come to realize that it is more important than I had ever imagined for doctors to truly understand themselves before they can think about helping people. I know now that I must determine that which is most valuable to me, and hold these values through the thick and thin of medicine. Without this, I will surely lose sight of my responsibilities as a doctor. These ideas have also been echoed in the late Bernard Nathanson who said: "It has been my experience that only those who have an inflexible inner spiritual column supporting the immense weight of medical obligations and responsibilities survive intact the lure of the worldly temptations in the medical world....without such an absolute guide to virtue, doctors, exposed as they are to greater temptations than most, are likely to fall further." The formation of this ‘inflexible spiritual column’ has now become of utmost importance to me.
James Orbinski was a doctor working for Doctors Without Borders/Medicins Sans Frontiers (MSF) during some of the most serious crises of our time. He also became president of the organization and accepted the Nobel Peace Prize on behalf of MSF. His book was called, almost too perfectly (pun intended), ‘An Imperfect Offering.’ In the book he describes vividly his experiences as an MSF doctor. Most notably, he worked during the UN intervention in Somalia in 1992 and then during the Rwandan Civil War in 1994. After describing his experiences, he goes on to discuss the problems facing Humanitarian work in the world today. The book is so titled because of the recognition that even amongst highly successful organizations such as MSF, the aid offered is far from perfect. It has become clear to me now that while I have adopted a somewhat more skeptical view of humanitarianism, work in humanitarianism has become a serious call in my life. As Orbinski described his experiences I began to feel that his work was serious medicine. While I recognize the need for medicine around the world and even in my own community at home, the work done by Orbinski seemed of the utmost importance. While it is possible for me to do this, I believe that it is my duty as a humane caregiver to be involved in providing access to care in places that have been deprived of this privilege. I am sure that my understanding of this area of work will become clearer to me as I work through medical school. Finally, on this topic, Merton advises: You cannot tell me who I am, and I cannot tell you who you are. If you do not know your own identity, who is going to identify you? Others can give you a name or a number, but they can never tell you who you really are. That is something you yourself can only discover from within.”
I believe I may have more to say on these subjects, and if I feel it is appropriate, I may update this post with more reflections on my revelations from abroad. This post is perhaps the most personal thing I have ever made public. I hope that whoever reads it finds what I have said informative or perhaps even inspirational. I hope that anyone considering studying abroad may find this blog as an invaluable resource of one person’s experience. I have done my best to lie out an honest evaluation of my experiences. At times I have failed to keep the blog regularly updated and I have not been completely satisfied with any of the posts, but I have found that in writing I have been able to reflect much more seriously than I ever could have without. If nothing else, I hope that perhaps my words and pictures have brought a smile to the faces of a few.
I now, finally leave you again with a poem out of, yes the Lord of the Rings. I think the plight of a searching college student could not be put more beautifully than in the following words, written by J.R.R. Tolkein:

The Road goes ever on and on
Down from the door where it began.
Now far ahead the Road has gone,
And I must follow, if I can,
Pursuing it with eager feet,
Until it joins some larger way
Where many paths and errands meet.
And whither then? I cannot say


  1. Tom I love this post! Write more!

  2. Tom,
    I love this post, too. It sounds like the semester was just amazing. Quite an adventure!
    aunt jane