Thursday, 17 March 2011

Stress Free Life of an Endocrinologist who is also a Medical Anthropologist

Wandering Medical Anthropologist and Endocrinologist: A prescription for a Stress Free Life

Day 1 March 4th, 2011

EuroStar. Paris Gare du Nord to St Pancras, London. 2h 32 min. How quickly the time passes, through the Chunnel and then a different scenery. ( How did these two smaller countries dominate the world for centuries?). A very chilly arrival Hall under the dome of the Station, a huge clock welcoming you. Quick line at Tube Ticket Station to get the Oyster Card refilled. Russell Square. 5 minutes. British Museum, the mother of all Museums. Thai Lunch. Tasty. Good ambience. Nice to walk through the China town. Piccadilly Circus. 1 hr to Heathrow terminals 1,2,3.

Outside Bus 140. Station Road, Hayes. Short walk to Comfort Inn. Take out Lamb and Nan. Delicious

Day 2

3.45 AM. Up and ready for the bus at 4 20 but it is late, thus missing its connection at Terminal 5. London Buses will take you to Terminal 4 gratis. No bags to check in. Quickly through security. Skyteam Club. Quite luxurious. A nice shower and shave. First of the many good meals for the day. Left London, quickly through the security and Immigration at CDG. Enough time to check emails at the Air France Lounge at Terminal 2 E. CDG to IAH 10 hr 15 minutes, announced the Lady Captain of the 777-200ER. Still arrived fresh. Good time to read slowly. At IAH less than five minutes to go through Global Entry automatic immigration and a dedicated channel to leave the airport premises. Wait for the hotel shuttle. Comfortable hotel. Sound Sleep.

Day 3

After breakfast, back to the airport. IAH to OMA 2 hr. Lunch served. A glass of chardonnay as well. Greeted warmly by the AVIS rent a car staff at the OMA airport. A nice car to drive through the predicted snow. 95 miles to the REZ and the Blue House. Driving through the dreary I 29 but decided to enjoy looking at the Loess Hills. Missouri River. Bridge at Onawa exit. Chat with the toll keeper. Another Quiet day

Day 4

Endocrine Clinic at the Health Centre. Not very busy. Connecting with colleagues. Lunch with a patient who is also a teacher in the Indian ways to me. I told him I have an important meeting two days hence. He said: do not speak too much about yourself, may your voice have healing words to help the Indians.

Putting the final touches to the presentation I have to make two days hence.

Day 5

To Oklahoma City

Back on the road. 95 miles back to the airport. Flight to DEN and change planes to OKC. John arrives from San Antonio, rents a car and off we go to check into Marriott’s Hotel. Space. Sterile. Friendly. Bill from Indianopolis joins us, we go to Lakeside Grill. Typical American resto, décor to match. Large. Chicken. Marlborough Sauvignon Blanc. Pleasant Dinner. Restful night.

Day 6

To Shawnee and Ada

Breakfast at the hotel. Joined by Peggy from Vermont. A lovely lady with a budding anthropologist for a daughter, who is off to Nicaragua to do a short term volunteer job in the countryside with Fondation Albert Schweitzer.

We drive to Shawnee and pick up Bob. Delightful Onondaga man with expert knowledge of the workings of the Indian country.

We arrive at Ada, to meet with the Chickasaw Nation Lt. Governor who is also the Chairman of the National Council of American Indians. Humble. Gentle. Soft Spoken. Accommodating. Direct to the point. Honest. Attentive. Curious

I present a cultural interpretation of the process of our care for Indian patients at the Health Clinic of the Winnebago Tribe of Nebraska. Intrinsic motivation. Stress Management. Autonomy. Mastery. Purpose. Well received. (thanks for the Medical Anthropology training at Brunel University of London, England)

All of us are satisfied with our morning and we head back to OKC, stop at The Border, a Mexican café, once again American in taste and décor (after all we are in Oklahoma city?). Pleasant company. Back to the airport. OKC to DEN to OMA. Checked into the hotel near the airport where I usually stay, knowing I have to leave at 7 am to drive the 95 miles to the clinic, where the patients would already be waiting when I reach there, which was the case.

Day 7

Endo Clinic

Excellent Day at the Clinic. Our clinic is held away from the sterility of the hospital but in a warm and welcoming corner of the building. Each patient is greeted by the receptionist and then they are seen by a nutritionist, an exercise educator, a clinical case manager and then the Diabetes Educator who inspects their feet. This is repeated at each and every visit to the Clinic. So by the time they are ready to be seen by me, all the biomedical parameters are ready, and it is left to me to attend to their emotional, psychological, cross cultural needs.(thanks again for the Medical Anthropology training). One patient after another with stories and explanations. Most have complex stories but some are quite straight forward.

Even with all of us present, we can only care for 15 patients per working day (maximum) since between us, we wanted to make sure that all aspects are dealt with, not just the biomedical aspect which in my opinion accounts for no more than 25 % of the treatment of the chronic disorders of Diabetes and Hypertension and Renal Insufficiency.

A day like today, privy to enter the sociocultural life of so many American Indians leaves me euphoric.

In the evening, to Care Danh, a Vietnamese café 30 miles from the clinic, a perennial favourite of some of us. Apart from eating Bun Ga Xao, it is meet a young man, who came in with his family, who made sure he was seen by me, regarding his weight, his blood sugar and his blood pressure. This is the modern version of the Home Visit, the difference is that we do it at a Vietnamese Café at a very uninteresting Midwestern town in the USA. My colleagues make my stay and work at the Clinic-effective, enjoyable and a learning experience. Many Happy Indian patients today!

Day 8

Endo Clinic

Which was a repeat of yesterday, more satisfied patients, all aspects of their needs are attended to. Since American Indians area guaranteed health care under the treaty rights, no money is seen or heard or exchanged. All consultations and medications and investigations by lab and imaging are free.

Evening of socialization with young Indian friends: aged 10, 8, 5 and 1 and their parents. Invited them to a Thai resto in this northeastern desolate corner of Nebraska. An anthropologist’s dream to participate and observe, in a longitudinal fashion, the growth and enhancement of the life of these youngsters, children of the ancient people with their memories of their UmonHon, Navajo, Dakota ancestors etched into their faces. It is a moveable History Lesson!

Thai Resto run by Laotian refugees. Tom Kha Gai and Chicken Panang Curry

Day 9

Liminal Day

Medical work is over for this visit. On this Saturday morning felt a distance from loved ones from the other worlds. My Good Indian friend came over. Nice chats. Telephone calls. Chats over internet. Preparing for the next part of this journey.

Drove back to the airport, the fourth 95 mile trip on this visit. A sandwich from Subway. A glass of wine from Stellenbosch and a good sleep at the hotel near the airport

Day 10

To Texas

Early morning flight to Houston. At IAH changed my flight to a later one to SAT so that I can enjoy the lounge of the CO airlines. Ran into a friend MT who was coming in from Sydney and going to FLL! In the excitement of chatter, left behind the Macbook Pro charger, made me learn how to preserve the battery in the laptop! Short flight to SAT. At the Lounge, an extremely friendly and helpful CO person and attentive. She called the CO lounge at IAH, alors, the mac charger was never turned in, who would if they could have an extra charger, which was just lying around anyway, even if it was at an airlines lounge?

Texans are friendly even by American standards.

Rested for an hour or so at the Lounge and then took a taxi to the hotel nearby. Caught up on the emails, telephone calls and chat over internet(I chat with only one person, on line). The room at the hotel was large and comfortable.

The CEO of the tribe at the Mexican border had driven up, he came to the hotel, the drive from the border takes about three hours.

I chose the Tex/Mex cuisine at Los Burros and off we went.

Jolly giant of a man, jovial and can see he is content with his life. I realized that the internal motivating factors that I utilize for my patients, is blatantly present in him, which gives him the radiant look. And in good measure.

Autonomy( his job is very demanding but flexible), Mastery(CEO, administration) and purpose(to help the Indians). He had more of a sociocultural view of the health care delivery than a biomedical one, even though he has been involved in it for more than twenty years.

A good conversation over a mediocre meal(even my margarita was mediocre)and a possibility of duplicating the Peer to Peer Programme which has seen good results in the poor neighbourhoods of Phnom Penh Cambodia (MoPoTsyo directed by maurits van der pelt). A good meeting.

Back at the hotel, emails, telephone calls and chat on line. Good restful sleep.

Day 11

Journey to London

Back to the airport. Bad weather at IAH has forced delayed flights to IAH from SAT. The same helpful lady at the Lounge once again came to the rescue and made sure that I got a seat on a full booked flight. This is the beginning of Spring Break, a ritual among the recently pubescent college students on their way to their first ever hedonistic holiday and unexpected pleasures.

CO airlines does the best to accommodate its upper tier fliers, it is a good business idea to pay attention to people who give you their business.

AF club at IAH. A short stay. We boarded the flight quickly, 8 hr 40 minutes to Paris . seat 24 H with no one sitting next to me, but the seat did not feel that comfortable. At the AF Lounge at Terminal 2E, a certain urgency when you have to check your email and answer some of them, so an artificial urgency of the electronic interference.

A short flight to LHR. Slept most of the way. The skies over France was clear and as we crossed the channel, clouds gathered, but when we landed it was 15 C and sunny.

Heathrow Express from Terminal 1,2,3 which also houses the Central Bus Station. What a lovely way to go to Central 15 minutes .

Emerge from the station and you are surrounded by Middle Eastern Hospitality under different skies. They too are misplaced and I noticed that they have a cheerfulness absent in the faces of the Arabs who live in Paris. Colonialization, Past history and Oppression. Here they are refugees of the oppression of their own people: kurds, Iraqis, Iranians, Yemenis and other dictators who now kick out their own people, like they did the jews of arab lands soon after they came to power. May these unfortunate souls be incorporated as well into the societies of their choice like the jews of middle east now settled in Israel, UK, USA, Canada and Australia as well as France.

Colonialism of the bearded ones, ones with guns, the privileged of the desert. As I write these these dictators are confronting unrest in Bahrein, Libya, Jordan, Syria, Oman and Saudi Arabia.

A lovely hotel at 34 Sussex Gardens with Shaun directing the reception and doing a wonderful job of it. I have written about it at virtualtourist.

You can read about the Pavillion Hotel, at

Sundip at Apple Store, Regent Street

Tanzanian born Indian , 25 years in the UK

Pleasant helpful yet another spark of my reintroduction of life of london.

A student of Medical Anthropology from my alma mater, joins me for dinner at a Persian Restaurant. The chef is decidedly Persian, but the waitress is from Ulaan Bataar in Mongolia. Welcome to the new world of the metropolitan cities, where in the course of a few hours you have talked to Pakistani, irani, Iraqi, Kurdish, Mongolian, Tanzanian indian people who now call London their home. I prefer this new world to the old, staid one that I grew up in Melbourne, Australia.

Chelo kebab e barg

Jujeh kebab ba nan

A glass of sauvignon blanc from Stellenbosch.

A deep sleep of 12 hours at a quiet room at a Pakistani oriental decorated room in a Pakistani owned quaint hotel in the heart of London, while most of the inhabitants around are praying to Allah for better days.

Day 12

Journey to Paris

Yes, a very meaningful trip is ending but the journey will continue.

Eurostar to Paris Gare du Nord

Bonjour, paris and look forward to the French side of my life

Left St Pancras at 1502 (1602 in Paris) and reached Gare du Nord at 18 h15 ( two hours an thirteen minutes), RER E to San Lazare, train direct to BLesB. At home by 1915

Before anything, to taste two things I have missed on this trip: Nespresso and a piece of baguette with cheese..

Dinner was at a Creperie: Nordique which was a crepe of Ble Noir with smoked salmon, followed by a sweet crepe of chocolate and a little cider..