Thank you speech

This evening Emily (My successor) and I were the guest of honor at a baci hosted by the IM residents and teachers to welcome Emily and wish me a safe journey home. I was expecting to be asked to make a speach, so I prepared this. However, only Dr. Som Ok, the former President of the University of Health Sciences and the current Vice Minister of Health for medical education and human resources was asked to speak (which is OK with me.) But I will post what I had written here.

I came to Laos because I wanted to live and work outside America, and I had good mentors (Dr. Rosemary and Dr. Jon) who said it was a very nice place to live and work.

When I arrived here almost 16 months ago, I knew very little about Lao people or about Laos. I knew Lao people gin khaw niaw, (eat sticky rice) love spicy food, and that Beer Lao was “the beer of the wholehearted people.” That was about all I knew.

I want to thank you all for truly being the wholehearted people. You have welcomed me with open arms and showed me what that phrase means.

Thank you, Teachers. You have listened politely to my suggestions, even when they may not have been good ideas. You have gently guided me in the right direction when I got too far astray. You have supported me and helped me get things done for the residents and patients. You have taken me seriously, and thought about my suggestions when we did not agree. I want to thank you for recognizing which areas I could help you in and letting me help. And I want to thank you for not changing things solely out of politeness when my ideas were not good.

Thank you, Residents. Thank you for welcoming me to your hospital rounds, your lectures, and free time in the resident room. Thank you for trying to understand my lectures when they were too complicated, and for politely listening when they were too simple. Thank you for staying when my lectures go past 7:30, which they almost always do. You have supported each other well in learning from someone who does not speak Lao, not only translating for each other but also explaining and making sure everyone understands.

Thank you for welcoming visitors with the same warmth you show me, even if sometimes they do clinical teaching or lectures that are hard to understand, or tell you to do things that are not currently possible in Lao. Thank you for teaching me about diseases I knew little about, like Melioidosis or typhus, and guiding me through culturally complex patient interactions. Thank you for taking extra time to learn from me – to present patients in English, make a differential diagnosis even when you already knew what the patient had, and discuss what to do next, even if you had a plan with your Lao teachers that would not change based on our discussion.

I am very proud and lucky to be part of an organization like Health Frontiers. It is amazing to see what a group of dedicated volunteers can do with a little bit of money, a lot of time, and willing colleagues and students. I have a new way to judge NGOs and international health projects. I will look not only at how much they spend, or how many people they help directly, but whether they help local people create independent, sustainable changes. Health Frontiers projects in Laos have been successful because we are working with you, not telling you what to do or doing it for you, and because we have been able to commit far more human resources tha money -21 years of volunteers now.

However, I am even more proud and truly humbled by how hard you all work, and how committed you are to improving yourselves and healthcare for Lao people. You are all very smart people, and there are surely easier jobs, less stressful jobs, and better-paid jobs you could do. But you are committed to the health of the Lao people. The teachers show this commitment – you spend extra time on clinical teaching, lectures, organization of the program, and mentorship, without any extra compensation. And the residents show this commitment – you leave your practice, private clinics, and sometimes your home and family, to come study. Being a student is not easy, especially as an adult. I am very proud that you all chose to become residents and improve your knowledge and skills. You all give so much to your patients, students, and studies, even when you may feel like you have little time or energy for yourselves.

I know that as I go home to new challenges, you will all continue to rise to the challenge of teaching and learning. I am confident that our decision to make the IM residency more independent of day-to-day teaching by Health Frontiers volunteers will not decrease the amount or quality of teaching you get. I hope the residents all continue to work hard and improve their knowledge and skills. Do not get distracted by all the changes around you, but stay focused on becoming great doctors for all the Lao people. I know the teachers will continue to work hard for you, and I hope they will continue to improve their mentorship, teaching skills, assessment and feedback as new resource become available. And I hope the Lao government, University of Health Sciences, and Ministry of Health will continue to support the residents, teachers, and hospitals more and better with equipment, access to tests and treatments, improvements to curriculum and teaching skills, and improvements in undergraduate medical education.

Lao is changing – I have seen it just in the short time I have been here. Many of the changes are improvements. But the Lao people, especially young people like our residents, need to be careful about what parts of Laos you allow to change. I hope the things I have come to love will not change: your openness, gentle politeness, kindness, and honesty. Your willingness to work hard when needed and your appreciation of rest and relaxation, and your love of the Lao country and culture. I will miss these things very much when I go home.

So in conclusion, thank you again for a wonderful year of learning and teaching. I wish you all the best of luck, good health in the coming years, good learning and strong teaching in the future, and much happiness in your personal lives and professional fulfillment. Being a good doctor is hard, but it is also one of the best jobs in the world, and we are all lucky to be able to work together in this wonderful profession.

Now all that's left is writing and giving a goodbye lecture on Tuesday, a few meetings with Emily, Hakon, and Karen, some last minute shopping if my weight allowance permits, and eating as many yellow mangos as possible before Wednesday.

Letter to the Editor

I always write way to much for any letter to the editor to be published. So in addition to sending this to High Country News I'm posting it here:

Dear HCN,

I’ve been reading back issues of HCN while living and working in Vientiane, Laos for the past year. As a native Coloradan, outdoor enthusiast, and anti-corporate child of hippies, I tend to oppose commercial development of public lands and resources – mining, drilling, etc - pretty categorically. However, on a small point, I found myself agreeing with the mining representative in November 22, 2010’s cover story on mining “Hard Rock Showdown.” Mr. Cornoyer stated that mining in Arizona would be better for the planet than copper mining in Chile or the Congo. When Westerners oppose these projects, we need to ask ourselves where the resources that are not being mined in our states are going to come from, and where they are going to go.

Laos is a beautiful and very mountainous country; filled with steep limestone mountains that are absolutely overgrown by tropical greenery. In size, it’s about 90% as big as Colorado, but stretches out along the Mekong River. The mountains extend well into our neighbors, Vietnam and Cambodia as well. They are great sources of natural resources – both ores and as the substrate for rubber plantations, timber cutting, and other environmentally degrading but profitable ventures.

In Laos, mining, timber cutting, and rubber plantation planting are happening with little or no concern about environmental consequences, even inside national protected areas. I do not know if Lao law requires environmental impact statements, but I do know that bribing the right string of officials will give businessmen access to land, which will likely be completely unregulated or supervised, and there is unlikely to be any legal action for cleanup after the project and damage is done. Corruption is rampant in South East Asia – Laos ranks 154/187 for most corrupt nations on the latest survey from Transparency International. (With 187, Somalia, being the most corrupt) Cambodia is 164, and Vietnam 112. The US holds slot 24. Some of the companies working here are trying to teach the Lao people and government about environmentally responsible stewardship of their natural resources, but many see it simply as a poor country where a bribe here or there can get you access to very profitable natural resources.

So Mr. Cornoyer is sort of right, even though my natural tendency is to assume he is wrong. When we westerners absolutely refuse to allow our own natural resources to be accessed, it likely means that the copper for those hybrid cars, photovoltaic panels and other electronic gadgets we love is coming from somewhere else on our small planet; probably somewhere with much less oversight. (43% of copper comes from Asia according to this site: http://www.lme.com/copper_industryusage.asp, but I’m pretty sure Asia isn’t yet consuming that percentage of electronic gadgets, hybrid cars, etc.) We may not see the unpleasant tailings piles, nor will our water, grazing land, etc be harmed, but if there is a demand for that copper, it will be mined somewhere. And the people affected may be subsistence farmers in the developing world who have neither the time, knowledge and experience to resist development, nor the political clout or legal framework to limit impacts. When we take a NIMBY attitude to resource use in the west, we may really be hurting poor and powerless people in other parts of the world much more than the corporations we think we are obstructing. And that’s not responsible citizenship any more than allowing unrestricted development of our own natural spaces would be.

Thanks for keeping me connected to the west over the past year. Keep up the great work!