Home Again, Home Again.

I’ve been home in the USA for 2 months now. I’ve been surprised by how little culture shock I’ve experienced. Maybe I’m just good at changing my expectations when I change contexts, or maybe I never fully adjusted to Laos. Or maybe coming home is always coming home and therefore positive, even if you’re coming from a very different place. I know I’m lucky that both Denver and Minneapolis feel like home now. It’s been nice to re-integrate relatively smoothly, but sometimes not feeling shocked to be home makes me wonder whether my experiences in Laos were ‘real’ or ‘valid.’ I spent the last 3 months I was in Asia traveling a good portion of the time - I left Vientiane September 17th and wasn’t back for more than a week until the last two weeks, which were a whirlwind of visitors. Since I don’t really have a full time home now, maybe I’m just still in travel mode, and when I settle down in June the culture shock will really hit.

The one thing that does consistently surprise and alarm me is how fast everyone drives. It took me a while to adjust to traffic in Vientiane - I blogged about it, and probably complained to many of my readers. But I definitely totally adjusted, especially to the speed. It is true that there are few true rules of the road in Laos - Christine, my predecessor was pretty accurate when she said the rules were “you’re responsible for what’s in front of you, what’s behind you is responsible for themselves, and don’t hit anything.” But everything happens at such low speeds that there is almost always time to react to whatever craziness is happening around you, and if there isn’t, the speed at which you collide with something/someone will be so low that the damage is minimal. American drivers have rules - lanes, stoplights that are observed, no right turn signs. (Free right turn, I miss you, even though I thought you were crazy when we first met.) But we drive so FAST! Even with all our rules, it’s not possible that we can all anticipate and respond to some change in our driving environment in time. I’ve been in more serious near misses (2, both people who were going too fast and tried to merge into me when they needed to change lanes suddenly) in 2 months at home that I was in 16 months of Lao driving, and I’ve been rear ended once. That was a low speed accident, but totally avoidable if the young woman behind me had been paying closer attention, going slower, and generally being more patient. Patience is something that has changed for me a lot in the last 3 years, and something I appreciate a lot more now.

But not having a lot of culture shock doesn’t mean I don’t really miss things from Laos. I miss the pace of life. Not just the traffic was slow in Vientiane, but just life in general. Things rarely started right on time (But not nearly as late as Africa) but it wasn’t a big deal to just wait. In a culture where there are no true emergencies some things don’t get done - some sick patients die who _might_ be saved in America - and some things that are lower priority tasks don’t happen, or happen much later. But the rest of life is so much more enjoyable when there isn’t constant pressure to finish what you’re doing and the rest of a long list of tasks. My Lao colleagues worked hard to improve themselves, their situation, and the care their patients received. The staff doctors worked hard at their clinics in the evenings to support their families and improve their situations. The resident worked hard when they were at work, often with inadequate support, and routinely attended afternoon and evening lectures despite being post-call. But they also took time to enjoy life - work started at a reasonable hour (8 or 9), they sat down together for lunch for at least half and hour every day, and when they had days off they spent them with family relaxing. Generally, I would say that Lao people as a group are happier than Americans as a group, which isn’t what you’d predict based on GDP, life expectancy, etc. It’s not that Lao people don’t want to succeed - they want to be successful in work, financially, and respected, and most of the doctors I worked with also really wanted to help people. It’s just that that is balanced by an ability to be present and happy in the simple moments of everyday life that are enjoyable. They have an ability to appreciate the intangible benefits of not rushing to get things done as well as the tangible benefits of getting things done.

I am doing my best to remain aware of this difference and make my approach to daily life as Lao as I can on my return. It’s not easy to be relaxed when everyone around you seems to be in a hurry. (See paragraph 2) And sometimes, very rarely, things do actually need to be done NOW. But when I find myself getting impatient or annoyed, I try to actively remind myself that the few seconds or minutes more I spend waiting for something, driving slowly, letting people merge at the last minute, aren’t seconds or minutes that I needed for something else. (Right now, my schedule is pretty flexible, I imagine this will be harder as I start working a 40-50 hour week again.) I try to remind myself that no one else cares that I may be in a hurry, so the only one that being annoyed really affects is me, and that effect is almost entirely negative. Generally, I’ve been doing pretty well at not being stressed out or annoyed by minor delays or hiccoughs that would have bothered me as a resident. (My time was much more precious then, though.) I’ll still call the nurse if the 1AM hemoglobin hasn’t even been drawn at 2, but I believe my tone is different when I ask why this is the case and how we can get things done. And I know, now more than ever, that if a minor delay in care is going to seriously harm a patient, that patient was probably in pretty big trouble already. I think many of my colleagues here would enjoy work a lot more if they could could appreciate this reality - many of the delays and errors that frustrate American doctors are things that are going to make no difference in the grand scheme. There’s clearly a happy medium of care delivery stress - Lao being too low, and America being too high - that would be a good thing to strive for.

Finally, I miss the sense of involvement and caring I had from my residents and colleagues in Laos. In Lao, someone, often a casual acquaintance, told me I was looking beautiful several times a week, and sometimes several times a day. Even going through the market, strangers would say how beautiful I was in my sin. It was weird to me - what is the appropriate response? You too? Thank you? I wasn’t used to people paying that much attention to me - my presence - unless they were close friends. In America we say “Hello, how are you?” but no one, even people you may work with on a daily basis, actually cares or expects an honest answer. In Laos, I felt like people genuinely cared. Another example - When I was traveling alone, especially in Thailand and Vietnam, people would ask me directly and early in our interaction if I was traveling alone, with a tone that I though implied both curiosity and some judgment. In Laos, people are shyer, so it would take a bit longer and the question was less direct, but it was still often asked. I perceived these questions a somewhat intrusive. Now I miss having interactions with someone who is that interested in my life (who isn’t a close friend or family member). I think saying “You’re beautiful” to a woman in Lao is sort of a way of saying that you acknowledge and appreciate your presence, they _see_ you are here. The same with asking if I was alone - I wasn’t just another white tourist, I was an individual person, traveling alone, which is a bit of an anomaly, and they were curious about me. In America I am a doctor, a gym patron, a person in line at the store, an airline passenger, but not an individual person who is present in the lives of those I’m interacting with. (Again, except my close friends.) It’s a bit de-personalized, where I often felt things were too personal in Asia. A final example - I still have a good number (more than 5) of baci strings on each wrist - white string that has been tied around my wrists and clipped a medium length. In more than 20 shifts at the hospital - all at least 12 hours - only 1 person has asked me what they were. Of all the nurses, colleagues, patients, and family members who have seen me roll up my sleeves to wash my hands and noticed I had a bunch of clean but frayed, ratty strings tied around each wrist, many of whom must have been curious or worried, only one has asked. (Are they an infectious disease risk? I do shampoo them every time I shower, so I hope not.) Again, with the exception of relatively close friends. I guarantee you someone would have asked or commented about something similar - easily noticeable, distinctive - at least once a day in Asia. They’re almost certainly unprofessional, but they remind me that a bunch of really lovely people wanted me to have a safe journey home and a smooth transition back to American life (and they worked!) So I’m keeping them, at least until I get home from New Zealand.

Oh, yeah, I’m going to New Zealand next. Departing Feb 14th and returning March 16th. I’m not going to do any health-care related activities (or at least not planning to!) so I won’t be blogging much, but I will probably try to post some pictures and brief impressions. Gotta test out my iPhone blogger app. And when I’m back and not spending time planning a trip, I hope I’ll find time and motivation to write more about Laos as well.