By Plane and Horse
A Peace Corps Adventure
My Peace Corps assignment was with an organization called, “La Associacion Regional Para El Desarrollo de la Peninsula de Nicoya” in the province of Guancaste. Our office was based in the town of Nicoya. Our areas of emphasis included building impact roads, developing self-help projects as water systems, 4-S agricultural loans, and community organization. In promoting community action in the villages and towns, I was introduced to many needs and people.
One day a young man named Francisco Acevedo Acosta from a community named Garza stopped in my office. He said to me, “We want you to help us build a landing strip.” He explained that their problem was during the raining season, all the roads were washed out and the only access they had was by boat, jeep, and airplane. The airplane would only land during low tide limiting access. I told him, I would help them.
I flew in on a small plane, landed on the beach, and planned a meeting with leaders from three communities. In the meeting of some thirty people, I was told, “We have the land. We will clear the brush with the machetes.” But they need help from the central government for equipment, dump trucks, graders, and materials. We selected a group of three representatives to meet with the Aeronautic Board of the government in San Jose, the nation’s capital.
Earlier, I had visited Garza during the dry season and met Francisco and that’s how we got acquainted. He was a young, determined, and motivated leader of that community. He had done some preparation for the planning and informed the people of the meeting.
I stayed overnight in a home and was scheduled to fly out at 10:30 that morning. A white flag was placed on a pole as a signal to the pilot, a passenger was waiting for a flight out. At 11:00 a.m., there was no airplane. I was told, the plane is coming. I waited until 12:00 noon. No airplane. A kindly woman brought me lunch, arroz con pollo (rice and chicken), and beans
I talked to Francisco and told him, I needed to fly out that day, because I was scheduled to take the bus the next day to San Jose for a Peace Corps meeting. He assured me that I would have transportation out. He arranged for a guide to lead me out by horseback. At 7:00 p.m. the guide told me, he wanted to attend a dance and asked if I could wait. I agreed, it was not a problem. I even attended the dance.
It wasn’t until 12:00 midnight, the scout was ready to hit the trail. Luckily the Peace Corps trained me in Texas to prepare a horse for a ride, putting on the bridle and placing the saddle on the horse.
It was a moonless night. The trail leading through the wooded areas was pitch black. My friend, the guide told me, “Don’t worry. You have only two legs. The horse has four legs.” “Thanks a lot!” was my reply.
As we rode through a stream, in total darkness, I could hear the hoofs splashing in the shallow water. Then we hit a muddy spot, the horse sinking in the mud, and in struggling to move through the mud, I was thrown off the horse. Fortunately, it was just soft mud.
Later, as we moved up a small hill, the horse pushing up the hill, the saddle strap got loose and I slipped off the horse, saddle and all. Again, good training came in handy to a young Peace Corps volunteer, me. I rode on. It seemed like an endless journey, along trails unknown, trusting a scout I had just met for the first time.
The horseback riding in San Marcos, Texas, the long treks (40 miles) in Puerto Rico, the rigorous swimming for survival, the rock climbing, the early morning calisthenics and running, the soccer competitions—all these prepared me for this moment. Here we were, two night riders determined to reach a destination without a rest stop, not even a Seven Eleven.
Seven and a half hours later, my hide battered, my arms and shoulders shaken loose, my spirit was still good. The sun had awakened, it was a fresh morning, and my guide said, “Here we are!” I said, “Muchas Gracias!” My guide headed back to Garza. He said he could do it in four hours. I got on the 8:00 a.m. bus and headed for Nicoya.
When I got home, I had enough time to shower, have a bite to each, and catch the next bus for San Jose. It was another long ride, eight more hours.
As we had planned at the meeting, we met with the government officials in San Jose. I drove the three representatives in the jeep belonging to the Association. They explained the need, how they had the land, that they would clear the overgrowth with their machetes, but needed government help for the completion of the project. The officials promised they would provide the gravel, the dump trucks, the grader. It was a cordial and successful meeting. Two months later, the landing strip was completed.
When I drove back to Garza, I stood at the landing strip, with a deep satisfaction in my soul. A group of small villages, with self-will and desire, once isolated, now had access to air flights out of their communities. In the Peace Corps, when one can tap the will of the people, to work together, to overcome a struggle, to seek the proper resource, life can be a lot better.
May 31, 2010
Monday, May 31, 2010
Listen to the Patient
Psychosocial Medicine: Thought-provoking essay
Jeremy A. Ginoza, R1 Spring 2010
Listen to the patient—he is telling you the diagnosis.
—Sir William Osler
I would sit and listen because I had to, really. I was simply an observer, along for the ride, literally. When I was a boy, I often accompanied my father, a well-loved Christian pastor, on his frequent visits to the sick and elderly in their homes. He was a minister in the United Methodist tradition, which I would come to learn as characterized by its openness and emphasis on living one’s faith in a practical way in the world.
My father, I remember, would warmly greet and reconnect with each person we visited, whether sick or well, with such ease and lightness of heart, as if we were all sitting on a porch on a Sunday afternoon together, sipping cool tea or lemonade. Then my father and I would both listen, as each person would tell us of their lives, physical or emotional struggles they had, and how they might be coping. We would listen, laugh, and empathize (my father with words, myself with respectful silence and perhaps some thoughtful facial expressions). My father would often offer a blessing of prayer, and we would wish the person well. I came away with a sense for how people could find everyday joys despite physical limitations and other tough obstacles, and how a simple visit like this could remarkably lift up and brighten someone’s day. At an early age, I also saw how much I could learn by following the advice found in an old proverb, keep your mouth shut and your ears open.
During my sophomore year in college, as my hopes and aspirations began to solidify, I settled on studying medicine. It was, I felt, the ideal career in which I could reach my fullest potential for both my skills in science and mathematics and my compassion for people. It was the final gesture of decision after years of shaking my head (at least privately) to queries of so many people as to whether I was going to follow in my father’s footsteps. I had inherited his personable demeanor and his rich, deep voice, after all.
I looked back on those experiences with my father and saw possibly the roots of my drive to study medicine. Hearing about someone’s ailments, and his or her daily struggle to cope, I wanted to do more than empathize and offer hope and prayer. I want very much to offer them the best opportunity for healing that today’s medicine can offer. What is more, though, as I reflect now on my early medical training, is that I don’t want to let go of what I learned early on from my father—a show of deep respect, humility, and care for the spiritual dimension of the person. Care in one dimension is not enough for me, and I believe this is why I find myself frustrated at times now in treating patients, much as I may have felt a bit helpless as a young boy, wondering what to say, even though I knew my place was to simply be, and to listen. Now that I am caring for patients as a resident, my foremost challenge is to develop skill at caring for the whole person, body, mind and spirit, within the time boundaries of a busy practice, and to have the wisdom to know when this is even possible.
An electronic health record offers many tools for supporting and guiding efficient patient care. One task I am pursuing now is to create an electronic template for interactions with patients that I am scheduled to see in our clinic, based on presenting complaints, including a checklist for a pertinent history and physical. I have found that the very process of doing this makes for some high-yield learning, and is helping to build the mental framework I will need to organize my thoughts and prioritize my time during the course of a busy clinic schedule.
Practice guidelines in the form of checklists and flowcharts are part of a growing trend which presents a lot to debate and consider. Sir William Osler said that the “practice of medicine is an art based on science,” and it’s worth asking if some of the art is lost in medicine when we apply standardized formulas and algorithms to a unique individual. The value of a tool is all in how it’s used, and if a chart tool could be utilized to be both thorough and time-efficient, creating space to address a patient’s multidimensional needs, then this supports a doctor’s and a patient’s bottom line.
Jazz musicians are well-recognized for their improvisational ability, to let the music flow through them with passion and freedom. A good jazz piece, though, begins with a structure, a formal composition, even, from which the improvisation emerges and then takes off. Otherwise, what you have is simply a jam session, and patient care is much more than a series of jam sessions in the pursuit of health. The art of the interaction is to have just enough structure, just enough spontaneity.
Music is great for bringing us back to listening. That, after all, is where the interaction must begin, to properly build the process of counseling and negotiating, all informed by the body of scientific evidence and reasonable standards. How to keep all this tapping to a brisk, yet unhurried, rhythm is my hopeful aspiration as I strive to be a physician worth his salt, and, when I start moving my lips, one worth listening to as well.
Jeremy A. Ginoza, R1 Spring 2010
Listen to the patient—he is telling you the diagnosis.
—Sir William Osler
I would sit and listen because I had to, really. I was simply an observer, along for the ride, literally. When I was a boy, I often accompanied my father, a well-loved Christian pastor, on his frequent visits to the sick and elderly in their homes. He was a minister in the United Methodist tradition, which I would come to learn as characterized by its openness and emphasis on living one’s faith in a practical way in the world.
My father, I remember, would warmly greet and reconnect with each person we visited, whether sick or well, with such ease and lightness of heart, as if we were all sitting on a porch on a Sunday afternoon together, sipping cool tea or lemonade. Then my father and I would both listen, as each person would tell us of their lives, physical or emotional struggles they had, and how they might be coping. We would listen, laugh, and empathize (my father with words, myself with respectful silence and perhaps some thoughtful facial expressions). My father would often offer a blessing of prayer, and we would wish the person well. I came away with a sense for how people could find everyday joys despite physical limitations and other tough obstacles, and how a simple visit like this could remarkably lift up and brighten someone’s day. At an early age, I also saw how much I could learn by following the advice found in an old proverb, keep your mouth shut and your ears open.
During my sophomore year in college, as my hopes and aspirations began to solidify, I settled on studying medicine. It was, I felt, the ideal career in which I could reach my fullest potential for both my skills in science and mathematics and my compassion for people. It was the final gesture of decision after years of shaking my head (at least privately) to queries of so many people as to whether I was going to follow in my father’s footsteps. I had inherited his personable demeanor and his rich, deep voice, after all.
I looked back on those experiences with my father and saw possibly the roots of my drive to study medicine. Hearing about someone’s ailments, and his or her daily struggle to cope, I wanted to do more than empathize and offer hope and prayer. I want very much to offer them the best opportunity for healing that today’s medicine can offer. What is more, though, as I reflect now on my early medical training, is that I don’t want to let go of what I learned early on from my father—a show of deep respect, humility, and care for the spiritual dimension of the person. Care in one dimension is not enough for me, and I believe this is why I find myself frustrated at times now in treating patients, much as I may have felt a bit helpless as a young boy, wondering what to say, even though I knew my place was to simply be, and to listen. Now that I am caring for patients as a resident, my foremost challenge is to develop skill at caring for the whole person, body, mind and spirit, within the time boundaries of a busy practice, and to have the wisdom to know when this is even possible.
An electronic health record offers many tools for supporting and guiding efficient patient care. One task I am pursuing now is to create an electronic template for interactions with patients that I am scheduled to see in our clinic, based on presenting complaints, including a checklist for a pertinent history and physical. I have found that the very process of doing this makes for some high-yield learning, and is helping to build the mental framework I will need to organize my thoughts and prioritize my time during the course of a busy clinic schedule.
Practice guidelines in the form of checklists and flowcharts are part of a growing trend which presents a lot to debate and consider. Sir William Osler said that the “practice of medicine is an art based on science,” and it’s worth asking if some of the art is lost in medicine when we apply standardized formulas and algorithms to a unique individual. The value of a tool is all in how it’s used, and if a chart tool could be utilized to be both thorough and time-efficient, creating space to address a patient’s multidimensional needs, then this supports a doctor’s and a patient’s bottom line.
Jazz musicians are well-recognized for their improvisational ability, to let the music flow through them with passion and freedom. A good jazz piece, though, begins with a structure, a formal composition, even, from which the improvisation emerges and then takes off. Otherwise, what you have is simply a jam session, and patient care is much more than a series of jam sessions in the pursuit of health. The art of the interaction is to have just enough structure, just enough spontaneity.
Music is great for bringing us back to listening. That, after all, is where the interaction must begin, to properly build the process of counseling and negotiating, all informed by the body of scientific evidence and reasonable standards. How to keep all this tapping to a brisk, yet unhurried, rhythm is my hopeful aspiration as I strive to be a physician worth his salt, and, when I start moving my lips, one worth listening to as well.
Little Threads
LITTLE THREADS
In a book on sermonettes for children, I found an illustration on little threads. Stretch out a single thread with both hands and break it. It is easy to do. Do it with two threads. It gets more difficult. By the fifth and sixth threads, it becomes even more difficult. This is the way it is with a lot of things.
This is true with our bad habits. Have you ever walked into a room where not a single piece of clothing has been hung? Have you been in a home where two days of dishes have been piled up on the sink? Have you gone shopping at a grocery store and found trash all over, wrappings and disposable articles of every kind dropped by uncaring, careless hands? Have you seen little children in moving cars unprotected and unbuckled? Have you wondered where the extra fifteen pounds came from? Have you heard foul words coming from the mouths of people and thought, how disgusting? Like little threads, each action, each neglect, each item, though miniscule, will build upon another. From little threads can come such bigger ones.
How often we say, “One more won’t hurt.” A puff of smoke. Another drink. A little white lie. Another mile with the gas gauge at empty. Cheating a customer, a friend, or the government. A burst of anger. Skipping an appointment. Procrastinating on paying a bill. Not admitting an error. Not locking the door. Not arriving on time. Breaking a promise. Failing to pray. Polluting the air, the water, the soil, the ocean. Not locking the gate to the swimming pool. Leaving a child unattended for three minutes. A day without exercise. A day without God.
Imagine what change can occur from so little if each builds toward one thing more, one simple correction, with one helping hand. A simple prayer. One act of kindness. Five minutes of daily exercise. Positive thoughts even for the most despised. Precaution at ATM machines, crossing a busy street, walking a dark parking, driving on high speed freeways, swimming in whirling oceans waves. Learning a lesson from every encounter. Reading one book a month rather than none. Honesty even in the smallest business transaction. Believing in oneself. Learning to trust the trustworthy, being cautious with the untrustworthy. Giving thanks for each good gift. Putting trust in God.
From so little can come so much. Life is full of little threads. In each of us, there are multitudes of threads: threads of thoughts, threads of emotions, threads of energy, threads of memories, threads of human will. Each is linked to a Center of a system, a network, and a spiritual dynamic. On these we build our habits, our character, and our lives. Imagine where we would be when we build on faith, hope, and love, all to make life better for self and for others. Everything starts with a single thread. May they be silver threads.
May 31, 2010
In a book on sermonettes for children, I found an illustration on little threads. Stretch out a single thread with both hands and break it. It is easy to do. Do it with two threads. It gets more difficult. By the fifth and sixth threads, it becomes even more difficult. This is the way it is with a lot of things.
This is true with our bad habits. Have you ever walked into a room where not a single piece of clothing has been hung? Have you been in a home where two days of dishes have been piled up on the sink? Have you gone shopping at a grocery store and found trash all over, wrappings and disposable articles of every kind dropped by uncaring, careless hands? Have you seen little children in moving cars unprotected and unbuckled? Have you wondered where the extra fifteen pounds came from? Have you heard foul words coming from the mouths of people and thought, how disgusting? Like little threads, each action, each neglect, each item, though miniscule, will build upon another. From little threads can come such bigger ones.
How often we say, “One more won’t hurt.” A puff of smoke. Another drink. A little white lie. Another mile with the gas gauge at empty. Cheating a customer, a friend, or the government. A burst of anger. Skipping an appointment. Procrastinating on paying a bill. Not admitting an error. Not locking the door. Not arriving on time. Breaking a promise. Failing to pray. Polluting the air, the water, the soil, the ocean. Not locking the gate to the swimming pool. Leaving a child unattended for three minutes. A day without exercise. A day without God.
Imagine what change can occur from so little if each builds toward one thing more, one simple correction, with one helping hand. A simple prayer. One act of kindness. Five minutes of daily exercise. Positive thoughts even for the most despised. Precaution at ATM machines, crossing a busy street, walking a dark parking, driving on high speed freeways, swimming in whirling oceans waves. Learning a lesson from every encounter. Reading one book a month rather than none. Honesty even in the smallest business transaction. Believing in oneself. Learning to trust the trustworthy, being cautious with the untrustworthy. Giving thanks for each good gift. Putting trust in God.
From so little can come so much. Life is full of little threads. In each of us, there are multitudes of threads: threads of thoughts, threads of emotions, threads of energy, threads of memories, threads of human will. Each is linked to a Center of a system, a network, and a spiritual dynamic. On these we build our habits, our character, and our lives. Imagine where we would be when we build on faith, hope, and love, all to make life better for self and for others. Everything starts with a single thread. May they be silver threads.
May 31, 2010
Why?
WHY?
A professor of philosophy had given his students an examination. The last question simply read, “Why?”
The professor passed only two of his students. One had written, “Why not?” and the other had answered, “Because.”
Some of life’s most profound questions are put in a single word, why. Why must people suffer? Why can’t I be like everyone else? Why do I have this disease? Why am I poor and unlucky? Why did mother have to die? Why am I a victim of the floods? The earthquake? The fire? Why is it that my son is missing in action? Why can’t we have a child? Why did I have to lose my job? Why was I raped? Why wasn’t I chosen? Why was I born in such dismal condition? Why can’t I choose my own death? Why?
Well, why not? We are all subject to the same. It rains on the just and the unjust. Life is not fair. There are as many circumstances as there are individuals. The law of probability just is: one out of so many will be affected no matter what it is. Nobody said life will be easy. Life is difficult. Everyone has a choice. Murphy has a point—when something can go wrong, it will. You were just in the wrong place at the wrong time. You didn’t care for yourself. You were warned. You knew better, but you did nothing about it. It’s genetic. The devil lurks in dark places. It was an accident. It was mere coincidence.
Well, because. Because the world is not perfect, but the world is arriving at perfection. Because each experience has a lesson in it for us. Because God wills good for those who love God. Because when we break nature’s laws, the consequence is decay, illness, and death. Because genes hold in them blueprints of biological life, physiological tendencies, and more. Because circumstances carry in them dynamics, consequences, and results all their own. Because the human character is still being transformed from lower to higher understanding, from selfish to unselfish intentions, from human to godly perceptions. Because everything has its time, its course and its purpose.
Furthermore, there are some things we cannot know. There are some things we need not know. And there are some things we will not know. So just live life in the best way you know how. Trust in the higher power of God. Search the inner knowledge which is Spirit given. Put on the Christ Mind. And you won’t have to ask, “Why?”
May 31, 2010
A professor of philosophy had given his students an examination. The last question simply read, “Why?”
The professor passed only two of his students. One had written, “Why not?” and the other had answered, “Because.”
Some of life’s most profound questions are put in a single word, why. Why must people suffer? Why can’t I be like everyone else? Why do I have this disease? Why am I poor and unlucky? Why did mother have to die? Why am I a victim of the floods? The earthquake? The fire? Why is it that my son is missing in action? Why can’t we have a child? Why did I have to lose my job? Why was I raped? Why wasn’t I chosen? Why was I born in such dismal condition? Why can’t I choose my own death? Why?
Well, why not? We are all subject to the same. It rains on the just and the unjust. Life is not fair. There are as many circumstances as there are individuals. The law of probability just is: one out of so many will be affected no matter what it is. Nobody said life will be easy. Life is difficult. Everyone has a choice. Murphy has a point—when something can go wrong, it will. You were just in the wrong place at the wrong time. You didn’t care for yourself. You were warned. You knew better, but you did nothing about it. It’s genetic. The devil lurks in dark places. It was an accident. It was mere coincidence.
Well, because. Because the world is not perfect, but the world is arriving at perfection. Because each experience has a lesson in it for us. Because God wills good for those who love God. Because when we break nature’s laws, the consequence is decay, illness, and death. Because genes hold in them blueprints of biological life, physiological tendencies, and more. Because circumstances carry in them dynamics, consequences, and results all their own. Because the human character is still being transformed from lower to higher understanding, from selfish to unselfish intentions, from human to godly perceptions. Because everything has its time, its course and its purpose.
Furthermore, there are some things we cannot know. There are some things we need not know. And there are some things we will not know. So just live life in the best way you know how. Trust in the higher power of God. Search the inner knowledge which is Spirit given. Put on the Christ Mind. And you won’t have to ask, “Why?”
May 31, 2010
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