I hate running. I love to have run. Being in school has put me in this horrible predicament: I am horribly out of shape and feel fatter then I have ever felt. So, what is the best way to combat such a situation? REACH HIGH! So I am signing up for a half-marathon in October in Durham. I have started the painful experience of getting back in shape. I can run a mile (don’t laugh), and I hate every minute of it. But, I would love to once in my life feel like an athlete. So here I go.

My dear friend Michael Watkins and I are tackling the gym together.  And I hope to join a fleet of my girlfriends in running the women’s empowerment half marathon in October.  (Thanks Cory and Austin for being willing to suffer through such a task with me.)

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So, its my penultimate day at Duke Raleigh’s ED with my preceptor. We had a patient come in that “barely spoke any English” per the triage nurse. “He has a friend with him that can translate” (also per the triage nurse). I am of course totally excited (and perhaps a little terrified) to practice my spanish again. I went into the room and introduced myself in English and in Spanish and then the Doctor walked in. He heard me introduce myself and petitioned me to translate for him.

Well, we muddled through somehow (thank goodness for the friend who was there that could fill in the gaps that I couldn’t do) Rosa, my Spanish teacher, would have been so proud of all the spanish I could still muster out. After the doctor left I started asking those other important questions that Rosa keeps telling us to ask… (and I am so grateful that I did!)

me:: De donde es Usted?
him: Honduras
me: HONDURAS!!! ( can you just imagine the excitement on my face when he responded with “Honduras”)
me again: Fui a Honduras a mes pasado! Donde en Honduras es Usted.
him: Las Merecedes.
me: LAS MERCEDES!!

( I of course had to be peeled off the ceiling at this point.) Can you even believe it? I of course was so excited that I couldn’t even attempt much spanish because I wanted so much to hear how he came here, what he was doing here, what made him come here. etc. I think I overwhelmed him a little with my enthusiasm. His friend very kindly translated all of my questions. And as I asked them so much of this patient took me back to our trip. He was so quiet. He barely made eye contact with me. I had to make myself slow down and be still to get him to stop looking so terrified of this crazy american who was drilling him about his hometown. When I got myself calmed down and still he told me a little about himself. He apparently came over here 5 years ago and had been working odd jobs here and there. He didn’t really tell me how he came here- I imagine that those are perhaps not the easiest questions to answer in that kind of setting. His family is all still back in Honduras, in Las Mercedes. I asked what their names were, but I am not sure I would have remembered the names even if I had met his family (Mom, Dad, and 2 brothers- both younger). I asked him if he remembered the clinic. He said that the building wasn’t there when he was still living there, but he did remember the group coming through. (again- how crazy is that??!!). He seemed so nervous to be in such a big hospital. His demeanor was so much like the people we met so many miles away. His friend said that it was so great that I could understand the vast differences in the hospital experience here vs back in Honduras and that he felt I could really understand his friends’ anxiety in a way others couldn’t.

I was in my own cloud of enthusiasm the rest of the day. I missed all my dear Honduran team mates and wished they all were there. I was reminded today what an amazing trip we took. I never would have even attempted speaking spanish had I not had all that time to practice, I would have perhaps never took the time to really ask where he was originally from, never would have had that camaraderie of a shared place and a shared experience of people.

I am sitting in a coffee shop
on a warm, bright monday afternoon
I smell toast toasting
And my chai is warm on the palms of my cupped hands.

My heart is aching.
For no particular reason
just heavy with a few purposeless days
and a misalignment of minds.

Leave me not to my own devices.
I look for remnants of criminal activity,
forage for bodies buried under the new growth
and pick at healing wounds.

Whatever found injustice will have been teased out.
Undisturbed, it would simply lie down and rest
somehow peacefully
had I not disturbed its grave with my incantations.

Perhaps instead of charging these tired bones
and chipping away at the remodeling
I could shroud the remains of an empty cause
and let Lazarus sleep.

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We had a fabulous evening of stacking jars and launching on pillows.

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Dennis Clements, MD, PhD, MPH gave a lecture entitled “Global Health, the New Kid on the Block” to a class of 40 or so mixed discipline students (nursing, medicine, physical therapy) interested in exploring medicine on a global scale.  The presentation outlined the progression of global health since its true, documented introduction in 1997.  It offered a defense for the need of global health initiatives, the changing health picture of the world by region, and finally Duke University’s initiation into and current role in global health.  Dr. Clements delivered a concise, statistically-dense presentation on some of the current and projected challenges of the global health initiative.  He challenged his audience as soon-to-be licensed health-care professionals to get engaged in an area desperate for individuals seeking an “unconsummated desire for sacrifice and service”.

Dr. Clements opened his lecture with a humorous, nostalgic reminder of the cell phone, circa 1997, the same year “global health” got its real, documented start. The phone was big, bulky, and probably did not offer a fraction of the services that today’s wireless enterprise boasts.  The leaps and bounds technology has made well represents the developing world of global health.  The US spent over 63 billion dollars in the last 6 years on global health initiatives.  There are currently 270 Universities in the US that report some kind of Global Health Program; 158 of those universities offer Global Health concentrations, tracks or certificates, 70 have Global Health Centers, 49 offer degrees.  As technology continues to explode, international travel transpires in a matter of hours and life expectancy, even in underdeveloped countries, continues to climb, our global picture of health is radically different.  It demands an interdisciplinary effort to study, research and practice population-based interventions, clinical care/treatment, address trans-national health issues all in a hope to achieve some level of global equity in health.  To do so, and in an attempt to meet the UN’s Millennium Development Goals, Dr. Clements stated that global health care providers work on addressing infectious diseases, chronic diseases, environmental threats, social determinants and health system strengthening.  He expanded each of these challenges with specific examples.  Dr. Clements concluded his presentation with his personal plug on why we, his audience, should be joining the public global health enterprise.  He highlighted and bragged on Duke’s very new, but already highly effective program and offered resources for additional information and opportunities.

Dr. Clements presentation on global health synthesized chart after graph after projected trend from the CDC, UN, WHO, of the mounting healthcare challenges to provide a concise argument for the importance of a global health initiative.  “Global health will soon be simply, public health” he stated. In a strong, fluid manor, Dr. Clements easily captured his audience with his clear and thorough understanding of his content in addition to expertly adding personal anecdotal stories that offered compelling asides to his slides.  Considering the depth of available information and complexity of the topic, an hour worth of content just barely whet the pallet.  I left wishing his hour long lecture was just an introductory speech to a day-long seminar on a changing global climate and how we, as soon-to-be health-care professionals, could get involved and make a difference.    My only reservation about the lecture was the failure to address the huge ethical conversation that is tightly woven into any kind of international effort.  The challenges that face the health care community are so much bigger than just the health issues.  How does one deliver and execute interventions that address the various challenges within the scope of the global health problem in a culturally sensitive, sustaining way, invited way?

Phrases are intoxicating.

Like the song title: Where from Here.

It sounds so melancholy and thoughtful and resounds so clearly as I contemplate that very question.  Where from here?  Where from here?

I’ve been reading Donald Miller’s blog almost every day.  It reads like a daily administration of good advice, sound thinking, reaffirming motivation.  “Luck favors the prepared” he says.

“YES! Yes it does” I think to myself and nod along in agreement.

Life seems so full of truth and heart-evoking responses of late.  I wonder why.  Is it the approaching graduation date; is it the near end of the chapter I am living?  I feel this same way as I approach the end of a book.  You read with with a hesitation:  you want so desperately to finish the book; to find out what happens, to participate in some way with the conclusion of this story….

and yet….

the bitter sweetness of it envelops you as you close the back cover back upon the handful of pages you have just consumed. Its over.  You will never know more.  The road you have been walking has ended.

Where from here?

Its always another book.  Another story.  Another road.  Another lesson, another heartbreak…. but where? when? how? and who?

Graduation, YES!  and then…

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