Everything is so familiar and yet I still feel somewhat of a stranger in my own home, my own state, my own country.
I knew things would be a little strange to begin with and so far it has been a reasonably smooth transition. I have reliable internet access, I have a phone so that I can be contacted anytime, anywhere and if I need to purchase anything, then it's at my finger tips. I'm back in the modern world and I've taken full advantage of all these modern luxuries.
I had dinner with a colleague last night who is also a friend I love dearly. He's incredibly smart and very experienced. We went through some of my clinical photos. During my time in Swaziland I often took photos of interesting cases or things I had no idea what they were and hoped to look up when I returned. He was able to identify some of the mysterious conditions immediately and I started to develop an uneasiness that can only be cultivated in a mind that is still somewhat traumatised by what she has seen recently. I lay awake all night thinking about what I may have missed whilst I was in Swaziland. Perhaps I could have made more of a difference had I been smarter? Maybe it was incredibly naive of me to go to a third world completely unprepared for what I would see. I am still acutely aware of the feeling I used to have when I would see patients and not have a clue what was wrong with them. It was the worst feeling in the world and despite the fact that I had absolutely no resources to investigate any further, I would still feel like I had "failed" the patient. As my time at GSH passed, I got better at dealing with my feelings of complete inadequacy and I would just resolve myself to the fact that patients would die without me ever knowing what was wrong with them. We had no autopsy facilities. This kind of uncertainty just doesn't happen very often here in Australia and as a young doctor (well maybe not so young, I did turn 31 on Saturday), it was confronting to not be able to have the answers we so desperately go in search of here.
I know in my heart of hearts that I did my very best. I worked my arse off and when I wasn't seeing patients I was often consulting textbooks to try and work things out. I know that my uneasiness is due to my fatigue and my often debilitating self-doubt. I just know that if I decide to work in the third world again, I'm dragging my friend along as my virtual resource centre.....
Today I embarked on my first trip to a shopping centre. Next week I start a new job working in a private emergency department. Surprisingly, the wardrobe I wore in Swaziland- which consisted solely of t-shirts, jeans and cargo pants- won't be appropriate for this new place of employment! I decided that I would take the opportunity to update my wardrobe, redefine my image and become a little more sophisticated. I was somewhat overwhelmed by the experience. I tried on all these clothes and nothing seemed appropriate. I looked like mutton dressed as lamb and realised that no matter what I wear, I can't remove the fact that I'm actually a person who has returned from a third world country and no amount of flash clothing is going to erase the fact that I'm now a different, less sophisticated person. I didn't buy a thing. In fact I didn't even buy any new underwear- which is virtually unheard of because I actually have an obsessive/compulsive tendency to buy extravagant pieces that are riduculously over-priced and inpractical. (However, my sister does design lingerie so I think the problem is genetic)
I ran into an old school friend whom I have not seen in 14 years. She asked me what I had been up to and I simply said that I had just returned from some volunteer work in Africa. She was enthralled and asked questions that simply cannot be answered in a short response in the middle of a shopping mall. She started telling me that she dreamed of doing something like that and that if she won the lottery, she would just spend her life working as a volunteer in the third world. She asked me why would I ever come back to Australia and I replied "Because I wasn't earning a cent and it was destroying my soul watching a population implode upon itself". Perhaps I could have been a bit more subtle. I did not respond positively and I think she was taken back by my blunt response. Basically I said that it was very easy to romanticise the altruism associated with "helping the third world" but in reality it's really tough and not always rewarding. In fact, I think my actual words were "You know, it was a fabulous experience and really challenging but there were also times when it was actually shit and I couldn't wait to get out of the place". She replied with the usual response that is starting to irritate my gut "Well you'll be such a better person because of it". Why does paying witness to utter devastation suddenly make me a better person? I know people are trying to be kind and positive when they say this, but I'd like to think that I was a good person before I even left for Africa. I spend everyday trying to "better" myself. My motivation was simple- I had skills and I wanted to use them where they were needed. I didn't go to "better myself" or because I was "told to go by God", I went with the intention to try and make a difference and the harsh reality is that I made very little difference. Swaziland and it's population are a mess and my very short time there changed nothing. People are still desperately poor and dying tragically from AIDS. This is the reality and perhaps why I cried as I drove myself home. I don't want people to tell me how amazing I am- I'm no different to anyone else who has gone there with the intention to help and every single one of us has returned with the country not being any better off than when we arrived. The problem is so overwhelming, so devastating and so incredibly complex that it's probably why I'm struggling to consolidate the experience and work out just what I need to do next. Perhaps I should just keep my mouth shut and tell people I took a sabbatical for 6 months. No one wants to know what sabbatical is- it sounds too academic.