The astonished look I absorb immediately after explaining my upcoming year is the facial muscles’ interpretation of the thought: “WHY?!”
Thus, my first post on this blog will be an attempt to relax your muscles of facial expression and to introduce you to next year’s journey. As some of you may know I tend to ramble, misspell and butcher grammar. So, if that’s too painful for you, I’ve added a bullet point synopsis feature to the top of each post. Ta Da!
The Bottom Line:
- I’m a head and neck surgeon moving to Ethiopia to help foster a sustainable head and neck residency
- I lived a privileged childhood, but various life experiences created a passion for global medicine
- Trump ruined my chances with Peace Corps, but it lead me to Mek’ele so I’m happy
- I can’t predict when I will die, so lets do this now!
For those of you who are willing to limp through, lets begin.
Why post about WHY?!:
I’m an American product of a primary care pediatrician and a pediatric infectious disease specialist. After meeting me and my parents, my journey through medicine would be more predictable than the most recent Batman vs Superman movie. Moving forward 32 years, I’m now a board-certified head and neck surgeon and have completed my fellowship in pediatric head and neck surgery at Lurie Children’s in Chicago. At this stage in my career, I’m supposed to nuzzle my way into an academic career at a well-known children’s hospital or join a private practice. Everyone in and around my life knows this and thus when I tell them the answer to their inevitable question of “So Josh, whats the plan for next year?”, it activates a ridiculously large amount of facial motor unit activation and a quick check of the inner conscious: “is he joking?!”
I haven’t studied it, but probably 95% of people either see that concept as too impossible or me as too sarcastic to allow their initial analysis to deem my statement truthful. It doesn’t upset me, I get it. Why at the first opportunity I have to practice on my own, would I move across the world to practice in Africa? This post will be an incredibly feeble attempt to explain that answer.
Why I’m practicing abroad
I’ve had a lot of practice answering this question over the past year. I’ve been able to distill my answer to a 30 second, 2-3 sentence retort that really only serves to help relieve facial tension. But, with each time I robotically dictated these thoughts, I became more acutely aware that they do not convey the fullest truth. I’ve been telling people: 1. I’ve always wanted to do this type of work, 2. I’ve spent the last 10 years learning this unique skill set, why not use it where they need it and 3. I can either do this now when I don’t have a family or at the end of my career. So lets break these down, one by one.
- I’ve always wanted to do this type of work:
Now, this is kind of a meaningless statement mainly because I don’t even know what type “this type of work is”. Also, I haven’t always wanted to do whatever it is, but it has occupied a tremendous space in my adult mind. When I try to distill where the desire really came from, I start in 10th-grade biology (where every thrilling story begins).
By this time, my pediatric parents had exposed me to at least two forms of religion and left it to me to decide what to pursue. I chose sports. I can confidently say that my own code of morality was built within the confines of team sports. Soccer, baseball, and basketball taught me that only with trusting your teammates and intense disciplined practice can you succeed in life (performing well in games was the most important thing in my life at the time). Team ethics combined with the trial-and-error ethics I practiced with my parents, always pushing what I could and couldn’t do has helped shape the way I view my place in the world.
Although the house I grew up in didn’t have a white picket fence, I fit that stereotype pretty well. My parents did a great job of keeping my developing moralities in check but gave me certain liberties to explore. Over time, I started capping my own limits and could check myself back into line. I remember vividly one such example: There’s a wall on the side of the house I grew up in that connects to the driveway. I’d often drill the basics of each sport against that wall, even blending sports by throwing a tennis ball against the wall between the windows, performing a 180 turn and jump shot into the basketball net behind me. As you can see from the picture here, there’s a narrow margin for error.
Inevitably one afternoon, on repetition 100 of throwing the tennis ball against the wall, I glide it straight through the lower pane of glass on the left, creating a jagged ventilation port into my parent’s bedroom. I knew the risks and despite being ready for the punishment, my mom simply said: “we can get it fixed, just be careful next time.” I think any teenager would walk away from this with the same smirk someone gets when they covertly uncover the “get out of jail free” card in Monopoly, but I was furious. Here, I thought my ethics and morality were constructed with concrete borders, I then knowingly step out of those borders and it’s OK!? No, that wasn’t suitable and I grounded myself for a week.
This was an important lesson for me as a developing human being, but for you, it should reemphasize that I lived an easy, comfortable childhood which would eventually become a train-tracked path through pre-med, medical school, residency and fellowship without derailment. Therefore, when I was asked to research the epidemic of AIDS in a country of my choosing in Africa as an assignment in my 10th grade biology class (I told you this is were it started, but I guess I kinda lied), it should come at no surprise that my view of how life should be was violently challenged. I didn’t know it at the time, but the myriad of emotions I experienced that semester formed a reservoir for which I would taste from at key moments in my life.
Fast forward to the summer between my 1st and 2nd year of medical school (yeah, nothing super important happened between this time). My dad, the infectious disease specialist trained with Dr. Mark Kline who founded Baylor International Pediatric AIDS Initiative and had clinics all over the world helping to lower the rate of HIV transmission and to treat those already infected. After the two of them talked, Dr. Kline offered the opportunity to join their group in Botswana for the summer. I leaped at the opportunity to see if what I learned in 10th grade was real, or a misinterpretation. Today I won’t go into what I experienced there (because I already have in another blog), but you can imagine it transforming my emotional reservoir into an entire lake of emotional experiences for which to sample when encountering my own emotional dilemmas.
Following that trip, every disease I learned and every patient I’d treat, I would sip from that lake and briefly compare experiences. When it was time to decide my own life path of surgery or pediatrics, I’d be cheating my inner-self if I didn’t admit that I pictured myself operating in Botswana. Pulling the trigger, I matched in head and neck surgery and the rest you know.
- Why Ethiopia?
Never mind how convoluted this answer is, it’s progression was surprisingly mindless. At the end of July 2018, I’ll be joining the faculty of Mek’ele University’s tertiary hospital (Ayder) where I will help train and teach 3 Ethiopian attendings and 8, soon to be 12 residents.
The decision progress began during my 4th year of residency when my very good friend and stellar OB/GYN, Cori Maund, made the decision to join Seed Global Health with the Peace Corps and move to Liberia for the year (you can see her adventures here). She made the connection with the help of a Physician recruiter in our emergency department, who also happened to be the former dean of my medical school. Inspired by Cori’s selfless actions and fueled by my favorite metaphorical lake (from above in case you fell asleep), I contacted Seed Global Health to see if they would be willing to take on a head and neck surgeon.
After A LOT of searching, conferences, e-mails and time it seemed like there was perhaps a place for me in Malawi. I was about to graduate from residency (it’s now May 2017), do my year of pediatric fellowship and then move abroad with the Peace Corps. But, in late May, the Trump Administration announced a 12 million dollar cut to Peace Corps forcing Seed Global Health to completely reconfigure their support structure. My position vanished. Heartbroken, angry but determined, I turned to networking. Through one of my otologists, I learned of Dr. Richard Wagner, founder of Global ENT Outreach. He and his colleagues have established otology missions all over the world. I called him the next day, explained my desires and inquired if he could advise me. The first words out of his mouth were “I know exactly where you will go next year, it’s a hospital in Ethiopia…lets go there together in November.” I was dumbfounded and hesitant, but the excitement in his voice gave me hope. I ended up visiting Ayder and Mek’ele University in November 2017 and fell in love (this visit will be featured in a future post).
Two months later, I had a contract with the hospital and my life was set.
- Now or Never:
Another simple answer. No matter who I talked to, it was clear that if I wanted to spend at least a year abroad, I would either have to do it now or when I retire. Since I’m single, no children and I am in no rush to start my career, the timing is perfect. Besides, this experience may completely manipulate my life goals and set a completely different career path. I thrive on the unknown and the excitement it produces. It’s now or never baby!
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Thank you for all your support and if you’d like to hear or see anything specific, leave a comment!