Slow progress?

Ever find that time is moving on, that organisating things is perpetual and that little of substance is being achieved?  It's been about 5 weeks since my trip to Germany.  I seem to have been on-call often, with my sleep-wake cycle being sent into disarray.  When opportunites come emails are sent, phone calls are made, answers are few...  Progress with paperwork has been at times frustrating.  It's also been four months since I was last in Eastern Europe.  Masters studies have been squeezed into free time, however, each week seems to run into the next.  Where has the time gone?

Where are things going, what am I achieving?

Stop.  Reflect.  Perspective check.  I think I sometime struggle due to defining personal success (and thus to some degree self-worth) in terms of achievement and overt productivity.  The outworkings of such a philosophy can be quite dangerous.  If I 'fail' to achieve, does my worth diminish?  Do patience, planning, contemplation and relationship building have no worth?  Does God's love for me change depending on how 'productive' I am (or what I would personally deem as productive)? 

Comforting to know however, is that God's plans will come to fruition regardless of my efforts.  He has saved my be his grace, not through my own worth.  Even if I were infirm and immobile, God's grace and love shown to me (and thus my worth in his eyes) would not change.  Jesus' death and resurrection has made this certain.  All work and service for Him should be as an outpouring of thanks, not as a definer of self-worth.  The funny thing is, things seem to happen when you entrust the efforts to God.  The results are often different to expected, yet more praiseworthy in hindsight.  Afterall, he is creater and sustainer of all.  Reflection makes it plain that it is far better this way - just need to be daily reminding myself of this!

So, planning and preparation over the last two months:
- Further discussion with the medical council of Saarland, list of required documents formalised
- Teaching schedule for the Eastern European Congress of Christian Medics provisionally written
- Key note speech offered to PRIME at said conference
- Provisional offer to teach medical communication skills at a medical school in Ukraine in May
- Potential for a further trip to Romania to teach medical communication skills to medical students later in the year
- Masters coursework on epidemiology (part one) completed [means a 1/6th of the course is done now!]
- Medical rota for next rotation finally obtained (many swaps will be required however...)
- Getting to know people better at church.  Feeling that fellowship and being able to encourage others is improving as a result! 

Lets see what the next few months hold!

Return to Saarland

So, this is it, the return to Saarland.

After a somewhat eventful and prolonged journey; DHL lost my train tickets; my plane was cancelled at short notice; booked online tickets with Eurostar / TGV / Deutsch Bahn whilst on my way to London; telephoned and booked a hotel room in Paris; I can greet you from Germany.  Highlight of the journey was definitely the TGV driver appologising that the train could only manage 280km/h due to the icy weather and then deciding to travel at 310km/h anyway!

I've come back to Saarland (south west Germany) for several reasons.

Firstly, I made some really great friends here back in spring 2011, when I had the opportunity to complete an exchange semester here.  This was a truelly blessed and influential time, and I am extremely grateful for it.  It's been fantastic to be able to catch up with some of these including those from church (instant warm welcome and lunch invitation - love it!), friends from work, and friends from halls ('gudd Gess' has been shared!). 

Secondly, I've had a job interview here.  The interview was for the department of Nephrology (kidney medicine), one of the departments I studied within whilst here on placement.  I sent off an application a few weeks back and they said that they were interested in hearing more - hence my determination to get here!  Thankfully, the interview went really well and I've been accepted!  The head of department was approachable and open, telling me more of what to expect and the challenges and opportunities ahead.  My previous supervisor also came and put in a good word for me (I have retrospectively rewarded him with fine scotish whisky and M+S shortbread).  So, I've got a few formalities to sort out with the administration, however once that's sorted I'll be able to receive the contract.  Unexpectedly, my second year of the UK foundation programme may also count towards my speciality training, shortening the process by a year and letting me enter at a higher pay-grade (score!).

Thirdly, I needed to figure out the German equivalent of the General Medical Council.  This has proven to be the challenge of the trip so far...  They required 13 legal documents, after a lengthy discussion I managed to persuade the administration to accept 2 of the documents I had brought with me.  Turns out I need to become good friends with a notarist in order to legally recognise and translate my certificates, scripts and legal forms into a legislatively acceptable format.  I think there may also have been further miscommuncation during the meeting, as I had to spend several minutes persuading them that I was infact a real practicing doctor inspite of not having an MD.  Definite character building experience!!!  (although nothing that a combination of pray with coffee + german cake can't fix).  I have admin lady's email address and will be in further contact.  I seems possible to get everything together, it'll just involve quite a bit of hassle, time and expense.

So, it's great to be back in Germany.  Job is set and the language skills are coming back.  Sadly, lots of the students are away or in exams at the moment.  Encouragingly my church pastor tells me that quite a few new christian medics have started this year.  A christian medical group has also recently been founded.  Also, incredibly excitingly, I have discovered that a russian speaking congregation have started to meet in the town - Mega Awesomah!!!  Looks like there will be plenty of opportunies for Christian medical fellowship and improving my russian language skills!

In summary - I'm seeing many opportunities as to how I can serve here in Germany.  There will be many opportunities to learn more about people, my strengths and waekness, langauge(s) and cultures.  The present frustrations are useful to me as they will prepare me for what is to come.  It's also a great humbling experience and will allow me to serve others much better and to learn to rely on and work hard to honour God.  Just need to remember this when they say in the administration tells me in their direct manner - Nein, das ist unmoeglich!

Looking backwards, looking forwards, looking east!

The year that was 2012 is slowly drawing to a close.  It's been a busy one.  I've been blessed with many opportunities to head east, visiting quite a few countries for the first time.  This has included: a parisian New Years celebration with old friends (plus oysters & cigars); navigating a crazy interrail route around Ukraine, Hungary, Poland, Austria and Germany (with a tour of Chernobyl powerplant enroute); enlightening medical teaching trips to Ukraine (twice); summer camps with teaching opportunities in Lithuania and Belarus; short stays in Latvia and Estonia; backpacking around Russia having chance to see St Petersburg, Moscow and Kursk (with fantastic guided tour); and giving a week long series of lectures as part of PRIME on 'Whole Person Medicine', 'Stigma in healthcare' and medical communication skills to medical students at the University of Cluj-Napoca, Transylvania (Romania).  I've been made incredibly welcome by those I've met and have some great new friends.  I'm always amazed at how despite different cultures, the gospel (aka good news and promises of Jesus) unites people all around the world.  I have been shown such love, kindness and patience by those I've met and often stayed with over the past year - I cannot be thankful enough!  It's also been the year where I've gone from medical newby panicking about taking bloods to scary SHO on-call, being given even scarier responsibilities.  I've had some really great wards, inspiring supervisors and a fantastically supportive and caring church family, who've helped me keep my perspectives in check.  Furthermore, by grace, Preston now has a Christian Medical Fellowship group.

2013 also looks to be another year of challenge and adventure, with potential trips to Czech rep, Austria, Ukraine and Romania on the horizon.  Latvia is another contender.  God willing, I'm hoping there may also be a trip/holiday to Russia in the pipeline (buh-dum-cha!).  This may even be the long awaited year when I embark on the Trans-Siberian railroad and finally reach Vladivostok, the 'Ruler of the East'.  If the pace of work continues, 2013 should additionally herald the completion of year one of the Global Health masters (PG cert - woop!) and also potentially the dreaded MRCP part 1 (medical speciality exam). Mega Слава Богу if I manage that one!

Most excitingly however... there is a likely change of scenery ahoy.  Whilst adminsitrative formalities are ongoing, I've accepted a clinical position in south-west Germany to start in September 2013 (black dot on map beneath).  I can envisage many opportunities and beneficial challenges in working there; I greatly look forward to embracing these!   

So, what have I learnt in 2012?

1. Trust in God; work hard; things happen.
2. Travel is easy, the mind provides barriers, flexible is key. (Haiku!)
3. Effective time management is never to be underestimated.
4. Necessity is the mother of invention.
5. I have the ability to teach.
6. Stereotypes are limitted in truth, isolation helps reenforce them.
7. Aspirations are not limitted to a particular culture.  Neither is self-interest.
8. The Russian language is an enigma slow to unravel.  The reward of doing so however is bountiful.
9. God is faithful, even when I am not.  Praise be purely to him.

Key
-  Yellow : Countries visited previously
- Orange: Countries visited this year
- . Red  .: Countries on the hit list for 2013
-  Green : Germany, planned new home
-  Black  : Location from Sept 2013

Corruption in healthcare

Corruption is a major problem in healthcare.

Corruption in healthcare is a major problem in the nations of the former soviet union.  There are many reasons for this, however none that are insurmountable.  My masters' tutorial group chose the topic of healthcare corruption for our presentation.  Your thoughts on the presentation are most welcome!

Corruption in healthcare

Corruption in Healthcare on Prezi

Why is there corruption?
No nation is immune to it, however some health systems are unfortunately afflicted by it more than others.  Ultimately it boils down to the problem of the human heart - putting perceived personal interests above those of others (and of God).  Christians we can be shining lights in this field, showing that corruption needn't be the only way.  Key in this is remembering:

•  Who we are:
• Romans 3:23 - all have sinned, all fall short of God's glory.

•  Personal accountability & integrity:
• Matthew 7:3-5 - pull the log out of our own eye before others

•  Jesus' sacrificial love:
• Matthew 22:37-39 - love the Lord your God with all your heart, soul, mind and strength, love your neighbour as yourself.

•  We are accountable:
• Luke 16:10-13 - God cares about how we live.
• “One who is faithful in a very little is also faithful in much, and one who is dishonest in a very little is also dishonest in much. If then you have not been faithful in the unrighteous wealth, who will entrust to you the true riches? And if you have not been faithful in that which is another's, who will give you that which is your own? No servant can serve two masters, for either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve God and money.” 

România - este un loc frumos!

Hmmm, looks like I might be falling in love with another country and her people…  I’ve just had the great opportunity of teaching medical students for a week with an organisation called PRIME (Partnerships in Medical Education).  The uniting theme was that of ‘whole person medicine’ i.e. when you value the patient as a person rather than just the condition they bring with them, you dramatically improve quality of healthcare, diagnosis, treatment relevance, concordance and compliance.  The concept is drawn from the foundational biblical principle in love and service of God, we value and have compassion for our neighbour, regardless of situation.

As a result, I led a diverse range of lectures and seminars on topics such as:

• Breaking bad news to patients
• Identifying and managing depression
• Stigma in healthcare; including alcohol and homosexuality
• Evidence based medicine in practice
• Corruption and accountability in healthcare

These sessions were complemented by further teaching from a colleague specialising in Breast and Thyroid surgery from the UK.  The students were engaged and had many questions from our teaching sessions!  I am thankful for this and learnt a great deal from them too.  I even managed to get a few laughs and at one point a round of applause – something greatly unexpected.

During the afternoons  I had chance to learn from a series of sessions aimed at teachers within the medical school on methods of teaching medical students.  Again the PRIME principles of ‘whole person medicine’ were the foundation – whole student teaching?!?!  I think around 20 different teaching means and styles were covered, all applied with a mixture of theory, practice and discussion.  I again learnt a great deal from the chance to work with several wise and experienced colleagues from the UK, being privileged to share in their thoughts, preparations and actions.

And as for Romania, her culture and people…  The warmness of the welcome was pretty extreme!  We were very well looked after and supported.  I’ve made some good friends and had chance to experience a culture unlike those I’ve been to before in Eastern Europe.  The food is good and language pleasant to listen to (and sometimes even comprehensible).  As the name suggests, it’s latin-based – perhaps you can guess the meanings of: bună seara, merci, and adio?

The last thing to perhaps say, it that Transylvania is not a scary place (apart from the all-enveloping fog!).  Give it a try!

Belarus - the void between ideals?

Belarus - the void between ideals?

Belarus (aka white Russia), is a country in Eastern Europe, bordered by the EU to the west (Poland, Latvia, Lithuania) and the Russia/Ukraine to the East.  It's boundaries have fluctuated massively over the centuries with its people coming under successive empires and conquests.  It lost a quarter of its population during the Second World War, with 90% of its capital city, Minsk destroyed.  It became part of the Soviet Union until its dissolution in 1991.  Over the past 18 years it has had one leader, Alexander Lukashenko, who has ruled the country through the surrounding economic and political instability of the 1990s and the increasing international isolation of the 2000s.  To be frank, western media rarely portrays Belarus in a positive light.  The US government called Belarus, "Europe's only remaining 'outpost of tyranny' ".  The BBC was recently allowed an interview with the Belarussian leader - a summary can be found here.  When describing Belarus the BBC states:

Two decades later (after FSU collapse), the sense of national identity is weak, international isolation continues and the nature of political links with Russia remains a key issue. 

Thus the stereotypical image of Belarus, is that of a grey, centrally planned ongoing 'soviet-style' dictatorship, lacking in freedom, opportunity and fairness. However, beyond the portrayed stereotype, very little is known by those in the UK of the people of or indeed life in Belarus.  I am very grateful for the chance to have had a visa, giving me the opportunity to explore the nation of Belarus and meet the people who live there.


Learnings from Belarus

1. Lukashenko (the president) is not unpopular.

2. Belarussians view their country as a young country, that is bound to make some mistakes as it develops its own national course.

3. The country and its infrastructure are surprisingly modern.

4. The countryside is beautiful.

5. There seems to be relative freedom in expression, so long as you remain inline with the law (sometimes tricky) and don't organise activities to overtly criticise the ruling party.

6. Many Belarussians are confused by the EU's stance of isolation towards their country.  Ethnically, historically, culturally and linguistically Belarus has many ties with Russia.  It's not a case of choosing to align oneself towards one or the other. Belarus falls under both European and Russian spheres.  'Narrow-mindedness' may in fact come from the West in failing to recognise this.

7. Minsk central MacDonalds was recently demolished to build a new library for the university.  The other MacDonalds remains on Lenin Street however...!

8. The believing church is active, dynamic and growing in Belarus.

9. Don't flush toilet paper - it is for the bin next to the toilet.

10. The roads in Belarus are really good - the best I've seen in the Soviet Union.

11. They value their environment and have quite a few natural parks - 'how were we to survive, if it were not for the blueberries and mushrooms?'

12. Hyperinflation means the amount you can take out of an ATM is limited by the width of dispensing slot.

13. Belarussians are friendly, inquisitive and full of ingenuity.

From Russia with love...

So after flitting my way around Eastern Europe for several years, I've finally made it to Russia.  The process has been epic and not something I thought I'd be able to arrange myself.  However, by grace it has been achieved and by grace I managed to see some great sights, meet with some great people and learn a huge amount about the fascinating and awe inspiring nation - it makes up a ninth of the world's landmass!  Unsurprisingly, I still feel like I've only just scratched the surface.

So, here are my initial thoughts and perceptions from my trip - things I hope to build on with time!

1. Russia is huge and is to some extent its own world

2. No smile does not mean no like

3. Russian history is a very complex beast

4. People have the same fundamental yearnings and desires regardless of nationality

5. The concept of an 'ideal' government is not objective

6. Our view of the world is shaped through the lens of the media

7. Night trains are a fun, convenient and comfortable way to travel long distances and meet new people

8. The concept of milk with tea is a non-starter. Mixing Smetana with tea causes mass dismay.

9. The dress code for Moscow is black.  For St Petersburg it's a flat cap.

10. Due to depth, the escalator for the Metro can take several minutes.  If suspecting imminent nuclear war, head to the metro.

11. Always complement the Russians on their fountains

12. Saturday is wedding day.  Arrive at tourist sites early to avoid the wedding crowds.

13. Russians are very very good hosts!!!

Большое спасибо мый русский друзьями, россия очень красивый стран. мне нравится это очень. Слава богу!