This week marks the official handover of my job as Mukinge’s director of clinical services to one of the other docs who’s planning to stay longer. I’ve been nominally in charge for about 18 months now, but since I’m planning to head back to the US in November, we wanted to do the transition a few months early to work out some of the bugs. So far, the transition has been less than smooth, but we have three more months to work it out.

I have been working closely with Dr. Edgar Mutimushi, who is taking over as the hospital's clinical services director, my former post.How to hand things over well must be a recurring issue for missionaries and aid workers all over the world. I haven’t figured it out yet. So many of us want developing countries to be ‘self-sufficient,’ but this is a more complicated issue than it seems. So much more is needed to keep a project running here than at home, and it’s almost impossible for the community to support these projects with the limited resources they have, even if the residents have embraced the idea and want to make it work.

I’ve seen projects that would have died simply because there was not enough money available to purchase 20 gallons of fuel (currently priced around $14/gallon in the town where I live). I’ve seen equipment at the hospital become unusable because of a lack of batteries or because we didn’t have a UK-style electrical plug (about $2, plus a 5 hour one-way bus ride to get to a store that sells them).

But these small expenses, at least to me, loom larger for a community that is chronically strapped for cash. Many residents live on a meager income generated from subsistence farming, while others have overextended themselves financially to buy into the ‘American’ dream of possessions, comfort, and entertainment. Add to that the need to support large, extended families (the money order post at the post office must be the busiest place in town) and most of the time, even small expenses can be difficult to meet. It would be unfair for an institution to expect its cash flow to come from the pockets of its workers.

So I’ve been learning to let go, but it’s difficult because I know the road has been made much smoother for me by the gifts and resources that I have at my disposal as an American with good support from home.

The road is certainly rockier for someone to do my job without those resources. True ‘self-sufficiency’ is still a long way off. In an ironic way, I'm beginning to see that a good handover actually means that I continue to be involved, present, and available to help meet needs even though I’m no longer the person in charge. Or to put it another way, to not only hand over responsibility, but also to hand over my resources and control of those resources so that the work can continue to move forward without me.

Thanks for reading.

I’ve always wanted to use a Flannery O'Connor title for my blog. I often have weeks that are exhausting, yet intensely satisfying at the same time.

One of the problems with medicine in the U.S. is the sheer distance of it. Your “doctor presence” has to be mediated by white coats, scrubs, ultrasound machines, tubes, oxygen, and so forth. When going to the hospital, many people expect to see a loved one “hooked up” to various machines, pumps, IVs, catheters, etc.

Here, some of those barriers still exist, but often the distance is frighteningly close—frightening because it reminds you of your own mortality and frightening because as a doctor, you work with little reserve.

At home, we think little of transfusing 5-10 units of blood in the ER, followed by another 30-50 in the OR. Here, I donated a unit of blood on a Monday afternoon, and that evening it was given to a woman receiving a C-section. It was the only unit of type O blood we had.

The next day, I was called to obstetrics because a newborn baby wasn’t breathing. We put a tube into his lungs, and I spent my lunch break acting as a ventilator until he began to breathe on his own.

Such things make you wonder what happens when you're not there to be a blood bank, a ventilator, or the doctor to perform a C-section?

The title of this blog, taken from one of Flannery O'Connor’s short stories, was trying to say that our actions have a much bigger impact on us than they do on others. This isn’t a complicated idea, but it’s profound nonetheless. I think the corollary also holds true. If you don't save the lives that you can, you may also lose your own way in the process. What I often struggle with is how exhausting that process can be, especially when you are stretched thin between work and interpersonal relationships, which take a lot of effort to keep smooth.

I believe that the lives of others are worth it; what I don't often remember is that when it seems like I'm spending myself to the limit, I'm also saving myself from callousness and ineptitude as well.