Merry Christmas!

Finally got back on email and had all these wonderful Christmas
greetings awaiting me. Thank you all! I made homemade eggnog, and
sweet potatoes are still awesome all the world over, and Christmas is
way more fun when you're an adopted uncle. Thinking of all of you for
the holidays.

Love,
Matt

Ants in my pants

Quite literally today, the ants crawled up my pants, as I am visiting
one of the elderly missionaries on the station who's been a bit ill and
wondering how I can suavely smush the ants beneath my scrubs without
seeming like a strung-out meth addict. The fecundity of African bugs
requires a second sense to avoid breathing them, bathing with them, or
drinking them in your water. The bugs range from the beautiful --
moths, preying mantises -- to the large -- some crazy jumping
rhino-looking beetle and of course the palmetto bugs, near and dear to
the heart of anyone who's lived in Houston -- to the organized --
termites, army ants. I'm reminded of Pilgrim on Tinker Creek, when
Dillard describes the water bug eating the frog, and the sheer volume of
life that the bugs represent. The amount of alteration that the
termites put on the landscape is a testament to their numbers and their
impact.
Occasionally you will get a stream of ants migrating from one place to
another, and the only recourse is to get out of the way. Apparently you
can control the flow with ashes, a practice which reminds me of building
dams in the street gutters when I was a kid. And it leads to
fascinating voodoo-like rituals of ash circles around your bed and
doorsills to try to keep them out. I sprayed my doorway to get rid of
the regular ants (this practice is strongly discouraged with the
migrating ants, as it tends to send them into a swarming frenzy) and was
pleased to have a little pile of dead ants in front of my door for at
least 2 weeks. Apparently the Raid here is a big stronger than the US
-- probably DDT or something. I have fortunately been free of the
marching version of the ants in my house to date, and have lived in
harmony with the bugs, although something has recently broken the truce
(did they hear about the ant pile-up in front of the door?) and is
giving me bites on my arms and legs that appear when I wake up. Today I
had to share my dining room chair with a praying mantis who had perched
on top of it and was reluctant to move. I am starting to feel more
sympathy for those homeless folks I used to see in the ER in Denver with
their 'bug problems'....

end of the road

The road literally ends at the hospital -- this is one of those times I
wish I could show you a picture -- and about 100 yards from my door.
The amount of witty phrases this brings to mind seems to have no end,
but its primary impact (other than cutting the commute to the nearest
airport down to about 10 hours) is that my front yard essentially
becomes the bus stop, market, and main thoroughfare for the surrounding
towns. Every day there's a group of about 15-20 people hanging out
waiting for the bus to come, some of whom I've gotten to know a bit. It
makes the rural area seem less rural, as there's a fair amount of
traffic with the buses and trucks and vans picking up people or dropping
them off here at the end of the road.
I've been hanging out with some of these passers-through when I get a
chance, but finding out people's stories is a little more difficult than
I'd hoped given the language barrier -- it's hard to make small talk
through an interpreter, or even broken English. But I've been trying to
make sure I get out and do at least one authentic cultural event a week,
if not more. So I've been to weddings and funerals, eaten caterpillars,
visited a friend preaching at a local church (seeing them dance the
Bible and him up to the altar was one of the funnier things I've seen in
a church), and this week I went to a local soccer game that my neighbor
was playing in. Actually, that wasn't so much a cultural shock,
although a few things were a bit unusual -- having to slash the grass on
the field down before you can play, the dog running out in the middle of
the players, the fans rushing the field several times during the play of
the game to celebrate a point or argue about a call (the game was
delayed for 30 minutes while they argued about whether a goal counted
that went off the goalpost and barely crossed the line of the goal), and
yours truly as the 'big man' being entrusted with the prize money to
award at the end, all with a dramatic lightning-filled backdrop and the
wind and rain. It was the first time I have actually been cold in
Africa (the top of Kilimanjaro doesn't count). The home team (my
neighbor's team) won by the margin of the disputed goal, and as the
visiting official, I got to award the cash money, about $20. Perhaps
they will be able to purchase a real soccer ball with the winnings, I'm
not sure if they have a plan.
Culture shock is hitting with a bit of a vengeance, as I find myself
getting frustrated with things that I probably wouldn't have cared about
a few weeks ago. I'm still learning sensitivity as to what I should
work to change and what I should accept. I'm right on schedule with
what most books I've read seem to mention, and knowing that makes it a
bit easier and more manageable -- not just me being a miserable person,
but a normal reaction to a stressful situation. Keep praying for me for
that.

life in Mukinge

Still haven't given you a great picture of what things are like here, so
I thought I'd try to remedy that. In attempt to feel like less of a fat
American compared with the 2% body fat of most African people you meet
(and that's the healthy ones) I've taken up running every other day,
unless it's pouring rain, which it rarely is in the mornings. So I and
my Canadian counterpart Curtis hit the red mud trails around the big
hill that lies to the left of the hospital, waving at the people hoeing
in the fields and occasionally stopping to say hi to someone we know. I
haven't had to fight off the packs of dogs which occasionally roam the
trails, although other fellow runners have. Then it's back home to my
bathtub (no shower for the Brits that built these places) and breakfast,
usually followed by a bit of guitar practice. I have to roll into work
around 9am (I know, you feel sorry for me) because the nurses aren't
done rounding until then, and they get peevish if you interrupt. We
have so many doctors right now that I only have to be responsible for
the men's ward, which is pretty light duty, so I usually wander around
looking for people to practice scanning, helping out in the OR
(theater), or working in the outpatient department. Then it's off for
lunch for two hours, and back to the grind from 3-5. On call on the
weekends has been quite busy, but during the week usually is fairly
slow. We usually get a bolus of admissions around 4 pm, so you may end
up staying a bit late to tie a few things up, but mostly it's easy work.

My free time is consumed with a variety of things -- good cooking is a
bit of work, but fortunately I have trusty Mark Bittman to ease the
transition. I've been experimenting in the kitchen, trying to read up
on some medical info, swimming in our pool, and playing roulette with
the laundry dryness versus the chance of an afternoon rainstorm. So far
I have gambled for that bit of extra dryness and lost several times, but
it was satisfying when it paid off. The rain is quite fun, much more
like Texas rain with its sudden downpours and thunder and lightning.
The mud is quite manageable, too. I will try to get some of my seeds in
the ground this weekend -- nothing like planting tomatoes for Christmas,
eh? I have a fantastic shovel that I bought in town that I am quite
proud of and am looking forward to getting some use out of.

Our new Zambian doctor arrived yesterday, and I had he and his wife over
for dinner tonight. I served fried okra, pork chops, and rice in a
vague attempt to approximate something that Zambian doctors might like
that I like as well. I think they were perhaps more shell-shocked by
the experience than I was, but were game to try new things and gracious
about my clumsy attempts at hospitality. Entertaining consists of
trying to get together enough flat surfaces and fork-like utensils to
feed four people -- few things match, but I haven't exactly been pining
over the lack of wedding china. If I have to have the president over
for dinner, then we'll see about getting some nicer stuff.

WIRN vol 3

Actually, my reading these days has been confined to medical texts and
old Dorothy Sayers murder mystery short stories. Every day I find
myself faced with another medical question which I feel I should know
the answer to -- how thick should the endometrial stripe be on
ultrasound after a miscarriage, which side the vagus nerve twists around
the esophagus when it crosses under the diaphragm, how many days you
should treat for a course for PCP pneumonia -- but I have forgotten and
have to look them up again. Medicine has been a curious mix of
improvisation, high-tech solutions, and old school answers to
questions. It's hard to build a library to answer all of these
questions -- for example, the section on removing sequestra for
osteomyelitis states 'this disease does not affect patients in the US
today and so will not be covered here.' Thanks for that helpful bit.
It does leave lots of room for organizing continuing medical education
for the staff, however, which can be fun, and trying to get protocols
and systems that dovetail with what we have here. And I enjoy the
challenge of trying to fill in nooks and crannies of knowledge which I
have touched on in brief, but now must practice in reality.

The holly and the ivy...and the avocado

Christmas below the equator is always a funny experience for us North
Americans, I think. (BTW, I've been trying to figure out which way the
drain goes down, but for some reason this seems to be more difficult
than I expected. More updates to come.) Last Saturday I walked into
town listening to Karen Carpenter sing I'll Be Home For Christmas while
getting a massive sunburn on my neck. This week we had Christmas carols
during our Friday night potluck (I made samosas, which turned out pretty
good), but it's hard to feel much sympathy for good King Wencelas
tramping through the snow while you're sweating against the couch.
Poinsettia plants are replaced by poinsettia trees, snow-shoeing is
replaced with swimming in the pool, and Christmas trees are replaced by
fake ones, or nothing at all. And of course, your family is a long way
away. But that being said, what Christmas here really brings home is
the message of what the Episcopal church calls Advent -- appreciating
Jesus coming in the past, and wishing he'd come back soon. Suffering
deserves to end.

the perils of blogging unseen -- the author's aside

After my last success at accessing the internet (hurrah! -- to be
pronounced with a British accent -- hur-aah) and re-reading my posts, I
realize that I come across as a bit whiny, with multiple comments on the
power, internet, etc. And also a poor speller/grammatician (see, I
think even that's misspelled). Please rest assured that your prayers
have carried me through with a cheerful heart and patience for the
issues as they arise. Mostly I meant to convey that I was trying
desperately to keep my loyal readers posted on what was up, and even if
not communicating well, was thinking of each of you. With that out of
the way, back to less complaining things.....

beaten by a coffin

One of my first medical successes was a man admitted 4 days ago to the
wards. One of the local superstitions/customs is to throw a traditional
'medicine' on the coffin of recently deceased people; the coffin then
acts like a Ouiji board and seeks out the person who was responsible for
the person's death. That person is usually attacked, often fatally, by
the coffin and the men carrying it. In effect, every death is
accompanied by an act of assault and often murder, making the scene
doubly tragic and also perpetuating a vicious cycle of death, with the
victims often being the elderly that cannot flee quickly. On Monday, a
70 year old man was the victim of this, presented agitated and bleeding
from his right ear, and eventually lapsed into coma. After medical
treatment and prayer, however, he came around 3 days later, and is now
awake and talking and eating.

It's often hard to know what to do, and I had debated to drill holes in
his skull to relieve the pressure, but as he never localized I decided
not to, and in retrospect am glad that I didn't. Interestingly, the
police were involved, but very little action gets taken in these
situations. Several of the long-term missionaries are convinced this is
demonic possession; even if not, the retributive murder of innocent
people is obviously something to speak out against, and something to
pray about as well.

Act I, Scene II

Bieppe from Mukinge!

The country was on fire as I flew out from Lusaka, must of been 100
brush fires burning in the bush in the surrounding lands around the
city, with the termite mounds standing up like burned out chimneys in
the middle. After the pilot's amusing struggle with the aircraft
controller's accent in order to get off the ground (it's a good thing
Lusaka International isn't that busy) we did make it out here with
little incident, and as you get closer the fires gave way to the green
of the game park and the area of Mukinge. They built the hospital here
because of the abundance of water in the area. As you fly in, you
approach two low green hills, and then a patch of white as the hospital
peeks out between the trees. In the dry season, the trees that were
planted around the hospital flower, so as you hike you can always pick
out the station by the blaze of color amidst the green.

I settled in with the requisite words of wisdom from the staff who has
been here longer -- beat the grass for snakes at night, unplug your
computer when the lightning storms come, enjoy the mangoes while they
are in season -- has been easier than expected. My accommodations,
while not large, are plenty sufficient for me, and the hospital is
surprisingly roomy after my experience in Rwanda. I have a lovely
grenadilla vine growing up my screen door, but the fight against the
daddy-longlegs seems to be never ending. I did suffer the
disappointment of my fan breaking as soon as I got to Mukinge, but the
beginning of the rainy season is really a good time for that to happen,
not too hot, in the 80's. Other than that, life in Africa has been as
expected -- the phone lines are down, there's a gas shortage so my stove
doesn't work, and there's no electricty for three days after the most
recent storm. Hopefully the power will be back on today. I'm hiking
into town (about an hour) to go to the local phone company office to see
if I can get on my dial-up there.

Send recipes and eggplant seeds.

Care Packages

Not that I'm begging, especially since I still haven't even made it
through my package of Gobstoppers that I bought in the airport, but
after spending over 1,500,000 on groceries, I did realize there were a
few things that were unavailable, which I can picture myself enjoying
and feeling deprived about in the months to come:

guitar strings
seeds
spices (you can get MSG, salt, pepper, cinnamon, paprika, and nutmeg
here, but that's it, unless you grow it)
music
nuts (peanuts are all that I've seen)
recipes. If you've got a good one, say how to make sweet potato fries,
or sweet potato pie, or sweet potato fritters (actually, there's a good
variety of stuff to be had in the supermarket here, I'm just saying....)

That's all for now. There's a link on the side to postage rates from
the USPS. There's nothing better than logging on the internet and
having a inbox full of well-wishes, thanks to you all. Sorry I can't
log on to my blog yet to respond in kind to your comments, but rest
assured they get to me via email.

vicissitudes of medical work

Thought I'd give you a brief picture of what medical life is like here.
Overall, it's been pretty much what I expected. The doctor's day is
less packed, and it seems much less busy as things which seem like they
should be less difficult (suturing a wound, putting in a suprapubic
catheter, casting a fracture) end up taking quite a bit of time, so that
you don't feel that you're getting that much done. We are hamstrung by
supply shortages, despite a recent container sent to us by Samaritan's
Purse. One of the frustrating things about relying upon donated
supplies is that there's no supply and demand ordering, so that you end
up with excesses of certain supplies and deficits of others. So we have
boxes with open heart supplies, laparoscopy equipment, expired lunch
meat (no kidding!), and laminectomy sets, all of which are essentially
useless to us due to manpower, expertise, or equipment lack, while on
the other hand what we need are things like gloves, tape, ECG
electrodes, IV fluids, and medications like potassium, all of which are
much less expensive than what we got, but infinitely more useful to us.

I got a promotion when I got here -- I'm the head of radiology, and also
the direction of continuing medical eduation. Since I'm the only one
with any significant ultrasound experience, I spend some part of my day
doing scans. We have a curvilinear probe and a vaginal probe for a
Sonosite Titan machine, which is good, since I'm fairly familiar with
it. I'm definitely stretched past what I was trained on -- my training
for recognizing ectopics is only somewhat transferrable to diagnosing
pelvic masses, but you do you best. Unfortunately, my only reference
text out here is a OB/GYN ultrasound book from 1985, when they had
barely invented the technology, so it is of limited use. You do the
best you can and try to keep improving with practice.

As for my patients, I'll save that for the next installment.

I'll do my best to keep the blog updated (I'm sending these posts sight
unseen, hopefully you're still reading them) but between phone service
being down several times a week, power outages, dial-up internet with
speeds around 7-20 kbps, and limited access to a phone line in the first
place it may be a bit sporadic at first. Thankfully, we are getting
wireless satellite email setup sometime in the next month or two, God
willing and funds available, so at that point I should be a bit more
reliable. In the meantime, don't give up on me.

what's going on out there?

Gentle reader, you may be wondering why no posts for two weeks, then all
of a sudden, multiple posts at the same time. An explanation awaits the
patient mind. Life in Africa, although surprisingly connected, is
unsurprisingly inconsistent. This week was marked by a loss of
electricity for three days, the loss of the telephone service for the
past week and a half, and the countrywide lack of natural gas, so that
trying to cook, bathe, or boil water for drinking became a bit of a
chore. On the good side, dinner by candlelight is always fun, my
computer has a relatively new battery that still holds its charge well,
and my entertainment is relatively power-free anyway (guitar, dominoes,
cards, dinner with friends). And we emerged on the far side unscathed.

So, I'm writing posts as the mood strikes, and I figure I'll post them
when the opportunity arises. I hope that your thirst has been slaked,
for a time at least. And salvation awaits in the guise of a Dutch man
who is going to wire us for wireless satellite internet at some point in
the next several months. Hopefully my ability to show you pictures will
increase at that time.

More African notes

Writing today from my guesthouse kitchen table. There's a brownish
tablecloth on it, which is good, cause I've already managed to spill my
coffee on it twice. It's a little bit more brown than when I got here.
I think my body temperature is gradually adjusting, especially with the
breeze coming in through the night windows. It carries the smell of
smoke and exhaust that seems to permeate the entire city. It's the
smell of development, I guess, but it does stink, and you only partially
get used to it. While I'm writing, I'm working my way through my iTunes
collection to make sure that I have actually listened to all of the
songs that I own; I'm up to the M's, working backward. Later, that will
be replaced by the intermittent whine of mosquitoes trying to make my
life miserable. Imagine me waking up bleary-eyed in my boxers at 1am,
stumbling around my scattered luggage, trying to smash its tiny little
insect brains against the wall, and you'll have a good picture of my
nights. In contrast, during the day my Migayi-like ability to snatch
them from mid-air would baffle anyone who has ever watched me play
organized sports. Perhaps my coaches didn't motivate me enough.

Today's basically the last day before I head out to Mukinge, where I'll
be for the next two years. I rode the matatu (the public bus/vans that
run around throughout the cities) into town today. Like most African
cities, life seems to exist along the roadsides, and today I was struck
by the sight of women breaking rocks by hand to make gravel, next to
another group making license plates (you have to buy them yourself
here). Lack of opportunity makes a type of prison for you; watching
those women perform prisoner tasks on the side of the road brought that
home.

leaving Thursday

That's right, just got here and I'm already leaving! To Mukinge from Lusaka, that is. Thanks to all who were worried about my guitar; British Air managed to locate it and forwarded it on, so we're back in tune and rocking the African night. Gotta drown out those birds.

I had my interview for my Zambian medical license today, during which they quizzed me on my knowledge of Chinese medicine and wanted to know the proper nerve block for chronic pancreatitis. Apparently medicine in Zambia is trickier than I thought. They gave me my letter despite my ignorance, thankfully.

The plane ride out is on Thursday. I had the opportunity to visit an orphanage here in town, where I met a kid named David. He had gotten to the orphanage after his parents died. He went to live with his uncle, and during a trip to town lost his uncle's bicycle (it was stolen). His uncle got mad, so he tied him to his bed and set the house on fire. He ended up with second degree burns on his hands and face. He's in the orphanage now getting his medical care taken care of.

Poverty sucks. So do people like that uncle. Keep praying for the country here.

greetings from Africa!

Hello to all!

I made it fine, although I'm missing a guitar everything else made it
smoothly. Check out the blog: www.mattcotham.blogspot.com for the
blow-by-blow. It's warm but not too bad, the rainy season has just
begun so there's been some fun lightning storms, and I am now a fully
licensed Zambian driver, although this wrong-side of the road bit is a
little dodgy. And I'm already picking up British colloquialisms....

Love to all,
Matt

p.s. my new phone number will be 099-187121, just in case someone's got
the hankering to call (or text me!)

zambian diaries

Africa is hot! I woke up this morning after some heat-fevered dream
that I was competing against another teacher to win some kind of class;
the details are a bit fuzzy, but he was making fun of my use of cologne
while I got the class to say that I smelled better anyway. The class
was voting that they liked me better. I can't even blame these dreams
on the Larium yet. Figuring I was done getting sleep for the night. I
flipped open my laptop and looked at the time, 1:40, and wiped off the
sweat while comtemplating what to do to fill 4 hours until it was even a
reasonable time to get up. My roommates get up to take a bath around
2am (that's some dedication to cleanliness!) and then go back to bed,
and mostly I spend the time listening to the UFO bird going strong
outside. I was reading City of Falling Angels on the plane (funny what
you'll read when your choices are P for Peril, the latest Tom Clancy
knock-off, and Maeve Binchy in the airport bookstore) talking about the
lack of ambient noise in Venice; the average decibel level there is
around 10 less than the average city. I wonder what it is here in
Africa, but it's got to be lower than that, cause that bird sounds like
it is sitting on my windowsill and making a sound straight out of Close
Encounters; a two tone, off pitch, low whistle. Just enough noise to
remind me there's a whole part of the world that I usually forget about
in the city. And keep me entertained in the middle of the night. I'm
contemplating the nature of African birds that sing during the night,
when strangely about 3am it starts to get real light, which mystifies me
for a while until I realize that I hadn't reset my computer clock and it
was really 5am, not 3. The bath made slightly more sense at that point
(although not much) and my sleeping ego felt less bruised, since I had
actually managed 5 hours instead of merely 3.

That's pretty much the highlights so far. Things will continue to be
pretty slow until I get out to the hospital, which won't happen until
next week, if then. I have to interview with the Zambian medical board
on Tues, then will likely fly out on Wednesday after doing my shopping
if they give me the thumbs up. I'm guessing I need to shop for around a
month's worth of groceries, which will be tricky, since I usually shop
for about 2 days worth at home. Somehow I doubt you can buy a month's
supply of cilantro and french bread, but I'll give it a try. In the
meantime I keep myself entertained by spending a fair amount of time
changing into what I hope will be a cooler set of clothes, only to
realize that it didn't make that much difference and all I've really
accomplished was getting another shirt sweaty. I'll get the hang of
this fairly soon, I would guess.

More to come soon, but I'm still in the process of setting up my email
and phone service, etc.

Getting in touch

Hey --
wanted to make sure you all knew how to get in touch with me overseas. Most of the stuff is already on the blog -- if you click on my profile, there's a link to email me, my address should be on the page, and there's a handy postage calculator on the side if you want to send me something.

I'm told that email is REAL slow over there, to the point that if you start a email to me, it's better not to reply but start a new message, simply because of the space required. But don't let that stop you from cluttering up my inbox.

Likewise, comments on the blog are automatically emailed to me, so you can just comment on something and I'll get it. Of course, everyone else can read it, too, so no awkward secrets over cyberspace, please....

The Final Countdown

Ah, southern Thanksgiving -- feel sorry for all you who don't get your choice of carrot cake, pumpkin pie, pecan pie, pumpkin tart, or key lime pie for your Thanksgivings. And that's after the sweet potatoes, which are pretty much dessert themselves with the pecan/rice krispie topping. If you've had them before, you know what I mean.

Some of you will be glad to know that the robe is making a strong push to rescue itself from being sidelined and reincorporated into the luggage. It's gonna be a tight race to the finish, however. Honestly, everything seems to be fitting fairly well, although I'm sure I'm still leaving behind some stuff I wish I could take and taking some stuff I'll never use.

What I'm reading now, cont....

Perhaps I should pick a new heading, since I read a fair amount....WIRN, perhaps?

Currently, thanks to sheaves of reading material from fellow Yalies, I am enjoying a small debate on what is good developmental theory. Apparently, the Nobel Prize delegates discovered this guy before I did (hey, med school wasn't the best for my liberal arts education) because he won in 1998. I fully agree with their choices, however, because his observations are profoundly obvious, usually the sign of a great thinker in my book (cf, gravity, etc). His basic premise is that development should be increasing the freedoms of the people that are going through it; freedom becomes both the desired end of development as well as the means through which development occurs. This would be freedoms in the broadest sense -- from want, fear, premature death (shades of FDR here), oppression, and the list goes on.

Although I would argue as a Christian that what we do with those freedoms has more bearing on being human that the freedoms themselves, and I would also state that many people have made poor choices with their freedom -- I fundamentally agree with Sen that as a developmental theory, this makes the most sense to me. Moreover, it provides a useful framework within which to hang my work in Africa: helping to ensure one of those freedoms. Unfortunately, as I think Sachs would point out, you need a synergy of multiple freedoms being addressed simultaneously, with poverty at the base of many of them, for development to become forward moving and sustainable.

All that to say, I need to read faster so that I have less to pack.

Almost there....

Howdy to all of you!

I thought I'd update everyone on where I'm at....no, still not in
Africa, but getting closer. I finished the written part of the ER
boards on Tuesday, which was the last big hurdle to get out of the way
before I leave, and despite eye strain and a bit of a headache, I'm no
worse for wear. Thanks out loud to all of you who were praying for me.
I have to admit one of my worries going overseas is losing some of my
professional 'edge', so it was good to try to consolidate some of that
info. We'll see if anything sticks. So now it's trying to get all my
stuff loaded into bags to take over with me without going over the
airline limits. It's gonna be tight, yet one more round of purging to
go (my mom's quilt and the bathrobe didn't make the cut, but dominoes is
still in...for now).

It's been a busy month since I left Denver, traveling around to North
Carolina, Houston and Chicago to see some of you and your beautiful
kids. I am chomping at the bit these days to get out there, but I don't
officially leave until Nov 21st, so if you're around and we haven't
already made plans to get together, your last chance is rapidly
approaching. It's been great to see all the support out there and
people who are genuinely interested in helping the people of Zambia. If
you don't know what's going on with the world's efforts to help with
diseases like HIV and malaria, drop me a line and we'll chat. If you
still want to know how to get involved and help, we should also talk
before I leave. Unfortunately, I did get turned down by the Gates
foundation in my attempt to get some malaria research funded through the
hospital, so I'm going to wait to get on the field before I draw up any
further plans right now.

I appreciate your continued prayers and support. My biggest concerns
right now are about transitioning to a new culture and new friends,
never very easy for us introverts. Keep me in your prayers for that.

Good to see and hear from all of you! I'll write again from the other
side of the world!

Matt

p.s. If you haven't checked it out already, you should see the blog:
mattcotham.blogspot.com. I update it much more frequently that I send
out emails and it's got useful info about the millenium goals and zambia
in general. I even put a RSS feed on it so if you have a homepage like
yahoo or MSN or google or something like that you can get it delivered
to your computer when it's updated....

Two posts in one day

I must have a lot to say today....

In case you were wondering about the project red link on the side of the blog (or if you weren't but are now) this article from my hometown paper helps fill in a few details. It actually goes through how much each of the companies involved is donating as well.

My personal favorite is the totally customizable Chuck Taylor All-stars....

malaria updates

Finished the boards! Woo hoo!

I dropped my subscription to the Journal but for some reason they still send me their emails. This article is ostensibly about advances in medical treatment, but also points out that the biggest impediment to stopping malaria (a disease which kills 2 million a year and infects close to 500 million by WHO statistics) is not the medical side of things, but the political will. The only question is will we muster it.

2 days, 2 weeks, 2 much fun

Ah, the light at the end of the tunnel. It seems that I may get to finally hit the road after nearly 5 months of waiting since graduation. It's been a bit hard to sustain momentum for that long. But the grind is nearly over, the departure date looms closer, and I'll nearly be done with the boards on Tuesday, which will be the last major hurdle to overcome before I can leave. And if Kinky Friedman wins, it will definitely be a sign to get out of the country.

I'm looking for good ideas for Xmas gifts to take over with me -- any suggestions are appreciated, otherwise it may be stuffed jackalopes or Texas football jerseys. Not sure that's exactly what those canadian ex-pats are looking for, however...

Massive Change

Thought some of you might be interested in this --http://www.massivechange.com We went to go see the exhibit at the Chicago Museum of Contemporary Art (well, actually, we went to see the museum and found that they had removed everything in the museum so that we could see nothing else but this exhibit.)

I have some fundamental issues with the underlying assumptions that buttress these people -- namely, the idea that technology will solve the world's problems. As I mentioned to Leslie at the time, everytime I see something like this I remember the Biosphere which my dad's company built. You remember how we were going to study how to build space stations and couldn't even make the thing airtight in Arizona, with everything available to us here on earth. Anyway, when the docent goes blithering on about how the internet will spread to rural Africa when these $500 computers get distributed, when that represents 8-9 months of income and no technical support/repair exists, I go a little crazy.

That being said, there's some cool ideas.

check out the new subscription link

I figured out how to put a subscription link on the blog (thanks for the suggestion, Heather) so you can put this on your email or home page pretty easy. Cool, huh? Just click on the antenna like thing to the right.

Okay, perhaps studying isn't that boring

Well, it is, but I got distracted today. Check this out.

http://www.kakophone.com/

You geeky myspacers have probably already found this, but it's fun.

What to say....

There's really not that much exciting to talk about when you're studying for the boards. However, I can share that if you're planning on poisoning your guests at your Halloween party, you should use phosphorous, because it causes your BM's to smoke and you to barf luminescent vomit, which might almost be worth the lawsuit you'd get.

from sea to shining Lake Michigan

Just got back from my taste of America tour, which included such quintessential American treats as sausage on a stick, steak on a stick, fried Coke, etoufee, and singing country songs about Mexican liquor in a Korean karaoke bar with my Puerto Rican friend. It really doesn't get any better than that, maybe it will take care of my homesickness for awhile....

On the downer front, the Gates foundation turned us down the weekend, so we're back to square one on projects for Zambia. Still brainstorming on that one. It's back to studying for the boards and trying to figure out the best way to ship a bunch of dishes overseas.

too much talking

The Glittering Eye » Blog Archive » Sub-Saharan Medical Braindrain

The Glittering Eye » Blog Archive » Sub-Saharan Medical Braindrain

A similar topic was published in the NEJM over the past year. Part of the reason to go over there, but also raises questions of how we can be more sensitive to our brothers in Africa by the policies we have in the US.

Africa later....and earlier

I have found out that my departure date will be pushed back a week to Nov 21st, so it looks like Africa is looming a bit later than originally anticipated. On the flip side, though, on my drive into Fort Worth, the temperature outside was 98 degrees, so I'm getting used to it a bit earlier....

gas prices in Zambia

As I was driving home today from Colorado, I passed a gas station in Childress, TX that was selling gas for $1.94/gallon. I tried to remember the last time I had seen gas under 2 bucks. One of the missionaries in Zambia was talking about gas being over 7/gallon over there, and I was reminded about how we're all in the same boat, and what's an inconvience here has completely shut down things like transportation or generators over there. And then I was struck about a comment I'd made (and have heard others make, too) about how it might be good to have gas prices stay high for a while to pressure the economy into building more fuel-efficient cars, etc. I was chagrined at my lack of perspective on the problem. For better or worse, what we do here has far-reaching impacts overseas as well, even in things that we might not think about.

So I'm not hoping for high gas prices for a while. And if you want some cheap gas, go to Childress.

What I'm reading now, part deux

You may not have realized it, but the road to Zambia leads through Boone, NC, or at least it does for me. I spent the past three days in North Carolina visiting with some of the members of Samaritan's Purse who are helping me get overseas, but unfortunately the Holiday Inn's evil empire prevented me from telling you about it while there. So now that I'm back in the freedom of the west (this is Clayton, NM) I can get you up to speed, on the many things I've learned, like what OCC stands for at SP (a good 15 minutes spent on deciphering acronyms) and how best to butcher an elephant for the meat if you have to (use an axe, although you're still not allowed to hunt them anymore in Zambia, so I doubt this will come up). I did have the opportunity to meet with Dr. Jim Foulkes, who was out at Mukinge for more years than I can possibly count, and had a great dinner with him and his wife.

For the way home, I got a copy of Sword and the Scalpel, a biography of Bob Foster, the missionary that started the hospital. The book takes an overwhelmingly rosy view of the missionary life, but I was struck by a line that his sister says early in the book: 'It seems like my life has been full of goodbyes.' Almost exactly the same thing was said by one of the missionaries in Rwanda when we were leaving as well, and I was struck by how transient so many of the relationships that you make are overseas, as people get transferred in and out, you move on to other things, or circumstances change. Another book recommended to me by one of my old residency classmates, The Dressing Station, ends with the author basically isolated and alone and moving back to England to have a more normal life after he'd travelled the world with all of these great adventures.

This is all to say, not that I'm dreading going overseas, quite the contrary, but that I'm grateful for all the friends and support that I have already. If you're reading this blog, you're probably already near and dear to my heart, and I thank God for all of you. And I can't wait for all the people that I'm going to meet along the way in Africa, too!

updates

Hey all --
my email address is changing today -- don't send anything more to my
comcast account or it will get bounced. As always, my permanent
forwarding address with yale will still work (matt.cotham@aya.yale.edu)
or my gmail account (mattcotham@gmail.com)

Also, my address in Texas until I leave is:
325 Rivercrest
Fort Worth, TX 76107
303-393-1786 still the same.

And finally, my address in Zambia will be:
Matt Cotham
c/o Mukinge Hospital
P.O. 120092
Kasempa, Zambia

Don't have a Zambian phone number yet.

Hope you all can make it either tomorrow or Sat to hang out. The dance
floor is looking good.

Matt

last days!

Hey to all of you! Last week in Denver -- wow, couldn't go out with
better weather, huh? Not quite the fall spectacular of Telluride, but
perfect for sleeping in the hammock for a few more hours.

To help me see all of you and also to get rid of my last remaining
stuff, I'm having a garage sale this Fri and Sat. I'd love to have you
all swing by during or after to help me polish off my liquor supplies.
Also, if there's anything of mine that you want, come claim it for free
before it gets sold! I'm still looking for a home for my golf clubs,
the wireless internet set-up, the subwoofer, DVD player, not to mention
a bunch of crap like heaters and ironing boards and plants and camping
equipment and my old Texas flag. Tell me someone wants to give my Texas
flag a home.

So anyway, the sale officially lasts until 3, the sangria will probably
start flowing around noon unless I need a few shots to help me haggle
with old ladies about the price of my sundae dishes -- then it's every
man for himself. :) There's plenty of good dancing room on my mostly
empty wood floors.

I officially board my plane after church on Sunday!

Hopefully I'll see all of you (those that are in town, that is) before I go.

Matt

The Last Days

In Denver, that is. Official Denver good-byes are this weekend as I step on a plane first to North Carolina, and then Texas. I did get to experience the best of Colorado this weekend, at least, with friends in Telluride in time for the first snow and the aspens changing. I'll put on some pics in a bit.

Still no word yea or nay from Gates. I am now the proud owner of at least 5 lbs of review books for the boards, however....

NEJM plug

For those who get it, the editorial in this week's New England JOM is about the Gates Foundation's effect on international giving and focus and how far short we still fall. It's at least as interesting as the articles about fingolimod or echinocandins or the radiographic appearance of lanthanum, that is. How can I be this far out of date only 6 years out of med school?

Go ahead complete!

I got the go ahead from Mukinge to submit to the Gates Foundation. So the preliminary step will be submitted tomorrow. Apparently they are not wild about organizations that have religious affiliations, so keep your fingers crossed....

What I'm reading these days

From No Picnic on Mt Kenya:
"So unexpected was this sight amid the savage scenery of Batian, that I could not help thinking 'It is too beautiful. Do I deserve to experience it?' and unconsciously my thoughts wandered to the simple character of the Humpback of Brazil who, as Guido Rey relates, having climbed Matterhorn with the first party from the south, knelt down and thanked God for having created such a marvellous universe."

Pictures from Yellowstone.

A call for seeds

One of the things I'm hoping to do is bring some seeds with me when I
go; if you've got some good varieties that you think would do well in
Africa save them for me or send them on. No zucchini!

Donation information

I put this in my last email, but here's the info as well on the blog. You can follow the links on the side to WMM or SIM.

To donate to my account it is through World Medical Mission, account #003220. I can use these funds to help with ministry related projects while I'm over there.

As most of you know, I am being fully funded through the World Medical Mission Post-Residency Program. If you'd like to contribute to help docs go overseas in a similar fashion, it's account #13765, also through WMM.

If you'd like to donate to the hospital, it's best to donate to Serving In Missions, with attention to Mukinge Hospital.

Finally, if you'd like to help fund a project or have an idea in mind about how you'd like to get involved while I'm there, let me know and we'll talk.

Last days in Colorado

Hey!
The time is drawing nearer! 1 month left before I leave Colorado for
good (at least for awhile). The tentative Colorado schedule is as follows:

Wyoming Sept 5-13
Denver Sept 14-19
Telluride Sept 20-24
Denver Sept 25-Oct 1

Then it's off to good old Texas to get some studying in. For all of you
in Colorado, let's get together before I split for good!

tuesday is D-day

Dog day, that is. The final bittersweet parting between me and the smelly, matted Saint next to me, currently snoring as I write this. A final pic to remember her by....

Getting ready for Zambia...Colorado style