Play it again
Twenty years ago, I was sitting on the concrete stairs outside the Shoulder to Shoulder apartments in Santa Lucia, Honduras, when I heard the announcer on a colleague’s short wave radio say that US troops were moving into Afghanistan. My compatriots (physicians, nurses, residents and medical students) on the medical mission out of the University of Cincinnati shared our frustration – What had we gotten into? What did the US hope to accomplish? Russia had been in Afghanistan for 10 years, and left without a victory.
Six months earlier I had been part of a MSF team extricating itself from Ingushetia after the kidnapping of a colleague. We were there to support local physicians and refugees in the Chechen War. At the time of our exit, colleagues and I were horrified about what would happen to our local colleagues as we pulled out--they had put their lives on the line to work with us hoping to help their communities. I was angry and frustrated with MSF, but finally made some peace with the messiness of it all. Mission Chechnya was my fictional effort to come to terms with all that happened.
Ten year later (2010), pundits debated Obama’s decision to escalate our efforts in Afghanistan. Some spoke about the futility of it all, the corruption of the Afghan administration we supported, the corporations and organizations that benefited from continuing a military effort.
So here we 20 years later watching a replay of Vietnam. Instead of people standing on the top of the US embassy in South Vietnam, people flood the Kabul airport. Many lives and billions of dollars later we face the messy realities again--those who benefit from war and those who suffer, the underbelly of US military power. While I support Biden’s decision, I acknowledge the difficulty of it all, the human lives hurt and damaged, the loved ones lost, and local Afghan citizens with damaged lives and dreams.
And again . . . Recently, Family Medicine led the National Academies of Sciences, Engineering and Medicine's effort to report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. The 500 page report, is a repeat call to action, one voiced by the founders of family medicine over fifty years ago, repeated by those calling for equitable health care reform that the ACA –Affordable Care Act -- did not quite achieve. And a necessity this time, if we have any hope of repairing our broken health care system. Click HERE for a 1 page summary in JAMA Viewpoint. We must do more within Medicare and Medicaid, and medical schools and hosptials to support training in primary care and in communities where there is a need, and to reward the choice of a primary care specialty. It is time to have the political will and leadership to push aside the organizations and individuals who benefit from what has been the status quo.
And again . . . The COVID-19 pandemic continues. Here we are again. I had hoped do be over COVID by August, 2021, even though I never quit wearing a mask in the clinic. Now I am masking again at the gym and in stores and watch in horror the many who do not. Delta and Lambda strains take hold in the unvaccinated areas of the US and around the world. Continents are still without adequate vaccinations. And even the countries with vaccination success stories are facing challenges. We read of three vaccinated US senators who have contracted COVID. “Why get the vaccine if you are going to get sick anyway?” Patients ask me.
There are no easy answers. Medicine is learning as we go with COVID and it is hard to inspire trust or confidence as we figure it out, especially in the US where steps to protect the public's health is a political football. I coped with the first surges by writing COVID Chronicles: How Essential Workers Cope. The stories of humor, hope and resilience are still relevant.
And now Henri . . . we wait for the hurricane to hit New England later today. Bird feeders are down and chairs are off the 2nd floor porch. Trash receptacles are in the garage. We have removed all the possible missiles we have control over. Looking around the neighborhood, not every one has. With the full moon, the tides are high and if the storm hits at high tide, 7 p.m. here, there will be quite a surge.
So we wait and persevere. During these difficult times that seem to replay again and again, may you find you own inner peace.
Be Well. Stay safe.