Reflection

I'm gearing up for another educational trip to another part of the world, and I've been reflecting on my trip to Juba. Wow. Though its only been a couple of years, I feel as though I've grown so much. Looking back on my time at the University of Juba, a mix of nostalgia, pride, and humility overtakes me. I realize now how much I didn't know, and how much I didn't know that I didn't know. At the same time, if I were to try to teach anatomy, biochemistry, and anatomy to the equivalent of first year med students now I think I would have to do a little more review the night before...

Speaking of which, I'm preparing for a trip to western Kenya to help teach various topics to medical students. Yes, I will no doubt have to review the basic sciences to a greater extent, but I think now I can enrich these topics with interesting clinical information from my extra 2.5 years of experience. While I'm there I'm hoping to get some clinical experience as well as continue to work on a project born out of the SSMEC. I'd also love to do some traveling in the area. Maybe I'll keep going with this blog when I have thoughts to share. It is certainly fun to see in retrospect. 

Learning

In medicine, life long learning is essential. The fundamental knowledge of the physician is ever changing. Multitudes of research studies are published yearly, many with clinically important information that may change the way you practice daily. I've always enjoyed the learning process and I think this an important part of my career choice.

Learning is an interesting thing. How do we gain knowledge, and then retain it for use in everyday life? Perhaps the most memorable way to learn is through experience, by making mistakes and learning from them. In general, though, I think the learning process is one of constant challenge. By learning new information, we are constantly challenging our view of the world. If we come across a piece of information that we were previously unaware of, we must alter our world view so that it is consistent with what we now know to be true. By world view I mean the way we as humans make sense of the complex environment in which we live. If you think of learning in this way, its hard not to start integrating the information you take in daily. When confronted with something new, we think "does that make sense?" If not, we evolve, we grow.

This is most easily seen with day to day learning. In Juba, my world view is constantly changing due to the entirely new experiences I'm having. New foods, new accents, new people, new stories... I could go on forever. In the classroom, however, it might not be as easy to see. Sometimes information we learn in class seems too discreet, too singular, to fit into this model of learning. For example, I taught the students about muscle tissue last week. We talked about the different types of muscle, how to recognize them on a slide, and muscle contraction. This may seem to be outside the realm of our everyday world view, but I'm not so sure. Even the cellular intricacies of muscle contraction should make sense to us based on what we see in our daily lives. We see mothers embracing their children, similar to proteins engaging each other. We see the step by step process of mundane tasks, such as laundry or driving a car, and can relate them to the intricate step by step process of muscle contraction. Its just a matter of fitting it into the students already functioning world view. We have experience with our muscles everyday, and whether we pay attention or not, we've already made assumptions about how things work.

Even with biochemistry, which for students is often very hard to visualize, we can use this model to improve our learning. By explaining the big picture, and using familiar analogies, we try to insert the new information into the framework the student has intuitively built. We try to give the student the tools to think hard about what we are saying and decide if it fits into their world view, and if not, we try to figure out where the misconception may be. It is often a simple misunderstanding or incorrect assumption.

The process of learning is difficult and often frustrating, but if we keep in mind the bigger picture we can begin to see how everything connects, and this, to me, makes new information so much more exciting!

Teaching

Time flies when you’re busy, and we’ve been busy. I’ve been teaching histology with microscopes we brought, and it’s going well. So far we’ve made it through the cell, epithelia, nerve, and part of muscle tissue. Next week will be connective tissue, and then we’ll have lots of review and lab time before the test. I'm also teaching some anatomy, which will pick up when histology is finished. The students say they don’t mind histology or physiology, but they are definitely struggling with the biochemistry. Hopefully we can help them through these essential subjects.

It’s funny to think that I am now an instructor. Students constantly hound me with questions (which are fun!), ask me about their grades, yell at me for not getting the notes out on time, etc… It’s interesting to be on the other side. You realize you can’t please everyone, but you can do a lot to help the students. Every day we have 2 hour help sessions where the students can ask us any questions they may have. These sessions are great for the students to get questions answered, and they’re also great for us to get to know the students. Most of our classes are lectures due to our time constraints, but we have started tutorial groups and I run the histology lab as well. I try to make my lectures interactive, and it would be nice to have more small-group activities, but minimal faculty and time are the issues; we have a lot of material to cover. The neuroscience class taught by one of my colleagues will be starting weekly team based learning sessions, so we’ll see how those go. One of the hardest parts about teaching here is finding the right speed. We don’t want to go to fast, but we need to cover a certain amount of material. It’s a fine line, and we are constantly adjusting based on student feedback.

It may seem odd that second year students like us are teaching at a medical school. I don’t think I’ve explained this, so I’ll take this opportunity to do so. The medical school here is based on the European system, in which students go straight from high school to Medical school. Here, their first year consists of broad base classes much like the ones we had in undergrad (math, biology, English, etc…). The second year is where the medical curriculum begins, with biochemistry, anatomy, histology, embryology, and physiology. We are teaching the 2nd and 3rd years, and we teach them many of the subjects we learned during our first year of med school and during undergrad.

It’s been great for a few reasons. The material is fresh in our minds, so with minimal studying the night before I’m able to talk about these subjects in good detail. Histology is pretty straight forward anyway; the hardest part is learning to recognize tissue, which comes with time. Also, most of us have degrees in biochemistry, so the biochemistry class is right in our strike zone. We’ve done all the normal physiology, anatomy, and embryology as well, so these topics are well within reason.

The difficulties arise when students ask questions about clinical scenarios. We know on a very basic level how our material fits in to the clinical picture, so these questions we often cannot answer. It has been fun for us to look these things up and It’s definitely a good head start for pathology. Overall, however, we are teaching material that is within our capacity. In fact, I think we might even be better suited to teach some of this material than physicians who have been practicing clinical medicine for a while. Of course, a pathologist would likely do 1000 times the job I’m doing with histology, but the principles of biochemistry I think many physicians like to forget.

So, we’ll continue teaching until our time is up. I can say already that I will miss the students greatly when we leave. They are so great, and we’ve been getting to know them better and better as they become more comfortable with us. This has been an incredible experience so far, and we’re only half way through!

That’s all for now, hopefully I’ll be better at updating in the future.

Goat Meat

There's something special about the way people socialize here. A sort of affection built into the culture that we in the US don't have. Its not uncommon for two men to walk down the street holding hands. Greetings are much more personal, often accompanied by an affectionate pat on the shoulder. When you enter a room you greet everyone with a handshake and a hello, even if you don't know them. I've noticed this closeness more than once when traveling outside of the US. It seems especially noticeable here, perhaps because of the many years of war.

Lately we have been going out to eat at a few of the many roadside grills around our housing. There are many places within walking distance that serve tea with ridiculous amounts of sugar and dehydrated creamer. We usually get "fool," or Egyptian beans, sprinkled with cheese and eaten with bread. We did splurge a few nights ago and got some goat meat along with our fool:



Its all eaten with your hands, and shared with the whole table. Something about eating with your hands is more satisfying...

If you look around you'll see many people drinking tea, eating together, and lounging in the shade to escape the heat. That, mixed with the smoke and noise emanating from the various generators makes for a pretty interesting scene.

Quick Update

Classes are progressing nicely. We are still unsure exactly what knowledge the students already have. They tell us they have had introductory biology and chemistry courses, but I have had to explain transcription, translation, and electronegativity on many occasions. We are constantly reevaluating our lessons to make sure the students learn the information they need for our course and have the foundation to back it up.

Now that we have been here approaching two weeks I can say a little more about the culture. I am constantly humbled by the stories we hear daily. After nearly 50 years of war in Sudan, you can imagine that most people here have some pretty interesting stories to tell. Its not always the long stories that remind you of this, even mundane questions like "how was your day?" may be met with "any day without war is a good day." If you look around the city there are constant reminders of the post-war climate, with many soldiers and much development. These constant reminders of my own good fortune and the struggle for peace bring our mission here into focus, to support the development of this budding nation. Not with money, or commodities, but with knowledge, which seems to be more sustainable on its own. We have much work to do, but I think we are making a tangible difference for our students.

Head Above Water

We are starting to get into a routine. We wake up at sunrise, drink some tea, and head to the University to lecture. On the way we buy large bottles of water, and perhaps some fresh rolls to nourish us throughout the day. We inquire about the electricity situation, which has been dismal, and begin lecturing at 8 or 9. Check out the preliminary schedule we presented to the students:



We have since updated the schedule, adding tutorials and extra lectures. What a great bunch of students we have here. We have large amounts of material packed into each day, and the students crave more. If it were up to them, they say, we would lecture from 8am to 8pm. We, however, already have our hands full preparing lectures, labs, and tutorials. After giving lectures we start preparing for the next one, and from there, we head back home to eat dinner and relax a little before working throughout the night. Our work has been interrupted by lack of power, and the technology we have come to rely on is not always readily available. I have to admit, though, it is nice to sit in a candle lit room, sipping on tea, studying for the day to come.

The housing we have is great, but there will be very little electricity for the next 14 days or so. We have only been here a week, though it seems like a month. We spend most of our days working at the university and getting to know the students. We have also seen quite a bit of the city, venturing to the market or a small store to pick up supplies. Everyone is very friendly, and I don't feel out of place in Juba. Here is a picture of a street lined with shops after a small rain storm to give you an idea of what its like:



The storms can be fierce, often accompanied by harsh thunder. For now, I think we have our hands full with our lightning fast students, our new classes, and the new culture. Hopefully we can keep our heads above water.

Juba: First Days

We arrived in Juba on Thursday and have been settling in. Our housing is very nice, with running water and a refrigerator. We have been welcomed to the University by the deans and have begun to plan for our teaching. I will be teaching histology with the microscopes we brought with us, and biochemistry as well. The schedule is set, and we are preparing for Monday.

We met with the students this morning, and they are amazing. So hungry for knowledge, so ambitious. I think we have the opportunity to make a great impact here not only by teaching, but by listening to their stories and learning. I know I will learn more from them than they will learn from me, and I hope we can provide needed structure and engage in the study of medicine together.

So far the internet at the school has not worked, so we have found a hotel with internet for now. Hopefully they will get the school internet up at some point and I will be able to update from there.