Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Monday, April 28, 2003
    Happy Monday

    Argh. I'm hospitalist again this week. Yes, I know I said I'd never do it again, but here I am... doing it for the money. As a result, blogging may be light this week - but here's another delightful email from Chuen-Yen, reporting on conditions in Malawi:

    Salutations! Here are some thoughts for this week:

    I occasionally fantasize that I�m well adjusted to Malawian culture. Anon, I am inevitably reminded that this is a delusion. The farrago of warm welcomes I received upon returning from vacation is case in point. BAH staff declared it a pleasure to have me back. Friends embraced me. Some patients delivered fresh produce. I was offered another goat.

    After initial greetings, �Did you gain weight?� was a common follow-up question. As I hadn�t checked, I awkwardly responded, �It�s quite possible,� to the first few enquirers.

    Another recurrent statement was, �You must have enjoyed your holiday. You�re a bit pale.�

    With such pleasantries, I became a tad self-conscious and rushed to a mirror at first opportunity. The reflection suggested my pallor had actually decreased due to recent elemental exposures. Expat friends confirmed this observation. Later, I stepped onto the hospital�s only scale. The reading was identical to that of three months prior. Several nurses tried to console me by remarking, �You look heavier than that.�

    My sunburn was another point of interest amongst the locals. Having walked across a glacier sans protection, my peeling face required intermittent application of various salves. However, the dark Malawans aren�t familiar with sequelae of sun exposure. Burdened by an average life expectancy of thirty-six years, most don�t survive long enough to appreciate skin cancer. On the other hand, they are well acquainted with chemical injuries and fire accidents. Hence, I gave a lengthy explanation using the analogy of industrial mishaps.

    Such interactions are contextually logical. In a country ravished by disease and famine, obesity is a status symbol. Where poverty equals interminable days of laboring under glaring sun, only the privileged are pale. Most people don�t have the luxury of worrying about consequences of UV radiation. Hence, when complimented on how fat and pasty I have become, I now graciously accept the flattery.

    Take care,



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