An Unexpected [Unwelcomed] Preface
I was looking for a relaxing fall; however, not this way.   I broke my ankle in three places, and the ankle only has two bones.  I wish it was at least a semi-heroic event, but a can of turkey gravy doesn't come close.   It has, however, become a mythic story:

I do not know whether not being able to do almost everything is worse or needing Anne to help me. Really, without her constant assistance, I would have needed a rehabilitation facility... or nursing home.   I  am alive and trying to do a few things I had been putting off...  I may even catch up with my long to do list.

My Nurses... Another Batch

I have loved teaching the students at Mercy and this batch was no exception.  As usual, there are some really bright students and some I have to wonder about ..... and most are good students who work hard.

There were some exceptions from the usual:

• There are three students from Africa; this was a first.   (I would like to think they had heard of my teaching skills... but no one else did.) 
• And this year there are six males ..... also a new record.
• My co-leader for a number of years, Candy Mohan, had decided to try living and working in England.  I missed her, but not for too long.  Roberta Binda, who has been a long time dependable tutor, successfully stepped into the co-leader role.  
• So we started with only two tutors ..... On the first day I met the part time midwifery faculty, Nathleen McNeil.   And as if by the fates or the gods, she was interested in being a tutor.  
• Just one more and we'd be at full strength ... Hello Sister Meg Eckart!  Many years ago Meg was a Mercy Volunteer and has since returned to Guyana as a postulant with the Sisters of Mercy.   Director Elsie recruited her to teach Communication and English... And I recruited her to be a tutor for the PBL.
• What a great way to start! Full strength...    

Everyone Gets a Prison Shot.

As well, Roberta, Nathleen and Meg have been carrying on the PBL course without me ..... and I am glad.   I see it as showing the methodology has taken some hold at Mercy.   I don't think that either Tony Carr or myself  thought that it could happen without us .....    a small blessing.




Roberta and Nathleen are hoping to attend a Problem Based Learning Conference at the University of Delaware in January; I have been trying to help by cobbling together some financial support to assist them.     Someone gave me a cheque for  $1200... and a former student who just happens to live near the U. Delaware offered to house them when they were at the conference... and Mercy Hospital is going to assist them.  I have been begging a few other groups as well. I was excited when Roberta and Nathleen told me that they wanted to attend so they could adapt some of their other courses!   If you feel the urge to assist ..... we would welcome your  donation.

The Dreaded Postmortem
And Roberta and Meg took the students to their "unofficial" PBL Graduation: a visit to the morgue at Georgetown Public Hospital.

Roberta emailed me:

Just to let you know how the visit went...it was good, the usual: we were in the side room, this time we had a Doctor with us. They explained some.  Two students couldn't stay, a few were in and out ..... they did not allow students to wear face masks or have any mints in their mouths....I was not happy with that, but I followed the instructions.  Quite a number of students were interactive:  they  were allowed to touch organs. They only saw abnormal organs, though. 

Students opted to use the cafeteria for the "pop" and I had enough money to buy chocolates for everyone too. The debriefing went fairly well.+

Sister Meg agreed to go with me ..... and was really nice, even remaining for the debriefing. I read the Asher Lev excerpt and they were all silent a bit after.  They had some interesting expressions, most reported problems with safety (scalpel handling, blood etc.) and professionalism of staff /dignity of body,  but almost everyone ate after returning (before the debriefing) ..... so I think they handled it well.    It was a bit weird doing this without you ..... thanks for the guidelines.

Hey, it was a bit weird not being there, too, ..... but I'm really happy you and Meg were there.

It Isn't All Roses 

The second year students had to call the Lunch Room their home classroom.

Every year your donations have improved the education of the nursing students as well as the faculties.  This year the school was repainted, a strange little step was removed... all good stuff...  However,  the facility for the students is too small to accommodate all the students.  Trying to find space for the PBL small groups is a real challenge some days.   I wonder if we will ever get a facility designed for the needs of students and teaching effectiveness.

Thoughts on my 2019 Trip

I have been back a few weeks and my mind has been adjusting to my broken ankle and the cooler weather.  I wanted to reflect on my "experience" of another six weeks in Guyana.   Actually,  Guyana feels like a second home as I have come and returned many years...  a routine that now is not foreign yet is very different than my retired life in Ayr...    In Guyana, I work hard almost the whole time I am there. (Well, okay except for my two sociology field trips to Mabaruma and Lethem 😉)   And I really love it - for a short time.  I know I couldn't keep that pace up... So I am thrilled to be back in my home with Anne... and usual Sunday breakfast with Henry and the guys.  English soccer and old "B" movies... And  I will be more careful shopping in supermarkets!     I am thankful to have such a wonderful life ..... and I give thanks to all those who have helped me and I have helped. 

I know the wisdom of maturity has been, "It's not what you do; it is who you  are."  I never did believe that and still don't.  I guess my maturity is still a way off...   I am most "me" when I am doing what I love - and probably need.   

I have a few more things to say.. So I may get another Blog off before I decide about next fall.

Thanks for reading.   John

I Should be Looking at the Finish Line, But....

One Week Left

I know my trip is a little shorter than my usual and it seems to have been busier than usual.  Yes, the self-inflicted travels to Mabaruma and Lethem were way too enjoyable and informative to regret except from the workaholic side of my personality ..... and my retired self is trying hard not to have that side re-emerge.   This week my easy-going-contented side seems to have lost the battle.

The Final Exams for the First Class of Graduating Psychiatry Residents   
Usually everything happens slowly - really slowly - in Guyana; the Master's Degree in Psychiatry is really an exception.  It was a dream in 2015... and now it is a reality.

Drs. Elizabeth, Veneta and Stefon

Three doctors, Elizabeth Nickram, Veneta Gangaram and Stefon Henry have written their final exams... and with more than two-thirds of the marks in they have been exceptionally successful.. I wish my marks had been as good in graduate school!  There is only one section [the dreaded 200 Multiple Choice Questions] left to be graded.   I have had the privilege to be the "External Faculty Member" for these exams.   Yes, I have had to grade the Oral Exams and the Answers to the Short Questions part, and my main official duties were to take the sealed envelope from the University of Guyana Invigilator and open it and hand it back.  I accomplished this academic feat without incident three times.   I didn't have to suffer through the hours of sitting there watching the residents write.

During the oral exams each resident had to assess a person whom they had not seen before.   I found their interviews to be organized, strategic and competent.  And as it is my custom not to do anything by the book, I asked each person being assessed how they would grade their resident.   Really, the person who came for help is a most important evaluator and they all responded positively with quite specific comments.   Then, Drs. Bhiro Harry (Chief Psychiatrist, Guyana) and Odalys Mirabal Benitez (Cuban Psychiatrist assigned to the Psychiatry programme for several years now) and I questioned each resident and then proceeded to grade each one.

At exam time, we had to take a taxi to the other side of the
hospital  because the flood-water was way over our shoes.  It did
take their minds off  the exam.

The Short Answers section had 10 questions, one submitted by each person who had taught them over the years. The same group, with the additions of Drs. Pedro Pons Brovet, a Senior Neurologist and Geriatrician, and Zenia Lopez Mompel, another Cuban Psychiatrist who had worked in the Guyana clinic for many years, met for a couple of hours to grade the exams individually and then establish a consensus mark.  I don't know why I was surprised, but I was the easiest marker ..... at least with the questions that I understood.     I enjoyed a stimulating academic debate.

We still have to wait for the results from the last section, but no matter:  I am proud to have been a part of history.  And besides from the local staff there have been other volunteers who have spent many hours visiting and on line, sharing their wisdom.   These include (and if I have forgotten someone, please excuse me):

• The pioneer Dr. Tony Carr, a British-trained Internist and Psychiatrist, who has been involved since 2007 and is responsible for me being involved in Psychiatry.   Without his enthusiasm and commitment I doubt this degree would have been possible.   The Residents still bow their heads when his name is mentioned.

Sujay, Brenna, Peter and Ram

• Dr. Peter Kuhnert, a Family Medicine Doctor and Lutheran Pastor,  who called me almost a decade ago because he thought I was a Psychiatrist and even after he found out I wasn't, has still stayed involved.   It was his vision and energy that brought the first exploratory team to Guyana to explore how a small group of volunteers (Dr. Sujay Patel, Psychiatrist; Ms. Brenna Christian, Teacher; and, Rev. Ram Kalap, Chaplain) came to Guyana in 2013 ......  And from that small visit, this group has gone on to create an impressive legacy.   A Canadian NGO "Mental Health Without  Borders" is functioning strongly to support Mental Health issues in Guyana  and elsewhere. For example they have contributed funds that make it possible for my nursing students to travel to the National Psychiatric Hospital.

Sujay and Shrenik with the 2018 MHWB Team

• They are also in the final stages of formalizing their academic relationship with the Master's Programme through the International Health Science Educational Institute at Georgetown Public Hospital with a Memorandum of Understanding.  This is an enormous undertaking for a volunteer group; They will need  your prayers and financial support.

• This initial group, under the leadership  of Dr. Kuhnert, has brought yearly teams of professionals to teach and work in Mental Health and the Residency in Psychiatry.   Peter has also been the driving inspiration behind the Guyana NGO, Institute for the Development of Psychiatric and Mental Health Resources in Guyana.  They have raised enough funds to bring the three senior residents to the Grand River Hospital in Kitchener, Ontario for a one month's Medical Observership - amazing.

• Dr. Shrenik Parekh, Child Psychiatry Residency, including several trips with MHWB and Peter's teams.  He has been the online educator, taking over from Dr. Carr.   As well, he has been responsible for arranging and scoring the 200 multiple choice questions for their final exam.  

Sorry: My pictures of Shrenik must have been transferred 

to my external drive in Ayr, so you 

will just have to imagine a really cool South Asian male.

I know he is in the group one above, but he deserved his own.

I knew I was going to forget someone important:  Dr Erv Janssen.  He is a Child Psychiatrist from Oklahoma who had been coming here for more than a decade before I first came.   He organized his church, Fellowship Lutheran Church, to take Mission seriously.  He brought down health teams, music teams and construction teams yearly.  He has left his imprint on the  success of the Master's programme...

And I can't even find my old black and white picture of Erv

so I'll include a picture of his wife, who is ..... like ..... way cuter.

Sometimes when you are always there...

Last but never least, my friend and colleague, Dr. Bhiro Harry.  He is definitely the Father of Psychiatry in Guyana.  (He should be the Grandfather of Psychiatry but his children aren't obliging him.)   For many years , he was the only Psychiatrist working with the public in Guyana.

There is almost no one in Georgetown who has not heard of Bhiro.  It is usual if we go out for a beer that one or two people just want to chat with him and thank him - or ask for some money!  (To be clear it is not seldom that we go out for a beer .....)

In my life there have been a few people who have been just like me, even though we are seemingly nothing alike in personality or background.  Bhiro is a pastoral shrink and I may be a secular pastor ..... so in a way we are similar.

Bhiro has supported every effort to strengthen psychiatry and all the Canadians who have come to assist.  You can count on him and therefore, may not notice his contribution.   I can say without a doubt that without his welcoming support of all of us, there would have been no changes to Psychiatric services in Guyana.

Thanks, brother!

And thanks to you for reading so far .....
More to come .....
I have more to write about after I am back home.
John
 

Four Down - Two to Go...

Time is flying by... and once again I am reminded of my own fallibilities of body and mind.  It is a good thing the problem is familiar; I seem to have done it every year.  " I am going to do ....." this that and the other thing.   As usual, I will get less than half done...  including not writing a Pulitzer Prize- winning blog... You will have to settle for "good enough".

Visit to Lethem

For the second weekend in a row, I was given the privilege of flying (this time  to Lethem on the Brazilian Border) as an impostor psychiatrist. You can go by minivan on a potholed dirt road,  overnight for 18 hours; I declined that experience.

This time it was Dr. Stefon Henry who did all the work, while  I played tourist. Actually, he is a hometown boy from there who made good.   I mean that everyone knew him.

I started with the commercial district ... a mistake, as it is a strip mall of Chinese Discount Stores who seemed to sell the same "junk" to a never ending line of Brazilians who were looking for bargains.  Henry made up for that over the next two days.   

 

After he finished his clinic he was the radio guest at the local station (Radio Lethe 95.1).   He was the bonafide expert on how to increase your mental health.  I was sitting inside with them during the broadcast... He talked about 10 things people can do to help their mental health.    I was impressed with his ease of conversation, and so were other people who stopped us later, saying they had heard him.

Brazil Here I Come.

"Wait! I have to go back and get my passport."

"No you won't need one... Have a beer!"

(I was wondering what the inside of a Brazilian prison looked like.)

Our car approached the Guyana Immigration stop .... and the man just looked at us and waved us on.  I thought of similar times when I was with my Customs Officer brother at the border between Vermont and Quebec, and people would just honk and he'd wave ..... they were going for gas or bingo.

Now we approached the Brazilian border stop ..... and there were rifles.  I knew this was an official stop as our driver put the open beer between his legs.   The officer looked at us and knew Troy and Stefon, so waved us on.

We were going for wine and liquor and beer... and some household goods for Stefon's large family.  We did the same thing on Sunday morning because they realized the three gallons of wine was not enough!  And a few beers for the road .....

Churrascaria Everywhere

I remember when there was only one in Georgetown... In Lethem they are everywhere and certainly the most popular... Clearly not the place for vegetarians.   However, I loved it.   Here it is served on a pre-made skewer:  Churrasco but it sounds like Shohas.

KUMU Falls

I love waterfalls, so Stefon arranged that we go ....   I imagined that we would just get a taxi, drive up to the Falls and go for a swim.  Not exactly!   We had to get a minibus because we made several stops all over Lethem to pick up some of Stefon's brothers and sisters and nephews and nieces...  and then we headed out...

We were on the Rupununi Plains... red dirt roads with lots of pot holes. They also have an amazing way to repair roads.  They simply create new ones to the left or to the right of the bad one.   So sometimes there are three or four alternate roads .....

Water in the old road?   Just start one on the right .....

We arrived and the gate was locked ..... No problem for the locals:  we would go around the back way... However, the back way had a road and bridge that was muddy, wet and a little weakish looking.    We could go back, but in John Wayne's famous words, "Men never retreat."  Instead, we should have chosen "Discretion is the better part of valour."  We got stuck in the mud .....  No problem ..... Out came the ropes and the beer.

We did finally get the van onto the bridge; then it occurred to us, with the wisdom that only beer can bring.  "We will need to leave."   And if it rains we will never leave.  Right now I was thinking that the Brazilian prison was looking good.   Again no problem.  The driver would just get a running start off the bridge and get back up the hill .....  and sure enough, soon the bus was safe on high ground.















Now to the waterfall.   I remember asking more than once "Are we there yet?"  This really doesn't look like a trail."   As the kids bounced over rocks and streams, I actually needed someone's hand to steady myself ..... A true sign I am old!  I should be embarrassed to write this but alas, it is true.

Of course, you can't go anywhere without cold beer.

 //

And yes, Caroline, Izzy and Sydney this is just before the current
took me ass-over-teakettle downstream ..... muttering
"My mind is younger than my body."

Stefon playing King of the Falls.  My mind is not that young!

Once Again

I have rambled on and not gotten to other more important reasons for me being in Guyana ..... students in nursing and psychiatry.  I'll have to save them for another blog ..... I must finish this with a tribute to

Stefon's Family

Over the three days I was in Lethem, Stefon's brothers and sisters and parents welcomed me into their homes and lives; they drove us around when Stefon forgot to book a ride,  and they constantly made do ..... when one brother's car was available but could not get to Brazil and back, we changed cars to get us there ....  I will no doubt forget their names, but never their kindness to me.

 

 

I would like to write more but I have lots still to do today, including reading for Problem Based Learning -- oh, and a lunch and a dinner.   Life is good.

Here is a link to more pictures from Lethem.... for the truly dedicated!  Just pics, no commentary .....  If you have a question, I'll respond.

wonderful and random Lethem pictures



Thanks for reading.

Abbreviated Blog

This is Amerindian Month
So in honor of this wonderful heritage and the fact that I was tired out by the travelling...  an exciting video.   The dancer are acting out all the steps they  need to go through to change Bitter Cassava which is poisonous into the main food staple of the Indigenous People of Guyana.

https://youtu.be/xRnusVIupog

If either guilt or energy or a combination of both, I will get a "real" blog out later this week.

Thanks,
John

And a Little Traveling Music, Please

Mabaruma on the Northwest Coast

Psychiatry afforded me the opportunity to see a part of the country that I had never seen.  It was a short one hour air flight but would take more than a day to get there by boat.  (Ah yes, thank God for planes!) Usually two psychiatric residents go to run the monthly clinic at the hospital.  This time I went instead of one of the residents; this meant that Dr. Jackie had to do the work of two while I played tourist.   

Here are a few stories and some pictures.

This is the "downtown" market area
on the Kaituma River

It is hilly and the air was fresh.

Mabaruma is in Region 1 - Barima-Waini  (formerly Northwest Region) and is the regional capital.   It is a small, friendly town in a heavily forested area and I do mean forested.   Five feet off the road you really couldn't get through.

Jackie and I stayed at Broome's Guest House.  (It did seem that almost everything was named Broome, as they were one of the first families to develop the town.)   We were greeted by one of the daughters and shown our room before we had another breakfast for the day.   We were certainly well fed and could even request what we wanted for meals.  (I requested potato fries instead of the usual plantain ones.)  They went out of their way to make us feel like we were at home.

Our lodging.... and I loved the colours!

The dining room.  It seemed that there
were always interesting people from everywhere
to chat with at every meal;

A view/ from my balcony.

Somebody had to Work

Main Hospital Reception Desk and Emergency

The main entrance to the Mabaruma Hospital

No, Jackie is not the file clerk;
 it is her consultation room.

After breakfast we headed to the Hospital where Jackie would spend most of the day seeing people.  Some walk a huge distance every month to be at the clinic.   I sometimes feel overwhelmed by the difficulties of having a mental illness in Guyana (or anywhere). This day Dr. Jackie saw a young man who was doing extremely well and was looking at moving to Georgetown to go start university.  Jackie told me this later because I quickly disappeared on a minibus to go downtown.

Downtown Mabaruma

It was a quick trip "downhill" to the market area.   I started to walk around and see the sights and I soon got to chatting with the shopkeepers about their products and customers and lives.   They were interested in the strange white guy as it seemed that most visitors just look, and walk by them ..... and as typical of all Guyanese, they have relatives in New York or Toronto.   Many didn't mind having their pictures taken though they had no way of ever seeing them. One store owner had a cousin in Toronto and was going to send me her email and I would send the picture on to her Canadian family -- but I doubt it.  So here is a picture of her and her mother (?) in case the relative is a reader of my blog 😁

 


Blogger and Pictures - YUCK!

I can't get the pictures to stay where I want them... and I utter small ejaculations that the priests with whom I live have not heard in the Presbytery before.  So almost all the pictures are online at:

https://photos.app.goo.gl/1xgzB6XGLKki4akk6

This may be too many pictures even for my most ardent followers.  I will post "Faces of Mabaruma" and my "Artsy Collection on FaceBook soon.

Now I feel better...

Some Thoughts on Mabaruma

Mabaruma is next to Venezuela and is one of the places that has taken the brunt of the economic catastrophe that has happened there.  (I will leave my political opinions aside about the causes of the disaster there.)   There are homeless Venezuelans throughout the town and the hostels are overflowing and there is no work...  And in some ways the Venezuelans are like Americans.   They are a proud people who were once at the top of the economic heap and they still act like it.   They project to the Guyanese (mostly Amerindian) that though now penniless they are still better.   Even I could see the hostilities that are being built up ..... and which usually come to a head on the weekend when people drink too much and some violence and property damage occurs.   At the local levels, we are all quick to identify who is "not us" ..... as with Americans and Mexicans, Canadians and our refugees, even at the small town level,  as in my home of Ayr in Ontario, we are quick to see who is not an "Ayr-head".   It is such a deeply entrenched feeling that no wonder we think God must have intended it when we were created.   

I met many people who have lived their whole lives in Mabaruma,  They were never sick enough to be sent to Georgetown for treatment nor were they the smartest who could go to school there.  I know I have lived in small communities before, like West Pubnico, Nova Scotia where most families had been there for generations; however, most of them have traveled throughout the province or Canada or even farther.  For many in Mabaruma, their whole known world is Mabaruma.  I cannot even imagine who they really are or even who I would be if that town was my whole life.  I was about to slip into arrogance and say that I was the one who is better off ..... but I am not sure.  I think the people of Mabaruma are just like people everywhere.    They try to: make a living, take care of their family, yell at the teenagers, get tired, angry, laugh and cry ..... and play.  Some even gamble; I lost a couple of hundred Guyana dollars in a game of cards.  Actually, I gave it to one of the guys to play for me as I really did't have a clue what they were doing.   My player lost quickly!

Fourth, political correctness in speech was unknown... and yet there seemed to be less hostility to one another.   One guy at the card game was called "Monkey".   As soon as I heard that, I was waiting for the fight... It never came.  And there were similar names that would have caused a big reaction in Canada, though maybe not in Trump's America.  WE are certainly more careful with our speech, but I am not sure we are more accepting of another...

Enough...  Thanks for reading.

John