Abstract

In lieu of an abstract, here is a brief excerpt of the content:TellingAlvan A. IkokuMost everything had gone as I had imagined it. The plan was to eventually do international health work in Africa. So it was important to add another year to my medical studies, to leave Boston and gain some level of comfort working in French. The year was to be divided between France and Gabon. I was more than halfway there, having spent enough time in Paris to feel proficient in the language, and having also completed several months of clinical rotation at the Hôpital Necker. There was one disruption: my father passing, perhaps of cardiac arrest, the attack occurring in the village—over an hour away from the nearest emergency room. The event required a month back home in Nigeria, to carry out funeral ceremonies and attend to my mother. But on my return to Paris the plans remained unchanged. I completed my rotation and soon after I was in Lambaréné. Ready for another three months of clinical work in a Francophone setting. Ready for a rural version of my rotation. Ready too for a second return home. Gabon was close to Nigeria, and I could visit once I was done.Medical school was my first attempt to fulfill deeply felt duties to two homes, Nigeria and the United States. Practicing international health in Africa was a way to resolve any tension between these duties. At the time, this meant training in the States and working to improve health south of the Sahara. There was little room for thinking the reverse might be more appropriate. I wanted to bring a standard of care from one home to another, or as I often said, to learn how to practice with limitations, to be as good a physician as one could in any setting. But one limitation I couldn't accept was a language barrier between myself and my patients. Learning a new language made the most technical text come alive and it made patients people. So I made my case for an additional year of medical school abroad, and it was granted.Once in Lambaréné, my limitations became apparent and troubling. It wasn't simply a matter of still being, in every sense of the word, a medical student, nor was it simply due to the waiting halls— not waiting rooms—of patients at the Polyclinique, almost as full in the evening as they were in the morning. As expected, there were several advanced cases of illness, even deaths, that I felt would have been prevented if we had seen the same patients in Boston. But what made my limitations so keenly felt was confronting them as a provider for people who were surprisingly and intimately not others, people who were suddenly so closely like myself. Gabon was not Nigeria. The fellowship was still meant to occur abroad; it was still a project of global health. Yet the patients themselves resisted that enterprise. They gestured to parts of their body as I had seen aunts, uncles and cousins do. They did to the French language what I had heard many in my family do to English, bending Europe in ways that were too familiar. Again, Gabon was not Nigeria. So this familiarity was neither expected nor prepared for. These encounters left me disarmed, porous and eventually aware that my education [End Page E1] to become a physician had relied on a process of de-familiarization.The inability to alleviate pain, decrease morbidity and prevent mortality felt strangely intimate and demanded reflection. The distance that seemed necessary for clinical practice was not possible, and I needed to learn to care while feeling the discomfort of being familiar. I found one way through language. I let my French become imperfect: bent, stilted, with gaps. The patients filled those gaps with words, or with more questions about their own illness. They seemed less intimidated, more willing to go over what I had encapsulated in a single concise, practiced sentence. They wanted any elegant sentence broken down. I obliged and the goal of each visit became to have the patient form sentences with me. I began to feel that what we produced together should be part of good...