Sunday, November 1, 2015

National Pride and Sentimental Affiliation

On June 17th this year, a young man joined several others gathered for an evening Bible study at a South Carolina church. He stayed for almost an hour while they read their scripture. Then he stood up, pulled out a gun and started shooting them, reloading the gun several times, and killing a total of nine of them.

The young man was a white man. Those killed were black. His rage was borne of cold-blooded racial hatred. He targeted people of a specific color.

The horror shook the country. If you just watched one of the YouTube speech videos of one of its victim, state senator Rev. Clementa Pinckney, it is not hard to share the despair. Of the senselessness of the act. His politeness of speech alone, in the crude world of American politics, imbues antithesis of violence. "Why" that reverberates in ceaseless expanse of darkness, echoing, bouncing, feeds this anguish. 

This despair collided with a particular history of this country: of the race relations between the whites and the blacks. I certainly bear no depth of understanding of this country's history of race relations. My understanding is rather simple: black people were forcefully dragged out of their native countries, enslaved, dehumanized and traded as commodities in more barbaric times of this country. This country has come a long way from that disgrace. But it is not a transformation that has happened overnight. There has always been sides, and people have struggled, suffered, to come to the stage it is now. They have made improvements in slow, painful steps. There have been violent oppositions to each of these changes. 

Confederate flag represents one of those opposing sides to the American black people. Reminding them of those times when several states fought, claiming their rights to own slaves. South Carolina was one of those states. And its state house proudly displayed the flag on its grounds claiming legacy of their past. Multiple attempts over decades by more fair-minded people to have it removed had proved futile.

After the racist massacre in the Church, slowly a call started burgeoning, touching on the wrongs of racial past: to remove confederate flag from South Carolina state ground. This was opposed by many, who probably aligned themselves to the white racial supremacy of the past. But the mainstream politics, media was rather unified in calling for the removal. The state government ultimately bowed to the call. The confederate flag, that symbolized atrocities of more barbaric past for many, that fluttered in glory for decades against the cringe it incited on many, was removed.

It was a humble moment for me. I thought, better instincts of human beings had prevailed. And to collectively attain that better state, I suspected, if you were a citizen of this country, you would be proud. That would be a form of a national moment where I could, for that instance, claim the pride of national identity.

As an immigrant, I know, I will never share that sense of nationalism in this country. I have no claims to the sufferings of their past to share their joys. But more than that, nationalistic feelings have not been particularly appealing in general.

Interacting with fellow immigrants from Nepal to this country, I sense that many find the question of national identity particularly acute. Perhaps it is aggravated by the difficulty of assimilating to the new culture and place. Perhaps it is realization of a difference of national identity that introduces a certain sense of insecurity in a foreign land. Regardless, many appear to have developed a sharpened sense of affiliation to Nepal.

This was reflected in an acute form when earthquake rattled Nepal recently. They exhibited an extraordinary generosity; they reached for their pockets, some made journeys to Nepal to volunteer, many penned their love for the country in their social media pages; the affection was palpable. The connection to the nation was visible. Even in less extra-ordinary times, their longing is visible-- in their daura surwals and dhaka topis in dashain (I do not see many doing the same in Nepal itself), exaggerated glitters of Teej, serene landscapes of Nepal (rather enhanced by extraordinary photography skills) on their Facebook pages affixed with nostalgic expressions.

It is a sentimental affiliation. But it is a mistake to think of this as a national identification that gives a claim to moments of pride akin to the lowering of confederate flag in South Carolina state grounds.

As immigrants, ours is an identification of convenience. We can mostly choose what we like about Nepal, polish it with imageries and mold the affiliation to our liking. On rare occasions when we are forced to face the inescability of national identity -renewing passport, being harrassed in the airport for one thing or other- we seek the most convenient solutions to patch the hiccup. We find relatives in power and bypass the procedure, or in worst case scenario bear the burden of the procedure in silence saying it is only this time I have to endure this. We don't even protest if we found the processes unfair. Why take the unnecessary burden when I will be away in another country in a day?

But the burden imposed by boundaries of the nation called Nepal is inescapable to many who live in that country. It is not with longing they think of their nation. But daily struggles in navigating a collective society. It expresses itself in violent forms in their daily life: public officials who ask for bribes to carry the official process of selling your property, political cadres who threaten your life for your beliefs, justice system which answers to calls of bribes than arguments of reasons, tax payer funded public officials who see the service seekers as slaves and find every reason to impose hardship. The weakest among them suffer the worst of the imposition.

Are we willing to take up that burden?

That is why it is best if we recognized our romance with the notion of nationalism as what it is: a sentimental affiliation. The claims to glory of nationhood belongs to those who toil in that inescapability against all odds, to elevate the collective society to a mass of better human beings. It belongs to the weak who suffer just based on the fact that they happen to be born there and have no escape. It also does not belong to those who live in the confines of the nation but prey upon the weak ones to feed their needs.  

Saturday, April 25, 2015

Earthquake

Hope we find comfort and courage to deal with the suffering brought along by this devastating earthquake. 

Saturday, January 24, 2015

Questions

Hospital internist called asking for help. "He is about to leave, perhaps in next half an hour, but I need your help."

We endocrinologists tend to get exasperated with such last minute calls. For the types of problems we deal with, most of which are longer-term diseases, time of hospital discharge is not a very opportune moment. Yet I held my patience. And the internist was no cavalier soul trying to cover up her incompetence at the last minute of patient care. She was a genuinely concerned doctor.

The patient was a young man with type 1 diabetes and required insulin to sustain life. He was brought into the hospital after he collapsed following heroin injection. Just a few days ago, apparently, he was released from prison. He was unemployed, did not have health insurance, and did not have money to buy insulin.

This doctor was concerned about what would happen with his need for insulin once he left the hospital.

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The patient was a huge mess. His problem was a product of addiction, poverty, social-politico factors beyond the comprehension of a doctor who cared for patients with hormonal disorders. I can recommend and adjust medication dose but enable access to a medication? That is beyond me. What did she expect me to do?

That was my first reaction.

But she had reached out in desperation. So we talked to each other for a while to see if there was any way out. At the end, we came up with a plan. We decided to switch him to a cheaper form of insulin that would be injected just twice a day. Hospital pharmacy would dispense a vial that would last him at least 2 weeks. I would schedule a follow-up for the patient at my clinic with diabetes educator within a week and with myself in 2 weeks. My clinic would provide him some free insulin samples that the pharmaceutical companies gave us and enroll him in drug assistance program offered by these companies.

He did not show up to the appointment with the diabetes educator. But showed much later to see me. Having had type 1 diabetes for most of his life, he had a good knowledge about diabetes self-management. He was living in couches of his relatives: ex-wife, father and brother. He had been getting insulin samples from one clinic or another and sometimes using friends' insulin.

I talked to my clinic staff. They immediately arranged for insulin that would last at least 2 months and started paper-work for patient assitance program for providing long-term insulin.

At the end, he said, "I really appreciate the thing you guys do."

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That is the nature of this profession. We deal with the failures: failures of normal physiology and failures of persons, society. A patient should not be foraging for insulin in the most wealthy and powerful nation on earth. But that happens. Why is a different question. And it is at the receiving end of these failures that we, doctors, are positioned.
It is a good position to be. Especially if you have support to be able to make things happen. To have opportunity to tell yourself, I helped another individual in need, in pain, and in suffering. That opportunity to assertion of a meaningful life is what motivates many of us to seek or pursue this profession.

Yet, I know, there is now a constant variable whose shadow will follow me in all my interpretations: that of an immigrant. After starting my professional practice at the country I was born, experiencing being a doctor there for a few years, I am now back to practice in the country I was trained at. How much a claim an immigrant doctor has to meaningfulness of his vocation? Is loyalty to individuals in pain, suffering any different when you are an immigrant doctor? How and why, if the answers are different? These are some of the questions.