Refocus on Ecuador

Today was a more typical San Francisco day; cool, windy, overcast. A good day to devote myself to education. I have to try to focus my interest when I come to this massive conference. There are so many choices, so many different lectures, symposia, and courses. I decided to attend a symposium on a mental health program in Ayacucho, Peru, a city of 100,000 about ten hours by bus from Lima. There was no psychiatric care available to this community until a couple of psychiatrists from Yale volunteered their services in developing a program to provide mental health care. They are challenged by limited resources, and work with local nurses, psychiatrists from Lima who volunteer their time on the weekends, interns from the local university, and foreigners who contribute in various ways. There are significant difficulties communicating with the local population, most of whom speak Quechua and Spanish, and often the medical consultations include the family of the patient, the non-Spanish speaking physician, the Spanish/English speaking interprator and then the Quechua/Spanish interprator. Quite the circus. There are all sorts of misunderstandings, both because of the language differences, but also because of the cultural divide.

Most of the attendants of the symposium were from various South American countries, some who practiced in the United States, and fewer from Latin American countries. I was trying to find psychiatrists from Ecuador. I am not sure what I will say when I meet one, but I am hoping to see what possibilities there may be for employment in Quito. I will be unable to get a license, but would like to volunteer in some way. There is an Ecuadorian society of psychiatrists listed in the syllabus for the conference, and I found a meeting in Guayaquil in November at the Hilton Colon, which is where Eric and I stayed when we visited in March. I also found a conference in Columbia, but I am not sure how safe it will be to travel to Columbia. I feel as if this is a treasure hunt, a challenge to find an opening, someone who can direct me, some way to be useful during my time in Ecuador, to offer my experience and skill as a psychiatrist.

On the other hand, I remind myself that the point of taking a year off is NOT to work. Sitting with my sisters yesterday reminded me of how wonderful it must be (and having NEVER taken any time off in all the years since FOREVER) to wake up each morning and do whatever I decide to do. Not to have deadlines and an appointment every hour and no time to read or relax or play. That is part of what I am looking forward to; a life of leisure. Of course, I can hardly imagine what a life without work feels like. Both my sisters have chosen lives without work outside of the home. I do not discount the effort required to maintain a home and a family, because I am very aware of the energy I devote to my family, but my life has also included a full-time 40-plus hours a week at the office. So I am evidently conflicted. I want to play full-time, but I cannot imagine not working as a psychiatrist.

I met with dear friends for dinner tonight, and we caught up with our lives. Included in the discussion about Ecuador is the challenge of changing direction, changing careers. Alan is writing a book aobut retirees starting new businesses. I am excited about making a shift in my life. I have been a psychiatrist since 1983! I feel that after 26 years, that is all I am qualified for. What else am I capable of? Alan's wife Vickie started a new career as a business developer for a pharmaceutical company. She began as an executive assistant just a short few years ago and has taken more and more challenges to reform her career in a very exciting direction. She is my age and this was a completely different move for her. She began in a lawyer's office, moved to a pharmaceutical development company in Salt Lake, moved to New Jersey and then the Bay area, her job evolving and advancing. Very inspiring. The point being that changing my career and choosing a novel path may be the best course of action.

So I spent my day exploring working in Quito as a psychiatrist....but perhaps that is just because this is what I know; what may be much more of an adventure is to choose an entirely different direction.