Jeph Mathias – Life Outside of the Square (AUMSA Conference 2014)

general doubts made for a story that resonates with your conference so I had a look at your website and I found all these amazing people talking about international health medicine and arts crocodiles and snakes passionately pushing your personal limits because his issues bigger than yourself and humbled I wondered what I could add to that but he asked for a story so you guys put yourself in my in my shoes I’m in an indigenous village in Colombia Colombia’s in the middle of her of a civil war and the government does not as healthcare to areas held under guerrilla control so that the local population won’t support the guerrillas Mitte stance on frontier thinks that everyone deserves health care no matter where they live so that’s what they’re doing there we’re doing there anyway after a day of medical work seeing indigenous people I’m tying the hammock the mosquito net up over my hammock Elena and Liliana ral nurses are scaring luminous laughter around them as they cook dinner the metronomes provided by miguel withers axe chopping firewood if none though our doctors and the other side of the clearing tying up his hammock I really enjoy these trips you know they you see great things you got remote rivers we meet interesting things the amazing pathology but right now I’m ready for town this is the date the sixth day and tomorrow we’ll be back home at our base I’ll go to sleep in a bed wake up late drink some good coffee read a book listen to Silvio Rodriguez music tranquilo I’m just telling the last knot on my hammock and a hand falls in my shoulder I turn around and my hat sinks to my boots there’s this kid 16 maybe little bit of her fuzz of a mustache in hazlet he’s carrying an ak-47 big knife dangles at his waist and he leans forward to mean he says softly and jefe quiere hablar the boss wants to talk I’m being kidnapped 1998 about 3,500 people a year were kidnapped in Colombia by the guerrillas mainly to rent to finance the operations with ransom money amiss if we’ll pay anything for me but a whole lot can go wrong between ransom and release and at minimum I’m guaranteed a several month jungle safari but the mortality for kidnaps about fifty percent I think of my wife in town pregnant and wonder if I’ll ever see her again Liliana and Elena just over there I wonder about shouting to them but I don’t vomit OCC’s pronto bring your medicines so I take our small medicine box he flicks his chin towards the jungle shows me the way with his rifle and I walk ahead of him and as I walk I don’t turn around but knowing that there’s a gun and a knife in the hands of a 16 year old behind me makes them grow to this big in my mind it’s terrifying I’m hyper aware totally freaked out I can feel drops of sweat running down my armpits and after 200 meters that feel like 200 light years we come to a guerrilla camp with boys like him and camos with ak-47s our sauntering around laughing loudly they see me walking with my box in front of a guy with a gun and look at me like wild dogs scenting the fear it’s an amazing experience I don’t know what to do guy says wait here and they bring me a kid it shows me his cut hand it says fix this his friends laughing tell me the story Pablo was raping in an indigenous woman when her husband walked in with this machete he swung his machete he plot he public blocked it a gun went off a trigger was pulled the guy’s line did Pablo continues raping his wife with his bleeding hand besides beside her

husband’s corpse I’m not used to a world where it’s normal to kill a man and rape his wife beside his body this is out of my experience it’s a relief when an older guy comes up and he calls over to two kids with camos and he says medical these are your nurses and he says to them do whatever he says got it Els medical he’s a doctor he’s a doctor I’m a doctor that’s my life rest I grab it at last is something I know what to do I know how to lay out surgical equipment I know how to put out forceps and needles tell him I can give orders so I start on autopilot I start doing repairing an extensor tendon and dividing a wound irrigating it and listening to the story of this guy’s as he carries on clinical medicine right then was my Savior gave me something I could do I didn’t have to think about the violence and fear around me I’m just tying the last extracting the last extension strip around his finger when the first boy turns up and he says the boss is ready now sure I say I’ve got a bill to give him my bravado is as thin as the microscope coverslip and he’s totally unimpressed and says let’s go so walk ahead of him again down a path it’s dusk now and we come to a clearing and in the gloaming I see two chairs once got a dark shake on it the voice is heavy and melts away and I’ll walk over terrified welcome I’m Chi Cesar surprisingly warm friendly voice and the hand sticks out I take it telling myself to grip firmly show myself as manly and afraid I’m horsey from Australia say confidently if the story if it gets out I don’t want anyone knowing that a doctor from New Zealand help the gorillas to gray eyes look at me right through my lie you’re not horsey and you’re not Australian by hand goes limp and his grip the hope drains out of me like blood to my boot why did why did I say that everyone knows that we all know it’s a basic fact of life you don’t cut Colombian guerrillas time stretches and yawns and gates I don’t know what to do then he throws back his head and laughed and says and I’m not sure either come Sid let’s talk my heart starts beating again and I sit mucho gusto I stumble and try a few more awkward openings but consummate a conversation only ready starts flowing when he starts asking me questions what’s emissive doing here why can your program really help forgotten villages like this he listens attentively asks perceptive questions seems to know what he’s talking and subtly he shifts it and then I didn’t know quite when but he started probing me not MSF who are you how did you get here what’s your story how did you get into med school why whoever asks you why you got into med school so I tell him about receiving an application form for med school when I was volunteering at Mother Teresa’s in Calcutta having a choice in my hand I could sign an application washing dyeing destitutes and kali gut or guidance physiology in auckland didn’t know which way to go but in the end I thought well maybe I can do more for poor people if I’m if I’m a doctor so I signed it chucked it in a red pillarboxing in Kolkata arrived in Auckland three months later and that was my choice I said Mother Teresa or curly goth and he says this Colombian guerrilla with a assault weapon over his knees that’s killed many people

he says Mother Teresa there was a great lady there was someone who showed the world a different way unbelievable the night’s thickening around us and we said in deeper fiction and suddenly he whistles the boy at the clearing edge appears he says das said missus the boy melt-away re materializes with a tray he nods towards towards me to our guest he sees the boy offers me a tray or brings the tray over to Ken’s on it beer I pick up one it’s ice cold ice cold beer in the middle of the Colombian jungle totally surreal it’s all totally unreal drinking cold beer in a Colombian rainforest beside a guerilla leader with his weapon gives me this kind of kiss that our likeness sure I’m being kidnapped but I can’t do anything about it and so I decided well I’ll reverse this tactic I’ll ask him about himself and it’s as if he’s been waiting waiting for me to ask he tells me stories of climbing in the Andes with his friends Beck Vinnie says we knew we’d never die tells me tricks for fishing out in rain forests muddy rain forests rivers and we argue about who was the greatest footballer he goes for ple I’m for Maradona he’s talking freely and freely now delves back into his boyhood he’s from a compass in a family that moved to me verging he worked worked hard at school did well was the first person in his family ever to qualify for university got into a free government University studied history worked hard again had a gorgeous girlfriend biologist called Fabi he he and she both won scholarships to USA and then he says to me but how could I go and leaves us of a country my Colombia beautiful and amoral where people die amaz admits plenty I couldn’t go you had to choose between mother Teresa and and medical school I had to choose between Colombia and USA and I joined the gorillas but Furby went there’s an aching pause Debbie went we’re both sitting there silent and then he says for the risk Libya lost versus most riskiest anoche tonight I could like write the saddest verses it’s the opening line of her one of my favorite poems so I give him the next line it’s cribbage por ejemplo you’re not es taster the other et Dylan azules boss Astros hello Lea hoes he picks up gives me then it gives me the next and so this Kiwi Indian doctor in Colombia and this Colombian MA in history and guerilla leader sit together and recite line bartender line a poem by Pablo Neruda Chile’s Nobel laureate and we drink beer surreal night is thick and black now we’re silent unable to see but viscerally aware of the human being beside us it’s a long silence and then from the blackness this soliloquy so here’s che son lover killer he dreams of peace and he leads village boys to shoot and screw fighting a war for FARC that’s totally unwinnable because that’s lost its lost it’s very soul and anyway the fight is against the evil in the human heart men can love mean can’t cheer will screw our neighbor until eternity Colombia will never have peace and justice and digis women will die in childbirth kids will die from pneumonia a president will fly to USA if he gets a hit if he gets a headache I’ll never see my

family again I’ll die forgotten in this jungle while Febby serfs in California if I try to leave the military police will give me torture me and kill me so I’ll keep running no swimming through this river of blood all for nothing that final nothing is as hollow and as hopeless as Macbeth’s what do you say to that I sit there in the night swirling mind he can around and around bets cut the thick night here and there record flight I just sit hollow beside this desolate human being I’m submerged in silence and infinity deep down way above me on the surface night in six strident whistling’s give ripples and I just sit there empty and totally alone and totally connected to this other human and then after I don’t know how long I hears voice from a million miles away but your friends must be must be worried come I’ll walk you back and so we walk back side side by side has gun on his shoulder like a third companion between us right to the edge of the village wheezes our ways part now adios and I say may go well for you you mean that I die quickly he says blackly know that your dreams may come to pass my dreams drowned long ago in blood and mud at least tomorrow’s dawn should be bright and clear well maybe it’ll be showing at midnight I give up on my upbeat subjunctives and just see adios he adds amigo embraces me and says hermano brother and I walk away without looking back Elena’s sitting by the campsite arms around in these books totally distraught as I walk into her pool of light where you she says talking to a man about a horse I say in a voice that’s not my own she’s heard about the murder and the rape she’s Colombian she knows that you don’t talk about Nigeria she knows but you never mentioned it again and so that’s my story Gerald dedicate it to you so why why that story dragged out from my subconscious an unforgettable conversation from 15 years ago sure I repaired an extensor tendon but it’s not really about medicine and Colombia 1998 has nothing to do with all current 2014 does it but it does because you know I think all of us each in our own way is seduced by this big beautiful poorer four world that we live in well we have responsibilities he’s surely dead now Jay a gun a knife leishmaniasis maybe he was captured and tortured and killed but he’s dead and I see now that he he called me that night because he needed someone to listen to his eulogy as he gave his own as he ran his own funeral the fire of life was dying in those gray eyes of his he’d felt the hand of death on his shoulder and he’d given up but he still had dreams and he still wanted to talk and he chose me too and I understood because we were both there for the same reason that night in Colombia Chennai we’re both dreaming of a different world trying

what we could using what we had but the fates those three blind ladies that snip the threads of life the fates gave him an ak-47 and they gave me a status code and what he said in their final podium farewell occurs in a manner he said to me I failed me my gun but let’s see you go ahead in this world change it with your stethoscope that’s why I chose a story the fates gave you if we want a few in this room a stethoscope a Stila scope and an invitation to live passionately go out in this world will live passionately take your stethoscope take your life out there it’s an invitation not a command you can choose Mother Teresa or medicine bark or USA but the invitation is there most of you will probably choose to do first world consultant to choose some some technically difficult aspect of medicine end up somewhere between country G Peru Walker and auntie auntie Erick pediatric corneal icefish system Mayo Clinic New York but maybe about five of you will choose the lifts travel path donor which five one of them could be you so why move out why rip open the silk cocoon your first speaker yesterday subjected she ended up in a young Colombian slum with her family I got be in poetry in I change it up in the Cambodian summer I got be in poetry in Colombia but we go both got amazing intense adventure filled lives and there for me is the first reason to move out the panic between Murray Walker and Neil is Chris caused by world warren career paths but go outside the fence and you make your own career path you colored as you go I don’t know where I’ll end up but I’m guaranteed a surprising exciting life and for me with my adventurous heart that’s everything I don’t want to know the end of my story I want to find it out as I live it the second reason equally crucial no more crucial it’s important have a look at these statistics here if you’re somewhere from a real Walker to Mayo Clinic they don’t they don’t matter at all but for most of the world this stuff is crucially important the big questions of off our planet of your generation should have been of our generation we we failed about equality justice fear distribution of resources the relationship between human beings and the relationship between human beings in the environment that’s the big stuff if you do something really technically difficult learn how to radiologically embolize bleeding out reason rich 97 year olds it’ll be really hard you have to do lots of study you’ll be well paid it’s difficult it’s important for the patient in front of you clinical medicine always is but you’re spending your life dealing with one of the planet’s little questions I want to go for the jugular I want to be the end of big stuff I want to deal with the planets big questions that’s why I want to move out even if we’re comfortable up here on the top deck of the world now in our lifetime Sydney in yours global disparities are going to bite global warming water a major war something’s going to happen and the choice is to stay comfortably over the top big or get down the into the boiler room and see what’s going on and I’ll want to be down there where the actions happening we’ve learn how to very cleverly separate the two dicks money resources finance medical skills we partition partition and then very nicely and totally unfairly between rich and poor world’s my mother-in little kids Minh was treated last year for florid manic

depression by a Pakistani psychiatrist meanwhile almost simultaneously my neighbor here in India had a son who was hearing voices and he was schizophrenic New Zealand has many psychiatrists India has one too every 200,000 people 3 2 million then it’d be 12 psychiatrist for the whole of New Zealand my mother’s well now I’m really grateful my neighborhood my neighbours son Vivek killed himself last year without ever seeing a psychiatrist moving out makes us really deal with that stuff means you’ll be you’ll be working something you believe in passionately you really believe in and that’s enough isn’t it a while a wild unpredictable adventurous life and doing something you really truly deeply passionately believe in that’s enough reasons to move out isn’t it but there are more let’s get on to those so perhaps you think that the biggest intellectual challenges the hardest technical stuff that’s all found it inside the picket fence not so put yourself in my shoes here we’re in a remote Himalayan valley and I’m out in the village doing some community health week phone call from curry hey Jeff you’ve got to come back serious patient here so I’ll jump in my mountain bike was Beck find a guy with compartment syndrome in his forearm he’s got all five of the peas you’ve learned about pain pulseless pallor perishing Lee cold paresthesia and piss-poor possibility of treatment and you see he needs it he needs to fetch yata me now in New Zealand it’d be an orthopod with Anna nice assist and a clean theatre with a nurse and all the 60 drugs and equipment he needs a handle of urgency doctor like me wouldn’t even be allowed to stand outside the door here in the Himalayas I was reading a book learning about how to do a fresh shot of me while Sam was cleaning up her cleaning up a room you remember being in a rugby changing room before a big match you’re nervous as a store as a horse before a storm and then the Rif knocks on the door and says next time there tell I felt when sin knocked on the door said brooms ready boss I took him in with me he’s a Korean med student with us dr. H II really super nice guy clinically couldn’t do anything at all but he could retract and he could turn the pages of a book so I nice the ties the sky from on the styloid to middle epicondyle town of the styloid took a deep breath with kickoff time 25 centimeter incision down the length of his arm and it was just like the rugby match once kickoff goes it all happens all that anatomy anatomy I did in medical school all that years of emergency medicine paper since I sewed up surgical technique it was there i dissected down retracted identified anatomy this yellow nerve don’t cut that and got down to his deep fascia but if the most medically satisfying moments of my life were sliding this scissors along the deep pressure and this dusky purple muscle loses up just like the book said it would patient’s pulse returned his hand picked up I said ah Kim said oh ho and now there’s a guy living in a remote Indian village can still use his vet his hand he didn’t lose his his land his family didn’t starve he didn’t starve incredibly satisfying I’ve learned to do my own spies anesthesia here cesareans appendicectomy even hysterectomy I’ve been at surgical camps and remote places with three of us operating simultaneously in the room I do the simple stuff while the other guys to open their further thought amines and stuff like that all under spinal anesthesia was known as and these statists it’s super stimulating never never had a bad outcome by the way super stimulating super challenging incredibly satisfying more challenging than anything I ever did in New Zealand or try this one I was expedition dr. Adam if a Space

Camp in 2009 a Sherpa was felt was found dead and his friend was unconscious blood pressure 60 over 40 respiratory rate 35 GCS seven the guy had one foot out the back – all right the Indian Army doc had given them some theophylline but this was an asthma his sets of alright didn’t sound like aspirin his chest just working out what what was going on was hard enough and he cold tainted 5,300 meters I’m Italy calculated his arterial blood arterial blood gas and with some other clues we figured out it was methanol poisoning from contaminated whisky Wow we needed ethanol as the antidote but where’d he get ethanol in her space camp I seem to run around all all all their expeditions and in another unforgettable moment Russell Brice famous New Zealand guide arrived with his last bottle of smirnoff vodka have this he said I know you’ll lose a bit of an I ever would he clearly didn’t believe what are you saying but we got the vodka 50% alcohol by volume which made it easy to calculate doses but then our problems did we give it a New Zealand you put in a nasogastric tube and give it in G but if we yes rates will kill him how do we give it IV do you give smirnoff vodka out of a bottle IV the guy’s going to die and we did we gave it we gave it gave it IV looked after him all night with a rotor of doctors he survived did fine can’t ever us the next year in ICU in annoyin Auckland maybe you will calculate arterial blood gases in your head but you’re never going to deal with a really serious patient flicking between Hindi English Spanish and Portuguese with an archer an Argentinean guide a CRO a Croatian and a Serb you need just never going to do their Connor stuff back on those those camps in Colombia was going back a Jaguar jumped into the water three metres from us I could smell I could smell its fitted scent you never say never a medicine but I’m gonna tell you you’re never gonna see a Jaguar when you do a ward round in Middlemore Hospital step out and you’re going to see and do stuff that you you’ve never done before last month I was on a work trip had to cross the 5000 meter pass as a part of the trip part of my work and again I can tell you you’re never going to use ice X and crampons to get into it the Christchurch Hospital move out the world’s waiting for you out here come on and it’s not just one-off 60 technical challenges like IV vodka or fasciotomies think of this a community-based malaria program in Colombia required negotiation skills clinical skills how to choose malaria workers from remote villages relationships between indigenous and displaced black people there’s no textbook for how to how to plan and run such a program we’re finished with people from villages with the equivalent of forum for education able to take blood fell take blood films use microscopes diagnose and treat appropriately falciparum or vivax malaria amazing incredibly satisfying and we’d argued microscopes out of the jar out of the government the local hospital was was doing a maintenance schedule on the motor microscopes unbelievable and the odd Jaguar thrown in as well and now health health workers in India village women who learned how to treat about 30 common diseases could use antibiotics knew how to do a referral incredibly useful for their communities incredibly satisfying for us and a relationship with with local people what was a fabulous thing to do I now work in community-based adaptation to climate change which involves sitting on mud floors talking in Hindi listening to stories of how villages are effective understanding government policy understanding meteorological data a lot of development theory putting it all together it’s incredibly into intellectually challenging much more than anything I ever did in New Zealand but wait there’s still more move out and you’re gonna meet meet some amazing people in your work you’ll be stunned stunned and handled to be part of the same species a five year old girl who walked across a

5000 meter mountain pass to come to a surgical camp just about did she survived farmers slum slum dwellers Sheila Sheila’s children Michael Android wood road workers you’ll be proud to be in the same species as these people and your friends are going to be extraordinary people too large II just got a house-surgeon degree he’s the finest clinical doctor bite by a distance that I know anywhere in the world he does orthopedics ophthalmology urology general surgery thoracics done as does his own anesthetics is a fantastic physician and pediatrician and he’s a great guy so go tell him as a friend mark and calf Delaney marks an Australian lawyer calf is a PhD in mathematics they’ve lived 16 years 16 years and in Delhi slums just because they think sharing lives of poor people as worth it friends and deli who’ve taken a slum boy with leukemia to all that incredibly confusing painful scary bits of giving giving bone marrow transplant and in Auckland and in Delhi he’s gonna die next week but show on Cheryl and undergrad unbelievable people and there’s a beautiful girl who was sold as a six year old forced into marriage of twelve ruined herself when she was sixteen lived in a house shared a house with us plays velu balloon volleyball with their kids laughs she’s got a scarred face and there’s a totally beautiful person it’s lovely to have people like that in our lives this plane it’s got incredible people on it if you moved outside of the picket fence you’re going to get to know them some of them and move out to make you will bigger if you draw your circle from ReWalk it to mail it’s pretty good maybe you’ll go out on a few tourist routes but get outside the picket fence in your worlds much much bigger in Columbia we lived at a place called a real socio which translates as creek and it deserves its name but i used to go and play play billiards here in a bar where there was guys throwing down gold nuggets as wages on the on their poker they all had gun guns and their hips we lived in a slum house on poles in cambodia beside the big brown mekong sliding fast with its silt and sadness taught some village kids to swim in their in their river live leaks to see so jack actually cried when our friends died of AIDS I wish the world didn’t have AIDS and Wars and poverty and inner quarter but hick if it does I want to be out there I want to be in the thick of it socially to mow my world’s really bacon the New Zealand High Commissioner stayed with us in our little Himalayan village because he was funding the project and I talked to lower caste woman with schizophrenia who must be some of the most marginalized people on that on the planet Helen Clarke personally sent us off for our big Mekong expedition and the Vick a local fruit seller one day in the market came along to me and said hey Doc look at how you here any operations healing and he starts pulling down this trail isn’t not here for Vicki I’m glad it’s healing well I’m free to move across this convoluted crenelated social world of else I can go anywhere and very people few people can it’s an amazing privilege in temecula t sure I have to know the exact new course of the median near that the wrists if I do a wrist block but also have to be able to speak Hindi life to understand tribal social systems my met in Finland development is as relevant as my medicine are they in GIS was part of my work there’s always something else to learn someone else with a different experience international health for anyone with an explorer’s heart it’s going to take you interesting places intellectually to so there they are reasons to move out to surprise choose a life that’s that’s big and relevant to the whole planet choose intellectual challenges choose to work in the whole world not just it’s up a dick give yourself a big world socially give yourself a big world physically give yourself a big world intellectually give on out here fantastic no but this be honest there are downsides otherwise the whole world would be out here and it would be the crowded beach not the least traveled road and I’d be looking for something else to do so here’s some of the downs first thing there’s no money in it you’d be a zillion year if you discover the treatment for wrinkles or a drug to keep Cooper’s ligaments tense toward you do pretty well just focusing

on titanium knee replacements for Westerners or angioplasties for rich 90 year olds but there’s not really much money in reducing maternal mortality and Lao or finding the cure for malnutrition let’s be honest these resources for top did problems not for global plot not forgot our global problems someday we’ll recognize that if the bottom dictate sinks so does the top deck but we’re not there yet try to articulate the solution to malnutrition in a world that’s actually using in food and you’ll be called a communist it’s much matter financially at least to Decatur excedrin and Ramiro and treat pneumonia in Rwanda but which is more relevant relevant relevant to the rich world were relevant to the whole world and that’s your challenge do you want to be relevant to the rich world of the whole world relevant to people with diseases or people with money some rich sure rich people produce carbon dioxide and their causes climate change but it’s for people who feel the effects and no one pays me for community-based adaptation to climate change you out here no no no money in it so let’s be honest move out means move away from the top dick move off the top dick move away from resources move away from money but I’m not really sure that’s vets are down I’ve got everything I need I really enjoy myself secondly it’s not it’s not a career move sure I remember New Zealand I do locum sometimes and sometimes I look at the consultant list up there and I see names of people I once used to teach now in their junior and it unsettles me sometimes and I wonder what it would be like to live the well-traveled Pathan I asked God hey mate why don’t you make me like one of those guys no questions no angst just live my life do a bit of trout fishing climb a few mountains and you know what he says tell sells my head and he says hey kiddo that’s not your life you’re made for something else you know what the big guys right I I don’t think I could do it this is my life and I really can’t imagine living another way sure I told you some exciting stories about thing things that happen but there’s a whole lot in between things don’t work the electricity goes right in the middle of a big procedure the hospital base hospitals never said their supplies for their immunization camp you told them about three months ago it’s pretty frustrating sometimes even in general life you know you’re in the bank and some guy pushes in front of you and stick things go really slowly internet cuts off just when you’re middle of a really good conversation with your best mate back home sometimes it’s just plain hot tiring can be pretty frustrating and if those are just minor irritations there’s some more personal stuff too a couple of years ago my kids and I all got typhoid felt pretty terrible every month so every monsoon here but we got better every monsoon here mold invades our house me and two of my kids get asthma we’re on we end up on steroids I hate it and yeah if you could get ty four wooden essman in New Zealand you wouldn’t get TB a couple of years ago I had paresthesia down my leg and I’ve got a lumbar puncture and a wicked headache and when I got my CSF result there was PCR positive for TB and I was terrified thought I was going to lose the function in my legs T be a record itis I was on anti TB medications my liver functions were going off shook my fist at God and said why me you know what he says he says hey kiddo why not tell us was my head again you’ll be all right he said Here I am now here’s the ticket they’re two bigger stones sure I’ve got a really exciting life my wife Karen’s working in international public health she’s doing a PhD in Sweden she’s running a community mental health program which is have you ever been done before it’s pretty hard work but it’s fantastically stimulating for us we chose it but our kids never did Rohan our son pines for New Zealand our two girls competition Jim careers were finished by their parents decision to

come out here a couple of years ago three years ago we were living in a Delhi slum four meter by 2 meter room for our sitter for the six of us if you want to understand poor people you really have to share their lives but it was pretty violent poverty’s not not their murders around us though the lanes friend with open faeces that’s where we got out typhoid from and can you imagine how I felt as a father when my eight-year-old daughters had really aggressive vicious thumb boys with knives on them throwing walks and shouting at my at my eight-year-old kids and I thought I chose that for them and I wondered why and I wondered really if only my kids are important like that wisten will says or maybe everyone’s kids are important maybe the kids of those village people who have to end up sending them to the six trade in Delhi because of our carbon dioxide are they important too it’s big questions but it really hits hits you right here but there are conversations last year we crossed a five thousand three hundred meter pass them in a five thousand seven hundred meter pass with their kids including our five-year-old amazing adventure huge mountains big stuff you can’t do that in New Zealand no New Zealand kids get to do that maybe they don’t have skateboards and bicycles and go to swimming pools but they do wild stuff and at the end of the day what we give them is a really big world as big as us we give them we give them all our friends we give them what we have and it’s great the other really big one it’s loneliness we’re deeply imbued with the landscapes and the cultures of our growing up in 2008 when I was back in New Zealand I climbed cortical Mount asmin with Brendan Richard and Rory three of my best mates fantastic in 2013 Rory and I went here Hopkins Valley one of my favorite places on earth we had our rifles and we made our theory where the deer were went up there and amazingly there there were two kilometres away five deer we had this stalk on our bellies ducky ducking into gullies and climbing things keeping off the skyline took us two hours to cover two kilometers and we shot five deer my best mate and I carried out 70 kilogram packs stuffed with meat took us about four hours to cover the five kilometers back to the hut which was downhill amazing time turned the venison and to salami brought it back to India tangy with a taste of New Zealand mountains salty with a flavour of friendship and bitter to some way in the end the taste does the mountains I haven’t climbed with my friends the trout the trout I haven’t fished the deer I haven’t shot the good times of my friends are having had because I’m here we get emails from people about a party a birth a funeral even we wish you were there I wish my wife Karen could have another gardens of Eden trip with her best friends but she won’t because she’s doing international community health for men for mentally disabled people in India a couple of years ago the the black dog of depression was at my throat and I really didn’t want to be here wasn’t sure what I wanted to be in the planet now I took antidepressants but what I really needed was my best friends I didn’t have anyone I could really talk to who really understood me and I shouted at God and God just said rub my head again that’s why I’m bald hey you’ll be you’ll be right it’s okay Here I am okay so I’ve raved about moving out surprised adventure meaning a big world intellectual challenges but at the cost of money and friendships and personal comfort maybe even medical risks but here’s the big one for me the clincher it’s a love story way back then when I was in Auckland medical school my first

day I was in the cafeteria the same place you guys have your pies and play cards and miss your lectures and and this chick walks in and I talked to her and she says we asked each other why we’re in medical school and the answer was to share a privilege to get out into this big world to work in a village somewhere maybe the Indian Himalayas here we are Karen and I and a few years ago we’d been to Colombia and we’ve had done masters and international health and she Adrian Phil and I are done development we’re done all the stuff we’d had all these adventures were back in Christchurch I was an easy registrar she was a public health physician and she comes home one day we had nice settled lives and she says it’s time three months later we had all that gear packed into a a container that’s still sitting on a earthquake ravaged farm in Christchurch and we sit off Manali India out here and we’ve moved out two villages and moved out away from clinical health clinical medicine more into community health and development and community mental health and all sorts of interesting stuff and it’s fantastic and you know years back when we got married we vowed to each other we’d live passionately and intensely and we had this crazy hippie wedding where I dressed in her turban and rode up in a horse and there were flowers and toe rings and an Asterix feast and stormed the heights mud fight and all that stuff we had all these readings from Gandhi and Dylan Thomas and one from Henry Paul Theroux on Walden Pond and he said I came out here to live my life deliberately so that when the time comes to die I will never ask did I truly live and I don’t know where our story goes from here it’s a love story I’ll find out being by living it but I know that when the time does come for us to die will not look at each other Karen and I and wonder if we truly lived