David Lauter the surgeon blogs about his preparations for his trip as well as his emotional expectations.

It’s a sunny Saturday afternoon in the Pacific Northwest, exactly 72 hours before I leave for my first experience with MSF. I’m excited, in fact so excited that I am making an effort to curb my enthusiasm. Although the process has seemed tedious at some points, in retrospect it has been a rapid timeline from the beginning of my application in April to just four months later in the first week in August when I received the email offering me the assignment for September at Paoua, Central African Republic (CAR). Getting ready has been a whirlwind of vaccinations, research on the CAR, wrapping up paperwork and loose ends and now packing.

Packing has been an interesting experience. When I was younger I prided myself on packing light and sparsely. Over the past several decades, between traveling with children and the prevalence of wheeled luggage, my packing habits have become bloated. But in reading the document “Guide de Bienvenue RCA” (Welcome Guide to the CAR), I see that my luggage is supposed to weigh no more than 15 kg (33 lbs) so I have to return to my old ways. Although there has been no official packing list, I have received a tremendous amount of help and advice from MSF and a surgeon who was posted to the CAR earlier this year. Here is a photo of most of what I plan to bring:

Packing © David Lauter/ MSF

Laying out my kit for this photo reminded me of the book “Material World” by Peter Menzel where photojournalists traveled to 30 different nations around the world and documented the lives of an “average” family in each country. Each chapter begins with a photograph of a family outside their home, surrounded by all their possessions. It led me to take our copy off the shelf for another look at the three African countries (Mali, Ethopia and South Africa) that were included in the book.

Even with my bag all packed, I am sure that I will run-through a check-list umpteen times over the next three days. That’s my way of doing things. As Tuesday nears, I’ll become more pre-occupied with the practical details of departure (did I pay all the bills, is there enough cat food in the house, what time to show up at the airport, etc), and less so with the anxieties and expectations that obviously accompany a trip like this.

Regarding the emotional aspects of the trip, I expect that the hardest part for me will be leaving my children for the six weeks I am gone. MSF seems to have done its best to prepare me for the trip including a “what to expect” review of typical reactions and experiences of previous workers. But as with all major endeavors in life, I expect that my own personal experience will inevitably be different than the one for which I am prepared.

This knowledge that I will soon be facing “unknown unknowns” likely accounts for my dreams of the past week. They have been filled with heavy-handed symbolism right out of “Dream Interpretation for Dummies”. On Tuesday, I dreamt the classic of being enrolled in some type of college program, having the campus map and schedule of classes in my hands but just not being able to make sense of it all. Later in the week I had a series of dreams involving train travel with my children and a variety of friends, family and assorted acquaintances where the common theme was me being separated from my children and the attendant anxiety over the possibility of not finding them further down the line. My only reassurance about my emotional health is that I have been fully clothed in all these dreams! (Of course this all a bit tongue in cheek and if I was a fan of emoticons I would have put a smiley face after that last sentence)

Despite my dreams, like most surgeons I think of myself as bulletproof, both physically and emotionally. It is a trait that generally serves surgeons and our patients well, particularly when the going gets tough. Hopefully the patients in Paoua will get some benefit from that outlook as well.