The past

Dr. Dora Anne Mills

In my 20s and 30s, I was fortunate to work, study, and/or travel abroad, including in Tanzania, Nepal, India, and the USSR (yes, that shows my age!). Upon returning home, people would ask about my journey. What were the highlights? What was the worst thing I saw or experienced? What had I learned? How had the journey changed me? I would show my photos and tell a few stories, with my mother often being my most patient (and only) audience. But these questions, especially about the impact on me, I could not answer for months, and sometimes several years.

In the mid-1990s, nine years after living in Tanzania, I was flying home from a month-long return trip there. During the long-haul flights, my task was to write a commencement speech I was to deliver at a local college a few days after arriving home. Before I left for Tanzania, this seemed like a good plan. After all, there surely would be some insights from my travels I could share with the graduates. However, I found myself with a complete block. So much I experienced the last month I hadn’t had a chance to digest, much less write about.

For instance, I had expected to return to the same village I lived in a few years earlier. From the emergence of AIDS, a dramatic reduction in childhood hospitalizations, a new road bringing more reliable public transportation to the area, a new water tower pumping safer water, there were many noticeable changes to the landscape. And over the nine years, I and the people I was visiting had changed as well. All of this was too much to quickly discern, digest, and glean some insights from. Five days later, my speech barely mentioned that I had just stepped off the plane from a month in Tanzania.

The present

This New Year’s weekend I feel the same way I did on the plane, with a bit of a block on discerning where I’ve just traveled. We’ve crossed a holiday in which our passports are stamped with evidence that we’ve journeyed through 2020, and we’re now stepping off the plane into 2021. I normally pause during this holiday to reflect upon the year past and look to the year ahead. However, I realize that for me, reflections at this point are like showing photos and telling stories from a trip. We’ve just arrived off the plane into 2021, and we’re still not sure what fully happened in 2020. What were the highlights? What were the worst things that happened? What have we learned? How has 2020 changed us? It seems like we don’t fully know the answers yet.

Instead of reflecting or writing this weekend, I’ve spent much of it working, especially on our efforts to vaccinate as many as quickly as possible. I appreciated a restful New Year’s Eve alone and fell asleep by 9 pm. I hiked a mountain in western Maine on New Year’s Day, grateful for Stabil macro spikes, LL Bean hiking poles, and good conversation with a friend to distract me from the ice flows. I enjoyed the quiet cozy white out of a snowstorm while snuggled in a woven blanket. I connected with some loved ones by zoom. Throughout the weekend, I’ve stayed in the present. It’s been a good place to be.

The future

And looking ahead? If the impact of the last year is too murky to discern, the glimpses at the landscape of 2021 are much like the white out of a snowstorm. The surge continues to ravage the country. Variants of the virus that are more contagious are emerging. More long haulers are reporting challenging chronic conditions. Vaccines are being distributed and administered in wealthier countries, but not quickly enough, and not at all in many parts of the world. Those on the health care frontlines are exhausted – emotionally and physically. The pandemic has exerted its toll in other ways, with apparent syndemics of loneliness, addiction, suicide, abuse, and joblessness. Protests continue against public health measures. Many children have missed nearly a year of school. The wounds of racial injustice are still hemorrhaging. A new president is to be sworn in. But the current president states he doesn’t want to leave. Our cyber-infrastructure has been under attack. This is the first weekend of ice fishing in northern New England, but most lakes lack sufficient ice to stand on.

Connections

A couple of years after my return trip to Tanzania, I was working in public health in Maine, carefully following data and trends. What struck me was seeing the connections between health and other measures, such as correlations of many health trends with the 1990s loss in much of rural Maine of our manufacturing base as well as with the lack of access to education and transportation in those areas. It was challenging to describe these connections to others until I realized it was one of the enduring lessons for me from the visit to Tanzania nine years after living there. The dramatic reduction in childhood hospitalizations was associated with the new water tower, which pumped safer water, something critical to child health. The emergence of AIDS correlated with the arrival of public transportation, which allowed villagers who had moved away and picked up the infection while living elsewhere to return home. Those connections were so clear with a nine-year span between visits as well as a couple of years to reflect on my observations.

The insights helped me to realize that no matter where we live, there are certain threads that weave the blanket that holds our society together – agriculture, economy, education, environment, health care, political participation and stability, public health, transportation, and utilities (e.g. water, electricity, internet). When one of these threads becomes unraveled for some or for all people, other threads are likewise stretched and sometimes torn.

Many of the challenges we currently face are related to each other, and that’s not hard to see. This includes the pandemic, political unrest, and more recognition of racial injustices. But it is harder to fully discern how they are all pushing and pulling at each other and the lessons those interconnections may teach us. As for reflecting upon 2020 and looking ahead to 2021? The only clarity is that the pandemic indicators point to a challenging January. And the most important and urgent health strategy besides masking and distancing is vaccination. For now, it feels okay to stay in the present, to stay safe and healthy. What do I need to do today – for work, for helping others, for my emotional, spiritual, and physical health – all while staying safe. And how do I connect with loved ones, even if not in person?

I am content to have my passport stamped as having departed from 2020 and having arrived in 2021. Although the original hope for 2021 was a return to 2019, we know that the journey to 2020 has inexorably altered the world and changed us in ways we may not yet be aware of. It may take months and years for us to discern the impact. That time will come. But for now, it’s sometimes ample enough to remain in the present and just to stay safe. Happy New Year and a Healthier 2021!

Dora Anne Mills, MD, MPH, FAAP, Chief Health Improvement Officer, MaineHealth