KWANINI TULIPENDA KUWA MADAKTARI? Lets look at this first purely from the perspective of personal investment and expectation. To practice medicine, first, you have to go to medical school. Thats five years right there and Internship one year. Then, theres residency, which adds anywhere between three and four years to the deal. After that, there may be a fellowship, sometimes two fellowships, because really, at that point, whats another year or two So basically, from the moment you start into medical school to the moment you finish your training, youre looking at a minimum of eight yearsfor most people its closer to tenbefore youre even close to being considered a real doctor. And these are not fun, carefree yearscertainly not the way most people spend their twenties, at least if the producers of Bongo Fleva or beer advertisers are to be believed. You spend these fetal-doctor years indoors under fluorescent lighting, nose pressed into books filled with inscrutable diagrams and endless acronyms, while everyone in the world, including some of your patients, appears to be having more fun than you. These are years spent doing a whole lot of work for little or no money, ignominious tasks relegated to those contractually obligated to never complain. These are years of thousands of lost hours spent at the hospitals Muhimbili/Temeke/Mwanayamala/Amana au Kantaramba?? Instead of with your friends and family, who always seem to be wondering where you are and why youre still there and when, if ever, youll be coming home. These are years spent defying all common sense about circadian rhythms and the regenerative powers of rest, largely awake and caffeinated to an almost toxic degree. Andthis last part is the real kickerthese are years after which you will end up in hundreds and thousands of dollars of debt, all for the experience of what amounts to hard time in a well-intentioned Bongo land. I repeat: not fun. It was true that I wanted to be a doctor, but there were other things I wanted to be at the same time. Like many people I knew, I imagined that by the time I was thirty (OK, maybe thirty-five), I would be in a committed relationship with someone that I loved, or at least sort of liked. Maybe I would be married. Perhaps I would have kids, presented the time and the opportunity and provided that the corrosive powers of time did not rob me completely of my reproductive potential by the time I was ready for the responsibility. Barring that, maybe I would have a dog. Or at least a fish. But then I would go into the hospital on my Internship rotation and see a bunch of bitter, tired men in their thirties, still years away from their first paying job, all either single or divorced or in some way separated from their spouses, and their sole message of wisdom to impart to their medical students was, Dude, whatever you decide to do with your life, dont do this. But despite it all, despite the complete disconnect between the life of medicine as we saw it and the real life we envisioned for ourselves, many of us decided to become doctors anyway. Why? I believe that for most people, theres a spectrum of reasons. First and hopefully underlying all the other reasons, theres probably the pure and honest desire to want to do good in life. I want to help people. Put aside the fact that many jobs are expressly designed to help peoplethe wapiga debe helps people by getting them in the buses, the dry cleaner helps people by pressing their shirts, the street mime helps people by making them realize that no matter how terrible they think their lives are, at least theyre not street mimesand you have what seems like a pretty good blanket answer to throw out there at interviews and family functions, provided that there are absolutely no follow-up questions. (Unfortunately, there always are.) Perhaps some people have a special facility for applied science. That seems reasonable enough. Theres so much Biology and Chemistry and Physics and Physiology in medicine that in medical school, we spend two straight years studying nothing else. That said, there are plenty of people who are gifted in Biology and Chemistry and Physics (PCB) who have no business being anywhere near other human beings, and would perhaps better serve the world in the back of a computer lab, writing Battlestar Galactica fan fiction and engaging in heated online arguments with others doing the same. Maybe you have had a Medical Experience, and as a result of your Medical Experience you had an epiphany and decided that you would like to become a doctor yourself. A personal incident of illness or injury, time spent caring for a sick parent, a particularly moving episode of ER(Magonjwa ya Dharura) Yearsthis overall seems like a valid precursor to a career in medicine. (Well, maybe not the ER thing.) You have had an encounter in the field and have some true and earnest desire to either perpetuate the good that you have witnessed or to expose and eradicate the wrongs. However, if this were the main reason that people decided to become doctors, medical schools would be filled with classes of students with dead parents and crippled siblings, and at least from my experience, this is not overwhelmingly the case. There are, however, plenty of people in medical school who have a doctor in the family. Usually one parent, sometimes both. Coming from a medical dynasty can have its pluses and minuseson one hand, these people are usually down-to-earth and diligent, as they are going into the family business and know both what to expect and what is expected of them. On the other hand, some of them act like by virtue of birthright, they are doctors already, and the actual process of medical training is just an unfortunate technicality. Sometimes people become doctors because its a well-respected field with which most people have a passing familiarity. The window dressings of medicine are well known to any layman with a televisionthe long white coats, the stethoscopes slung casually around the neck in battle-ready position, the Hippocratic oath to first, do no harm. The doctor is an icon, instantly recognizable. Children tell parents they want to become doctors the same way they say they want to be teachers or scientists or astronauts, because they know what doctors are, and what they do, and because expressing an interest in medicine makes parents instantly happy like in my case. (Maybe there are some children who express the desire to be hedge fund managers when they grow up, but those children should probably be checked periodically for clustered sixes in the hairline.) Early on in medical school, some guys in my class used to go out to bars near Muhimbili wearing their medical school IDs with the notion that it would help them pick up women especially students from Jangwani or Tambaza While their technique was dubious, they perhaps more than any of us understood the power and respect of the medical degree. And the thrill that a new intern feels the first time she is referred to as Doctor is universal and undeniable, the excitement of finally being accepted into an exclusive pantheon, something like being knighted. And lets not beat around the bush, sometimes people decide to become doctors because of the money. No one talks about it, but risking excommunication, Im telling you. Its hardly a get rich quick scheme, but for most of us, it is at least a get moderately well-off slow scheme. While I certainly dont think that you should go into medicine solely for the money especially in Bongo (there are much easier ways to earn moneygrowing and selling your hair for high-end wigs comes to mind), I also dont think its wrong to consider a career in medicine for its practical benefits. A stable career with good earning potentialisnt that what most people look for? But no, we dont speak of such earthly concerns, especially not when the popular notion of The Good Doctor imagines him subsisting solely on handshakes and goodwill. Though no one ever seems to want to talk about the details, I can confidently tell you that while income varies across specialties and geography, overall, doctors make a lot of money. Lakini kwetu ni kazi ya wito tu kana kwamba Docs wamepewa wito cards!! So there is altruism. There is the academic interest. There are societal influences and personal influences and there is of course the matter of money. Students going into medicine probably cycle through most if not all of these reasons at some point in their decision process, sometimes multiple times in one day. It is easier, for example, to be altruistic at 9:00 a.m. than at 2:00 a.m. Motivations also may change as an individual matures, and the rosy idealism of the twenty-two-year-old first-year med student may eventually give way to the real-world considerations of a married father of two trying to support a young family on a single salary. I cant understand everyones reasons or the factors that temper their decisions, but in most cases it boils down to this: we want to become good doctors because we want to be able to make a positive and meaningful difference in the lives of people when they need help the most. And for this privilege, were willing to deal with the rest of it. For All DOX MDs: (MUHAS: 2003-2008). Naomba kuwasilisha.