Lab Voices
Lab Voices, brought to you by Pathologists Overseas, elevates the experiences of laboratorians and pathologists around the world. Each month, we interview an individual who has worked to improve pathology and laboratory medicine in a resource-limited setting.
Lab Voices
Susan Morin Interview
Dr. Merih Tesfazghi interviews Susan Morin. Susan has extensive experience working as a clinical lab scientist and quality assurance officer in hospital labs in the states. Susan was a Peace Corps Volunteer in Sierra Leone. Additionally, she was a quality assurance advisor with Pathologists Overseas in Eritrea, Bhutan, and West Indies.
Welcome to the Lab Voices Podcast from Pathologists Overseas. This is Dr. Merih Tesfazghi co-director of External Quality Assessment at Pathologists Overseas. Today I'm interviewing Susan Morin. Susan has a bachelor's degree in biology. She has extensive experience working as clinical lab scientists and quality assurance officer in hospital labs in the states. Susan had, uh, volunteered with Pathologists Overseas and served as an advisor for quality assurance in Eritrea, Bhutan, and West Indies. She had also volunteer with US Peace Corps in West Africa. Hey, Susan. How are you?
Susan:I'm fine.
Merih:So, we can start with a very brief introduction about you.
Susan:Mm-hmm. Mm-hmm.
Merih:And then we'll talk about your volunteer activity and what you did. So you can start with your introduction. Yeah.
Susan:Okay. So, the question that most people ask me is, how did I ever get involved with Pathologists Overseas?
Merih:Yeah.
Susan:I was a Peace Corps volunteer in West Africa in a country called Sierra Leone, which if you saw the movie blood Diamond, that was the the country that I was in.
Merih:Yeah, I did
Susan:You know, I was there and I taught school. I'm also a secondary school teacher, and I taught school in Sierra Leone for two years, and then I stayed for a third year and worked in a teaching hospital in the capital city. I have since met lots of Return Peace Corps volunteers. And I think the mantra that we all say to one another when we get together and reminisce is once Peace Corps volunteer always a Peace Corps volunteer. And I think that that philosophy, that mantra is more philosophical than it is, practical. I don't think any of us get over the thrill that it was for us to live in a foreign country and to be accepted by the people that we were working with and for. So, how did I get into PO after all of this?
Merih:Mm-hmm.
Susan:I was looking for a way to get back overseas. Oh. Between 1995 and 2000, I was scouring everything, talking to everybody that I knew, cuz I really decided I wanted to get back overseas and work in some capacity. I was working in a teaching hospital, north of Boston.
Merih:Mm-hmm.
Susan:And the pathologist that I had a personal relationship with called me one night at home, and he said, Susan, I just got this newsletter from an organization, an NGO out of Washington University in St. Louis. They're looking for a QC person to go to Eritrea. That was in early 2000.
Merih:Mm-hmm.
Susan:My first question was, where is Eritrea?
Merih:I always explain to people where it is.
Susan:Everybody asked me that. So, I applied, and I got a call from Jack Ladenson in April of 2000, and Jack called me at work, and he said he was pleased with my resume and, he had decided that he was going to send another volunteer back into Eritrea. And I'd like you to go. And I said, oh Jack, that's wonderful. And he said, I can't promise you anything. He said, I don't know how long you can stay. I don't know if the money would run out. So Jack said to me, Susan, I want you to go home and I want you to think about this because you have a really good job. You're a, a senior person here. You're in charge of the QA of the lab. Go home and think about it, and then call me tomorrow when you're ready to give me a decision. I said, okay, Jack. So, I hung up the phone. I walked into my supervisor's office, and I gave my notice. I turned around. I went back to the phone and I called Jack, and I said, well, I've made up my mind. I just quit.
Merih:Wow.
Susan:Yeah, there was no doubt. Yeah. There was no doubt that this was what I had been searching for for years and years and years. So, I quit the job and I was in Eritrea by the middle of April, in 2000. Then I know this is going to sound kind of dramatic. Melles, who is the, um, director of the Central Health Lab.
Merih:Mm-hmm.
Susan:He picked me up at the airport. I'm almost embarrassed to say this, but when I was flying in and the plane touched the ground
Merih:Mm-hmm.
Susan:I, um, I started to cry because all I could think of is, my God, I feel like I'm coming home. And even now, as you can tell, I can't talk about Eritrea a lot before I start to get very emotional and I have no idea what made me feel that way.
Merih:If you can tell me more about it. What do you think was the reason, like, you're coming for the first, that was your first time.
Susan:Mm-hmm. Mm-hmm.
Merih:And, but still you're emotional about it Eritrea.
Susan:Right. So I hadn't had a chance to meet anyone, and I hadn't had a chance to know what the country was about.
Merih:Mm-hmm.
Susan:This was a completely spontaneous reaction when I was landed in Eritrea, a feeling of something in the future going to happen that was going to change my life. Not necessarily bad or frightening, but twice in the past, after I got this feeling, very shortly afterwards, something happened that actually did change my life.
Merih:Mm-hmm.
Susan:I think that I was coming, quote, home in a sense that this is what I had been looking for for four or five years. This is what I had wanted more than anything in my life at that point, was to get back overseas into a country that I could experience, that I could learn, that I could become involved. And it might have been that feeling of at last, after all this time, I'm finally getting to do what I want, but to broaden that. That feeling of me coming home when my plane landed only increased, exponentially the whole time I was there. Never anywhere that I have gone, and I've lived in lots of different places, and traveled extensively. Never, ever have I felt the kind of kinship and bonding and, spiritual connection with anything like Eritrea. And it might have been all of that combined and because of my bit of psychic awareness that caused that emotion, but I was ready to go by the time that that plane hit the ground.
Merih:Mm-hmm.
Susan:I couldn't wait. Um, Melles was there to pick me up. I stayed with an Australian couple at their house because my place wasn't quite ready yet.
Merih:It's, very interesting story. So when, when you heard back from Jack, before you go to Eritrea, did you know what was the scope of the work and for how long you were going to stay in Eritrea?
Susan:It wasn't known how long I was going to stay in Eritrea because Jack did not want to say that there definitely wouldn't be political problems, then I would have to get out or he said something about maybe there won't be enough money to keep you there; so, he would not give me a time. But that was unimportant. I just wanted to go and then we'd see what happened?
Merih:Okay. So, now you are in Eritrea...
Susan:Right.
Merih:And what was your experience like? Take me through your experience from the work you've done there to the people, the food, and everything. Did you feel welcomed? You know, your entire experience.
Susan:Okay, so let's talk about the professional experience first. I had worked in the Peace Corps and, and was well aware of third world medical facilities. I was astonished when I got to Eritrea, as were many of the visitors that came with Pathologists Overseas. The strong desire of everyone from the Minister of Health, all the way down to the individual college graduate techs that came into work in my lab. Everyone wanted things to go well. They wanted to do the work so that their own people would benefit by that. So, the backing that I had from the Eritreans themselves was overwhelming. There were difficulties of course, which they're always are: our instruments would break down and sometimes the controls wouldn't come in in time, but it was having that camaraderie of all of us being in this together and not me as a foreigner. Not once did I ever feel like I wasn't one of them. I'll just give you a quick little thing. The morning after nine 11, when I came in, everyone in the lab was standing, waiting for me to come in. And on the entrance there was a corkboard. And on the corkboard, they had put all of these wishes and little pieces of paper with things on them with"we love the US" and"we are so sorry." And they all stood there, and they all came up to me. And one by one shook my hand and said,"we're so sorry." That to me spoke volumes about the Eritrean people. So professionally, I had a wonderful Senior Tech, who was brilliant, who I did manage to get into a university in United States.
Merih:Mm-hmm.
Susan:And he got his master's degree and then he was going to go on and get his PhD. And he went to Kansas University. But, we set up a computer system, with the help of Mitch Scott at Wash U. We had a reference lab set up, so that we would pull specimens from patients, and we would send'them to WashU. WashU would then send them back.
Merih:Yeah.
Susan:Yeah, so, we actually had a reference lab that we could send the tests that we didn't do. And when we found out the majority of tests, we figured out how many were, what were the ones that we were sending over most, and those were the ones that we decided to put on the chemistry analyzers to um, bring those tests in-house. There was a patient, who had a really bad thyroid problem, and with my interaction with him and his father, and the fact that, that we kept him abreast of what was happening with all of his blood work and acting as, as his advocate. He then managed to get the drugs from Jack for his thyroid condition and has since become able to live a life that he couldn't live before. Mm-hmm. So that was definitely something that was gratifying.
Merih:Mm-hmm. Looking back now, how did you assess the quality of the lab, by the time you get there and what was the change in terms of quality and service?
Susan:Pathologist Overseas was always sending guests to come to see the work that they had done. We were their showcase lab.
Merih:Mm-hmm.
Susan:We were the jewel in the crown, so to speak. So, we had lots of people that would come over. Dr. Hoenecke and his wife would come over, and Mitch Scott came over. And then there were other dignitaries from the embassies that would come over. I, I had a very good relationship with the ambassador from Qatar and the administrative assistant to the Dutch ambassador, and they would bring in people to show them. And they were unbelievably surprised. They said they would never, never have expected, that in a little country, one that no one knew about, and that had just barely come out of, a 35 year struggle. So, it was amazing for me in the beginning when I got there how well, it was equipped because of Jack. But by the time that we really got the whole QA program working nationally, we had new analyzers in, and we had set up the whole QA program. But it mirrored a very progressive country in Africa. I don't think there was probably anybody on the Horn of Africa that had the kind of facility that we had and which was substantiated by the guests that we had.
Merih:So, I'm very happy as an Eritrean, I'm very happy to hear that you had a very good experience in Eritrea. So let's talk about, you know, the other side of experience, the culture, the people, the food?
Susan:I wrote down some of the adjectives that came to mind when I think about, Eritrea: a generosity of spirit and of material goods and graciousness. My best friend in Eritrea was an Eritrean man named Russom, and he and his wife were my family while I was there. Once, when I went up with Russom to his village, oh, probably about an hour and a half, two hours out of Asmara. And we walked up for about two and a half hours up to his village at the top of this high hill.
Merih:Mm-hmm.
Susan:And when we got there, of course it was the custom. We sat down and immediately our feet were washed and a coffee was put on, for the coffee ceremony. And I can remember saying to Russom's uncle, oh, that is a beautiful little stool. It had been a stool, three-legged stool. It was carved out of a piece of wood, and I said, that is really beautiful. When I left, he insisted that I take that stool with him. Now, this had obviously been in the family for a long, long time, and he would not take no for answer. And this is somebody that was living in a house with no electricity, no running water with four or five children. And yet he was going to give me that stool because I said I liked it. So the graciousness and the generosity. Russom, my best friend, and his wife Russa, I would eat there at least two or three times for lunch and then on weekends I would ride my bike down to their house and I would eat at their house probably at least two weekends a month. And, Russa always knew what to serve, my very, very favorite things. And she got so sick of it at the end of three and a half years that I think she was probably glad to see me go. But every time I went there, I wanted shiro and kicha fit fit. I didn't feel like anything else.
Merih:These are most people's favorites food.
Susan:I absolutely loved it. Absolutely love it. Yeah. I really miss it.
Merih:Yeah.
Susan:So, making a difference. I think one of the things, and I think that's the Peace Corps spirit, to know that you can go in and you can make a difference. One of the things that I managed to do is, I sent Russom, who had fairly good English, but I sent Russom through English classes because if he could speak English well enough, he might be able to get a job as a driver for one of the embassies.
Merih:Mm-hmm.
Susan:Jack gave me the unofficial title of being the Goodwill Ambassador for PO.
Merih:Mm-hmm.
Susan:So I would frequently, when he had sent guests to Eritrea, we would always go down to Massawa. head I would take the guests down. This was what I was doing to help Pathologists Overseas. Even though I loved going to Massawa I was giving back a little bit of what I was doing and trying to let all of these people know what a tremendous job Pathologist Overseas was doing in this country.
Merih:Mm-hmm.
Susan:And then on the emotional and sad side, there's times when things happened that you remember that stand out. And when I wrote down the words sad on my list of things about Eritrea, I thought, well, what exactly made you sad? And the one thing that stands out in my mind starkly is where the central lab was located. It was on the main road coming from up country, from Keren, down into the city and then out to where anyone wanted to go. And when the disagreement with Ethiopia developed into fighting again, I walked out to the front of the lab. The laboratory was manned and staffed by ex-fighters. Melles was an ex-fighter, and most of the older techs were all ex-fighters. Being older myself, I developed a very, very close relationship with these ex-fighters. And we used to sit around at coffee break and have coffee, or they would come to my house, or I would go to theirs, and they would tell me wonderful stories about The Struggle. So, I had a tremendous amount of respect for the fighters and The Struggle and what they had gone through and for the country in general. But, I can remember, when the kids were coming back from upcountry, from their service, and they were in their trucks coming down and they were all leaning over, and all the fighters were out in front of the lab. The kids were waving from the trucks and, you know, as kids do, thinking they're immortal. And I watched all the fighters throwing cartons of milk to these young kids and waving to them. And, um, when we all turned around after they were gone, there were tears in the eyes of all of those men that watched their own children now go back and have to do it all over again. And I think that closeness, that feeling that I still get of watching the generation of Eritreans that I was intimately involved with, the old fighters and the young fighters, bonded me even more to the country. Was what I can remember is probably my saddest and most emotional experience, although there were other ones. And it's not just living in another country. I have found through my travels all over the world that if you can learn to immerse yourself in a situation that you might not feel relatively comfortable with, and you can gain whatever it is, even if it's not something that you particularly care for, but if you can interact with other people, if you can know that you are not the wherewithal to the entire world. That everybody in the world can do very well without you and your ideas because their ideas are just as good most of the time.
Merih:Mm-hmm.
Susan:So, I think my interaction with lots and lots of expats, but the Dutch and, and the Aussies and the Italians and the Belgians, the ambassador to Qatar, Indians, the Māoris from New Zealand were there getting rid of the mines when the war started again. But to listen to these people talk and to realize how much every other country is pretty secure in their own estimate of themselves, I that sometimes the egotistical attitude that some people feel even about another country, you know, a Frenchman or whatever. If you get to live with people and if you interact with them on a daily basis, you find out we're all exactly the same. We all want the same, exact thing. We want peace. We want freedom. We want the best for our kids. We want our kids to be better than we did. We want to be educated. But I think if we could experience that, there might be a lot less war. It's almost like mediation. Instead of going through a divorce in the courts, you mediate. Well, the mediation is to get to know somebody else, get to know a Muslim, go to church with a Coptic Christian, sit across the table from, from somebody that doesn't agree with your political ideas. So that made me really come back and say, I'm really glad that I live in this country. I'm really glad that I had the chance to live in Eritrea. The other thing that I liked about the Eritrean people is their self-reliance.
Merih:Mm-hmm.
Susan:And their pride. And one of the things that I learned that made me admire the Eritrean so much. So much was their self-reliance with their shoes. I love the story of the shoes.
Merih:Mm-hmm.
Susan:That because of the rest of the world had turned their back on Eritrea and because the United States needed Ethiopia.
Merih:Mm-hmm.
Susan:And everybody else just turned their back. You know, they didn't have any shoes after all of these years of fighting, when it was almost over now, they had no shoes. They had to go back and start all over again. So they got these old tires.
Merih:Mm-hmm.
Susan:And they made shoes out of tires.
Merih:Yeah.
Susan:And that's the symbol of the reliance of the Eritrean people, which of course is this huge statue in the middle of square in Asmara.
Merih:That's right.
Susan:So that self-reliance, that's saying, we don't really need you. Pride when the kids would come up and hassle me or ask me for money. I had one older man come up and hit the kid on the face and say to him, Eritreans don't beg. The culture. Never had I been in such close proximity with three different religions, with the Muslims, the Coptic Christians, and the Protestants. And one of the things that I think was the most physical evidence of this, and this is where I used to take my field trips when I took the guests from PO. If you stood at the Coptic Christian Church in Asmara
Merih:Mm-hmm.
Susan:And you looked due West. And if you look straight across in your path, you could see the Coptic Christian cross on the fence. You could see the Catholic church cross on the cathedral on Liberation Ave, and then you could also see the Minarets from the Islamic faith.
Merih:Yeah.
Susan:And that fact, the physical manifestation of that, but also when the fighters told me that during The Struggle, Wednesday was designated as the day of religious observation, so that the Muslims didn't do it on Friday. The such and such didn't do it on this day. Then the Christians did it on Sundays. Everybody did it on the same day because there wasn't any difference really. They were all praying for the same thing. And I thought that was a beautiful sentiment. I thought that was one of the things about the Eritrean people, the personification of The Struggle, at least at that time.
Merih:Mm-hmm.
Susan:That made me admire them so much and respect them. You get a chance to travel also. I was extremely lucky. I managed to go all over the country. I could never get to Nak'fa. They wouldn't give me the clearance to go to Nak'fa. But, I went all the way down to Assab. I went to all the regional hospitals to set up the program of quality assurance that I was there to do for Pathologists Overseas. I met with nothing but a hunger for knowledge from the physicians, from the nurses, from the technicians in the lab. Everybody wanted to learn.
Merih:Mm-hmm.
Susan:My lectures were wonderfully attended. There was always lots of questions. Some of the things that we were trying to bring in, they didn't particularly care for. But with prodding and with me discussing why this was so important, it was just so uplifting to find somebody in the laboratory medicine that could interact with a surgeon, and tell the surgeon, gee, I'm sorry, but the lab isn't going to accept any specimens that don't have a label and a name on them.
Merih:Mm-hmm.
Susan:And that was where I felt I did a a lot of difference, but then I certainly educated people that I never would've been educating otherwise.
Merih:You basically went to the regional hospitals, how long was that? Is it like a one day workshop? Or two days?
Susan:Oh no.
Merih:Mm-hmm.
Susan:No, it was multiple times, during the year to the regional hospitals and for stays of one to two weeks. So this is an intensive, training for the lab technicians And then the adjunct, was with the lecture to the medical staff, but I was there to teach the lab technicians quality assurance and quality control, because up until that time there hadn't been one quality control system throughout the entire country.
Merih:Mm-hmm.
Susan:So, when I went there, I was supposed to organize this so that if you got a high blood sugar in Mendefera and the doctor said, it looks like you've got diabetes, I want you to go to Asmara. When the patient came down to Asmara, after all that time and energy and money to get to Asmara, he's not gonna get a different diagnosis from the doctor in Asmara because the results in Mendefera were incorrect. So, we wanted to unify everything, have everything the same type of quality controls. We had one company of quality controls. We had one chemistry analyzer. We had one hematology analyzer, so that every result could be matched in Asmara and the diagnosis would be, substantiated.
Merih:I was gonna add, it was, you know, the effort was to standardize the country, right?
Susan:Yes, yes. It was a standardized method of clinical laboratory chemistry throughout the country, starting with Asmara.
Merih:Interesting. Very interesting story. So, for how long did you stay there, in Eritrea?
Susan:Uh, three and a half years, probably close to four.
Merih:And most of the time, you spent your time in Asmara, right?
Susan:Yes. Mm-hmm. I did.
Merih:So, some people would be, interested to know, how did you finance your trip to Eritrea and your stay in Eritrea? Were you supported? Was it personal? Can you tell us about that?
Susan:Mm-hmm. um, well, my trip is paid for by the organization.
Merih:Mm-hmm.
Susan:Pathologists Overseas paid for my trip to Eritrea. They also were responsible for finding lodging for me when I was in Eritrea. So, when I arrived, I already had an apartment that was set up with everything that I needed. Then also end of the year Pathologist Overseas would fly me home for a week or two weeks vacation and then fly me back.
Merih:Mm-hmm.
Susan:All of the things that I needed, Melles was charged by Jack to make sure that I stayed healthy.
Merih:Mm-hmm.
Susan:So, and luckily I did. So I had access to the new hospital that was right next door to the central lab. Um, and If I ever needed anything, I could just go to that central hospital and I could speak to a doctor there. Plus, we had lots of doctors that came in with Dr. Haile. He was a surgeon at Howard University, and he established a yearly program with a group of medical professionals that came to Asmara every year. They stayed at Simbel in the same complex that I lived in. That's how I got to know Dr. Hinely so well.
Merih:Mm-hmm.
Susan:and they performed, depending upon what medical group was there, they would perform surgeries or examinations from early morning until late at night for one solid week without a day off. Sometimes two weeks.
Merih:Yeah.
Susan:They had very, very little time off that they didn't want to waste because the Ministry of Health had broadcast the fact that Dr. Mezghebe was coming into the country. And, if you had any of these particular problems, please come down to Asmara and his organization would see you. So this was also something that was uplifting for me to see how much this Eritrean doctor was giving back to his country, even though he had left when he was in high school to get his education.
Merih:Yeah. Yeah. I know him.
Susan:Oh, do you?
Merih:Yeah. Yeah, I do know him. Yeah. Um, wow. So very, very interesting. You know, I'm glad that you had a very good memory about Eritrea.
Susan:Mm-hmm.
Merih:You know, I didn't want us to stop, but I'm gonna ask you one more question, maybe two. So you have alluded to this, but what have you gained by volunteering, in Eritrea or elsewhere? What do you think you got from your experience as a volunteer?
Susan:Um, I can answer that in two ways. With my two major volunteering experiences, the Peace Corps in the seventies and with Pathologists Overseas, from 2000 to 2006. I said, yes, I'm going to the Peace Corps. I'm going to West Africa, or Yes, I'm leaving the hospital. I've got a chance to go to East Africa and work. They always said to me, oh my God, I could never do that. You're so brave. I could never do that. And I tried to tell them that as much as I'd like to say that it was my huge humanitarian desire to do well for the whole world and to change the world. That was only a very, very small part of it.
Merih:Mm-hmm.
Susan:The biggest part of my wanting to go overseas was yes indeed to help, or I would've just gone overseas on my own. But the biggest part was the feeling that I got personally.
Merih:Mm-hmm.
Susan:From being involved with people that I was actually helping. So rather than sending money or sending clothes through a drive,I could actually live with these people and on a day-to-day basis see what I was doing. And that was the best experience for me to talk to the young children in the nursery to go to the orphanage where I volunteered. And just to see a difference, to see a smile, or to see a parent understand with my limited Tigrinya, what we were doing. And that to me was the main reason that I went. That's the main reason that I volunteer today, is to see somebody smile and to know that for the very short time that I am here, I have made a very small difference in some people's lives and that is the most gratifying thing.
Merih:So what do you say to people, who are actually contemplating to volunteer
Susan:Mm-hmm.
Merih:What would you advise to them?
Susan:A lot of the reading that I've done on psychology, because I'm fascinated with the human brain, so I do a lot of reading about modern insights into the human brain. If someone has thought of going...
Merih:Mm-hmm.
Susan:Step out of that range of but what if this happened and maybe I won't be able to do it and will I get sick? And, is everything gonna be taken care of? Just take the first step. I think that's all you have to do. You have to make up your mind that this is something that I think I want to do. Take the first step. Go to somebody that's been there and talk to them, fill out the application, call people, read about the country where you might be going, become familiar with the realm of things that you might do, because nothing in all of the experiences that I have had in my life matches the times that I lived overseas with people that were gracious and kind and loving. Not that you don't have that here.
Merih:Mm-hmm.
Susan:But to have people that aren't family and friends, sacrifice for you and help you and bring you into their family and make you part of everything that goes on with them, that's something that you have to do. You have to leave your comfort zone, and you have to do that.
Merih:Well, I really, really enjoyed your perspective, to hear your experience. It was very interesting.
Susan:As you can see, I could probably talk about Eritrea for, two or three hours.
Merih:I can feel that. And, Thank you very much for joining me.
Susan:You're welcome.
Merih:That was Susan Morin. Thank you for listening to the Lab Voice podcast. I'm your host, Dr. Merih Tezfasghi. To find out more about Pathologists Overseas and our projects, visit www.pathologistofoverseas.com and follow us on social media. Podcast edited and produced by Taylor Harris. Theme Music by Tim Amukele.