Each year, the local gynecologist is required to participate in Continuing Medical Education,a program designed to compare and demonstrate different ways medicine is practiced. In previous years, the Painters have attended CME sessions in Raleigh and Hawaii. This year was their first opportunity to choose an international site from a list that included Australia, Africa, England and Ireland.

John was sure that either Australia or Africa would be his choice, because he’d always been curious about both. The trip to Australia seemed to fit his professional time frame better, but fate had other plans for him and Donna.

The trip to Australia was cancelled,Donna explained. “But John had already gotten all his patients moved, so we had to go on one that was close to the same time, and this Africa trip came up. It was between that and Europe. There was no contest for John, who definitely wanted to go to Africa. He’s really into National Geographic.”

The Painters left the comfort and convenience of their home Nov. 29. After 24 hours of flying between three continents, they landed in East Africa and began a pre-arranged tour that combined four days of hospital visits with 12 days of photographic safari.

They were thrilled to be in the exotic country, surrounded by the living subjects of pictures they have seen in magazine spreads and on cable television. But John and Donna soon realized the difference between observing ravenous animals on the hunt from the comfort of their home and witnessing their ferocity from the inside of an old safari van a few yards away.

Donna recalled a terrifying experience during one of their sightseeing excursions, when she and her husband were touring in a convertible safari wagon with fellow doctors and tourists, driving near groups of lions, called prides.

“I loved to stand up the whole time and ride because you could see out, and I’m just like a kid,”she said with a giggle. “First, we saw a small pride of lions just lying around; it looked like you couldn’t get them up. Then, we went a little farther and we saw about 11 that were hungry, and you could tell because their stomachs were caved in.

“We were observing them and our guide said, ‘Why don’t we pull around the other side and see some more?’ So, he started backing up to get around and the wheels got stuck and started spinning. We were going, ‘Oh man!’ but then, thinking, ‘This is nothing, he does this every day.’ ”

The van was at the edge of a drop-off about 18 inches deep, and the lions approached. They began to swat the van with their tails as they walked past.

“John and I were in the very back and … there was no trunk space and we could see the hole, right there. Then, the people in the other safari wagon got a plan and started circling to keep the lions away. The top was open, and I don’t know why we didn’t close it — I think we started to panic. I didn’t think about falling over, I just thought if we got in there, we would not be able to get out.”

With the calmness of the skilled doctor he is, her husband climbed into the very back of the wagon. Donna, meanwhile, worried.

“I said, ‘Don’t you think we oughta go up front where we can put all the weight in the front?’ and he said, ‘No, that’s the opposite of what we need to do. We need to sit down over the wheel well, and that will give him some traction.’ I knew he knew what he was talking about, so I had faith and sat down. John started rocking it through and, finally, it spun and it moved enough to get out. You could tell from the faces of all our comrades around that they were scared. And on that night, that’s all we could talk about.”

Their fear would soon be overshadowed by grief, however, as they rode for hours over bumpy one- or two-lane dirt roads that led to hospitals in Kenya and Tanzania, where they became witness to the reality of a substandard health care system.

“The medicine’s totally different, if you were to compare,”John said. “Most of their hospitals — and they do have a system like we do, as far as your small hospital, your secondary center and your tertiary center — are church-supported and, sometimes, funding is stopped for whatever reason. They all have the same problem: They can’t get medication, they can’t get supplies, they have a difficult time getting physicians, nurses or staff.”

One of the operating rooms they visited was a simple structure with no windows, through which birds were able to fly. Medical personnel lacked sterile hypodermic needles and had to wash and reuse their rubber gloves in a country where “they have a tremendous population of people who are infected with HIV.” One doctor begged the visitors for pins to set a boy’s broken leg. They collected water from a mud hole into a canteen and let it settle overnight to separate the dirt from the water. And, at a hospital in Kenya, the couple learned that at least 90 percent of babies are born “in the bush,” with no one in attendance except, in American terms, a “lay midwife.”There is no record of the birth.

“It’s really very far behind. It made me realize just how pampered we are here,” said John, who took with him bandages, surgical scissors and hemostat clamps to donate.

Here, he said, we have too many TVs, too many appointments on our agendas, too many people to call, too many choices to make.

There, “you quickly run out of telephones, TVs, electricity,” he said. “Simple things like toilets are nonexistent, and the roads are quite different. Literally, on the safari, the only thing you’re following is the tracks of previous safari people.”

But, the Painters admitted, the Sumburu and Masai people they met were not unhappy. Though they did not have the medical or technological advances we are used to, they were not desolate people whose children suffer with stomachs bloated by starvation. They were not sitting, waiting for missionaries to bring them food or clothes. They were healthy, happy, active villagers who spoke two languages fluently, performed for the foreigners and enjoyed simplicity.

“If they were deprived, it’s in our eyes, not their eyes,” said John said. “They gave me the appearance of being contented people. They might have nothing but their personal belongings … but they were happy. Civilization really appears to change people when you put them in a community.”

John and Donna, who have been married less than two years, agreed that their trip showed them how to fortify their relationships — within themselves, as a couple and with the new friends they made from across the country. They snapped more than 30 rolls of still camera film and have nearly a dozen video tapes to help them recall their experiences with laughter, tears and reflection. And, of the tokens they brought back with them that they did not give away as Christmas gifts, including a special bamboo bracelet given to Donna by a “beautiful African woman” named Elizabeth, they will decorate a wall in their home as a daily reminder of the lessons they learned.