To Diss or Not To Diss

The man wrote beautiful lines like:

“When forty winters shall besiege thy brow,
And dig deep trenches in thy beauty’s field,
Thy youth’s proud livery so gazed on now,
Will be a tattered weed of small worth held”

He also wrote some of the most wordy and flowery put-downs ever. A certain trauma surgeon I know has nothing on the Bard of Avon, William Shakespeare. He wrote 154 sonnets, 54 plays and some of the coolest disses ever.

Check this one out from All’s Well That Ends Well (Act 3, Scene 6):
“A most notable coward, an infinite and endless liar, an hourly promise breaker, the owner of no one good quality.”
Reminds me of someone famous..😳
Or this one from As You Like It (Act 2, Scene 7):
“Your brain is as dry as the remainder biscuit after voyage.”
Ouch!
Or my personal favorite from The Taming of the Shrew (Act 3, Scene 3):
“Away, you three-inch fool! “😂
I keep wondering, “what is three inches?”
Or this one from Timon of Athens (Act 4, Scene 3):
“I’ll beat thee, but I would infect my hands.”
Now that’s mean.
Now this one is special; from Troilus and Cressida (Act 2, Scene 1):
“Thou sodden-witted lord! Thou hast no more brain than I have in mine elbows “
Jeez, elbows?
To round it off, from Henry IV Part 1 (Act 2, Scene 4):
“You starvelling, you eel-skin, you dried neat’s-tongue, you bull’s-pizzle, you stock-fish–O for breath to utter what is like thee!-you tailor’s-yard, you sheath, you bow-case, you vile standing tuck!”
Now that is dissing.

Words! Aren’t they awesome?

This Healthcare Thing

“Nobody knew health care could be so complicated.”
– President Donald Trump, February 27, 2017

Outside the military and veterans, our congressmen and senators and recipients of Medicare, all other Americans fall into one of three classes where health insurance is concerned:
Those who receive employer-sponsored plans, the freelancers who need to buy their own and the poor who cannot afford it.
Under Obamacare, each of these groups saw significant changes.
Depending on whether the changes were predominantly positive or negative depended on factors like political affiliation, profession, socio-economic class and age.
Those under the employer-sponsored plans saw plans that added on things like pediatric dental and vision care, mental-health care and inclusion of children up to age 26.
For the freelancers, the exchanges suddenly allowed the purchasing of affordable plans plus the benefit of getting coverage for pre-exiting conditions.
The biggest boon was felt by the fraction that was too poor to afford insurance yet ineligible for Medicaid. This was done through expansion of Medicaid. The poster child of that is Kentucky.
In 2013, about 13 % of the non-Medicare population had no form of health insurance. By 2015, that fraction had fallen to less than 7%. The estimate is about 300,000 to 500,000 have benefitted from Medicaid expansion in the state.
As with everything, the devil is in the details and in this case, that devil is twofold – money and politics.
Paying for the Medicaid expansion is a bone of contention between the states and the federal government.
Also, there were significant tax increases on those who make more than $250,000 a year to pay for subsidies for those who couldn’t afford to buy insurance on the exchanges.
Then is the fact that companies with 50 or more full-time employees are compelled under the law to insure all employees, a condition that deterred a lot of companies from hiring.
Politically, the desire to annihilate all things Obama is also driving the desire to repeal and replace.
Trumpcare might lead to less tax increases, be less onerous on employers and remove the Medicaid burden BUT will it maintain the same level of insured Americans?
From what is out there, I doubt it but since it is just a framework, the devil will be in play again – in the details.

It’s All About The Product

“Take care of your people and they will take care of your customers.” – JW Marriott

Every busines offers a product. Offering the best version of that product is the main aim of any business..
A hospital is no different. It offers a product. It’s called “Patient Care”
Every hospital aims to offer the best patient care versus all the other hospital competing with it for business.
The most immediate face of patient care in any hospital aren’t the doctors, administrators or janitors. They are the nurses. They are the most immediate parameter used by patients to rate care in any hospital. The care they give will make or break a hospital.
So a hospital that aims to win business and be seen as great cannot afford to skimp on nurses. That hospital will aim to get the best and most experienced nurses. They will also get younger nurses who hopefully can take the place of the older nurses one day but they will not be the dominating group in the nursing pool. The older and more experienced nurses should be.
Then you come to the doctors. You want the best. If you have good ones, you strive to keep them. If they threaten to leave, you try to meet them halfway. If they are surgeons, you stroke their ego – you may need both hands! Then remember the product you offer is patient care and you need good nurses and doctors to achieve that.

Interestingly, there is a trend in the US that boggles the mind. Hospital administrators seem to have forgotten what the product is. They’ve forgotten what really matters. They are bogged down by the numbers so much that they have lost sight of what their product is – Patient Care!
So some lay off nurses, get rid of good doctors, seeing personnel cost as a liability instead of an asset and in the process, worsen patient care. They nickel-and-dime the quality of their product to death – no pun intended.Personnel costs may be a problem when one is dealing with the Post Office but in a hospital, that is the key for a great product.
Now this happens because a lot of hospital administrators honestly do not know and understand the ins-and outs of patient care. Running a hospital is not the same as running, say, UPS or Walmart. They are both businesses but one deals with people – sick people – and there is a high degree of unpredictability that the numbers do not always reflect. That is the problem classically-trained business minds have. It is no accident that physician-owned-and-ran hospitals do better than non-physician-owned ones. It is also interesting that the longer an administrator has been at a position in a hospital, they better the decision-making gets. This is because they are forced to develop relationships with the doctors and nurses and thus acquire a feel for that unpredictability.

Which brings me to my point – that hospitals should be run by physicians and nurses, supported by a finance team. This should be a physician who does clinical work not a desk-hugger. It is the only way that the product, patient care, will always come first and not some arcane numbers. Having a finance team will reduce any excesses that physicians are sometimes prone to when new medical technology or drugs are available. The vision of a hospital will also be more in line with the real needs of patients in a community and the future of medicine not the numbers. The other doctors and nurses in the hospital are more apt to find a listening ear in a physician CEO than a classic MBA daydreaming about numbers and spreadsheets.

Sure, not every physician can be a good administrator but honestly, looking at what is out there now and how physicians and nurses see being treated all over, what do we have to lose?

I Told You So

When the first president, George Washington, was sworn in as president in April of 1789, no political parties existed.
About 3 years later, bankers and businessmen in the North, supportive of the policies of the then Secretary of the Treasury, Alexander Hamilton, would start the Federalist Party. The Federalists believed in a sound fiscal policy and nationalism and really reflected the interests of the commercial North.
In 1793, Thomas Jefferson, then Secretary of State, formed the Democratic-Republican Party. Jefferson was against the centralizing policies of the Federalists. He wanted “states rights” for the agrarian South.

Even though Washington didn’t belong to either party, he tended to be sympathetic to the Federalist positions.
Over time, a deep animosity developed between the two parties based on ideology. This animosity really reared it’s head during the French revolution (1789 – 1799) and in Washington’s second term.
The French revolution ultimately led to a war between France and Great Britain. Hamilton wanted the US to support the Great Britain while Jefferson supported the French revolutionaries. Washington stayed out of the fray, keeping the US neutral. However, when Britain captured US ships trading with France, Washington was forced to negotiate with Britain. This galled the Democratic-Republicans.
The rancor that ensued forever tainted the view Washington had about political parties.Even though he was asked to lead the nation for a third term, he refused. He wanted to escape the hate in the capital to the solace of his farm in Virginia.

In early 1796, with the help of Hamilton, Washington started working on his Farewell Address. It was published in the Daily American Advertiser, a Philadelphia newspaper, in September, 1796.
In it, he advised American citizens to view themselves as a cohesive unit and avoid political parties and issued a special warning to be wary of attachments and entanglements with other nations.
These words from the address are quite poignant even today, even prophetic:
“They (political parties) serve to organize faction, to give it an artificial and extraordinary force; to put, in the place of the delegated will of the nation the will of a party, often a small but artful and enterprising minority of the community; and, according to the alternate triumphs of different parties, to make the public administration the mirror of the ill-concerted and incongruous projects of faction, rather than the organ of consistent and wholesome plans digested by common counsels and modified by mutual interests.
However combinations or associations of the above description may now and then answer popular ends, they are likely, in the course of time and things, to become potent engines, by which cunning, ambitious, and unprincipled men will be enabled to subvert the power of the people and to usurp for themselves the reins of government, destroying afterwards the very engines which have lifted them to unjust dominion.”

I wonder what the first president would say if he was to come alive in 2017 America. Probably he would utter these words that the writer Gore Vidal said are the four most beautiful words in the English language: “I told you so!”

The New King

The new King was different. As soon as he ascended the throne, he banished all the wise men. He didn’t need their counsel, he claimed.
The strangest thing though were his pronouncements. A week after he was made king, he claimed that the old queen had tried to poison him. The only problem was that the old queen was blind and deaf and could hardly walk.
The he announced that the men from the Northern Province were planing a revolt. What made this astonishing was that the Northern Province had the most loyalists to the monarchy and so the whole nation wondered why he said that.
Then shortly after that, he claimed that the people of the Ajia Kingdom to the east were bringing disease into his kingdom. The King of Ajia were angry and pulled his envoy.
Over all in the kingdom, everyone wondered why he said the things he did. They all feared what he might say next or which other kingdom he might anger.

One afternoon as the King walked through the royal gardens, he saw a beggar hunched near a tree. He wondered how the beggar got into the royal gardens and asked his guards to remove him. As the guards headed towards the poor man, he started crying out loud:
“O King, have mercy on a hungry and suffering soul. All I want is some food.”
The guards grabbed him and started hauling him away but his cries got louder.
“Stop!’, ordered the King.
The guards stopped, dropping the poor beggar like a sack of potatoes.
“Now why should I give you anything?”, asked the King haughtily.
“O My King, because I have a gift for you”, the beggar answered.
“You have a gift for me?”, the King asked, sneering.
“Yes, I do”, the poor beggar answered.
“Well then, let me see it. If it is worth my while, I’ll feed and cloth you. If not, you are in deep trouble”, the King barked.
“It is a story, my Lord, a wonderful story indeed”, the beggar said fearlessly.
“A story! A story!”, the King said as he burst out laughing. “Well, let me hear your story then, you wretch”. The King’s curiosity got the better of him.
And so the beggar began to tell the story:
“There was a Shepherd Boy who tended his sheep at the foot of a mountain near a dark forest. It was lonely for him, so he devised a plan to get a little company. He rushed down towards the village calling out ‘Wolf, Wolf,’ and the villagers came out to meet him. This pleased the boy so much that a few days after he tried the same trick, and again the villagers came to his help. Shortly after this a Wolf actually did come out from the forest. The boy cried out ‘Wolf, Wolf,’ still louder than before. But this time the villagers, who had been fooled twice before, thought the boy was again lying, and nobody came to his aid. So the Wolf ate all the sheep in the boy’s flock.”
There was total silence in the garden after the beggar finished speaking.
“That is the story, my Lord”, he added.
The King looked sternly at the beggar, opened his mouth to speak and then thought better of it. Finally he said to the guards, “Feed him, clothe him and throw him out of the kingdom like all the other wise men”.
Then he turned and walked back into the palace.

Some claim that after that encounter, the King made no more incredulous statements. Others claim that nothing really changed and that he angered the King of Ajia with his claims so much so, that war broke out between the two nations. Yet there are those who claim that the encounter never happened.
Whatever the case is, those who have ears, let them hear.

A New Ghanaian

As Mother Ghana turns 60, can we ask for a new Ghanaian? An angry and restless Ghanaian? Not the pseudo-humble and meek type but the confident and demanding species with an aggressive genotype? The type who gets angry at mediocrity, harvests that anger, like Kojo Anan Ankomah says, and uses it to build our nation? Whose creativity knows no bounds, is unfettered and roams like an angry and hungry lion in the Serengeti? Can we?
That restless, angry, demanding, aggressive yet creative Ghanaian will have a mantra. It will be that remixed verse from the famous 1997 “Think Different” Apple campaign:
“Here’s to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They’re not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can’t do is ignore them. Because they change things. They push Ghana forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change Ghana, are the ones who do.”
God, as you bless our homeland Ghana, please give us that Ghanaian too!

Find A Bush

Dear Ghana, 5000 miles away, the echoes of the ongoing and heated debate about the plan of the government to implement free senior high school education reached my ears.
One would think that it is a great idea and would be welcomed by all. Besides, free education is written into the constitution. However, over the years, Ghanaians have grown rather cautious over the use of the word “free” and so a number of them are asking a rather poignant question:
“Can we afford it?”, and that question is resounding across the country.
Plans to dip into the country’s Heritage Fund, one of two funds created for posterity and funded with oil revenue, have been scrapped. Some analysts think it is going to be funded by a combination of government spending cuts and higher taxes. The only problem with the latter is that one of the present administration’s campaign promises was not to raise or institute new taxes. (Another was to institute free senior high school education).
Other analysts think the plan should be scrapped for now since higher taxes will not be good for the economy.
I say, find a way. Please find a way. If it means revamping the whole educational system, please find a way.

Many years ago, when I lived in Berlin, I went out bike-riding in the woods outside the city with a friend. Sometime in the late afternoon, we got hungry and decided to take a detour through some trees to get to a restaurant.
About 100 m into the trees, something caught our eyes. A little ahead we both stopped and looked back. We couldn’t believe our eyes. Behind a bush was a couple going hard at it in the late afternoon chill. I was about to burst out laughing when my friend put her finger over my lips, shutting me up. They were totally oblivious to our presence a few feet away and the cold. We got back on a bikes and rode away. When I was sure we were out of earshot, I stopped, got off my bike and burst out laughing. My friend looked at me quizzically and then drawing on a popular saying, she spun it into these words that I have never forgotten:
“Wo ein Wille ist, da ist immer ein Busch”.
Translated, it goes:
“Where there is a will, there is always a bush.”

So to my dear nation of Ghana, I say,
“If the will is there to give every child in Ghana the gift of education, you will find a bush.”
You will find that bush behind which you can achieve your aim, damn the cold, damn any nosy bike riders, damn whatever V8s those parliamentarians need, damn expensive celebrations, damn corrupt deals. Look at those ledgers and get creative. Look at the system – tweak it. Make it a national effort not a partisan push.
Yet no matter what you do, don’t give up on the idea of free education, then education is truly the great equalizer. I can vouch for that. Like the 19th century US congressman from Massachusetts and educational reformer, Horace Man, once said:
“Education then, beyond all other devices of human origin, is the great equalizer of the conditions of men, the balance-wheel of the social machinery.”

Imagine 20-25 years down the line. Imagine that generation of kids looking up and asking:
“So what did you all do with all that money you borrowed and the revenue you got from oil, gold and cocoa?”
Imagine the answer being:
“See all those doctors, scientists, engineers, authors, artists, coders, executives, architects, geneticists, teachers, accountants, lawyers? That is what we used it for”.
Would that be so bad?
Remember, where there is a will, there is always a bush. Find it and get busy!

His Greatest Quality

Abraham Lincoln would have been 208 years old today. The 16th president is seen by many as probably one of this nation’s greatest presidents. What made him remarkable was his empathy. In all his biographies, it seems to be the running theme.
In a piece for Time magazine, the historian and biographer Doris Kearns Goodwin wrote:
“Perhaps the most important of his emotional abilities was empathy–the gift of putting himself in the place of others, to experience what they were feeling, to understand their motives and desires.”

In 1916, Lord Charnwood, a British aristocrat and admirer of Abraham Lincoln published a bio of the great leader. Among other things, he wrote this about Lincoln:
“For perhaps not many conquerors, and certainly few successful statesmen, have escaped the tendency of power to harden or at least to narrow their human sympathies; but in this man a natural wealth of tender compassion became richer and more tender while in the stress of deadly conflict he developed an astounding strength.”
In his day, he recognized the evil of slavery, yet sought to understand the position of the slaveholder. He mourned the loss of his soldiers and gave speeches that comforted a nation at war.

His empathy is often attributed to his bouts of depression and the losses he suffered – the loss of his mum when he was 9, the loss of his first sweetheart, the 22-year-old Ann Rutledge when he was 24 and the loss of his 11-year-old son Willie when he was 53.
As a young man in Illinois, he often had to write letters for people in the community who couldn’t write. Hearing the stories of these people may also have helped him developed the ability to walk in others’ shoes.

Nowhere is this empathy more demonstrated than the letter he wrote to the daughter of his friend, William McCullough, who was killed during a night charge near Coffeeville, Mississippi during the civil war.
Below is the letter he wrote to the then 22 year-old Fanny McCullough who was near a nervous breakdown after hearing of her father’s death. Remember Lincoln had lost his own son 10 months earlier:

Executive Mansion,
Washington, December 23, 1862.
Dear Fanny
It is with deep grief that I learn of the death of your kind and brave Father; and, especially, that it is affecting your young heart beyond what is common in such cases. In this sad world of ours, sorrow comes to all; and, to the young, it comes with bitterest agony, because it takes them unawares. The older have learned to ever expect it. I am anxious to afford some alleviation of your present distress. Perfect relief is not possible, except with time. You can not now realize that you will ever feel better. Is not this so? And yet it is a mistake. You are sure to be happy again. To know this, which is certainly true, will make you some less miserable now. I have had experience enough to know what I say; and you need only to believe it, to feel better at once. The memory of your dear Father, instead of an agony, will yet be a sad sweet feeling in your heart, of a purer and holier sort than you have known before.
Please present my kind regards to your afflicted mother.
Your sincere friend
A. Lincoln

Fanny found inspiration in that letter and went on with her life. She fell in love with a soldier who unfortunately, died in action too. She held up though and finally married, dying at the age of 80. That letter from Lincoln was found among her possessions.
On this day like every other day, I pray this country would be touched by the Spirit of Empathy that possessed our 16th president and made him such a tower of humanity.

Beware of Reichstag Fires

“This is a God-given signal, Herr Vice-Chancellor! If this fire, as I believe, is the work of the Communists, that we must crush out this murderous pest with an iron fist.” – Adolf Hitler to Franz von Papen

On January 30, 1933, Adolf Hitler was appointed Chancellor of the Weimar Republic (this was how Germany was referred to after WW I) by the President, Paul von Hindenburg. No party had an outright majority but Hitler’s National Socialist Party entered into a coalition with the National-Conservative Party, giving them 33% of the seats in the German legislative assembly, the Reichstag. The National-Conservatives thought they could tame Hitler. However he had other plans. He wanted to abolish the constitution and democratic rule and establish a nationalist-dictatorial regime. He wanted to do this legally and to this end, he planned to exploit the German constitution. He needed the Enabling Act.

The Enabling Act was a special law that gave the Chancellor the power to pass laws by decree, without the involvement of the Reichstag during states of emergency. These special powers could stay in effect for four years after which they could be renewed. It had been used just once since it was instituted and that was when Germany was hit by hyperinflation shortly after WW I.
Hitler needed to get a two-thirds majority in the Reichstag to enable him to pass the Enabling Act.
The way he went about achieving his vision is worthy of study.

As soon as he was appointed Chancellor in January, 1933, he petitioned President von Hindenburg to dissolve the Reichstag and schedule new elections since there was so much fragmentation. Elections were scheduled for the 5th of March, 1933.
The only other party that stood in Hitler and the Nazis’ way was the German Communist Party. He had to get rid of them. He also had to generate a state of emergency that would justify passing the Enabling Act. He achieved both aims with one blow.
The Reichtag Fire of February 27, 1933.
There is a school of thought that the Nazis set the fire. Even if they didn’t, Hitler exploited it expertly.
On that fateful Monday, a fire broke out in the Reichstag building. It gutted most of the building. Shortly, a young Dutch immigrant, Marinus van der Lubbe, who had arrived recently in Germany was arrested as the culprit. Van der Lubbe was an unemployed bricklayer and a communist. That was all Hitler needed. He declared that the fire was the first in a series of attacks planned by the Communist Party to take over the country through a coup. He called it a “sign from God”.

The day after the fire, he got the president to enact the Reichstag Fire Decree. This basically abolished all civil liberties – habeas corpus, freedom of expression, freedom of the press, the right of free association and public assembly, the secrecy of the post and telephone. It would be years (after the WW II) before they would be reinstated. Newspapers not friendly to the Nazis were banned.
The narrative that the Communist were planing a coup spread like wildfire, helped on by the amazing Nazi propaganda machine and supportive newspapers. A purge of communists ensued and soon, there were none left to contest the elections on March 5, 1933.
The Nazis increased their share of the Reichstag seats. They also received the support of the other right-wing parties like the National People’s Party and the Centre Party. To get to two-thirds, the final step was intimidating the Social Democrats and preventing them from taking their seats in the Reichstag. This they did with ease.

On March 23, 1933, the Reichstag passed the Enabling Act and the rest like they say, is history.
Beware of Reichstag Fires!