Echoes From the Hallway

Just sometimes, the practice of medicine becomes onerous. Just sometimes the pulmonary embolisms are too stifling, the myocardial infarctions too pressurizing and those hip fractures too achy. With one case following the other, one’s empathy and compassion get buried beneath the units of blood, chest compressions, epinephrine boluses, endotracheal tubes and measured urine outputs. 
After hours of patient care, one reaches a point where thoughts of the warm couch and a cold one are so intrusive that, they threaten to sweep away the right doses one has memorized for starting a patient on Amiodarone.
Sometimes, the practice wears on the body and the soul.

Recently, I had such a day. Finally, after some 13 or so hours, I scurried off to the locker room to change and head home. I was so relieved to be able to finally leave it all behind. Or so I thought. 
I changed faster than a Broadway artiste and headed for the door. 
Now, the locker room has two main doors. One leads into the operating rooms suite while the other leads to a long hallway that is flanked by a ward, two intensive care units and waiting rooms for family members. The hallway also leads to a stairwell that leads to a door that lets one out of the hospital.


As I neared the into-the-hallway-leading locker room door, I heard a curious sound coming from the hallway. For a minute I thought someone was crying but the walls muffled the sound. I opened the door and made the left turn into the hallway and was immediately greeted by a most heartbreaking sight.
In the hallway were maybe 20 people who seemed to be related and they were all crying really uncontrollably.

It is not uncommon to see the family members of patients in either intensive care units hanging around in the hallway instead of staying in the waiting rooms. The reasons they do that are myriad. The most common is that the waiting rooms are full. Another is that a patient was just admitted, so the family members are still finding their bearings. Other times, the patient might not be doing well and the loved ones are all trying to see him or her before it is too late. Then, there is also the instance where a family member dies in one of the units. 
As I stopped momentarily, frozen by the display of grief around me, I knew this was one of those instances where a patient had died and the family members were grieving openly in the hallway. It was not the first time I had seen patient family members crying in that hallway but never had I witnessed that number of weeping and heartbroken visitors.
For a minute I thought of using another route to the parking garage but something made we walk down that hallway between all those sobbing people and a chaplain, trying unsuccessfully to console them. The sobs bore into my very soul and their tears seemed to just flow. For what seemed like an eternity, I walked down that hallway, legs and heart quite heavy.
Finally, I turned the corner, went down the stairs and out of the hospital. 

Just sometimes, the practice of medicine becomes onerous. Just sometimes the pulmonary embolisms are too stifling, the myocardial infarctions too pressurizing and those hip fractures too achy. With one case following the other, one’s empathy and compassion get buried beneath the units of blood, chest compressions, epinephrine boluses, endotracheal tubes and measured urine outputs. 
After hours of patient care, one reaches a point where thoughts of the warm couch and a cold one are so intrusive that, they threaten to sweep away the right doses one has memorized for starting a patient on Amiodarone.
Sometimes, the practice wears on the body and the soul.

I walked briskly to my car, opened it and sat down. I noticed I was breathing rather fast. I tried to catch my breath and thoughts. Suddenly, my tiredness felt so secondary. Suddenly, the long day felt so unimportant and the warmth of my couch was not such a pressing need.
The empathy came flooding back. The compassion rolled over me.

I had seen grief and sensed loss and they made life so much more important. They put what I did, what we do within those walls in perspective. They humanized the pulmonary emboli, the strokes, the dissections, the fractures. I sat in the car and realized that I could not let my empathy and compassion be buried under units of blood, chest compressions, epinephrine boluses, endotracheal tubes, and measured urine outputs. That I had to reach in there and fish them out as soon as I realized they were drowning in the busy-ness of the day. Then behind those people we call patients, behind those people who make us work really hard and miss out on warm couches and beds are the lives they have left behind and hope to return to. Lives that include people who love them and will cry uncontrollably in a cold hallway if these patients do not make it.

I started the car, reversed and drove off. The radio came on and an old Stevie Wonder song was playing but even that could not keep the echoes away – the echoes of those visitors crying in the hallway. Death really has a way of reminding us about life and a special style of putting it all in perspective.

That Picture from 50 Years Ago!

On December 21, 1968, NASA launched the Apollo 8 spaceflight. Onboard the Saturn V SA-503 rocket were 3 astronauts.
Frank Borman was the commander, Jim Lovell was the navigator and William Anders was the one responsible for photography. The objective was to have them orbit the moon and study it for a possible moon landing.
For photography, Anders had among others, a Hasselblad EL. It was the first motorized Hasselblad. He had two lenses for the Hasselblad – an 80 mm f2.8 and a 250 mm f5.6. He shot on 70 mm Kodak B&W as well as Ektachrome (color) film.
They inserted into the moon’s orbit three days later. The plan was for them to orbit the moon ten times. As they did, Anders took pictures of the craters on the moon surface with the Hasselblad.
 
Just before 16:00 UTC (11 am ET) on December 24, 1968, they were coming around for the fourth pass, when Anders saw a view that made him exclaim:
“Oh my God! Look at that picture over there! There’s the Earth coming up. Wow, that’s pretty.”
Anders was observing an “Earthrise” – the Earth emerging from the lunar horizon.
(Image borrowed from the NASA Archives)
 
Due to the Moon rotating around the Earth synchronously, an Earthrise is not usually observed from the Moon’s surface. This is because, from anywhere on the Moon’s surface, Earth remains in approximately the same position in the moon’s sky, either above or below the horizon. Earthrise is generally visible only while orbiting the Moon, and at selected surface locations near the Moon’s limb, where the oscillation that ensues between the two celestial bodies carries the Earth slightly above and below the moon’s horizon.
 
As later computer simulations would show, at that point, Anders was the only one who could see the spectacle. His initial shot of the Earthrise was on the B&W film already in the camera and with the 250 mm lens. Then he asked Jim Lovell to hand him a roll of color film. He took the B&W roll out, inserted the roll of Ektachrome and shot the first color image with the 250 mm lens set at 1/250 second and f/11. More images would subsequently be shot.
 
When the astronauts returned to Earth on December 27, their success was hailed. Not only was their mission a success and helped land the first men on the moon on July 20, 1969, with the Apollo 11 program thus catapulting the US past the USSR in the space race, but it was also a bright light that helped end a very depressing year in the history of the US. 1968 was marked by the never-ending Vietnam war, riots and protests and assassinations (MLK and Robert Kennedy).
 
The “Earthrise” image was used for a postage stamp. The image has been described as “the most influential environmental photograph ever taken” and helped beget “Earth Day”. There are those who think it possibly spawned the environmental movement.
 
Those men were sent up there to discover the moon but their biggest legacy may have nothing to do with the moon. Like Anders later said, “We set out to explore the moon and instead discovered the Earth.”
They were so awed by what they saw that still up there orbiting the moon, in what was to become a seminal moment in TV broadcast history, the three men read, one after the other, the first 10 verses of Genesis 1 to an enthralled nation on December 24, 1968. Like Lovell said, “The vast loneliness is awe-inspiring and it makes you realize just what you have back there on Earth.”
 
I do not believe in Intelligent Design but these words from Genesis that those astronauts read to the world from up there says so much: “And God saw that it was good.”
The “it” is the universe including this Earth of ours. This makes our little planet good too. Our Earth is good. Our Earth is beautiful. Let’s take care of it. We may not believe the words in Genesis or even doubt the whole space program. One fact remains though – for now, this planet Earth is all we have and we better take care of it, or soon “…it will not be good.”

Don’t Get Carried Away…By those Drones!

In 1848, the people of Venice, chafing under Austrian rule for over 50 years, revolted. An Austrian battalion under Field Marshall von Radetsky was sent to quell the rebellion. He blockaded the city causing starvation and disease. However, he could not get close enough to the city to bring his artillery to bear. That is when a young Austrian artillery lieutenant named Franz von Uchatius thought of what would become the first Unmanned Aerial Vehicles (UAV) or drone.
On July 22, 1848, the Austrians filled balloons with explosives and launched them towards Venice. Unfortunately, the wind was not in the Austrians favor and the balloons were blown off course. Some were even blown back towards the Austrians positions and exploded over them. They tried again a few weeks later on August 22, this time launching the balloons from the sea but the outcomes were no better.
 
Over the next century, other countries would try variants of Unmanned Aerial Vehicles (UAV) for military purposes but it was the Israelis who would perfect it for war against Syria in 1982. Their success in using drones for reconnaissance led to an explosion in the development of these vehicles. Now drones are used not only by the military but they have found use in civilian life. From capturing live events to surveying dangerous areas, drones have found use in several industries and sectors, including the health sector. It is its use in this sector that inspired this piece.
Much of the information on the use of drones in healthcare being put out make claims about how drones will change the practice of emergency medicine in particular and all of the healthcare delivery in general. There is also great optimism that drones could revolutionize healthcare delivery in remote, hard to reach regions.
Some of these claims are being proven in a country like Rwanda where the use of drones has changed the way medical supplies and blood are delivered to hospitals around the country. Remote areas in this hilly country can be supplied easily with medical supplies and blood using these unmanned aerial vehicles. Other claims, however, have to be weighed against the healthcare needs of each country and the resources available. This is especially true for poor countries like Ghana.
With these two factors in mind, drones may not always be the first choice when considering new purchases or investments for the healthcare sector.
 
Using three clinical examples, I’ll try to illustrate why drones, revolutionary as they may be in the transport of medical supplies and blood, should not always top the list of healthcare needs for a developing country like Ghana.
 
The first example draws on the so-called Ambulance Drone. This has been made popular by a video made by Delft University of Technology, in the Netherlands. This a drone that carries an automated external defibrillator. In the video, it is flown to a patient who collapsed on the street and used to defibrillate his heart.
Now, a human heart does not fibrillate without reason and the reason in each instance is very bad. The major cause is an acute blockage of blood flow to the heart. The fibrillating heart fails to pump blood to the brain and so the patient passes out. Without chest compressions and fibrillation, death is rapid. However, even after shocking the heart out of that terrible rhythm, the patient has to placed in an ambulance by paramedics and transported to a hospital where a cardiologist can open up the blocked vessel or vessels with stents or a surgeon can bypass them.
So, though this AED drone may help shock the heart out of ventricular fibrillation, humans are needed to place the patient in an ambulance and drive him to a hospital for definite care. Very little can be done for these patients at the side of the road. Data shows survival is dramatically increased if patients are taken in for revascularization quickly.
 
Next, let us look at a condition often touted as being indirectly amenable to resolve with a drone’s use – the treatment of the anemic pregnant woman at a remote location with blood.
Now anemia in a pregnant woman is always serious. It can be chronic due to say, malaria, or it can be acute due to hemorrhage or bleeding. When such a patient reports to a clinic or a community-based health planning compound, a midwife or nurse can evaluate this patient and make the call for blood. If the anemia is chronic, she could easily transfuse the patient by getting a drone to drop off a unit or two. However, if the patient is actively hemorrhaging, she belongs in a hospital because active bleeding in a pregnant woman can end very badly for her and the fetus and is an emergency.
Let’s just say it is placental abruption, a condition where the placenta is detached from the uterus. She is going to nee surgical care and transfusing her blood is not going to fix the underlying problem.
Also, the bleeding and transfusion can set off a condition in the body called disseminated intravascular coagulation (DIC). As the body loses blood, it tries to form clots to reduce the bleeding. This depletes the body of clotting factors, thus worsening the bleeding. This a vicious cycle that needs to be taken care of in a hospital. It is another emergency.
The patient needs to be placed in an ambulance by paramedics and driven to a hospital where she can be cared for properly.
 
The third example is that of snake bites. Worldwide, there are about 5 million snake bites a year. 100,000 of these patients die. Due to underreporting in poor countries, the numbers could be much higher. In Ghana, vipers seem to be the most common snakes that bite, although there are also cobras. The snake injects the body of its victim with a venom. If this venom leads to generalized symptoms, the condition is called envenomization.
Getting envenomed by the venom of a viper leads to several symptoms the worst of which is the bleeding that often requires blood transfusions. The tissue at the site of the bite can also die and as the venom spreads, more tissue in that limb dies also. This often needs surgery to remove the dead tissue or in worst case scenarios, amputation of the limb. Failure to admit these patients, treat them with anti-venom plus other supportive measures can result in death.
Sure, a drone can deliver the anti-venom in a cool state and even blood and antibiotics but ultimately, the patients need to be transported by paramedics in an ambulance to a hospital.
 
In all three scenarios, we realize that even if a drone can arrive quickly with first-aid materials, the patient still needs definite care in a hospital and that demands paramedics and an ambulance. Drones cannot do that. At least, not yet.
 
In the healthcare system of every nation, one can tease out three main sectors: Preventative Care (Public Health), Emergent, Acute and Chronic Care (Hospitals and Clinics) and Rehabilitative Care.
In spite of all the strides made in preventative health, the bulk of healthcare delivery is seen in the emergency, acute and chronic space. This calls for community-based clinics that can be first in line to see the sick. Those that need more advanced care can then be transferred to district hospitals or even the bigger regional ones. This calls for an effective way to transport not only the acutely ill but also emergencies. This calls for ambulances.
For the transport of these sick patients, trained personnel are needed who can care for these patients during transport. Paramedics are needed.
Without a good and effective system to transport patients to the effective points-of-care, all the drones in the world flying all the blood and medications available will not save these patients. No politicizing will change that. It is that simple.
 
Thus, in a country with as few resources as Ghana has, maybe our eminent concern should be making sure the country has good ambulance coverage. It is reported that Ghana has 55 working ambulances. That is it.
What about the areas with bad roads or no roads? Well, if we are ready to invest in the newest technology, it shows a willingness to think out of the box. Maybe we need to get helicopters not drones to fly patients out of these areas. Maybe we can use hovercrafts in the areas under water.
 
So do we need drones at all? Yes, they can revolutionize the supply chain in the healthcare sector. That is a need that has to be met. However, as shown through the examples, the greatest supply chain in the world is useless if those who need care cannot be transported effectively and efficiently to the hospitals and are left to die far from the points-of-care at the back of pick-up trucks and in taxis.
I hope we can take care of our pressing needs first and not get carried away like those balloons filled with explosives the Austrians launched back in 1848.

What Is In A Culture?

The word “culture” has many definitions. It ranges from “customary beliefs and social forms…” to “cultivating living material in nutrient media…”
 
There is one definition that fits the present exercise I am embarking on and it is:
“the set of values, conventions or social practices associated with a particular field, activity or societal characteristic”.
 
Thus if one should examine the way we cook in Ghana, one could easily say we have a rather spicy culinary culture. Most meals are cooked with lots of pepper and other hot spices.
 
So let’s take the societal characteristic of infidelity in Ghana, a practice that seems to be more common among men than women and stands at the heart of the misery of a lot of married women. One can reach to our history of polygamy to understand why some men find the need to be with more than one woman. Another factor that plays into this practice is the lack of opportunities for women in business and the economy. Thus some women find the need to look for men who can “sponsor” a good lifestyle. All these factors play together to create a culture of infidelity.
 
Another societal finding is the sexual exploitation of children. Among a lot of men, sex with girls in their early teens or even pre-teens is not seen as abnormal. Looking at a history of child brides helps in getting to the bottom of this nefarious practice. Historically, girls were seen as ready for marriage and childbirth the minute they started menstruating. Thus it was not uncommon to see child brides. This terrible practice may make some men see sex with children as not being abnormal, thus creating a culture of sexual exploitation of children.
 
Then is the issue of sexual harassment of women. Anecdotally, this is a rather common occurrence in Ghana. It is seen in schools, workplaces, in bars, restaurants and even at places or worship. A 2013 study by Norman et al looked at sexual harassment at 4 Ghanaian medical schools. Of all the students interviewed, over 60% of the women reported some form of harassment versus 39% of the men.
 
Sexual harassment can often lead to sexual violence and that is yet another societal characteristic. The stats are damning. According to a 6-year collection of data by the Domestic Violence and Victim Support Unit (DOVVSU) of the Ghana Police Service, approximately six women are likely to be raped every week. Between 2011 – 2016, there were 30,408 cases of assault. If one adds the number of children assaulted, it more than worsens the picture. From 2011 – 2014, 5,752 children were defiled.
 
Though a lot of men and some women will not accept, certain societal norms allow these practices to flourish.
Probably the first of all these causes is the phenomenon of gender inequality. The fact that some see women as being less than men and only alive to cater to all the needs of men, even their sexual urges, is a problem. This inequality has been propagated through history and is often supported by religious beliefs. The results are sexist and misogynistic behaviors.
Secondly, the exploitation of the “weak” by the more powerful feeds into this. This is a phenomenon that is as old as humanity itself. So one sees girls getting assaulted by men or even boys by older women or men. Men wield most of the power in society and this power is used in lots of these instances of assault in a predatory fashion. So a woman seeking a job or even a promotion may have to give sexual favors to achieve her aim.
Thirdly is the rampant indiscipline. Sexual urges are common in all humans. However, one learns to control them and also learns to seek consent from a prospective partner before trying to engage him or her in any sexual activities. In a society that in undisciplined, it stands to reason that a large section of the men (and women) will have no personal discipline and a lack of the ability to control urges. If one adds the view that women are less than men and are there to cater to the needs of men, a toxic brew develops that propagates harassments and assaults.
Further, a lot of men in the society do not see rape or sexual assault as something that is wrong and criminal. Some even but joke about it or even minimize it. Some brag about sexually assaulting women or even children, seeing that erroneously as a feather in their cap.
To make matters worse, these predators are often not punished and can go on to assault again. In the villages, the elders take care of the case, often only reprimanding the perpetrator and telling the victims to live with it. In the urban areas, shame often keeps victims from reporting assaults.
 
Taking all these factors that perpetuate sexual violence against mostly women, can’t one say there is a certain culture that keeps these abhorrent practices alive? Now the presence of such a culture does not mean all men are predators but rather that certain norms persist that allow some men to act in a predatory fashion.
 
Which brings me to my question – what could one call such a culture?

Of Tribes, Germs, Missionaries and Colonizers

“Their association with outsiders has bought them nothing but harm, and it is a matter of great regret to me that such a pleasant race are so rapidly becoming extinct.”
– Maurice Vidal Portman, Officer in Charge of the Andamanese (1879 – 1901), in a presentation to the Royal Geographical Society titled, “The Exploration and Survey of the Little Andamans” on January 30, 1888.

On November 17, 2018, John Allen Chau, an American missionary was probably killed by the Sentinelese, an indigenous people of the North Sentinel Island in the Bay Of Bengal of India, as he tried to make contact with them in his attempts to convert them to Christianity. 

Though his death is heartbreaking then any death is sad –  there is a family grieving a loss and a life has been cut short – the young man may carry some blame for his early demise.

The circumstances of his death also present an opportunity to examine the history and shed some light on what indigenous people had to go through as Europeans colonized the world.

In spite of a ban on tourists making contact with this indigenous people to protect them from diseases, in spite of the fact that it is known that they do not want any outside contact, in spite of the fact that Chau could not even speak their language and the Sentinelese definitely did not understand English, Chau was so convinced of the need of the Sentinelese for salvation that he broke Indian law on three occasions  as he traveled to the island. He probably lost his life on the third attempt.


“The Sentinelese”. Image borrowed from “Business Insider India”

The stubborn insistence of Chau to reach the islanders resembles that of most missionaries. In their zeal to spread the Word, they often do not consider a very important issue – that of immunity and the spread of diseases to indigenous people. 

Let’s take the example of smallpox.

Smallpox was a terrible viral disease. Before its eradication was announced on May 8, 1980, at the 33rd World Health Assembly, it had a mortality of about 30%. Those who survived had to live with extensive skin scarring. Sometimes blindness ensued from corneal scarring.

The disease is believed to have originated in ancient Egypt and spread from there to Europe and Asia. Several ancient epidemics like the Plaque of Athens in 430 BC, the Antonine Plaque (165-180) and the Plaque of Cyprian (251-266)  in the Roman Empire are all thought to be due to smallpox.

The disease was still ravaging the European continent even as Columbus sailed to the New World. Smallpox till then, was unknown among Native Americans so they had developed absolutely no immunity to this deadly disease like the Europeans.

From around 1519-20 when Cortes landed in Mexico till about the end of the18th century, smallpox will lead to the deaths of around 90% of the Native Indian population in the Americas.

The introduction of smallpox by European colonizers would also lead to the wiping out of indigenous tribes like the Khoi Sai in South Africa in 1713 and the Aborigines in Australia and New Zealand.

Smallpox may have been the most devastating but the colonizers spread other diseases like the flu, rinderpest, and syphilis. 

Thus the appearance of European colonizers among the indigenous people of the Americas, Africa, Australia, and Asia meant possible deaths from the unknown diseases the colonizers carried.

Besides the actual spreading of diseases through contact, the forceful changing of the customs and practices of the indigenous people by the European colonizers lead to some deleterious health effects too. In Africa, for example, a lot of the diseases like cholera and sleeping sickness that ravage the continent were held in check through the nomadic lifestyle of the indigenes. Once the indigenous people were forced into towns by the Europeans, issues of clean water and sanitation become real issues and led to the spread of diseases.

This forceful changing of the customs, lifestyles, beliefs, and practices of indigenous folks around the world by European colonizers was often spearheaded by what could only be described as the cultural arm of the Colonizers – the missionaries. Wielding the Bible and promising salvation, they forced indigenous folks to not only forsake their traditional beliefs but also to change their lifestyles.

Now missionaries have through history done a great deal in places like Africa but they also in many cases spearheaded the western domination, providing a moral basis for it. They spearheaded the land grabs and provided a theological basis for colonization, the slave trade, apartheid, and segregation, even if the Quakers helped end the TransAtlantic Slave Trade.

Reports from the Congo tell of missionaries who sold the indigenes off to the slave traders. The sentiment is probably best captured in this saying made popular by Bishop Desmond Tutu:

“When the missionaries came to Africa they had the Bible and we had the land. They said ‘Let us pray.’ We closed our eyes. When we opened them we had the Bible and they had the land.”

Thus the appearance of missionaries did not always fortell good things and so the Sentinelese have every reason to be suspicious. Events in the past did not help either.

In 1880, A British naval officer called Maurice Vidal Portman visited the island in efforts to make contact with the very reclusive tribe. They all hid from him but for an old couple and four children. He captured them and took them to the British post of Port Blair on the neighboring Andaman Island. The old couple died shortly afterward and Portman returned the children with gifts, that the islanders probably never saw as gifts. Over the years, they have resisted all attempts of foreign contact, even killing two fishermen who accidentally drifted on to the island in 2006. Even a National Geographic Team was attacked with their choice of weapons – arrows.

If one looks at what has happened to the indigenous people on the Andaman archipelago, of which the North Sentinel Islands are a part, one cannot blame the Sentinelese for being too wary. The Andamanese people, possible migrants from the African continent, have lived on those islands for over 25,000 years. There were 5 main tribes – the Great Andamanese, the Jarawa, the Jangil, the Onge and the Sentinelese. At the end of the 18th century, when Europeans first showed up, there were over 7000 of them. As of about 2010, there were 52 Great Andamanese , 380 Jarawas, about 100 Onge and maybe 100 – 200 Sentinelese left. The Jangil went extinct in 1921. They have been wiped out by disease, violence and loss of territory.

The Jarawa and Sentinelese have survived due to a stubbornness and refusal to make contact with the outside world. Can you blame them?

There is every possibility that if Chau had made contact with them, they could have contracted bacteria and viruses from him that could wipe them out. Even the contact with his corpse endangers their very existence. 

In the past, an army would have been sent to punish the Sentinelese for killing a missionary. They all would have been killed or enslaved. Even today, that could still happen then very little can stand in the way of the forceful conversion to Christianity that the West has touted as a prerequisite for civilization for centuries. 

I guess even if contact with Europeans killed off indigenous tribes, they all died saved. I hope the Indian government will keep protecting them and the rest of the world will learn to accept differences and diversity. We could all still learn from people who live in tune with the very Nature we are so busy destroying through civilization.

What Are You Grateful For?

A Persian poet named Saadi Shirazi wrote a book titled “Gulistan” or “The Rose Garden” in 1258. From the chapter titled “On the Excellence of Contentment” come these lines from “Story 19”:
“I never lamented about the vicissitudes of time or complained of the turns of fortune except on the occasion when I was barefooted and unable to procure slippers. But when I entered the great mosque of Kufah with a sore heart and beheld a man without feet I offered thanks to the bounty of God, consoled myself for my want of shoes…”

That is why in the Freestyle Clip #16, I ask: “What Are You Grateful For?”

It Is Not Normal

The German physician, Theodor Bilharz was the first person to recognize that urinary schistosomiasis was caused by the parasitic flatworm. He was working in Egypt in 1851 when he made this discovery. Thus the condition is also known as bilharzia or bilharziasis.
The Brazilian parasitologist Pirate da Silva described the whole disease cycle in 1908.
The disease is found in tropical countries in Africa, the Caribbean, South America, Southeast Asia, and the Middle East.
There are 5 species of the flatworm that infect humans and they are often found in freshwater, where they can bore through the skin and enter the bloodstream. Even though they have a predilection for the urinary bladder or the intestines, they can ultimately affect other organs, even the central nervous system.
 
When the bladder is infected, one of the symptoms is hematuria or bloody urine. In areas where the disease is endemic, it is not surprising to find a large percentage of the population with bloody urine. The attitudes of the people in these areas in interesting and are illustrated by this study from Nigeria in 2004.
 
The researchers from the College of Medicine at the Edo State University questioned about 3800 people from a population in southeastern Nigeria, where genitourinary bilharziasis is endemic. The questions touched on their knowledge about and attitudes towards the disease – whether they used preventative methods when in freshwater bodies, whether they had been infected before, if they got treatment when infected or knew the cause of the disease.
 
Even though knowledge of the disease was quite high, the researchers were struck by the attitude from a fair number of the respondents. When asked about getting treatment for symptoms like hematuria, the stated that:
“… their condition was a stage in the course of their human development and therefore, it is a natural stage in the course of existence. They have learned to live with it until it disappears on its own or they die with it. However, they do not believe in divorce even when there is no child.”
 
This attitude has also been confirmed anecdotally by colleagues who have worked in other areas in West Africa where genitourinary bilharziasis is endemic. They have heard responses like: “Everyone’s urine here is red. What do you mean that is abnormal?”
This dire lack of understanding this morbid condition does not spare them from the sequelae of genitourinary bilharziasis – bladder cancer and kidney failure.
 
The attitudes of these people in areas endemic with schistosomiasis almost parallel a rather disturbing state in the US – the epidemic of gun violence and mass shootings..
 
Dear America, it is not normal that a young man shoots up a school with six and seven-year-olds. It is not normal that people are gunned down in churches, synagogues and movie theaters for no apparent reason. It is not normal that this occurs almost every week.
IT IS NOT NORMAL!!!
These killings should not be a stage in the course of our human development and should not be seen as a natural stage in the course of our existence. We should not learn to live with it until it disappears on its own or they die with it. We should not.
IT IS ABNORMAL!!!
Maybe you think it is a small price to pay for the right to bear arms. Listen, it is a price alright but it is not small. It is destructive and evil. Accepting it as a way of life is wrong.
 
I am not asking for anyone to take away people’s guns. All I am saying is that there should be a sense of urgency to do something about this scourge – and it is a scourge. Thoughts and prayers just aren’t cutting it. The death of fewer than 5 people has literally halted development of driverless cars and yet over 300 people have been killed this year alone by mass shooters and not one committee has been set up by lawmakers to deal with this abomination.
Are we as a nation so jaded we cannot see the “blood in the urine” anymore? Are the killings now just par for the course? Part of life?
 
Every day I drop my daughter off at school, I sit in the car watching her walk into the school wondering if she will walk out again that afternoon. I sit there knowing that there is a large possibility that I might not see her again. That even though there are cops present at the school, all it takes is one bullet. And I know I am not alone. All across this nation millions of parents live with this dread and foreboding. Is this normal? Should we just accept it like docile sheep being led to a slaughter?
 
The Nigerians in explaining why they did not get treatment for hematuria secondary to bilharzia replied, “we do not believe in divorce if there is no child”. It pretty much sounds like a play on the marriage oath, “Till Death do us part”. I guess like them, we plan to “live with it till it disappears on its own” or better still, maybe we all need to get guns and if we have to go down in a blaze of glory.
 
That cannot be normal.

That Moonlight in the Gloomy Night

An Ode to Music

The invasion of Russia by Napoleon started in June of 1812. In the subsequent Battle of Borodino that September, a battle that had the highest number of casualties of all the Napoleonic wars, he routed the Russian army but did not completely annihilate it. He then followed the retreating army of Tsar Alexander I to Moscow, thinking the Russians were going to surrender.
By the end of October, Napoleon realized the Russians were not going to surrender. Moreover, the Russian winter was starting to take a bite. Of the 286,000 men he entered Russia with, he had only 95,000 left and those men were freezing, hungry and ridden with typhoid fever. Napoleon and the remnants of the Grande Armée had to withdraw. By December when he crossed the Russian border, he was only left with 23,000 men. Napoleon had with the withdrawal handed victory to the Russians and they were elated.

Tsar Alexander I commissioned the building of the Cathedral of Christ the Savior to commemorate the victory. Even though Alexander himself died thirteen years later, work on the cathedral continued.
By 1880, it was nearing completion. Other upcoming festivities were the 25th anniversary of the coronation of Alexander II in 1881 and the All-Russia Arts and Industry Exhibition in 1882. With all these festivities in view, the composer Tchaikovsky was asked to write a piece that would capture the spirit of all these festivities.
Tchaikovsky began work on the project on October 12, 1880, and at the end of six weeks, had composed what was to become his most famous piece – the 1812 Overture.
A piece known for its powerful finale marked by cannon fire, the chimes of bells and vivid brass notes, it debuted on August 20, 1882, in Moscow.
Even though Tchaikovsky hated the overture, and described it as “… very loud and noisy, but without artistic merit, because I wrote it without warmth and without love”, it is truly one of his most remarkable pieces and suited the festive nature of all those events perfectly.

The power of the 1812 Overture truly lends itself for celebratory occasions and thus it is no wonder it is played during firework displays on July 4. It has also been used for movies and coopted into others’ work.
For me though, the overture is a piece that wakes me up and gets me going. It seems to summon my animal spirits and turns me into a doer, ready for the day. A lot of mornings, it is the piece playing in the car as I drive to work. Those crashing cymbals and cannon fire have a kick.

Which brings me to the crux of this essay.
There are musical pieces that get us into specific moods. On the other hand, we sometimes pick specific pieces to suit certain occasions.

I remember my bachelor days when I’ll set the mood for an impending date with some Barry White. His baritone could work wonders.
At parties, you want something bumping. Something with beats that make the diaphragm on the bass cone in the speakers bounce. Some hip-hop, R&B, hip-life, soukouss, salsa, merengue…something that helps with gyration and inspiration.
At worship, 50 Cent would not do. There, you want hymns by Charles and Joseph Wesley or even gospels by Cece and Bebe Winans.

On the other hand, hearing the notes of the trumpet flowing from Miles Davis might make you think of the concept of the Cool. What is the Cool? Billie Holiday’s voice might remind you of lynching through her song “Strange Fruit”. Whitney’s music may make you yearn for love and the warmth of the One. Phil Collins’ may make you miss the ’80s.
Music can do that.

Being the soundtrack of our lives, we tend to pick the right ones for the right occasions. However, it can also make us long for the situation to fit that soundtrack.
Music lifts, it exalts, it calms yet can also excite and invigorate. It makes us want to make love but it also reminds us of the one who got away. It makes us cry and yet can make us feel like we are floating on a cloud.
Music does that.

These seemingly conflicting roles of music always come to mind when I am listening to an opera or watching a musical.
Whereas the music of an opera takes you to a “certain” place, a musical, in mixing dialogue with music is more like picking the right music for the occasion.
Both genres seek to tell stories but that is not the most important thing with an opera.
With an opera, it is really all about the music. One does not have to understand the lyrics of the aria “Nessum Dorma” from Puccini’s Turandot to feel the tug it exerts on the heart and the yearning one feels in the Tenor’s voice. Even though the opera tells a story too, that is not the essence of the experience. It is the music. The composer wants you to close your eyes and let the arias carry you to a special place.
Musicals, on the other hand, have dialogues that are important to understanding the story. The music is a bonus and the pieces set the mood and add a certain verve to the experience. Thus even though the music in “Wicked” is great, ultimately one needs to pay attention or the essence of the story is lost.

An unknown writer once wrote, “Music gives a soul to the universe, wings to the mind, flight to the imagination and life to everything.” How right he or she was.
The ability to immerse oneself totally into a swirling amalgamation of tunes and tones at the perfect harmony and pitch can transport one to a great place. Whether you play a piece to set the mood or the piece you heard has got you reminiscing, let yourself go. Like the German writer, Jean Paul wrote in his novel “Titan”, “Music is the moonlight in the gloomy night of life.”

So be it the powerful pieces of Tchaikovsky or the unmistakable piano sonatas of Chopin; be it the unmistakable voice of Bob Dylan or the guitar riffs of Jimmy Hendrix; be it the soul of Aretha or the rock ‘n roll of Elvis; even the rhymes of Tupac, the melody of Egya Koo Nimo or the pitch of Makeba…let music seep through that night and light it up with beats, harmony, and soul.

On That Tightrope

Since the midterm elections about a week ago in the US, I have been thinking of funambulism, the art of tightrope walking. Now bear with me, I’ll explain.
 
You can argue till you are blue in the face but a representative democracy is really the fairest kind of government there is. It is far from being perfect and making it work and keeping it going is tough, however, it beats autocracy any day.
Sure, some autocratic-run nations are bucking the trend and achieving good standards of living for their people. However, the human can never be oppressed forever. Sooner or later, the wish for freedom erupts in ugly ways.
 
With that said, representative democracy has its challenges too and sometimes, I compare its practice to doing a walk on a tightrope spanned between two skyscrapers. One needs concentration discipline and balance. One small slip and it is plunge down into the depths of anarchy where fascist, autocrats and dictators lurk.
 
If one watches a funambulist as they walk across a tightrope, one notices that they hold a long bar during the walk. This bar, known as a balancing bar, is quite important for the art.
It does three things:
– it reduces the rotational torque of the funambulist, so he or she does not tilt off the rope;
– it lowers the center of gravity, giving the walker more stability on the rope, and
– by allowing the walker to shift the bar to one side or the other, helps with balance.
Thus we see how important the balancing bar is.
 
If I compare practicing representative democracy with tightrope walking, what in this system is comparable to the balancing bar? If the system itself, embodied in the leaders, is walking the tightrope, then elections and the people’s ability to vote form the balancing bar.
Think about it.
The votes of the people can move the nation to the left or the right. The votes of the people can provide leadership that stabilizes the country or leadership that causes it to tilt off the rope.
The votes of the people are what the leadership needs to stay on that tightrope. Without them, the leadership falls off and another takes his place.
 
There is a big difference however in the control a tightrope walker who has over the balancing bar versus the control a leader has over the balance the vote provides in a representative democracy.
Whereas the funambulist totally controls the bar and thus its effect on his walk, a leader only influences the electorate by his actions and words. If they like what they see and hear and appreciate how he wields the power of the balancing bar they have handed him, they give him control to make the changes necessary to keep the walk going.
If they are displeased with him, he notices a gradual or sometimes even sudden shift of the bar into other hands.
 
Thus one sees how potent the ability to vote is. Each voter has the ability to closely affect how a nation is ruled in a representative democracy. Sure, one can lament the role of money and corporations. One can also lament the slow speed at which change occurs. To the first, I’ll say, ultimately the will of the people comes through. To the second, do remember the analogy – representative democracy is like tightrope walking! Speed is an enemy during this feat.
 
It is no wonder that the first thing an autocrat, dictator or fascist does on attaining power is to ban elections. It shows you the power inherent in the will of the people.
No matter where you are in the world if you ever have the opportunity to vote, do so. It is a power that one never wants to give up, then like the balancing bar, it keeps a representative democracy on the rope and accountable to the people.

In Her Toes

It started at the base of her spine – a sweet tingly sensation…then it started spreading…up her back, making her arch it…into her face, making it feel warm…into her chest, causing her to heave it…into her groin, making her gently undulate it…breathless, she felt it spread everywhere…and as she finally started to moan, she also felt it…

“in Her Toes”