dimanche 17 août 2014

A LETTER TO MY CUBAN FRIENDS AND COLLEAGUES IN LA HABANA, CUBA


No es muy comun se escucha cosas buenas sobre Cuba en la prensa aquí en los Estados Unidos. Así que estaba feliz de leer este artículo de France lo que dice el estado de salud cubano y su comparación con los modelos disponibles para los Países en Desarrollo, Incluso más rico que Cuba, Países no-tienen un sistema tan bueno como Cuba. Y por supuesto todos estamos tan orgullosos de los médicos que prestan servicios en más de 60 países de todo partes  del mundo, incluyendo Bután,un pais pequena en la frontera con la India, quien tiene millones de médicos sans el objetivo de ayudar países en desarrollo !
Es una gran placer y  de orgullo para mí que mis amigos-han recibido una buena educación en Cuba y que, muchos de ellos, que son médicos, son ayudandolos comunidades sin servicio de medicos, en todo el mundo ..

It is not very often you hear good things about Cuba in the press here in the United States. So I was happy to read this article from France which tells the state of Cuban Health Care and comparing it with the models available for other developing countries. Even richer countries than Cuba does not have a system as good as Cuba. And Of course we are all so proud of the doctors serving in more than 60 countries around the world, including Bhutan, which borders with India with millions of doctors but without a culture of helping other developing countries.
It is a great source of pride for me that my friends have received excellent education in Cuba and that many of them, who are doctors, are serving deserving communities all around the world ..

Cuba: un modèle selon l’organisation mondiale de la santé
Posté dans  Santé juillet 31, 2014

Selon l’organisme onusien, le système de santé à Cuba a valeur d’exemple pour tous les pays du monde.
Le système de santé cubain est mondialement reconnu pour son excellence et son efficacité. Malgré des ressources extrêmement limitées et l’impact dramatique causé par les sanctions économiques imposées par les Etats-Unis depuis plus d’un demi-siècle, Cuba a réussi à universaliser l’accès aux soins à toutes les catégories de la population et à obtenir des résultats similaires à ceux des nations les plus développées.
El sistema de salud cubano es reconocido mundialmente por su excelencia y eficiencia. A pesar de muy limitados recursos y el dramático impacto causado por las sanciones económicas impuestas por Estados Unidos desde hace más de medio siglo, Cuba ha logrado universalizar el acceso a la atención a todas las categorías de la población y para obtener similares a los de las naciones más desarrolladas resultados.
Articulo escrito por

Docteur ès Etudes Ibériques et Latino-américaines de l’Université Paris IV-Sorbonne, Salim Lamrani est Maître de conférences à l’Université de La Réunion, et journaliste, spécialiste des relations entre Cuba et les Etats-Unis.
Son dernier ouvrage s’intitule Cuba: Les médias face au défi de l’impartialité, Paris, Editions Estrella, 2013 et comporte une préface d’Eduardo Galeano.

CUBA A MODEL FOR DEVELOPING COUNTRIES IN HEALTH CARE. AN ARTICLE IN FRENCH

Cuba: un modèle selon l’organisation mondiale de la santé

HavanaClinic2947-dfa7a
Selon l’organisme onusien, le système de santé à Cuba a valeur d’exemple pour tous les pays du monde.
Le système de santé cubain est mondialement reconnu pour son excellence et son efficacité. Malgré des ressources extrêmement limitées et l’impact dramatique causé par les sanctions économiques imposées par les Etats-Unis depuis plus d’un demi-siècle, Cuba a réussi à universaliser l’accès aux soins à toutes les catégories de la population et à obtenir des résultats similaires à ceux des nations les plus développées.
Lors de sa récente visite à La Havane en juillet 2014, Margaret Chan, directrice générale de l’Organisation mondiale de la santé, a fait l’éloge du système de santé cubain et s’est montrée impressionnée par les réussites dans ce domaine. « Cuba est le seul pays qui dispose d’un système de santé étroitement lié à la recherche et au développement en cycle fermé. C’est la voie à suivre, car la santé humaine ne peut s’améliorer que grâce à l’innovation », a-t-elle déclaré. Elle a salué « les efforts de la direction de ce pays pour faire de la santé un pilier essentiel de développement[1] ».
VBK29-CUBA_FIDEL_CAS_10022g
Cuba a basé son système de santé sur la médecine préventive et ses résultats sont exceptionnels. Selon Margaret Chan, le monde doit suivre l’exemple de l’île dans ce domaine et remplacer le modèle curatif, inefficace et plus couteux, par un système basé sur la prévention. « Nous souhaitons ardemment que tous les habitants de la planète puissent avoir accès à des services médicaux de qualité, comme à Cuba », a-t-elle souligné[2].
L’OMS rappelle que le manque d’accès aux soins dans le monde n’est en aucun cas une fatalité découlant d’un manque de ressources. Il traduit, au contraire, un manque de volonté politique de la part des dirigeants de protéger les populations les plus vulnérables. L’organisation cite à ce titre le cas de l’île de la Caraïbe comme étant le parfait contre-exemple[3]. D’ailleurs, en mai 2014, en guise de reconnaissance à l’excellence de son système de santé, Cuba a présidé la 67ème Assemblée mondiale de la Santé[4].
Avec un taux de mortalité infantile de 4,2 pour mille, l’île de la Caraïbe présente le meilleur indicateur du continent et du Tiers-Monde, reflétant ainsi la qualité de son système et l’impact sur le bien-être des enfants et des femmes enceintes. Le taux de mortalité infantile de Cuba est même inférieur à celui des Etats-Unis et se situe parmi les plus bas au monde[5].
Avec une espérance de vie de 78 ans, Cuba est l’un des meilleurs élèves du continent américain et du Tiers-monde, avec un indicateur similaire à celui des nations les plus développées. En moyenne, les Cubains vivent 30 ans de plus que leurs voisins haïtiens. En 2025, Cuba disposera de la plus grande proportion de personnes de plus de 60 ans d’Amérique latine[6].
Un système de santé au service des peuples du Tiers-monde
Cuba fait également bénéficier les populations du Tiers-monde de son expertise dans le domaine de la santé. En effet, depuis 1963, Cuba envoie des médecins et autres personnels de santé dans les pays du Tiers-Monde afin de soigner les déshérités. Actuellement, près de 30 000 collaborateurs médicaux travaillent dans plus de 60 pays de la planète[7].
operacion milagro
L’exemple emblématique de cette solidarité vis-à-vis des plus démunis est l’Opération Miracle lancée en 2004 par Fidel Castro et Hugo Chávez. Cette campagne humanitaire, mise en place au niveau continental dans le cadre du projet d’intégration de l’Alliance bolivarienne pour les peuples de notre Amérique (ALBA), consiste à opérer gratuitement les Latino-américains pauvres atteints de cataractes et autres maladies oculaires[8].
En une décennie, près de 3,5 millions de personnes ont pu retrouver la vue grâce à l’internationalisme cubain. Ce programme social, créé dans un premier temps pour le Venezuela, a été étendu à tout le continent avec l’objectif d’opérer un total de 6 millions de personnes. En plus des opérations chirurgicales, la Mission Miracle fournit gratuitement des lunettes et des lentilles de contact aux personnes atteintes de troubles de la vue[9].
Au total, près de 165 institutions cubaines participent à l’Opération Miracle, qui dispose d’un réseau de 49 centres ophtalmologiques et de 82 blocs opératoires dans 14 pays d’Amérique latine : la Bolivie, le Costa Rica, l’Equateur, le Guatemala, le Guyana, Haïti, le Honduras, la Grenade, le Nicaragua, le Panama, le Paraguay, Saint-Vincent et les Grenadines, le Venezuela et l’Uruguay[10].
La solidarité médicale cubaine s’étend également à l’Afrique. En 2014, LABIOFAM, l’entreprise de production chimique et biopharmaceutique cubaine, a lancé une campagne de vaccination contre le paludisme en Afrique de l’Ouest, dans pas moins de 15 pays[11]. Selon l’OMS, ce virus, qui affecte en majorité les enfants, coûte la vie à 630 000 personnes par an, « la plupart étant des enfants âgés de moins de cinq ans vivant en Afrique ». « Cela signifie que 1 000 jeunes enfants meurent chaque jour de paludisme[12] », rappelle l’Organisation.
De la même manière, Cuba forme de jeunes médecins du monde entier au sein de l’Ecole latino-américaine de médecine (ELAM). Depuis sa création en 1998, l’ELAM a diplômé plus de 20 000 médecins de plus de 123 pays. Actuellement, 11 000 jeunes en provenance de plus de 120 nations suivent une carrière de médecine au sein de l’institution cubaine. Selon Ban Ki Moon, secrétaire général des Nations unies, l’ELAM est « l’école de médecine la plus avancée au monde ». Il a également fait l’éloge des médecins cubains qui travaillent dans le monde entier et notamment à Haïti : « Ce sont toujours les premiers arrivés et ce sont les derniers à partir. Ils restent sur place après les crises. Cuba peut montrer au monde entier son système de santé, un modèle pour beaucoup de pays[13] ».
091027-CubaELAM-VisitofMargaretChanWHO
En faisant l’éloge de Cuba, l’Organisation mondiale de la santé souligne qu’il est possible pour un pays du Tiers-monde aux ressources limitées de mettre en place un système de santé performant et d’offrir à l’ensemble des populations une protection sociale digne de ce nom, s’il y a la volonté politique de placer l’être humain au centre du projet de société.

Docteur ès Etudes Ibériques et Latino-américaines de l’Université Paris IV-Sorbonne, Salim Lamrani est Maître de conférences à l’Université de La Réunion, et journaliste, spécialiste des relations entre Cuba et les Etats-Unis.
Son dernier ouvrage s’intitule Cuba: Les médias face au défi de l’impartialité, Paris, Editions Estrella, 2013 et comporte une préface d’Eduardo Galeano.
Contact : lamranisalim@yahoo.fr ; Salim.Lamrani@univ-reunion.fr
Page Facebook : https://www.facebook.com/SalimLamraniOfficiel
________________________________________
[1] Prensa Latina, « Directora de OMS reconoció labor de Cuba en materia de salud », 16 juillet 2014.
[2] Agencia Cubana de Noticias, « World Health Organization Praises Cuba’s Achievements », 14 juillet 2014.
[3] Prensa Latina, « Directora de OMS reconoció labor de Cuba en materia de salud », op. cit.
[4] EFE, « Directora general de la OMS está en Cuba para ver avances en investigaciones », 15 juillet 2014.
[5] EFE, « Cuba cierra 2013 con la tasa de mortalidad infantil más baja de su historia », 2 janvier 2014.
[6] Oscar Alfonso Sosa, « Crece esperanza de vida geriátrica en Cuba”, Cubadebate, 29 avril 2014.
[7] Salim Lamrani, Cuba: les médias face au défi de l’impartialité, Paris, Editions Estrella, 2013, p. 49.
[8] Cubadebate, « La Misión Milagro cumple hoy diez años : ha devuelto la vista a 3,4 millones de personas », 8 juillet 2014.
[9]Ibid.
[10] Ibid.
[11] Agencia Cubana de Noticias, « Cuba’s LABIOFARM Launches Malaria Campaign in Western Africa », 30 mai 2014.
[12] Organisation mondiale de la santé, « World Malaria Report 2013 », 2013, p. v. http://www.who.int/malaria/publications/world_malaria_report_2013/report/en/ (site consulté le 19 juillet 2014).
[13] Nyliam Vásquez García, « La escuela médica más avanzada del mundo », Juventud Rebelde, 28 janvier 2014.

mercredi 6 août 2014

PLEASURE WITHOUT DESIRE

One of my favourite philosophers, Gilles de Leuze, once famously declared:
Tell me your desires, I will tell you who you are.
In the western minds, who you are, is often confused with, what you are.
No such confusion exists among American Indians, who are interested in who you are.
To them, who you are, leads to what you are.
A desire in the Oriental context is so different from the Western context. The Buddhists renounce Desire, the Yogic Philosophy encourages disengagement from desire.
Once sitting inside the now defunct El Modelo Restaurant in Piedras Negras in Coahuila, I was asked this question, by a visiting psychotherapist from California who spoke with a west African accent. Can you condense in one sentence, how to achieve happiness?
I thought about it, and answered
Decrease your desires. That will make you happy.
This was long before I had encountered Buddhism or Yogic philosophy.
I had learned it from the Indians.

I was recently crossing the Missouri River, looking at its flow, the banks with eager, green trees.
It filled me with pleasure.
That is when I thought about Pleasure without Desire.


Pleasure rising out of Desire is addictive.
It may create aversions
Which may fuel structural defects of the mind
Addiction or attachment may arise out of the memory of that pleasure
In the end, that desire causes pain.
Those who live under regimes that promote Desire, by denying them, double that pain. (I am thinking about my Iranian friends)
But the Indians remind me, there are plenty of Pleasures to be had.
My UmonHon Indian teacher reminded,
Did you see that eagle flying around?
What about the clouds on this bright day on a blue sky?
The more I think about it, I realized that Indians know how to live a life of pleasure from which Desire is isolated, Desire is outside the sphere of pleasure.
Working soon after with my Mexican colleague, I realize that it is the Pleasure without Desire that drive us to do our humanitarian, holistic medical work.
Look for pleasure that does not leave you with craving
Pleasure without desire can be found
In relationships, not just personal or family relationships but in the concept that the Indians have: Mitakuye Oyasin, We are all related
The above concept was well illustrated by an Israeli Soldier involved in Operation Moses when they airlifted 100 000 Ethiopian Jews stranded in refugee camps to Israel. An American reporter asked the soldier who was carrying an elderly woman to safety, Is she heavy? And he answered; she is not heavy, because she is my sister.
Everybody is the same; it is easier to say that. In the 1970s, it was generally accepted social sciences theme that People are rational and the departure from rationality occurs because of emotions such as fear, affection or hatred. But we now know the above to be incorrect.
Instead of what you can do for me, ask what can I do for you
Try to be a Human Being

HUMAN
How one day, after coming home hungry from an unsuccessful walrus-hunting expedition, an INUIT found one of the successful hunters dropping off several hundred pounds of meat [for him]. He thanked him profusely. The man objected indignantly:

" 'Up in our country we are human!' said the hunter. 'And since we are human we help each other. We don't like to hear anybody say thanks for that. What I get today you may get tomorrow. Up here we say that by gifts one makes slaves and by whips one makes dogs.'
Giving thanks or showing your gratitude is also a form of pleasure without desire. So are remembering people who had been kind to you in the past.
The sensation of pleasure without desire is entirely different from the ecstasy of pleasure that arises out of desire
Try it and you would see

You might even like it

AMERICAN INDIANS AND THE ISRAELI NOBEL LAUREATE, DANIEL KAHNEMAN

AMERICAN INDIANS AND THE ISRAELI NOBEL LAUREATE, DANIEL KAHNEMAN
When I began working with the Indians, it looked like they were intent on educating this “tribal” boy into the ways of Indians. I clearly remember an elder telling me: whoever is sitting in front of you, treat them with respect. Just because he is wearing simple clothes and speaks humbly don't under estimate him. Two things he stressed that I must try to do. RESPECT all Indians regardless of their age and show no JUDGEMENT.

That man waiting to see you, wearing a torn tee shirt and ancient jeans is the leader of the Eagle Clan of this tribe, He has knowledge far superior to that of yours and certainly far deeper than yours, so don't dismiss him,thinking  he is just another old indian. I took this advice to heart and to this day, I try not to judge Indians under my care.
In a study published some years ago, most family practitioners have already made up their minds before even they see a patient they are familiar with.
Oh, no, it is not Mrs J again, she must have Migraines! And then the doctors construct the conversation around that conception and treatment would end up being inappropriate! in many cases. This incongruity was recently seen in an Indian patient of ours who was suspected of having Renal Problems, but the PA (physicians assistant) who saw him thought he had come to see him about an elevated blood test and he dismissed it not being serious. So the patient is still left with the problem, may be the PA felt he has done a fantastic diagnostic job!
Why do we make judgements? Why do we tend to believe in our intuitions? Are the intuitions true or are they convenient?
While the fighting between Israel and Hamas was going on, news reports avoided other tragedies that were taking place in the region, some of greater magnitude if not equal
50 000 Yazidi Kurds were driven into the hills with no food and water and many children died of starvation 
Hundreds of Shia civilians were made to dig their own graves and shot by the Islamists.
A drone hit a prison used as a headquarters for the Sunni Jihadists and killed 60 militants and allowed 300 prisoners to escape.
At least 300 people were killed in Syria in one day, the fighting has now broken into Lebanese territory where the Shia villagers are being massacred.
The media makes it easy for people to remember and reinforce what they want to believe . If you are supporter of Hamas then you would be far less interested in hearing about the atrocities being committed in the name of Islam by muslims on each other but would readily see the scenes broadcasted of the gruesome tales of Gaza. What anti semitic people consider as aggressive may not be seen as being equal to the barbarity of the Muslims by Kurds forced to flee to the mountains.
So,  easy memory recall facilitated by media or propaganda makes it easier for us pass judgement.
I have noticed that in authoritarian countries I have visited or lived in, the newspapers report all the atrocities around the world and write glowingly about their own countries. You don't have to be authoritarian but would like to influence the people, as is the case in Malaysia, where reading the newspaper you would get the idea that the country is inhabited only by Muslim Malays.

I highly recommend a book called Thinkig Fast and Slow by Daniel Kahneman. He is an Israeli, currently a Professor at a Prestigious north American university and a recipient of Nobel Prize in Economics. He and his colleague at the Hebrew University of Jerusalem, Amos Tversky in the 1970s formulated the rule of thumb thinking (heuristic thinking) and biases. A seminal article was published in the Science magazine in 1974 under the title
Judgement under Uncertainty: Heuristics and Biases
It is available as an appendix in the book.
The following ideas  are taken from the introduction in the book.
We always make judgements about three and four year olds and predict that they may become lawyers because they are argumentative, professors or engineers because they are nerdy, or psychotherapists because they are sympathetic. Of course these predictions are absurd.
It is also clear that our intuitions were based on the resemblance of each child to the cultural stereotypes of a profession.
The next example is taken verbatim, about Steve selected from a representative sample
An individual has been described by a neighbour as follows: “Steve  is very shy and withdrawn, invariably helpful but with little interest in people or in the world of reality. A meek and mildly soul, he has a need for order an structure, and a passion for detail.”
The Question to the reader is:
Is Steve more likely to be a librarian or a farmer?
The personality resemblance to a stereotypic librarian is striking in the above description, and the statistics are ignored. There are 20 male farmers for each male librarian in the United States. So the chances of finding a meek and mildly soul in a tractor is greater than finding him at the reception in a library.
This is the Heuristic (roughly, a rule of thumb) way of thinking to make a difficult judgement.

Answer this question.
Is the letter K more likely to appear as the first letter in a word OR as the third letter?
While most people intuitively would say the letter K appears more often as a first letter, the reality is K along with L N R and V  occur more frequently in the third position .
If the question has been about letter Q you might have hesitated but K? most people would use the rule of thumb and say K occurs most commonly as the first letter and this causes a bias in judgement.

Is adultery more common among Politicians or Doctors or Lawyers? You might be tempted to say it happens more often among Politicians especially Republicans or Tea party members in the USA but Physicians whose affairs are not reported in the press beat them to it.
I will let you read the book for other interesting theories and examples.

So I thank my teachers American Indians especially the Meskwakia for putting me on the right path. To this day I try not to judge people by their appearance.

Two of my close friends I met very casually on airplanes where there are less chances of making a judgement! once on a flight to Siem Reap and another time on a flight to Los Angeles!

I personally had experienced a example of heuristic judgement  of this sort in academic circles. I used to sport long hair tied in a pony tail with ornaments from indigenous tribes and with bracelets making noises and would (still do) wear colourful clothes given to me by the tribes as gifts.
I was at a conference in Honolulu, dressed as above, giving a lecture on the Social aspects of Chronic Diseases, I noticed that no one was paying any attention. A year later, I cut my hair (for personal reasons) and gone were the ornaments. I gave a very similar lecture at a conference in Lincoln, Nebraska about Society and Illness and it was well received! I am the same person, I was talking about similar subjects but my appearance got me respect in the second conference.

Poscript:
Here is another example of our bias and how that influences our judgement, taken verbatim from a review of the book in NEW YORK TIMES by Jim Holt
, consider what Kahneman calls the “best-known and most controversial” of the experiments he and Tversky did together: “the Linda problem.” Participants in the experiment were told about an imaginary young woman named Linda, who is single, outspoken and very bright, and who, as a student, was deeply concerned with issues of discrimination and social justice. The participants were then asked which was more probable: (1) Linda is a bank teller. Or (2) Linda is a bank teller and is active in the feminist movement. The overwhelming response was that (2) was more probable; in other words, that given the background information furnished, “feminist bank teller” was more likely than “bank teller.” This is, of course, a blatant violation of the laws of probability. (Every feminist bank teller is a bank teller; adding a detail can only lower the probability.) Yet even among students in Stanford’s Graduate School of Business, who had extensive training in probability, 85 percent flunked the Linda problem. One student, informed that she had committed an elementary logical blunder, responded, “I thought you just asked for my opinion.”
The last sentence by the student tells us no one likes to be told that their intuition is not in tune with reality. My humble friend from Bogor, dressed simply in clothes bought in Cambodia (not branded ones from Milan or Paris) often is mistaken by the Flight Attendants as an intruder into the Business Class, this happens often, last time it happened was on a Garuda Indonesia flight from Jakarta to Amsterdam!
So, the warning is,
if you act on your intuition, you would most probably will be wrong!