dimanche 21 septembre 2014


Wherever there is oppression, CUBA lends a hand..
And some of the results can be beautiful MUSIC.. that carry that message

Africa Beats: Aziza Brahim voices Western Sahara blues
21 September 2014 Last updated at 00:01 BST
Aziza Brahim was born in the disputed territory of Western Sahara, most of which is currently under Moroccan control, and grew up in refugee camps in south-west Algeria.
Now she is using her beautiful and compelling voice to draw the world's attention to the ongoing plight of her people.
"I think music is the most powerful weapon," she tells Africa Beats. "If I can give publicity to my conflict, it's a duty and a satisfaction."
She comes from an artistic family - her grandmother is Al Khadra, a legendary Saharawi war poetess. Aziza Brahim left the camps to study music in Cuba and now pursues her musical career in Barcelona.
Her fourth album Soutak (your voice) was released earlier this year to high acclaim.


Realizamos desde aquí nuestro particular homenaje a los Hijos de las Nubes, que lucharon contra la invasión del enemigo, a través de las imágenes del documental "Goulili Dios Moi Ma Seour", producido por Inger Servolin para Iskra Films en 1991. 
Quizás uno de los mejores documentales realizados sobre la Mujer Saharaui y el conflicto de su país.

Cubans in the island in general are aware of the struggles of the Saharawi people. Many of the university students have or have had classmates of Saharan Origin. At the  Latin American School of Medicine, there are quite a few students from Saharawi studying to be doctors. Cuba has conducted Humanitarian Medical Missions to this particular region, as part of their global strategy of helping poor people with health and sanitation and vaccination and maternal child health.
The man conducting the Tea ceremony is studying Medicine at ELAM medical School in Havana, Cuba


I begin my lectures on Medical Anthropology, discussing how the common metaphors in the society had changed from Religious to Medical. Benjamin Franklin suffered from Gout, because of a Sinful Life, now it would be referred as an Unhealthy Life Style. Metaphors about Cancer abound, and in combinations with military metaphors, dominate the daily headlines.
I have noticed that people take a certain delight to inform you (Is it because I am a Physician?) of the latest catastrophes to fall upon the individuals in their social circles.
Is it a superstition to avoid the same fate falling upon them?
Within a matter of days, I was told of someone suffering from stage 4 Colon Cancer, another with Prostate Cancer, a middle aged man suffering seizures and slipping into a coma, a death from breast cancer, someone’s toe being cut off because of gas gangrene.
I am very optimistic by nature and would like to hold the world not as a dangerous place but a pleasant place to live in. There are certain risks to be taken in achieving this pleasantry and that, one does in ones own stride.
I would like people to be healthy, would advise how to maintain health.
I wanted to know the origins of this obsession with disease rather than Health and was reminded of the little anthropological study I did with myself as the patient.
I approached various specialists in different countries and presented myself with a desire to know more about prevention of disease. But the doctors kept on asking me; do you suffer from any symptoms? No, I said with glee. All of them, American or European or Asian were baffled. They can give me advice only when there is disease but not how to prevent that very same disease.
When the metaphor is about Disease rather than Health, the discourse also turns to Disease rather than Health.
The scare mongering media with its outlook of sensationalism adds fuel to this fear of ill health and harm.
Mary Douglas, a British Anthropologist, devoted her professional life to studying Risk and Danger.
Working with American Indians one good lesson to learn is that Life is chaotic and an order cannot be bought or readily accessible and that one has to accept it. Uncertainty is part of life and one has to adjust to that. That lesson has been very helpful to this wandering Jew!
So I was very happy to hear from my good friend, the humble man of Bogor, who is very interested in Prevention of Diseases among all his employees!

This morning, he had arrived at the lakeside near his house where a few faithful had gathered and they spent the next one-hour jogging and walking and talking. A bicycle ride completed the morning exercises followed by coffee and breakfast in the office for all those present.
I had left a BP/Pulse recording machine with him and occasionally he would send a reading on himself or someone he is concerned about.
My friend the humble man of Bogor who is now 53 years old had the following BP Pulse reading this morning:

BP   105/65 mm Hg
Pulse 52 beats per minute.
He is on no medications.

Thank you, dear friend, for positive news in this world full of so much negative news! Positive in that, emphasizes what is normal, negative emphasizes what is abnormal

vendredi 19 septembre 2014


This morning, I received the following text message from an Indian friend of mine, who lives in a remote reservation. She had consulted me about her Thyroid Dysfunction years earlier. When her glucose fluctuations began worrying her she consulted her primary care physician who immediately prescribed medications that made her sick and she discontinued taking them. She wrote to me at that time and we decided to follow a path of a change in lifestyle, searching for better food, and becoming more active.
She kept her appointments with her primary care physician, and the text message this morning was prompted by her last visit to the doctor.
I copy the text message in full:
Dear Dr, I just recently went for my check up with my FP. I still manage everything by nutrition and exercise. However I just found out she has ordered me a medication called “simvastatin 20 mg”. She had not called me regarding this but is this something I should take? I am not on any medication and don't want to be. I do take omega 3 krill oil, could this be causing my cholesterol to be high?
(Rick Two Dogs, a Lakota Medicine Man with a Jewish Medical Anthropologist)
The questions are:
Does she need Simvastatin therapy to lower her cholesterol? How high is her cholesterol? Are there other non-pharmacological methods of lowering her cholesterol? What is the significance of higher cholesterol in this lady who is nutritionally competent and is not sedentary?
The above are strictly biomedical questions. For an anthropologist, something far more serious that gives rise to the erosion of confidence in the medical care is taking place.
The patient was not told during the encounter that she would be prescribed a new medication. This patient is extremely health conscious and a good explanation and discussion would have been welcome. Her last foray into medications was a disaster for her with gastrointestinal complaints and also symptoms of low blood sugar. It caused enough anxiety in her to send me a text message, and I live 4000 miles away!
It is well known that in the developed world, 50% of the times patients do not take the medications prescribed and in some chronic conditions this level may rise as high as 80%. When worming with marginalized people with other social issues, it is all the more important to have communication open and non judgemental.
In the hierarchy of medical care in the western world, with its predominant biomedical ways of thinking, the blame has always been directed at the patient. Even the word, compliance is a guilt laden, accusatory term.
So, when a few years ago, we suggested that the “doctors may be non compliant”, they were indignant. No, they protested, we do the best for the patient; it is up to them to take the medications.

One of the earliest observations I made with the Indians that I work with, which I could translate anthropologically into practice, was this. When they go to their traditional healers or attend healing ceremonies, there was no problem of “non compliance”!
I recognized the following “reasons” for this “success”.
Healer and the Patient share the same culture
There is no hierarchy
No orders, only suggestions
A strong belief in the outcome
No remuneration of any kind
Gratitude for the outcome
In my opinion, if an Indian knows that you respect her or him, you can be sure that medical outcome is helped by that fact!
Indians in America are some of the poorest people in the country but they do have access to primary care and medications and investigations. So many of the patient related structural factors are absent. The other patient related factors are mostly remediable, if the provider takes the time to find out and it would need a little bit of analytic investigation.
Explanatory models of why the chronic condition is not well controlled, I have had traditional Indians tell me:
There have been too many deaths in the tribe recently.
My children play after school sports in the nearest town.
I will devote another blog for deciphering this among many other explanatory models of Indian patients.
Even if the provider feels that he or she is unable to confront the social aspects of medical care, they can pay attention to Physician-related Factors, as enumerated below in a review from Mayo Clinic.

Physician-Related Factors
Not only do physicians often fail to recognize medication nonadherence in their patients, they may also contribute to it by prescribing complex drug regimens, failing to explain the benefits and adverse effects of a medication effectively, and inadequately considering the financial burden to the patient.3,55 Ineffective communication between the primary care physician and the patient with a chronic disease such as CVD further compromises the patient's understanding of his or her disease, its potential complications, and the importance of medication adherence.5 Failing to elicit a history of alternative, herbal, or supplemental therapies from patients is another source of ineffective communication.
Communication among physicians is often insufficient and may contribute to medication nonadherence. Direct communication between hospitalists and primary care physicians occurs in less than 20% of hospitalizations, and discharge summaries are available at less than 34% of first post discharge visits.64 Inadequate communication between physicians, hospitalists, primary care physicians, and consultants also contributes to medication errors and potentially avoidable hospital readmissions.64,
I shall reply to the text from my friend from the isolated part of the USA:
Please do not begin the medication.
You can find out the absolute numbers of Cholesterol either from the FP or from the Clinic. You can also ask the FP, WHY he/she decided to put you on this medications? Also ask him/her the various side effects of the medication.
We can talk on the phone and figure out why the cholesterol has risen. And try to make changes accordingly.

It feels good to be of service to the native people of this Turtle Island. Please be assured that what has failed our patients is the SYSTEM rather than the Servants of that System..

jeudi 18 septembre 2014


A CURE FOR STRESS: LAUGHTER or having Jewish Sense of Humour helps.
I am a Doctor/Anthropologist to some of the poorest people in the USA. Because they live in isolated regions, access to what other Americans take for granted are minimal, Education and Food to give two examples. When applying for jobs, they are slotted into the lowest of the rungs in the hierarchy, thus perpetuating their dire financial straits. They have some of the highest rates of Obesity and Type 2 Diabetes in the world.
To add insult to injury, there is a fair bit of racism shown against them by the majority culture.
They have something that makes them UNIQUE, their cultural identify, their tenacious adherence to the teaching of their ancestors.
They are the American Indians.
They also have excellent access to health care not congruous with their socioeconomic status because of the treaties they made with the invading Europeans, All of them entitled to reasonable primary and secondary medical care, without cost to the individual.
With constant stress of every day living staring at them, you would think of them huddled around, morose and tepid in their relationships?
Nothing could be further from the truth! I have never heard anyone laugh as much as the American Indian. Not just a little bit of stretching out your lips a little upwards, the Have a Nice Day kind of smile, but what can be described as Belly Laugh! As if the laughter is arising deep in their souls, deep inside their bodies.
Laughter is contagious, as witnessed by the lack of solemnity in our clinics in isolated hospitals, in villages with no shops or cinemas and the nearest towns are hours away by car. So much so that a visiting Nurse (European American) commented at the lack of decorum at the clinic. We only laughed out louder!
Belly Laugh releases endorphins from the brain, which activate receptors on the surface of the endothelium of the blood vessels, releasing Nitric Oxide that in turn dilates the blood vessels. That increases the blood flow, decreases inflammation, inhibits platelet clumping and reducing the formation of cholesterol plaques!
Do you need any further incentive to laugh out louder?
Out of the blue, a neural connection to Nitric Oxide!
What other medications or natural food/supplements increase Nitric Acid?
Sunlight, Olive Oil, Bitter Melon, warm bath, pranayama
And Sildenafil Citrate!
Which is a selective inhibitor of Phosphodiesterase 5, which is known to enhance Nitric Oxide and increase venous circulation. (It was studied for its effects on Cardiac Failure, but had some interesting side effects)
A Johns Hopkins study published as early as Oct 2005 in Circulation, demonstrated that Sildenafil reduces by half the hormonal stress on the heart.
The commercial name for Sildenafil is Viagra!
For those of you who cannot manage a good hearty laughter, may I remind you what that American Philosopher Woody Allen once wrote?
Sex is the most fun you can have without laughing!
As Epidemiologists would say, here is the scientific proof for it! Viagra! Reduces Stress!

Jewish New Year is just a few days away, what a nice way to wish HAPPY NEW YEAR to my friends…
Laugh if you can. Read quotes from Woody Allen.
Why are so many Comedians Jewish? Even though Jews are only about 2.5% of the population in the USA, and nearly ¾ of all well known comedians are Jewish?
Jon Stewart, Groucho Marx, Billy Crystal, Adam Sandler, Jackie Mason (Yaakov Moshe Maza), Sarah Silverman, Jerry Seinfeld, Larry David, Sacha Baron Cohen (Brit, Oxford grad and creator of the unforgivable Borat), Mel Brooks (Melvin Kaminsky), Lenny Bruce (Leonard Alfred Schneider), George Burns (Nathan Birnbaum), Gilda Radner, Bette Midler, Moe Howard of the 3 stooges (Moses Harry Hurwitz), Seth Rogen, Andy Samberg (David Andrew), Peter Sellers (Brit/American), Woody Allen (Allen Steward Konigsberg), Howard Stern….. et al
Suffering gives rise to Laughter one of them quipped without realizing Laughter is a great remedy for Suffering. Not all people who suffer become comedians!
So I leave you with Happy New Year Greetings, may the coming year be less stressful, and read jokes like the one below; laugh loudly at comedy movies or series.
A waiter comes over to a table full of Jewish women and asks, “ Is ANYTHING all right?”

It was mealtime during a flight on El Al. “Would you like dinner?” the flight attendant asked Moshe, seated in front. “What are my choices?” Moshed asked.
“Yes or No,” she replied.
Parting thought: People don't realize that our management has not changed in over 5775 years!