Unexpecteed Pleasures...

Unexpected Pleasures

La Habana, 27^th June 2009

Two important conversations, both related to my work in Anthropology and also the future of my work here in La Habana. One from MLR who wants me to give talks to Docents of various hospitals so that they would be introduced to Medical Anthropology before we introduce the subject to the thousands of students from various countries studying Medicine in Cuba. The second was with RMLG, a woman who singularly was behind the re introduction of Medical Anthropology to this country and has worked tirelessly to have a Masters Degree in Anthropology approved by the Senate of the University and has introduced a whole new generation of students to Anthropology, especially Medical Anthropology which happens to be her favourite as well. Still in Cuba, we don’t have the possibilities of studying Anthropology in depth, so my contributions are an important addition. She had been away, one year travelling the 24 departments of Venezuela, visiting various municipios and trying to undertake a study on the level of poverty in that country. That study took her more than 10 months and this was followed by a two month stay in Spain, mainly in Madrid and Barcelona. Thus our paths have not crossed in a while and now that she is back to stay for a while in the country, we had to rekindle a project dear to our hearts, which is to write a book on Symbolic Healing.

On my medical blog, www.crossculturalendocrinology.blogspot.com I will write more about Symbolic Healing.

RMLG is a good example of a Cuban academic, who dedicates her time to organize the Maestria course here in la Habana, at the same time had completed her Doctorate degree on the Healing aspects of the Yoruba rituals in Cuba. She is a busy mother and wife as well, with a busy husband and four children, one of whom is studying Lyric singing in Barcelona, the youngest is about to enter the Faculty of Dental Medicine here in Cuba.

Because of the inadequate resources or well directed resources in research, research at the socio cultural level thrives in Cuba. The biomedical research is concentrated in Immunology and Vaccine Therapy, Rehabilitation and there are specific institutes dealing with these. There is plenty of research being done in the fields of Psychology, Sociology and now the seeds are sown for Anthropology as well. I am glad to have been a part of this process in Cuba, to enable an anthropological vista of the eeryday life here in cuba.

We have set the date of December 2010, a deadline, for the publication of our book Symbolic Healing. This is a good incentive for me, justifies an intellectual stay in France while working on this, strengthens my connections with Cuba and maintain my academic appointment here.

I remember reading a guyanese intellectual teaching at UWI in Kingston, Rodney by name, talking about the triangular traffic,between metropolitan countries, africa as a source of slaves and the Caraibe as the destination for the slaves to work on plantation whose products would be exported to the metropolis. My triangular life is about to begin: the metropole being Paris, where an intellectual life to complement my intellectual activities in Havana, with field work done and stimulus obtained from my long term friends, the Indians of North America. So for the coming year, I would be fully participating fully in three different cultures: French, Cuban and North American Indian with occasionally touching the general society of North America.

Time for dinner. ALP suggested a newer place, and off we went, the three of us, after CGM joined us. It is called TV Café, and it really looked like an upscale café/nighspot in any of the latin american country, more Panama, because of the expected proportion of Blancos y Negros.. Salsa videos werebeing projected on to the screen, the general noise level grew as the hour became late and just before 10, when the nocturnal activities began, it was time for diners to leave and revellers to enter. Our dinner was tasty and served in an extremely efficient manner and timely and we enjoyed it. It made me feel that the changes in this sphere of entertainment of the people of cuba is good and we can look forward to such newer places all over Havana. For those interested in numbers and always comparing their countries moneda nacional with that of Cuba, that dinner, with a main dish, a juice or beer or a drink, and icecream to follow cost a grand total of 10 dollars!

Shabbat Shalom and Kaddish for Cecil Helman

Shabbat Shalom from San Cristobal de la Habana

26^th June 2009

I have missed lighting the shabbat candles, this past Friday I was at a hotel in Omaha, Nebraska; the Friday, I did light the candle but much later in the night when I returned from Santee Indian Reservation in Niobara. The Friday before that I was at home in Paris, when I could light the candles and say prayers of thanks for all the good things happening around me/us. The Friday night before that was spent aboard Continental Airlines Flight from Houston to Paris…

Why bringing up lighting of the candles for jewish shabbat when I am about to leave for France? To my parisian life with its newspapers and cafes and nice wine and champagne?

It is 3 30 pm in Havana and I was supposed to leave at 5 pm to Jose Marti International Airport to catch my evening flight to Paris. Being dogged by a premonition, as the clouds climbed up the sky, I called Air France in La Habana.. There was a recorded message to say that one could check in at www.airfrance.com 30 hours before departure, what use is that to me with no access to internet here in Havana?... a crispy cuban voice came over and fired rapidly at me with an educated Habana accent.. Senor.. el vuelo es anulado… the flight is cancelled.. ah well.. why fight this divine intervention? I did not ask for any reason.. just to find out what time does the flight leave tomorrow.. and whether I do have the same seat.. Yes, the upstairs seat is still assigned to me and she reminded me, without explanation, without compensation or without asking whether I needed any help, that I should be at the airport at 12 noon!

Normally we tend to blame airlines from poorer countries for such a behaviour, but Air France is well known for this lack of care for its passengers. If they do get to you, they are polite and even elegant, and of course they dress well and talk well.. but I thought of Cubans from the provinces who had come alone or with their families for their long expected visits to Europe, most possibly to other points than Paris; what about the tourists who had spent his last calculated cuban CUC and is now at the airport waiting to enter the departure lounge? Would he spend the night at the airport? Where the amenities are minimal and the food abyssmal? I do hope that they have made some arrangements for stranded passengers at the airport.. since they could be put on the flight on Air Europa to Madrid and then connections.. or some other european airlines, Virgin and BA from London; Lufthansa from Francfort, Iberia from Madrid or at a pinch Cubana itself… but I doubt it, the people manning the desks would think of these tasks as being to cumbersome and it is so much easier to tell people to come and check in tomorrow than thinking about their personal hygiene..

Ah well, the shabbat will be here soon, I may not be able to count the stars, it is very cloudy here, it is threatening to rain with its usual thunder and lightning.. ah well life in the tropics…

I am sorry to arrive in Paris one day late, but this is the third consecutive trips to Paris that I have been delayed, today, on 29^th May, my flight to New York and then Paris was delayed and transferred to Houston and on 24^th April, my flight to New York was cancelled and my trip to Paris postponed via Houston. I will make the most of my extra few hours in La Habana, this city of faded portals and unending affections.

Nothing is predictable in La Habana

The last day in Havana. 26^th June 2009

Where was I on 26^th May? Where would I be on 26^th July?

When you are in Havana, you are disconnected to the world a little bit, it is welcome for someone constantly bombarded with news items of all sorts to wade through. I have been here for five days, I am not sure what has happened in Iran where there were street demonstrations when I left, where is Obama’s health initiative headed for, let alone any news about Sarkozy or France. In the last few days, there was no mention of France in TV, newspaper or what passes for a newspaper, or in any form of discourse. Thus France has to remain in my heart alone.

Living this itinerant lifestyle, you have to miss out on some of the pleasures of a fixed life. Thus my good friends from Melbourne Australia came to Paris on 14^th May and left on 26^th conciding with my absence there. I arrived in Paris on 30^th May from Houston. I left Paris again on 10^th, since then I have been in Miami twice, passed through Nassau, visited the Omaha, Winnebago and Santee Reservations and also a good friend in Yankton, South Dakota. Now after a few days of resting my body and my mind, I am ready to go back to my life n France, in Paris, to be specific.

What lie ahead? I look forward to my three weeks in Paris, then it is New York for a weekend and the Pow Wow of the Winnebago Indians and lots of unexpected visitors,for whom a bottle of Dom Perignon is waiting; also to celebrate the birthday of MiHu..

But the immediate thoughts are on la Habana. I am so happy to have come. It has reinforced my love for this city and this country, have made some new friends. It feels like I came to Havana with a purpose and that had been accomplished, but please don’t ask me what that was.

It was good to see the people I came to see, it was nice to spend hours in discussion and learn new things. The most memorable line I will take with me, would be the one which a senior member of the Public Health Team told me: the shortest distance between two points or objectives in Cuba is not a straightline but a sinusoidal one..

1 pm Friday. May all my jewish friends be blessed with the peace of the coming Shabbat. Shalom.

As if the feast was not enough in these past four days, the last of the five women I had come to see appeared with her friend and colleague B. B’s daughter would be celebrating her Quinze which brought back multiple memories of my years in Cuba when I was the official photographer for so many Qunize! Ah Well..

LL whose friend OL I had encountered at the Cuban Embassy in Malaysia, is an intelligent psychologist with whom I share many interests, the least of which is our love for Anthropology.

So once again, Cuba has given me what I need without any strings: abundant affections, genuine friendships, a mother with few words but that which are wise, and caring at level which most of us have forgotten in our hurry to become rich and progressive.

In a few hours I will leave for the airport but before, as a precaution let me call Air France in La Habana, whose telephone number for those in need is 8332642..

Cuban Generosity of Educating poor foreigners

Day 4 Havana

Woke up in the middle of the night feeling unwell, and that was to continue for the rest of the day. This became a day of rest. I slept on and off most of the day. The body felt so tired and feverish as well.

The diagnosis entertained were: Acute on Chronic Gastritis. Caused by Coffee, Rum, the excessive heat as well as Chocolate.

The second diagnosis to consider was the so called 24 hour virus, now confirmed because the illness lasted no more than 24 hours. With fever and muscle weakness.

This also gave me a chance to understand the kindness of cubans.

The professor at whose home I am staying, brewed camomille with anis tea to calm the stomach to be followed by green tea. Then left one litre bottle of rehydration fluid, made from a packet. Made sure that the telephone was disconnected.

I did not wish to see any body. And since there was no hunger no food either. She left the telephone number of the neighbour to call in case I needed help and called to chek with her whether I had called. Since my friends knew I was sick, the telephone kept on ringing but I was falling in and out of sleep and in the afternoon everything was quiet. I had a fever of 38 degrees and the thought of not being able to catch the flight on Friday was bothersome indeed.

I had a restful sleep

Day 5 Havana

Woke up feeling refreshed and afebrile. And made plans to go to the house of friends to wait the visit of a Chinese Student here to study Spanish and Tourism and her guide, a recent graduate from Dept of Economics.

We had ordered Arroz con Pollo from the restaurant nearby and the day was calm, as if it knew a heavy downpour was on its way.

Just after the visitors arrived, the skies opened up with thunder and lightning and heavy downpour, it was a much needed rain and the earth bubbled with joy. The thunder was so strong that the animals were huddled inside the house.

GX is from HuHot in Inner Mongolia, she along with nearly 1000 other chinese students are here to spend one year of studying Spanish and then five years of Tourism and Hospitality. This increased exchange of students between China and Cuba, so far there are 2000, resulted after the visit of the respective presidents. They came in October and already they can begin to speak Spanish and I am sure that before they start their courses in Tourism and Hospitality, they would be proficient. A separate school has been created for them at Tarara, just a few miles east of Havana. They are well guarded in that they have cubans to guide them and introduce them to the life here and are not able to wander aorund or slack at their studies.

AP is the cuban guide who came with GX. She looked more like an university student than a professor at a school. She had just graduated herself from the Department of Economics, and was seconded for this job and hopes to return to her department at the University.

We had a pleasant time together, ALP was a graciuos host and we talked and entertained ourselves well. It had taken them only 40 minutes to get from Tarara to Vedado, at first by bus to Havana, the bus station and then to catch the collective taxi to vedado .

I have had two very quiet days. Tomorrow is my last day here in Havana and Cuba. I have been able to speak to Baracoa and to my friends there. Do not feel isolated as I have been able to send and receive emails. The lask of internet is a blessing in disguise so that much time is saved which is spent in solidifying allready solid friendships.

Por que yo soy revolucionario/a?

Day 3 La Habana Diaries 23 June 2009

I will tell you why I am a revolutionary

I was sitting in a verandah of a colonial house lined with plants, with antique furniture and you knew you were in the house of someone with taste and class.

I was born into the middle class in Pinar del Rio, the lady with extremely fair skin and hair slicked on to her hair, continued. I am now 56 years old and I am grateful for my life.

Thanks to the revolution I was able to go medical school as I wanted to become a doctor and given the opportunity to work in the field of epidemiology and also in the small group of people trying create vaccines. Had I been in another country, perhaps I could have more money, but what the revolution has given me, perhaps they couldn’t have given me. I have travelled all over the world representing my country and I am grateful to have seen so much and having experienced so much. Both my children are doctors and live in Cuba.

I am grateful for my life and I am grateful for the revolution for having given me this life, of being to participate in education of other doctors, to participate in research leading to public health breakthroughs. I have this wonderful house and I am quite content with my life. Also I take pride in the advances in medicine in cuba especially in public health and also the help we have given to so many poor countries in this world. I had a project among the Ayamara in Bolivia for ten years.

I am stuck in the heady days of the 1980s which was the heyday for me, before the responsibilities and travel took away that freedom. Everytime someone wants to criticize the revolution, I remind them of their long history of association with the revolution.

I had lunch with her and my good friend ALP. The lunch was at La Roca, a restaurant in Vedado, where there is a pianist belting out nice tunes to accompany the dinner. The service was quick and efficient and the price extremely modest. I had pollo supreme which reminded me of what cubans in miami call pollo a la plancha with moros, with a nice glass of mango juice to start with and a nice chocolate icecream to finish.

We would have spent six hours in conversation by the time I said good bye to them after coffee and a most delicious home made fruit juice. Our conversation touched all aspects of our lives but mainly the spiritual aspect and how that affects our relationships and the priorities that we should make for ourselves.

Using her analogy, I must not forget what are my priorities and cannot let other things enter or destroy those priorities. Morgan and Paris are priorities, writing a book or compiling information on Medical Antrhopology to present to doctors is another one. The latter one would be a homage to my friend and mentor, Cecil Helman.

American Indians would retain their priority in my life without trouble or much discussion. As Rabbi Akiva once said.. the rest is all commentaries.

This woman, an example of cuban ness in its all flourishment, a well educated and well travelled and well connected woman holding no great dislikes in her life, not sprouting anti imperialistic slogans or cliches against any one person or country, was an inspiration indeed. I felt good listening to her since her ideas resonated with me well, especially with some those are fundamental to my belief system.

The conversation had been long and hard, one of the purposes had been to counsel our common friend ALP about the realities of this transition in Cuba. I told them that during liminal periods one tends to commit errors and one has to be especially careful.

Now back to La Roca Restaurant and the lunch. The pianist, an elderly gent with flowin gwhite hair, whose fingers emit those wonderfully romantic songs through the piano. The food is well prepared, adequate and the ambience good enough for a cuban lunch. I have noticed that the service in the public sector in cuba has improved dramatically as if some one had sent a circular to each of the heads of places of public interest, to sharpen their services. The icecream was just delicious.

Tired after so many hours of intense discourse and counselling, I was happy to get home and rest a little bit. An endocrinologist from Hospital Amjeiras came to visit and the conversation took us to a time when it was appropriate time to leave for La Torre restaurat for our dinner.

The endocrinologist had finished doing the field work for her research for doctoral degree (Ph.D), she had interviewed more than a thousand women regarding sexual dysfunction in this society. It is a very large number and the data voluminous, but it would be very interesting to see the results. The field work was done in Habana Vieja that would make it even more interesting!

Perhaps they are sexually very active, there is also great academic attention to the sexual dysfunction in this country. The Institute of Endocrinology has a separate Department of Psychology with some eminent psychologists who dedicate their research into the psychological aspects of sexual dysfunction. The lead researcher told me that about 40 per cent of her patients had diabetes and the other 60 per cent had other chronic problems, including Tobacco Use and Alcohol Use which are taken into account in the psychology fo sexual dysfunction.

As we were discussing this, I realized that we in the west generally do not pay much attention to the sexua l dysfunction of our patients. (we meaning the providers), is it due to the fact that an average provider has not ime to bring it up since that would invariably involve counselling and also would involve time, and unlike dietitian, diabetes educator and physical education teachers and other sundy professionals, we don’t have a proliferation of sex therapists to whom we can just refer any one patient who complaints about his inability to achieve an erection! More nutritionitsts have not reduced the rate of increase in obesity, more exercise people havenot made people healthier. Only in a system in which the profit motive is taken out such as the Indian Health Service and VA Health Service in the USA or the NHS or Health Services in France, that a patient could freely express and expect to receive more than just a few tablets after a consultation. Michael Moore’s Sicko may have been an exaggeration but certainly there is some truth to it. And you can see the struggle President Obama is having trying to reform the health care system, from drug manufacturers and insurance companies…

About the Five Good Friends I had come to see

Day 3 in Havana. Early Morning.

As usual, another night of deep sleep. During the week with the Indians, the sleep was so disturbed, waking up at 2 am and then again at 4 and sleep until 7 am. But in Miami and here in Havana, the sleep comes easily and well.

I have come to visit five women, I am sure that European tourists would immediately have a picture of me, in some centre of nocturnal entertainment, entwined in the arms of a shapely mulatta! No these are the five people, who have kept in touch with me and have kept the fire of my love for Cuba going during my absence.

ALP was a professor at the Univesity in the department of Religion and had gone abraod on some educational missions(believe it or not, she was once sent to Sao Tome and Principe!). Grown up in the pre revolutionary era of bourgeoisie, she gladly made the transition, but bad luck had tracked her all her life. Her only son, an artist as well as a doctor, went on a mission to Cabo Verde islands and did not return, which is an unforgivable crime by Cuban government standards. Her husband was a well known professor of International Affairs, who died a couple of years ago. She is left here in the island with her son away, unable to come and see her and she is not given visa to visit him, a large apartment by the malecon. Yesterday I went to her house around 10 am in the morning and we were talking and talking until 5 pm.

Don’t be away so long, my friends are saying to me, we have so much to discuss. Like the people who work with the Indians, who ask me for a n international perspective on their work, cubans in the island would like to know my opinion about their personal life as well as the political changes which are constantly taking place in the country

CGM is a professor of psychology and a good friend of mine for a long time, like the above. She is very content to live here in Cuba and has no intention to migrate or seek her fortune elsewhere and tries to live well within her means, within the salary allotted to her. She was once married to a well known painter, so when you enter her house, the large works of art stares at you. Her only daughter, graduated from University of Havana, studying about Autism and then went on to the University in Spain, where she has distinguished herself with her doctorate (cum laude). Proud of her daughter, her country , she has done excellent investigations into one of the neglected aspects of Diabetes, the psychological aspeects of Sex and reproduction in patients with Diabetes and as such is invited to all parts of the world to give talks and present papers. Just this last month, with two colleagues from the Institute whichis attached to the Institute of Endocrinology they were in Sao Paolo Brasil. She travels two to three times a year, with about a month or so per year or two in Spain. I have never heard a single negative word about life in Cuba.

LS is my mother, my cuban mother who has facilitated hours of intellectual stimulation fo rme. She holds a high and respected position in the Ministry of Culture. She has introduced me to writers and artists, always provides me the names of the cuban ambassadors to the coutnries I am travelling to and keeps me in touch with the literary life in Cuba. She is also widely travelled but prefers her quiet life, with its necessary official duties, in a small apartment in Vedado, surrounded by original artworks including Guayasamin, whom she counted, among many well known artists, as a friend.

AA is an investigator at the Institute of Endocrinology in the Departmentof Psychology and we immediately took a liking to each other, when we met at the meeting of Assocaition of latin American Socieites of Diabetes in November 2007. She is a good correspondent and has kept me in touch with the tunes and tides of this society. In her early thirties, she has a son, well integrated into the educational system of Cuba. She is from a seaside town nearby. She has been married to an American journalist who has lived in Cuba for more than ten years. So meet the two of them for dinner is a pleasure indeed, to hear various viewpoints about life in Cuba. He is never vitrioliic about Cuba or USA, where his parents still live. They were waiting for me at the airport when I arrived. They also introduced me to ArteChef, and this time we plan to try another new restaurant La Torre. She has aquiline spanish features, and carries the proud name of one of the great cuban revolutionaries of the 19^th century. She gets to travel to the USA with her husband once in a year or two and once in a while attends a conference abroad.

The last woman I came to see, LL, is a story in fortitude and determination. In her early thirties, she was struck with Hodgkins Lymphoma in her teens, and underwent treatment here in Havana. That did not stop her from completing her studies here at the university majoring in Psychology and also going to Lima, Peru to complete her Master’s degree. A clever investigator, I would very much like to collaborate with her, since she studies the psychological effects on people suffering Endocrine disorders. I look forward to a good conversation with her, in which we could discuss plans for her Doctoral studies.

So you can understand why my life in Cuba is one of sheer pleasure. A Cuban bourgeoisie woman who was on the plane from Miami to Nassau going on vacation to Atlantis, asked me, how is your life in Cuba, I answered, I have spent some of the best years of my life in Cuba, it was the epoca de oro for me. The solidarity of the Cuban people, the sheer nature of their affection and this is the country I have the best and the longest discourses about all and every thing in life. (France is a possibility but not until I become proficient in French!)

Then there are many others, humble and holding responsible position, like Mr J who is a mechanic in the Food Production and Distribution branch of one governmental department, who sees the ice making and grain producing machines are working in order: Mrs M, daughter of a once brilliant ophthalmologist, who is the director of the Museum here and who has visited all the major museums of the world, to givejust two examples in Havana.

It is a pity that I cannot visit Baracoa before I leave for France. That s a minefield of affections fo rme. My adopted daughter Claudia lives there, like I was separated from my own father during my growng up days, she is from me. But we talk on the phone, and will make all efforts to see each other.

So, dear friends of mine from all parts of the world, you wont hear the pathetic cries of material shortages of the third world, nor of the restrictions placed on us by international economic meltdown, but only good news about the possibilities that are available to an enquiring mind: just this afternoon, I hope to meet, a doctor who was in charge of pupblic health and prevention and is now working in Panama and Rdominicana; a metaphysical poet; the ambassador I met in Hanoi… What else? I shall just wait… Havana to me is always an unending feast… and I don’t need Mojitos or Daiquiries!

Vedado, mi barrio de la Habana

Monday Afternoon, Day 2 in La Habana. 22 June 2009

Is today the Equinox?

Whatever day it is, it s a hot day here in La habana. Only people who have been to Tropical Rain forests could understand the heat here. Todavia no es agosto.. and they recall that distant august when the dictator Machado was overthrown..

The departure of the Malagenas was as surreal as it could be. We brough down their luggage which could barely fit into the boot of the car but when the driver closed it and tried to open it, no way, it refused to budge.. all the while a caballo, a policeman on a motorcycle was watching the event with interested eyes. Here two foreigners with two huge bags and two carry on bags, obviously bound for the airport, the car in question is a lada so it being a taxi is out of question, and of course he could have asked awkward questions which would have put all of us on the defensive. But he was watching and didn’t meddle.

The neighbours bought whatever equipment they had and eventually some sat on the boot and moved it in every possible way and finally with the help of the screw driver, was ale to flinch it open. Now the bags had to go into the car rather than th eboot if the same experience confronted them at the airport.. so you can imagine, two spanish girls with their luggage huddling in the back of a Lada and their host sitting in front holding their hand luggage.. it was almost a scene from the movies, but each and every bit of life here is fit enough for the movies.. this is the most surrealist country..

As we were inspecting the car for damages, a friend of mine arrived and off we went to buy a bottle of Havana Cluba Rum.. tell me in which country they sell 50cl bottle of Rum, Anejo Blanco for under three dollars? Not everything is bad in this country..

Made contact with my cuban mother who would be in Montreal for a work related visit next month. My tansient life in various continents mean missing out on other travellers since I cannot be guaranteed to be anywhere except my usual locations scattered around the globe. I would have very much liked to have gone to Montreal and seen her, taken Morgan along, but for more than one reason, I am unable to.

A good friend of mine, whom I had known since my university days in La habana (not as a student but as a professor), and I began talking at around 10 am and we finished around 5 pm so that I can go and say hello to the departing malagenas.

Her son took the destiny which was not his and caught it, and it always comes at price.

She herself has suffered various deviations in her path, her bourgeoisie parents were not expecting a revolution in 1959 that were to change their lives. In her spacious apartment, I could think clearly with my head when I was hungry, perhaps the effect of ketones in my head but after the homecooked lunch, I could no longer think clearly with the head but could feel it in my heart.

The long conversation tired me, being a psychologist among the indians gives me energy but being a psychiatrist to the cubans takes away all my energy. People are between the devil and the deep blue sea, especially if they are venturing out of the ordinary. I will have to return tomorrow to her house to meet a high functionary of the health department as well as true metaphysical poet rebel.

It is 7 pm in Havana and it is still light outside. One full day without email and Internet, and once again disappearing into the lives of the cubans here. The world outside isnt here but we are here disconnected

11 pm. Today it was peaks and valleys with the hunger and eating and feeling drowsy in this heat. Now to retire and sleep

It was good to connect to Baracoa. It is amazing even after an absence of this magnitude, yourself or your imagined self exists in their imagination.

Manha sera outra dia… a nice song by Cesaria Evora comes to mind..

Thinking about my Brothers Yitzhak and Eliyahu...

Cuba Narrative 2

Today is 22^nd June 2009

On June 14^th 2005, I was in the lobby of the Hilton Hotel in Hanoi, having requested the receptionist to page my brother over the PA address:

Dr Hartoch please come to the desk!

I could see my brother and Catherine entering the hall and bewildered by thefact that someone was calling out to them, who knew who would be there, he had a rose in his hand, presumably for my friend Nga. I had writtent to him that, to celebrate his birthday, I would ask my good friend Nga to come and meet him at the lobby of Hilton in Hanoi and that I had sent him a present.

The present was to be myself.

I was in Singapore the day before on the 13^th June 2005, was on my way to Myanmar, but couldn’t pass up on this opportunity for a quick trip to Hanoi, which lasted no more than 24 hours!

Was a memorable birthday for me and my brother..

The day is heating up here in havana today and here I am thinking about all the loved ones. When you are in love with a country and surrounded by likeminded people, the heart naturally turns to those whom you love…

So I send this tender message to the person around whom my world revolves, Morgan in Paris. It is difficult for her to adjust to the many lives of this wandering Jew..

I am quite comfortable with my different lives..

I carry Australian Passport and forever grateful to that country for the wonderful years in Melbourne, on three different epochs of my life: as a student, as an itinerant and lastly as a Medical Doctor. But now, apart from wonderfully pleasure filled visits to friends in Melbourne, the life is not bound to Melbourne nor Australia. Thank God for Qantas!

The most important life is the life in Paris, with which I have some struggles which I hope to solve by the end of this year. If people ask me now, where do you live, I have to say I live in Paris, since that is where my home is..

My life among the American Indians which gives me so much pleasure and more importantly insights into life itself and the strength of innocent friendships that continue year after year.

Cuba is a feast and a envelope of emotions, an intellectual stimulant and a lubricant to my heart. It is so special to me, and it will remain so. And it is nice to pay that homage to this country where I am writing this.

My life in Miami is where I touch the North American life, so it is not fully north american in the sense that it is yet another version of north america. I always wondered whether people who live in North Dakota or Idaho consider Miami part of their country or part of some Banana Republic? As it has been mentioned before. The amalgam of various spanish speakers from vilages around the continent gives a lustre to the city. I have loved Miami from that very first day in August when I arrived there as a student!

Another transient life, which has been made bearable by the clean house at Seri Kembangan in Kuala Lumpur, where I regained my love for Malaysia! In the past seven years of travel in Asia,there have been innumerable visits to Vietnam. Cambodia, India, Malaysia and Singapore and the country closest to my heart in Asia, Myanmar/Burma..Singapore is the least favourite since it is an artificial construction of a nationality , country and people. Malaysia has become dearer to my heart, it is the country that I identify with most in Asia. India is an emotional burden, always happy to leave, always come back for more of that emotional burden ..

Thus here I am revolving around my different worlds. Last weekthis time I was with the Indians, then on to Miami and now in Cuba, next week this time, I would be sitting at my desk at home in Paris.. then New York and then UmonHon and Hocank Indians, back to Miami and on to Paris, few days later to Bangalore and Kuala Lumpur, Phnom Penh to reach the dream.. Yangon and Chaungtha!

People keep on asking me, arent you tired of all this travelling? I always reply, I am waiting for that day to arrive, then I would gracefully sit at my desk and complete reading the various books waiting to be read… but first of all, let me finish this one, Terun Tejpal’s The story of my Assassins…

People come here to fall in love over and over again..

It is not that often in Cuba that I get to converse with tourists who are here for a short while. Every one loves Cuba and the three Spaniards I had dinner with were no different. Long before they left these shores they had become addicted to the sense of cuban attachment. They recount countless stories of how cubans try their best to get their attention so that ini the end cubans get what they want or go after another victim, you do have to be clever not to fall into the schemes of the cubans. I must say that tourists have a sense of how safe is this country and they quite eagerly embrace the cuban practices.

Los Amigos is a very successful enterprise run by black cubans, thus bringing truth to the saying that all cubans when necessary would wrok very hard. Throughout the time we were there, they were busy and at 11 30 pm when we left fresh diners were still coming in.

The menu is not adventurous butis well known, it is well prepared. The salads come presented well but it is the same ingredients once sees at cheap restaurants as well,

When we arrived at 9 30 all tables were occupied and we saw our names under reservations for 10 pm. The living room of the house had been converted into a paladar,where there were three tables wedged together and a corner bar, in the opening on the wall was the communication to the kitchen, on the other side. There was an entrace to another room where there were two other tables ( possibly not allowed but then they an easily shut it off if inspectors were to come, there was a member of the family at entrance watching who is coming and who is going, just to be sure). Very friendly service, there were two servers both very busy. The menu is ordinary but may not be ordinary for a non cuban: bistec uruguayo, pollo canciller may sound strange to spaniards. The salad was totally unimginative. I noticed that the prices have risen, but that is the global trend, but it is only for people in the outside the salaries have increased! Majority of the diners were Cuban, this is something I have noticed. And they were all dressed nicely. In fact it was difficult to distinguish the interior from a café in many a countries. What pleased me more than any thing is that the house is owned by Black Cubans and it is very rarely than you see Black Cubans in this enterprise, you are so used to seeing Black Cubans hustling for a dollar of this economy outside the hotels or at cafes where there are tourists. Good Luck to them.

I wanted to order some fish, but Cari, my friend advised me that with this tremendous heat they were having, it isbound to have an effect on the quality of the fish. Chicken Breast breaded with rice.. salad was nothing more than a few straws of cabbage. Instead of ordering a cuba libre, I decided to make my own, but they had run out of many things, since today was Fathers Day! Ron Anejo Blanco which tasted more like the street rum and a can of Tu Kola.. and I could have a drink or two.

The Bicyclist Miguel from Barcelona ordered a bistec uruguayo, in addition to a salad and a bowl of black beans; so did Cari but without Frijoles Negros, Maria ordered another beef dish and Nuria, both of whom are from Malaga had Pechuga de Pollo. Two cervezas, three bottles of water.. and a couple of hours went by swiftly talking about various experiences in Cuba for them. It was refreshing for me to see Cuba through their fresh and such enthusiastic eyes. Also like tourists, they fill their days up with activities, sightseeing, rushing here and there, and you can see that they are extremely happy to be here in Cuba.

So am I!

Cuba Cleans your heart..provides fire for my love for Paris

To Understand the Love for France … while in Cuba

One of the things I would like to do on this trip is to find out the relationship, inversely or otherwise between the love I hold in my heart for cuba and the love and adjustment and integration I have to do in France.

The official France is very strict and asks mountains of questions, and papers and registrations and witnessing etc. They are very strict about whom they allow to participate in their sacred idea of France. One thing I have to tell you from the begning is that France is willing to accept you, but you must prove your Frenchness, you cannot be a hyphenated French person, you are either French or not French. Currently I am not French, but all there is compelling reasons for me to become French. I don’t mean by nationality, I am quite happy with my Australian nationality, which I have not renounced in all the years I have lived abroad, but to become French in your mind. Intellectually I can understand the concept and accept it, and even would say I am fond of the structures of what Frenchness mean, but the heart has to be spontaneous. I have always felt I have a Cuban heart, and it is always wonderful to hear Cuban ambassadors talking about Cuba as our country , when in conversation with me. I have in every way felt part of the cuban society, culture, intelligentsia.. It is not the reluctance to repeat it in France but it is the deep sadness I have in my heart to give up my Cubanidad. So what I have to do on this visit is to understand the compromises I have to make in Cuba so that I can fall freshly in love with France..

Welcome to Nuestra Isla Rica.. Mi Cuba

It is searingly hot here in Habana. Unrelenting and burning through to your bones.

This morning I left the house of my sister in Miami at 530 am, arriving at Avis Rent A Car at the Miami Airport, to return the car and then a line to check into flights to Nassau, with the usual share of Cuban American Transporters, called Mules because they ferry goods to Cuba for a price. One has to be careful about their friendliness since it has always a motive, sure enough Gema from Marianao said Hello and in the end she asked me whether I could take one of her bags since it would cost her less.I said I would ask the agent who flatly denied it. Lo Siento, I said to Gema, at the same time, this crass materialization of Cuban friendship. Same thing happened as I was standing waiting for the Luggage at Nassau Airport, a cuban man came to say hello and spoke in extremely bad English, the regalia of cuban america..new shoes, gold chains, gold bracelets and gold rings, and Low Class, I will pay you to take one bag for me. I said politely, I have a bag to take and I cannot do any more. I noticed that they both stopped their smiles at me and were no longer interested in asking me questions about Cuba. Since I did have the chance of the ears for the few minutes they were plotting to exploit me, in answer to their question, How is cuba, I answer: the ten years I spent there it was sheer paradise. They want to contradict, these exploiters of the very same country they have fled, but they were in the process of begging me for a favour.. ah well. I am much better off without such friendships. I have felt that th e best Cubans do live inside Cuba!

The immigration and Customs at Nassau was quick so was the check in on Bahamasair to Havana. I was left with over two hours to wait, fortunately I was at the only Bahamian food outlet in the airport (the others are Dunkin Donuts, Wendys, and many candy stores), I could somehow pick up a wireless signal, so I was able to call my friends in Miami and Paris.

Smooth flight, but some bumps as we approached Havana. I was full of trepidation, my love for this island has its foes, some unknown to me (I really don’t care about them), but some from quarters from people wo matter to me.How I can tell them, I need to come to Cuba, it is not an obsession but a Humanitarian need for me.. I laughingly remembered an UmonHon Indian remarking, while everyone is trying to get out, our doctor is trying to get in.

Very quickly through Immigration and Customs in Havana and my friends were waiting. The lady trying to match the luggage tag to luggage spoke in english to me, I said why are you speaking in English to me, she laughs, you look like you are in disguise (desfraze), are you a Hindou or an oriental.. Si, yo soy oriental, pero de Santiago de Cuba, and we laugh..

The drive from the airport to the city. How many many times have I taken this trip? They should give you a special visa, joked my friends. They drove me to the house where I stay and we shared a good cup of coffee, first one of the many to come, I am sure..

It is obvious, I have come back to the land of talkers and social interactions, we were all talking non stop as if we were afraid of a silence, I knew what is the best restaurant in our part of town..it is the torre on top of the Focsa building with its magnificent view of town. I would like to go if I have a chance..

Two Spanish visitors joined us, more chatter, they were from south of spain but still found this heat intolerable. Both have fallen in love with Cuba, one more than once, but this is the usual story. I tell allthose who care to listen to me, when a tourist comes here, whether from Melbourne Australia or Malaga Spain or Moldova.. I can guarantee you, they will love Cuba. In fact it was Pico Iyer who said, when I chatted with him after his presentation in Portland at Powells, Every one falls in love with Cuba… but don’t make the mistake of falling in love with a Cuban… I know what he means and I issue the same warning, for falling in love with a cuban is an expensive business. Cuba is the most expensive country in the world to make a telephone call to! ( Corea del Norte does not count!)..and your chances of falling inlove with a North Korean resident in Pyongyang is slim indeed.. also they don’t dance all that well..

I have been here four hours, I have already made two new friends, saw three good friends I had come to see ( I had come to spend time with five good friends and my mother)..

The dinner would be at the paladar Los Amigos..

What would Life be like in the Moveable Feast which was mine for Years

I am sitting at the Lounge at the Houston Airport. I am on my way to Miami and then on to La Habana. I am looking forward to being back in Havana, alas I cannot return to Baracoa on this visit. What would it be like? My friends are eagerly waiting my return, the affections have not diminished. Like Pablo Neruda says in his poem Exile.. It is I, who has changed.. Malaysia Cambodia Burma all have come into the picture with deep impressions. Paris France has sealed my heart and has put on a claim on it!

But I long for Cuba, the endless afternoons, hot and humid, like the weather I am going to experience..(todavia no es agosto, my cuban mother would say), the endless banter and so reminiscent of my days of innocence which I prolong. As a good friend Roy LLera once said.. just walking along a street in Centro Habana, you have so much to see and experience, not just the faded portals and decaying glory of the buildings..

Pico Iyer once said, Cuba enters your life and clings on. I do not know of any foreigner who has come to Cuba for a visit and has not fallen in love.. and it is a searing love, demanding love and longing and nostalgic and touches at the strings of your heart and tests your competence as a lover and a human being.

This is what I am looking forward to..Which other country puts at your disposal, such an array of intellectuals and fantastic eccentrics and human beings who tattoo themselves into your heart?

Ah well, La Vida realmente es un sueno, as Gracilosa de la Vega once said..

Waiting for MunChing .. as in Waiting for Godot!

The Blue House at the UmonHon Indian Reservation is ready for MunChing..It is raining this morning, so some leaks needs to be fixed, before she comes.. He He! A patient arrived to repair the house and his wife is as fastidious about cleaning the house as MunChing.. may they have a good time talking about Dust and Dirt Elimination..

MiHu will spend some time showing her around the place and take her hiking along the river Missouri. MunChing will be immersed in Indian Culture for one week with occasional outings for something to eat.. perhaps Raspberrys Bistro or Vietnamese Restaurant Cafe Danh or the thai restaurant..No american food in the Blue House, sorry.. there will be a orange juice for her, and of course a nice bottle of Trumpeter Malbec from Argentina for me and MiHu! Mila from Philippines married to an Indian has been notified so pancit with shrimp will be prepared one evening.. and Munching will be exposed native american food which no restaurant ever serves.. Fry Bread, Indian Taco, mushroom soup, corn mush etc.. The highlight would be the PowWow of the Hocank Indians..

WELCOME MUNCHING FROM SERI KEMBANGAN TO THE BLUE HOUSE AT THE RESERVATION OF UMONHON INDIANS..

A Quiet Sunday afternoon at an Indian Reservation

It is very pleasant, this solitude, being alone in the house, surrounded by silence and all windows open and it is verdant all around, with large trees standing guard.

sundays are a good time to catch up on emails from friends.. and that is what i have done.. now to pay a little attention to reading..

I bought some new books just a day or two ago. 

Those who love magical realism, would love to know more about its greatest proponent, Gabriel Garcia Marquez, not its originator, that honour must go to the Cuban, Alejo Carpentier.

An authorized biography has been published just three or so years after the publication of an autobiography..

A fresh and insightful biography about a most popular writer of the 20th century, says one review. The book is by Gerard Martin who spent seventeen years researching thoroughly for this book..

Gabriel Garcia Marquez: A life

I look forward to immersing myself in this book, preferably at the start of a long journey, like the one planned for August from Paris to Bangalore to Kuala Lumpur to Phnom Penh to Yangon and back to Paris...

As an Endocrinologist, a physician specializing in metabolism of the body, I am often asked to discuss the effect of Food in the various aspects of the functioning of the body. I am interested in the prevention of diseases rather than trying to follow the latest trends in the treatment using a wide variety of unproven or not so proven drugs.

so it is nice to combine my interest in human nutrition and literature.. The book is Twinkie, Deconstructed.. the sub title being My journey to discover How tot he Ingredients found in Processed foods are grown, Mined(yes, mined) and manipulated into what american eats.. I plan to condense the important points for the digestion (sorry for the pun) of my patients and colleagues and will put it on www.crossculturalendocrinology.blogspot.com

it is by Steve Ettlinger. Just a simple question to you food mavens? what is polysorbate 60 that makes the taste of icecream in america so different from a cone of icecream from Coppelia in Havana? more to follow..

Bed time reading and the book that accompanies me to toilets and restaurants and airlineslounges is by Tarun Tejpal, whom I consider to be one of the best writers in contemporary India.. This is his seecond book I am reading, the title is  The story of my assassins.. Beautifully written, thus appealing to those with the love of the language and weaving a complex story of his complex country and thus of great interest to travellers to his magical country, it is an eloquent esssay and commentary of the life and society in the most divided of the societies.. I quote a few lines from the book:

Chaaku learned that almost allfo the world lived in colossal and constant fear.Afraid of everything- the police, officials and courts, the thugs, criminals and mafia; afraid of the estalishment and the anti-establishment; afraid of failure and of criticism, of being humiliated and of being mocked, of being ugly and of being bald; afraid of cockroaches and of cats, of the seas and the skies, of lightning and of electricity; afraid fo priests and physicians; afraid of dying  and of living. More than hope, people's lives seemed to be defined by fear. Most hope, it seemed, was only about somehow eign able to negotiate fears successfully. A tiny minority managed to cross the line of fear- of the police and the courts and failure and censure and priess and cockroaches- and this tiny mnority then became the shapers of the world in which the rest lived..

Those of you who do not know Tejapl, he is the founder editor a very influential weekly called Tehelka (see their website) in India, exposing crime and grime while applauding the fluorescence of that society..

Let me go back to my Nespresso and Tejpal...

An Eclectic Day in Paris.. in June

An Eclectic Day in Paris

It is not that often that in a short span of a few hours, you have such a variety of experiences as I had today in Paris. You have to appear a little Exotic, appear Friendly and be approachable.  Looking Pretty Helps!

Social services offered by the State to its citizens is nothing short of INCREDIBLE and would make all the westerners especially Americans from the USA drop their jaws.. Developing Countries should use the French Model, rather than the selfish, aggressive models of other economies.

Health Care does not ONLY mean, access to Doctors, Clinics, modern Technology and the latest medications and investigations. It also includes the social services provided to make the lives of its citizens much more comfortable, and for the unlucky ones, much more tolerable.

The Economist, on its 28 May 2009 issue had an article  Life is Expensive about the health care delivery (should it be called that? In USA?) in USA, giving one solid example, like the many most people have heard or be aware of.

An IBM executive began experiencing pains in the region of his chest, instead of going to a GP or Family Practioner, he refers himself to a Cardiologist (Fee for service system allows this route, in the name of freedom of choice in providers). One week later, he has had many tests, a CT Scan, an angiogram, a stress test, an Echo Cardiogram, a Doppler test of his carotid arteries. At the end of the week, the specialist doctors said: we cant find anything, but here is the bill, $15000. The company doctor, a humble GP, consulted him and asked him some simple questions.. Which the specialists had forgotten to ask in their busy schedules and appointments for invasive procedures. Has your lifestyle changed in any fashion in recent weeks? Yes, the executive answered, I have taken up gardening. The pain in the chest region was due to this unaccustomed stress and it went away quickly..

We are taught in Medical Schools, a good history is important.. But globalization of Medical care and economies have left very little time for such niceties.. And of course, at a tremendous price, which someone or other has to pay..

I went to interview an officer of a private company which works closely with the social services agencies of the Government. The services provided to lower income families were impressive indeed, and the same services are offered to middle and higher income families as well, since a couple in the higher income bracket many need similar social assistance when it comes to health, disease, pregnancy, children, education. The array of services offered to children, nannies, visiting nannies, psychologists, medical doctors at little or no cost were very impressive.. On and on, went the list.

It turned out that the lady explaining these matters, was married to a New Zealander who now lives in Paris. I thought to myself, how many Parisians would be married to New Zealanders? A handful at best, and here I am talking to one without even looking for one. It gave an additional adder to our conversation. NZ was once considered to have the best socialized care, which the progress and globalization has eroded into, and they have fallen off that pedestal.

When I came back to the flat, I was glad to see it spic and span, thanks to the lady from Ivory Coast who had laboured over it. Did you know that in France, if you employ a cleaning lady, the government gives you tax credit? In the end, she is paid well, illegal immigration is reduced and it costs you much less.

On my way back from Burma, I noticed a black spot on the back of my hand, I thought it was a burn, but when it did not go away, and when I became aware of it on my arrival back in France, I thought of Melanoma (the burden of being a doctor) and that our beloved Bob Marley had died of it because he ignored a black mole, saying Black people did not get Melanoma! Within 24 hours I had an appointment to a Dermatologist, with offices just off the Champs Elysses . At the entrance to his office, which like most doctors offices in France are without the flurry of activities of clerks and nurses and receptionists and bill collectors and other odds and ends, you go to a waiting room and then the doctor comes out and leads you to a consulting room, not a cubicle, one of the many in a long, aseptic corridor..

There was a statue which was the typical Buddhist one, the kind in Burma they pray to, before going on a journey, more like a Nat, a spirit. He is the Burmese equivalent of an Ellegua or a Gunpati.. The dermatologist turned out to be a Jew but a deep admirer of Buddha. Made me feel at ease to see Burmese script in golden letters prominently displayed. A nice encounter. We talked in general about the two cultures we held in esteem in common. He looked over my entire skin and assured me of the benign nature, kidded me for being so nervous and prescribed some creams, much more cosmetic ones rather than therapeutic ones, but one including an antifungal one for my nails. The entire pleasant episode of nearly one hour had cost me 90 euros including the medications. If I were French, most of the money would have been refunded or given as tax credit. But I was glad to pay for this service.

On the train home, I took a double take, a man was standing at the entrance, a splitting image of David Gumpilil, the Australian aboriginal actor. I looked at him again, and had he told me he was Australian, I would have no trouble believing. He was also scrutinizing me, and he spoke, in English with a French flourish, are you related to Ravi Shankar? There is a resemblance and I amsure others have told you that before. This, I chuckled to myself, is a by product of looking a little exotic and even more so when you costume yourself with exotic clothing, like a Hmong Jacket or a Kadi Bandar shirt from Bangalore (like the one I was wearing on this day).. I have been told I have a resemblance to Caetano Veloso (this was in Brasil) and to Mahler (something that floored me, but he was Jewish after all!) by no one other than the president of the Mahler society of Malaysia! 

Imagine this scene, if you will. The train is crowded, people are trying to get home, it is about 8 pm in the evening (there is still bright light), they are tired after a long days work and the train is crowded, and this conversation attracts a lot of curious attention and not to mention a few smiles as well. I have heard of Ravi Shankar and admire him for introducing the Sitar to the west, but no one has ever told me I bear a resemblance to him.

Where might you be from? I am from Ille Maurice but have lived in Paris for more than thirty years. We had a very nice chat. I have genuine affection for Australians, he continued, and more than once, Australians have stopped in the streets of Paris to ask me whether I am an Australian aboriginal person. I told him that I had recently read a book, the first of a trilogy, by Amitav Ghosh about the migration of Indian indentured laborers, mainly from the north to the island of Mauritius. While most were from the north, some went from the south as well, as this gentleman’s ancestors may have done. 

I explained a little bit to him about the Todas, Vedas of the southern subcontinent who are racially related to the Australian Aboriginal population and that it might be the reason that he looked Australian! My name is Sookia, he said, do not forget that name, since I am going to call you and invite you to my house for a nice cup of tea. I thought to myself, a very long time ago, someone from the old Madras Presidency (TamilNadou, AndhraPradesh, Karnataka) by the name of Sukkayyah might have migrated to Mauritius.. We will talk about when we met.. 

We got out of the train and we walked together until he had to go in another direction, he said, do not forget, I will be calling you ( I had given him my card, explaining that one of the many telephone numbers is the one to call in France)..

I was thinking of the various interactions so far this afternoon.. A French woman married to a New Zealander, a French Jew devoted to Buddhism, a JUBU, like they are known in the USA ( must get him a copy of Louis Kaminitzers book, The Jew on a lotus, I made a mental note), and now a descendant of a Tamoul labourer to Mauritius now French in his speech and manners..  

I decided to go into the pharmacy to get the creams the doctor had recommended.. I picked up my courage, and asked the pharmacist, where might you be from? Oh I came from Vietnam very long time ago, but I am only one quarter Vietnamese, I am also Cambodian and Chinese.. It was nice to make this new friend, since her pharmacy is very close to where I stay in Paris. And I might visit her pharmacy later for other needs.. And it would be nice to talk a little about Cholon and Saigon; Mekong Delta and Bun Ga Xao and so on..

This was my day.. When I got home, prepared a nice repas for a good friend, born in the island of Corsica to a father from Chicago and a mother who had descended from the aristocracy fleeing Haiti many many years ago..

Ah well, as the poet Pablo Neruda once wrote.. What all happens in the course of a day..

Dont attend too many Educational Conferences..it might not do you any Good!

Incessant Attendances at Conferences and Lack of Knowledge Accrual

I am a Consultant Endocrinologist to some small Clinics at the Indian Health Services of the United States Public Health System (thank God, Indians like the Veterans in the USA have a semblance of Socialized Medical Care!)

But it never ceases to amaze me how often the employees, from the top down, attend meetings, training sessions, educational seminars and the like. And to tell you the truth I have never seen even a small amount of the acquired knowledge filtering through. I was astounded when I learned that a Nurse in one of the small clinics had attended 14 sessions in a period of six months, all paid for by monies of the Indian Health Services! 

A waste of money indeed I thought, the top officials are culpable, since the last meeting I attended at a holiday resort outside Tucson in December 2007 was an absolute waste of time. It looked like some of the top officials of the Indian Health service got together with their friends and wanted to be in that area just before Christmas. The material presented were of no interest, worse still irrelevant and the participants were more interested in shopping just before Christmas than learning anything. I lamented the gross waste of money which could have gone to save some Indians!

So it was very gratifying for me to listen to BBC World Services on 29th May 2009 on my way to the airport to leave the country: they were reiterating all the research  that demonstrates that attendance at conferences with rare exceptions fail to increase knowledge and that most of the information gained is forgotten within a  short period of 7 to 10 hours!

They had didactically studied mechanisms of knowledge accrual and it was something that had been taught to us while we were medical students:  Observe, Practice and Teach.

The four critical paths they identified in knowledge accrual was

Experience

Practice

Remembering

Reflection

And that the knowledge retained well in the following percentage order..

70 per cent of the time it is the experience of actually doing something

20 per cent of the time it is when you learn from others

Only in 10 per cent of the time you learn from attending conferences and educational seminars.

It made me think immediately, many of our workers attend hours and hours of Diabetes care training and I don’t see any improvement in their performances. It is because they had not assimilated the knowledge and nor had any chance to reflect upon it. I had suggested that all people who attend seminars or educational sessions have to give a summary in front of their colleagues what they had learned at the seminars, in this way they would be forced to reflect what they had learned. 

Peer to Peer Education, a concept elucidated and practiced in one of the poorest countries in the world, Cambodia, under the direction of its tireless organizer, Maurtis van der Pelt, is an example of how this form of knowledge accrual is a good model for patient care and welfare and outcome. The fact that they do it at a fraction of the cost of diabetes care in the united states and still have comparable results is truly outstanding.

So it is the method that is important rather than the substance. A professor from Miami coming and talking about the latest innovation to a group of mid level providers leave no impression, but a peer suffering from “Diabetes coming to the slum or suburb where you live and talk to you about his experience of Diabetes is invaluable. In these times of economic insufficiency in the West and other regions ( The Government of Samoa just cut their annual Health Budge by 25 %! Solomon Islands is accused by Amnesty International of neglecting to provide health care to the slum dwellers of Honiara!), this would be a good model to adapt not only in the poorer countries but also in the richer countries. Cuba has taught us that economic difficulties need not stand in the way of providing excellent general medical care to the population as long as the inherent strengths in the society (solidarity, friendship, caring) are made to play a role. American Indian Tribes and their health care systems are an unique opportunities of taking into consideration the social strengths inherent in their culture and employing them for their own benefit. This is much more than the usually touted Cultural Sensitivity, Cultural Competence, Cultural Knowledge etc. It is about the Sufferers to teach the Providers about the Illnesses they suffer from, rather than the current mathematical model, a mechanical idea of cause and effect and treatment and cure.

A wonderful professor in Madurai, India has done studies in the medical community about knowledge accrual and the preferences of the participants. Doctors in India seem to prefer to gain knowledge at small group sessions and discussions rather than attending large conferences. American Indian patients much prefer learning about their diseases at a one to one level and in an ambience of cultural sensitivity. Peer to Peer Education was highlighted by the Team Up Educational events held by the HoCank Diabetes Programme in rural Nebraska where patients suffering from Diabetes were educated in small groups and they learned from each other. As one participant put it: We have been given diabetes education numerous times before, but have never received it until now. It is interesting to note that every one who attends those peer to peer sessions becomes knowledgeable to look after their illnesses and the laboratory measurements demonstrate that.

So in poorer countries, in poorer communities in richer countries, the care for diabetes is not to follow the technological pattern of care provided in richer countries. There is a tendency in the poorer countries, I noticed that in Jamaica, where the doctors try and practice Medicine as if they are living in a richer country, mainly going from a human approach to a technical, mechanical approach. But there was no money and there is no money and there is no sight of it in the future.. In the budgets of these struggling economies.

Peer to Peer Care takes into account the strengths of the communities, which will be determined by the culture of the participants, there is no need for direction from outsiders ignorant of the inherent cultural strengths. and can be independent of Governments and organized health services

If you are interested in knowing more about Peer to Peer Medical Care for Chronic Conditions in your community, please do get in touch. I will facilitate that for you with the help of some eminent friends..

PS  In some very poor countries, notably in India and Cambodia, the doctors and providers are paid to attend these meetings, with drug companies picking up the tabs for their transportation, hotel accomodation and a stipend! Think about the Ethical implications of this..