lundi 31 décembre 2012

WHEREVER I AM, MY HEART IS ALWAYS IN CUBA FELIZ ANO 2013

During the course of a calendar year, I get to celebrate many NEW YEAR celebrations, either directly or indirectly:
The most important for us at a personal level is the Jewish New Year or Rosh Hashonnah. 
in 2013 it would occur on the evening of September 4, 2013.
I can never predict where I would be, but this year I hope I will be celebrating it somewhere new!
Chinese New Year will be celebrated by my friends in Malaysia, Singapour and Indonesia as well as elsewhere...it falls on February 10th.
Happy Tet to all my Viet friends in Vietnam and Viet Khieu
Then there is the Burmese New year which is buoyant with their new hope for their democratic country! Once I spent Pesach in Siem Reap which coincided with the Khmer New Year..
The Traditional Kickapoo celebrate their New Year in February, usually no outsider is invited!
The Hocank, UmonHon and Meskwakia all celebrate a full moon festival, coinciding with the harvest in July and August.. I am usually present at one of those..
The golden era of celebrating New Years for me was in Baracoa where I made it a point to be present and watch the sun rise over the hills on the first day of the year..
I have also spent New Years in Cochin, Merida, Miami, Kingston, London, Firenze, Melbourne, Brisbane among others...
It is a nice exercise for memory to remember the various new year celebrations and wonder...
Whatever happened to those wonderful friends with whom you had celebrated those days?
In Guyaquil, Ecuador?
in the Blue Mountains of Jamaica?
in Iquitos, Peru?
in Suva, Fiji?

ah.. well..La Di Da..

It is a nice day here in Paris, the high is predicted to be 10 C
in La Habana it would be a sunny day with a temperature of 26 C

vendredi 28 décembre 2012

PEER TO PEER EDUCATION IN DIABETES: MOPOTSYO OF CAMBODIA


In Praise of Peer to Peer Education Network in Cambodia and its director Maurits van Pelt

 (on the third month of treatment, the blood sugar has become normalized!) Consistency, welcoming and caring approach, solidarity with the patient, lack of hierarchy all contribute to the success)



 (which Doctor in the western world wouldnt like a patient like this: Blood Sugars during one month: 93, 110, 96, 126 mg/dl taken around the same time of the morning; Blood Pressure of 95/66, 118/83, 123/78, 133/89. These are actual patients under treatment)
 (yet another popular Peer Education session in place, the time is 7 AM!)

In Praise of Peer to Peer Education Network in Cambodia and its director Maurits van der Pelt

(medications charted in the personal log)
When I was living in Jamaica, running rural clinics targeting poor people with Diabetes and Hypertension, I became aware of the “ politics of International Aid” and the local actors, who were truly actors in professional clothing, benefitted most.  Attending conferences and training workshop saw them filling the First Class sections of Air Jamaica flights.
I decided to investigate a Swedish grant of sizable amount, to empower women in the countryside, and tracked the expenses and the outcome. I came across a group of people, with no great expertise in that field but chose to attend conferences in Budapest and Alabama and had invited “foreign experts from Sweden” (which is usually a part of the aid deal) who had produced some glossy publication. It was difficult to find what happened to that grant, but with the help of some conscientious civil servants, I found out that the final result of those thousands of dollars was this: Two families were helped to become independent by making bammies. Bammies are a Jamaican cassava bread of indigenous origin, the making of which is a common knowledge among the rural people.
Erudite scholars of International Relations, from Argentina to Germany to Sweden, had cried out against the Elite to Elite transfer of technology, knowledge and cash which was later used against the poor to whom the aid was intended
UKAID Department for International Development  DFID had stated that governance is important in delivering of the aid effectively.
Evidence shows that in order to deliver sustainable international development we must be able to understand and work with its politics.
SOMETHING VERY SIMILAR IS HAPPENING IN THE FIELD OF DELIVERING CARE FOR PATIENTS WITH TYPE 2 DIABETES AROUND THE WORLD, ESPECIALLY THE DEVELOPING NATIONS, WHETHER RICHER AS IN MALAYSIA OR POORER AS IN JAMAICA.
Humble entrance to the poor area and the home where the MOPOTSYO peer education is held
 Cambodia is a poor country, so may not have the latest technology. No technology can replace human warmth and concern.
 Maurits with some of the participants at the MoPoTsyo Peer Education Network
 A Happy Peer Educator in front of her home... Patients arrive at 6 am and by 8 30 am they have all left for work! so that she can rest and reflect on that morning's work and plan.

Those professors from the West and their cronies, these charlatans, aggrandized themselves collecting information like a child does stamps and proudly displaying them in multitudes of articles. What has happened to Nauru (known through their publications to have the highest rate of Diabetes Type 2), but the locals are left to suffer after the charlatans have left with their tents and red carpets. A new breed of locally grown began making appearances benefiting because of their acquaintance with the Gang of Charlatans at International Meetings in their well-pressed suits. They too began writing publishing grandiose plans to save the planet of the “impending epidemic” of obesity, Diabetes etc. Their initial papers were received with thunderous applause by the likeminded, but what happened to these programmes, which were touted as the cure for this “epidemic”?
I became interested in the Peer-to-Peer Education Programme after listening to Maurits van der Pelt, its director at a meeting in Phnom Penh, Cambodia in 2008. From the beginning I had the intuition that here is a method of providing Humanitarian Medical Care in a responsible, culturally sensitive fashion without embellishing ones own curriculum or pockets.
There were many articles throughout the world, talking about the Peer Education programmes, most of which was modelled after the Biomedical paradigm, as a an auxiliary to feed into the existing system, rather than an independent system which would co exist with the current approach (which has failed the patient both in the west and the east if we are to go by the rates of Diabetes Control around the world!).
All had glorious intention, and promised a great deal and within a year or two they all fizzled out but they did get a paper or two published.
Why is the Peer Education Network MoPoTsyo of Cambodia important?
You can follow the track record of the PEN and you can see that it is
Producing good results (in fact comparable to the practices in the west) at an incredible affordable price, less than about 120 dollars per year per patient
And Expanding to other provinces than its origin and increasing the services provided to hundreds more of the poor.
You can read the highlights at

The relevance of MoPoTsyo has never before been acute as it is now. Within two days I read two publications, one from the USA and another from Malaysia:
1.   Primary Care Providers are not capable or have interest to provide counselling in the prevention and treatment of Obesity and thus Type 2 Diabetes as well. This study from the USA.
Bleich SN,Bennett WL, Gudzune KA, et al. National survey of US primary care physicians’perspectives about causes of obesity and solutions to improve care. BMJ Open 2012;2:e001871.doi:10.1136/bmjopen-2012-

001871
2.   High percentages of  medical encounters at the Public Health Clinics in Malaysia are bound to end up in errors dangerous enough for the patient. Most of these errors are preventable.
Results
The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable.
Conclusions
The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors.
Research article
Medical errors in primary care clinics -- a cross sectional study
Khoo E, Lee W, Sararaks S, Abdul Samad A, Liew S, Cheong A, Ibrahim M, Su SH, Mohd Hanafiah A, Maskon K, Ismail R, Hamid MA
BMC Family Practice 2012, 13:127 (26 December 2012)


In light of these things, one admires MoPoTsyo and its Peer Educators (many of whom I know personally and have observed them at work) more. A group of interested citizens of Sentul City, West Jawa is interested in establishing a Peer Education Network, at a very small scale at first to look at and aid in the prevention of Obesity (BMI of over 22 Kg/M2), Diabetes and Hypertension. Mo Po Tsyo would certainly be our model.

It is good to keep in mind that, those of us who have seen it first hand, that the private medical care in the low and middle income countries are not in better shape!

Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients.

 Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D (2012) Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review. PLoS Med 9(6): e1001244. doi:10.1371/journal.pmed.1001244
 The friendly accomodating Chief Peer Educator of Cambodia 
One observation which is important: can you tell the Peer Educators from the patients?  This solidarity accounts partly for the success of the programme. Ignore the two foreigners!

mercredi 26 décembre 2012

THE PREVENTION OF DIABETES, HYPERTENSION AND OBESITY IN INDONESIA


THE PREVENTION OF DIABETES, HYPERTENSION AND OBESITY IN INDONESIA: THE SENTUL HEALTHY HAPPY LIVING
Indonesia shares two major characteristics with its neighbours in South East Asia. One is the Economic Prosperity and Democracy since the fall of the Dictators and secondly, is the galloping rate of Diabetes and Hypertension in the country.
This multicultural archipelago, united politically with Bahasa Indonesia as its national Language, has a population of 238 million souls, half of whom are under the age of 20 years.
Conservative estimates put the prevalence of Diabetes at 7 million of the 119 million adults over the age of 20 (i.e., one in sixteen adults) and Prevalence of Pre Diabetes at 17 million (i.e., one in 7 adults). If nothing is done, you can expect most of the 17 million to progress towards Diabetes.
In the densely populated island of Jawa where the capital of Jakarta is located, studies previously had shown a low prevalence of Diabetes
1982    1.6%
1992     5.7%
In a study published in 2006, the prevalence of Diabetes in Jakarta was 12.4% (double the rate ten years previously) and the rate of Pre Diabetes was 30 % (a staggering one in three resident of Jakarta!).
If you think the high prevalence in Jakarta may be due to its industrialization and rapid westernization, I was surprised to read a study from Ternate (another one of those magical names from Indonesia, like Bogor, Bandung.), a historically important but currently a far away island where the prevalence was found to be 19.6%.
I will not speculate the aetiology for such high and rising prevalence of Type 2 Diabetes in Indonesia. I have noticed that foreign experts are almost always wrong since they bring their own ideas of aetiology of a disease, such as I noticed in Cambodia, where one foreigner suggested it is because of the Hindu Admixture of the Khmer and another Australian expert had no doubt it was due to eating rice, which the Khmer have been doing for about 2000 years?
As someone who has worked with Indigenous populations, it is not enough, like many Diabetes epidemiologists from Australia and UK have gone around the world, collecting stamps of the islands and proclaiming high prevalence of diabetes. As Native people would ask: we are sick and tired of you foreigners telling us we have high prevalence of diabetes, but can you tell us how to combat it. Then the foreign ambassadors of stealth capitalism would declare the useless mantra: exercise more, and eat healthy, change your lifestyle.

What can we do about the rising prevalence of Type 2 DM in Indonesia?
First of all,
Find a group of people who are also interested in this health project.
I am lucky to have become friends with PJ in Bogor and his Sentul Healthy Happy Living Group.
Then ask them, how I can help them, not dictating what is to be done, but how can I assist in what they want to do.
What is their philosophy?
PJ Philosophy:
A healthy body exists in a Happy Body
Mind has to change before Body will follow with good health.
What is the ultimate aim?
The good sensation of Well-being.
Who is the target group?
Friends and Staff and their families.
Economically less fortunate members of the society, who are interested in:
Prevention of Diabetes, Hypertension and Obesity
Treatment of Diabetes, Hypertension and Obesity buy using a Peer-to-Peer Education Network model, highly successful in Phnom Penh, Cambodia.
This is the idea for 2013, my contribution to Indonesia. It would be nice to be successful in this programme.
 (they dont even get out of their large cars to get their fat laden Frappucino)
(Pizza Hut and KFC are owned by the same corporation, and you can see them all at any mall or a stop in the highway)

What was heartening was a study published by Prof. Soewondo from University of Indonesia.
Controlling Blood Pressure has a protective effect on Diabetes, if the Indonesians decreased their waistline a little bit, their chance of getting Diabetes is lower and Of course, whether you want to get Diabetes or not, stoping to smoke or not smoking at all is a very healthy idea.

Prevention of Diabetes fits in well with the Philosophy of Sentul Healthy Happy Living. The following could be done to prevent 
Diabetes and High Blood Pressure:

Become Physically Active. We invite you to join us in the morning at Sentul Lake and You would see how quickly you become healthy: activity as well as socializing and stress reduction.
Do not eat Greasy Foods, and control your sweet food consumption
If your blood pressure is higher than 120/70, then try to bring it down by regular exercise.

You must do exercise to get your body in shape rather than thinking of loosing weight. Once you incorporate exercise (walking, stretching, jogging and breathing exercises) into your routine, you will begin to notice a soft addiction wanting to exercise. Slowly you would notice that your energy level increases, your breathing capacity changes and after three months you are able to jog and then at the end of another three months you will begin to notice a change in your body, with the central part of your body becoming firmer.

Mind Body Time Management
if you say to yourself: I dont have time, then ask yourself, what do you have time for?
Good Luck and Welcome to Sentul Healthy Happy Living..

dimanche 23 décembre 2012

UNEXPECTED PLEASURES IN PARIS OF JAWA: BANDOENG


UNEXPECTED PLEASURES IN PARIS OF JAWA AND MEMORIES OF THE MAGIC OF BANDOENG
On a good day, without the perennial traffic jams Indonesia is famous for, you can reach Bandung from Bogor in about 3 hours, I was advised. I was entrusted to the care of WoWo, on instructions from my good friend PJ. WoWo turned out to be more like a guardian: Driver, Guide, and purveyor of Food. After a brief stop at a roadside Starbucks, we reached Bandung in less than 2 ½ hours.


I had planned to look the remaining Dutch colonial architecture and I was not disappointed. There were many of them, most of them in good shape, some of them turned into government building, such as the Satay Building.
Bandung like Bogor are words from my childhood, I scratched my head for memories and I realized that I had heard it from my father, who knew the history of this region, mention it in relation to some of the giants of the political scene of that time, Nehru of India and Nasser of Egypt, to whom he bore a resemblance.
I remembered clearly now, once while visiting him in Kuala Belait, he mentioning about the 1954 conference of African and Asian states which was to become the Non Aligned Movement, organized by Soekarno.
Over the years the august body deteriorated in its ideals, its current head is nothing like a non-aligned state to look up to: Islamic Republic of Iran!
But this visit was so very satisfying. The first stop was of course at the African Asian Centre which might have looked grand in 1954 but the museum and the hotel nearby which still stands which may have accommodated the leaders stand as withered metaphors for the grandiose ideas of these western educated leaders who exploited local ignorant nationalistic fires and turned their countries into poor, corrupt and back ward nations.
Soekarno and the Chinese hating Suharto are not remembered and now Indonesia ranks just below China in its rapid growth and economic potential, but with a huge population of 243 million people stretching out from the Sharia-crazy Bandar Aceh (you can expect it to become the least developed part of Indonesia soon, as they are more interested in hijabs and prayers than human development) to the other extreme ending in Papua, covering multitudes of islands, volcanoes and languages and cultures!
It is a magnificent country, the most diverse in all of SE Asia. How lucky am I to have known SEAsian gems like Cambodia, Myanmar, Malaysia and Indonesia!
Braga Street gives you a glimpse of the past. Old cafes have been turned into art galleries but there are enough to remind you of the grandeur of the café and intellectual culture of Bandoeng of yesteryears.
A Kopi Tiam, Koffehuis Oey takes you back to the era of the Kapitans, the Chinese gentlemen of wealth, industry and influence; very much like the Baba culture of Malacca, who built homes faithful to their ancestors, maintained their original culture but mixed extensively with the new. There were many coffee bars still with the flavour of the Dutch clinging on to them.
While walking along the street, we were approached by a group of young girls attending a local Muslim school and I have chronicled that experience in an earlier blog
Encounters with the Enchanted

Certainly that was the highlight of the visit. Visited the Campus of ITB where Soekarno was once a student. Felt the very refreshing atmosphere of this university where the university students walked with pride and confidence and also a sense of unity.
While looking through an Indonesian Book Store, I was introduced to the Term Hijabbers. Like in Iran, Hijab, even though not compulsory outside Aceh, has now become a fashion item and I saw multitudes of books on how to look sexy, romantic, confidant etc. in a hijab!  Good on you, Indonesia! There were books on Wedding Hijab and also fashion models sporting hijabs of various types. So Hijab has become a fashion item rather than a proclamation of faith or even more importantly an item to separate one group of people from the next.
The meal at Kopi Tiam Oey was sumptuous and it was time to leave, within 2 hours 15 minutes we were back in Bogor!