samedi 28 avril 2012

PEER EDUCATION AND PREVENTION OF DIABETES AMONG THE INDIANS


PEER-TO-PEER P2P EDUCATION AMONG CHEYENNE RIVER LAKOTA INDIANS

I have just spent five full days at the Youth Diabetes Prevention Programme, under the guidance of MS M Walking Elk. The days flew past, despite it being long days from 6 am wake up to 12 midnight going to sleep. But each day was exciting and extremely satisfying.
I had just been with Maurits van Pelt and Rin the Primary Peer Educator of the Programme, MoPoTsyo Education in Phnom Penh, Cambodia. I realized that what Ms MWE and her staff of dedicated local people were doing was just that, Peer-to-Peer Education. So I concentrated on this visit, on the education and learning experience of the Peers, in this case Lifestyle Guides for the Indian children. On the last day, a Friday when the bright weather had changed into windy and rainy, I gave an anthropological opinion of our experience together.
Seven out of Ten children and their families have made some sort of changes that would be reflected in the body measurements, most welcomingly the decrease in body fat percentage!
In the article I had mentioned in the previous blog citing a study from the Harvard University, which credits the social factors and interventions for the reduction of childhood obesity in Massachusetts.
I could honestly say about Youth Diabetes Prevention Programme of the Lakota at Cheyenne River, the following, regarding the right direction of the outcome of their hard work:
Good Management of the Staff by Ms MWE. Each member of the staff has a unique personality but they blend in well together and produce what is promised.
The Staff members feel  a sense of freedom
The staff was carefully chosen for their dedication to the objective, which is the continuing good health into the future of the Indian Children. They were very eager and keen to learn more things and asked questions for which I had to prepare answers each night.
The Peer Educator, called the Outreach Worker, was from the community they were serving and new the target population very well. This is a spread out reservation and distances are large.
I thoroughly enjoyed my days with the Cheyenne River Lakota and I bid adieu to them, knowing well that they will be in my heart in the days to come: regardless of where I would be, Indonesia, Cambodia, France or Cuba!
MERCI BEAUCOUP, MES AMIS LAKOTA!


mercredi 25 avril 2012

Poverty is the Obstacle for Prevention of Obesity in the USA and other richer countries




POVERTY IS THE OBSTACLE FOR REDUCTION OF CHILDHOOD OBESITY. IN USA AND OTHER RICHER COUNTRIES

I am closely involved with several Indigenous groups in their effort to combat Obesity in the Young. Things in common for the Indigenous People living and trying to maintain their culture amidst Immigrants from Europe, Africa and Asia, are:
Threats to their efforts to maintain Culture and Religion
The Food Deserts they are allocated to live in, where healthy food is not available.
Disparities in social life: Income, lack of respect from the Immigrants and their descendants.

For years, I have felt that Obesity (as well as Diabetes) among the Indigenous peoples are Social in nature and that a western, science oriented approach will not solve this problem.

Despite the increasing number of Nutritionists and others involved, childhood obesity as well as adolescent obesity as well as adult obesity have only climbed steeply.



So it was so heartening to read an article published today on line, 23 April 2012.trumpeting that at least in one state in the USA, the rate of obesity among the children was dropping. In one of the wealthiest states, Massachusetts, the childhood obesity has been decreasing. (Pediatrics, the official journals of American Association of Pediatrics, the authors are from the Harvard Medical School).

Two Points from the article stands out:
A.  Even though there has been a decrease in Obesity among the Young, the same privilege did not extend to poor people.
B.  From their research, they couldn't determine why such a drop in the rate of obesity had occurred: they suspected the following SOCIAL factors might have played a role.
1.  Decreased Maternal Smoking
2.  Increased rate of Breast Feeding
3.  More limited TV advertising of sweet foods to young children
4.  Greater awareness of Childhood Obesity
Strangely enough, the poor had no access to good food, good nutritional counseling or medical care.
One instance I know is that the Gov. Assistance vouchers encourages them to buy Juice that is loaded with Sugar and Carbohydrates, but in general there is very little socially conscious nutritional counseling that easily available to the poor in the USA.
I am currently with a group of Indigenous people with wonderful spiritual connection in the middle of a State that most Americans have not visited, the nearest town is 100 miles away and the nearest small city is 160 miles away. There is one supermarket in town; even the corporate giants of Junk Food, such as McDo or Burger King have a branch here, because of the isolation. The supermarket is the main source of food.
As Michael Pollan had said, shop along the periphery not the central part of the supermarket since healthier items tend to be on the periphery.
Here, apart from part of a wall with some withering fruits and vegetables, the periphery was loaded with the same, chemical food, food that is preserved, plasticized, in fact they were mostly “Food Substitutes”
And some incongruity as well, banana chips made in Philippines, Add water to make Smoothies made in Turkey, and highly priced sports and juice drinks. It was very interesting to note that most of the “healthier items” were priced beyond the means of an average resident of this place, one of the poorest counties in the USA, with an average annual income of 7400 Dollars (poverty level is at 24000 Dollars for a family of four).
POOREST COUNTIES IN THE USA

There were thousands of items in the shelves of the supermarket, I inspected about 200 items and was getting depressed towards the end, as I could find only FOURTEEN items that I could honestly recommend to friends and relatives! And to those who seek counsel. (That is SEVEN OUT OFA HUNDRED)
I am listing the fourteen of the 200 I inspected yesterday afternoon… and I don't doubt that the ratio of the rest of the supermarket would be any better. In an inspection of food items in two poor areas of the USA, where the indigenous go to shop, the ratio was pretty much the same, but those being less isolated had greater choice of fruit and vegetables, but still 8/10 items were not conducive to good health.
I told my coworkers who were with me, that in fact, we were choosing between Bad Food and Worse Food!

Del Monte Fruit Naturals
Calvo Guacamole  
Hendrickson’s Oil and Vinegar
C and H dark brown sugar
Crystal Brown Sugar
Shure Fine Olive Oil (of all the food items from this cheap producer, this is the only one. I would avoid them)
Post Raisin Bran
Post Shredded Wheat
(Kellogg’s had unwanted ingredients)
Crystal Farms Cheese
Daisy Sour cream
Earth Grains 12 grains Bread
Sara Lee 12 grain Bread (avoid any other bread from Sara Lee)
Chobani Greek Yogurt (avoid Yoplait which may be dangerous to your health, also Activia)
Tofu

In general, well-known brand names were of lesser quality, had unwanted ingredients or were calorie dense (Uncle Ben’s Rice).

As an easy code to remember, I told them:

AVOID FOOD ITEMS THAT CONTAINS DESCRIPTIONS OF INGREDIENTS:
HIGH.
LOW…
UN..
NON..
HYDROGENATED…
NATURAL
ORIGINAL

I also found the following book very helpful for counselors and their indigenous clients.
EAT THIS, NOT THAT
BY DAVID ZINCZENKO
It is a helpful guide to the supermarket shopping and also has lots of myth busting nutritional advice.
All staff working with me will have a copy of the book with them and they can familiarize with the items described in the book and also the various Fast Food place and the choices there …

As we were leaving the supermarket very close to where one would pay the cashier.  .
Was
DELI EXPRESS MUFFIN that would take the cake even in this country where so much bad food is available:  a whopping 640 calories for one single small muffin!
IT WOULD TAKE ONE WHOLE HOUR SERIOUS EXERCISING ON BIKE OR ON A FOOTBALL FIELD TO BURN OFF THAT SMALL MUFFIN….


SO, What did I have for lunch today?
One of the staff members had prepared wild elk and wild rice with onions and mushroom..  Thank You..




dimanche 22 avril 2012

Omar Khayyam, The Sky and South Dakota


That inverted Bowl we call The Sky; Whereunder crawling coop’d we live and die.
The Rubáiyát of Omar Khayyam
In less than 24 hours, I have gone from one part of this blue sky (e) to another... as i was driving through the scenery with a horizon drawing your attention away from your soul, I remembered the verse of Omar Khayyam.. The Blue Sky was certainly like a perfect dome of an inverted bowl..
After welcoming the Nespresso, seeing some painted toes, it was a pleasant american resto, in the refurbished part of a town which had known better time and fame.. blackened salmon.. A drinkable red that loosens ones mind, and brings articulation to the emotions.. Very Pleasant..


As I entered the usual hotel for the nights sleep before catching an early flight, the front desk clerk whom I have never seen before says, I have the special room for you... Yes I can enjoy the Jacuzzi tonight to let the Pinot Noir evaporate through the pores of the skin..Unable to sleep more than three or four hours, up again and back to the airport and then to Denver, a clear day, a nice day to fly, snow capped mountains..
The West begins here.. all of a sudden a change in the ambience.. A short flight takes you over the mountains on to the plains with small hills and soon Rapid City welcomes you. Friendly people, but something incongruous here, the cultural diversity has an artificial tone to it. Asian adolescents with punk haircuts. Young white men with tattoos...amidst this the Indian walks around, lost in his own land..
A "Mongolian Grill" manned by mexicans, thai and vietnamese... you can at least choose what you are eating... My curls needed a trim, walked into a salon in the Rushmore mall and a grim looking lady did a decent job of shortening the hair and giving it a little order...
Three hours of driving through silence of the immense spaces, dotted with small towns, Red Owl, Dupree, Faith, City Centre... some no more than a sign post.. hardly any traffic or signs of human habitation..
Eagerly arrive at the Reservation of the Lakota at Eagle Butte... The Indian clerk at the front desk looks at me indifferently and hands me a key.. a nice room with refrigerator and a microwave.. living in style in the Reservation!
I am looking forward to my week here with the Lakota...

jeudi 19 avril 2012

Noite de Saudade


A NIGHT FULL OF SAUDADE
When did that word enter my vocabulary?
Saudade.. Long before Cesaria Evora sang Sodade in 1994.
An unbridled sensation of nostalgia, mixed with a tenderness in which you feel you are in love with the world, and that you want that tenderness to spread to every one you know…
I am in one such moment.


I am with American Indians. As I was about to leave, JLP comes in, in his hands two photographs of me, with long hair taken the year I had begun to come here…. Once a month, rain or shine or snow…this loyalty has paid off, people now think of me not as a stranger who lives in far away lands but a member of the family who goes and comes back.
You must love us, because you come back, month after month…
You arrive back to the blue house where you are staying; the cold night is approaching, and the sensation that you had done something for others. A sacrifice for other people, they return their thanks mixed with their smiles.

I open the door; pour myself a glass of Sauvignon Blanc from Aoetearoa, that long white cloud of a land in our south…
Think of all those I love, starting with the little ones. How I wish Miss Ruby were here. Calling me Oncle Oncle.
Grateful for Paris, Grateful for Hocank and UmonHon Indians, and the Lakota whom I would visit next week…
This nostalgia is a combination of love and affection that you have in your life, and the sudden desire to poses them knowing it is far away…
I had Caspian Caviar with a nice bottle of Cabernet Sauvignon from Oz just recently at Le Rits, in Phnom Penh.
The names of the cities roll of your tongue without difficulty, who was holding my hands in that resto in Palermo, in that distant land that produces a good drop of Malbec? Was it only yesterday or was it years ago?
I listened to Enrico Macias, born Gaston Ghranassia in Constantine, Algeria to where his Andalusian Jewish ancestors had been exiled in 1492. Jewish music that survives as Chaabi in among the Berbers of North Africa. Ya Rayah. A popular song indeed, sung by that great Dahmane El Harrachi but popularized by Enrico Macias. Longing for his land, visa denied because he is Jew who also loves Israel…
Yasmin Levy whose father was the editor of aki yerushalayim , the ladino newspaper from Israel, who sings very haunting Judeo-Spanish songs of the Middle Ages.
I listen to them one by one, and as always a song by my all time favourite, Cesaria Evora.

Dear friends and other lovers, thanks for being here with me, as I write this full of love for all of you.

Soheil nafisi, Ahmed Shamlou. what a great poet. How does he conjure up such images?
A nice day among the Indians, content to be a Jew, content to be a lover to my friends, content to be a human being away from the commercialism of profit and losses.
My first visit to Jakarta begins in just a few days. Do you remember, Multatali? Pramoedya Ananta Toer?
Ah well I am traveling to their lands.

Gracias, mis amigos, muito obrigado...

mercredi 18 avril 2012

ET TU, BRUT US



ET TU, BRUT US (A)

Endocrine Society says FDA excludes critical research in decision-making on BPA use in food packaging
Chevy Chase, MD— The Endocrine Society, the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology, expressed disappointment today in the U.S. Food and Drug Administration (FDA) for neglecting key research and endocrine principles in deciding not to ban BPA in food packaging.
BPA is a known endocrine-disrupting chemical (EDC). EDCs are substances in the environment that interfere with hormone action resulting in adverse developmental, reproductive, neurological and immune effects in both humans and wildlife. Many of these chemicals are designed, produced and marketed largely for specific industrial purposes, but they are also found in some natural foods and may become further concentrated as foods are processed.
In 2011,
 China banned companies from manufacturing,
 importing or selling baby bottles that contain bisphenol 
A (BPA), a potentially dangerous chemical routinely 
added to everyday plastic products.
China joins Canada, France, Denmark and the European Union in recognizing that this chemical is linked to a number of harmful health effects like breast cancer, heart disease, obesity, hyperactivity and other disorders.
Unfortunately, BPA is still routinely used in hundreds of consumer products sold in the United States.
BPA became widely used in the manufacturing of plastics in the 1950s. Today, in addition to plastics, The chemical is used in countless consumer products, including the lining of canned food containers, cigarette filters, dental sealants, certain medical devices and the coating of the paper on cash register receipts. Recent studies have found that BPA leaches into canned foods -- particularly green beans -- from the lining of the can.
 Sometime I wonder, whether the agencies in charge of regulation is regulating safety or profit in the USA.. it is a pity it is applied to HEALTH care. If you are interested in PROFIT ( as in Corporations, or  Private Practice of Medicine for Profit), then the health of the patient is not as important as it is a source of income for you.
A cunning lawyer in Austin, Texas once told me, he advises his doctor clients: Cling on to your patients with Chronic Diseases, your financial status would be fine!
How awful...
Let us think of the Great Physicians of the past, such as Rabbi Moses ben Maimon also known as Maimonides
"The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthroply could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
May I never see in the patient anything but a fellow creature in pain.
Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocationand now I turn unto my calling."



mardi 17 avril 2012

WELCOME TO OMAHA AND SOME DEAR FRIENDS

I left home, in Paris at 0610 on a Monday and arrived at the hotel near the airport in Omaha at 12 10 am, ie 25 hours later..
Most people abroad has never heard of Omaha but many of them recognize it when I mention Warren Buffet (today he was mentioned as having some medical problem, Good Luck to him).. oh, that is where he lives!
But Omaha is the name of the tribe that lived in these parts for many centuries..and the name of the state also a geographical description of this area in their own language..
so how nice to hear this ancient tongue coming out of the mouth of a 2 year old! I taught her to say Sawadee to the Thai Chef at the Resto we had lunch today and she dabbled in some Thai Food!
And this is truly a land of very friendly people! native or recent or earlier migrants! The Thai Chef invited me to come to Songkran celebrations to be held in a park..I didnt have the heart to tell her that I dont live here..
Earlier I had gone to the Marshalls Store in Omaha. I had bought a suitcase on my last visit here one month ago but as it often happens in long trips, the zipper had been broken. the manager with a happy smile on her face was only happy to assist in exchanging the damaged goods. and the Sales Assistant had a smile to light up and drive any sad thoughts!  Americans are friendly and more so to a foreigner!  Thank you for your kindness...
Happy to be here, among the Indians for the next two weeks... to arrive at another level of interaction, more human than most, more child like than most....
Few minutes with the Indians, and the fatigue of long travels vaporize.. I am honoured that they allow me to come, rain or snow, to see them and look after them... year after year... Estoy agradecido!

dimanche 15 avril 2012

THE PROPHET OF PENANG

 During one of my early regular visits to the Far East, in 2004, I crossed over by bus to Johor Bahru, where memories of a distant night when I witnessed snake charmers and liver oil peddlers, drew me.
I was happy to see the religious co existence of various denominations, with their temples dominating the skyline. The Hindou temple was having a book sale.
That is where the title
TOXICS IN PLASTICS  caught my eye. I devoured the books of Consumer Association of Penang's books being sold there and was convinced in 2004 that Idris Mohammed who was the director and still is of CAP was a visionary. I used these materials to give a talk in the USA in 2005 and every one laughed at the thought that Plastics could be dangerous as they sucked their "healthy" water in cheap plastic bottles!
I was lucky in 2008, with my good friend MunChing, to visit Idris Mohammed and felt as sort of intellectual spirituality emanating from him. This guy is a prophet, I felt, and I cling on to that belief to this day. I tirelessly talk about chemicals, real things in soft drinks, the plastics and BPA and its dangers, the various phthalates in our environment and food..
If you wait long enough, the science would prove your convictions, as long as they are pure...
so imagine my satisfaction this weekend when I read in scientific journals and given wide publicity.. the following:
DIABETES LINKED TO PHTHALATES  published on line April 12, 2012 in Diabetes Care!
People who had higher levels of Phthalates in their blood, had greater chance of suffering from Type 2 Diabetes!
Thank you for your guidance, the Prophet of Penang, Mr idris Mohammed. Yet another star of congratulations in your skies!







Medical Anthropology in Paris The Cuban Connection


Medical Anthropology in Paris- The Cuban Connection

Soon after graduating from the Medical Anthropology programme in London, I was requested to give an introductory course in Medical Anthropology at the University of Havana. The people who became friends, RMDLG and ALP, CTGA, all professors at the University remain close friends to this day. Also, being a fresh graduate, I was not prepared to give a class at postgraduate level at a University where the average student is so hungry for knowledge. I decided to visit various universities in Europe and thus congeal a unique course, under the guidance of my professor and friend, Cecil Hellman. I visited London, Paris, Heidelberg and Oslo on that trip.
The love and connection with Cuba grew in the ensuing years and situation in the island also changed so that I can now expect my colleagues from Havana to visit me in Paris.
Over this past weekend one such visit did happen, Dra RMDLG, who is in charge of Anthropology at the University of Havana paid a visit of three days. She is a Medical Anthropologist and our ways of thinking are very similar, even though her Doctorate is in Philosophy and mine is in Medicine.
We talked about many things, academic and personal and one of the points of discussion was my attachment to Cuba. We could conclude that all the countries I have lived in, I loved them at that time, but none of them have left continuity in my life, except Cuba. I share a past with Australia, Brunei, England, Jamaica and I share a present with France and USA. Many other countries, like evanescent lovers, loved and left with no memories, Malaysia and Myanmar among them.
Only with Cuba, I do share a Past, a Present and a Future; thus my longing for that country. My Cuban mother was right, people fall in love with Cubans, and you fell in love with Cuba.  I also realize that if you are in love with a country because you love someone in that country, and as soon as the love affair is over, the country also leaves you along with your lover!
We wondered aloud why break dancing (good but not original) by a group of marginalized young Parisians attract a large crowd during their sightseeing journey through Paris? Is it the value of street theatre? A respite from the walking? Or creating a distance while enjoying a spectacle? The name of the anthropologist, Marc Auge and his concept of Non Space did come up. That type of break dancing by marginalized people can be seen at any of the tourist places in the west: Miami or Havana, Barcelona or Brussels, Los Angeles or London. Still one has to explain the attraction!
Various meals in between conversations, walking around this beautiful city of Paris, discovering new statues, I had never paid attention to the statue near Pont Alexandre, which turned out to be that of the Liberator, Simon Bolivar.
A certain academic plan, which would strengthen my relationship with Cuba, was drawn up, including the revision of a book we were planning to write together.
I realized that since 2006, my visits to Cuba had decreased in frequency as my visits to south East Asia increased. This is the natural change in frequencies, I know in my heart that the importance of South East Asia has played out in my life, professional attachments such as that with MoPoTsyo.org would remain but strong friendships of recent past would blend into oblivion.
Welcome to Cuba..
So if you wish to spend some time, chatting, being caressed by the breeze from the ocean along the sea walk on the streets of Havana, I will be waiting for you.