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mardi 17 janvier 2017


   “Wherever you have friends, that’s your country. Wherever you receive love, that’s your home. Whoever gives you love, that’s your parent.” – Tibetan saying.
As quoted by the Dalai Lama.
David Spero RN writes a blog bringing in philosophies from all parts of the world and blending it, making sense of it for our daily living.
This morning he had a note with ten quotes and the one I tagged on to was this one from Dalai Lama.
There is a great attraction to Buddhism among the westerners, especially among the Jews, for its independence in thought, consideration of others, lack of violence and a calm way of life.
It is said that the best known Buddhists in the west are mostly Jews and there is a delightful book called The Jew on a Lotus about the Jewish and Buddhist interaction, which HH Dalai Lama had requested.
I very fondly thought of my Cuban Mother, Lucia, who said to me all those years ago: Most outsiders come to Cuba and fall in love with a Cuban, you have fallen in love with Cuba! The above wisdom from HH Dalai Lama fits to a tee my affection for Cuba and the love that awaits me there.
Now that there is easier methods of communication, I always look forward to affectionate notes from Cuba. This morning already I have received notes from Moa and Havana. One of them beseeching me to cover myself up in the cold weather, a cold that they cannot even imagine.
Time to fix a cup of coffee (powder bought in Cochin) and look at the Yoga Sutra, opening to page III.50
From desirelessness even for that, the seed of conjunction being destroyed, comes Kaivalya
Dr Jayadeva Yogendra has an erudite commentary on it. Kaivalya is liberation or freedom.
While wandering around Barbados, dr FF from Ivanhoe in Melbourne asked me: you are truly trying to be free, arent you?
I had always wanted to free myself of attachments. I even made a list of things you have to be free yourself of and I can tell you that I have manage to be free of most things in that list, compiled such a long time ago, except one which I will explain.
First of all free yourself from the way you look and do not act that is congruous to other eyes to your looks
I am constantly asked whether I am from here or there, to a degree that it has become amusing, still trying to figure out why they think I am a Brasilian when I am in Spanish speaking South America. I also do not strongly identify with the passports that I carry, even though I have tenderness towards Australia, an attachment that took me nearly a decade to get over.
That brings to the second attachment, your nationality or your passport or whatever. I am not talking about a cultural identity, but a nationalist identity, especially those you long for. While I was a student in London, I realized that living there for centuries will not make me English, but may afford me a British passport. Currently my love for Cuba and American Indian is not an attachment but a sign of respect for them. I am grateful for the love shown to me by Cubans and Omaha Indians.
Free yourself of your profession. In USA especially and in the west, your character is associated with your profession. I am a doctor, a Specialist Physician but you will never guess that when you meet me, I have gotten rid of that white coat and the cultural uniform of being a doctor. As my friends know, I love being a doctor, in the sense of being involved in the stories of the people I am honoured to look after, the Indians. When travelling which I do with regularity, I am not very sociable but when someone does ask What do you do?, an  oft asked intrusion in USA, I say, correctly I am an Anthropologist and the conversation does not proceed further. With newer model planes, A350 or B787, I request a single seat, affording me the privacy on long haul journeys, one of which is coming up in just one week.
Free of your skin, free of your white coat and free of your passport, the next easiest thing was to be free of family. In countries such as Cuba or the American Indians, this idea would be considered sacrilegious, but to me it was one of the easiest thing to do.
Unlike most people, I never grew up with my parents and when I saw them together for the first time, I had already formed my personality and looked at them as strangers, which they remained for the rest of their lives. 
This brings me to the greatest gifts I have received in my life, the greatest of which is that I am a Jew. Other gifts include Being Australian, Being a Doctor to the Indians, Being associated with Cuba. as you can see it is the greatest gifts in your life that you have to free yourself of.
Other great gifts have been friends, some came and gave their love and their kisses and left, nonetheless they were great gifts, others stayed for the journey. From medical school days, I can think of only three who have stayed: MGW, RH and NK. Jamaica offered some of its flavours which I enjoyed but when it came time to leave I left with no regrets, same with Baracoa in Cuba. London, Paris, Brussels, none of them have given me good everlasting friendships even though I enjoy my visits to these places.
Friendships with deep meanings, for me, come from Omaha Indians and Cubans.
I still remember, a Cuban artist telling me: You are not a friend but a tatoo in my heart
So the greatest gift I have received, Je suis Juif, I am not sure I am ready to free myself of that.
Coming back to the Freedom and how to achieve it, I remember sitting at the El Modelo restaurant in Piedras Negras (since then closed, an elegant reminder of yesteryears), Dr San Pedro with his west african accent asked me: can you summarize for me, how to achieve personal happiness
I did not have to think too much
To become happy, decrease your desires, I told him. 

lundi 16 janvier 2017


The portrait above is that of the Great Chief Sitting Bull of the Lakota.

I had spent this weekend indoors. While this house is in an isolated part of the less populated state in the USA, there is wifi and thus I was connected to the world. I was reading and writing. While I am not in the Social Medial circles, I enjoy connecting with  people I have already connected and enjoy conversations, exchange of notes or emails. 
This weekend, I had connected with friends and correspondents from Buenos Aires, Bariloche in Argentina; Rio, Sao Paolo in Brasil, various places in Cuba, Brussels in Belgium, Cordoba in Spain, KL in Malaysia to name a few places, and of course Miami, Florida; Little Rock, Arkansas, Portland, Oregon, Eagle Pass, Texas etc etc..
The conversations tend to become directed towards inner happiness in one way or another, so it was good to dust off notes from my good friend MC in KL when she had gone to India to learn Yoga and its philosophy.
I will quote her words in answer to the question:
What are the qualities expected from the learner of any system in Yoga?
She writes: Qualities expected from all learners of Yoga are among others, discipline, perseverance, devotion, commitment and faith in the Yoga and the teacher .
Also the learner must have a very stong desire and fortitude to learn and follow restraints in order for true learning to take place. It is also crucial for the learner to be disinterested in the material world, if not he/she will be distracted from the path.
I felt very spirited after reading this
When people ask me questions regarding oriental or american indian philosophies, I quote for them and showing their similarities: Guru comes to those who are ready. It is also found in Jewish teachings, for miracles to happen, the participants have to prepare themselves and be ready.
You can use it in the field of medical care as well. One of the pleasures of being a Doctor to the Indians is that long consultations involve delving into other dimensions of life and suffering . American Indians are very interested in the belief systems of other people and are happy to listen to stories and tales of other cultures 
In Medical Care, we could say, Health comes to those who are ready to accept it.
In Iran, each person try to read a few words or sentences of their renowed poet Hafez, seeking guidance 
In the Persian tradition, whenever one faces a difficulty or a fork in the road, Or even if one has a general question in mind, one would hold that question in mind, and then ask the Oracle of Shiraz

for guidance.
More often than not,
Hafiz, in his own enigmatic way would sing to the questioner and through the song, would get the questioner to look in the mirror of his/her soul.
Upon reflection in the mirror of Hafiz's Ghazal one would be inspired with an answer, a guidance or a direction.

the first line upon which the eyes of the reader fall, would give the answer to the direct question, and the rest of the Ghazal would give further clarification.

I can look for a few words from Yoga Sutras of Patanjali but I know that when I reach the Consulting Rooms (much like a Lounge really) there would be unending wisdom waiting for me, as much as I am ready or willing to understand.
Yoga Sutras arrived in my life when I was fully ready, thanks to Vandana Yadav, Aparna Ganesh and Munching Yong as well as Kuala Lumpur, Malaysia.
My teacher was not a saffron robed guru with a beard but a Chinese accountant working for a Cable TV company in Malaysia!


Oliver Sacks wrote in the Introduction to this book:
Cecil Helman is many things: old-fashioned General (Family) Practitioner, psychiatrist, cultural anthropologist, storyteller, poet and artist-and all this comes together in Suburban Shaman, a beautifully written, devastatingly honest (and often very funny) account of an audacious and adventurous life.
Cecil, a South African Jew, was my teacher where I studied Medical Anthropology in London, later he became a a good friend and was instrumental in helping me offer the first ever course in Medical Anthropology in Havana, Cuba.
He passed away in 2009, I miss him and a homage to that is his appearance in my eyes and his words in my heart, when looking at the Medical Practice with an Anthropological Eye.

It happened when American Diabetes Association published their recent recommendations regarding care of patients with this chronic illness.
First I give you a summary published by a writer who is not a medical doctor but who has concerns of the society and the patient in mind; to be followed by a summary by a "diabetes Expert" who has only drugs and body as a machine metaphor in his mind. What a pity..

First I will quote from Cecil's book, in his words:
It took me some time in practice to realise that a fundamental aspect of Family Medicine was its attitude to uncertainty. After literally tens of thousands of consultations with patients, and many hundreds of house-calls, clinnical practice eventually taught me one big, and rather soberinng lesson: It's that the more you know about doctorinng and why it works (or does'nt work), the more you realise how much you don't know. For despite its patina of science at its core medicine -and not just Family Practice-is not really about certainties, nor ever has been. To the disappointment of some of the new breed of "techno-doctors" as I've called them, it's also about doubt and ambiguity, and ethical dilemma that are sometimes difficult or evven impossible to solve. It's also about the limits of human expertise, especially with serious, chronic or incurable diseases.

When I began working with American Indians, one of the first lessons they taught me was the acceptance of ambiguity, and chaos present in one's life, over which may be superimposed some form of suffering from an illness.

Here is the same recommendations of American Diabetes Association presented from a patient's or the societal point of view and those of an Techno-Doctor who is more interested in numbers and paper print outs.

New recommendations for 2017 include:
·        Assess patients for psychological problems, including diabetes distress, depression, anxiety, and disordered eating.
·        Determine patients' social context, including potential financial barriers, food insecurity, and housing stability.
·        Perform autoantibody testing in first-degree relatives of people with type 1 diabetes to assess risk.
·        Consider periodic vitamin B12 measurements in metformin-treated patients, with supplementation as needed.
·        Consider empagliflozin and liraglutide in patients with type 2 diabetes and established cardiovascular disease.
·        Assess sleep pattern and duration as part of diabetes management.
·        Prolonged sitting should be interrupted every 30 min with short bouts of physical activity.
·        Clinically significant hypoglycemia now defined as ≤54 mg/dL, with “alert value” for taking action at ≤70 mg/dL.
·        Include fat and protein counting in addition to carbohydrates for patients who use premeal insulin.  
·        Bariatric surgery is re-named metabolic surgery, with threshold for considering it in patients with type 2 diabetes lowered down to BMI 30 kg/m2 (27.5 in Asian-Americans).  

The American Diabetes Association (ADA) recently issued its revised Standards of Care for 2017 (
summarized here). There are several changes to these guidelines this year. Therefore, it is important that anyone involved in the care of a patient with diabetes read them. The overall standards are long and detailed, but are summarized in one of the articles in the supplement. Here, I highlight and summarize are few of the most important changes.
·        Screening for diabetes is emphasized again, but with some clarification on whom to screen and an example of a validated tool to use for screening.
·        The evaluation of a patient highlights the importance of comorbidities, including assessing sleep pattern, HIV, and various psychiatric disorders.  
Several changes were made to pharmacological therapy:
·        The recognition of vitamin B12 deficiency with metformin use is new but important, as it may contribute to neurological problems.
·        The costs/affordability of medication have been highlighted, including the high cost of insulin (which was previously considered inexpensive).
·        Recent cardiovascular outcome trials are discussed to support a recommendation to use empagliflozin or liraglutide in high-risk patients with cardiovascular disease.
Although these may be the most important/novel updates, the standards have been updated and clarified in several areas and will probably affect clinical practice significantly. 
You can see the doctor had neglected to mention the psychosocial aspects of a disease which is very socially oriented whereas the other writer had included all the recommendations including the psychosocial ones.
This is not an isolated example. The bio medically oriented doctors whether in private practice or at the university think of themselves as experts of a narrow spectrum of paper outputs and printed laboratory tests and neglect the person who is suffering from the disease and reduce that person to a collection of papers and results and part of the Evidence based Medicine.
He was a good friend and I miss him.


16 January 2017
It is that time of the year in these Plains. Leaves had already fallen into oblivion and the stark trees pait themselves against the grey canvas of the skies where it ends or begins we have no idea because of the snow, ice, sleet and slush stored in them.
When I began visiting this reservation, I used to excuse myself for the three months, January, February and March being advised that these are the harshest months as far as the weather goes. Elders began mocking me saying that I was not man enough to face the natural changes in the planet and I began coming during winter as well.
But not without trepidation. Before arriving I would pray to the Spirits, Please look after me, I am not used to this kind of weather, usually coming from Havana or Miami, where the daily temperature could be a full fifty or sixty degrees warmer F.
But this year, there has been a difference. During my December and January visits, despite the plunging temperatures I have not felt the cold, nor is my emotions feeble and nor am I afraid to go to the clinic because of the snow or the cold.
In fact during this winter I have not felt the cold at all? Being an Endocrinologist one might be prone to ask; Have something happened to your hypothalamic hot/cold switch? 
None of that.
It is something that I read which had an impact upon me. 
One day in November, a recommended TED talk given by a gentle woman as well as a blog from KL arrived in which Sadhguru was the featured philosopher.
The gentle woman said: It no longer matters to me and I do not strive to achieve, what others or the other person thinks of me, but I ask myself the question, How do I feel in the presence of that person.
I thought about it a lot. We dont have to behave in a way to impress the others just concentrate on how we feel in a particular situation, whether in the company of a person or an impending storm.
The other philosophical thought was from Sadhguru.
It seems that we are constantly fixing little and big problems or conundrums that come our way, they seem to be never ending. What if we fix ourselves  in such a way that  the large and small problem will not threaten us and our body and mind that has been fixed will automatically take care of the large and small problems.
Before arriving at the small village of the Indians, after leaving India, Cuba and Miami, all sweltering under unusual heat, I prepared my mind and my emotions. Get rid of the structural defect of Aversion, Winters come and go, it is the law of nature and as Elders said, when it gets very cold, think of the life trying to sproud underneath the weight of the snow and ice? There are clothes to wear and a new Quechua jacket had been given to me as a present and my body was protected. Take deep breaths and dont think of yourself, think of the nature around you, our deer brothers and our eagle and buffalo brothers..
I felt no cold. I was in the Clinic and for the first time in many years I caught myself not complaining about the cold weather.

This advice can be useful in particular situations where you have to confront a co worker, a dining companion or questions about your personality and behaviour. How do I feel? in these situations and not behave or talk so that the other person would be impressed. 
Prepare your mind and body so that you are not wasting minutes and hours wondering how you are going to take care of that particular problem, and tomorrow it would be another one.

It has been a good advice, glad I followed it. 
I am not cold despite it being cold, wintry, icy and rainy outside.
on Friday, I will be heading south to Miami, other climates and other social situations and once again, all these would be a memory, not an unpleasant one at that .


The mercury has not crossed the zero, outside it is an eery silence, the roads of this hamlet gleam, the ice thick as paste. No humans in sight, no vehicles, not daring this experiment of nature humans have not mastered, slithering like snakes if they are to step on this blighted blanket of ice of deception.
It is good to recollect moments of lost loves and lovers, feel warm to the friends and lovers waiting for you across the oceans, with a sense of content, of having lived, continue to live with a heart clean and pure, with a welcoming smile, more than ever in this world of increasing confusion.
I was sitting at a cafe in Quito, Ecuador waiting for someone or other when I was hit with saudade, the kind that returns to me often like a good friend.. and noted it down..
4 JUNIO 2000
It is such my friends
The end is always the same
Whatever had happened
The beauty, the magic,
Nothing matters-
What does saudade matter?
All that you could give each other
Only tore you apart--
A manha será outra dia…
What images pass through
This crystalline heart of mine
Fragrances that were forgotten
How could one not remember such knots of passion?
Where was that?
How could one not forget?

for many years I always wandered around the world with a book of verse of Pablo Neruda and ah.. the comfort it offered.. and here is one.. fit for this day of ice and snow and cold skies and silence..

Exiles! Distance
grows thicker.
We breathe air through a wound.
To live is a necessary obligation.
So, a spirit without roots is an injustice.
It rejects the beauty that is offered it.
It searches for its own unfortunate country,
and onnly there knows martyrdom or quiet.

poem Exilio by Pablo Neruda  from Isla Negra, a Notebook.

It is so nice to pass on this love for Poetry to the next generation
In the Peninsula of Quiberon in Brittany, under the sculpture of a Fish, which can be seen in the above photo, is a poem by Pablo Neruda and each time we pass by the sculpture, I would recite the poem in Spanish!


I have been travelling regularly to Cochins since 2004 and I had chronicled my travels and photographs in the website The Virtualtourist, which was acquired by Trip Advisor and now on the brink of being eliminated. I wanted to save the photos and while trying to download the pictures, I saw how much Fort Cochin especially has changed in the last ten years!
So these photos have already acquired the status of "yesteryear photos".
I will post here a sample of the large number of photos.
When I began traveling to Jew Town, Mezuzah of this type could be seen, on my last visit, I couldnt see any and in fact there were only four jewish inhabited houses in Jew Town.
In Ernakulum, near Market street and Jew Street Junction, is the Nursery and Aquarium of the last Jew of Cochin, the illustrious Babu. I met him on my first visit and have kept in touch with him regularly since then.
I have enjoyed the Ferries that ply between Fort Cochin and Ernakulum, there is something exotic and enchanting about the ferry ride and to this day, I love to ride on it. The ritual of standing in line, paying your few rupees, the rush of humanity towards the boat, the impatience of the commuters and the noise and sliding of the boat through the waters.. all peg in my love for this city by the bay 
In Kerala, it may be elsewhere in India as well, a tea shop is called a HOTEL, so this modest tea shop which has recently undergone remodelling reminds us of its namesake, the great sultan of Mysore, Tipoo.

I met Aneesh Aboo Bakar long before I stayed at Ballard's Bungalow and we have managed to keep in touch. On a monsoon day, seeing me hovering in the hotel to escape the rain, he lent me his umbrella, which I returned and then stayed at the hotel as well. He had a stint at Muscat and now lives with his family in Paravur and we exchange text messages now and then or speak on the telephone.
an unchanged scenery, this photo from 2004, of fresh catch being offered, Later on, shacks opened up where they would cook the fish for you for a price, but it was a tourist trap where exorbitant prices were being charged for the preparation of the fish

One used to be able to see Hanukkia for sale, but the popularity of the jewish items are such that they disappear very quickly. I have not seen one for sale in years.

The old Cochin Airport was a disaster, but the new one is quite comfortable and secure. In the olden days, there was nothing on offer except these packaged foods but now one has a Lounge and well prepared food available before boarding the flight. also there are good connections to Doha, Abu Dhabi, Dubai, Kuwait, Saudi Arabia, Muscat as there are millions of Keralites working there. Connections to the rest of the world is sparse. Flights to Kuala Lumpur and Singapore , one or two a day and that is it. One can get to Colombo as well. Not well connected.