HEROES OF QUILMES, DOCTORS AND NURSES AT THE HOSPITAL AT DR OLLER FRANCISCO SOLANO IN THE PROVINCE OF BUENOS AIRES IN ARGENTINA

 I had come to Buenos Aires to visit a good friend of mine, whom I had known in La Habana, Cuba. He works as a front line doctor in the peripheral urban hospital at the municipality of Quilmes at Solano.

He invited me to go with him and we set off from Flores, the heavily commercial and formerly jewish neighbourhood of Buenos Aires.

You can reach this hospital from Flores by public transport, it may take two hours, with a combination of Train, Bus and Tram etc. We requested an Uber and you could see that most of the drivers did not wish to go there, far and unsafe but in the end a Venezuelan immigrant took us. the ride took nearly one hour.

Flores is a very eclectic area. While specks of elegance of the past could be seen in remnant architecture and also in cafés like the Clapton, the area is heavily commercialized with a visible presence of outsiders (the future of the commercialized world): Bolivians, Peruvians, Chinese, Koreans, turbaned Sikhs from India and "Senegalese" which I think is a generic term for anyone with dark skin from West Africa who camp out in the pavements with stacks and stacks of their merchandise , cheap and fake, made in China. I was reminded of such a scene from Cotonou in Benin 

A Dominican hairdresser and his Peruvian client.

From this chaos of a futuristic vision of an unequal world, we travelled deep into the Argentine history. As minutes went by, decades were being stripped off the facade of Argentina. 

Donkey driven carts began appearing alongside motor cars. One could easily be arriving at a less propitious suburb of an Ecuadorian town or a poor town in Mexico (faces here are mostly of mostly European people!, some looking at you with  onerous intentions)

Poverty is the common denominator. with it comes lack of access, to paths to prosperity in the future. Amidst what might be judged as desolation and desperation, by standards of the World Bank or biased visitors, one could meet a group of dedicated professionals who keeps the definition of what is it to be a doctor, what is it to be of service and what is the essence of medicine.

Entrance to the hospital at Solano, Quilmes 

Dont exhibit your iphone, I was advised, it might disappear 

I felt very humbled by this visit. Even though I practise humanitarian International medicine, in front of these doctors and nurses, my star dims, they are the true humanitarian international medical providers, at great personal sacrifices to bring relief to a very nearly marginalized population.

As I was being shown around the hospital and the clinics, i had the feeling of being back in the places that I had worked. this one reminded me of the University hospital in Jamaica. 

Every single person I met was warm and greeted me and welcomed me. 

When I am in such a place, my immediate reaction is to get down and help with my diagnostic skills. The best was yet to come.

I was left behind at the Doctor's common room while my friend was attending patients and this gave me an ample opportunity for  participant observation as a Medical Anthropologist.

The first thing to note was the electric atmosphere of warmth and collegiality and no sense of hierarchy. Every one brimmed with enthusiasm. 

I could imagine the kind of medical dilemmas and confusions they are facing and how they are managing to provide relief, comfort and cure to those who arrive at these doors of the hospital.

there was easy flow of friendship and conversations. There was no tension caused by the workload on the other side of the door to the entrance to the doctor's common room. 

I closed my eyes and imagined a doctor's common room in miami, usa 

obviously there would be symbols in the room of the wealth of the country, those things are only soul-less symbols which betray the tension of the room. The hierarchy would be evident between doctors, nurses and auxiliary personnel and there would be arguments and complaints and questions. In fact those rooms are usually used as a space to let out frustrations and personal character deficiencies.

The exchange of conversations in this room at an peripheral area of Buenos Aires were flowing smoothly. One of the doctors had cooked a chicken stew and there was camaraderie and joy as we shared our humble portion as if there was a big fiesta. 

I enjoyed meeting these heroes. in their daily activities they may not recognize the humanitarian work they are doing

As Eugene Delacroix, the french painter had remarked: people remember you for the relief of pain you offered them.

the gift of a material matter evaporates soon, can you remember who gave you what gifts? but you will not easily forget a gift of kindness, a gift of time and a gift of relief of pain and anxiety.

This is what these heroes do, whenever they can, however well they can.

I respect them for it . My heart felt good that i share the same noble profession at these proud humble grateful people in this corner of Argentina, their proud country.

My own small contribution was to help my friend in the interpretation of some blood studies on an asymptomatic patient with high lymphocytes in his blood.

It was a special day for me I thank you and dedicate this blog to the heroes at work at the hospital and clinic at Dr Oller Francisco Solano in the municipality of Quilmes outside the city of Buenos Aires in Argentina

 Back to the cacophony of Flores

A comment from a close friend in Florida Dr MW

Thanks for the very comprehensive blog. You have to take your hat off to your MD friend and his co-workers for giving so much to those who need so much and at risk to themselves. They are angels of the world. Nice of you to join them. 

FROM THE CHAOS OF BUENOS AIRES TO THE CALM OF MONTEVIDEO, JUST ACROSS THE RIVER, THIS IS ANOTHER WORLD

 I had gone down to Buenos Aires that magical city which capture my dreams after my visit there and then the subsequent visits. The pandemic put an end to regular visits and i wanted to visit a close friend.

the former elegance of the cafe culture can be sniffed in some places..

He lived in the barrio of Flores, which was a jewish neighbourhood before, and there is still a strong jewish presence with much of the wholesale textile, schmatta as it is called in yiddish, in their hands. but what makes this commercial area interesting are the numerous immigrants in the near past, the majority being Bolivians and Peruvians, not to mention the Chinese, Koreans, turban wearing Sikhs.. and "senegalese" which has become a generic term for Black Africans from Africa.

They are all peddlers, the Chinese and the Koreans have kiosks and vegetable stalls, the Sikhs seems to be enjoying running small shops and the "senegalese" and the Bolivians and Peruvians spread their wares, which is nothing special but generic, manufactured in china but in thousands, and the cacophony is deafening.

I chatted with a "senegalese" man, i asked him in French, where he was from, Senegal but he did not answer, when i asked, which part of Senegal. I had a flashback, i could be at djem al fina in Marrakesh where lots of sub saharan migrants lay out their wares just like here.. all fake from china. sunglasses, football jerseys etc.

There is also a lesson here

Argentina used to be one of the richest countries in the world, so much so that a phrase was in common use in the past centuries, going to the argentines, to denote becoming wealth on emigration to Argentina.

Corruption and political judgments have made this country, sad to say a "third world" country, at the level of a developing country, certainly lower than Malaysia but on the level of India in development, nowhere close to any European country. This in a country which took pride in the fact that they were not South Americans but Europeans ..

To me Buenos Aires is the new world order, this is what will happen in the major cities of the rich world, where the immigration is already at a record high.. there would be "senegalese", "bolivians" and "peruvians" selling generic sunglasses, and fake football jerseys and clothes for all occasions to bring down the elegance of couture of the rich countries.

A short 45 minutes flight across the River Plata and you are in Montevideo. Everything is orderly, immigration is automatized and very quickly, you could order an Uber car and then leave this pretty but small international airport.

A garrulous Venezuelan who was against all left wing leaders of this continent past and present including Hugo and Fidel, chatted non stop on the way to the centre of town, along the tree lined streets along the sea. the centre of town and the hotel where i am staying has the appearance of the 1950s, innocuous and interesting. A homeless man, more than slightly inebriated greeted atthe door of the cafe and mumbled something.. In general people are nice in this small south American country.

FACAL my type of Café! Bienvenido a Montevideo..

 

LAMENTO HABANERO. THE LAMENT FOR MY LITTLE ISLAND IN SPANISH AND ENGLISH

LAMENTO POR MI ISLA RICA, MI CUBA

A lo largo de los años de visita a Baracoa, la primera ciudad de Cuba, fundada en 1511, tuve la fortuna de conocer a muchos estudiantes brillantes, algunos de los cuales optaron por estudiar Medicina. Uno estudió en Moa una ciudad industrial en la parte oriental de Cuba y el otro estudió  en la parte occidental de Cuba. Ambos tienen ahora 28 años, ambos se han convertido en especialistas y prestan servicios de manera regular en las ciudades donde viven.

Ambos son curiosos, uno de ellos me llama a menudo para discutir los casos bajo su cuidado, el otro me escribe con detalles de las visitas domiciliarias que hace en los días que está de guardia las 24 horas.

Ella me escribió ayer. 

De los 12 que comenzamos juntos nuestra formación en la especialidad solo quedan 3, los otros 9 se han ido de la isla, la mayoría a Miami, sabiendo muy bien que no podrán ejercer como médicos. Ahora mi carga de trabajo se ha cuadriplicado y estoy constantemente en el trabajo, enfrentando las dificultades que enfrentan todos los cubanos, tratando de comer algo de valor nutricional, premiarse con algunos regalos o salir con amigos y amantes en sus noches libres de fin de semana.

Un total de 230 000 jóvenes cubanos abandonaron el país el año pasado, casi todos ellos con estudios universitarios y casi todos con destino a EE.UU. Cualquier ideología que tuvieran antes sobre el servicio al país se evaporó con la falta de esperanza de cualquier avance en el campo de la salud pública y la mejora personal. Han invertido el sistema económico, me dijo un joven médico, fui a la universidad durante 6 años y trabajé duro para obtener la certificación como especialista, pero no me recompensan, pero se espera que sirva, mientras que alguien que es costurera reparando ropa gana más. dinero para mantener un estilo de vida razonable.

Ella escribió:

Se invirtieron los papeles..los profesionales no tienen derecho a un salario decente.. y los que no tienen ni siquiera estudios básicos son los que ganan buen salario.

Mientras que el medico despues de pasar tanto trabajo, estudiar 6 anos y mas.. haciendo guardias y sacrificios no puede mantener un hogar .

Esta fuga de cerebros de Cuba, la más grande en su historia revolucionaria desde 1959, haría una mella irreparable en el futuro de Cuba y también como diría Daniel Kahneman, premio Nobel de Economía: uno tiende a recordar lo más reciente en lugar de lo más reciente. pasado glorioso. La mayoría de los cubanos son demasiado jóvenes para recordar las victorias de la revolución y solo recuerdan las terribles dificultades del presente.

Mi joven amigo médico continuó la conversación.

Me he acordado de ti ahora

Acaba de venir un paciente de 70 años para que yo le atendiera a su nietacita

Dice que soy muy bella y joven para ser medico (el pense que yo tenia 20 anos)

Se quedo muy agradecido con mi consulta

Me dice: Doctora no malgaste su juventud y su talento en este país.

Estas palabras me hirieron como cuchillos oscuros hundidos en mi pecho. El dolor de mi pequeña isla de Cuba sufriendo emocional, psicológica y físicamente fue demasiado para mí para contemplarlo. Siempre he trabajado en Medicina Humanitaria en los países en desarrollo más pobres, pero siempre ha sido voluntario, nunca me obligaron a hacer lo que hago, ya sea en Colombia o Camboya, y el trabajo es puro placer. Mis queridos jóvenes, que tanto se sacrifican en todos y cada uno de los pueblos de Cuba, con la mayor entrega que supera el nivel ordinario de atención médica en tantos otros países, se están cansando de las condiciones extremas de trabajo y las conversaciones son sobre cómo y cuándo y dónde salir en la primera oportunidad.

Como dice aquel gran clínico cubano en el Hospital Calixto García al decir: nos hemos vuelto mendigos ilustra, mendigos ilustres..

(Calixto Garcia Teaching Hospital, home of so many illustrious doctors. Dr San Martin. Dr Julio Ferrero of Miami)

Soy cubano de corazón y tengo toneladas de memoria para toda la vida tanto en Baracoa como en La Habana y mucho del entusiasmo temprano de la revolución cubana parece haberme tocado en mi país lejano de Australia... durante mi formación como doctor. Esta tarde, mientras la joven visitaba a un paciente en su casa de una pequeña ciudad del occidente de Cuba, una amiga que vive en una isla cercana vino a pedir orientación y consejería médica. Pasamos mucho tiempo discutiendo sus condiciones y también disipando su miedo a las futuras enfermedades que podrían surgir de su situación actual. Ella estaba complacida y yo también, hablando de los dos países en los que había vivido y mis experiencias en ellos y mis amistades con los embajadores de su país en Cuba.

Una hora después de que la señora se fue, me envió un mensaje de texto para decirme que me había preparado un plato típico asiático con camarones y que vendría a dejarlo. Me quedé muy satisfecho con los gestos agradables.

Y recibí esta nota de mi amiga médico

Mira que me acaban de regalar ?

Hacia anos que yo no vea un pirulo

Desde que estaba en la escuela primaria

Parecía estar genuinamente encantada.

Esta es la solidaridad que aprendí en Cuba. Haces todo lo posible para tratar de ayudar y estar agradecido por las pequeñas recompensas y recolectar tantos afectos como sea posible.

Salí de La Habana hace exactamente dos meses.

Te extraño, mi Isla Rica.

My Cuban Sister in La Habana

LAMENT FOR MY ISLAND RICA, MY CUBA

Over the years of visiting Baracoa, the first city in Cuba, founded in 1511, I had the fortune of knowing many bright students some of whom chose to study Medicine. One studied at Moa an industrial city in the eastern part of Cuba and the other studied in  the Western part of Cuba. Both are now 28, both have become specialists and serving on a regular basis the cities where they live.

Both are curious, one of them often rings me to discuss cases  under her care , the other writes to me with details of home visits she does on the days she is on 24 hour duty.

She wrote to me yesterday. Of the 12 of us who began our specialty training together only 3 remain, the other 9 have left the island, mostly to Miami, knowing fully well that they will not be able to work as doctors. Now my work load has quadrupled and I am constantly at work, facing the difficulties all Cubans are facing, trying to eat something of nutritional value, reward yourself with some gifts or go out with friends and lovers on your weekend nights off.

A total of 230,000 young Cubans left the country in the past year, almost all of them university educated and almost all bound for the USA. Whatever ideology they held before about serving the country evaporated with the lack of hope of any advancement in the field of public health and personal improvement. They have inverted the economic system, said a young doctor to me, I went to the university for 6 years and worked hard to get certified as a specialist but I am not rewarded but expected to serve whereas someone who is a seamstress repairing clothes makes more money to maintain a reasonable lifestyle.

She wrote:

The roles were reversed... professionals do not have the right to a decent salary... and those who do not even have basic studies are the ones who earn a good salary.

While the doctor after going through so much work, studying 6 years and more... making guards and sacrifices cannot maintain a home.

This brain drain from Cuba, largest in its revolutionary history since 1959, would make an irreparable dent in the future of Cuba and also as Daniel Kahneman, the Nobel Prize winner in Economics, would say: you tend to remember the most recent rather than the glorious past. Most Cubans are too young to remember the victories of the revolution and remember only the dire difficulties of the present.

Cuban doctors on international missions. it is impressive how Cuba has been providing health care staff to over 79 countries around the world.. including after natural disasters. of this, it has no equals, rich or poor.

My young doctor friend continued the conversation

I have remembered you now

A 70-year-old patient has just come in for me to take care of his little granddaughter.

He says that I am too beautiful and young to be a doctor (he thought I was 20 years old)

I am very grateful for my inquiry

She tells me: Doctor, don't waste your youth and your talent in this country."

These words hurt me like dark knives being sunk into my chest. The pain of my little island of Cuba suffering emotionally, psychologically, physically was too much for me to contemplate. I have always worked in Humanitarian Medicine in poorer developing countries but it had always been voluntary, I was never forced to do what I do whether in Colombia or Cambodia, and the work is sheer pleasure. My dear young friends, who sacrifice so much in each and every village in Cuba, with the greatest of dedication that surpasses the ordinary level of medical attention in so many other countries, including the USA are getting tired of the extremes of work conditions and the conversations are about how and when and where to leave at the earliest opportunity.

As that great Cuban clinician at Calixto Garcia hospital used  to say: we have become mendigos illustrates, illustrious beggars..

I am a Cuban at heart and have tons of memory to last me a lifetime both of Baracoa and Havana and much of the early enthusiasm of the Cuban revolution seems to have touched me in my faraway country of Australia..during my training as a doctor. This afternoon, while the young lady was visiting a patient at her home in a small city in the west of Cuba, a friend who lives in a nearby island came to ask for medical guidance and counselling. We spent a long time, discussing her conditions de ella and also dispelling her fear of the future diseases that could arise from her current situation de ella. She was pleased and so was I, talking about the two countries she had lived in and my experiences in them and my friendships with her country's ambassadors to Cuba.

One hour after the lady left, she texted me to say that she had prepared a typical Asian dish with shrimp for me and she would be coming by to drop it off. I was very pleased with the pleasant gestures.

And I got this note from my doctor friend

Look what they just gave me?

It's been years since I've seen a pirulo

Since I was in elementary school

She seemed to be genuinely delighted

This is the solidarity that I learned in Cuba. You do your best to try and help and be grateful for little rewards and collect as much affections as possible.

I left Havana exactly two months ago.

I miss you, my Rich in Affections Island.

MY PASSION FOR CERTAIN COUNTRIES AND THEIR DISPASSIONATE FUTURE

 A friend of mine jokingly once asked me: do you choose to fall in love with countries with peculiar problems or does it just happen?

Myanmar, for instance. For a period of 2002-2019, i was able to visit Myanmar multiple times and had a chance to see the country from north to the south , to the west to the east in the company of my Burmese friends. I truly enjoyed the country, the people, the food and the kind ambiance of the country.

I do not have to tell you what is happening in Myanmar!

Iran entered my life very early. I remember reading Omar Khayyam's Rubaiyat while still in school and i still remember some of his verses. I was very fond of reciting them while I was a school student 

Unborn tomorrow, dead yesterday 

why fret about them, if today be sweet.

Hamadan and the tomb of Queen Esther in Hamadan..

My best friend in Kuala Lumpur, MYC, introduced me to things Persian, as that city hosts a large iranian exile community. but the person who truly rekindled my desire and love for Iran was a graduate student at Henly Business School. I think it was she who told me about Shamloo and Soheil Nafisi and Farogh as well as many other artists .. songs.. movies..

With each passing month, my love for Iran grew. alas, I was advised against visiting Iran. 

Now I can enjoy Iran only on line and I wish my friends there the best.. despite the situation in the country.. but the goodness of the people would prevail.

I do not have to tell you what is happening in Iran? 

OH CUBA OH MY POOR CUBA 

I can travel freely in and out of Cuba and it is the country where i feel all the genuine affections in the world. But I cannot forget the dire economic situation in Cuba, the useless Cuban passport ( so is the Burmese or Iranian passport) to whom no one would give visa unless you are bent on visiting Montenegro or Indonesia, the sense of uselessness, powerlessness and lack of hope the people feel. I love you and miss you, my little island, but i do not have strength any more to carry your burden..

Please do not get me wrong, there are many other countries and cities that I love..

Australia whose passport that I hold 

Malaysia and to a lesser extent Cambodia 

Israel France London Paris ..

Paris is a good place to be, when you are in love..

Lately I say, I am 1/3 Cuban 1/3 French 1/3 Israeli

a clever man asked, that makes up only 99 per cent and what about the one percent, okay make it Cochini..

and the place where I became a Doctor of Medicine and an Anthropologist .. London

IF YOU WISH TO DIE EARLIER, MIGRATE TO THE USA, I TOLD A GROUP OF FOREIGN ENDOCRINOLOGISTS AT A MEETING

 I am fortunate to visit USA to be with the indigenous people of that country and on arrival at  JFK or Miami, the first thing that hits you, is the girth of an average American. The fact that nearly 8 out of 10 Yanks/Yanquis (so that the rest of the population of the American continent are not alluded to) are overweight or obese and the children are following the same path. There was a time when they pointed fingers of blame at the unruly and undisciplined minority populations but right now, white black yellow or any other American rose of any colour is overweight or obese.

This year my travels have taken me (in my other work as a humanitarian doctor) to France, Morocco, Tunisia, Mexico and Cochin in India, all these places boasting of good food (what comes first Humanitarian medicine or the attraction of food). I dread returning to the USA, the fright not of the polemics of a divided nation or the continuous streaming of gun violence but the thought of Food offered as Food. Fortunately for my microbiomes, I take off again..

Quiberon, France

Casablanca, Maroc

Merida, Mexico

From Air France you expect nothing but the best 

Resto Sfaxienne Neptune, Rue Le Caire, Tunis

Restaurant Hotel Grand, MG Road, Ernakulum, Kerala

I am not implying that good food is not to be had in the USA, but the ease of access to good food is limited for various reasons. The easily available food while tasty is laden with chemicals that your grandmother cannot pronounce and had not eaten. Thus the obesity. I salute my foodie friends in the USA, in Miami, in Boynton Beach, in Little Rock etc etc.

With Obesity comes, other diseases such as Diabetes and High Blood Pressure and other metabolic diseases.

As a wise elder of a tribe in the USA said to me 

The Americans make money making you sick, and they make money making you well.

I am preparing a lecture to be given to the Nurses who look after the infirm in one of the tribes that I work with. It is a pleasure to educate them and in the process that I learn a lot too.

In my previous studies with the Native populations I had seen that when they consume FOOD rather than highly processed pseudo food, there is no rise in blood sugar after their meals. 

I had always wondered the different order of eating food in various countries and noticed that in countries which are noticeably thinner, like Japan or France, the carbohydrate is relegated to a latter time slot and the initial piece is usually something that can coat the stomach. A very clever Nutrition Biochemist from France has done some good research to prove that certain order do blunt the post prandial glucose response.

This is the experiment on my self tonight while I am in the United States, emotionally preparing taking off to the land of the blue turbans and find out about the presence of Jews among them in the last century.

6 10 pm. My blood sugar is 102. Divide it by 18 to get mMole value

I ate at home, prepared by my Jamaican brother Abdul

Calaloo (a cousin of spinach but very Caribbean), tomato and vegies for spice and Hogfish very common in the florida Keys.

The wine was a sauvignon Blanc from Aotearoa (Brancott)

I finished my dinner at 6 30 pm 

The blood sugar at 7 10 pm was 105 . i finished the wine.

at 750 it was 106

and at 9 10 pm, two hours after i sat down to eat, the blood sugar was 94

THE MORAL OF THE STORY FOR AMERICANS IS THIS, IF YOU EAT AN APPROPRIATE MEAL, THE BLOOD SUGAR DOES NOT GO UP AFTER EATING. PLUS, IT IS ALWAYS GOOD TO HAVE A GLASS OR TWO OF WINE, FOR ME BOTH RED OR WHITE WINE WORKS WELL.

This works for patients with Type 2 Diabetes as well.

L'CHAIM

PS I do not have Type 2 Diabetes nor do I take any medications or supplements.