jeudi 4 décembre 2008

Among the UmOnHoN people


   with a Macussi Indian Child in Southern Guyana
   The world Chocolate  is an Indian word..Aztec Xocalatl
The journey to the Indians is always arduous.. first of all there is the trip to the USA.. My flight from Paris had to take a detour over Spain and Portugal and Azores and then go north to Boston and come down to New York, adding two hours to the trip. ( I am sure there was bad weather along the northern, more usual route from Europe). The flight was near empty and the journey was monotonous. I tried to read ( Tim Parks: Dreams of Rivers and Seas, it so happens it is a about an anthropologist but set in India), but couldnt concentrate, the food was just average.. even though the Air France Lounge at CDG had Moet and Chandon... a good start to the journey. The arrival at New York Airport was civil and without pain. The long wait, the night already dropping before 6 pm and the intense darkness through which yet another three hours of journey to a town where the temperature on arrival was MINUS 6 degrees Centigrade.. past midnight.. nearly a day to get here..Checking into the hotel, I ask myself.. why? and on waking up, I realize that I am going to the Indian country and there would be so much joy and contentment waiting for me and not to mention laughter and genuine affections.. My association with American Indians have been one of the best gifts in this life for me.. Thank the Spirits.. 
Next morning, reminded that I am in America, Food is a problem, stock up on some organic food for the few days I am in this country. Huge Car at the Rent A Car, they are being kind by giving me a huge car, I ask for a downgrade, but i need a car with a radio so that i can listen to BBC radio while driving up north to the Indian reservation.
The time goes quickly, the road is straight and without much to look at. The trees are bare of their leaves.  BBC World Service.. and The Economist.. you can keep yourself informed.  Not even the NPR, which is the best of the lot available in the USA can hold a candle to BBC or the Economist when it comes to its coverage.. Just different tunes I suppose..
The item on BBC world news said that by all reckoning Somalia is the most undernourished country on this planet, a pathetic honour. The world focuses on Pirates on the Gulf of Aden, but one hundred thousand Somali are at risk of perishing. No food, Little Rain, Poverty making them eat the animals they need to survive..War lords and no law of the land..
Just one blink, my mind goes back to Seattle where I was less than one month ago.. one of the common sites at the Seattle Tacoma Airport is the number of Somali people working ( another airport where their presence is felt is Minneapolis).. but these somalis are far away from the borders of malnutrition.. malnourished indeed but all were obese or overweight.. what is the lesson? a people who have undergone undernourishment and a mechanism to protect themselves during the times of famine, have no protection in the land of plenty.. I was told by a professor from University of Washington that Somalis have the highest rate of obesity, Diabetes and hypercholesterolemia among the migrants of that part of the world.. Poor Somalis.. so much suffering , whether in the Horn of Africa or Seattle.. 
That made me think, all non european people who have undergone some form of mass extermination: American Indians, Somalis, Cambodians.. when they are resettled in one form of another.. the degenerative diseases of the Europeans descend upon them.. High Cholesterol, Obesity, Diabetes.. There has to be a relationship to the Trauma!  but how to find out its contribution? at least it would give us a way to attend to those people who have suffered the trauma, now have additional physical and emotional burdens of western diseases...
Tomorrow at the Clinic of the American Indians, one after another of the patients would come, with cheerful faces, hearty smiles and wonderful stories.. It is difficult to imagine the difficult life they lead in their own land, now disposessed and disenfranchised.. descendants of another genocide by the European arrivals less than three hundred years ago.. 
Time to go to bed and be fresh for the Indian patients...Just to spoil them, not the milk chocolates of the usa or uk, but Le Roux from  Quiberon, the best chocolatier in France.. a little bite..

mardi 2 décembre 2008

What a Lovely Day in Paris


I had to make a couple of changes of Metro and suburban trains to reach the home of Dr Keuky. As always a pleasure to see him and the time went quickly disucssing the drafted document  by Daniel Liew and Yong Mun Ching for the Five Year Plan of Cambodian Diabetes Association. After the meeting I was glad I was going to Kuala Lumpur after giving the presentation in Cochin on December 19th. I had been invited to Calcutta and it would have been great especially in light of the literature I have been reading, but in Calcutta there is no chance I can do anything for Cambodia but in Kuala Lumpur in the company of MunChing something good will come out for cambodia and Diabetes there.
After leaving Dr keuky's house i went to the EDF DiversiTerre Foundation near the Metro Sevre Babylon where they were holding an exhibition on Rapa Nui, Ille de Paques.. Easter Island. it was in September 2003 that I visited Rapa Nui on an impulse and for the next eighteen months my life took a different direction, with various meetings in Buenos Aires, Bangalore, Pondicherry, Yangon and finally in Tokyo, Takaoka and Hokkaido. Felt a little nostalgic about the faces in the photographs and thought about the first rapa nui graduate of medicine, Carolina who should be finishing her studies now in Cuba. It would be nice to see her settle into the Hospital in Hanga Roa and administering care to her friends and relatives. Such is the gift of Cuba.. I am sure there are more students from Rapa Nui studying medicine in Cuba at the moment..
Feeling elated, Dr Keuky, the thought of returning to Cochin, a reunion with MunChing and Daniel.. i wanted to finish the last few chapters of Amitav Ghosh's book The Calcutta Chromosome.
I was so engrossed in the book that in one short trip i missed the stations TWICE!  the book is exciting in content, intriguing in its direction, enchanting in its historical associations and a biting commentary on the current social situation. Amitav Ghosh has written a number of tomes:
my favourites have been The Glass Palace (history of Burma and the Indian national Army woven into it), The Hungry Tide about the Sunderbans and the excellent recent novel The Sea of Poppies.. nothing short of excellent.  When a writer can transport your mind into another state of equilibrium and excitement, it is the best medicine, better than all the anti oxidants in the tea in China!  I am taking this book to KL so that my friends there can read it.. 
I had asked Romesh Menon, owner of Dal Roti in Fort Cochin after Arvind Adiga had won the Booker Prie  this year for his White Tiger, why such a resurgence of writing in India in recent years. My dear Chap, he swelled with pride, India always had great writers, it is only recently the publishers started taking a chance on them, and they are now laughing all the way to the bank..
here is an excerpt from the book  The Calcutta Chromosome
for what we have here is a biological expression of human traits that is neither inheerited from the immediate gene pool, nor transmitted into it. It's exactly the kind of entitty tthat would be hardest for a conventional scientist to accept. Biologists are under so much pressure to bring their findings into line with poiltics: right wing politicians sit on them to find geners for everything, from poverty to terrorism, so then they'll have an alibi for castrating the poor or nuking the Middle East. The left goes ballistic if they say anyting at all about the biological expression of human traits: it is all consciousness and soul at that end of the spectrum

Good Read  Highly Recommended
A visit to Rapa Nui  Isla de Pasuca Ille de Pacques  Easter Island  is good for a traveller
Good to have a friend like Mun Ching

A Bientot...


vendredi 21 novembre 2008

Cambodia: A Delightful Month Past full of Rewards





Dear Friends:

The Last few weeks have been very rewarding since I have received recognition directly and indirectly for my work with the Indians of North and South America.

 

The Office of Faculty Development is pleased to announce that the audio of the SPAHP Distinguished Lecture  presented by Dr. Shaheb is available online at the url below: 

 http://winstream.creighton.edu/spahp/DLSeries/DrShaheb.wmv

 I visited Cambodia in the company of Dr Keuky, President of Cambodian Diabetes Association to which I am an International Consultant. Also present in our group for part or most of the time were:

Dar Buena Suerte Goodman RN , Outpatient nurse Director from the Yakama Tribe Indian Health Services Clinic in Washington State, USA

Mitexi Rosette Stabler and Maria lopez,both graduating doctoral students in Occupational Therapy at the Creighton University in Omaha Nebraska USA

Ron Raab, President of Insulin for life, a humanitarian aid organization based in Mebourne, Australia.

We did  teaching sessions and saw patients in various parts of the country. Mitexi was able to film some of the teaching sessions and they have been uploaded to youtube.

If you go to  www.youtube.com and type in Diabetes Cambodia you will get access to the 11 or so videoclips. It is in English and Khmer so it will be helpful to Khmer speaking patients. The teaching is done at the level of patients and peer to peer educators, so some people in the developed countries may find it too basic. But it is geared for Cambodia.

While I was in Cambodia, I gave a talk during the 5th Annual Diabetes Day at the Health Sciences University in Phnom Penh. Mitexi may upload the video of the lecture to youtube later. I met some delightful and dedicated people during that day, Maurits from MoPoTsyo NGO dedicated to Peer to Peer education; Dr Issakidis from Medicines sans Frontieres, who might stay on in Cambodia after MSF leaves Cambodia and Dr Jim LeGerfo , a wonderful doctor with years of cross cultural experience from the University of Washington in Seattle.

I will upload some of my thoughts on Diabetes and Cambodia on my blog

http://medicoanthropologist.blogspot.com/

 

There were numerous Cambodians who made our stay welcoming and fruitful: first and foremost Dr Keuky, the indefatigable President of the Cambodian Diabetes Federation; Drs Touch Khun and Sopharin, along with Theavy who belong to the CDA, Dr Cham Seam of the Kratie Province, Dr Witchouk from Mongkol Borei Hospital. Thanks also due to Miss MunChing Yong of Kuala Lumpur, Malaysia who played host to all of us at her home in KL and to Ko Maung Maung owner of Mandalay Inn (www.mandalayinn.com) in Siem Reap who was a gracious host to us all.

 

While I was visiting the HoCank tribe of Indians in NE Nebraska, I was interviewed for a video presentation the Transcendental Meditation University in Fairfield, Iowa is doing to assist the Indians incorporate Meditation as a form of complementary therapy for their high rates of Diabetes and Heart Disease.

I thank my dear friend Sandra in Melbourne for a wonderful time together in Melbourne, Australia and the pleasure of meeting MiHuSa there ..

Diabetes Cambodia: Personal Notes




 

Personal Notes

I had the great pleasure of seeing many patients with Diabetes . But the following four patients stood out in my memory

Group A

1.    Director of Health for a Province      STATUS

2.    Owner of a large, busy upscale restaurant   WEALTH

Neither WEALTH nor STATUS guarantees good diabetes care since none is available CONGRUOUS with the needs of the individual patient with diabetes.

Endocrinologists/Diabetologists/GPs with their offices in Bangkok Singapore will not add to the health care of Cambodian patients with Diabetes.

A wealthy woman from western provinces of Cambodia flies to see her Diabetologist in Singapore. Her consultation lasts just over half an hour, comes back always with one prescription or more and more lab tests ordered, with very little education and only BIOMEDICAL and PHARMACEUTICAL follow up is carried out. This is PARTIAL care of the patient and has to be complemented by time, education and knowledge which can be done only in Cambodia in case of Cambodian patients. (then we might even have Cambodian patients from Melbourne and Seattle coming for service!)

Total cost of the visit to Singapore to see the doctor, around 1000 USD.

Kuala Lumpur or easily reached HoChiMinh Ville in Vietnam are no substitutes either for more than just clinical competency.

This pattern cannot be encouraged. ( reminds me very much of the University of Miami School of Medicine, my Endocrine Alma Mater wanting to attract the rich from south American countries to come to Miami! Technical rather than human medicine!)

An alternative would be a TEAM available in Siem Reap

Consisting of

A volunteer doctor from abroad complemented by a Khmer Doctor. The voluntary doctor has to be deeply interested in other cultures (otherwise would they volunteer?) and we can look towards Australia, Europe and USA. Australians and French seem natural choices.

It would be good if they can donate two weeks to four weeks at a time, so that a roster could be drawn for one year at a time.

A NURSE DIABETES EDUCATOR ( Michele Smith RN CDE from the Indian Health Services now serving with UmonHon Nation would be my role model for the position. She has more than twenty years of experience managing diabetes programmes and her recent stint was in North Dakota managing four outlying diabetes clinics, with the help of peer to peer educators, assistant physicians, in an area larger than siem reap province, under difficult weather conditions)( she plans to donate her time in the future, she may be enticed to become a Consultant to the Cambodian Diabetes Association)

Visiting Podiatrist, who would do continuing care of the patients as well as involve in patient as well as educate health care providers in the region

There is a strong role for the model of peer to peer educators ( one per hundred patients a la MoPoTsyo model in Phnom Penh). If the Peer Educator is provided with Internet connections, Dr Yehuda Kovesh would be available constantly and consistently to provide help when needed over the internet or through the CDA website. ( the Indian Health Service Peer to Peer service provides Laptop and internet connection to the educators )

 

IT IS FAR MORE COST EFFECTIVE- FOR THE RICH, POWERFUL AS WELL AS THE POOR- TO PROVIDE CULTURALLY RELEVANT, MEDICALLY APPROPRIATE THERAPY IN CAMBODIA THAN SENDING PATIENTS FOR SHORT MEDICAL VISITS ABROAD OR SENDING PROVIDERS FOR INTENSE EDUCATION IN OTHER COUNTRIES AT SEMINARS.

B.

TWO OTHER PATIENTS STAND OUT CLEARLY IN MEMORY, I SHALL WRITE CASE HISTORIES ABOUT THEM SEPARATELY.

1.    A 19 YEAR OLD PATIENT AT KOSSAMACK HOSPITAL DIAGNOSED AS TYPE 1 DIABETES NOW WEIGHING LESS THAN 30 KILOGRAMS WITHOUT CONTINUAL ACCESS TO INSULIN.

2.    WE SAW THIS PATIENT, A 29 YEAR OLD IN KAMPONG CHAM, WHO WAS DIAGNOSED AS TYPE 1 DIABETES AND BLOOD SUGAR LEVELS UNRECORDABLE BY GLUCOMETERS WITHOUT ACCESS TO INSULIN THERAPY

Fortunately for both of us, they didn’t develop Ketosis. In patient no 2, urine testing for Ketones showed negative results, making me think of Ketosis Resistant Diabetes. We would follow such patients and try to delineate the aetiology of this condition. It is Diabetes, but Ketosis Resistant, such as patients I have seen and cared for in Jamaica as well as numerous American Indian patients who present with Hyperglycemia and ketone negative urine, who are young , in their mid twenties at the time of diagnosis and have other social or chemical factors inducing their insulin resistance. We will follow these two patients in the first instance.

This is the end of my report to Dr Keuky on this eventful visit to Cambodia. I am writing this from Cochin in India. 

jeudi 28 août 2008

Few Days of Rest and Relaxation in Cochin India











It does take a little bit of time to get into the rhythm of Cochin, after the "normal" pace of our lives in France or United States.
Vegetarian Food, Ayurvedic Massages, walking along quiet streets, reading and writing, and no sightseeing, no social activity other than with local friends from other visits.
it took more than five days to find the rhythm of the place and after that it was fine, even began appreciating how friendly the locals are, in fact I consider Malayalees to be the friendliest of the Indians.

samedi 26 juillet 2008

The Not so United States of Knowledge

I was flying from Omaha to Cleveland on my way to Paris. When the plane docked, the friendly flight attendant was chatting with a young girl, who said she was in Eigth Grade in Omaha School system. He asked, what is your favourite subject at school. She nonchalantly answered: None. Then he said, mine was history, we wondered why we had to learn history and now i know that to deter us from creating the same errors we must learn history.
then he decided to ask some questions to the girl.. remember she is in Grade 8 and will be entering the High School to complete her high school education.
Which year was the American Independence? I dont know
Who was our first president? I dont remember
Who ran through the streets shouting, RedCoats are coming! stunned silence
Who said: give me liberty or Death. bored and silent
A look of consternation came over the face of the flight attendant. When you go back to your school in Omaha, please tell the teacher that there is something wrong when a Grade 8 student does not know who was the first president of the united states.
Then he kidded her, Who is buried in Grant's tomb. I dont know was the answer.

Those of waiting to get off the plane and listening to the conversation were dumbfounded at the stupidity of the educational system, that this young girl was totally ignorant of the history of her "great" country. I felt ashamed for my american friends.
Even I knew the answers to the questions.

Sad state of affairs: glad he did not ask, which year was the French Revolution? Who said, Le Etat se moi! Who was the first prime minister of India? who was Zhou En Lai?

China and India and Brasil will have no problem of diadvantage over america, where they are educating grade 8 students with no knowledge of anything. No wonder American kids dont do well in science and mathematics as students of their age from Lithuania and Poland..

Shame on You, No kid Left behind facade of American Public School Education.
When I first came to the USA, someone said to me, the best in the world is here so is the worst. There will not be a single 8 grade student in all of Cuba as ignorant as this little girl from Omaha!

lundi 21 juillet 2008

METAPHOR FOR CHANGE: AN IMPRESSIVE TALE IN HOCHIMINH CITY VIETNAM

METAPHOR FOR CHANGE
An Impressive Tale in Ho Chi Minh City
Highlight of my Friends, Food and Far East tour of December 2007

A feast in the literal sense, that is Saigon/HoChiMinh City: Food, active people, moving in orderly fashion and innocent interactions. Delicious food wherever you looked. It is said that Vietnamese food is like the best Chinese food cooked by a well trained French chef. I ate only a little at a time because I wanted to eat often!
All through this, my guide was Pham Thi Nga. She is lithesome, enthusiastic, open minded and transparent. She had worked at the national Airlines of Vietnam for three years. I had met her on one of her first international flights from Hanoi to Siem Reap in November of 2003. She has travelled with Vietnam Airlines to Tokyo(her favourite), Seoul, Australia and Europe. She makes friends easily and her life was full of exhilarating interactions for a woman so young. She was the first woman chosen for pilot’s training at Vietnam Airlines, but all her friends and family discouraged her by insisting that it s not a woman’s career. I felt sad she decided to withdraw, for she would have excelled in it, she has the inner strength and personality to go with it. But she would use it in another sphere to excel, I am certain. She is currently an Administrative Assistant at an International company in HoChiMinh City.
Our day in HCMC, accompanied by her father, a good looking gentle man from the North, was a full one, buoyed by succeeding interactions.
I wanted to visit the largest maternity hospital in all of Vietnam (the scenes from le Premier Cri, comes to life here, as I had recently seen the movie in Paris). We drove past the cathedral ( I was told that 1/3 of the colonial budget for Indo Chine was devoted to building this edifice, brown stones from Marseilles, withstanding the time and temperature), walked along the Embassy row, French colonial buildings interspersed with the modern concrete ones.
The first dinner was at Bun Bo Hue, right in the heart of the city. Very attentive staff and the food arrived, so good to have a person who lives there to guide you on this gastronomical tour of this delicious country. Also, Nga was careful to make sure that none of the dishes contain pork or pork fat, thus making ordering food an adventure. The mid morning meal on this first day was at a busy restaurant near the market, where the local population was busy eating, noodles, and various other combinations. Nga ordered and I just ate, with security and delight.
The hospital filled me with a greatest desire to serve, so good to be medically qualified, to be present where I am needed, of course, compatible with my personality and the little talent I have in taking care of people.
Long walk to the Zoo exhausted me through the heat. At the entrance, there were festivities to entertain children, sponsored by some soft drink in tetrapak ( bienvennue, la obesite!). Zoo with some lonely animals ina textured garden setting bearing the french signature. We walked around slowly, escaping the heat in the shadows of the palm trees carefully transplanted from other tropical climes.
A Hippo eyed us suspiciously, the pygmy hippo couldn’t disappear fast enough. The lonely Orang Utan did not answer my queries in his native language, did he think my questions were rudimentary or did he only understand the iban language of the tribes near by. An ostrich was forlornly looking for its disappeared feathers, a sheep heavily clad in his winter coat, snoozing away much to my envy, an outback Cassowry, cockily turned his blue ornamented hood, the elephants playfully took the cane strips offered them by the children.
I was getting tired, worn out, exhausted by the heat. A freshly squeezed cane juice brought back the breeze of life.
The museum saff was on lunch break, so the time was passed looking at the children, obesity beginning to appear with the adoption of preservatives in the food. Ah well they have to live through this sense of development which would include Diabetes in the future. But many many Vietnamese are proud of their food and not willing to give it up, even as an occasional treat, food which are not good for their system.
Well organized archeology of the country told in historic terms, some embellished in the soviet era rhetoric . A good collection of Khmer sculptures, poor Cambodia, so much of its treasures are abroad, some intact and some in state of disrepair, Musee Guimet in Paris. May Andre Malraux be pardoned!
Time for another meal. A welcome one. PHO 24, freshly prepared PHO, a Vietnamese staple. Food in Vietnam is fresh, fragrances of the countryside and made to order. No traiteur orientales here…
The night before I had met a group of young Vietnamese entrepreuners and workers, at a café called AQ Café. I liked the fact that Cafes are catering for the locals rather than trying to score the tourist trade with dubious qualities of food and service. Vietnamese men and women with hope written all over their face, unlike other asian countries, they are firmly rooted in their culture and the atmosphere was electrified with the chatter in Vietnamese with an occasional translation for me. I thoroughly enjoyed watching them, feeling a part of their hope and aspiration and at the same time grateful to be present there with my dear friend Nga, being introduced into her world.
Their resonated through the air to my ears, Quan, Hoang, Duy Anh, Quyen, Thuy, Tung, Hach…
Riding as a pillion passenger through the maze of traffic in HoChiMinh city is a thrilling experience indeed, thanking every moment I don’t have to drive through it but I can see that with a little bit of maneuvering one can learn to drive in HoChiMinh City. Alcohol consumption in large amounts have not arrived in HCMC yet, so there is a secure feeling that the drives of the countless numbe of motorcycles are in control of their vehicles, whereas in Thailand, they blame alcohol for the high number of accidents there on the roads.
Balmy nights, the people who give character to the streets have gone home, leaving an eeriness to the deserted streets in this big city. Riding as a pillion passenger, with wisps of hair and fragrances writing poetry on your face and in your heart. Being grateful for a day and night like this.
Nga represent the new Vietnam, based firmly on the positive values of the old. VN is not changing to fit into the world order by rejecting itself, but incorporating the best of the other society into the strengths and weaknesses of their own society.
Vietnam is a not a violent society. And the freedom and respect accorded to women puts it way ahead of the latin American nations, with the exception of Cuba, possibly Argentina and Chile, where there is socially organized and condoned violence against women. Here is a young woman, who by the sheer determination has gotten ahead in the cut throat competition which has been imported into Vietnam as it integrated itself into the world economy. She likes being Vietnamese but at the same time learns from others, such as her like for Japan and French fineries. She prepared a meal for me and her friend Thuy and her father in her new apartment, which is in the process of owning ( that alone is magnificent in that she is able to do that). All fresh ingredients, bought that morning at the market which is quite close by. I walked around the neat apartment, kept so well with feng shui which is welcoming. It had a better ambience of welcome than the hotel I was staying, eventhough it was a small boutique hotel well designed by a local Vietnamese architect.
A fresh perspective for me into the age old mystery of Vietnam and its people, my undulating respect for Ho Chi Minh, the indefatiguable leader of the Vietnamese people, who brought them dignity and self respect, was strong enough to expel two mighty metropolitan empires, France and USA. What amazes me is that an average Vietnamese does not hold any grudge either against the French nor the American.. A great lesson in humility for me, brought up in the egoistic tradition of the west.
On this tour of Friends, Food and Far East, I wanted to fulfill a desire inside me to see people who rotate through the skies of my imagination and thoughts. The first stop has been HCMC and I wanted to recreate in my mind our last encounter at the CDG airport in Paris and the time before eating at the restaurant serving northeastern Vietnamese cuisine (bordering China). Memory from travel hangs like a mist over the longings one has, never having left it lingers on, but reminds you of the pleasant times.
The lesson I have learned from Nga is this. It is not your aspirations and desires that define you but the clarity with which you look at it and the lack of deviousness to bring about change. She has a heart , exemplifying what Uncle Ho stood for, and from whom Uncle Fidel might have learned a lesson or two. Do good things to other people, and to those are unfortunate, do more without expecting anything in return. Let all of us get ahead together, let us not step on each other on our way up the ladder.
If a young Vietnamese girl can complete her university studies, do well her in her job at Vietnam Airlines, think with clarity to buy a house in her homeland, think positively about her country and her culture, those of us who live elsewhere, whether in countries which are sheer imitations of the west ( such as Singapore) or oppressed societies ( such as Burma) or affluent societies such as Australia or USA, can also do our little bit: honesty, sincerity, compassion and respect. As my American Indian teachers had instructed me, it is only through Love and Respect that you can hope to change anything in this world where so much violence and suffering is inflicted upon so many innocent and undeserving people.
Thus I present to you, a positive picture, a metaphor for change for Asia, to feel good in our hearts, which is connected to Asia in one way or other.
Think yourself as an Asian, my father once told me, not confine yourself within its geographical boundaries. Let all of us get ahead, at the same time be proud of who we are…

This note, needless to say, is dedicated to my good friend, Pham Thi Nga of Vietnam, she belongs to both the North and the South.
Finished writing this, without editing, at 1 pm Miami Time on 6th January 2008

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