DAY IN THE LIFE OF A PHYSICIAN ANTHROPOLOGIST

When I was finishing my post graduate studies in Medicine (Endocrinology) my contemporaries were busy scouting for future residences and private practices. I was intent on an International Career which would satisfy my hunger for cultural knowledge as well as the desire to travel. Indigenous people chose me, rather than the other way around. I realized that all the knowledge accumulated in the medical school in London, residency training in Melbourne and Brisbane and the Endocrine training in St Louis and Miami in the USA of very little use if you want to be of help in HEALING the multiple insults the indigenous people have endured and many of which is now seen in their bodies and minds. I studied Medical Anthropology under the excellent stewardship of Profs Hellman and Frankenberg in London. 
Thus was able to carve out a life as a Physician-anthropologist. Also have the time to travel and learn, having travelled to nearly 100 countries.
Indigenous people believe in the equality of professionals, they dont put too much weight on your qualifications and board certifications but consider your HUMAN aspects and their perceived idea of your desire to be of assistance for healing.
Yesteday was a typical day for me. For the sake of the privacy of the people I work with and work for, I will not mention the names or locations. Most 'tourists' to indigenous areas do not realize that they dont really wish to be visited to satisfy someones hunger for off the track travelling.
I am always impressed with people who work with indigenous people, for their dedication for the welfare of the indigenous people, all over the world.
The visiting nurse arrived and in the company of the Consultant Dietician, we set off on a long drive to visit the isolated camps of family groups. On this clear day, I enjoyed the tribe.
It was particularly pleasing for me to see lots of NATIVE palm trees to this region. In the Afro Cuban belief system known as Santeria, the supreme spirit Xango is represented by the Palm tree and I thought fondly of my friends who always send me good feelings from their rituals in Cuba.

 The indigenous people do not like to destroy their environment and like to live surrounded by the native habitat. A typical native collection of trees and plants 

 It was time for Lunch and the Visiting Nurse suggested that we drive to a town near by.
A charming little town, very original and nostalgic of the great days of glory, well situated by the water.

 The decor of the restaurant was a throwback to the 1970s and the people were very friendly and welcoming and the food can be described only as purely local. I had some GROUPER fish and sweet potato.

The drive back to the clinic was long, over one hour. I sat looking at the scenery, endlessly consuming the trees and brush and water that passed me by, languorous in the mid day heat.
Medicine, Anthropology, Culture all in the course of a working day.. 

SOCIAL BEHAVIOUR AND MORTALITY IN RICH AND POOR COUNTRIES

The bigger killer of human beings all across the world is Cardiovascular Diseases and in this study it has been pointed out that the MORTALITY from Cardiovascular Diseases (DEATH) is predominantly due to Social factors: Diet Physical Activity Processed Foods(related to income) smoking(the largest contribution)

For CVD, metabolic risk factors (lipid levels, blood pressure, diabetes, obesity) accounted for about 40% of risk; hypertension was the largest factor.

I have felt that Type 2 Diabetes, Obesity are SOCIAL diseases. Lipid levels point out to diet, once again determined by socioeconomic or educational levels

There are factors outside our control but most of the factors for ILL HEALTH are within our control.

The question is, why do we keep on doing it, knowing well that our actions would lead to Ill health_

September 3, 2019

Modifiable Risk Factors Account for a Majority of Cardiovascular Disease and Mortality

Karol E. Watson, MD, PhD, FACC reviewing Yusuf S et al. Lancet 2019 Sep 3

Metabolic factors, such as hypertension, are the largest contributors to CVD risk, and behavioral factors, such as tobacco use, are the largest contributors to mortality risk.

To assess the worldwide impact of cardiovascular disease (CVD) and contributing risk factors, researchers used data from PURE, a prospective cohort study of people in 21 countries from five continents (NCT03225586). Countries were stratified by income level; 11% of participants were from high-income countries (HICs), 66% from middle-income countries (MICs), and 23% from low-income countries (LICs).

The authors evaluated associations of 14 modifiable risk factors with total mortality and CVD (CV death, myocardial infarction, stroke, and heart failure) in over 150,000 people without CVD at baseline. Results during a median follow-up of 9.5 years were as follows:

Overall, about 70% of cardiovascular disease and deaths were attributed to modifiable risk factors.

For CVD, metabolic risk factors (lipid levels, blood pressure, diabetes, obesity) accounted for about 40% of risk; hypertension was the largest factor.

For mortality, behavioral risk factors (tobacco and alcohol use, diet, physical activity, and sodium intake) accounted for about 25% of risk, with tobacco use the largest factor.

Ambient air pollution was associated with 14% of risk for CVD.

In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger associations with CVD and mortality than in HICs.

COMMENT

PURE suggests that most cardiovascular morbidity and mortality can be attributed to a small number of common, modifiable risk factors. While some factors (e.g., hypertension) have effects across all countries and income levels, others (e.g., household air pollution) vary with income. These data indicate that, just as disease prevalence and outcomes differ by country and resource level (NEJM JW Cardiol Sep 3 2019; [e-pub] and Lancet 2019 Sep 3; [e-pub]), so too might preventive strategies need to differ.

For mortality, behavioral risk factors (tobacco and alcohol use, diet, physical activity, and sodium intake) accounted for about 25% of risk, with tobacco use the largest factor.

Ambient air pollution was associated with 14% of risk for CVD.

In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger associations with CVD and mortality than in HICs.

COMMENT

PURE suggests that most cardiovascular morbidity and mortality can be attributed to a small number of common, modifiable risk factors. While some factors (e.g., hypertension) have effects across all countries and income levels, others (e.g., household air pollution) vary with income. These data indicate that, just as disease prevalence and outcomes differ by country and resource level (NEJM JW Cardiol Sep 3 2019; [e-pub] and Lancet 2019 Sep 3; [e-pub]), so too might preventive strategies need to differ.

KINDNESS IN THE TIME OF DIFFICULTIES MY LIFE IN HAVANA CUBA

KINDNESS IN THE TIME OF DIFFICULTIES

I have always wondered why the Cubans who live in the island are so kind and demonstrate a sense of solidarity that one rarely see in other Latin american Countries.

It is a mindset they have grown up with from an early age, it has to be. While there is a fair share of ungrateful people in Cuba as well, whether they are doctors training to be specialists or well worn manipulators of the social systems. But in my experience over the many years, for every one bad person in Cuba there are nine other good people, who are grateful and not only that but they go out of their way to be of help. Not like the cunning retired military man with a car who once said, if it is good money I am up to it.

It was a hot day, as happens here in the dog days of summer, especially in the month of August. I am spending one week to get away from the madness of life in Miami as well as their unaccountably childish, feverishly fascist pronouncements. It is quiet here in Havana, one does not walk around in the middle of the day of course.

I enjoy massage therapy in Cuba, where the medical masage therapist is usually well qualified with years of studies of the relevant human systems to benefit from this type of massage.

Valentin is a friend, but he lives about 90 minutes away at the mercy of buses and private car collectives. It can take him up to 120 minutes to get to my house, but at time he has been lucky to get back home in one hour.

I called him and he promised to be here mas o menos before lunch time as it is better to have a massage in an empty stomach. Today it took only 2 hours for him to get to my house from his house in the next province. We talked for a while and then he got to work on the parts of the body that needed a little anti inflammatory massage as well as some muscles that needed relaxing.

It was one of the nicest massages I had received and felt very comfortable and relaxed. Over lunch prepared by my landlady, we talked about his plans for the future. Like most Cubans in the island, he is good at more than just one thing. He is a master tailor, a hobby he took up at age 9 and he is very good at construction, which began as necessity has turned him into a professional.

I have friends in his town, and I wanted to send a few things including medications to my friends and a gift to the recently graduated medical student. He got up to leave and of course accepting any form of payment from me was out of question.He acceeded to accepting the bus fares to and fro but refused any sort of compensation for the hour long excellent massage.

After he left I contemplated about these kinds of actions, unselfish, no ulterior motives but a genuine desire to be a friend to you. The occidental concept of Time is Money has not crept into the Cuban mindset, plus the thought is,it is time to do something for the other.

Dr Altshuler, the father of the current head of Physics at the University of Havana and son of a founding father of Cuban Communist party, had told me when I met him during my first days and months in Cuba. If you are interested in only yourself, go to USA but if you are interested in the welfare of the others, you have come to a Paradise, said talmudically this son of polish Jewish migrants to Cuba.I am happy to say that I have taken his advice to heart. As American Indians would say, be grateful, do something for others and be humble.

I am spending some delightful, tranquil days in these dog days of summer in La Habana. I came here from Quiberon, France, Vienna, Austria and Cochin, India. When I leave here, after a short spell with the Indians, I will be in France, the Austrian alps before returning to Havana, Cuba.

THE ARCHAEOLOGICAL SURPRISE WAITING FOR YOU AT HEMMABERG IN AUSTRIAN ALPS

A MAGICAL DAY AT THE SLOVENIA-ITALY-AUSTRIA BORDER OF MOUNTAINS AND LAKES

I was visiting my friends BB and D who live in a small village of Sankt Mikael near the small town of Bleiburg along the Austrian alps. Both are natives to the area.
Two things apart from their company that I enjoyed mostÑ
the spectacular scenery, various mountains and the easy access to the the three countries surrounding these mountains
the second was to discover the history of Austrian Empire and how this corner of the world was moulded by that Empire, Romans came and went and I was astounded to learn that Austrian Empire stretched all the way to Ukraine and down to the Adriatic (much like the Persian empire stretching to Armenia and Egypt and India)
we set out in the morning, leaving the valley and climbing up into the mountain ranges.

 The local people regardless of their nationality are deeply religious and sacred structures were strewn along the mountain highway which was well maintained with its multitudes of tunnels.M

 Mr D told of the time of the cold war when this border was heavily fortified but now one is not aware of crossing the border, lest one notice the spelling of the words such as Restaurant changes, yes we are in Slovenia.
The geological formation of these mountains are much more chalky than rocky and one could see landslides on the sides of the mountains like scars.
My International phone is based in Miami, so whenever I cross a border it sends me a message to say: welcome to ...such and such country.. This is an excellent service offered by T Mobile which allows me to use my phone in over 160 countries with notable exceptions so far of Cuba, Morocco and Jordan ..I am sure North Korea is not also part of the plan neither Iran.. but i have no plans to travel there in the near future.

 We were headed to the lakeside village of BLED .. I scratched my head, that name is so familiar .. then Mr D enlightened me, this used to be summer home of Josep Broz Tito, the strongman of Jugoslavia. We had a substantial proportion of Yugoslavs in Australia when I was growing up so some of these names had stuck in memory.

 Most of the tourists to this lovely town were european but i could detect the early sightings of Chinese tourists. You need a car to get here so there were many young and old people who were motoring around these parts.
The lake is magnificent with a castle overlooking. Tito's estate is well out of the view but one could guess and the postcards with its aerial view can be bought in souvenir stores.

Mr D and BB are serious mountaineers and they often come here to begin their trek of parts of these mountains and they know the area. They insisted that I try the local sugary sweet dessert and the local coffee which is strong . With the lake for a backdrop, the midmorning snack was welcome..

 While there were many tourists and most of the shops were to cater for them, didnt feel overwhelmed by the tourists, despite the spectacular scenery of lake the mountains.

 On the Slovenian side we snaked through the mountains crossing some picture perfect villages and closer to the Italian border ahead (with Austria on your right over another mountain range), came across some serrated mountains so sharp and regal that I was reminded of the poetry of Pablo Neruda whose thin country in South America reminds one of the eternal fire and mountains. No wonder that presence is seen in his poems, the mountains, rain of Temuco and the sea and his favourite home of Sebastiana facing the Pacific Ocean. I told my friends, I too would write poems and prose if I were living surrounded by such majestic beauty

At one time these villages may have been isolated and poor and agricultural but infusion of European money and free borders have brought visible development along the triple border area. Austria is definitely richer of the three but you can see the recent climb on the prosperity ladder both on the Slovenian and Italian sides.

I am a Jew but my devout catholic friends both in Miami and in Fort Cochin chide me saying that I have been to more christian churches than them. I am not religious so very rarely step into the jewish or christian places of worship for worship but when you are travelling these sacred places are part of the scenery and I enjoy visiting them.

 Tervisio for the ordinary tourist is the typical tourist trap, but for my mountaineering friends an ideal place to set off to the mountains. The restaurants were full of tourists with slavic nordic and teutonic faces, with poor quality food and cheap plonk like we would say in australia with inflated prices. 

 Why should they are when you can offer such magnificent mountains:

I felt genuinely happy 

 Interesting to see brews with  faces of Bob Marley and Che among others..both Bob and Che  were for emancipating yourself from mental slavery ...and they ended up as icons of cheap capitalist brewery promotions..

 One can return to Austria from Tervisio rapidly and the highways are very efficient and very soon we were passing by the tranquil but very large lake, WertherSee.. on our way back to the small village ..

It was such a wonderful day
Man can never match the magnificence of Nature ..
Mother Earth, the Indians call it..