THE TRAGEDY OF HOW ORDINARY PEOPLE BECOME REFUGEES

When I first arrived in Miami as a student, the reputation of Venezuela was that of a rich country with lots of its citizens owning prime real estate in Miami, a corrupt country where the rich stole and the poor remained poor, but they had petroleum.
Look at the situation now!
are going anywhere they can go, as living in Venezuela, a large country which has everything has become untenable. Who would have thought the little island of Trinidad, the site of MIGUEL STREET of the Nobel Prize winning VS Naipaul would end up having a refugee crisis?

Scenes like these are repeated in Boa Vista across from Santa Elena de Uiren in Venezuela.. Cucuta on the border with Colombia.. In Barranquilla, it was heartbreaking to see families walking along dragging their half broken suitcases..

Hundreds of thousands of Hondurans, Guatemalans and Salvadorans along with thousands of Africans are knocking on the door on the USA in its southern front..
They are fleeing violence in Cameroon and many other countries.
Add to it the economic refugees from every country in Latin America excluding Chile who can enter without a visa to the USA.. thousands of Cubans, Jamaicans and everyone in between..Argentines, Bolivians..

Whether Iraq, Iran, Syria, Libya, Cameroon, Honduras, El Salvador, Guatemala, Afghanistan.. they are all fleeing violence and look to living in peace. Thousands of sub saharan africans are fleeing poverty, hoping for a better life in Europe.
When I am in Asia, I see refugees in Thailand, Malaysia and Singapore, some fleeing violence from Myanmar, some fleeing poverty. Even India which is already bulging at its seams have an illegal alien problem!
There are many failed states and vulnerable states ..and people have the right to expect a better life.

One thing is clear, much of the violence is man made much like Climate Change, in that people in power ignored problems while enriching themselves. I think we have to stop blaming Colonialism or Slavery but look squarely at the current political leaders and system that brings havoc that drives the people out.
the best example is Venezuela .. a rich country with all the resources being run into ground by the government it has.. No blaming the USA or Europe..
I feel hurt at the tragedies of these refugees whether they are Spanish speaking or Arabic speaking. It is stressful enough to migrate legally to another country, leaving your identity culture and family behind, the clandestine arrival must add several layers of stress. 
When I was in Israel, a country which has successfully assimilated refugees from Arab Countries, Russia among others, I was frightened by the prediction that the next holocaust would be in Europe and it would be against the Muslim refugees and migrants. I would add the increasing violence against legal and illegal immigrants in UK USA Australia would morph into a societal pattern of discrimination which would further curb the dreams of the would be immigrant to integrate into the society.

To the millions of people, displaced internally and externally around the world, may the SPIRITS protect you and may you find contentment and a way forward..

A PHYSICIAN-ANTHROPOLOGIST CONSUMES ONLY ORGANIC FOOD FOR FOUR DAYS AND THIS IS HIS REPORT

When my interest began in the additives and chemicals to the food we ingest and the continuing rise of non communicable diseases such as Type 2 Diabetes and non-auto immune Hypothyroidism, I learned so much about what is that we eat..
Before that, I questioned
The number of Nutrition Specialists and Diabetes Educators have increased disproportionately, so has the prevalence of Obesity and Diabetes?  in the USA 
I was astonished to see the amount of Type 2 Diabetes in poorer countries such as Cambodia and developing countries such as Malaysia and India. The aetiology of these inexplicable rises were explained aways using the western epistemiology: Too much Food and Too little Exercise..Nowhere there are mentions of Krispy Kreme along the Malaysian Highways and KFC outlets with wifi in Phnom Penh.
Long before I became a Physician, growing up in Australia I noticed that if I ate the typical Australian Diet I wont live very long, as my body was rebelling against what I was feeding it. As an adolescent I discovered Greek Food, in the city where I lived in Australia which is the second largest Greek speaking city in the world, which might have saved my life!
In any case, by the time I became a doctor and a specialist physician, I knew that while the Medical establishment was barking at the wrong tree of QUANTITATVE nutrition, the real answer may lie in QUALITATIVE nutrition, i.e., food which is food, free of Hormones, additives, antibiotics, ground up non plant based or corn fed which along with antibiotics and hormones destroy the microbiome of the animals and birds that we eat and thus passed on meat which is highly toxic, giving rise to all the diseases which are based on this inflammation.
Why has AUTISM has increased so much? 1/68 american children have been diagnosed with some form of Autism Spectrum Disorder!
If Hypothyroidism is an auto-immune disorder, how has its prevalence increased by 20 fold in the last thirty years?
Four is a magical number, scientifically and culturally for many of the people I work with. On the fourth day of eating American Food, a group of Tarahuamara Indians from Canyon de Cobre had their total and Low density cholesterol elevated, four days of consuming organic diet, many of the children who exhibited symptoms of ADHD attention deficit disorder had less problems in their classrooms..
Children's exposure to pesticides has been linked to a wide range of disease, including asthma, ADHD, autism and cancer . A maximum residue level (MRL) is the highest level of a pesticide residue that is legally tolerated in/on food or feed when pesticides are applied correctly, so that the amounts of residues found in food must be safe for consumers and must be as low as possible. However, the toxicity was set in the adult population, not on children, and it does not take into account the multiresidue in food. Therefore is a priority for children health to reduce exposure to contaminated food, similarly to baby food, where no pesticide residues are admitted according to the European Directive. Interventional studies have shown that an organic diet reduces children's exposure to pesticides, and when kids switched from a conventional to an organic diet, urinary pesticide metabolites dropped to almost undetectable levels . Organic food also contributes to increasing nutritional quality: a recent meta-analysis reported that organic food is richer in vitamins and antioxidants compared to conventional ones. The environmental benefits of organic agriculture to air, soil and water, consist of lowering the total toxic burden to our ecosystems. As demand for organic foods continues to grow, more farmers are likely to view organic methods as a viable and marketable option, helping to stabilize supply and price.

The above was published in the Italian Journal of Paediatrics in 2015.
So, when I had a week in the USA, specifically Miami, Florida I decided to consume only ORGANIC food, I must say I did succeed , up to 99 per cent of the time. I sprinkled some onion powder which was not organic, had cuban coffee which cannot be organic! he he, in the USA, perhaps in Cuba, yes..

 Organic Salmon, organic brussels sprouts

shopping at ALDI.
Was it easy, not really. when every one around you is eating toxic American supermarket diet. But I have good self control over the food I eat.. and what I drink.. Champagne is always welcome..
What are the results?
Needless to say I began to feel better
The swelling of the abdomen after meals were much reduced but after the second day I began noticing a curious phenomenon.
I wear glasses and I am aware of the visual limitations but the colours began more prominent and i could see further. I had been reading Murakami Haruki's last book, often engrossed in it and I noticed that my thinking was way clearer without any muddy thoughts. I certainly attribute these two physiological changes to my consuming only ORGANIC food !
On this Friday Night I am in Miami, Florida, so I wish all my friends and relatives everywhere SHABBAT SHALOM.

One week from today, I would be in Cochin, I would go to the Cemetery and say Kaddish for Sarah Cohen of Jew Town who passed away at age of 96, taking with her the history of the Paradesi (Foreign) Jews who had arrived at the port of Saude just south of Fort Cochin in early 1600s.. I plan to visit Elias Babu at his synagogue at Market Street in Ernakulum and wish his family L Shanah Tovah . Happy (Jewish) New Year 5780.

https://medicoanthropologist.blogspot.com/2018/11/paying-respects-to-last-jew-of-cochin.html

HOW DIFFICULT IT IS TO ACCESS AND CONSUME ORGANIC FOOD IN MIAMI

The answer is quick: Not that easy
Where I stay in Miami, in the Kendall area, there are a variety of supermarkets within easy reach, say within 10 km.
There is Navarro, El Presidente and Fresco mainly catering for the Latin clientele; then Publix an established supermarket as well as Trader Joe's and Whole Foods, the last of which my friends in Portland call, Whole PayCheck because of its prices.
Unfortunately the food sold at the Latin Supermarkets are of poor quality but cheaper. I suppose one could find some vegetables or canned goods or something like that, but in general they do not carry Organic items. It is a commentary on the financial status of their clientele. Recently I went to Fresco and was disappointed to find that the only ITEM they had organic was a tub of Icecream! Looking at the ingredients of their frozen food, it was horrifying to see the chemical overload. I would still go there before I return to Cuba, as I can get Frijoles Negros at a reasonable price but that alone is not a reason to go there.

The second tier is PUBLIX and ALDI a german origin supermarket which is aggressively expanding in the USA. 
Both Aldi and Publix have organic items but they do not have dedicated areas for their organic foods. One thing I noticed was that the non-organic items sold by these supermarkets are of a good quality and if you want to eat better, one could carefully choose some items.

 went to ALDI yesterday and bought organic items necessary for my stay for the next four days. I did not particularly think that they were expensive, comparable to the prices of non organic food, at best 30 per cent more expensive.

Thanks to the Nutrition Consultants at the place where I work, I was able to do this experiment of eating nothing but Organic for four days.
I was spurred to do this by a scientific study that showed that just four days of Organic food bettered the attention in ADHD attention deficit children.
Secondly, we had begun a family under our care on Organic food as much as possible, and within six weeks there were improvements in Blood Sugar and Blood Pressure and Cholesterol and complete disappearance of Liver Fat deposits..
That goes with the hypothesis I have about Inflammation in the body that comes through FOOD which has been adulterated with chemicals.
It is not JUST carbohydrates or Proteins or Fat that harm you (anything in excess would harm you by the way), nor any of these vitamins and diet supplements would decrease this inflammation, but it is the QUALITY of the food .. meaning no chemicals, Food that is Food 
When I buy food in Cuba, I know where it came from, most vegetables are direct from the farmers, Carnero was butchered that morning and arrive at the shop within hours, no chemical additives as long sa you dont buy Highly Processed food manufactured in Argentina or Brasil . Eat Cuban when you are in Cuba..
How easy was to access organic food, it was not easy. because i wanted to be as close to 100 per cent organic just for these four days.. including Coffee and Tea.. I was able to get Organic tea but not coffee.. Milk yes, sugar yes but not coffee..when I made the organic meat into a pattie and ate with organic brown rice, i did not have the condiments which were organic..I corrected the situation today..

So what happened to this Physician-Anthropologist who ate nothing but Organic food for four days in USA?
To see the results I recommend, you read the next blog ..

Oh HAVANA . WHAT A DELIGHTFUL WEEK SEPTEMBER 2019

On the day arrival, a family, an aunt, two nieces, the one below in her third of LAW studies arrived and we had a lovely dinner together and then followed by some dancing listening to AFRICANDO on Spotify streaming service.

THANK YOU DEAR FRIENDS FOR MAKING THE EFFORT TO COME AND VISIT

especially considering the current transportation difficulties in Cuba!

Isnt it a luxury to live surrounded by the aesthetics of CUBA?

They had come from a town in the next province of Mayabeque and had taken them two hours to get to Vedado. Friendships have a different sense and obligations here in Cuba.
They stayed with me for the night and left next day after a nice breakfast together..

HAVANA IS TRULY AN UNENDING FEAST: A DELIGHTFUL WEEK IN SAN CRISTOBAL DE LA HABANA

I had been looking forward to my return to the island, with a brief sojourn in Miami where I enjoyed spending a couple of days in the Everglades National Park.

 The sun was rising as the Uber car share approached the airport. The driver looked an educated man and he turned out to be an ex-professor from an upper level university in Havana, taught philosophy, came here 15 years ago for purely economic reasons, looks forward to spending time in Cuba when he retires in 3 years time.

 At Miami airport, the check in for the direct flights to Cuba are on a seperate area, as they have to make sure your documents are right. It went smoothly enough.
The agent had an air of the islands about it and a name sonorous to remind us of tranquil beaches of the Caribbean: Myrna
She turned out to be from Haiti and the world is small enough that she knew the Haitian colleague, a physician, of mine!
The security was over with quickly and there is no immigration check when you leave the USA, so very soon I was in the Flagship Lounge of the American Airlines. I was looking forward to the breakfast.

 I like the idea that every single person in that club, including the lady who prepared the omelette was from another country and I usually engage in a little chat with them. Speaking Spanish has definite advantages in Miami.

 I was engrossed in Haruki Murakami's Killing Commandatore, a gripping tale in his typical style. Before long the lush greenery of the Havana region began appearing below and we landed safely.
The Immigration at Havana airport has been streamlined recently and the young lady was pleasant and stamped me in. Quickly through another x-ray security, checking for fresh agricultural products and then hand over your health form to the doctor or nurse manning the table. I was happy to recognize the doctor present today, he teaches at the Medical University for Latin American Students.
Today they were checking all canned food. I can travel around the world with just a carry on luggage but to Cuba, I arrive laden with goods, including this time lovely canned olives from Israel. A mangy dog a good metaphor for the current cuban crisis, sniffed at our canned good, taken out of the luggage. The efficient young lady was studying to be a lawyer. At the Havana airport it is not unusual to see students at the high school and university levels doing their work/study requirements and they all smile politely at you.

 I am surprised how heavy my luggages are, not used to travel like this to other parts of the world, but this is not just any country, but I am going home to CUBA and friends are waiting..
My driver was prompt but taking a snooze in his 1964 Peugeot and soon we were off to the city through such familiar scenery,

 To me Havana is a moveable feast and I enjoy its sights over and over again..

 Soon I was in my neighbourhood of Vedado and felt welcome by the familiar buildings, such as this Art Deco building just two blocks from my home.

 This little known monument at the corner of L and Linea is  dedicated to the CHINESE men who fought and died during the struggle for Cuban Independence. It has been there as long as I could remember.
My landlady was home, having arrived at my flat early enough to prepare a nice welcome Lunch..

 The sumptuous lunch did not foretell of the restriction that were put in place just a few days later, as a result of the blockade by USA of the petroleum supplies from Venezuela.
Turkey, Rice and Beans (Morro), avacado, freshly squeezed Mango juice, sparkling water and of course as always a cup of nice Cuban Coffee.
I am always humbled by the great solidarity that Cuban people in the islands show each other and other signals of resiliency against the man made difficulties from inside and outside.

I felt very welcome ..in the next few days, each and every day and night there would be visitors from near and far to make this ordinary life in Cuba an exciting one..

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.