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CUBA IS THE FUTURE FOR LATIN AMERICA AND PERHAPS THE WORLD On my way out of Cuba, from La Habana, on COPA airlines flight to Panama, I w...

vendredi 21 juillet 2017


Medical Knowledge ALONE is not sufficient to heal
Most people suffer from Illnesses and the medical profession objectifies those symptoms elicited and then gives it a name, and it becomes a Disease. During this objectification, the social, the cultural, the societal, the psychological, the economical aspects of the symptoms are forgotten.
Thus the patient leaves the consulting room with a Diagnosis and a treatment. Whether the treatment is appropriate or consistent with the guidelines of the various medical societies, the majority of the concerns of the patient have not been met.
This is where the questions formulated by the late Medical Anthropologist (my teacher and friend at Brunel University of London) Cecil Hellman come in handy.
Cecil Helman, an anthropologist, suggested that a patient with a problem comes to the doctor seeking answers to six questions:
1) What has happened happened? This includes organising the symptoms and signs into a recognisable pattern, and giving it a name or identity.
2) Why has it happened? This explains the aetiology or cause of the condition.
3) Why has it happened to me? This tries to relate the illness to aspects of the patient, such as behaviour, diet, body-build, personality or heredity.
4) Why now? This concern the timing of the illness and its mode of onset (sudden or slow)
5) What would happen to me if nothing were done about it? This considers its likely course, outcome, prognosis and dangers.
6) What are its likely effects on other people (family, friends, employers, workmates) if nothing were done about it? This includes loss of income or of employment, or a strain on family relationships.
7) What should I do about it -or to whom should I turn for further help? Strategies for treating the condition, including self-medication, consultation with friends or family, or going to see a doctor.
  • 1) Helman CG (1981).Diseases versus illness in general practice. JRCGP, 31, 548-52.

If the Primary Care Providers kept these concerns in their heart, so much distrust and second opinion seeking or seeking of other forms of treatment would become unnecessary.
In the context of taking care of patients with chronic conditions this is even more necessary.
I will give two examples: both of which are Signs or Symptoms and not actually DISEASES, unless the Doctor makes it into a disease.
A man around 30 years old, had been alcoholic for many years and now is seeking and gaining a foothold in the normal world. While he had conquered his Diabetes, Hypercholesterolemia with diet and advice from his counselors, he remains anxious and at times it invading the tranquility of his life and has bad effects on his self esteem.
He had come to see me, a Specialist Physician, An anthropologist: I could delve into the source of his anxiety from a social and cultural point of view and as a Doctor, could prescribe some medications. While I spent time delving into the current and immediate past life of his as well as his aspiration for the future, “I would like to become a productive member of the community”, it would be a crime if I sent him home just on his medications. I sought the assistance of a Psychologist who agreed to see him and help him with his anxiety.
So even though he had come for his anxiety, I would have been, even though I am a specialist Endocrinologist, amiss not to refer him to a psychologist.
I am very grateful for Dr Cecil Helman for the above wisdom and I always remember what a Meskwakia elder said to me: Please make sure that the patient leaves happier than when they came in.
The second context I want to write about is a patient had been told she has Pre-diabetes (in itself a constructed diagnosis) and given medications and asked to come back in three months for further measurements of the parameters that gave her the diagnosis of Pre-diabetes.
The patient all those questions outlined by Dr Cecil Helman.
Why me? Why no? Are there alternative forms of treatment? What will happen to me? To my family?
We are not discussing about the correctness of the diagnosis or the appropriateness of the treatment but whether or not the expectations of the patient had been met. The answer to the former is Yes and as regards to patient’s expectations being met, NO.
She comes to see us. I know her socially, as we know every one in this small village.
What is that I can do to change or reverse the diagnosis? Is this possible? What are the lifestyle adaptations I have to do? And my family? How would they be affected by these changes.
My role is to comfort her, to assure her, not to question the diagnosis or the treatment, but explain the laboratory results in the global perspective of her life, her marriage, her children and her family history of diabetes and her own cultural history and the role of the disease in it.
I needed the more than normal period of consultation to do this but she left the room, happy, ready to follow a prescribed regimen of lifestyle changes which would be good for her and husband and family and with no need for the medications.
She agreed to some basic nutritional changes but more importantly she made promises to keep in touch with the Health Educator and the Nutritional Therapist on a weekly basis and she would come when I am here next month. I was glad to hear that she would like her husband to come when she comes to see the Medical Nutritional Therapist.
In view of the strong family history of Diabetes, she stands a chance of that diagnosis in the future but now she should be given a chance to prove her determination to put a stop to the changes in the blood test.

I wish her well

jeudi 20 juillet 2017


9 South Korean Nursing Students from Pusan, South Korea spent two days with us and many days with other members of the Health Department of the Winnebago Tribe of Nebraska. I was surprised to learn that Western Iowa Tech Community College has an active International Programme and these students were here for three weeks to immerse themselves in American culture as well as observe the clinical practices. 
I am glad they chose to come to the Indian Reservation, as they would be exposed to a more culturally oriented medical practice rather than visiting one of the established medical establishments in the city where they would be staying. There they would be just seeing a variation of the excellent medical and technological medical care they are already used to in South Korea.
They were polite to a tee, very proper, very grateful, very soft spoken and eager to learn.
It added a little spice to our daily routine as well. Of course Native American Culture and Korean Culture has many things in common.
They delighted in simple pleasures of being in the midwest such as visiting a farm, going to the water amusement park, attending a parade.
I am delighted to know of the presence of a International Exchange Programme in the city of the community college, an forgotten outpost of the American expansion in the 18th century.

 I was happy to give them an introduction to the Native American Anthropology and also how we use the culture as a carrier of our health messages and treatment strategies .
 After observing the various aspects of the health care at the Tribal Programmes at the Winnebago Hospital, the students uniformly said :
1. at the winnebago clinics, patients are put first. Every one tries to help the patient
they said: before we came, we thought only about nursing and not about patient 
2. They were amazed how closely the doctor and the nurses worked together at our clinic and that they were amazed at the higher status of nurses at the Indian Health care facility.

 Many of the students fell ill during their stay, unable to adapt to the very hot midwestern summer weather with its added humidity, the allergens in the air.
Junior Nursing Class Curriculum.
It was very interesting to listen to them about the harsh days of High School when their days started at 8 am and after the school finished at 4 pm, they went to remedial lessons and then attended Academies for extra tuition, which often went to 11 pm and sometimes until 1 am. The sleep was only 4 or 5 hours per night! That is how tought the competition is to secure a place in the Universities in South Korea. (the situation is very similar in Japan, China and Singapore)

dimanche 16 juillet 2017


I look forward to my Qatar airways flights. In May, I flew 10 long haul flights back to back with them and in the first two weeks of this month of July, I have been lucky enough to fly 4 long haul flights with them.
I realize that the most important person for you on long haul flights (of course a pilot who is vigilant) is the Flight attendant who is who is "attending" your side.
USA and Europe based airlines have been cutting down the number of Flight attendants on each flight, even if you are flying Business or First Class. 
Qatar Airways, recently selected as the Best Airline in the world, an outcome I wholeheartedly agree with, has a bevy of Flight Attendants. The number of flight attendants per flight alone does not guarantee service but generally on all the flights I have been on with Qatar Airways (with RARE exceptions, the service has been the best)
Still, you remember some FAs more than the others, for other reasons than the best service they gave you. I can reel off the names of several: Christopher from Goa, Maria from Rumania, Barbara from Poland, Kedsarin from Thailand...
But today, on my DOHA to JFK flight I was so lucky to have MIJIN from South Korea on my side: she was the perfect FA, polite but not servile or arrogant, acquiescent to your demands with grace but not with a chip on the shoulder, pro active to make sure your needs are anticipated and always there when needed but not intruding into the privacy which is fly most people fly upfront in Qatar Airways.
 She has worked with QR for a number of years and she hails from South Korea. She has been on most of their long haul flights and delights in travel. Once a month she makes sure to go home.
QR has strict policies regarding contacts between the workers in the company whether FAs or Supervisors at the various lounges having contacts with the passengers. Also my chance of encountering MIJIN on another trip is very small because of the large reach of QR to more than 150 cities around the world and the nearly 10 000 FAs in its fodder. So I wish her well in her chosen career and she made me realize what a good FA is all about and my trip went very well thanks to her.
The crew of the QR flight I came in would be resting now in NYC and tomorrow they would return home. 
Needless to say I plan to fly QR again
In August I have a chance to fly them  JFK to Doha, Doha to Casablanca, Casablanca to Kuala Lumpur via Doha and KL to Paris via Doha..


This is how hydrated my face was when I began my journey from DOHA to New York JFK.
14 hours later, despite having a total of 8 hours sleep, the face demonstrates the dehydration of a long flight .
I wish I was in Siem Reap or KL, where I could easily arrange for a relaxing facial massage after a long flight..
Strangely enough the Uber Driver who took me to my sisters home was a qualified Physiotherapist and Massaged Therapist and we talked about the importance of getting body massages on a regular basis.
On this 21 day round the world trip, I was able to have daily massages for four days in Siem Reap and a lovely facial by Anna at Guinot in KLCC in KL.
After seeing the above photograph, I have decided to abstain from alcohol for a two week period and see the effects of it on my skin..

vendredi 14 juillet 2017


I am at Riad Hamdani, a bed and breakfast lodging place, Moroccan style, very comfortable and inspiring near the Mohammed V International Airport in Casablanca.

In the morning, facing the garden and the swimming pool I sat down for my breakfast, which I had been looking forward to, I would like a Maghrebi breakfast please! Soon enough ingredients began arriving one by one, apricot marmalade, peanut sauce, citrus marmalade, cheese, yogurt, watermelon, thick crusted Moroccan bread, a tasty omelette but the centre piece was indeed: MSEMEN, a flaky pastry like pancake with layers separated, filled with butter and crispy and very tasty.
It is difficult to make this, the owner, who with her Moroccan husband owns and runs this place, said to me. She is of Belgian origin from a place closer to the German border. It takes very long time, and it has to be spun and suddenly it occurred to me, she is describing something I commonly see in the streets of Cochin, Kerala, India and also in my favourite eating-places in Indian parts of Kuala Lumpur.
Mesamen or musamen (Arabic: مسمن), also called malawi, malawah or murtabak, is a rich traditional, pancake-like bread of the Maghreb, most common to Morocco, Algeria and Tunisia. These pancake-like breads are usually an accompaniment to a cup of aromatic morning mint tea or coffee. Msemen can be stuffed with vegetables or meat fillings.

Yes, the humble Paratta or parotha of Kerala is a cousin to this bread, which can be eaten at breakfast or as a snack or filled with meat or potatoes.
I especially felt good about the MSEMEN today, thinking of the young Muslim spinning his murtabak like a dervish in the café that I visit now and then in Fort Cochin, Kerala.

Also the Maulana Indian Resto in Seri Kembangan, where my best friend in asia lives, a good place for Parotta or Murtabak and some curry.
I have had Parottas in
Kerala India
Seria, Brunei, also Kuala Belait 
Doha Qatar
Its cousin in Casablanca
And look forward to learn more about its migration from the Middle East to India as well as Maghreb.
To Kerala, I am sure it came from Saudi to Yemen to Cochin!

lundi 10 juillet 2017


Two things stood out on my recent trip to PARIS..
Unlike the disdain the locals exhibited towards English, majority of the people I encountered were speaking English! No more, pas de anglais discrimination by black as coal Malians pretending to be French by adopting the worst of the French!
I had overcome, to a great degree, my psychological dislike of the French people and their arrogance, and was feeling warm towards them, on this trip to France. I had not been in Paris for a couple of years and the striking observation was that more and more French are speaking English, and the arrogance associated with their monolingual capacity seems to have dissipated a little. Even the policeman whom I asked for direction gave it to me in English.. viola, what is happening?
Now they are speaking English, I was speaking more than my share of French. It felt good to be trying to speak French and i was lucky.
For the past two months I have had a French Tutor, who has been helping me improve my French, without intimidating me or forcing me, in a very natural way of learning a language.
The second thing I noticed was how expensive Paris has gotten to be. Everything imaginable for a visitor had gone up. Unfortunately I arrived at the wrong time of the year in Paris and it was crowded, hotels overbooked, restaurants crowded than ever.The tourists have also changed, there were well do Indians and Asians enjoying their visit to this magic city.
i wanted to improve my proficiency and among the newer methods of language learning, they always advise to get a Language parent, who would be tolerant and patient with you, use body language to reinforce the word, much the way a parent begins to communicate with their child . I was lucky to find a Language parent like that, and I have noticed that she has helped me to improve my French, my vocabulary, my confidence in speaking French.

 and there are some principles of rapid learning, I listened to them on a Ted Talk video. The speaker who sounded Australians was not a great speaker and also not very good at communicating his ideas, but had great ideas that he had been thinking about for many years 


He talks about five principles and seven actions and they sound rather logical and helpful and certainly it has helped me with my french.

Good Luck to you ..