Sleep, Memory!

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We are in darkness;

The night is still and vast;

Yet you are restless

Troubled by our past;

The times we failed;

When lack of vision,

or of will prevailed

and led to indecision,

Times we faced conditions,

Outside our ‘rules’ of life,

When we ceded visions

To raw fear and strife.

Yet all was redefined

by a woman who willed

In Poem and steely mind

Giants  to be killed.

Forget the shameful past!

Dream the coming day

Of promises that last!

To Sleep the night away.

Sleep, Memory! Dream

What’s never been

But one day will be,

When light returns again.

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Belize

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Aldous Huxley wrote in Beyond The Mexique Bay (1934) “If the world had any ends Belize would be one of them. It is not on the way from anywhere, to anywhere else. It is all but uninhabited.” Huxley was one of the few adventurers, more than 80 years ago, to visit what at that time was one of the most remote corners of the British Empire. I met him at a UCSF school of medicine conference shortly before he died.

My daughter has been a devoted scuba diver since her teens, and searches the world’s waters to the best places to dive. That broght her to Belize, and when she found it possible to cash in from a silicon valley job, she and her husband John moved to San Pedro, Belize, on the world’s longest N/S reef. So between Huxly and Amy I simply had to go there, though without my daughter’s advice I would have forgotten Huxley.

Belize today is sparsely populated by 395,000 inhabitants spread over 8,867 square miles; the population density is the lowest in Central America and one of the lowest in the world. : less than 20 / sq mil. Honduras 9 million) AREA 8,867 mi² 2017382,444 ( by comparison, Guatemala 17 million,

Once known as British Honduras, Its unique culture and history make it both attractive and exotic for expatriates, especially from the USA.The mainland, while less developed for tourism, produces plentiful meat, dairy products, and fruits and vegetables. Farther upland toward Guatemala are dense jungles, a pine highland, pyramids and temples – many not yet excavated.

The Mayan civilization of more than a million people was centered in the area from 250-900 AD. Belize gained its independence from Great Britain on 21 September 1981 under the Peoples Party Government led by Prime Minister George Cadie Price, who launched the movement for self-government with the formation of the People’s Committee on 31 December 1949 after the British Colonial rulers devalued the British Honduras Dollar bringing much economic hardship on the colony’s residents.

The Population is very diverse, made up of a multiplicity of cultures, speaking many languages. English is the official language required in obligatory K-8 grades. Spanish is widely spoken by the largest ethnic group therefore most people are bilingual in both English and Spanish; many speak and understand local Creole, or Kriol.

Census 2010 49 % mestizo; 23% creole ; 7% garifuna (African)

5 % white; 6% mixed; 3.6 % menonite ( german)

The Menonites. Despite small numbers, are very significant. Beginning in 1958, they settled in mainland Belize, at the invitation of the government, which hoped to promote their agriculture and stock industries. The land was sold at bargain prices, in isolated inland areas. The Menonites gradually divided into two groups, those who hold to traditional ways, and those who adopt modern farming and husbandry practices. ( The locals wryly call the latter group ‘Mechanites!’ )

Some 4000 mainland Menonites contribute greatly to the carpentry, engineering and agriculture of Belize. .They produce milk, cheese, beans, corn, melons, honey, chicken, and eggs and meat, There are more cattle than people in the country. They are also skilled in manufacturing hardwook furnitureand homes. In San Pedro, on Ambergriss Caye (Key), for example, they hold a very popular Farmer’s Market once a week, where local merchants and residents load up on Menonite products. On the other hand some eco activists complain the Menonites disregard the environment leading to large scale deforestation.

Territorial Conflict with Guatemala is longstanding. The border is quite porous, so that people are able to cross into Belize to escape conditions in Guatemala and elsewhere in Central America, attracted by the stable economy and government. There has long been a fixed exchange rate between the $Bz and $US at 2:1.
Many immigrants move into communities of trasients, like one I visited called Progresso, and thereafter gradually enter the workforce without citizenship. It may be that the relative stablity and attractiveness of Belize contribute to the many decades old conflict with a notoriously corrupt and failed Guatemala that continues to claim Belize as its own. While Mexico (Yucatan , Quintana Roo) borders Belize there is no similar conflict, or signigficant similar transborder migration.

In each of the recurring U N votes on the Guatemala claims to sovereignity over Belize, the United States abstained, thereby giving the Guatemalan government some hope that it would retain United States backing. Finally, in November 1980, with Guatemala completely isolated, the UN passed a resolution that demanded the independence of Belize, with all its territory intact, before the next session of the UN in 1981. The UN called on Britain to continue defending the new nation of Belize. It also called on all member countries to offer their assistance.

A last serious attempt was made to reach an agreement with Guatemala prior to the independence of Belize. The Belizean representatives to the talks made no concessions, and a proposal, called the Heads of Agreement, was initialed on March 11, 1981. But the Guatemalan government refused to ratify the agreement and withdrew from negotiations. Meanwhile, in Belize pro Guatemalan opposition existed. It engaged in violent demonstrations with four deaths, and many injuries. A state of emergency was declared. However, the opposition offered no real alternatives to Independence, which came on September 21, 1981, without any agreement with Guatemala A recent Guatemalan referendum, a foregone conclusion, confirmed their belief that Belize is national territory. The Belize governor is proposing a Belizian referendum to approve submitting the dispute (again) to an international court. He argues that, as before, Belize sovereignity will be verified. Signs and billboards in the countryside declare: YADAT TU WE… Creole for THIS IS OURS!

Languages

English is the official language “used in all domains of public life”, including the government, the legal system, the media, and education

Kriol is English colored Creole

Spanish is the home language of 2/3 but English is spoken by 80%

54% speak Spanish well, and 52 % speak English most can be considered literate..

44% kriol, 10% Maya 3%\ German, 3% Garifuna

Religion

Catholic 40% Protestant 32% Pentecostal 8% 7th day  adventist 5 % Menonite 3.7 % all others 20 %

Currency The Belize Dollar, $Bz is fixed at 1/2 $ US In effect, like Panama, the currency therefore is the $US. This provides stablility and avoids the temptation to devaluation that a national floating currency offers.

Therefore, visitors are not likely to find prices for food and lodging in Belize a bargain. In San Pedro, the main city on Ambergris Island, prices are roughly those of coastal USA. On the other hand, cost of day to day living is attractive especially to retired people,who find both the climate and the culture very appealing. There is an uncommon but universal courtesy and grace in relationships that is not often found elsewhere. Nonetheless, the average San Pedro resident in fully intenet connected and agile.

In the media, Belize seems to be often painted darkly for violemce especially around Belize City, said to have high crime and murder rates. Nonetheless, that is not the case in the tourist heavy areas. My daughter and her husband live in San Pedro , on Ambergriss Island and have never had problems there. We went to the inland cities without any trouble anywhere; and, of course, had no problem at a mountain equestrian resort. Except for the infamous botfly! I never saw, never heard, a single mosquito…but, collected quite a few botfly bites whose vector is… the female mosquito! Even now , a week later, I can count 80 or 90 little inflammed nodules, the nests of what is an intradermal maggot! It is a long story, perhaps, but may be of interest to some. I’ll append it to the end of this post.

Government

Belize is a Commonwealth nation, a parlimentary democracy based on the British monarchic model of self government under a ministerial system. In January 1964. The official name of the territory was changed from British Honduras to Belize in  June 1973. Full independence was granted on 21 September 1981. By Comparison, the Cayman Islands remain a British Crown Colony, are smaller and more densely populated.

In many places today there are strong indigenous movements. Yet in Belize they seem relatively mild, most often taking the form of criticism or rejection of values found in the so called developed world. As an example see below some comments on modern medicine and technology by a Belezian native healer:

From A Belizewan Medicine Man: Peter Singfield
Xaibe Village

Singfield is not an admirer of the titled elite or their practices: In general, his observations reflect a common reaction of indigenous people to the way of life among the more dominant cultures. He is a part of a widespread rebellion within the indigenous worlds of the Americas… from Alaska to Patagonia… they rebel against, resent and reject the abuse, arrogance and ignorance of moderns. In many cases outrage among indigenous peoples today is far more hostile and violent than Springfield’s which is merely quite critical and dismissive. His website contains a long list of ailments he has cured without modern medical means. Some quotes:

Doctors and scientists do not mix. ( dont mix in, don’t get it) I believe they are among the most ignorant segment of the human species. Ignorance defined here is unwillingness to learn. They should lynch the Lawyers first then the Doctors.

“Clear cutting of virgin jungle for raising Beef of poor quality pays well when selling to the pet food industry so a green peace idiot can feed a cat or dog — the child they never had in a world so screwed up it is not conducive to raising of human children.Green Peacers — may they all end up where they belong — in Hell!!

At some point you must personally decide which side of the humanity fence you are. Modern World or Salt of this world.I don’t want to know the world you live in — and really am not interested in the problem with diseases you have. They come from life style –

If you walk with me your eyes will be opened — do you really want that??

My Friend !!!

Conceptions
Are but receptions
Of our Fantasies

Which can be
The monopoly
Of our fear

Then — what of reality ???
Do we banish with a cheer
All our feasibility ???

Oh !!
Comfort me
My fantasy

All is not right!
Feel my fright
Of this!!
Our cold reality

Life Expectancy: Despite very limited access to medical care (Singfield might say because of it), and despite lockstep media reports of violence and death, longevity has remained remarkably stable always. For example since 1975 it has changed very little, unlike some places in the USA.

1975–1980 68.6
1980–1985 70.4
1985–1990 71.5
1990–1995 70.6
1995–2000 68.6
2000–2005 68.5
2005–2010 69.5
2010–2015 69.8

Source: UN World Population Prospects

A Visit to Mountain Equestrian Tours (MET)

My daughter Amy organized a trip to MET. The owner is a Californian who began 30 years ago to build an eco friendly dude ranch. Today it is eminently accessable by a flight from Houston to Belize City, where the dude is met by the owner’s son in law, David, for a 90 minute drive directly to MET. On the way an optional visit to a zoo or a meal, or shopping can be elected.

The ranch itself is at once rustic and elegant. For example, there is no electricity except for charging electronic devices. Light is provided by kerosene lamps and candles at evening meals. I usually left the kerosene lamp in my cabin on and found them suprisingly long lasting and soothing. The windows were open to air, and the beds mosquitoe netted, although I didn’t ever see a mosquito. Never; but more later on that! . (In the Panama Canal Zone 1954-5 I also never ever, saw a fly or a mosquitoe, thanks to draining of swampy areas and .. very likely… DDT. )

The second morining we went on a half day horseback ride, very comfortably, at least for me because the experience is not new. The following day was devoted to an all day ride, which leads me to write about:

Two pesky Belize flies: The Botfly and Sandfly

Myiasis is the parasitic infestation of the body of a live animal, usually a mammal, by fly larvae . Some species grow in the flesh of their hosts, while others grow in the intestines.

The three major families of flies encountered in myiasis can be divided into two groups for comparison of host-location strategies: (1) Oestridae; and (2) Calliphoridae and Sacrophagidae. The former are all obligate parasites, the latter include obligate and primary facultative parasites. In the Oestridae, the majority of Cuterebrinae deposit their eggs at sites likely to be visited by the host, whereas the majority of Oestrinae, Hypodermatinae and Gasterophilinae deposit their eggs or larvae directly onto the host.  https://www.tandfonline.com/doi/abs/10.1080/00034983.1995.11812964

The botfly, also known as gadfly ( Sorry Mr Socrates but the appelation does seem apt!) is transmitted on the wings of a mosquito; warmed by the host’s skin, the botfly egg hatches and burrows in, growing into a larva, or less kindly, a maggot. A swollen nodule develops causing severe itching, but it is almost impossible to scratch to death! The larva breathes through a tiny tube, which, fortunately, can be blocked with heavy ointment like petroleum jelly. Otherwise the larva matures and in a few weeks a new bot fly is released. Note: one way to control the Bott is to seed sterile male flies in the infested area. In that case the female eggs are sterile and merely itchy more like an ordinary mosquto bite.

Sandflies (aka sandfleas or no-see-ums) are common in mangrove swamp areas and sandy beaches. They also cause bites which don’t seem to heal, but a heavy ointment will suffocate the mites. To control the sandflies, beaches are often raked daily, and controlled by exposing them to the heat of the sun.

Lieshmaniasis is a more unusual problem caused by sandfly bites, and may cause sores, leaving scars.   The Screworm is a related burrowing larva seen locally.

The day was beautiful. The horseback ride itself was uneventful, except for an oversight of my own. I have diabetes, and use Basal ( long acting) insulin, rarely adding a fast acting dose. Breakfast was early, fast, and light, and I had eaten nothing since. Moreover I was having too good a time to think about my blood glucose. But A lifelong time indulgence of mine is physical activity. It is my drug of choice. Several times I have forgotten that strenuous excercise can burn a lot of glucose, leading to low Blood Glucose Level, and related symptoms. In that case I don’t remember that I’m burning glucose quite fast until I become weak.

At the end of the ride we had to climb down about 600 ft to a waterfall. By the time I got there I felt very weak, understood the reason, and laid down on a rock to eat a couple of granola bars while the rest of the folks went swimming. In a half hour I felt well and climbed uneventfully back up the hill. Problem solved, right? Wrong. I didn’t realize was that while I rested I was being bitten by mosquitoes. I didn’t hear, see, or feel them. Not one.

My ride home was uneventful though onarrival, I encountered one of those events that often happen to a physician in such circumstances. At least it has happened to me often. The owner’s teen aged son drove a station wagon home.. He crossed a bridge too fast, lost control and rolled the vehicle into a creek, about a 15 ft drop. Fortunately the depth of water was only a bout 1 1/2 ft. The wagon was totatlled, landing on its passenger side while people hung from seat belts. Jeff, one of the passengers managed to crawl up and reach the driver side windows, break them, and push the door up and open so the rest of the passengers could un-clip to climb up and out.

But he hurt his shoulder somehow in the crash. and complained of ill defined numbness of his arm and hand; the shoulder was painful. That evening after supper, as darkness fell, the owner– whose son and wife were devastated by events– asked me to look at Jeff’s shoulder.

The shoulder was not deformed, nor was the clavicle. There was tenderness to direct palpation anteriorly, but diffusely, and the shoulder could be passively moved through a nearly full range of motion with little increased pain. No discoloration or break in the skin. The arm and hand were intact in every sense, without deformity, weakness, loss of sensation, or limited strength.
They were considering driving to a hospital in Belize City, or more optimally in Merida, Mexico, to be sure there was nothing serious. That would, of course, be an all night effort, an Xray, and— if an MRI were available it would likely be put to use with, I expect, little benefit except that someone has to pay for such expensive stuff!

So I bit the bullet, and explained that it seemed unlikely there was a fracture; there was no dislocation; no sensory loss, or circulatory deficit. I suggested that in such circumstances an icepack was ideal, with a makeshift sling. If there did happen to be a minor fracture a delay of a few days would not be problematic. The next morning he was almost totally asymptomatic. Amen.


How do you do Mr Maggott! . Within a couple of days I discovered more than 40 slightly swollen red itchy spots on my trunk, abdomen, and extremities. They were caused by botfly larvae nesting cozily in my skin. In travels over much of the globe, Panama, the Phillippines, Mexico and South America, and in practice since 1955 I had never met the botfly. .

A brief on-line excursion will offer more than most anyone wants to know about these little devils. The eggs are transmitted by mosquitoes and hatch in the warmth of the host’s skin. The larva burrow in and develpe in the skin, while breathing through tiny tubules poked up from their intradermal nests. If allowed to mature for several weeks they become ugly little grubs and can leave the nest.

In Beliz most such D hominis infestations are handled by individuals themselves. They usually suffocate the larva by the application of occlusive substances (eg, nail polish, petroleum jelly) .  24–48 h after application, the larva begins to deflate, collapsing its retrorse spines. The larva can then be expelled by applying pressure around the cavity to extract it, or by the use of a snake-venom extractor. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)70146-5/fulltext#back-bib1

Since my own infestation was relatively early, I got good results from self treatment. I didn’t have enough scientific curiosity to let these maggots mature for six weeks until I could pull them out by their ugly little faces to examine them closely!

Physicians and US Health Care 2019

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T

Every undisclosed payment, free sample or all-expenses-paid trip is an attempt to manipulate. And whenever clinicians or researchers take the bait, it’s patients who are put at risk”. R Pearl Forbes Dec 10 2018

There is ample and well documented evidence of the way drug and medical equipment manufacturers co-opt and groom both physicians and the public. (1) For physicians the evidence is all around us. Physicians accept:

Gifts that influence medical decisions or practice.: :

Meals, and samples from attentive, attractive drug ‘reps’.

Subsidized Continuing Medical ‘ Education’ ( read grooming!)

Subsidized or free medical meetings

Free samples of costly drugs to promote later sales.

Physicians are not quite innocent in accepting such freebies; we know there is a payment due, but fail to make the obvious conclusion: Don’t accept the bribe!

ProPublica Dr B gave overly favorable reviews for Swiss drug company Roche but failed to disclose $3 million in direct payments from the company since 2014, claiming the lapses were “Unintentional”!

Brigham and Women’s Hospital in Boston revealed that Piero Anversa, a high-profile physician and cardiac stem-cell researcher, had falsified and/or fabricated data in at least 31 medical journal publications.

Tito Fojo, MD, PhD in The John Conley Lecture found that “the last 71 chemotherapy agents receiving FDA approval extend life by an average of only months—time often spent in pain, isolated from friends and family.” (2)

Misleading Direct To Consumer TV ads largely pay for ‘free’ TV. They are often so misleading as to be absurd; but they work! When an ad claims that a drug, “significantly increases the chance of living longer” What does that mean? Nothing! Another ad can state that a medication ‘can improve (symptoms) ‘ up to 75 %’ That must mean-75%-100 % may see no improvment! ( Step right up Ladies and Gentlemen! See the two headed woman grow another body!)

Medical trials funded by drug companies are 30% more likely to show their drugs are safe and effective compared to independently funded studies, according toa consortium of medical and statistical experts (the Cochrane Coalition.)

Is there something physicians could do? Various new Oaths have been written:

I swear to fulfill, to the best of my ability and judgment, this covenant:

Hippocratic Oath: Modern Version
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University  (Good, but anachronistic in 2019)

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

“The original oath is redolent of a covenant, a solemn and binding treaty,” writes Dr. David Graham in JAMA, the Journal of the American Medical Association (12/13/00). “By contrast, many modern oaths have a bland, generalized air of ‘best wishes’ about them, being near-meaningless formalities devoid of any influence on how medicine is truly practiced” Probably modern oaths are written by a committee or by congress! (Sorry.My rant…Ed)

I agree the modern oaths are not much improvement in the 21st Century. We live in a new era, the equivalent of the time when the printing press and cheap paper appeared; what followed then was constructive chaos because information, and commuication only available to the few, became available to the many. Isn’t that what is happening today on a much wider scale? A world wide scale? It is as true of medical information as everything else. Therefore even if we physicians may refute or ignore the assertion that we are complicit in the prohibitive cost of US Health Care, we should realize that is irrelevant; we are no longer in charge. Who is? Our world with almost unlimited access to information formerly confined to the elite of medicine: to us. If we think we are in charge we could read Marcia Angel’s book; and if we still want to be the alpha wolf of medical care, simply going on line and looking up any disease, condition, medication or treatment option should abuse us of that illusion. Is there reason to reconsider the ethical practice of medicine? Even by drug companies? Yes!

If so, physicians should do that both individually, and collectively through professional organizations. We cannot absolve ourselves from being complicit by saying “ I myself wasn’t paid millions.” Rather, we could consider this: “I sold myself far more reasonably, like most of my colleagues! Still, I am not altogether innocent; I realized there would be some kind of payment due, but failed to make the obvious conclusion: Don’t!:”

I graduated under the old oath, from the University of Minnesota School of Medicine in 1954 and have been grateful every day of my life. There is no more privileged, challenging, joyous, or fulfilling work. Some things do not change! Not yet at least…

We should consider an Oath something like this which:Recognizes that patients have more access to information and therefore are more able to participate in medical decisions about their health and health care, and reads as follows:

I PromiseTo:

Conduct myself in the most rational and far sighted way I can, avoiding careless, thoughtless, or self serving prescription of medications or procedures that may harm the biosphere, or the health of my

patient or the bioshphere, or the wider community.

Honor traditional, rational and moral standards of medical ethics but willingly discuss and render my opinion about those I feel are unwise or harmful.

Refuse nominally free continuing medical education (grooming) through enticements.

Honor my patient as I do myself, being always willing to take time to explain the reasons for my opinions and always ready to listen and consider respectfully my patient’s ideas, concerns, objections and wishes.

Honor my patient’s right to choose among the various options for treatment or nontreatment.

Condemn  and Reject  Direct to Consumer Advertising by drug companies, manufacturers of medical hardware or devices; and by physicians or other healers.

Refuse payment for unmerited ‘research’ and speaker fees; where these may be justifiable, I may accept only after independent peer review and a commitment to total transparency.

Always take into consideration whatever effect my practice may have on the environmental, medical, biological, and economic aspects of medical care.

Alwaysbe ready discuss and to adjust my fees according to my patient’s request, regardless of any presumed ability to pay.

Respect the ethical guideline of medical care, Primum non nocere, First Do No Harm, while carefully taking into consideration my patient’s personal needs choices, and wishes.

Hold my patient’s medical history, diagnoses, and treatment to be privileged communications between us only, unless my patient directs me to act otherwise, or when consulting with a medical colleague about a difficult case, where the consultation is also a priveleged communicaion.

(1) Among the best reading on the subject are:

The Truth About Drug Companies by Marcia Angel, MD. For many years she was editor of the New England Journal Of Medicine. (ISBN 9780375760945)

Overtreated by Shannon Brownlee (ISBN: 9781596917293)

Selling Sickness Ray Moynihan, Alan Cassels (ISBN-13: 978-1560258568)

Mistreated: Why We Think We’re Getting Good Healthcare—And Why We’re Usually Wrong,”by Robert Pearl MD (ISBN-13: 9781610397650)

(2) JAMA Otolaryngol Head Neck Surg. 2014;140(12):1225-1236.

(3) No doubt freedom of speech could be claimed in defense, and yet Direct to Consumer Advertising is like shooting an automatic weapon into a crowd. Freedom to kill with an automatic weapon is the same sort of crime as killing through dishonest and deceptive advertising. One is killing for its own sake, the other is killing for profit. Neither is protected free speech!)



Peace Corps or Peace Corpse

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The Peace Corps was established in 1961 to promote and represent our US society.  In the words of founder Sargent Shriver: “There is no better advertisement for what this country stands for than an individual Peace Corps volunteer walking down the street unarmed, wearing the same clothes that the people do, eating the same food, living the same life, and being there as an independent free-standing person who believes in democracy and who is compassionate to his fellow man.” (italics mine) In 2001 he spoke to volunteers more poetically:

Be servants of peace …

Work humbly, persistently and intelligently …

Weep with those who are sorrowful …

Care for those who are sick …

Serve your neighbors …

Serve your towns …

Serve the poor …

That is your challenge.”

In the early 1970s I was medical advisor for the Peace Corps Training Program in Davis California. It was housed at Cactus Corners, west of town in a former migrant farm worker camp. Experienced Nepal Peace Corps volunteers, and Nepali advisors taught the rudiments of Nepali culture and language during 12 weeks of training. Among many details applicants learned that touching people or eating was only done with the right hand, the left being used for wiping after a bowel movement; that while sexual activity is prominently displayed in stone and tome, in practice it is hidden; that while common drugs are cheap and readily available, to use them is demeaning, confined to the lowest wretches of society. Ironically, though, volunteers at that time were often college graduates, whose attitudes and behavior with regard to sex and drugs was the inverse to those of most Nepalis.

Volunteers were chosen who were skilled in matters felt appropriate  for  remote Nepali villages: teaching, science, demonstrating  advantages of modern agriculture, or technology. The election of individual villages was made by the monarchy,  the King, not by Peace Corps or villagers.   In a sense the volunteer would be subordinate to the Peace Corps mission, to the King, to the culture, to village elders as well as enviromental, societal, and health risks.

Clearly there would be major challenges for volunteers who were  mostly young and not very world wise; who had been born and raised in a country and culture that never significantly exposed them– either physically or psychologically –to the the sort of enviromnet where they were to serve; to infections, privations, foreign values, limitations or dangers.

 Volunteers would be subject to risks that were underappreciated and unfamiliar. They would be like idealistic young people everywhere who volunteer or agree to serve in distant places under difficult situations. In the same youthful ardor and confident spirit  of military recruits, they would be cultural warriors in a cause greater than their own. The word Corps seemed  military, but under the circumstances, reasonable.

On arrival in Nepal, after a relatively short introduction to the Peace Corps staff in Kathmandu, and some practical advice and directions, they would be sent off to their assigned village. Their Nepali language skills,  were essentially those of a 2 or 3 year old but they would walk,  often alone, carrying their belongings to an assigned village. The journey would take several days over mountain trails, across snow melt streams, and  through villages where the rare sato manchi, (white man) is the object of great entertainment and attention to everyone, especially packs of excited children.

Even so, the journey was welcome, exhilirating, a  sweet pure adventure which would animate them greatly. However, nearing  the end of the first half year in a village,  volunteers  found they not only had to deal with trobiling recurring health problems like diarrhea, or amebic liver disease, but manage it alone, although with remote advice from Kathmandu. Sometimes, following their protocol for bloody diarrhea, when it did not respond to treatment, a stool sample would be mailed to Kathmandu. But it was such an interesting and attractive package, it might be stolen. 

In time it would become clear that a culture thousands of years in the making would scarecly change in two years. Sent to teach science, for example, the volunteer had  to develop the wisdom and skill and patience to work with a revered village teacher who probably felt threatened, who didn’t ask for the help, and whose basic-element world consisted of earth air fire and water;  whose teaching methods were harsh and didactic; whose resources were extremely limited; and who could understandably resent his brash young uninvited competitor.   

The volunteer who, by planting and fertilizing his demonstration cornfield,  may have convinced the local folk to do the same, but then might find  that the cost of artificial fertilizer abruptly increased 5000 percent, because the sole provider of chemical fertilizer had won life’s lottery and raised prices. Villagers might therefore conclude that  handfuls of cow dung were more practical, even if less productive.

Facing  such problems, a degree of volunteer depression sometimes developed for the first time, though often unrecognized. Even so, as the two year assignent drew toward a close, friendships developed, and language skills improved,  the beauty of a thousands year old philosopy, music, and art became apparent; most volunteers recovered. Despite illness, difficulties, and disappointmnts, to have met and overcome the personal challenge of two years in remote Nepal was a rewarding accomplishment, and an incomparble life changing experience.

So while changing Nepal would be difficult and unlikely, what would change, was the adaptive and successful volunteer. Change would be  evident both physically and mentally. Those who were able to complete a tour of duty often changed  even in  appearance, gait, attitude and habitus. By contrast to young men, women,  perhaps the hardier and more resilient gender, adapted and recovered more easily. 

My own 1970s involvement in the Nepal training projects in Davis California was to teach about health matters, especially infectious diseases transmitted by food and water; to urge avoiding suspect food that can’t be washed with soap and water or peeled, or treated by soaking in dilute clorox; to avoid water or even tea unless previously boiled for at least 15 minutes; at high altitude, where water boils at a lower temperature,  to pre-treating water with a saturated Iodine solution, carried about in a small glass leak proof bottle for use whenever away from home. ( 5 drops to each glass of suspect water, 15 minutes before drinking) I also spoke of general medical matters, reviewing templates for dealing with infections, GI diseae.  parasitosis and other health topics.

As one might imagine, all this was often so foreign to the volunteer’s own experience that it may have seemed pedantic, obscure, or complicated; therefore the details were recorded in a handout, which included the  protocols for commeon expected health problems. Even so, almost all Nepal volunteers would have difficult bouts of diarrhea; when I later visited in-country vouluteers the first ten minutes of discussion was almost always about frequency,  consistency, character, and color of: stools.

As the years of Peace Corps experience in Nepal accumulated, it was found that the death rate among volunteers was higher than the US military in Vietnam. And while neither was numericaly or proportionately very high, the questions were: Why? What could be done?

I was sent to try to seek  answers and walked for several weeks to vist  a different volunteer each day. It seemed to me that cultural, medical, mental, and physical problems  faced in relative isolation, were most significant.  Unfortunately for UCD it became clear to all that 12 weeks training in Davis California  was not so  effective– or even as economical considering drop-out rates– as would be training volunteers for the same 12 weeks in Kathmandu. The Davis training program moved to Nepal.

Over time the Corps volunteers selected became somewhat older and more often female. Training in-country increased. However, there continued to be reports from volunteers who claimed that both local law enforcement and Peace Corps Administrators tend to deny or obscure problems, especially sexual those of sexual abuse where they, like local authorities,  tended to blame the victim. To some degree  abuse may be increased by cross cultural misinterpretation of typical US  youthful dress and behavior.   Yet  a common complaint was/is that when in country help or even litigation has been pursued it too often reflects local preconceptions; and there is little to no interference by Peace Corps administrators.

Why so hands- off? Could it be that better investigation might create burdensome paperwork, threaten survival of a project,  or make new funding more difficult? Despite efforts to improve, under-reporting  of adverse events by the Corps still seems common. 

Despite alleged evidence of under-reporting the   2015 Statistical Report of Crimes Against Volunteers states that 13 percent of volunteers reported one or more crime incidents, including 268 Volunteers (3 percent) who reported serious crime. A total of 219 Volunteers (2 percent), including 206 women and 13 men, reported one or more sexual offenses (non-aggravated sexualassault, aggravated sexual assault, or rape). Of those, 91 (41percent) were victims of non-aggravated sexual assault. (whatever ‘serious or aggravated’ means!)”

TheDaily Beast Reports “ PeaceCorps Inspector General Kathy Buller has led internal investigationsthat have led to 21 criminal convictions for crimes such as rape,attempted rape, abuse of minors, embezzlement, theft and possessionof narcotics. She’s a career watchdog, with nearly 30 years ofexperience in the inspector general community.

Buller charged the Peace Corps with employing procedures that have hindered er office’s oversight efforts, and said the agency was not fullydisclosing its sexual assault reports. “Are Volunteer victims ofsexual assault better off when the Peace Corps is allowed to withhold information from the Inspector General and operate in secrecy?”Buller asked, “or when the Inspector General has full access toinformation and can hold the agency fully accountable?“ The agency seems to hold that the privacy of volunteers is at stake. But  that implies the office of the inspector general would not treat reports responsibly. https://www.thedailybeast.com/the-peace-corps-awful-secret


The official report of ‘sudden’ death of Mitchell Herman in 1918 was excpyionally cryptic: Aside from the report of his death there was no information.  None. Surely more is known.  Several other deaths stand out: Deborah Gardner was murdered by fellow Peace Corps worker Dennis Priven, who turned himself in after stabbing her – 22times. “Even after everyone knew it was Dennis, (there was an ) effort by the Peace Corps to put the blame somewhere else…. to make things go away,” says Weiss. “That impulse seized the Peace Corps within moments of Deb’s death… the Peace Corps hired and paid for the best defense attorney available in Tonga. Priven was found not guilty and the Peace Corps quietly shuffled him back to the United States,where he lived freely, for decades. Working for the government.”

It is time to re evaluate Peace Corps, not only for unresolved problems but because the  primitive  world is disappearing, developing, changing incredibly fast without our help.  I grant that a two year embedded experience may change positively and forever the life of a volunteer exposed to a new world, a culture,language, values, ethic, or way of being.

That certainly is true of young LDS missionaries who are as idealistic and committed as Peace Corps volunteers, but consist of two people teams that have the support of a world wide organization, and often others in the local community who are ‘there for them’. It  is not a lonely or hair shirt experience in country; there is a clear mission.

By contrast, as the Peace Corps operates and is administed now, its purpose is too vague, too unfocused, and its administration too neglectful, too dedicated to bureaucratic self interest. Volunteers deserve better. Their idealism, commitment, and sacrifice are not justified in terms of the original stated goals or an ineffective, inefficient  self serving adminstration whose purpose and methods have become  irrelevant and obsolete.  The Peace Corps  once such a powerful and admirablely concieved program, is  dead. It is a Peace Corpse and deserves a respectful eulogy and merciful burial. RIP.

China Roads

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The Amercan concept of changing the world, as exemplified in the Peace Corps is admirable and idealistic, but is no longer relevant because the world is very quickly changing on its own, adopting and adapting the American Way without help. Great cities spring up everywhere. Production of sophisticated and reliable equipment, software, and intellectual property is almost a universal. We are, in the US, no longer alone.   China, perhaps the most striking example, has changed itself so rapidly and so radically that it is potentially  on track to become the world’s greatest trading nation. Deeply embedded in China’s history, is the projection of strength and power through trade. At least since the 1970’s their concept of The Road has been actively pursued around the world, as a part of an ongoing long term effort to promote commerce.  In the US,  China TV ( CTV), promotes Belt and Road — interconnected trade routes throughout Eurasia and parts of Africa, calling to mind the Silk Road of the middle ages.

TheBelt and Road is only one of many China Road projects proposed or completed during almost fifty years. They proposed and abandoned a second Amercan Canal across Nicaragua, like one the USA considered before building the Panama Canal. A second Panama Canal had been started by the USA but was abandonded during World War II. China completed it.

In the 1970’s I first became aware of The Road concept while working with  Peace Corps in Nepal. (the subject of another post).  At that time there was only one road in and out of Nepal: to India. But it was tortuous long, dusty, rough, and often closed for weeks at a time due to rain or other problems.  By contrast, while I was there, China opened a modern all weather ‘Friendship Road’ to Kathmandu with connections  as far as Singapore.  https://en.wikipedia.org/wiki/Friendship Highway(China%E2%80%93Nepal)

China National Highway 318 

At the Tibet- Nepal border  is a Friendship Bridge.

KodariSindhulpalchok District,    Nepal
Zhangmu,  China

Although recently earthquakes have temporarily closed the road it is being repaired; and a railroad is under construction.

While roads can promote trade, they can have less welcome effects. In Nepal, for example, the appearance of the Chinese was feared; their ancient and powerful past seemed to make them haughty, arrogant and agressive.  In a short time down the road came a long,  violent, and very bloody political upheaval along Maoist lines. But ultimately the thousands year old and monarchy was ended, and a  relatively democratic coalition government developed. Arguably, that is a significant improvent over rule  by kings. 

Friendship is a central theme of China Roads. There are many featuring that name, like the propsals for Thailand and Myanmar. The world wide efforts by China, ofter through roads or other means of communication and commerce is apparent everywhere.

https://news.mongabay.com/2015/05/china-unveils-plans-for-huge-railway-in-south-america/

 Chinese Premier Li Keqiang, announced the intent build a South America road to reduce transport costs of commodities like oil, iron, and soy produced at inland sites. Li followed the announcement with a visit to South America to strengthen trade and investment relations between China and Brazil, Colombia, Peru, and Chile. The proposed route runs 3,500 kilometers (2,200 miles) from Rio de Janeiro state northwest around the northern edge of Bolivia into southern Peru, ending at the Peruvian coast. He pledged to invest $250 million in other projects like mines, dams, oil concessions, and transit infrastructure.

The Chinese projects likely would be financed through loans to the various countries involved; to promote trade that benefits all who participate in a joint project requiring contributions from all . China has money to loan, and appears to have the experience and the will to build. Their Can Do spirit  reminds one of the USA when  the Panama Canal was built  on the disasterous failed French attempt to dig a sea level ditch lke the suez Canal. The US built what is still the worlds largest earthen dam, to harness the Chagres River,  drain the swamps,  control malaria, and built the lock system where lift power is provided by water. That canal operates today, exactly as when first completed. While  China’s  heavy construction and  promotion of commerce is consistent with the Chinese past, it also draws upon the U S 19thcentury model of international investment where a financial return is expected and usually realized.

Of course there is much competion in every sense, and there are many similar proposals for projects, railways and roads. But it seems clear that China has skilfully adapted Capitalism for their  their own idiosyncraic use, and will continue to do so. Their view and approach are traditionally long term, and consistent with the structure of their current top down government. Will their success continue? As is always the case: For better or for worse, We Will See.

The Word

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150 feet of books line the walls of our home today, where 6 feet are my mother Melba’s, and 15 feet are my grandfather Leon’s. Even when I walk by they whisper. Melba’s is the voice of Poetry from many anthologies, Tennyson, Browning, Gibran, Longfellow, Yeats, Lowell, Kipling, Frost, Poe, Coleridge; Melba’s kitchen writing desk was always decorated with cuts and clippings from poems of all kinds including Silberstein and Seuss.

Leon’s books and writing include sermons, a complete Shakespeare among the poets he liked, a first issue of the 1908 Brittanica, a forty volume Harvard great books series and dozens of his own pamphlets. Cheap and easy access to paper and printing had led to pamphleteering and ultimately to the downfall of Church/ Monarchic rule. Pamphleteering had been the mother’s milk of that change and of our own democracy. So Leon was a pamphleteer in keeping his time.

Melba was an English Major and an English teacher who taught us in a one room 10 child school in Santo Domingo, Mexico using the Calvert System1 , a home school program still in existence. In the early 1940s it provided for eight grades in six years; there was not much history of the US included then, but we learned about Britain from 1066 on. Melba also filled our lives with books and poetry, often reading aloud,when Bob worked on our Holden Washington miner’s cabin in the evenings.

Lost in Melba’s forest of poetry, are some Lakeside Press publications 2The Southwestern Expedition of Zebulon M. Pike;  The Border and the Buffalo by J R Cook; Bidwell’s Echoes of the Past;Commerce of the Prairies by Josiah Greg; , and My Life on the Plainsby George A CusterWhy?

Melba always wanted to write her own book about her grandparents crossing the plains in covered Wagons during the mid 1800s; but she didn’t have much first person material or didn’t have it sufficiently to memory; maybe sheep and orchard farmers had more urgent concerns. So she collected and studied about overland U S travel. What is left behind are the books she collected for research and the first chappter of her book.

The mid 19th century was a time of Westward US exploration and expansion; a time of agressive and roughshod Manifest Destiny. The incomparable report of the Lewis and Clark Expedition was a call to other would be explorers Among the Lakeside series are reports of other expeditions like those of : Pike, Gregg, Cook, and Custer, filled with historic names connections, and detailed descriptions. They are plainly written, clear, and sometimes shocking to 21st century sensibilities. As in reading Mark Twain, we must forgive them for living in their own times, while honoring their contribution to our history.

Commerce of the Prairies by Josiah Gregg is exemplary; he was a physician but became so sickly, with stomach problems and tuberculososis that he could not work. In those days an oft reccommended treatment for chronic illness was good air and exercis. Like John Bidwell would later,  Gregg, became a traveling saleman of sorts: a commercial trader, joining wagon trains moving manufactured goods from Independence Missouri to Santa Fe, Mexico, and later to Chihuahua. His health improved so quickly and dramatically, that he continued to make trips back and forth during the next ten years until his death.

His book is rich with details of the journeys, the people, the land, and the problems on the way.

This is a cut from Gregg;

gregg map

 

It is great good fortune to be born into a place, a time, and a family where reading and writing are the stuff of life. The words and pages of our lives transcend and unite generations of family, and are far more meaningful, real and personal than a grave or the ashes of cremation.

Like Gregg, our grandfather Leon went West for the first time in about 1900 when that was reccommended to improve his vision, possibly over- strained by studies. His health and eyesight improved, but he loved the West so much he would never leave. Leon met Anna while he was in seminary. She was a Loyalist native of Nova Scotia, and joined him, in Nevada City, california where they were married. Like Gregg they became incurable Westerners. Leon was an ordained Methodist Minister for 60 years in California, Hawaii, and Panama. He maintained connections with the East, intermitteltly and at a distance; viz, he was a longstanding friend and compatriot of another Methodist minister, Martin Luther King. Yet the West was dominiant in their lives. Leon attended Stanford briefly when it was still a farm; he and Anna attended Stanford School of Medicine as volunteer cadavers when they died. Leon was also a writer. He left hundreds of sermons, though cryptically abbrevited, pamphlets, letters, and several history books,as Historian for the Methodist Conference during his later years..He befriended Syngman Rhee during his exile to Hawaii in WWII.

Whenever I wonder or doubt who I am, I listen to my Mama’s and Grandfather’s books, and words. Even as I walk by, they speak. Why write today during this cyber age tsunami of contradictive and conflicitive communication and information. To leave a little record of my own expedition through life for those who must live in yet another periodic cataclysmic change in human life so typical of humankind. Perhaps what I write now will become meaningful for someone someday, just as are Melba’s and Leons books and words to me now.

2.https://en.wikipedia.org/wiki/Lakeside_Pres Lakeside Classics  is a series started in 1903 to reprint neglected classic works. In 1910 selections turned to first-person narratives of American history, especially those which were rare or out of print. Themes included the Civil War, the Old West, exploration and frontier life. . The first was Ben Franklin’s autobiography. By 2015, !the series included 113 volumes.

Cook, Gregg, Bidwell, and Custer are great ‘reads.’George Armstrong Custer was always a cussed rebel, graduating last in his class at West Point. Yet he became, above all, a lifelong member of the US Army calvalry. He earned fame and success during the Indian Wars. In his book he makes very clear that it was Warfare with great cruelty on both sides. The interaction between tribes, the Indian Bureau, Settlers, traders and others are described in much detail. Where warfare is concerned, the Indians and Custer made up rules as they went. In that sense they were perfect enimies. His book begins with a detalied description of ‘The Great American Desert’: The Great Plains. He.served with many historic figures like Sheridan, Billy the Kid, and Gen Hancock; his book is rich with descriptions of soldiers, Chiefs, settlers, guides, and the motives and nature of buffalo slaughter; His campaign, understanding and defeat of the Witchita, and his insightful, tough and politic negotiations with the Cheyenne are remarkable. Of course, we know the ending of Custer at Little Big Horn, in another famous historic event.Bidwell left home at 19 determined to settle. He made a claim but lost it becuse he was not married or of age. So he tried commerce taking goods from St Louis to Santa Fe and Chihuahua. The business failed but he  learned Spanish. Arriving in Califorina in about 1841 he was amomg the first Americans there, and began to work for John Sutter. B ecause he spoke Spanish he interpreted for Sutter becoming privy to many critical negotiations with the Mexican governors. In his book he speaks  extensively of the time, the place, the people and the birth of California. When his horse and mule were stolen he followed the thieves to Chico and took them back. However he thought the place was the most beautiful he had ever seen and in time, settled there becoming a well known historic figure, whose estate became Bidwell Park.

 

Wake Up, Dad

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When TV began to resize our world

my father saw the end of civilization;

This box is the tomb of reading, doing,

memory, imagination and communication.”

No!” I said. “It is the birth-womb

of shared knowledge and hopes,

the loom of language, tolerance,

And the death of misanthropes.

Dad never changed his objections

to that toxic pixillated  curse.

His elegant deep earth projections

Were aborted before birth.

He lost his right to drive,

lost his confident sensuality,

And though his body was alive,

He struggled with reality.

He lost is his wife of 60 years;

and at night searched in desperation

and sometimes knows he hears

her voice in song or conversaion.

Convicted in his 10th decade

Of breathing too much mining dust,

Of  many rules he disobeyed 

And unrepentant  wanderlust,

He puts on clever acts

to make it very clear

he understands the words or facts

that he pretends to read or hear.

You were right about TV.” I say,

It shrinks the mind and heart,

spits out toxic babble night and day

Devaluating all words might impart;

It’s knowledge without knowing,

and movement without motion

Mindless reaping without sowing

trivializing genuine emotion.

Perhaps,” My Dad suggests,

There are bright worlds to find 

pinned like brittle butterflies

to vast dusty walls of mind.”

Dad! That’s can’t be you!” I say:

It must be from a blog;

You never talk that way.

You speak only analog.

Then I start; open up  my eyes

“We’re awake,” I say

“We were asleep I realize!

I’ll come again another day”..

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