Essays on América xenophilia
The subjects are jailed minor boys and girls awaiting deportation, hearing or trial. The facility where they are kept is among the best, both physically and operationally. It is an older but well maintained juvenile detention facility, with a large gymnasium, an astro-turf sports field and an extensive library. There are many opportunities provided by volunteer groups, and various departments at a nearby College…For example, the art department promotes inmate art works; the results are visible inside and outside: sculptures, mosaics, and murals, created by juvenile inmates: The facility is uncrowded; local inmates are housed separately from the illegal alien children — all, by definition are under age 18– The subjects of these brief interviews are confined to a secure facility because they have a violent or criminal past, or both. They speak, read and understand their primary language fairly well but their ability in English is very limited.
One never knows, in such circumstances, what is exaggeration or lies, but I have been doing similar interviews for a number of years, and in time one becomes more able to evaluate them. These, of course, were children; yet they were far more frank, open and expressive, less manipulative, than many adults.
Considering the alleged situation in their country of origin, and the unique opportunities available in the facility ( the jail), one might think they would be happy, or at least feel fortunate. But they are not, despite nourishing food, shelter, medical care, training in English, access to books and both video and classroom teaching.Why unhappy?
First, they are children, and moreover, teens, who by some law of nature are often unhappy and unhinged. Second, they are not free where they are. As Children their views are short-sighted and self focused; as humans they value freedom. It should not be surprising that they don’t like the strange food; but they hate worse the confinement. They want out; even if they go back to a situation that was dangerous or intolerable, it would be a place where they might Try Again to return. The reader may note that most had somehow had access to enough money to hire a coyote. Why? I cannot say, but wonder whether if criminal or drug activities were responsible, directly or indirectly. Their individual stories are moving. Here are condensed versions of a few.
Male Age 16, El Salvador Crossed on foot TX in 2014 at age 14; coyote $7k paid by parents. However, after crossing had no further assistance. Lived on street, Las Vegas; arrested for theft. Sleepless, wants sleep med and pain med for back problem. We spoke at some length about the dangers of using addictive medications for sleep or chronic pain, both best treated by being active physically! I doubt he wanted to hear such stuff, though; he didn’t seem impressed.
Male Age 17, Honduras Coyote paid $ 10k by family, 5k deposit, 5k due on arrival. Arrived age 14. Reached a relative in Las Vegas but later arrested after caught in robbery. Says he may be sent back, but will return, and is taking classes in English. The food is terrible in the USA, but the country is great!
Male age 17, El Salvador Crossed the border at San Diego asking for asylum. Sent to Oregon, placed in a shelter; but fell in with folk who lived on the street. Was arrested for theft and assault. Allowed that the request for asylum was not really valid; it was just a door that he opened. If he is sent back he will come again, this time without a claim for asylum… will cross some way, probably on foot. ‘ Better illegal here than legal there.’
Male Age 16, Honduras Dad paid for coyote, but when he got here dad sent word: ‘Good Luck, you are on your own’. Lived on the street. Arrested for assault. Expects release soon, wants to go back to Honduras because he has family there who are not without economic advantages. I asked: drug business? Yes. ‘Better a rich criminal there than poor and illegal here’.
Male Age 16, Mexico Was a ‘mule’ for marijuana smuggling; entered into Arizona on foot, but was immediately caught. Sent to Phoenix. Expects to be deported. However, in Sonora, his home, he doubts he will be able to avoid going back to being a mule. Why? Realistically there is no other choice
Male age 17, Honduras Caught while crossing near Houston; has family somewhere in US but they did not respond to attempts to locate them. Seems a bright kid, communicative, but didn’t know who his namesake, Roosevelt, was. I told him briefly about two presidents by that name. both, and he plans to look them up in the library and ask the English teacher to comment.
Female Age 14, Mexico Coyote crossed border AZ in a car trunk. Placed on bus to Las Vegas. Arrested prostitution and theft. Jailed then transferred here. Is awaiting hearing, pending transfer motion. On zoloft and resperidol not sure what it is or why. C/O tooth problem. Whether released or sent back home thinks she will return one way or another, this time with some English. She understands she has no skills and no advantages except quite a few years ahead for profiting from her looks. I expressed surprise that plan in place at her age, but she looked at me sideways, and commented that she lives in the real world where people have to deal not with ideas but with facts; besides, she said, ‘I have a good connections in Vegas.’
Male Age 16, Honduras Crossed on foot to reach his uncle here. But the uncle was unable to take him in. Lived on street; theft, prostitution, drug abuse. Arrested states he was ‘beat up’ and remanded to Foster care. Has HIV, probable source uncle? Hep C?He doesn’t know. On medication now. I asked him about his unusual first name. He said it was from a famous poet; he knew nothing else, but says he likes poetry. I suggested he try to look up two poems that may have something to do with his unusual last name. The first is by Oscar Wilde:
The lily’s withered chalice falls
Around its rod of dusty gold,
And from the beech-trees on the wold
The last wood-pigeon coos and calls.
The gaudy leonine sunflower
Hangs black and barren on its stalk,
And down the windy garden walk
The dead leaves scatter, – hour by hour.
Pale privet-petals white as milk
Are blown into a snowy mass:
The roses lie upon the grass
Like little shreds of crimson silk.
The other poem is by Brazilian Eduardo Alves da Costa, fairly easy to understand for Spanish speakers: Essentially: The first night they robbed a flower from our garden. We said nothing. The second night they openly trampled the rest of our flowers. We said nothing. Until the weakest among them entered our house by night and stole our light; and knowing of our fear, ripped our voice from our throats; then we could say nothing.
Na primeira noite eles se aproximam
e roubam uma flor
do nosso jardim.
E não dizemos nada.
Na segunda noite, já não se escondem:
pisam as flores,
matam nosso cão,
e não dizemos nada.
Até que um dia,
o mais frágil deles
entra sozinho e nossa casa,
rouba-nos a luz e,
conhecendo nosso medo,
arranca-nos a voz da garganta.
E já não podemos dizer nada.
Comment: These histories pose a problem: they put a face on illegal immigrants even though in this case they are criminals. The last three cases in particular suggest that it is risky to look at them, or to hear them, too closely. The same is often true of all criminals, and illegal immigrants. While our country cannot open our borders to billions of people from all over the world, we share a hemisphere with many other Americans, North and South; we share a common cultural and ethnic past with people on our borders.
In fact, as always, the USA needs immigrants. If all illegal aliens were to disappear instantly, there would be an economic and social crisis here; in gardening, building, hotel maintenance, restaurant work, and farming, to say the least… and arguably, even in child-bearing! We North Americans are too often unwilling to raise enough children to replace ourselves. That is too great a sacrifice! Houses, cars, travel, education, health care, and entertainment are expensive priorities, and it costs several hundred thousand dollars and tens of thousands of hours to produce and to raise a child conscientiously.
A child, as often claimed, is a hostage to fate: a risk. But without children there is only past. Frankly, it seems possible that within 20 years we will offer to pay people to immigrate to our big beautiful USA. To relate stories like those above is not meant to glorify illegal immigrant children; yet, their desperation and decisive, high risk attempt to change their lives is the recurring story of the USA. Unfortunately, many of these illegal children come from criminal and drug dealing environments, or worse; they bring that with them. Some are MS13 members. But the first illegal immigrants who crossed the atlantic in wooden ships were often undesirables, rebels, or troublemakers. Some were criminals. All are kin to those, criminals or not, who pay coyotes or cross nations and deserts to reach our beloved land.
Adults who are illegal immigrants today are people whose journeys are even more hazardous, more sacrificial, than that of most child criminals; yet they also reveal an intense desire to find a better life in the US. As a consequence they create a better North America, and in a wider sense, better Americas.
My son Fred, a master carpenter, once again this April, drove from South Dakota to Baja California pulling a trailer full of equipment. He joined a group of Methodists to build small homes. In this case that is not simply a charitable act; the recipients of homes are limited to people who 1) work 2) have their own a half hectare lot, where they live in very marginal conditions, and 3) have children who regularly attend school. I go to build or to work as a translator for Lighting for Literature, providing small solar lighting units in the homes of the same kind of families, so schoolchildren have light to study in the evenings.
The clear majority of such families have a connection with the USA; it is generally with a close relative, usually one who has, during most of a lifetime, regularly sent money to their relatives to make their present and future more promising. That sort of story of immigrants and cross culture exchange is as old as time. It is the stuff of progress, and of civilization.
This is to suggest that when there is a “Take Care Of Your Diabetes” conference nearby it is worthwhile for those with, or at risk of, diabetes; likewise for medical professionals. I attended the TCOYD conference here in March 2018, though I had never done so before; it was offered for about the 6th time in Sacramento, and many hundreds of times in the nation. For professionals at this session the conference cost was $30, and less for others. It was held at the Convention Center, attended by at least a thousand people. There were no openings for walk- inns. The general idea is this: People with an inherited predisposition, or diabetes, or abnormal diabetes screening tests of any sort, are encouraged to do simple things themselves to prevent later problems. Moreover medical providers may discover more about ways technology promotes patient personal involvement in the care of chronic disease; and, I believe, about the direction and future of medicine. Joan Borbon clued me in to TCOYD. We volunteer at a local Student Free Clinic. So I signed up. For me, personally, the whole day was a triple delight.
First, because the general thrust concurs with one I have long practiced: That in chronic disease treatment and prevention, people must be their own principle care-givers and managers. Diabetes is the perfect example. Why? No one can manage the illness without the direct personal understanding and involvement of the diabetic or pre diabetic; no Doctor, Legislator or friend or family member. But technology places the means to do so in the hands of the individual. For example, in diabetes, the personal Blood Glucose Monitor allows people, 24/7, to measure and control their own disease. No more time consuming lab or office visits, days long waits for test results. Moreover, in the forseeable future, access to reasonable, personal technology and information will make self care ever more practical and efficient. In my own little lifetime, it seems to me the most significant development in diabetes care has been the personal BG monitor, which has become acessable, reasonable, and simple to use.
Second, because I, a stubborn, arrogant macho man, ignored my own clear symptoms and family history for at least 15 years before discovering my own diabetes…never listening to my life, never thinking about it.* Maybe signs of diabetes were so easily overlooked because my routine screening tests were always normal; my doctors and I relied on them without another thought. But if we had considered my family history, or even listened to the voice of my body, we could have discovered my type 2 DM much earlier.
Many people with an interest in diabetes attend the conferences over and again, gradually learning more and more about the disease. And yet, while the conferences are very informative, perhaps it's wise to keep some things in mind:
- Even if addressed mainly to the general public, these are medical conferences; they are funded completely by people who want to sell stuff–caveat Emptor — Buyer Beware.
- The eloquent and impactful speakers, aided by great media, are partially bought and paid for.
- The literature is as skillfully crafted to subtly mislead as are magazine or TV ads.
- The booths are staffed with highly trained professional salespeople. Beautiful, engaging people.
Third, The program is varied and relaxed enough to allow for casual unhurried conversation. A personal note: I like to run and sniff the world like an escaped hound dog. But always, even in childhood, Northern California has been the home where I return ever, where my family history and heart and dearest memories also live; as a physician, it’s been my medical home since 1959. Therefore in this broad focused meeting I often met up with old colleagues or friends who share an interest in diabetes. Steve Edelman, who many years ago concieved and organized TCYOD, was a Med student at UCD when it was still on the Davis Campus where I occasionally lectured; Demo Pappagiannis who coached and wrote several papers with me on coccidioidomycosis, was there. There were many other friends, colleagues, and physicians from Kaiser, UCD, Woodland, Davis, and Sacramento. And nurses; perhaps most of all. .
Nurses and P As are the Hands and Heart of medical care. Brooks Smith and I were the first lecturers for the UC Davis Rural Family Nurse Practitioner training program. It was in the Dept of Family Pracitce headed by Hughes Andrews, and managed by Mary Fenley and Leona Judson. Since then,– 45 years ago– it has evolved fast, grown, changed names, and fled the skirts of the Med School into the arms of Nursing. At the conference every local Nurse Practioner and PA I spoke with was a graduate of that particular program.
TCYOD is based in San Diego) at the center of a world of Spanish speaking folk with diabetes and prediabetes. Therefore A Cuidese Su Propio Diabetes– CSPD– is needed. If I were still crazy I would volunteer; but I am less insane now. Maybe someone can use material in Spanish I wrote for diabetics in Colonet, Baja CA. ¡Quizas!
* But during the first years of symptoms I was working day and night 7 days a week, rather doggedly doing My Thing with migrant worker night clinics, and Regional Rural Health which they grew to be, and Salud, an inner city clinic in Broderick, CA. At the same time I worked at UCD to establish an Occupational Medicine Program, and took on many consultant jobs in order to provide for my family, 6 people whom I supported but otherwise mostly left on their own. I was Sick, Out of My Mind. Over time I gradually developed severe bilateral lower extremity neuropathy. As my usual diabetes tests were normal, neither I nor my doctors explored diabetes further. A neurologist confirmed the neuropathy, but asked: Do you drink? Yes occasionally. Well! He said, Don’t. A podiatrist ordered some $400 shoes. I had had a laminectomy in 1975 for and acute disc with foot drop, with lipiodol studies, so a CT was done. Nada. I ignored some other things: that my neuropathy was better when backpacking – and burning a lot of glucose. That the cold bothered others it didn’t trouble me. That my balance was slaightly off. Only after several years of worsening neuropathy did I order an old fashioned four hour Glucose Tolerance test. Bingo! Ironically, today anyone with a personal blood glucose test kit can do that home alone. I”m happy to say that the neuropathy has receded with control of my disease.. like many people, I detest initialisms and acronyms but they are epidemic;; as they say, It is what it Is. IIWII. So, TVOYD; Listen To Your Body. LTYB; Listen To Yor Family, their words acts, troubles, and History. LTYF; Hear, Think, And Do. HTAD.
I have long treasured an original issue of The Mother Tongue by Lancelot Hogben. Lancelot, a Brit? Curiously, the author’s name is metaphoric for miscegenation, as is Bernardo O’Higgens, the revolutionary founder of Chile. In rather didactic fashion, Hogben makes the case for English as the most universally useful world language today.
You know what that Acrospeak is; you too have suffered from it. Acrospeak is used by experts to inform those desiring to become informed;in Powerpoint slides and lectures to symposia attendees. Incredibly, Acrospeak, which is usually familiar to those already schooled in a subject, confounds the uninformed who are hoping to learn. Is that stupid? Or What! While seekers of new knowledge puzzle over strings of CAPS which could represent– anything– the meaning is nowhere defined in hand-outs or powerpoint slides. As would be learners consider possibilities of obscure letters, the lecturer’s string of meaning becomes tangled.
Acrospeak could very easily be called acrodynia, acrolalia, acrothymia, acrodystrophy ; or any number of such invented but fairly understandable terms; terms we immediately recognize because they contain clues that come to us on the Indo-European language stream that flows through Sanscrit, Greek, Arabic, and Latinized European or Cyrilic languages. They are clues we don’t need to study, because they are embedded in our common languages, and especially in scientific language.
English, in particular, is a beautifully polyglot language. It is not only the most used language of science and business today, but one with roots in many other languages. Those of the Celts, Romans, Saxons, and Norman French conquerors were grafted onto English as it evolved over centuries. The result is modern English. On the one hand English spelling seems bizzare because it reflects the languages of all those who ruled the islands for centuries at a time; and the language of the conquerors themselves, whose language also had been inseminated by other conquerors. Therefore anyone who learns to read and spell English well has completed an introductory course to an array of Indo-Europan languages; most prominntly are those of Europe, but also those of the Mideast, and West Asia. What, for example does Hamas suggest? Never, as in Spanish jamas, planted there over centuries by Arabic Moors. Cognates for the word mother are recognizable from Sanskrit on, and similar language strings are common.
I once was ship physician on a research vessel to the Antarctic Peninsula. It was an abandoned former USSR icebreaker refitted in Finland. There were 17 scientists, not one from the same country, many from different continents. We all had to communicate in English
So here is my question to knowledgable and earnest people standing in front of colleagues who come to listen and learn: Why abandon centuries of language, and revert to CCP? Well, then, Clueless Cap Puzzles. And my plea: Do not abandon millenia of shared meaning that we all are at least vaguely familiar with. Do not tear out the common threads of language in favor of CCP. It may save space on slides, or breath for the lecturer. But that’s a poor tradeoff if the intent is to inform. And if you do abandon those clues of language, and revert to CCP, at least provide something on every slide to clarify, the acronyms, or a ledger that can do so.
I made a careless comment long ago to my brother-in-law, a proper Massachusetts elitist, by declaring it is a waste of time to study dead languages like Latin; or, ( more offensive,) French. It was an attempt to wake him up for a moment; it did but he was as Outraged as if I spit on his mother. Now, considering the power of language that comes to us down to us through the millenia I realize he had a valid point. He is long gone from this life; but perhaps he can hear this somewhere above or below. “In the face of CCP, I apologize for that crude remark.”
Some acronyms are so common they are almost universally understood: like ASAP or USA; or those a first grader learns on the street or from media– like this one which can also serve as a comment on Acrospeak: WTF! What’s That For? Well, No.
To a Surgicenter and KP:
And skillful doing:
From the first step
off the gurney,
to the very last,
I’ll remember you,
The skillful people,
was gently lavished
on a troubled knee,
That slept on attic floors
of Alta Peruvian Lodge
doing light work,
to ski free that Spring of ’53;
Was injured in a fall
leather strapped to 7 foot boards
with strips of metal
screwed to the edges;
And since those days
went many mountain miles,
but often effused complaints,
until it could no more.
How is it, Dr David,
that so many people become
a selfless, seamless whole
at a Surgicenter,
To give a stranger’s knee,
A second chance to ski,
lead pack llamas up trails,
bike, or walk the city,
When the mother country
burns with uncivil strife,
enraged by opinions
not our very own?
This old knee
doesn’t give away
it’s private opinions,
except only to say:
From the first step
off the gurney,
to the last off the earth,
… Thank You.
Panamà… as we pronounce it would be Pànama… is a metaphoric inversion expressed by the different accents. I first went there as an intern in 1954-55, not yet age 22, interested- vaguely- in tropical medicine but more concretely in adventure. Among my 8 colleagues, half were preparing for missionary work, one for public health, one for psychiatry. Before 1903, Panama was an isolated part of Colombia, an oligarchy run by four or five families. It was inaccessible by land across the Darien. The current sometimes road, actually highway 5, or the Pan American Highway, is still often impassable.
A canal had long been considered to facilitate travel between the Atlantic and Pacific, which required a long sea voyage around Cape Horn or difficult overland Balboa took across the isthmus of Panama. A French venture acquired permission to build the canal under the direction of Ferdinand deLesseps ( Suez Canal, desert, flat, no locks). He wanted to cut a similar sea level swatch across Panama. 40,000 French (and French colonials) died there due to that miscalculation, graft, malaria, yellow fever, poor nutrition and dysentery; it was abandoned. But in 1903 the US felt it could big crazy things. Teddy Roosevelt tried to arrange a canal treaty with Colombia and failed. But because of the isolation of the isthmus from Colombia the locals felt like colonists, and resented their voiceless circumstances and distant and neglectful rulers, like the rebellious British Colonies in North America. They found common cause with Teddy Roosevelt who wanted a canal, and revolted, assisted by U S gunboat diplomacy.
The US Canal Zone was about 10 miles across and some 50 miles long. Panama is Water, and water is the Power that could operate the locks of a canal. A dam was required to store that water, and also control the swampland created by the ever flooding Chagas River; and thereby to control mosquito borne diseases. Incredibly the huge project was completed by 1914! The original locks still operate unaltered, today.
Overall, The US Army Corps of Engineers and Black Caribbean laborers really did the heavy lifting: John F. Wallace conceived the engineering of the canal but became a victim of the terrain, disease, and the political bureaucracy; he survived there for less than one year. John Stevens, a famous civil engineer, took seriously the yellow fever/malaria problem. The largest earthen dam ever built controlled the Chagas River, and drained the swamps; which controlled the mosquitoes, malaria and Yellow Fever, and provided the gravity flow water power to operate the canal locks. Col. George Washington Goethels was finally given unrestrained authority, and was able to complete the job over the next 7 years. William C Gorgas, a U S Army physician who understood the relation of malaria to mosquitoes, convinced the Army to drain the swamps, making it possible from a medical standpoint to build the canal. A second canal was started but abandoned because of WWII; now it has been completed, arguably by China, who also had studied the sea level alternative as across Nicaragua but abandoned it.
In 1954 the canal was still operated by the US civil Service. There was segregation of several sorts. First, upper level administrators and U S military had the option to live on base, with typical military housing and commissary privileges with access to US goods and food. Most privileged long term US citizen employees of the Canal Company lived in bungalows. Second, short term US citizen employees like MD interns, lived in curious multi family wooden apartment buildings, each apartment located upstairs from a parking area below. The apartment buildings were oriented with long sides facing the sea breezes. They were two story wooden structures with space for parking underneath, and 12 ft high ceilings. There were no internal doors; the kitchen, dining and bedroom were in one line so that that the sea breeze, could flow through open screens placed above 8 ft. Each apartment had a bathroom off center and a heat closet to keep clothing dry. Construction was so light that people learned to speak quietly, even quarrel in harsh whispers. Sexual revelry was often audible, though as invisible as the morning alarm clock, flushing of toilets. Notice the 6 ft eves, a traditional style there. In the city they offer much needed shelter for passersby on sidewalks but shoot waterfalls out onto cars in heavy rain.
When I was there in 1975 the buildings were scheduled to be torn down. But the location was ideal, and all the infrastructure already in place. They were acquired somehow and have been gentrified, rebuilt so nicely that the old structures can hardly be seen. In the photo above, some of the screened breezeways persist. The open lower floor also is still there, but made into a living area, like a covered outdoor garden or patio.
The third level of segregation was provided to ‘local raters’ whose situation devolved from the building of the canal. The US Army had recruited English speaking workers among blacks of the Caribbean. Communication was more practical in English, and the work performance was superior to indigenous workers. ( Only the Spanish had managed to induce los indios to work through a brutal choice made clear in a statue at a Mission in Baja CA: a priest holds a bible in one hand and a skull in the other. Believe or die. Work now to live, and die for the glory of God and the Catholic Queen. But the Caribbean blacks were different, perhaps in part because, though paid less than US citizens, and they had significant inducements: Local raters’ were provided decent livable wages, living quarters, medical care, and allowed to buy US imported goods at a reduced rate from a local rate commissary. In the long run, however local raters felt abandoned after September 7, 1977, when President Jimmy Carter gave the Canal to Panama; a long standing local resentment of blacks with special privilege boiled over. Soon many ex local raters had nether job, nor any apparent citizenship. Yet there was, and is, a Black American Atlantic Coast and black Carribean island archipelago; it may be largely invisible to most of us in the USA, though it consists of many black communities which are the source for much unique American and Brazilian music, art, dance, custom, and language. Therefore, the abandoned black local raters of Panama, did not live in limbo; they have adapted or relocated. It’s instructive to kindle and google the many American Black authors, and the Quaker beginnings of the emancipation movement. The very first American revolution was black: Haiti. * Like most US citizens I often focus only on the Northern Hemisphere. We tend to forget that we are all Americans: one continent, one hemisphere, with a shared history, indigenous, immigrant past, and present.
We visited Panama City in late 2016. Much has conspired to make it the commercial and banking center of South America, rivaling Miami. The canal was gradually and totally transferred to Panama control by 2000. Panama has retained the $US as their currency, which stabilized the economy; despite many problems it became a place where people with means could find refuge from chaos at home, or for various thieves to hide money, including drug money.
The former head of the militarily, Manuel Noriega, a cooperator with the CIA, became de facto dictator and drug lord .The US invasion to depose him in 1989-90 was complex, while brief was a real war that has left a shambles of Noriega’s base of operations still unpaired. And the whole episode has became the source of many true lies: afterward there was an election at the insistence of the US; but the winning candidate was assaulted and Noriega declared the election null and void. While US invasion was widely supported by the populace, it was real warfare against a well prepared military, deadly and destructive. It was hugely condemned, as customary, in Europe and the UN; The Panamanian military was dissolved. However, the emergence of Panama as a commercial and banking center, and a repository for suspect money, continued.
The second canal has been completed, financed largely by the Chinese. Transit fee $100,000,000. A Trump hotel, shaped like a huge sail, looks like a twin to one in Dubai. A metro was completed last year.
Upscale barrios and yacht harbors, continued to appear. Old is being gentrfied, the president lived there near a fast growing tourist area, and expensive restaurants flourish. As to the currently strong US dollar, Panama is something of an exception, comparable to Chile. Most other countries today are, by comparison, a bargain. But it is a good place to visit, safe for the average sane foreigner, usually cool at night, when the ocean breeze is up. In the 50’s that meant street dancing to Lucho Ascarraga’s wild electric organ: Cha Cha Chas, with typical flat foot moves, keeping the whole foot including the heel on the floor and moving The Rest… none of that heel-high stuff. That, happily, is the same today.
Ancon Hill is the highest spot overlooking the Pacific entrance of the canal, with old gun embankments at the top, set among tropical forest. Several hundred yards down hill is the site of Gorgas Hospital where I interned in 1954. My oldest daughter was born there, delivered by a descendant of one of the founding families.
My Grandparents, Leon and Anna founded the Methodist church just at the edge of the Canal Zone. It was built and supported by the North American population of the Zone who operated the canal, and large number of military people who guarded it. But when the canal was given to Panama that U S population very quickly disappeared. The old church is imposing, but obviously neglected now. There was no pastor, but we spoke with a woman in the parish and she took us inside the elegant but sad and tired building.
We visited the site of the old Gorgas hospital, of French design. It had a stolid central administration building surrounded by a series of white one story buildings in colonial French style… a series of medical units, white wooden buildings with 11 foot high ceilings where the top four feet were open screens. The units were interconnected by covered walkways among sculptured tropical gardens to allow for air circulation. How well I recall doing a femoral stick on babies or spinal taps, sweating in the humid night air. At least that is the way it all comes to my mind; it is all gone. One wing of the admin center where interns stayed and sometimes slept during 36 on and 12 off shifts looks down darkly past the surrounding neglected padlocked wire fence strangely dressed in banners left over from some event. No one was around to ask if we might go in; and yet that seemed a small loss. I didn’t much want to view the corpse from the inside.
Even most of the relics of Old Town were full of color and life, on the way to being restored. thier roof still extended out 4 feet over the sidewalks and balconies to shelter people from the rain.
And the restoration was everywhere evident as well, set among the colorful lives of a small rich country whose future seems bright.
And we pretended to be rich turistas nortamericanos:
*You may want to kindle and google the many black authors of the Americas, the John Woolworth and the Quaker beginnings of the emancipation movement, and the first American revolution, which was black: in Haiti. Like many US citizens I often focus only on the Northern Hemisphere. But we are Americans: one continent, one hemisphere, with a shared history, indigenous, immigrant past, and present.
* * There is a 645 pp third edition of a book Americas by Peter Winn. But frankly, it seems to me simply a compulsive compilation of the ‘news’ we read in the US. Whenever the author treats places and peoples I know very well, the omissions and commissions of errors really rankle me terribly. My bias is this: The record of a people and a time are found in between the lies, and lines; and in fiction, poetry; in other words in Literature. Usually what we call News or History is moribund fiction without flesh or soul.
Self Management of Early and Silent Diabetes or Pre-Diabetes
Colonet is an inland town of about 2500 in Baja California. I have gone there four times with my daughter Amy and the Los Gatos Methodist Church to build small houses. They have now built more than 40, generally during Easter vacations so school children can participate. There are two doctors offices and two pharmacies in the tiny town but it serves a wide local area; ‘universal care’ is available at a government clinic staffed – in a common South American way –by a recent medical school graduate who must pay back year for year of medical school by staffing several remote rural clinics; he is there only a few hours each week, so people line up at 4 AM for one of the few openings. Otherwise they must see a private doctor at about US$35 a visit. For those who have a job, the average daily income is about US $10 per day, but work is not available year round. The nearest hospital is 60 Km distant.
It may seem surprising, but the area is highly agriculturally productive. The largest tomato grower in the world is nearby. The Driscol strawberries we buy here are grown in the region. Why? It sits between the ocean and the Sierra de San Pedro mountain range that reaches up 10000 feet to suck in winter rain, allowing for irrigation like a tiny San Fernando Valley; water and sun and hard work make it productive. Migrant workers, often speaking no Spanish, invade for harvests. This year it rained a great deal and the area is lush with small blossoming plants and green with bushy growth.
The local Christian Church has been very helpful in building the small homes. They often help people to acquire a tiny plot of land, which is a required, as well as someone in the family with a job. The pastor’s wife has diabetes as does her mother and their four year old daughter; they assisted in preparing for a series of evening diabetes screening clinics during my week there. The disease is so common that among the first 20 people screened ( excluding the pastor’s family) 9 had diabetes or pre-diabetes. Below is the translation from Spanish of the written introduction and information that was given to people who attended the screenings. Of course, the problem is obvious: When you find a person with diabetes, under these circumstances what do you do? I believe self management is the only realistic, timely, and practical option. To make that sort of thing work, it is best for small groups of people with diabetes to work together over time to solve problems like Where to find medications and supplies most reasonably; How to measure and keep track of glucose levels; How to safely adjust medication in view of the results. The pastor has an internet connection. It is a long and twisted road, but one that otherwise most Colonet people with diabetes travel alone. What follows below is information provided at the screening clinics, addressing the screening process, the general nature of the disease, glucose self monitoring, and possibilities for self treatment. It is translated and redacted from a Spanish blog.
RAPID SCREENING FOR DIABETES AND PRE-DIABETES
Blood glucose is measured about two hours after a sugar or starch rich meal.
Diabetes Positive Screening test:
- Any blood glucose level above 200 mg/dL at any time, including the
- Challenge test: Blood glucose above 200 mg/dL 2 hours after a sweet or starchy meal
- After 10 hour fast: any blood sugar over 125 mg/dL
PreDiabetes Positive Screening test:
- after a 10 hour fast: blood sugar 100-125 mg/dL
- 2 hours after sweet or starchy meal blood sugar 140-199 mg/dL
Conversions between mmol/dL and mg/ dL here
Screening tests are highly suggestive but not diagnostic. When positive, reconfirm whenever possible, with a qualified laboratory and physician.
These screening tests are valid at all ages.
Diabetes has serious complications, all caused by elevated levels of blood Glucose (sugar). In early years the disease is silent. One feels fine while high glucose levels destroy the most delicate but critical circulation in the kidneys, retina of the eyes, feet, and elsewhere.Fortunately we live in a time when prevention of that damage can be effective, and simple. But only those who have or who discover their disease can successfully treat it; especially those with the most common kind: silent diabetes. To do that the disease must be revealed… diabetes diagnosed if present,. , and then controlled by:
- Using a personal glucose monitor to keep track of blood glucose levels
- Measuring and recording glucose levels
- Learning to manage the illness… i contend that is best done as a member of a small group who regularly share their experiences and information.
Some may wonder why it is essential or practical to self control and self manage this particular illness. Although it can best be done with the help of a physician, only the person who has this disease can do so. Physicians cannot hang around 24/7. The time a physician can actually help most is after the disease had done so much damage that a foot has to be cut off, or a kidney replaced: too late for prevention. A competent physician welcomes self management of early or silent disease. All this may seem complicated, but it becomes quite natural quickly when the diabetic can:
- measure, blood glucose, record the result, and then
- use the results to manage and control the disease
- share results and experience with others who have diabetes for: a) interpretation of results; b) finding sources for test strips, medications or professional advice;c) understand medications and ways to manage it. For example, glucose monitoring is crucial, but very expensive. However, an hour drive away is a large international chain store where costs for glucose monitoring supplies are: ( US$): Monitor $ 9.00; 100 test strips $17.88; one time cost of lancing device $5.84; 100 lancet needles, $1.84 Total $34.24 , adequate for about 6 months monitoring– $0.19/day! By comparison, costs where test strips alone are $ .50-.75 each, are many times that depending on how many strips are required.
The personal glucometer (glucose measuring device or meter) is inexpensive, accurate and lasts for years. One must learn to use it, use it regularly and record results and circumstances affecting each test. . At first it is advisable to measure glucose levels often in order to better understand the illness. Yet because test strip use can often gradually be reduced to as little as 5 or six times weekly, plus anytime a concern arises. For example, one might suspect, for whatever reason, a blood glucose is low, and eat “just in case.” That should not be done: measure, don’t guess!
The blood glucose monitoring record: ( for one month…the first of 30 spaces appear) below)
|Date mo/day||Time 24 hr||Level before meal||2 hours later||Useful details like: what was eaten, an unusual event like illness, or any other comment|
How food affects blood glucose:
Carbohydrates fats and proteins can all be converted to glucose…which is vital to the human body even if too much is harmful. Some carbohydrates convert to glucose very quickly and therefore are a problem for people with diabetes:
Fast: processed or refined bleached grains like white wheat flour, and white rice; processed fruit sugars (fructose) like corn sugar and beet or cane sugar; starchy vegetables like potatoes and some sweet fruits like peaches, apples, bananas, oranges.
Slow: beans, seeds like most nuts, peas, lentils, meat, fish, chicken, cream is less fast than milk because less lactose, milk sugar.
Take control of your diabetes when it is silent and serious irreversible complications are most easily prevented.
You are the only person who can control your disease!
Note 1) Insufficient insulin was discovered to be present in diabetes nearly 100 years ago. Insulin is made in the pancreas; in the most common sort, Type 2 diabetes, the pancreas still can make some insulin, but not enough to meet the body needs; so glucose accumulates. The disease usually gets worse with time– especially if not controlled well. In type 1 diabetes almost no insulin is produced, and that is a different but related illness.
Note 2) Fasting blood sugar— after not eating for about 10 hours– can be deceptive in Type 2 diabetes because the pancreas has been resting (usually overnight) making enough insulin to keep blood glucose levels normal or nearly so.
Note 3) Hemoglobin A1C test: Red blood cells are not alive. They were grown in the bone marrow, and when growth is complete, they are delivered to the blood where they act as tiny carriers of Oxygen. That Oxygen is delivered to the tissues, and the empty red blood cells are sent back for more. They live about 90 days and are then discarded. But when they were being formed they took in the amount of glucose that was in the blood at that time. Therefore, the average glucose level in those red blood cells is a measure of the average blood glucose during the previous 90 days. Problem: both high blood sugars and low blood sugars can be seen in early type 2 diabetes because the pancreas can over react to high blood sugars and therefore over-produce while trying to catch up at night. So an average of high and low glucose can be deceptively normal. Conclusion: a challenge test, similar to the old glucose tolerance test, is superior to looking at averages or fasting blood glucose level. This screening test is significant because it offers a fast, and economical screening that can be done by anyone with a glucose meter.
Note 4) The personal glucose meter was pioneered by Richard K Bernstein, an engineer with severe diabetes working on a glucose monitor for physician offices. His diabetes became so advanced he began to control his own blood glucose very tightly and began to improve; then he did his own study among students, which suggested a personal glucose monitor was the key to diabetes control. What happened is classic:The study results were rejected by the academic medical profession. So he went to medical school and began to practice immediately as a diabetes specialist. His book –The Diabetes Solution- is largely viewable on line
Dr. Bernstein completely recovered on a very low carbohydrate high protein diet and tight glucose control; he suggests an average blood glucose of 81 mg/dL; he is alive, and lively, over 80 years old. He participates regularly in Teleseminar Webcasts. The March 29 2017 event can be seen here.
* A Modest Proposal is a 1729 satire by Jonathon Swift: ‘For preventing the Children of Poor People From being a Burthen to Their Parents or Country, and For making them Beneficial to the Publick’. He outrageously suggests newborns be harvested for food to reduce the numbers of poor and also feed the rest. Perhaps the only bearing of Swift’s satire to this little essay is the focus on the millions of poor we seem willing to sacrifice to diabetes, even though it’s cruel, and irrational. and avoidable.
By working together outside a system that tends to sacrifice the good to the perfect, and by self managing their own disease, people can at least greatly improve their lives and well being. Yet for our world’s millions of unsuspecting pre-diabetic and diabetic people, only those who discover their disease early and begin to self control it can easily limit its ravages. I believe that worldwide– and even in the USA– there are tens of millions who could benefit from a similar process until something more academically perfect comes along.
Even privileged, idealistic and committed people can become insensitive, intolerant, and dismissive, based on disagreement about dogma, about the meaning of ideas and words. Words are, after all, only symbols; like metaphors they represent things or ideas usually unseen. When we hear or read a word, we rewrite it in our own minds. We interpret and give it our own personal twist. When one half of our nation cannot stand to hear or see the other half, because of ideas or words, it would seem wise to ask ourselves Why do Words Hurt? Why are we so willing to wound one another? Or to put another way, Why so terribly thin skinned? Who ever said ‘sticks and stones will break my bones but words will never hurt me’ was from another era; like Swift.
It seems to me more appropriate to think about deeds rather than only words. So in Colonet this year, I wore a baseball cap with a silent modest proposal written on the face to imply that :
We are in this together. In this place, this nation, this world. We should try to ‘read’, or value one another for what we DO, not what we appear to BE: Not color of skin or political affiliation; or religion; or citizenship, or age, sexuality or gender— but rather, our behavior; our acts; and judge ourselves and others as reasonably as our acts allow.