Blargh

Remember that time I broke up with my girlfriend? Yeah. That was the worst.

In case you want to relive and reflect, here're some photos of Claudia and I in New York and half the entire United States.

Thug Life New Hampshire

You may not be able to tell just by looking, but the Upper Valley of Vermont and New Hampshire (or la Vallée Supérieure as it's known in the local French pidgin) is pretty rough territory. Teeming with gangs, hoods, hoodlums, toughs, thugs, and the thick hum of bluegrass harmony. It's a place where drugs like dope, whack, smack, and spank are sold by the handful; where drive-bys are a regular events at local sugar houses and pimps parade unchallenged down colonial boulevards and covered bridges; a place where homicide is the most common cause of death for youths next only to moose attack and bear attack; and where life is cheap because the good die young. If you want to survive on the streets of Hanover you better get street smart, fast. And get a gun too. To keep those moose of your back.

Got Goat?

Haiti may not have much of a future, but it's got good food. (It's got some good people, too, but after my last post I cannot officially go on the record saying that.) I’m not sure I’d ever eaten goat before, but I’d happily do so again.

The majority of our diet there consisted of various staples consisting primarily of fried meats (usually goat or chicken) and fried plantains supplemented by a few eggs, a few breakfast spaghettis, and a few sandwiches of what I can only guess was brain cheese. All washed down with either a 1 L bottle of coca-cola or a pint of Prestige, Haiti’s surprisingly satisfying national beer. There was also conche which tasted like... well, conche, so they can't all be winners, but our best meal, our big banquet meal our final day, was Chinese food. The best damn Chinese food in Haiti and, arguably, in all of New Hampshire and Vermont. And for dessert? Dous makos. Sugar, condensed milk, and... silly putty?

Eat it, share it, or press it up against a newspaper comic to save for later.

 

Hope for Haiti?

Haiti, if I may be so bold, is a lost cause. Some people just haven’t realized it yet.

Despite it currently being quite fashionable I must dissent and say Haiti will likely never, ever get better. I don’t say this simply to be contrarian – I like agreeing with people. I don’t say it because I dislike the Haitian people – I have no strong feelings for them either way. And I certainly don’t say it because I eschew foreign aid – indeed it’s because I so strongly believe in the benefit of foreign aid that I raise the issue. Were international charity and giving a bottomless trough of endless resources, sure, I would say, give to Haiti. They are not, however, and every dollar, euro, or yen spent somewhere is another pound, krone, or ruble not spent somewhere else. In this sense Haiti is more than just a lost cause; it is a black hole of limited resources. 

To begin, Haiti’s neighbor: the Dominican Republic. It is poor, underdeveloped, undereducated, underappreciated, and lives with much the same historical legacy of colonialism and corruption that Haiti does. In fact those with more than an American sense of geography will even note they share the same island in the same spot in the middle of the Caribbean. Yet despite their similar weaknesses over the past few decades they’ve both gone in dramatically different directions and now consequentially enjoy dramatically different presents. No one talks about saving the Dominican Republic. 

Back to Haiti. Since our actions in the present should be guided at least in part by prospects for the future let us focus on Haiti’s current chances for sustainability. A nation’s economy is not the only indicator or even the best indicator of wellbeing, of course, but an economy – any economy – is an essential part of its foundation for wellbeing. Without some semblance of substantive commerce health, education, development, and consequently happiness are all retarded. In light of this the developing world’s major economic advantage over the developed world, and what will largely allow the developing world to save itself, is its possession of a large, cheap, manual labor force with limited regulation. From this perspective Haiti has got it good. Situated close to the US, the most consumeryist consumer nation on the planet, they arguably have most the third world competitive advantages. Looking closer, however, the advantages are only skin deep for were you to want to do business in Haiti you’d run into some obstacles. To do business in Haiti you’d have to import your raw materials to a port and road system in disrepair using gasoline often in short supply to enable a largely illiterate workforce speaking a language spoken nowhere else using an unreliable electrical supply, an unclean water supply, and an undeveloped healthcare infrastructure to make a product that will be grossly overpriced and once again need shipment via broken roads and inefficient ports to countries that can likely buy the same goods elsewhere cheaper all while negotiating what is considered one of the most corrupt and least law abiding states in the world. And the Dominican Republic’s just right across the border. The end result? It ain’t cheap to do business in Haiti. The cost for us of a “decent” hotel room? $100. The cost of a 4 hour drive between towns? $150 not counting gas. The cost of a meal of goat and plantains and coke? $15. Why then would anyone want to do business with Haiti? How then can Haiti ever be free?

Back to the Dominican Republic. Developing nations have other strengths, however: agriculture, tourism, a tenacious population to name a few. With regards to the DR: yes, yes, yes. With regards to Haiti...? Unfortunately deforestation, soil erosion, and general mismanagement have led to a greater harvest of seasonal mudslides than any appreciable agricultural export. Unfortunately expressionless stares and a foreign tongue in a post-apocalyptic wasteland no matter how tropical don’t do much for tourists when manufactured smiles and a familiar language are right next door. And unfortunately the prevalent brain drain combined with one of the highest birth rates in the Western hemisphere guarantee only an ever increasing population with fewer and fewer capable leaders. Western aid makes up almost two-thirds of the national budget and a large percentage of the economy. This is not sustainable, and when the spigots run dry what will happen? When the population increases but the number of jobs and total arable land remains stagnant what will take place? When another populist election funded entirely by donation comes to pass, who will lead?

I think the most striking aspect of Haiti which makes me give up hope is the thoroughness of its poverty. I have been to a number of poor countries: Mexico, Honduras, the Dominican Republic, India and in all of these places there has been the poor, but there has also been, however small, an upper class and, more importantly, a middle class. There has also been a spectrum of poverty such that there was always the sense that there was at least something better that could potentially be obtained. In Haiti, however, outside the private gated communities of the affluent elite there is only a homogeneous lack. The only class seems to be the lower class. There is undoubtedly some difference between the very poor and the super poor, but it is a difference that if anything only heightens the sense of despair.

Immediately after leaving Haiti I flew to Fort Lauderdale, Florida, where I stayed at the Marriot Harbor Beach Resort and Spa to attend a medical conference. It was as big a contrast of wealth and poverty as you can get made all the more striking by the fact that a number of the workers and staff there were Haitian. I attended meetings in overly air conditioned banquet halls, lounged along overly manicured poolsides, and ate and drank more calories than I could ever need to burn. Only a few hundred miles away I had been sweating, working, and living in a whole other world. Perhaps in light of all this excess and wealth any money sent to Haiti, even if used inefficiently or wasted, is worth it. Perhaps when we’re spending thousands on luxury it’s missing the point to argue about the few dollars misspent alleviating poverty. I don’t know, but until Haiti shows promise or my robot heart shows softening I’ll be sending my box tops elsewhere. Polio anyone?

 

Crippling need aside, here’re photos!

* In case it were not automatically readily clear, these are my opinions and my opinions alone. I don’t know how my travelling companions feel about Haiti. I never asked them. I suppose they’d have nice things to say.

Man Vs Mosquito

If I had only one wish, and it were not to wish more wishes, it would be for every mosquito, everywhere, to gather together, holding hands, and to die a terrible, miserable, suddenly horrible death. Explosion. Implosion. Mosquito herpes. Whatever is most unpleasant for them, I’d wish that, and I’d be a happy man.

I recently travelled to Haiti. It was an “experience” in the same sense that military training and medical residency are “experiences.” You can probably rationalize a way to self-betterment, and convince yourself that the whole thing was somehow “good,” but nevertheless you describe the whole experience in quotation marks and would prefer to never do it again.

But let’s not talk about that, let’s talk about mosquitos. In Haiti, there are mosquitos, and they tried to kill me.

My initial mosquito-experience in Haiti began relatively uneventful enough. There was a mosquito here, a mosquito there, but if you avoided making eye contact with them they generally let you be. I left Port au Prince thinking that, of all Haiti’s unsolvable problems, mosquitos were not one of them. Then I arrived into Les Cayes.

Les Cayes is a coastal town along the southern Peninsula of Haiti, and overall is in most ways nicer than Port au Prince. Unfortunately one of those ways is not mosquito populations. They were a bother in La Cayenne where we stayed our first few nights, and they were a menace at the Institut Brenda Strafford where I stayed my last few nights. It was in the latter part of my stay where the mosquitos and I waged war, and it was here that the mosquitos beat me.

The first day at the Canadian ENT hospital (Institut Brenda Stafford) was I thought uneventful enough, but I awoke the following morning with a number of bites over my shoulders and arms. Figuring this was as much my own fault as the fault of the bumbling misguided mosquitos I resolved to redouble my DEET repellant efforts, fortify my canopy netting at night, and maybe kill a few to make an example. The following morning, however, there were still more bites. More bites on my legs. More on my arms. More on parts of my body I didn’t even know the mosquitos had access to. It looked a bit like I had the pox, except without so much the high fevers and crippling fatigue. It was nevertheless then that I knew if I were to survive I’d have to go on the offensive. The mosquitos were clearly coming for me, it was time now I came for them.

Over the next two days I aggressively pursued a campaign of mosquito genocide. Took regular breaks from work to round them up. Paid local militias to do unspeakable things. Only God knows how many mosquitos I killed in those ugly days. Dozens? Hundreds? Millions? We can only hope. The violence reached a climax when the treacherous buggers hired a local roach to lie in wait in my duffel bag in order to assasinate me. He made it part way up my arm and almost to my jugular before I shook him off and promptly smashed him into roach paste. And then smashed him a few more times for good measure. Lacking originality and the capacity for complex thought the mosquitos tried it again the following day, but both the second roach and his conspirators were taken care of once more. And by that I mean their poor mosquito children could no longer recognize their poor mosquito daddies.

Despite these efforts the bites continued appearing. No longer on my back and shoulders so much, I’d successfully protected those with t-shirts, but continuously on my arms and legs, and most specifically on my left knee where I wore my knee brace. It seems a hot swollen knee is mosquito nirvana. They loved biting it so much they purposely flew up my pant leg, past plenty of prime calf biting territory, and up to the one spot in my brace where they could see skin. I’m still not entirely sure how they did it, or even why they did it – do mosquitos hate me? -- but it got progressively disfiguring and generally unpleasant to look at. Thankfully, ten days later, before the mosquitos had chewed my leg off, I gathered my remaining troops, pack my bags, erected a provisional puppet mosquito government, and flew home.

In the end one could probably say my battle with the mosquitos was a metaphor for Haiti’s battles with poverty and legacy of colonialism and corruption. One could probably also just say it was a pointless, needless waste of time, energy, and, in no small amount, blood and plasma which, in a sense, is a also metaphor for Haiti. Regardless, the end. Goodbye Haiti, enjoy your mosquitos. Goodbye mosquitos, may you forever burn in mosquito hell.

 

You know it's a problem when the bites become confluent.

 

Dedicated to Dedicating

National Jewish is dedicated. Both in the sense that its healthcare personnel are dedicated to patient care and in the more literal sense, that everything is dedicated by someone to something. Everything.

Got too many awards? Put 'em on a plaque. Got too many award plaques? Put them in a stack on the wall. 



The last plaque is the award for the faculty member with the most awards.

Stack of plaques still insufficient? Use them as wallpaper.

If you rearrange the plaques into the correct order a secret passage opens up. Leading to a room with more plaques.

 

Of course it's not all just about the plaques at NJH. They've also got dedicated bricks.

Dedicated bricks are just like dedicated plaques, but with more Old World charm.

 

And dedicated bricks with plaques.

The greatest honor is getting a brick made out of plaques.

 

Since apparently one can run out of bricks to dedicate there's always plant life and local fauna.

The best woody shrubs are always dedicated first.

Dig donors don't trifle with pea gravel and compost, though. They go straight to dedicating buildings. Unfortunately buildings tend to run out pretty fast. So why not dedicate... parts of buildings?

Best damn vital signs room in the country.

 

 

I guess one should look at all the dedications and memorials as a sign of people's trust in the institution to use their resources wisely and for the benefit of future generations, and less as some over the top onstentatious display or kickback to the plaque-making industry. NJH certainly does good work. It is a little distracting, though. And just a little ridiculous.

 

 

"I dedicate this picture in the name of Mars. Ooh isn't that lovely?"

Fighting the MAC Attack

Denver is home to many of the nation’s great medical institutions including National Jewish, its preeminent boutique hospital. Once a center for TB excellence, with the near eradication of TB in the US it has had to move on to other mycobacterium and other lung diseases to remain relevant. It is therefore now also the nation’s best MAC (Mycobacterium avium-complex) hospital, and provides both an award winning breadth of care and an award winning mani-pedi. 

I spent four weeks there to learn all about Mycobacterium: its likes, its dislikes; hopes, dreams; everything. Having a particular interest in tuberculosis I figured I’d get an excellent education on the whole family of bugs in general, with a little bit of TB on the side to keep me interested. Instead, it was pretty much all MAC. There certainly was some M. abscessus masquerading as MAC and an interesting other NTM here or there, but there was essentially no TB and essentially nothing but MAC. MAC, MAC, MAC. Soooo much MAC.

MAC for those unaware, is America’s great undocumented plague. It’s in your jacuzzi, it’s in your shower, it’s in your pool. It’s probably sleeping with your wife. It’s also in the environment as well, and we all likely eat and breath it every day, but for some reason a very small – exceedingly small – portion of the population gets permanently infected with it and develops disease. They are, largely, the Lady Windermere population. There’s also a classic subset of tobacco-smoking, beer-drinking, middle-aged males who get it, but they’re a minority at National Jewish. Instead the Lady Windermeres are thin, tall, middle-aged Caucasian females historically with a tendency towards fastidiousness, but now, all too frequently, a tendency for breast augmentation surgery.* They are what keep NJH’s engines moving.

At Denver’s national Lady Windermere health center and spa, men and women are scheduled for two week stay where they get their MAC treated, their comorbidities managed, and explore all that cosmopolitan Denver has to offer. While there they get the attention of a personal physician dedicated daily to their care for (just about) as long as they want. Consultants, dietitians, and masseuse are readily on hand. The laboratory is ready to run a generous and likely excess number of tests. And top Michelin rated chefs prepare the day’s specials in the facility cafeteria. Although at a hospital patients are not actually hospitalized, but instead spend their nights at any one of many luxurious local accommodations. Throw in a novelty T-shirt and a romantic dinner for two the final night of their stay, and the boutique experience is complete.

Because the NJH MAC ExperienceTM is so long and intensive it is typically the realm of those who can afford to stay in a hotel for two weeks and receive countless tests and procedures. In other words, it is the affluent portion of the Lady Windermeres who make it to Denver for care. Thankfully both cash and credit are accepted. 

As much as I give it a hard time, National Jewish is an amazing place. The thoroughness of care and the research being done there are remarkable. Although it does attract the rich for financial reasons, the poor and underserved are present as well. Moreover the physicians and nurses who work there are dedicated, hardworking, and give much of their lives to their patients. It’s likely entirely unreproducible due to the realities of medical finance in the rest of the world -- and perhaps with some of its excesses this is for the best -- but truly there is no institution that can compare. NJH is a place like no other. At least that's what all the travel agents say.


*It is apparently a well known, but unscientifically established, fact among radiologists that the positive predictive value (PPV) of breast implants for MAC in a woman with right middle lobe and lingular bronchiectasis is high. Similarly, male nipple rings in a chest CT? Diagnostic of HIV.**

**This is not meant to slander HIV+ individuals or men who like nipple rings. Just radiologists. What louts.