Archive for October, 2013

Prevent Childhood Malnutrition

Saturday, October 12th, 2013

Miguel small

Van small

Give a man a fish, and you feed him for a day; show him how to catch fish, and you feed him for a lifetime.

Proverb

            For me, hunger has very real faces. There are Miguel and Van, and the woman whose name I have forgotten.

In 1968, while in medical school, I spent a summer in Nicaragua on the Caribbean coast. Fortunately I had a camera with me and brought back some photos that I still use for teaching.

Miguel was fussy and had a big belly and reddish hair. In this picture he is being held by his older sister. A Nicaraguan medical student and I tried to figure out what was wrong with him. Our mentor, Ned Wallace knew immediately that Miguel had kwashiorkor, a type of malnutrition caused by lack of protein.

We admitted Miguel to the hospital and fed him a high protein combination of bananas, rice and powdered milk. I expect that he is now a healthy 46-year-old man.

Van was not so lucky. He was quiet—too quiet for a boy of almost a year old. Only his big eyes moved to follow people around him. My picture shows him sitting on Jan Cunningham’s lap before her husband, fellow medical student Brian, started an IV. The next day Van died despite the best efforts at the little mission hospital.

We traveled by dugout canoes to small towns that had never had medical care. The people there seemed pretty healthy. They lived in a fertile land with lots of rain and sparse population. I remember one man telling me that he had just come back from his “plantation”. An image of a Southern mansion with white pillars jumped into my mind! Reality was that this was just a small area that he had cut out of the savannah where he planted his crops. My recollection is that, despite parasites and the usual childhood complaints, the kids outside of the city seemed well nourished.

Our home base, the Moravian hospital in Puerto Cabazas, had a different story to tell. A girl I saw in clinic one morning complained of stomachaches. She was a slender, comely and self-possessed 10 year old. I examined her skinny abdomen and found nothing wrong except for lots of gurgling sounds.

“What did you eat for breakfast?” I asked.

“Just some coffee. My father didn’t have anything else in the house.”

Whereas in the villages the food came from trees and plants a short walk away, in Puerto Cabezas the economy relied on córdobas (the Nicaraguan currency). People grew food and fished for money, not to eat. Sometimes they ran out of money—and food.

Our time in Nicaragua was 45 years ago. Malnutrition there has dropped dramatically in the last 20 years, but there are other areas in the world, especially in Africa, where it has risen alarmingly.

No child should be hungry, let alone starve to death. Yet worldwide 17,000 kids die every day from lack of adequate nutrition. This is a complex problem without easy answers. I appreciate the First Baptist Church of Bayfield focusing our attention on this issue. Moreover, I will write more soon, including about the woman whose death 30 years ago still haunts me.

© Richard Grossman MD, 2013

Vasectomy

Saturday, October 12th, 2013

“Can vasectomies really make a difference? Mine made a big difference in my life, and to this day, I consider it the single most important contribution I have personally made to the wellbeing of future generations….“ Paul Ehrlich.

 

It was time: I walked across the hall, lowered my pants and lay down on the exam table. Dr. Sam Callaway took good care of me.

We had two great sons and our family was complete. Although my wife volunteered to get her tubes tied, I decided to practice what I preached and went for the vasectomy. That was thirty years ago, and I’ve never regretted that decision.

My largest fear was that Sam’s office nurse would be around still, but Judy had already left. Sam talked to me as he worked and I barely felt any discomfort. He explained that he used a very thin needle for the local anesthesia, made tiny incisions and he was gentle. In a few minutes it was all over and I was on my way.

I’ll admit to some soreness that evening when I spoke at the prepared childbirth class my wife was teaching. And I moved carefully the next day when I needed to perform a cesarean. All in all, I took just a few aspirins (that was before ibuprofen!) and never had any ill effects.

Men have an anatomical advantage when it comes to sterilization. Whereas a woman’s tubes are deep inside her body, a man’s tubes, the vasa deferentia (singular: vas deferens) are much more accessible. When they are interrupted, sperm cannot get released, and the man is unable to cause pregnancy. Fortunately, sperm are only a tiny fraction of the male ejaculate, so sex is unchanged—or better, for lack of fear of pregnancy.

A vasectomy takes only a few minutes, is done with local anesthesia and is amazingly safe and effective.  The main hitch is that it takes several months to wash out all the sperm, and the man should be tested to be sure that he really is shooting blanks before trusting the surgery. Fortunately, the failure rate is less than one in a hundred.

Tubal ligation is more common in the USA than is vasectomy. Among married couples, one in 7 men is sterilized while one in 5 women has had the surgery. Since many sexually active people are not married, the overall statistics show a larger preponderance of women taking control of their fertility—more than a half million women are operated on every year while only half that number of men get snipped.

The popularity of vasectomy varies by country. It is rare in many parts of the world such as in Africa, but a quarter of men in New Zealand have had the surgery.

In Durango perhaps only one physician is left performing this important procedure after Centura took over the family practice group at Mercy. Dr. Mark Forrest has performed hundreds of vasectomies, including on some of my friends—and they have all done well. He says that it usually takes two visits: a consultation, then the actual surgery. He will check semen samples two and three months later, and if both are negative for sperm, the surgery can be considered a success. If this protocol is followed, the failure rate is lower than the rate of pregnancy after tubal ligation.

Furthermore, vasectomy is much less expensive. Nationwide, the price of male sterilization is $350 to 1000. Female sterilizations can now be done without an incision. Essure™ is an office procedure performed through the woman’s cervix, with mild sedation and local anesthesia. Unfortunately, its overall cost is about the same as tubal ligation—$1500 to 6000.

The first World Vasectomy Day will be observed October 18th of this year. This event was decreed by Jonathan Stack, an award-winning documentary filmmaker. The event will be celebrated by Dr. Doug Stein performing his favorite operations—you guessed it!—live from Australia. Dr. Stein has performed over 30,000 vasectomies, perhaps a world record.

Mr. Stack went to Dr. Stein for his own procedure, and thus got the idea for the film. His reasons for favoring vasectomy include: “…it’s time for men to share the burden of family planning” and “…we have to do a fairer job of sharing the planet’s finite resources.”

You can find out more at: www.worldvasectomyday.org, including links to the film’s trailer. They need money to finish this important film. I donated already, and hope that you will also consider supporting this film—because it is time for men to share the burden of family planning!

© Richard Grossman MD, 2013

Repudiate the Doctrine of Discovery

Saturday, October 12th, 2013

Our friend has spoken of the barbarities [extreme cruelties] which have been practiced towards the Indians, and of their present condition of degradation in contrast with their condition when William Penn landed on this continent.

Lucretia Mott, 1869

 

After showing the film “Two Who Dared” about the Sharps, a Unitarian couple who saved thousands of children from the Nazis, Charlie Clements asked for questions. I stood and asked what current conditions are analogous to German fascism that should spur us to action.

Charlie cited Darfur. This region of Sudan has been at war for a decade now, with three hundred thousand people slaughtered. It is not the usual genocide, however, where the conflict is based on religion or race. The two warring parties are both Muslims and of similar ethnicity, but one group is semi-nomadic and the other sedentary agriculturalists. Theoretically these two groups should coexist peacefully, but that is far from the case in Darfur! It seems that this conflict is over resources in that sparse land.

Right after asking Charlie my question, I thought of another situation analogous to Nazi Germany. This human tragedy is closer to home, however.

Our European forbearers invaded a prosperous land that supported its indigenous population very well. Native Americans helped some of the European settlers when they first arrived. How did we thank them? by uprooting them, waging devastating wars and introducing fatal diseases.

Using both bullets and disease, the European invaders killed off 80 or 90% of Native Americans. We came close to wiping out the people who had first rights to North and South America.

How could the medieval Europeans justify this massacre? The roots of this tragedy go back to the first half of the second millennium of Christianity. The Roman Catholic Church’s policy at that time was forced conversion of infidels (and of other enemies). Sometimes conversion was bypassed and the poor souls were killed directly. The Church ruled with fear and an iron fist.

Intolerance of diversity affected many groups. Fanaticism inspired the Crusades, resulting in the massacre of millions of Muslims. The last, Albigensian

Crusade was in Europe, against the Cathars, a Christian sect who protested the power of the Church. Cathars were obliterated in 1244 with the burning of the last 200+ of these protestants.

A single religious policy, the Doctrine of Discovery, made the conquering and massacre of Native Americans possible. Indeed, this Doctrine made it imperative that Christian Europeans conquer and convert in the name of Jesus. To quote Pope Nicholas V’s Papal Bull Romanus Pontifex of 1455, European monarchs were “…to invade, capture, vanquish, and subdue all Saracens and pagans and other enemies of Christ… to reduce their persons to perpetual slavery [and] to take away all their possessions and property….”

In 1823 the US Supreme Court upheld the continued right of Europeans to own and control property that once belonged to Indians in the case of Johnson v. M’Intosh. The Court maintained that the US Government, as the discovering sovereign’s successor, does have the right to nullify Indians’ interest in their lands. Thus indigenous people had no right to their own lands! This Doctrine became the cornerstone of USA Indian policy and was the basis for a Court decision as recently as 2005.

The world has changed vastly since 1455. Both the Church and secular laws have changed immeasurably. Our society is much more egalitarian; now every person has value. By today’s standards many of the dirty deeds that the Europeans did would be unconscionable. We should be careful not to judge the past by today’s values, but also must be sure that today’s laws and practices don’t perpetuate the dark past.

What should we of European descent do to make it right with Native Americans? It is impossible for us to provide complete recompense; too much has happened since 1492. For instance, many of European descent live on land formerly used by the Utes, and we are unwilling and unable to move.

            A first step is to become aware of past history. I don’t remember learning about the Doctrine of Discovery in school, yet it is a vital part of history. A public apology is in order; this essay is my personal apology. I understand that there are treaties between the Federal Government and Native Americans that the government has consistently broken. We should ask Washington to live up to its promises to our indigenous hosts. Finally, we must work to prevent similar unethical policies that lead to genocide.

                                           © Richard Grossman MD, 2013

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.