Saturday, September 16, 2017

How Long Have I Been Here?

Suicide Prevention Day - March and Speech 

No sooner were we leaving the airport two weeks ago than Bhiro told me that I was doing the keynote talk for the March in Better Hope on last Sunday.   I said, "No way.  You know I don't like to speak at public gatherings."  This is not because I don't like to speak; it is because I try to live by the fact that the Guyanese have a parade of "whites" proclaiming truths.   "I'll write your speech and you give it,"  I said.

After a period of hard negotiation, I lost and was told to give just a 10 minute speech in the middle of the speakers' list. Uh oh, now I knew it was the familiar barrage of important people talking to the assembled who were hoping that there would be food afterwards.   Fortunately, no matter what I said, it couldn't cause too much damage ..... kind of like preaching.

The March was to begin at 3:00 and walk  a mile to raise public awareness of doing something about the high rate of suicide in Guyana.  There is actually some good news: Guyana is no longer Number 1 at 44 per 100,000; We have dropped to 30 per 100,000.   This is quite significant and something to be proud of for the mental health system in Guyana and the numerous NGO's who have provided counseling and educational sessions throughout the country.

About 3:30, one of the organizers thought that maybe there should be some water as it was a scorcher, even by Guyana's standards.   So off we went to the nearest store to get water for 100 marchers ..... At this time, there were about 10 people - three of whom were driving.   And someone had to pay for it.  It is a good thing Bhiro was there ..... and he wasn't even one of the organizers.
Now it was 4pm and the crowd had come close to 20, with 5 of them driving... And we were still waiting ..... for what? We weren't going to get anymore people.  We were waiting for the police to arrive to guide us along the busy Public Road.   They too had been given a three o'clock time...  
But we were off -- after a fierce debate about whether we should walk in 3's or 2's.  The 2's won out because it was decided that we would look like more people.     We were raising awareness alright ..... The traffic driving west with us was stopped for us to walk the mile .....  

I took this pic from the end of the marchers!
When we arrived at the community centre field, there was already a cricket match that had been scheduled for this time. We had not!   However, the cricketers were gentlemen and sat down to listen to the brief speeches as we were already late.    The microphone was set-up to be at the backs of the audience as it was the only power outlet ..... interesting but the Guyanese took it as normal. To be honest, it wasn't a big crowd, with half the crowd being the cricketers, but at least the crowd outnumbered the speakers.

The MC reiterated many times in his opening (not so brief) remarks that this was a short programme. The first speaker from the Ministry of Public Health went 25 minutes.  Mercifully the other half dozen speakers and pray-ers were shorter but by no means brief.

My Speech

I had offered to be cut from the programme, as it was going on and on, but a guest is a guest.   I decided that I would be Canadian-brief and cut my 10 minutes to five.   I said that with the reduction of the still-high rate, about one half of the suicides in Guyana are impulsive and spontaneous with the ingestion of a lethal herbicide/ pesticide called Paraquat.   It is used in the fields for many crops; before the cane is harvested it is used to clear out weeds, snakes, etc...  One teaspoon ingested is lethal, so lethal that even if you drank it in an Emergency Room there would be no antidote or treatment. You will die a not-nice death within a few days.   There are in reality no restrictions on its sale ..... It is not unusual for a street vendor to be selling fruits, candy and Paraquat.   Banning Paraquat or at least lessening its easy availability would probably reduce suicides by half!

It is banned in all of Europe and most developed countries, except the US -- no one can explain the US today!   One Syngenta plant is in England where it is illegal to use for anything...  and shipped to -- you guessed it -- poor and less regulated countries.

The theme for the day was "Take Time; Save a Life"  which is almost identical to the previous year's, so I decided to be different.   I suggested that they forget about those contemplating suicide and think only of themselves - Be Selfish.    When they work in the fields and spray crops, did they know that it is absorbed by breathing and through the skin .....  and in 15 minutes you can't wash it off.   Paraquat stays in soil for at last 20 years... and in water some say 300 years...  There are trace amounts in the cereal they had for breakfast .....

Exposure to Paraquat, according to research by independent investigators (but not by Syngenta's researchers) leads to an increase in birth defects, elevated risk for Parkinson's,  trouble with lungs, kidneys, liver and more.   This is because it is a "Hit and Run" chemical:  it immediately attaches, but goes away and returns years later .....

And a line that got the cricketers' attention was this: "Hey guys!  Long term Paraquat absorption decreases testosterone production.  And (with my out-pointed, straight index finger) you want to know what happens?"  I slowly bent my index finger and it went limp... "And those little blue pills don't help with this problem.

"So be selfish:  get rid of this stuff!   Clean it out of your homes ..... tell local merchants to lock it up and label it.  Don't wait for the government -- a recommendation for a ban has been on a minister's desk ever since I came in 2002.   Do it for your wives and your children and yourselves."   (I chickened out of  adding, "You don't want your cricket bat to be the only part of you that's hard!" as the newspaper reporter had stopped writing.)  "And if you look after yourselves we will also reduce the number of impulsive suicides dramatically .....and you will maybe even get a Mother Teresa Award for caring about young people."

Dr. Harry (Bhiro) had a good speech on the theme.   He has become like a Psychiatry Saint ..... or since he is Hindu a Swami.   If you want credibility you invoke his name.  People need to be seen with him and just touch his "cloak" or the hem of his garment.

 You Never Know Whom You'll Meet  

The gentleman on the left kept staring at me throughout the whole programme.  After I had finished he came up to me and wanted to know where he had seen me recently... He knew he had.   We finally figured it out; it was at the Everest Cricket Club where I was writing the speech over a beer and some Banga Mary.  He (Primrad) said he was at the Everest praying!  He had to introduce me to his friends and told me that a custom in Better Hope was to have all guests have a beer....  Okay, I can handle that.   And then when I was leaving, he said,  "Well the first beer was for coming and you need  a second for leaving..." and all the guys agreed with him - so it must have been a real tradition.    I had a great chat with them about their lives and struggles and as I was was about to leave again, they told me about another custom.. "You can't leave on an even number of beers..."  by now I figured they might have been making this up...  Bhiro was leaving after having shaken the hand of everyone there, so I had an excuse to break tradition.

A Festival Dinner

As if  Bhiro had not had enough handshaking,  he had 4 tickets to an Indian Arrivals group dinner that evening.   He had to find two people to go with us, and with a stroke of luck he found two young women and off we went.  It was an Indian [South Asian] celebration to be catered with Chinese food by a Chinese restaurant and some karaoke accompanied by a single steel drummer and his computer who played Reggae most of the night.   It was a good time and good food... and we didn't see Bhiro the whole evening as he was making his rounds.

And I got my picture taken at the arrivals monument which is usually off-limits.  And this was just the first day of the week .....

I'll Let "My" Girls Speak for Themselves

I actually had a full week of PBL Classes and they were good.  Some other stuff like doing psychiatry rounds and teaching at Georgetown Public Hospital.  Those things will have to wait.

Thanks for joining me this week.

Saturday, September 9, 2017

Up and Running.. Okay so I am Walking Slowly

Still with the Prison Shots

The End of an Era

and then Family Services
We had dueling Acrostics  - Finance
Helen Browman has resigned as CEO at Mercy Hospital.   There was a farewell event provided by staff and board and students.    Helen has worn many senior management hats at Mercy since assuming the role of Administrator after Sister Sheila Walsh left many years ago.     

Sheila asked me what I had thought of her; and to be fair I said, "Well, she definitely has better legs than you do."  While at the time it may have seemed to be one of my usual slightly-less-than-politically-correct comments, it proved that I was speaking metaphorically.   Helen did have "legs".   She was thrown into the deep end with only a couple of months' crash course in hospitals and doctors, started at Mercy to be baptized with the huge (literal) fire of 2010.  She led the staff in getting everyone out and safe.  And so it continued until this week.   She was [and is] committed to Mercy and its vision.   
I would have bet she was off to the States, but she has chosen to use her skills in the GT area.   I'll write more in a couple of weeks because Helen is in Miami but only for holidays... just in time for Hurricane Irma's arrival.
Helen looks a little too happy to be leaving.

On a personal note, Helen has always greeted me and my colleague volunteers with enthusiasm.   I made many requests during the years and many of them were complaints [believe it or not].    I doubt that I could have had a more supportive and accommodating boss.    It has been one of my pleasures at Mercy to see Helen mature into a strong leader... and now taking on another project.

 And A Continuing Gift

Yes, once again many people have donated dollars so I could provide the new First Year Students with internet tablets in order to do their research in the PBL course.   I had thought that many would have a tablet already and I would have a few leftover; but none of this years students had one.  Many have phones but no data plans... They thanked me again and again.   I said they should thank all you who support me.   I love it when they have the resources to do good work because, to share a Guyanese Proverb,

"Harse nah know how fast he can run
tigah ah chase am."

And then I ask them who are the Harses and who is the Tigah?  I don't have to be nice; they have more than enough resources to all get A's.   Well,  most have no internet connection at home; several hours of chores; and, some an hour's journey each way; and some still have not enough money to have lunch.   But I just see those as minor inconveniences -- and hope they do, too!.  

This year we have set a record for males in the class - Five! The males are going to find it hard going because there will be too many of them to take advantage of the women ..... I mean their generosity in helping with the one poor male in a whole class of women.

You Know You are Old When...

 Do you see any resemblance?  
And it is not that one is tough and mean-looking and the other cheerful and sweet...  Actually, they are father and daughter... Taju was a first year student in 2003 and now Althea is in my class.  I have known Althea also for many years when I would visit Taju's  (really, Allison's) restaurant, Princess Kitchen ..... I can't ever remember her expressing an interest in nursing and I can't think how she got so grown-up!

 Robin Hood was Never like This

For one of my first classes, I use an old "values tool" called Robin Hood -- with Maid Marion, Little John and the Sheriff of Nottingham... Basically Maid Marion chooses to sleep with the sheriff to save the lives of Robin and Little John who are imprisoned.  They are freed and Robin calls her a Slut.  Little John takes her away to live happily ever after.  They have to rank the characters 1 to 4 as most to least moral ....  This is hard enough for them as there is not a right answer, but then I get them out in front of the class to defend their position against others who thought differently --  and Out Loud!   No one has ever died, but this year it was close!  Remember the Tigah...

Great News for Psychiatry Residency - Hopefully

And no it is not that the Grand Old Master - Dr. Tony Carr is coming back again for three weeks later to teach in person with the Residents and (because he is truly a workaholic) with Mercy Nurses as well.

Now Tony is good ..... and there have been some very recent phone calls with people from the University of Texas Southwestern, Department of Psychiatry to explore possible collaboration with the Master's Programme at the Public Hospital.  Dr. Adam Brenner is the Residency Director there and along with several senior residents (Monica Gonzalez and Theresa De Freitas Nicholson and an Ethicist professor, Dr. Elizabeth Heitman) he and Tony are already enthusiastically providing support. The Texans knew of a colleague from Vanderbilt who has established a Master's Programme in Emergency Medicine at the Public for several years.   Dr. John Paul Rohde is the Faculty doctor from Vanderbilt and by great fortune, he was in Georgetown now.
Left: Dr. Elizabeth Nikram, Chief Resident, Dr, Harry,
Dr. Veneta Gangaram, Resident, Dr, John Paul Rohde, Vanderbilt,
and the non-doctor John.
We were able to arrange a meeting on Friday and it was an exciting time thinking about all the future opportunities in working with UT Southwestern.  Dr. Rohde did try and bring the docs from Texas in, but the internet was acting up.      I will certainly be updating you on the progress of the adventure.

My Girls at Saint Ann's

Yes, I did get there and they were wonderful.  Many of the older girls have left and a whole new crop of girls are there whose names I will never get straight.  This is long enough, so I'l save their stories for next week.

Rashleigh found me... we were going to watch
Manchester United play on Saturday at Frenzy's.  But the Game got
bumped for coverage of Irma on the local? South Florida station.  While
I wouldn't say that the tv signal is stolen, I suggest
that it is "used under a somewhat questionable license".

Thanks for reading, John