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
till
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







Sunday, September 3, 2017

Unusual Early Edition - Thoughts on Arrival.

I usually wait a whole week to post my first blog but it seemed that many memorable events happened on the way getting here.

And the Journey begins...   Airways Transit was stuck on the 401, so they sent a cab to pick me up and it got stuck on the 401 too...  Anne and I said our farewells... with the same corny lines, like "Don't do anything I wouldn't do." and she still laughs.



Missionary?  Yes, of course.

Caribbean Air - the good and the bad.  I had a second bag this year you filled with stuff for Mercy and St Ann's.  I hadn't remembered to ask early enough for a "special dispensation" from their headquarters in Trinidad.  So I copied their letter from two years ago and presented that when I got to the check-in.  After a few people had looked at it, they gave it to someone in a duller coloured uniform.. "...if the boss said okay..."   If I didn't mention the date on the letter, is that a sin?  As long as it is a venial, no problem I don't mind it hot... So that is the good.

The bad is that when we got to Trinidad we had to wait an hour and a half for the second leg to Guyana.  After an hour Caribbean Air decided there were "mechanical problems" and we needed to change planes.  I think they were delaying our small number of passengers to combine with a later flight..  oh well.  The change was reminiscent of the old Brooklyn "Chinese fire drill" but it wasn't fun...  We had to leave the plane and were not allowed through the immediately adjacent door into the departure lounge.  No, we had to exit to the main area of the terminal and the re-enter.. This is 5 am... And I am always in my best pastoral mood after not sleeping.

We all lined up at a special  "In Transit" desk where there were three Caribbean Air people...who organized us in single file and then did nothing for a half hour ..... Chanting did not help my mood.  Next, a young woman with a very nice clipboard came to take our names because they needed to issue new boarding passes for the same seat ....  We were then escorted to "Security" again...  Wtf! My mood had moved to the demonic .....  They were very efficient.. They seemed only to have read the first few pages of the TSA manual... We could leave our shoes and belts on though our wallets had to be put in a basket, but not our computers ..... My paper notes in my shirt pocket had to get a basket, but not my watch .....  Anyhow the screener didn't go off..😕.  

Maybe because of my pleasant attitude, I got selected for a bag search.  As my ex-immigration officer brother says "They are always right ..... and never give them any attitude".  But a guy has to keep some integrity.  I had to wait for the woman in front.  She had six small cans of chicken in water... The officer decided that could be dangerous...other than the fact they were already screened in Toronto.  He shook them and smelled them and had a conference with the other officer, who was worried they were packed in oil though the can said water.   If she wanted to keep the chicken, she had to go back to the Caribbean Air desk - of course it wouldn't open for several hours.  She was making me look pastoral again .....  She left to go back to the transit desk.

When the officer got to my bag, I figured he saw both computers.   But he was only interested in one side pocket with my camera which he looked at briefly and put it back and I was on my way.   I'd get a coffee, but nothing is open .....

Arrival in Guyana

When we arrived at Cheddi Jagan Airport, I was thrilled to see we had docked right in front of the Arrivals Gate as usually they seem to park the furthest away.  Unfortunately, the terminal is under construction and the arrival area was ..... take  a guess.  Hell and gone at the other end.   I am pretty sure that they do this to space out the line as the old people now wish they had checked those bags. At 7 in the morning, it was cloudy and a cool 83.     The distance also gives the more time to get the baggage there, so it seems a shorter wait.

Immigration was efficient and there was even an orderly queue.   I was through in no time ..... way ahead of my bags.   I got my two huge bags and proceeded through the "Nothing to Declare" Desk.   The Customs officer had a bemused look on his face like "You must be Guyanese to pull a stunt like this."   He did ask what I had in the bags.  I said, "Donations to Mercy Hospital, the little girls at St. Ann's Home and some supplies for my teaching.    I was told that I could do this many years ago by the Head Customs Officer."  Now I had him.... We had to go speak to someone in charge.  He looked at my customs slip and me.  "Missionary"???   I think my cute pony tail made him stop for a moment. Then, "Sure, go ahead."   And my story was true.  I could probably fit my clothes in an overnight bag without the stuff I leave in Guyana.

And Bhiro was there waiting for me.   I am sure he likes picking me up as it is a real chance to visit with everyone he hasn't seen in some time.  Either they shout out his name or he does to them.  I am sure that my kids had the same experience when I was a real human being with a job and I would need to take them shopping with me.   It would take "forever" according to them just to get milk.   "Do you have to talk to everyone?"   

Kaieteur or Bust!


Berte was an excellent driver, so Bhiro and I chatted like old friends who seem to pick up a conversation from yesterday.   It always scares and amuses me that we have the same attitude to many things.   Somewhere on the trip, he said, "How would you like to go upriver by canoe to Kaieteur Falls; it is a 4 day trip."  This is one of the items on my Bucket List; how did he know.   I had wanted to do that since Anne and I flew into Kaieteur in 2003 or so...   Into the Amazon Jungle in a canoe battling rapids, long portages over land... just like the explorers of old...  Speaking of old --"Shit! that's me now."   Let me describe my last canoe adventure with Anne's sister from England, Caroline.  I wrote an old friend earlier this summer:

I thought you might enjoy a revenge laugh after my making fun of your disabilities.  Yesterday, I took Caroline canoeing as she thought it was quintessentially Canadian. I booked a 90 minute route, calm water...   She loved it.... I even remembered my boy scout merit badge strokes

About an hour into the trip… I started getting a bad cramp in both my thighs.   I had to stand up and stretch.  No problem; we’ll just pull over to the shore and I’ll walk around…  Well, Caroline didn’t exactly pull hard enough so we weren’t actually on the shore.  

No matter, I had to stand up… Stood up; one foot reached for the shore; however, the rest of my body stayed in the canoe – at least for a little while.  My left leg sent a message to my brain… Lean back… So I did; right into the river… Ass over tea-kettle.   Then. I had a lot of difficulty trying to stand up… I have so little strength in my knees…

Finally, I got on my two feet –of course, still in the river; I grabbed the canoe and gracefully put my first foot inside…However,  my left foot remembered the trouble earlier and refused to move ..… so straight backwards into the river again ..… at least it was the other side of the canoe.

Finally, I got back in the canoe and in the right place ..…  and we were off ..…

However, my sister in law was too concerned:
“Are you hurt?”
“Are you sure you're okay?”
“Do you think you can continue?”

I wanted to yell at her, “Shut up!... The only thing in pain is my EGO!”
But I was a good host… and thanked her for her concern.

Caroline does remember me saying, 
"My mind... ( gasp)..is younger..( gasp)..than my...(gasp) body."

Looks safe to me!

Planning Ahead... Neither me not Guyana

I had left on Thursday night so I would have a Friday when everyone was working and I could better arrange for Monday's first class.   However, I failed to notice that i is a National Holiday, Eid-al-Adha, and everything and everybody is closed.  Hmmm...

Oh well.. it is Guyana -- improvise.   I got some printer paper from an old student at the hospital. I called my friend, Taju, who collects all my mailings - including tablets and printer - and he came with his son Tommy to deliver them.   Even they had closed their restaurant on Friday.  

Then, I discovered two of the faculty who do the small groups were not going to be there for the first day of school... It did boggle my mind, but it does make sense when you are here.   They had to use Monday as a holiday day or lose it...   Another bright rule by someone who has never taught.   Improvise again... We will have the First day of school on the Second day and the Second Day on the First Day.  Got to stay flexible...  And as I say, "In a hundred years, who will give a "darn".

And my flat also flabbergasted me...  Everything was done by Helen - glass windows had replaced the open ones, so now no rain inside, a new mattress so I couldn't feel the wooden slats below,  My boxes that I leave were thoughtfully brought from the school by Candy.. and most important of all I had my own dedicated internet and the passwords and it worked immediately ..... a pleasure worth savouring.   Now I will just need to work around the daily blackouts by GPL.   

Saturday I did my usual running around .....   but this time the tablets for the students came with European A/C adapters... PISSSS...  So I had to roam the streets of GT looking for an adapter to the adapter... a really nice guy at NT Computeac told me all I need was a cheap adapter for the adapter at an electronics store on Robb... and sure enough there they were, and 30 of them too ..... good day as without them them the tablets would have been as useless as a third xxx.

Stopped and got my Guyana reading materials, from a history of Linden, to raunchy tales of Guyana Vol 2.,  Indian indentured servants in the l800's, and two novels to show I have culture .....

Then, got my Guyana "clean up"; I forgot again -- it is the first day of school for all the kids on Monday... So I had a long wait.  When I arrived Royston told me he would get right to me.  I said being the true liberal that I am "No; I can wait my turn".   Over an hour and half later I got my turn...  There really is a difference between disavowing "white privilege"  in theory and in practice.   Met lots of people on my travels including my "adopted" son, Rashleigh, who ran out of his flat when he saw me with nothing but a towel.   I thought he had some women over, but he said he was showering.


This is me with my Guyana haircut and Rashleigh after he dressed.

I got my essential groceries - ketchup, mustard, soy sauce, mango achar, jam [the kitchen had already given me some peanut butter] cookies, crackers, peanuts, butter.   I was going across the street to the beer distributor and ..... horror of horrors ..... it had closed!  I tried a few other places, but no cases ..... I had to walk across town to a known beer distributor but they didn't have any Banks in cans ..... [Carlton, what's happening?]   It was a long walk in the by-now heat of the day, To think of myself not as an addict, I remembered how far I had walked for my students adapters, so I deserved a few beers.   I did get  a taxi back to Mercy and a long nap.

Enough... I am here now and slowly getting set for Monday's new students..   Thanks for reading... John