Friday, August 22, 2014
How I Write
I am a reluctant public speaker, but I enjoy telling stories through the printed page; and have published three novels, plus non-fiction biography and memoirs. I write for enjoyment, both mine and the reader's (I hope.) If there is such a genre as "faith-based fiction founded on fact", that describes what I try to do. My target audience is not "religious" people, but the reader who has minimal or no interest in religion because he/she has never thought about it much. Some people term the genre "inspirational".
My writing falls into a gap between "Christian" publishers (for not being evangelistic enough) and many mainstream publishers (for even suggesting that God might be relevant to ethics or human behavior.)
Another Idaho author, Carrie Stuart Parks ("A Cry from the Dust") reports that publishers have strict boundaries on Christian writing: "No profanity, no sex, but you may kill as many people as you like." I hadn't crystallized it so concisely myself, but realized that's exactly the kind of block I have met in my own writing. Secular publishers reject my work for not being lurid enough to hold the reader; Christian publishers red-pencil some of my best lines. I respect God's name; I even omit the thoughtless abbreviation of surprise, OMG. But when ordinary people are insulted, assaulted, or otherwise given cause to express anger or distress, they often employ language that might not be appropriate in Sunday school, and it is unrealistic to portray them otherwise.
When searching for like-minded writers, there is, of course C. S. Lewis, whose "Out of the Silent Planet" trilogy, his "Screwtape Letters", and "The Great Divorce", among others, are classics far beyond my amateur talents. There is also Kimberla Lawson Roby, whose well-written novels about an immoral clergyman, she describes as faith based, but which I found overly explicit (in the one I read.)
I have tried to solve this conundrum by writing the way I hear the English language being used. If the result has social or ethical merit I will still offer my work to Christian bookstores, successfully in some cases. But I may loan a review copy for them to read first. ("But if you spill coffee on it, you've bought it.") I respect the manager who doesn't think it will be accepted by her clients, but some will see the story as a worthwhile contribution to understanding the world's conflicts.
There are other values besides financial.
Tuesday, August 12, 2014
Medicine and Faith
Every now and then, the newspapers report a child with some dire disease―leukemia or diabetes perhaps―whose parents refuse medical treatment, saying they will depend on God alone to heal the child.
If these same parents were caught with their child in the middle of a raging flood, or some other natural disaster, I think that in most cases they would not hesitate to accept rescue by boat or helicopter, acknowledging that God sometimes sends help by way of such things in this world. It puzzles me why they might think that medicine is less a part of God's created world than a helicopter is. Maybe it's the way they perceive the offer, perhaps with a requirement for cash in advance, or offered with arrogance; or because someone they heard of died anyway. Be that as it may, there is a need for both faith and medicine in medical crises.
To take diabetes as an example, one feature of this disease is a lack of insulin, a natural body product, which the body needs to regulate the way it uses food for energy. Damage to the insulin-producing cells in the body results in diabetes, and if not treated can cause death. Giving daily doses of insulin allows the person to continue to live. It’s not wise to treat a child’s diabetes with prayer alone, when she urgently needs insulin to survive.
Many cases of diabetes in adults, however, are caused by an unhealthy life style which “wears out” the insulin-producing cells. In early cases, simply modifying one's food intake and life style can restore health. But the person may find it very difficult to change life-long habits. Even though he understands what he must do, he finds he hasn’t enough willpower to maintain the change. I have seen prayer and faith make that change possible in some cases.
Faith in what or whom? Some advise self-reliance— “I am the master of my fate; I am the captain of my soul.” Others depend upon another person, a spouse perhaps, or a work partner, or a doctor or counselor. Some trust in following the rules set down by their particular religious group. Some others hope to be lucky.
This is a touchy subject. In matters of faith, those who claim to have all the answers often feel threatened and insecure if anyone argues against their particular interpretation. Many other people, more secure in their own faith, may suspect the person with “all the answers” has not yet addressed all the questions.
As Benjamin Franklin put it: “[Most suppose themselves] in possession of all truth, and those who differ are so far in the wrong. Like a man traveling in foggy weather, those at some distance before him on the road he sees wrapped up in the fog, as well as those behind him, and the people in the fields on each side. But near him all appears clear, tho’ in truth he is as much in the fog as any of them.”
I freely admit being a follower of Jesus, even though an imperfect one. I believe in a Creator God who takes benevolent interest in each of us and who has a plan for our lives if we, in our freedom of choice, choose to trust God. That’s my basic life view.
Some people reject this, blaming God for making the world the way it is and causing so much suffering. But before we cast blame, it makes sense to do everything possible to correct the wrongs we ourselves (or others) have caused or could have prevented. Among these causes that might be remedied I see infection, injury, ignorance, greed, demand for vengeance, and misguided desires or life-styles, to name a few.
There are some events, such as volcanic eruption, or earthquakes, over which we have little control. Perhaps God allows such misfortunes as a test of our faith, or to teach us how to help each other, or to teach nations how to get their priorities straight. That’s only a perhaps. I don't claim to know the answer.
Whether dealing with disease or disaster, it makes sense to use the facts of science as far as they can be applied. But there is a point beyond which intellect alone is not enough to fight mass murder or indifference, once we cease to acknowledge God.
If God exists and created the world, as Christians suppose, God is not a genie in a bottle. We do not bargain with God, or order God around. If this world is God’s creation, we can choose to accept it and seek to learn how best to live in it, or we can choose to be angry about it and raise our blood pressure to unhealthy levels. Rather than complain or panic when confronted with crisis, I often find it useful to ask for God’s help.
Some quite intelligent people believe that what I call answers to prayer are no more than coincidence. Perhaps so. My father used to remark that when people pray, coincidences happen more often. I tend to agree with him. I have seen many separate instances where something was accomplished by several people happening to be in “the right place at the right time.” To always ascribe such results to blind chance appears unlikely, considering the odds. There is a lot we don’t comprehend about God and the universe. But to state that the world depends on random chance is merely another way of saying that we don’t yet completely understand how order comes out of chaos.
How then is faith relevant? To me, it's the infrastructure of life. It is the fiber, the substance of what we call integrity, dependability, honesty, character. Without it, life and direction begin to wobble, become indecisive, or even collapse.
It is not faith’s function to abolish all trouble, but to deal with it effectively, whether by prayer or the scientific methods God provides through his servants.
“There is no narrowing so deadly as the narrowing of a man’s hunger for spiritual things. No worse evil could befall him in his course on earth than to lose sight of Heaven. And it is not civilization that can prevent this; it is not civilization that can compensate for it. No widening of science, no possession of abstract truths can indemnify for an enfeebled hold on the highest and central truths of humanity.
“What shall a man give in exchange for his soul?”
(Inscribed at Stanford University Chapel, Palo Alto, California)
If these same parents were caught with their child in the middle of a raging flood, or some other natural disaster, I think that in most cases they would not hesitate to accept rescue by boat or helicopter, acknowledging that God sometimes sends help by way of such things in this world. It puzzles me why they might think that medicine is less a part of God's created world than a helicopter is. Maybe it's the way they perceive the offer, perhaps with a requirement for cash in advance, or offered with arrogance; or because someone they heard of died anyway. Be that as it may, there is a need for both faith and medicine in medical crises.
To take diabetes as an example, one feature of this disease is a lack of insulin, a natural body product, which the body needs to regulate the way it uses food for energy. Damage to the insulin-producing cells in the body results in diabetes, and if not treated can cause death. Giving daily doses of insulin allows the person to continue to live. It’s not wise to treat a child’s diabetes with prayer alone, when she urgently needs insulin to survive.
Many cases of diabetes in adults, however, are caused by an unhealthy life style which “wears out” the insulin-producing cells. In early cases, simply modifying one's food intake and life style can restore health. But the person may find it very difficult to change life-long habits. Even though he understands what he must do, he finds he hasn’t enough willpower to maintain the change. I have seen prayer and faith make that change possible in some cases.
Faith in what or whom? Some advise self-reliance— “I am the master of my fate; I am the captain of my soul.” Others depend upon another person, a spouse perhaps, or a work partner, or a doctor or counselor. Some trust in following the rules set down by their particular religious group. Some others hope to be lucky.
This is a touchy subject. In matters of faith, those who claim to have all the answers often feel threatened and insecure if anyone argues against their particular interpretation. Many other people, more secure in their own faith, may suspect the person with “all the answers” has not yet addressed all the questions.
As Benjamin Franklin put it: “[Most suppose themselves] in possession of all truth, and those who differ are so far in the wrong. Like a man traveling in foggy weather, those at some distance before him on the road he sees wrapped up in the fog, as well as those behind him, and the people in the fields on each side. But near him all appears clear, tho’ in truth he is as much in the fog as any of them.”
I freely admit being a follower of Jesus, even though an imperfect one. I believe in a Creator God who takes benevolent interest in each of us and who has a plan for our lives if we, in our freedom of choice, choose to trust God. That’s my basic life view.
Some people reject this, blaming God for making the world the way it is and causing so much suffering. But before we cast blame, it makes sense to do everything possible to correct the wrongs we ourselves (or others) have caused or could have prevented. Among these causes that might be remedied I see infection, injury, ignorance, greed, demand for vengeance, and misguided desires or life-styles, to name a few.
There are some events, such as volcanic eruption, or earthquakes, over which we have little control. Perhaps God allows such misfortunes as a test of our faith, or to teach us how to help each other, or to teach nations how to get their priorities straight. That’s only a perhaps. I don't claim to know the answer.
Whether dealing with disease or disaster, it makes sense to use the facts of science as far as they can be applied. But there is a point beyond which intellect alone is not enough to fight mass murder or indifference, once we cease to acknowledge God.
If God exists and created the world, as Christians suppose, God is not a genie in a bottle. We do not bargain with God, or order God around. If this world is God’s creation, we can choose to accept it and seek to learn how best to live in it, or we can choose to be angry about it and raise our blood pressure to unhealthy levels. Rather than complain or panic when confronted with crisis, I often find it useful to ask for God’s help.
Some quite intelligent people believe that what I call answers to prayer are no more than coincidence. Perhaps so. My father used to remark that when people pray, coincidences happen more often. I tend to agree with him. I have seen many separate instances where something was accomplished by several people happening to be in “the right place at the right time.” To always ascribe such results to blind chance appears unlikely, considering the odds. There is a lot we don’t comprehend about God and the universe. But to state that the world depends on random chance is merely another way of saying that we don’t yet completely understand how order comes out of chaos.
How then is faith relevant? To me, it's the infrastructure of life. It is the fiber, the substance of what we call integrity, dependability, honesty, character. Without it, life and direction begin to wobble, become indecisive, or even collapse.
It is not faith’s function to abolish all trouble, but to deal with it effectively, whether by prayer or the scientific methods God provides through his servants.
“There is no narrowing so deadly as the narrowing of a man’s hunger for spiritual things. No worse evil could befall him in his course on earth than to lose sight of Heaven. And it is not civilization that can prevent this; it is not civilization that can compensate for it. No widening of science, no possession of abstract truths can indemnify for an enfeebled hold on the highest and central truths of humanity.
“What shall a man give in exchange for his soul?”
(Inscribed at Stanford University Chapel, Palo Alto, California)
Friday, August 8, 2014
Pacifism and War
I was a registered conscientious objector during the Korean war, just finishing my medical residency. I sincerely believed that all war is wrong. Since then, I have spent a lot of my life dealing with the human wreckage the insurgents and armies have left behind.
I worked as a doctor during the Shan rebellion in 1961-62, when the Burma army controlled the countryside in the daytime, and the insurgents did at night. I learned that the insurgents had confiscated all the villagers' guns, and even their dogs, until people were defenseless. Insurgents came for a neighbor in the night time, and told him that if he came quietly, they would not kill his family, and then they slit his throat.
My wife and I were medical first responders in Thailand in 1979, when half a million Cambodian refugees poured across the border to escape the advancing Vietnamese army. In Sa Kaew camp alone, we were part of a 1,000-bed hospital for some thirty thousand people, and that was only one of several such camps. Many died before reaching the camps. All because one communist government was fighting another communist government over doctrinal disputes.
In the early 2000s we saw Burmese refugees fleeing into Thailand, to escape persecution by their own army.
There are wars in Libya, in Nigeria, Congo,Iraq, Afghanistan, Syria, Ukraine, Gaza, and now a Muslim radical sect intent on killing all who won't convert to their viewpoint. Hard to understand. Harder, even, than understanding greed for oil profits, or for cocaine, or for increasing weapons exports. But how do you stop indiscriminate violence, without becoming violent too? Sometimes it appears that war is the lesser of two evils. But what ever became of common sense?
I worked as a doctor during the Shan rebellion in 1961-62, when the Burma army controlled the countryside in the daytime, and the insurgents did at night. I learned that the insurgents had confiscated all the villagers' guns, and even their dogs, until people were defenseless. Insurgents came for a neighbor in the night time, and told him that if he came quietly, they would not kill his family, and then they slit his throat.
My wife and I were medical first responders in Thailand in 1979, when half a million Cambodian refugees poured across the border to escape the advancing Vietnamese army. In Sa Kaew camp alone, we were part of a 1,000-bed hospital for some thirty thousand people, and that was only one of several such camps. Many died before reaching the camps. All because one communist government was fighting another communist government over doctrinal disputes.
In the early 2000s we saw Burmese refugees fleeing into Thailand, to escape persecution by their own army.
There are wars in Libya, in Nigeria, Congo,Iraq, Afghanistan, Syria, Ukraine, Gaza, and now a Muslim radical sect intent on killing all who won't convert to their viewpoint. Hard to understand. Harder, even, than understanding greed for oil profits, or for cocaine, or for increasing weapons exports. But how do you stop indiscriminate violence, without becoming violent too? Sometimes it appears that war is the lesser of two evils. But what ever became of common sense?
Tuesday, August 5, 2014
Ten-Year flashback in Flame Tree
They had been visiting on the Burma border, a half-day's trek from their hospital. A birthday party for the village headman's daughter, the invitation had said. Actually, it was a dedication ceremony for a new refugee village, but the Thai Border Police could not have looked the other way for that. George had been out walking with a village guide in the early morning when the top general of the whole Karen Insurgent army, Bo Mya, had appeared on the path ahead.
The supreme commander was a man about his own age of fifty-seven, heavily built, mustache curving down around his mouth. He wore a brown leather jacket and appeared out for a stroll except for the hunting rifle under his arm. His only companion wore forest camouflage, carried an automatic weapon and a backpack sprouting a radio antenna. When George glanced back at the village, he saw armed men poised silently at several points where no one had been moments before.
He had thought at first that the war in Burma was spilling over into Thailand, but as it turned out, the general had received an invitation to the village ceremony too.
At the feast in the village hall later that day, the general's adjutant had sat down at George and Vienna's table. "The general regrets that he does not speak English or Thai," the officer explained. "He wishes me to tell you that his rear guard will arrive soon, escorting a group of Burmese refugee students seeking asylum in Thailand." He looked out at the door where two soldiers stood at ease, rifles slung over right shoulder. "Some need medical attention, and he asks if you would have a look at them. The village clinic will be at your disposal, of course."
George poured more strong tea from the battered pot on the table. He looked up again. "Students. From Rangoon?"
"Exactly. The Burmese arrested them in the student uprisings and have been using them to carry army supplies." The officer cleared his throat modestly. "We, ah, distracted the Burmese unit in a skirmish last week, long enough for them to escape. Our intelligence staff has debriefed them and they appear to be genuine refugees."
"Of course I'll give them any medical treatment I can, Major, for as long as I'm here." George thought it good to raise a point of diplomacy. "To be frank. I'm not really certain what my relationship to the Karen army should be. I used to work in Burma a long time ago. But as a guest in Thailand, I should stay neutral if possible."
"I'm sure we have no problem with that, Doctor," the major said, "although I think you may discover the Burmese government different from what you remember, even hostile to outsiders now. Our people have been happy to have you nearby this few months. Colonel Bridgestone's wife was especially pleased with her gall bladder surgery"
George had only removed one gall bladder during his time in Thailand, and the patient had appeared to be a hill farmer's wife. Apparently nothing could be taken at face value out here. But it might explain the invitation to the birthday party.
As the major rose to return to his own table, George saw a stir at the door where two small grubby boys were shouting something to friends inside. An eager exodus of children and a few adults went to watch more soldiers passing by. The village headman leaned over from the next table. "This is the rear guard arriving," he said. I will show you to the dispensary." George and Vienna retrieved their sandals from the clutter of footwear outside the meeting hall and followed the headman to the dirt road that served as village main street.
The small boys from the meeting hall were strutting alongside a military drum corps passing down the street, bamboo fifes piping, drummers beating a tattoo on homemade drums of horse-hide.
Lagging behind the marching troops, a small procession had turned aside to limp up the path to the village clinic. Their gaunt exhaustion and ragged clothing contrasted with the clnic's small garden. Eight refugees in all, two of them carried piggyback by soldiers, another on crutches. Two soldiers carried yet another in a hammock litter slung on a stout bamboo pole. George surveyed the four sickest, laid on the treatment room floor.
One of the refugees identified herself as a senior medical student from Mandalay University, Ma Pyone Hla. She was a small slender Burman woman of twenty something. A scar creased her right cheek; Her English came out of a textbook, but the village midwife helped translate.
"What about the unconscious one?"
"He became sick two days ago with fever and headache, Doctor. I think, perhaps, malaria?"
"Any cough or diarrhea?" George knelt and checked the man's neck for stiffness.
"None."
He looked in the man's eyes and throat, listened to his chest. He probed the abdomen. Skin hot, spleen enlarged; probably the student's diagnosis was right. The little clinic had no lab equipment to confirm it, but malaria was common in these hills. "Let's get an intravenous line in, with a quinine drip." He looked up from the comatose man's side. "If it's cerebral malaria, he'll need I.V. glucose too. Vienna, see what's in the supply room, please."
Now what about these other three?" He indicated the next one in the row. "What's wrong?"
"He says his legs have no strength," the medical student answered.
"What did the Burmese feed you people?" He checked the man's emaciated legs.
"Rice, doctor. Sometimes with a few pieces of gourd sliced into it. They didn't have much food themselves, especially when their platoon was on the move." She lowered her head. "There were twelve of us at the beginning," she said in a small voice. "Two were beaten and left by the side of the trail to die when they couldn't carry their loads. Another died from an infected foot. And one was killed when he stepped on a land mine. My friend with crutches was hurt in the explosion."
"Doesn't the Burma army have minesweepers?" George's voice was soft.
"They used us as minesweepers. They made us walk in front of them."
"Well, let's look at them." He squatted by the young man with the crutches, whose pain was obvious. "Behma natheleh?" (Where do you hurt?) Obligingly, the student bared his right hip. A large swollen red area surrounded a small wound. George felt it carefully, noting the signs of an abscess under the skin. "Has he had any antibiotics?"
"The Karens gave him two sulfa tablets three days ago."
Not nearly enough, George thought, but maybe that's all they had. "Explain to him, please, that I must let the pus out so that the wound can heal." The young man took this information stoically, watching George do the minor surgery with local anesthesia and a scalpel blade, releasing greenish pus to flow into a small basin. He winced only once as George packed the wound open to drain and applied a bandage.
The major looked in at the door. "I think these other two have beriberi," George told him. "Starving people haven't enough vitamin B, and their muscles get weaker when they are fed." He stood up. "The clinic has medicine they can use."
"I think they probably did set us up that day," George said now, as he poured more coffee, but I'm glad we were there. I remember that young medical student from Mandalay, Pyone Hla. She looked completely worn out when she entered the village, but somewhere she had found a flower to put in her hair."
"She said there were twelve of them," Vienna said, "Four had died, and Pyone Hla didn't even want to remember how many times she had been raped. I wonder what's become of them."
"So, what do you think/" George asked. "If we go teach village health in Burma, we can leave all this hassle behind for a month or two. But will that just strengthen the dictatorship in Burma - Myanmar as they call it now - or will we be helping the hill tribes reach peace?'
"It used to be such a beautiful, prosperous country. If we can help it bloom again, let's go."
"Or I could go, and leave you with the grandchildren in Seattle, George said, "Burma may be opening to tourists but I don't like to take you where things could turn dangerous."
"I'll see the grandchildren and Burma, thank you. And before we come home we can stop off and work at the mission hospital in Mae Hong Son again. That way, we can give Jerry and Wilma Judson a month off, and I'll get to shop in Thailand."
"Got it all figured out, have you" George tipped his chair backward, balancing.
"I always have it figured out," Vienna purred.
The supreme commander was a man about his own age of fifty-seven, heavily built, mustache curving down around his mouth. He wore a brown leather jacket and appeared out for a stroll except for the hunting rifle under his arm. His only companion wore forest camouflage, carried an automatic weapon and a backpack sprouting a radio antenna. When George glanced back at the village, he saw armed men poised silently at several points where no one had been moments before.
He had thought at first that the war in Burma was spilling over into Thailand, but as it turned out, the general had received an invitation to the village ceremony too.
At the feast in the village hall later that day, the general's adjutant had sat down at George and Vienna's table. "The general regrets that he does not speak English or Thai," the officer explained. "He wishes me to tell you that his rear guard will arrive soon, escorting a group of Burmese refugee students seeking asylum in Thailand." He looked out at the door where two soldiers stood at ease, rifles slung over right shoulder. "Some need medical attention, and he asks if you would have a look at them. The village clinic will be at your disposal, of course."
George poured more strong tea from the battered pot on the table. He looked up again. "Students. From Rangoon?"
"Exactly. The Burmese arrested them in the student uprisings and have been using them to carry army supplies." The officer cleared his throat modestly. "We, ah, distracted the Burmese unit in a skirmish last week, long enough for them to escape. Our intelligence staff has debriefed them and they appear to be genuine refugees."
"Of course I'll give them any medical treatment I can, Major, for as long as I'm here." George thought it good to raise a point of diplomacy. "To be frank. I'm not really certain what my relationship to the Karen army should be. I used to work in Burma a long time ago. But as a guest in Thailand, I should stay neutral if possible."
"I'm sure we have no problem with that, Doctor," the major said, "although I think you may discover the Burmese government different from what you remember, even hostile to outsiders now. Our people have been happy to have you nearby this few months. Colonel Bridgestone's wife was especially pleased with her gall bladder surgery"
George had only removed one gall bladder during his time in Thailand, and the patient had appeared to be a hill farmer's wife. Apparently nothing could be taken at face value out here. But it might explain the invitation to the birthday party.
As the major rose to return to his own table, George saw a stir at the door where two small grubby boys were shouting something to friends inside. An eager exodus of children and a few adults went to watch more soldiers passing by. The village headman leaned over from the next table. "This is the rear guard arriving," he said. I will show you to the dispensary." George and Vienna retrieved their sandals from the clutter of footwear outside the meeting hall and followed the headman to the dirt road that served as village main street.
The small boys from the meeting hall were strutting alongside a military drum corps passing down the street, bamboo fifes piping, drummers beating a tattoo on homemade drums of horse-hide.
Lagging behind the marching troops, a small procession had turned aside to limp up the path to the village clinic. Their gaunt exhaustion and ragged clothing contrasted with the clnic's small garden. Eight refugees in all, two of them carried piggyback by soldiers, another on crutches. Two soldiers carried yet another in a hammock litter slung on a stout bamboo pole. George surveyed the four sickest, laid on the treatment room floor.
One of the refugees identified herself as a senior medical student from Mandalay University, Ma Pyone Hla. She was a small slender Burman woman of twenty something. A scar creased her right cheek; Her English came out of a textbook, but the village midwife helped translate.
"What about the unconscious one?"
"He became sick two days ago with fever and headache, Doctor. I think, perhaps, malaria?"
"Any cough or diarrhea?" George knelt and checked the man's neck for stiffness.
"None."
He looked in the man's eyes and throat, listened to his chest. He probed the abdomen. Skin hot, spleen enlarged; probably the student's diagnosis was right. The little clinic had no lab equipment to confirm it, but malaria was common in these hills. "Let's get an intravenous line in, with a quinine drip." He looked up from the comatose man's side. "If it's cerebral malaria, he'll need I.V. glucose too. Vienna, see what's in the supply room, please."
Now what about these other three?" He indicated the next one in the row. "What's wrong?"
"He says his legs have no strength," the medical student answered.
"What did the Burmese feed you people?" He checked the man's emaciated legs.
"Rice, doctor. Sometimes with a few pieces of gourd sliced into it. They didn't have much food themselves, especially when their platoon was on the move." She lowered her head. "There were twelve of us at the beginning," she said in a small voice. "Two were beaten and left by the side of the trail to die when they couldn't carry their loads. Another died from an infected foot. And one was killed when he stepped on a land mine. My friend with crutches was hurt in the explosion."
"Doesn't the Burma army have minesweepers?" George's voice was soft.
"They used us as minesweepers. They made us walk in front of them."
"Well, let's look at them." He squatted by the young man with the crutches, whose pain was obvious. "Behma natheleh?" (Where do you hurt?) Obligingly, the student bared his right hip. A large swollen red area surrounded a small wound. George felt it carefully, noting the signs of an abscess under the skin. "Has he had any antibiotics?"
"The Karens gave him two sulfa tablets three days ago."
Not nearly enough, George thought, but maybe that's all they had. "Explain to him, please, that I must let the pus out so that the wound can heal." The young man took this information stoically, watching George do the minor surgery with local anesthesia and a scalpel blade, releasing greenish pus to flow into a small basin. He winced only once as George packed the wound open to drain and applied a bandage.
The major looked in at the door. "I think these other two have beriberi," George told him. "Starving people haven't enough vitamin B, and their muscles get weaker when they are fed." He stood up. "The clinic has medicine they can use."
"I think they probably did set us up that day," George said now, as he poured more coffee, but I'm glad we were there. I remember that young medical student from Mandalay, Pyone Hla. She looked completely worn out when she entered the village, but somewhere she had found a flower to put in her hair."
"She said there were twelve of them," Vienna said, "Four had died, and Pyone Hla didn't even want to remember how many times she had been raped. I wonder what's become of them."
"So, what do you think/" George asked. "If we go teach village health in Burma, we can leave all this hassle behind for a month or two. But will that just strengthen the dictatorship in Burma - Myanmar as they call it now - or will we be helping the hill tribes reach peace?'
"It used to be such a beautiful, prosperous country. If we can help it bloom again, let's go."
"Or I could go, and leave you with the grandchildren in Seattle, George said, "Burma may be opening to tourists but I don't like to take you where things could turn dangerous."
"I'll see the grandchildren and Burma, thank you. And before we come home we can stop off and work at the mission hospital in Mae Hong Son again. That way, we can give Jerry and Wilma Judson a month off, and I'll get to shop in Thailand."
"Got it all figured out, have you" George tipped his chair backward, balancing.
"I always have it figured out," Vienna purred.
Wednesday, July 30, 2014
Humans Are Never Just "Collateral Damage".
Trudy Rubin's July 29th editorial in the Spokesman-Review highlights what Americans and many others often fail to do - to see imperiled people as humanity. They are not "others". Not "news items". Not "collateral damage".
All of us sometimes try to escape responsibility by putting the blame elsewhere, on someone "different" from us. Nowhere is this more obvious than in the present Gazan/Israeli conflict.
It's been sixteen years since I visited Israel, but I can identify with Ms. Rubin's observation that Gazans [and Palestinians living in Israel] are rarely seen as individuals. Rather, they are seen as opponents. Never mind that Israelis build new housing developments in West Bank territory, or blockade Gaza, or bomb Gazan neighborhoods. Hamas, in turn, fires rockets indiscriminately at Israel, and vows to eliminate Israel's existence.
Too many of us support the right to "get even". We idealize freedom, and justly so. But there is a difference between "freedom from" and "freedom to". Both have their place in civilization, but only when our own rights do not exclude the rights of others.
Military force alone is producing no result but mayhem.
Tuesday, July 29, 2014
CLICKETY-CLACK
There are times when I want to get totally away from every-day life and work, to think, or maybe dream, or learn something new. I suppose I could do this on the hillside above my house on a summer Saturday afternoon. But one of my favorite places to be alone is the railroad track outside Sandpoint, Idaho, on a hot summer day.
This isn't just any railroad track. This is THE main line of the Burlington-Northern Santa Fe transcontinental route, the place where the tracks divide. The left-hand track carries trains across northern Montana to St. Paul and Chicago. The right hand track leads them instead to Missoula, Helena, and the cities of the southern half of Montana. And in between the two main tracks is an old rusty siding, no longer used, ending abruptly at a pile of old railroad ties. I can sit there on the ties and smell the hot tar in the sunshine, listen to the whirring grasshoppers, see a hawk wheel slowly overhead. And watch the trains go by. I could sit there all day, if I hadn't promised my wife I'd take her to lunch.
One summer day, I wandered a little farther up the track, idly picking up pieces of scrap iron, rusty railroad spikes and the like and depositing them in neat little piles. When I returned, two men had taken my place at the dividing of the tracks. Seen from a distance, they wore hats that glittered, and they were doing something with fire. After watching them from afar, I reasoned that they were probably not sabotaging the rails at ten in the morning, and I strolled up closer.
The gleaming hats proved to be welder's shields pushed up on their foreheads, and they were merely a couple of bearded railroad repairmen surrounded by tools from a pickup truck parked on the road beside the track. We exchanged howdys. They spotted my notepad tucked in my belt, and asked if I was writing a book. I dismissed that idea with a small laugh, leaving me free to ask what they were doing.
"We take the clickety-clack out of the track," the older of the two told me. The mainline rails are an unending ribbon, free of the joints that used to give background noise to every train trip. I asked why the hot sun didn't cause such a long piece of steel to expand in the heat and bend out of shape. Even quarter-mile-long bridges need room to expand in the heat. I didn't understand his whole answer, but he said it is only an occasional problem. Like now, at this point. The inspection truck—a pickup that rides the rails on iron wheels—had recently been by, and had found a bump at this place as it passed, plus a couple more farther toward Bonners Ferry that they would presently go fix. He showed me a half-inch thick cross section of rail which he and his partner had surgically removed from the track with a large circular emery saw. They had then jury-rigged a small brick crucible around the gap, melted some of the track-side scrap metal with a welder's rig and re-welded the track together, polishing their weld smooth with all the care a dentist might spend on a front tooth filling. These two men were responsible for such repairs from Sandpoint all the way to Libby, Montana, an 85-mile long stretch.
These new methods of railroading fascinate me. After they left, I compared their work with the old unused spur, with rails bolted together every twenty or thirty feet. A date stamped into the rusty side of the rail on the spur said 1920. I moved back to where the main switch determines which route each train will take for the next thousand miles. There is no switchman there anymore. A computer in some city far way, activates the heavy-duty electric motor that moves the rails, and changes the overhead signal lights from red to green. In winter, an automatic propane-fired blower melts any ice that might clog the switch-points. I am told that the bits of scrap-iron I idly put in little piles next to the track might just as well have been left alone—a work train with a large magnet periodically comes along and recovers most of them.
But the job I have always dreamed about—the locomotive engineer—is still filled by a human being. A train is coming now; it had stopped down at Sandpoint station until the signal turned green. Its four diesel engine units throb mightily as it slowly accelerates its l06-car, mile-long load, the triangular pattern of the three headlights visible a mile away, The brilliantly painted orange-and-yellow engines with their Santa Fe logo are moving at thirty miles an hour by the time they reach me.
As he passes, the engineer, high in the cab, waves to me.
And the little boy inside me waves back.
This isn't just any railroad track. This is THE main line of the Burlington-Northern Santa Fe transcontinental route, the place where the tracks divide. The left-hand track carries trains across northern Montana to St. Paul and Chicago. The right hand track leads them instead to Missoula, Helena, and the cities of the southern half of Montana. And in between the two main tracks is an old rusty siding, no longer used, ending abruptly at a pile of old railroad ties. I can sit there on the ties and smell the hot tar in the sunshine, listen to the whirring grasshoppers, see a hawk wheel slowly overhead. And watch the trains go by. I could sit there all day, if I hadn't promised my wife I'd take her to lunch.
One summer day, I wandered a little farther up the track, idly picking up pieces of scrap iron, rusty railroad spikes and the like and depositing them in neat little piles. When I returned, two men had taken my place at the dividing of the tracks. Seen from a distance, they wore hats that glittered, and they were doing something with fire. After watching them from afar, I reasoned that they were probably not sabotaging the rails at ten in the morning, and I strolled up closer.
The gleaming hats proved to be welder's shields pushed up on their foreheads, and they were merely a couple of bearded railroad repairmen surrounded by tools from a pickup truck parked on the road beside the track. We exchanged howdys. They spotted my notepad tucked in my belt, and asked if I was writing a book. I dismissed that idea with a small laugh, leaving me free to ask what they were doing.
"We take the clickety-clack out of the track," the older of the two told me. The mainline rails are an unending ribbon, free of the joints that used to give background noise to every train trip. I asked why the hot sun didn't cause such a long piece of steel to expand in the heat and bend out of shape. Even quarter-mile-long bridges need room to expand in the heat. I didn't understand his whole answer, but he said it is only an occasional problem. Like now, at this point. The inspection truck—a pickup that rides the rails on iron wheels—had recently been by, and had found a bump at this place as it passed, plus a couple more farther toward Bonners Ferry that they would presently go fix. He showed me a half-inch thick cross section of rail which he and his partner had surgically removed from the track with a large circular emery saw. They had then jury-rigged a small brick crucible around the gap, melted some of the track-side scrap metal with a welder's rig and re-welded the track together, polishing their weld smooth with all the care a dentist might spend on a front tooth filling. These two men were responsible for such repairs from Sandpoint all the way to Libby, Montana, an 85-mile long stretch.
These new methods of railroading fascinate me. After they left, I compared their work with the old unused spur, with rails bolted together every twenty or thirty feet. A date stamped into the rusty side of the rail on the spur said 1920. I moved back to where the main switch determines which route each train will take for the next thousand miles. There is no switchman there anymore. A computer in some city far way, activates the heavy-duty electric motor that moves the rails, and changes the overhead signal lights from red to green. In winter, an automatic propane-fired blower melts any ice that might clog the switch-points. I am told that the bits of scrap-iron I idly put in little piles next to the track might just as well have been left alone—a work train with a large magnet periodically comes along and recovers most of them.
But the job I have always dreamed about—the locomotive engineer—is still filled by a human being. A train is coming now; it had stopped down at Sandpoint station until the signal turned green. Its four diesel engine units throb mightily as it slowly accelerates its l06-car, mile-long load, the triangular pattern of the three headlights visible a mile away, The brilliantly painted orange-and-yellow engines with their Santa Fe logo are moving at thirty miles an hour by the time they reach me.
As he passes, the engineer, high in the cab, waves to me.
And the little boy inside me waves back.
Friday, July 18, 2014
Consistent with Ebola
Mountain peaks twelve hundred meters high brood darkly over the forests and valleys of the Thai-Burma border. On the Thai side, a single paved road snakes northwestward from Kanchanaburi 210 kilometers to the small town of Sangklaburi. It then goes up over Three Pagodas Pass and on into Burma, following the route of the old Japanese “Death Railway.” It is often said that, in World War II, one prisoner of war died for each railroad tie laid down on that temporary, war-time rail link with Burma.
Nowadays, death comes from the forest itself in the form of falciparum malaria, scrub typhus, rat bite fever, and a host of other fevers still unidentified. They are borne in the undernourished bodies of thousands of refugees fleeing the military dictatorship that has held Burma in its grip for forty-six years. The diseases funnel through the refugee camps along the border, where lone doctors provide rustic medical care in thatch-roofed bamboo buildings, funded by such groups as Doctors Without Borders or the Refugee Consortium.
Other than these small outposts, the first line of medical defense is ten kilometers inside Thailand at the small community of Huay Malai, twenty km west of Sangklaburi town. Kwai River Christian Hospital is a twenty-five-bed facility with a couple of doctors and nine Thai nurses, run cooperatively by the Thai Baptist Missionary Fellowship and the Armed Forces Research Institute of Medical Science (AFRIMS), which in turn is a joint project of the Thai and U.S. military. Here AFRIMS maintains a research laboratory to identify the causes of fever in that part of the world. Most of the years I visited there, Dr. Phil McDaniel ran the clinical wards, assisted by a constant trickle of visiting doctors, medical students and the AFRIMS laboratory staff.
I was substitute doctor in Phil’s absence when, one Friday at 5:20 p.m., a child arrived from the refugee camp at Holokani. Carried in his mother’s arms, four-year-old Hon Side was feverish and convulsing. His feet were dark splotchy red from bleeding under the skin. He had an intravenous line in one arm and a letter from the refugee camp doctor, stating he had treated him for two days with quinine, ampicillin, and gentamycin, and was now referring him as a possible case of meningococcic meningitis
.
Two nurses quickly controlled the child’s seizures with an injection of diazepam and established a second IV line, while our current medical student (Pia Sannaraj, a Thai-American from San Diego) and I examined him. Neck a little stiff, a few rattles in his chest, and the ominous dark-red patches. He certainly might have meningitis, and while we waited for the lab’s first blood report we injected artesunate, an anti-malarial drug safer and more effective than the quinine he had received at the camp. While a male nurse-aide held him, gently but firmly bowing the child’s back, I carefully inserted a needle into his back, drew off spinal fluid and sent it to the lab. An hour or so later, the lab reported a normal white blood cell count, no malaria, normal spinal fluid, but noted the presence of blood in his urine and a very low platelet count, one of the factors that helps blood to clot.
That changed our thinking to Thai hemorrhagic fever, where blood and fluid leak out of the vessels causing a rapid downward spiral into irreversible shock and death. The trouble with that was, having had it for two days before coming in, he should either be recovering or dead by now. Nevertheless, Pia and I pushed IV fluids as much as we dared, trying to keep his blood pressure up while not suffocating him from fluid overload. The AFRIMS staff is not there on weekends.
I am a firm believer in coincidences whenever they appear. Dr. McDaniel would be back from his medical conference the next day, but he had sent his new associate, Dr. Kathy Welch, on ahead to escort a visiting doctor from Congo, Dr. Dan Fountain.
Dan and I go a long way back together as teen-age acquaintances in central New York State, same vintage but different medical schools, after which he went to Africa and I to Asia. He went on ward rounds with Pia and me Saturday morning, when we noted that the little boy, Hon Side, was now vomiting blood, and had a platelet count of 29,000, a level low enough to induce panic in doctors. Moreover, the kid’s baby brother had died with the same symptoms—not six months ago, as the original story went, but just last week. His fever was now 103, his hands were turning red like his feet, and his chest X-ray suggested we had better back off on the IV fluid.
When rounds were over and Pia and I were ready to begin work in the crowded outpatient department, Dan took me quietly aside. “I don’t know much about your Thai hemorrhagic fever,” he said, “But there may be problems for your hospital with that little boy. That looks for all the world like the Ebola virus outbreak at Kikwit, near our hospital in Congo back in ’95. It was just a case now and then in the villages until it hit the hospital, and then it spread like wildfire. They soon had 300 cases and about 240 of them died, including many of the hospital staff. You’d better notify Center for Disease Control.”
CDC, in Atlanta, Georgia, maintains world-wide surveillance of dangerous infectious diseases. Ebola virus is one of the worst, with no effective treatment, no vaccine, and an eighty to ninety per cent mortality rate. It took me a few moments for it to sink in. “It’s Saturday now,” I hesitated, “probably the quickest way to get help is when Dr. Miller comes back to the AFRIMS lab Monday morning. He has the equipment and know-how for this. But I thought Ebola only happened in Africa?”
“Monday is too late. Get on the phone now. Pia tells me she has a number for Dr. Miller in Bangkok.”
“You really think this could show up this far from Africa?”
“Who knows how these things show up? Ebola turned up in Reston, Virginia, in the 90’s. The origin was traced back to the Philippines, and nobody knows how it got there.”
We moved Hon Side into an isolation room complete with gloves, gowns and masks, and a bucket of hypochlorite solution to soak everything in. The head nurse reached Dr. Miller and he sent a lab tech to take special blood samples and freeze them. If it is Ebola, the minority of cases who don’t die can take weeks to recover.
“It’s not contagious until you have fever and bleeding,” Dan told us. “Each of you who has had contact with the boy will need to take your temperature twice a day for the next two or three weeks. If you have no fever, you are home free. If you do get fever, take malaria medicine. If you still have fever, turn yourself in at a hospital wherever you are and tell them you may have contacted an Ebola patient. That will get CDC’s attention, I assure you.”
Phil McDaniel had no trouble believing the danger when he got back next day, but we had trouble with the nursing staff, who wore gloves and mask, but would not put on a new isolation gown each time they entered the room, until we agreed to have them check him every four hours instead of every two. And we caught a substitution of Dettol instead of the required hypochlorite disinfectant solution. Danger of one’s own death from a disease never before encountered is hard for anyone to grasp. Americans hadn’t experienced a deadly epidemic in eighty years.
At latest report (by e-mail after I left for America the next day), Hon Side’s platelets had dropped to 14,000, and areas on his hands and feet were turning black.
After I got home two days ago, I thought my fatigue and aching muscles were from jet-lag on the long trip home. But today my throat is sore; I have a fever of 102 and my head is beginning to ache. There is a bruise on my hand; I don’t remember hitting it against anything. But it’s hard to remember anything today; I feel lousy, and just want to crawl into bed and sleep. I wonder what the emergency room doc would say if I tell him I may have Ebola?
How many people here will catch whatever I’ve got?
Tomorrow’s newspaper should be interesting . . .
if I’m around to read it . . . .
(from "After I got home" and onward is fiction.) © Keith Dahlberg, MD
Nowadays, death comes from the forest itself in the form of falciparum malaria, scrub typhus, rat bite fever, and a host of other fevers still unidentified. They are borne in the undernourished bodies of thousands of refugees fleeing the military dictatorship that has held Burma in its grip for forty-six years. The diseases funnel through the refugee camps along the border, where lone doctors provide rustic medical care in thatch-roofed bamboo buildings, funded by such groups as Doctors Without Borders or the Refugee Consortium.
Other than these small outposts, the first line of medical defense is ten kilometers inside Thailand at the small community of Huay Malai, twenty km west of Sangklaburi town. Kwai River Christian Hospital is a twenty-five-bed facility with a couple of doctors and nine Thai nurses, run cooperatively by the Thai Baptist Missionary Fellowship and the Armed Forces Research Institute of Medical Science (AFRIMS), which in turn is a joint project of the Thai and U.S. military. Here AFRIMS maintains a research laboratory to identify the causes of fever in that part of the world. Most of the years I visited there, Dr. Phil McDaniel ran the clinical wards, assisted by a constant trickle of visiting doctors, medical students and the AFRIMS laboratory staff.
I was substitute doctor in Phil’s absence when, one Friday at 5:20 p.m., a child arrived from the refugee camp at Holokani. Carried in his mother’s arms, four-year-old Hon Side was feverish and convulsing. His feet were dark splotchy red from bleeding under the skin. He had an intravenous line in one arm and a letter from the refugee camp doctor, stating he had treated him for two days with quinine, ampicillin, and gentamycin, and was now referring him as a possible case of meningococcic meningitis
.
Two nurses quickly controlled the child’s seizures with an injection of diazepam and established a second IV line, while our current medical student (Pia Sannaraj, a Thai-American from San Diego) and I examined him. Neck a little stiff, a few rattles in his chest, and the ominous dark-red patches. He certainly might have meningitis, and while we waited for the lab’s first blood report we injected artesunate, an anti-malarial drug safer and more effective than the quinine he had received at the camp. While a male nurse-aide held him, gently but firmly bowing the child’s back, I carefully inserted a needle into his back, drew off spinal fluid and sent it to the lab. An hour or so later, the lab reported a normal white blood cell count, no malaria, normal spinal fluid, but noted the presence of blood in his urine and a very low platelet count, one of the factors that helps blood to clot.
That changed our thinking to Thai hemorrhagic fever, where blood and fluid leak out of the vessels causing a rapid downward spiral into irreversible shock and death. The trouble with that was, having had it for two days before coming in, he should either be recovering or dead by now. Nevertheless, Pia and I pushed IV fluids as much as we dared, trying to keep his blood pressure up while not suffocating him from fluid overload. The AFRIMS staff is not there on weekends.
I am a firm believer in coincidences whenever they appear. Dr. McDaniel would be back from his medical conference the next day, but he had sent his new associate, Dr. Kathy Welch, on ahead to escort a visiting doctor from Congo, Dr. Dan Fountain.
Dan and I go a long way back together as teen-age acquaintances in central New York State, same vintage but different medical schools, after which he went to Africa and I to Asia. He went on ward rounds with Pia and me Saturday morning, when we noted that the little boy, Hon Side, was now vomiting blood, and had a platelet count of 29,000, a level low enough to induce panic in doctors. Moreover, the kid’s baby brother had died with the same symptoms—not six months ago, as the original story went, but just last week. His fever was now 103, his hands were turning red like his feet, and his chest X-ray suggested we had better back off on the IV fluid.
When rounds were over and Pia and I were ready to begin work in the crowded outpatient department, Dan took me quietly aside. “I don’t know much about your Thai hemorrhagic fever,” he said, “But there may be problems for your hospital with that little boy. That looks for all the world like the Ebola virus outbreak at Kikwit, near our hospital in Congo back in ’95. It was just a case now and then in the villages until it hit the hospital, and then it spread like wildfire. They soon had 300 cases and about 240 of them died, including many of the hospital staff. You’d better notify Center for Disease Control.”
CDC, in Atlanta, Georgia, maintains world-wide surveillance of dangerous infectious diseases. Ebola virus is one of the worst, with no effective treatment, no vaccine, and an eighty to ninety per cent mortality rate. It took me a few moments for it to sink in. “It’s Saturday now,” I hesitated, “probably the quickest way to get help is when Dr. Miller comes back to the AFRIMS lab Monday morning. He has the equipment and know-how for this. But I thought Ebola only happened in Africa?”
“Monday is too late. Get on the phone now. Pia tells me she has a number for Dr. Miller in Bangkok.”
“You really think this could show up this far from Africa?”
“Who knows how these things show up? Ebola turned up in Reston, Virginia, in the 90’s. The origin was traced back to the Philippines, and nobody knows how it got there.”
We moved Hon Side into an isolation room complete with gloves, gowns and masks, and a bucket of hypochlorite solution to soak everything in. The head nurse reached Dr. Miller and he sent a lab tech to take special blood samples and freeze them. If it is Ebola, the minority of cases who don’t die can take weeks to recover.
“It’s not contagious until you have fever and bleeding,” Dan told us. “Each of you who has had contact with the boy will need to take your temperature twice a day for the next two or three weeks. If you have no fever, you are home free. If you do get fever, take malaria medicine. If you still have fever, turn yourself in at a hospital wherever you are and tell them you may have contacted an Ebola patient. That will get CDC’s attention, I assure you.”
Phil McDaniel had no trouble believing the danger when he got back next day, but we had trouble with the nursing staff, who wore gloves and mask, but would not put on a new isolation gown each time they entered the room, until we agreed to have them check him every four hours instead of every two. And we caught a substitution of Dettol instead of the required hypochlorite disinfectant solution. Danger of one’s own death from a disease never before encountered is hard for anyone to grasp. Americans hadn’t experienced a deadly epidemic in eighty years.
At latest report (by e-mail after I left for America the next day), Hon Side’s platelets had dropped to 14,000, and areas on his hands and feet were turning black.
After I got home two days ago, I thought my fatigue and aching muscles were from jet-lag on the long trip home. But today my throat is sore; I have a fever of 102 and my head is beginning to ache. There is a bruise on my hand; I don’t remember hitting it against anything. But it’s hard to remember anything today; I feel lousy, and just want to crawl into bed and sleep. I wonder what the emergency room doc would say if I tell him I may have Ebola?
How many people here will catch whatever I’ve got?
Tomorrow’s newspaper should be interesting . . .
if I’m around to read it . . . .
(from "After I got home" and onward is fiction.) © Keith Dahlberg, MD
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