Nanadadzie Ghansah – Page 2 – The Creative Space

Lamentations from the Womb

Mother, dearest mother,
Here I sit in your womb.
Mother, dearest mother,
Yet I wish it was my tomb.
He raped you that night,
And planted his seed.
I am a product of your plight,
Forever a sign of that deed.
Will I not forever be a marker,
Of how he destroyed your soul?
A memento of times darker,
That left you forever un-whole?
That’s why I’d rather not be born,
Into a life unloved, dark and torn.

Mother, dearest mother,
Here I sit in your womb,
And wish I would smother,
Than be born with fake aplomb.
You smoke, sniff and inject,
Poisons day and night.
You are but a reject,
The streets your only right.
What awaits me is an ordeal,
Of cold homes with no love.
A terrible fate with a tight seal,
One that fits like a glove.
That’s why I’d rather not be born,
Into a life unloved, dark and torn.

Mother, dearest mother,
Here I sit in your womb and wait,
Mother, dearest mother,
Do you feel the burden and weight?
Are you really ready,
Ready for me in your life?
Will your love be steady,
Or will I see only rancor and strife?
I sense the unwillingness,
Then you are just fourteen.
I feel the uncertainness,
I was totally unforeseen.
That’s why I’d rather not be born,
Into a life unloved, dark and torn.

Does anybody ever ask us,
Find out if we are so inclined?
We never get to discuss,
The lives into which we are assigned.
We often do not care for this world,
Full of so much strife and hate,
Into which we are hurled,
After that nine-month date.
If you say this life is a gift,
Why fill it with so much pain,
And set us in it adrift,
With no cover for the rain?
That’s why we’d rather not be born,
Into a life unloved, dark and torn.

©️Nana Dadzie Ghansah – May 20, 2019

Into Loneliness and Despondency

I made an observation growing up that has stayed with me till now. I noted how men who had worked their whole lives would go into retirement and suffer precipitous declines in health, that in some cases, led to death. I filed that away.
Working as a physician, I have also made another observation that somehow ties into the first. I have noticed that older patients, being those 70 and older, who were still in relatively good health and looked physically fit, had something in common. They were active. Not just physical activity but most of them still worked regularly. The most impressive are the old farmers.
These physically fit seniors always stand in stark contrast to their compatriots who were not active.

These observations and other anecdotes have always made me wonder about the wisdom behind retirement. Why do we retire?
We spend years keeping a schedule that keeps us regimented only to one day give that all up for one that may not be as controlled and full. Somehow, that dramatic change has effects that are profound.

We did not always have retirement. The concept is actually just a bit over a century old. It is noteworthy that even in the 19th century, the older generation may have been seen as a burden. In his 1882 novel titled “The Fixed Period”, the then 67-year-old Anthony Trollope wrote about a fictitious country called “Britannula” where large numbers of old men were retired to a place where they would be encouraged to enjoy a year of relaxation, followed by a peaceful death – euthanasia – with chlorofom.
It was the German Chancellor, Otto von Bismarck, who in 1883, introduced the concept of paying senior citizens a wage to stay home and not work. He did that to take the wind out of the sail of the Marxists. The set age was 70 and with the life expectancy then, very few took advantage of that age.

In the US, the famous physician, William Osler, in his farewell speech as he left Johns Hopkins for Oxford, made remarks that earned him the ire of the nation. His speech centered on the theme of the energy of youth and the uselessness of old age. Osler, who was 55 at the time, claimed that men were virtually useless after age 40 years and should retire after age 60 years. He then jokingly referred to the Trollope book and wondered if the old should be chloroformed.
By the 1930s, with the Great Depression underway, dwindling job prospects for the youth made it necessary to “get rid” of the elderly workers. Roosevelt would introduce the Social Security Act and the retirement age would be pegged at 65…arbitrarily.

So what do the studies say about retirement? A rash of studies paint a rather grim picture of health after retirement and yet, there have been a few that have shown the opposite. One of the latter was a 2017 Dutch study that showed that men who retired in their 50s were less likely to die in the next 5 years than those who continued to work. Yet noteworthy is not the retirement itself but what the men were able to do in retirement. They were able to lead healthier lifestyles. Similar results have been seen in studies from Israel, England, Germany and other European countries.
However, the studies that show negative health effects of retirement greatly surpass those that show a benefit to health. Retirement allows one more free time to live healthier, why are there so many studies showing negative health results?
Boyle et al showed in 2010 that the loss of purpose contributed significantly to the development of Alzheimer’s in the elderly. Hill and his group have shown that the loss of that purpose leads to an increase in all-round mortality. Holt-Lunstad and her group see a correlation between loneliness and death in the elderly and Behncke showed an increase in the incidence of strokes and cancers in retirees. The US Health and Retirement Study showed an increase of 40% of strokes and heart attacks in retirees.

In spite of all these negative findings, the studies that show a benefit may give us a clue why retirement can be so bad for so many. The two big culprits may be loneliness and lack of purpose. Of course, family and friends can help one deal with that but what if one’s work was where one found companionship?
Loneliness can be so crushing that it induces a certain despondency that takes away even the motivation to be active. This lack of activity worsens one’s health. The loneliness in itself is also dangerous. Coupled with the lack of purpose, is it any wonder so many retirees do not do well.
It is important to note that in those studies where retirement led to health benefits, most of those retirees were not lonely, had a sense of purpose and stayed active.
Depending on one’s job, retirement might be finally a time to find some rest or it could be the beginning of a slow decline, physically and cognitively. It is even worse now that life expectancy is much higher than in the 1930s.
In all, these studies help explain my observations.

So should we retire? Should we put men and women to pasture, who may still live another 20 years and risk having them spend those years alone and without purpose?
I think the institution of retirement is here to stay and so each of us should have a plan on how to deal with it. If possible, one should maybe delay it for as long as possible. One should also try to develop other interests that could fill one’s time in retirement. Retirement communities are sources of companionship. Consideration could also be given to another career, even a part-time job or a volunteer position.

In a recent book titled “Late Bloomers: The Power of Patience in a World Obsessed with Early Achievement”, Rich Karlgaard discusses the ability of the human brain and our capabilities to still keep developing deep into adulthood. If we are ever developing and possess the ability to attain new capabilities, why retire onto loneliness, despondency, and lack of purpose. Maybe the ultimate antidote to the ills of retirement is to never stop learning. Like the writer T. H. White wrote in the novel, “The Once and Future King”:
“The best thing for being sad is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake in the middle of the night listening to the disorder of your veins, you may miss your only love, you may see the world around you devastated by evil lunatics, or know your honor trampled in the sewers of baser minds. There is only one thing for it then — to learn. Learn why the world wags and what wags it. That is the only thing the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting.”

Of Collapsing Bodies, Event Horizons, and Singularity

It is rather interesting that in the very year my interest in astronomy was really awakened, the world saw the image of a black hole for the first time. Even though others had postulated about the possible presence of black holes in the 18th century, it was really the work of Einstein that set the ball rolling. It all started with Newton, Einstein, and gravity.

Now Isaac Newton saw gravity as the result of the force between masses. Einstein saw it as the result of the curvature of spacetime.

To help understand the Einstein position without using the really hard-to-understand tensor calculus, let us do an exercise:

Imagine the universe is a large sheet of Spandex stretched and attached to several poles to keep it taut. Now imagine dropping a bowling ball into the sheet. It will dent or warp it, right? Good! Now drop a marble into the sheet with the bowling ball still on it. The marble will roll towards the bowling ball, wouldn’t it? If you drop smaller and lighter balls with different sizes and weights on the sheet, they will all follow the curvature induced by the bowling bowl and rotate around it before finally sinking into the depression it creates.

The curvature induced by the bowling bowl in the sheet of spandex is what causes the smaller bowls to rotate around it. (If one paid attention, one would notice that the path charted by the rotating balls is not a perfect circle but an ellipse).

In the same way, all the other balls will warp the sheet to a degree and cause their own curves. The biggest ball will cause the other balls to rotate around it – in this case, the bowling ball. The phenomenon whereby a body warps the sheet and thus induces other bodies to move along the created curve is what is similar to what happens in the universe. That is what we call gravity.

Whereas Newton saw the universe as being static, with everything having its place, Einstein saw the universe as being more dynamic. In Einstein’s view, space combined with time to form a universal “sheet” called spacetime with three spatial dimensions – backwards-forwards, left-right and up-down – and one-time dimension. Celestial bodies travel through spacetime and in the process, bend, warp or even curve it. The more massive an object is, the greater the warping. The planets orbiting the sun do so not because of a force exerted by the Sun but because they are following its induced curve in the spacetime fabric.

These bends and curves can even affect the path that light takes as it travels from a star. Newton saw light as a corpuscle with mass. Thus he thought that a star could affect its path through gravitational force. By the time Einstein came around, we knew light was a wave. Its path is bent because of gravity alright but not the Newtonian version but rather the Einstein relativity one – through the curves induced by celestial bodies. This phenomenon is called gravitational lensing and was proven elegantly by Arthur Eddington during a solar eclipse in 1919.

Thus gravity is not a force but the curvature induced in the spacetime fabric by celestial bodies causing them to move and rotate.

Einstein discussed his concept of gravity under what he termed “the Theory of General Relativity”, in four seminal papers that he published in November of 1915. A year later, a German theoretical physicist named Karl Schwarzschild published a paper that drew on Einstein’s work and made postulations that were at the time even more esoteric than Einstein’s. It would be years before the import of Schwarzschild’s work would be appreciated.

The paper was titled “Über das Gravitationsfeld eines Massenpunktes nach der Einstein’schen Theorie” (On the Field of Gravity of a Point Mass in the Theory of Einstein). In it, he delved into escape velocity – that is the velocity a smaller object needs to have to pull away from the gravitational curvature of a bigger body. This escape velocity is directly proportional to the mass but inversely proportional to the radius of the bigger body. So a rocket headed to the moon from the earth needs an escape velocity of 11.2 km/s.

Now imagine a scenario where a celestial body got smaller but kept its mass. The escape velocity from that body would increase. If the body kept getting smaller, it would reach a point where the escape velocity became equal to the speed of light – 300,000 km/s or 186,000 miles/s. At that point, nothing – matter, radiation, light, nothing – can escape from that body. It also becomes impossible for the body to stay intact and thus it disintegrates into a minuscule point whose only presence in the universe is a dark bottomless, infinitesimal entity called a “singularity”. Since no light escapes this point, it is invisible. However, this “singularity” induces a boundary called the “event horizon”. If another body goes over the event horizon, it vanishes into oblivion. Schwarzschild even presented a formula to calculate the size of an event horizon (the Schwarzschild radius).

At that time, physicists found Schwarzschild’s postulations quite arcane then most did not look beyond our planet. Yet if one considered the stars as the bodies being escaped from, his work made a lot of sense. Remember a star is really a collection of really hot gases or plasma and hot gases can get smaller as they burn out.

It would be years before the scientific community would understand it’s importance. His work joins that of Einstein and others in becoming the buttress for the concept and now the reality of black holes, a name coined disdainfully by the American physicist, John A. Wheeler, in 1967. Earlier this week, the world was treated to the first picture of the event horizon a black hole in M87.

According to theory, there might be three types of black holes: stellar, supermassive, and miniature black holes – depending on their mass. These black holes formed in different ways.

Stellar black holes form when a massive star collapses.

Supermassive black holes, which can have a mass equivalent to billions of suns, are found in the centers of most galaxies and are likely the byproduct of galaxy formation.

Miniature black holes could have formed shortly after the “Big Bang,” which is thought to have started the universe 13.7 billion years ago. They may be the result of faster moving matter causing slower ones to contract into black holes.

As noted above black holes may have been instrumental in how our universe formed billions of years ago. As mentioned earlier, stars are just a collection of hot gases fueled by intense radiation. As the universe formed, these massive initial stars burnt out creating massive black holes and pulling in other stars. They also emitted jets of high-velocity radiation that led to the formation of other stellar bodies. In a way, they are like the volcanoes of the universe – creators as well as destroyers. One massive one lies in the center of every galaxy. Like volcanoes, they are dormant most of the time. When they do get active, it is disastrous.

Schwarzschild was not the first person to think of the concept of a back hole.

Interestingly, back in 1783, an English priest, philosopher and scientist called John Michell, a man once described as “a little short man, of black complexion, and fat” would touch on this same claim in a presentation to the Royal Society. A few years later, in 1796, the French scientist, Laplace would make the same claim in his book, “Exposition du Système du Monde.”

In a letter to Einstein from November of 1924, the Austrian physicist wrote:

“Einstein, my upset stomach hates your theory of General Relativity—it almost hates you yourself! How am I to provide for my students? What am I to answer to the philosophers?!!”

I guess for us laymen, trying to understand the theories of Einstein and all it has spawned can lead to upset stomachs and even headaches. However, they definitely help us better understand our universe and our place in it. Moreover, they show how brilliant we humans can be.

On the other hand, the presence of these black holes points out the fallibility of the universe we live in and by extension the fallibility of us humans. Scattered around us are places where we can vanish into oblivion. Places where the laws we think control our universe and our lives do not work. Maybe the time has come to probe into these black holes and with that, face our very fallibility. How excitingly scary is that!

Should There Really Be an App for That?

“Conversations in Port Townsend,” interview with Tim O’Reilly, 1983

On June 29, 2007, Apple Inc released a device that has revolutionized how we live, communicate, shop or even read – the iPhone. Two years later, it released the iPhone 3GS, opened the App store and came up with the catchphrase, “There is an app for that”. Later that year, the company would patent the phrase.

Ever since those days, apps have literally become a very important part of our digital lives. As of the end of the 3rd quarter of 2018, Android users had 2.1 million apps to chose from whereas the Apple AppStore had about 2 million.

Apps have come to epitomize the role of technology in human lives and this is not new. Innovation got Homo Sapiens out of caves, away from a culture of hunter-gathering into large settlements all the way to the metropolises some of us live in now. Technology has led to longer life-spans and in some regards, higher standards of living. On the flip-side, it has also helped us destroy our environment and made it easier to kill each other.

However is the fact that we now want an app for all activities and pursuits, is the fact that we want technology to make life easier always a good thing?

In 2010, Airbus announced its new A320 class of engines. These were supposed to be more fuel-efficient and more cost-effective. Boeing rushed to get out its own version. The strategy depended heavily on building a plane that worked essentially the same as the previous generation. Out of the highly successful 737 came the 737 Max. This time around, Boeing put the engines on the 737 Max at the back making it back heavy and changing the center of gravity of the planes. This led to a situation where on take-off, the back sank and the nose pointed up, a condition that could lead to the plane stalling.

At this point, Boeing engineers had 2 options – place sensors in the plane to detect the impending stall and fix it through a computer program that forced the nose down or let the pilots take care of it at a time when the plane was being flown manually.

Well, in a world where there is an app for everything, guess what the engineers did?

They installed the MCAS (Maneuvering Characteristics Augmentation System) to sense and correct this. Now it is possible that malfunctioning sensors may have caused the MCAS to also malfunction and contributed to two plane crashes in 5 months that have claimed 346 lives!

Presently, there are very few hospitals in the US that do not boast of an electronic medical record system (EMRS). Pushed by former President Obama as part of the ACA, they have largely replaced paper records and the illegible writing of doctors. Yet, like a recent piece in Fortune magazine titled “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong” shows, this technology may have just birthed a whole new set of very bad problems.

The report cites examples of bad software that has dropped orders for important tests leading to patient mortality. In my own experience, I think EMRS take from the very essence of patience care – observing the patient! Walk into any hospital or doctor’s practice these days. Providers are not observing patients! They are starring at screens!

This is not to say the idea of EMRS is bad or that trying to prevent the 737 max is out of line. Not at all. The question I am trying to ask is, “Should there really be an app for all that?” Should technology always be harnessed? Can we leave certain processes and procedures to human judgment or are we too fallible to be trusted?

Social media has really flattened the world. The whole place has morphed into a global village of “likes” and “hashtags”. Yet, there are dark sides to this technology. The spread of fake news, the unauthorized sale of personal data, issues of validation, comparison, bitterness, and even isolation. It decreases attention span and makes us care about the wrong things. Zuckerberg et al got us an app that brought the world nearer. Did we really need an app for that?

Technology is at the verge of giants strides in artificial intelligence (AI) and machine learning. Soon, several professions will be obsolete because machines will take over the intellectual aspect of these pursuits – lawyers, accountants, radiologists, to name a few. Is this really the world we want to live in?

When most people think of the movie “The Terminator”, the picture of Arnold Schwarzenegger saying “I’ll be back” comes to mind. However, the movie is much more. Like Adrian McCullen wrote on “Medium”: “The real theme of ‘The Terminator’ is about Skynet, a powerful AI that becomes self-aware. The film centers around the dangers of AI dominance, where AI (in the form of robots) rejects human authority and realizes that to be fully in control, humans need to be terminated, much like the realization of the AI, HAL in the phenomenal 1968 Stanley Kubrick classic ‘2001: A Space Odyssey’.”

At the risk of sounding anti-science, which I am definitely not, maybe the world needs to sit back and consider when to let technology take a back seat and allow humans to take control.

Steve Jobs, in a 1994 Rolling Stone Interview said: “Technology is nothing. What’s important is that you have faith in people, that they’re basically good and smart, and if you give them tools, they’ll do wonderful things with them.”

If we could really look at technology as a tool, then we would know when to use one and when not to. Then we’ll realize that the fact that we have hammers does not mean everything is a nail. Then maybe we’ll accept the truth that there should not always be an app for that!

Those Who Cry “Wolf!”

We all know the Aesop fable about the shepherd boy who took his master’s sheep to a pasture near a dark forest and not too far from a village. One day, feeling bored, he cried “Wolf”. This drew forth the men from the village who rushed out to chase the wolf away. They found the boy doubled over in laughter but no wolf. He would repeat this prank a few days later and again, the men from the village rushed out to find him laughing and no wolf. When a real wolf appeared a few days later, he cried for help but no one showed up and he ended up losing a great deal of his master’s sheep. The men from the village did not believe his cry for help anymore. His cry of “Wolf” had become a symbol of attention-seeking behavior and they were not going to honor that anymore.

Which brings me to the story of Tawana Brawley. In 1987, Brawley, an African-American from Wappinger Falls, NY, claimed that six white men had abducted her, raped her, and left her in the woods covered with feces. They had scrawled racial epithets across her body. The story turned out to be untrue, leading to black eyes for many in the black community who sprang to her support. Reportedly, Brawley lied to escape the wrath of her mother’s boyfriend after she ran away from home for four days to visit her boyfriend. Did Tawana Brawley cry “Wolf”?

Three weeks ago, the black actor and singer, Jussie Smollett, claimed he was the victim of a racist and homophobic attack by two white men who beat him up, hung a noose around his neck and doused him with a liquid. The men also shouted racist and homophobic slurs at him. After days of intense investigations, the Chicago Police Department alleges that Mr. Smollett planned the attack and paid two Nigerian brothers to act it out for $3500. His motives were publicity and a better deal for his role on the series “Empire” on Fox. If the accusations are proven to be true, can one say Jussie Smollett cried “Wolf” too?

In both instances, we see an exploitation of racial animus. Though it may seem so, it is not only blacks who seem to exploit this phenomenon. Let’s take the case of Susan Smith, a white woman, from 1994. She claimed that she’d been carjacked in South Carolina by a black man who drove away with her two young sons (ages 3 years old and 14 months). For nine days, she made dramatic pleas on national television for their rescue only to finally break down and confess that she had drowned the kids herself by leaving them in her car and letting the car roll into John D. Long Lake in Union, S.C.Or the 1989 case of Charles Stuart who shot and killed his pregnant wife, Carol, as they drove home from a childbirth class in Boston. Mr. Stuart as you may guess was white. He blamed the shooting on a black man. Several black men were searched and questioned by the police. One named Willie Bennett, was finally arrested and charged in the killing before Mr. Stuart’s story began to unravel and Mr. Stuart jumped to his death into the Boston Harbor just before he was charged.

Heck, the whole Southern Strategy of the Republican Party, a strategy made popular by Nixon’s political strategist Kevin Phillips is based on crying “Wolf” – appealing to southern white voters by stoking fear for and animosity towards African-Americans.

Even currently, the President has declared a State of Emergency at the southern border based on fear of brown people overrunning the country! “Wolf!”

Though the examples cited may be few, they are but the tip of an iceberg. An iceberg made of racial fears and hostilities that hearken back to the birth of this nation and seem to dog our every step. Racism seems to be a cancer that continually eats at this country’s fabric and gets expressed in many ugly ways. It also gets exploited by the Jussie Smollets, Tawana Brawleys, Susan Smith and Charles Stuarts of this world for selfish and sometimes really evil purposes.
The fear of the other has replaced the fear of the wolf and the danger is, if exploited like in the examples listed above, like the men in the village, we as a society may become even more immune to the true accounts of hate crimes. It is already a fact that many citizens do not believe that there are Americans who are treated differently because of their skin color. The disregard of the attacks on those who are different may go up exponentially, exactly at a time when hate crimes are up.

Like the Chicago Police Superintendent, Eddie Johnson said, “Why would anyone, especially an African-American man, use the symbolism of a noose to make false accusations? How could someone look at the hatred and suffering associated with that symbol and see an opportunity to manipulate that symbol to further his own public profile?”Such a ruse, if indeed that is what Mr. Smollett did, cheapens the daily struggles of many African-Americans and people of the LGBT community and shows a privilege he seems unaware of. It also takes away the goodwill of many people of different races who try each day to do the right thing and treat everyone equally. In the Smollett case, for example, it is disheartening and unfair to many white and straight Americans who strive daily to be color and sexual-orientation-blind.

That is why is important that this country strives to overcome its burden of racism. Until that day where one is “… judged not by the color of their skin, but by the content of their character”, until the day that some leaders do not try to divide us by stoking fear of one group for the other, our modern versions of the Aesop’s shepherd boy will keep crying “Wolf”, when there is none in sight.

Reflections In the Shadow of an Eclipse

Progression of the Progression of the Super Blood Wolf Moon lunar eclipse

A week ago, I stepped out into the bitter January cold about an hour before midnight with my daughter. We wanted to watch the Earth cast its shadow over the moon and create a most wonderful Blood Moon eclipse. I also wanted to photograph the whole event.
It really was a most wonderful experience. We not only watched the interplay of two celestial bodies but being a very cloudless night, we could also see a ton of stars and even hints of the planet Jupiter.

An even cursory immersion into the realm of astronomy makes one realize how insignificant we humans are in the grand scheme of things. We are but dots in this wide, ever-expanding universe and staring into the heavens that night, as the Earth’s shadow marched across the Moon’s surface, our smallness did not escape me.

Thus, it was not only a night of infinite beauty, a beauty that helped to chase away a heaviness brought on by a difficult weekend at work but also one of life lessons.

The first lesson had to do with adversity.
The word “eclipse” may come from the Greek word “ekleipein” meaning “to omit, to fail” or from the amalgamation of the words “ex” and “leipein” meaning “ to leave”.
So an “eclipse” is not only “the total or partial obscuring of one celestial body by another” but the word can also be used to describe the “falling into obscurity or decline”.
The event was in a way a metaphor for when adversity threatens to force us into obscurity and decline.

The eclipse started by the shadow of the Earth steadily creeping across and over the moon. During this phase, the moon appeared to be composed of a dark and a light side. Though it made it look incomplete and imperfect, it gave it a certain beauty and uniqueness that reminded me of multiculturalism and cosmopolitanism, but I digress.
The shadow of the Earth creeping steadily across the moon reminded me of the times in our lives when adversity creeps in. Like the shadow of the Earth, adversity sometimes steadfastly moves into and then over our lives until it totally envelops our total existence; until it eclipses us and shuts out the joy and light that filled our day.
Whether we like it or not, adversity and problems are part of life. They are as part of life as the air we breathe. They show up in our lives not to make us just suffer but like M. Scott Peck wrote in his wonderful book, “The Road Less Travelled”, “It is only because of problems we grow mentally and spiritually”.
Problems force us to rise to the occasion, tapping into wells of unknown courage, creativity, and resourcefulness to survive. At the height of adversity, when our lives are totally eclipsed by problems, if we tap into our inner well of strength, we are changed for the better.
When the Moon was finally covered by the shadow of the Earth, it changed color. It gained a beautiful red color due to scattering of sunlight trying to reach it.
It is in the same way that we change when we stand up to adversity. We become stronger, wiser and smarter. We glow in our own version of “redness”.

The experience also reinforced a fact I have always known – that nothing good comes easy. The only way I could capture the images I got was because I ventured out into the bitter cold around midnight. If I had preferred the comfort of my bed and stayed indoors, there was no way I would have been able to observe and capture the images I got.
Nothing in life comes easy! The best things in life may be free but they do not come without toil. Life never gives anything great away for free. She always asks for sweat equity. There is no way around it.

On a night where the beauty of our universe impressed upon me our smallness as humans, lightened the heavy load on my heart, afforded me quality time with my daughter and amazing images of a beautiful eclipse, nature also reenforced important lessons.
In a way, the two lessons are tied together. Adversity helps to bring out the excellent in us whereas our search for the good often has to go through adversity, which if we surmount, not only leads us to the good but also bring out the excellent in us.
Like Benjamin Franklin said, “That which hurts, also instructs.”

Echoes From the Hallway

Just sometimes, the practice of medicine becomes onerous. Just sometimes the pulmonary embolisms are too stifling, the myocardial infarctions too pressurizing and those hip fractures too achy. With one case following the other, one’s empathy and compassion get buried beneath the units of blood, chest compressions, epinephrine boluses, endotracheal tubes and measured urine outputs.
After hours of patient care, one reaches a point where thoughts of the warm couch and a cold one are so intrusive that, they threaten to sweep away the right doses one has memorized for starting a patient on Amiodarone.
Sometimes, the practice wears on the body and the soul.

Recently, I had such a day. Finally, after some 13 or so hours, I scurried off to the locker room to change and head home. I was so relieved to be able to finally leave it all behind. Or so I thought.
I changed faster than a Broadway artiste and headed for the door.
Now, the locker room has two main doors. One leads into the operating rooms suite while the other leads to a long hallway that is flanked by a ward, two intensive care units and waiting rooms for family members. The hallway also leads to a stairwell that leads to a door that lets one out of the hospital.

As I neared the into-the-hallway-leading locker room door, I heard a curious sound coming from the hallway. For a minute I thought someone was crying but the walls muffled the sound. I opened the door and made the left turn into the hallway and was immediately greeted by a most heartbreaking sight.
In the hallway were maybe 20 people who seemed to be related and they were all crying really uncontrollably.

It is not uncommon to see the family members of patients in either intensive care units hanging around in the hallway instead of staying in the waiting rooms. The reasons they do that are myriad. The most common is that the waiting rooms are full. Another is that a patient was just admitted, so the family members are still finding their bearings. Other times, the patient might not be doing well and the loved ones are all trying to see him or her before it is too late. Then, there is also the instance where a family member dies in one of the units.
As I stopped momentarily, frozen by the display of grief around me, I knew this was one of those instances where a patient had died and the family members were grieving openly in the hallway. It was not the first time I had seen patient family members crying in that hallway but never had I witnessed that number of weeping and heartbroken visitors.
For a minute I thought of using another route to the parking garage but something made we walk down that hallway between all those sobbing people and a chaplain, trying unsuccessfully to console them. The sobs bore into my very soul and their tears seemed to just flow. For what seemed like an eternity, I walked down that hallway, legs and heart quite heavy.
Finally, I turned the corner, went down the stairs and out of the hospital.

I walked briskly to my car, opened it and sat down. I noticed I was breathing rather fast. I tried to catch my breath and thoughts. Suddenly, my tiredness felt so secondary. Suddenly, the long day felt so unimportant and the warmth of my couch was not such a pressing need.
The empathy came flooding back. The compassion rolled over me.

I had seen grief and sensed loss and they made life so much more important. They put what I did, what we do within those walls in perspective. They humanized the pulmonary emboli, the strokes, the dissections, the fractures. I sat in the car and realized that I could not let my empathy and compassion be buried under units of blood, chest compressions, epinephrine boluses, endotracheal tubes, and measured urine outputs. That I had to reach in there and fish them out as soon as I realized they were drowning in the busy-ness of the day. Then behind those people we call patients, behind those people who make us work really hard and miss out on warm couches and beds are the lives they have left behind and hope to return to. Lives that include people who love them and will cry uncontrollably in a cold hallway if these patients do not make it.

I started the car, reversed and drove off. The radio came on and an old Stevie Wonder song was playing but even that could not keep the echoes away – the echoes of those visitors crying in the hallway. Death really has a way of reminding us about life and a special style of putting it all in perspective.

That Picture from 50 Years Ago!

On December 21, 1968, NASA launched the Apollo 8 spaceflight. Onboard the Saturn V SA-503 rocket were 3 astronauts.

Frank Borman was the commander, Jim Lovell was the navigator and William Anders was the one responsible for photography. The objective was to have them orbit the moon and study it for a possible moon landing.

For photography, Anders had among others, a Hasselblad EL. It was the first motorized Hasselblad. He had two lenses for the Hasselblad – an 80 mm f2.8 and a 250 mm f5.6. He shot on 70 mm Kodak B&W as well as Ektachrome (color) film.

They inserted into the moon’s orbit three days later. The plan was for them to orbit the moon ten times. As they did, Anders took pictures of the craters on the moon surface with the Hasselblad.

Just before 16:00 UTC (11 am ET) on December 24, 1968, they were coming around for the fourth pass, when Anders saw a view that made him exclaim:

“Oh my God! Look at that picture over there! There’s the Earth coming up. Wow, that’s pretty.”

Anders was observing an “Earthrise” – the Earth emerging from the lunar horizon.

(Image borrowed from the NASA Archives)

Due to the Moon rotating around the Earth synchronously, an Earthrise is not usually observed from the Moon’s surface. This is because, from anywhere on the Moon’s surface, Earth remains in approximately the same position in the moon’s sky, either above or below the horizon. Earthrise is generally visible only while orbiting the Moon, and at selected surface locations near the Moon’s limb, where the oscillation that ensues between the two celestial bodies carries the Earth slightly above and below the moon’s horizon.

As later computer simulations would show, at that point, Anders was the only one who could see the spectacle. His initial shot of the Earthrise was on the B&W film already in the camera and with the 250 mm lens. Then he asked Jim Lovell to hand him a roll of color film. He took the B&W roll out, inserted the roll of Ektachrome and shot the first color image with the 250 mm lens set at 1/250 second and f/11. More images would subsequently be shot.

When the astronauts returned to Earth on December 27, their success was hailed. Not only was their mission a success and helped land the first men on the moon on July 20, 1969, with the Apollo 11 program thus catapulting the US past the USSR in the space race, but it was also a bright light that helped end a very depressing year in the history of the US. 1968 was marked by the never-ending Vietnam war, riots and protests and assassinations (MLK and Robert Kennedy).

The “Earthrise” image was used for a postage stamp. The image has been described as “the most influential environmental photograph ever taken” and helped beget “Earth Day”. There are those who think it possibly spawned the environmental movement.

Those men were sent up there to discover the moon but their biggest legacy may have nothing to do with the moon. Like Anders later said, “We set out to explore the moon and instead discovered the Earth.”

They were so awed by what they saw that still up there orbiting the moon, in what was to become a seminal moment in TV broadcast history, the three men read, one after the other, the first 10 verses of Genesis 1 to an enthralled nation on December 24, 1968. Like Lovell said, “The vast loneliness is awe-inspiring and it makes you realize just what you have back there on Earth.”

I do not believe in Intelligent Design but these words from Genesis that those astronauts read to the world from up there says so much: “And God saw that it was good.”

The “it” is the universe including this Earth of ours. This makes our little planet good too. Our Earth is good. Our Earth is beautiful. Let’s take care of it. We may not believe the words in Genesis or even doubt the whole space program. One fact remains though – for now, this planet Earth is all we have and we better take care of it, or soon “…it will not be good.”

Don’t Get Carried Away…By those Drones!

In 1848, the people of Venice, chafing under Austrian rule for over 50 years, revolted. An Austrian battalion under Field Marshall von Radetsky was sent to quell the rebellion. He blockaded the city causing starvation and disease. However, he could not get close enough to the city to bring his artillery to bear. That is when a young Austrian artillery lieutenant named Franz von Uchatius thought of what would become the first Unmanned Aerial Vehicles (UAV) or drone.

On July 22, 1848, the Austrians filled balloons with explosives and launched them towards Venice. Unfortunately, the wind was not in the Austrians favor and the balloons were blown off course. Some were even blown back towards the Austrians positions and exploded over them. They tried again a few weeks later on August 22, this time launching the balloons from the sea but the outcomes were no better.

Over the next century, other countries would try variants of Unmanned Aerial Vehicles (UAV) for military purposes but it was the Israelis who would perfect it for war against Syria in 1982. Their success in using drones for reconnaissance led to an explosion in the development of these vehicles. Now drones are used not only by the military but they have found use in civilian life. From capturing live events to surveying dangerous areas, drones have found use in several industries and sectors, including the health sector. It is its use in this sector that inspired this piece.

Much of the information on the use of drones in healthcare being put out make claims about how drones will change the practice of emergency medicine in particular and all of the healthcare delivery in general. There is also great optimism that drones could revolutionize healthcare delivery in remote, hard to reach regions.

Some of these claims are being proven in a country like Rwanda where the use of drones has changed the way medical supplies and blood are delivered to hospitals around the country. Remote areas in this hilly country can be supplied easily with medical supplies and blood using these unmanned aerial vehicles. Other claims, however, have to be weighed against the healthcare needs of each country and the resources available. This is especially true for poor countries like Ghana.

With these two factors in mind, drones may not always be the first choice when considering new purchases or investments for the healthcare sector.

Using three clinical examples, I’ll try to illustrate why drones, revolutionary as they may be in the transport of medical supplies and blood, should not always top the list of healthcare needs for a developing country like Ghana.

The first example draws on the so-called Ambulance Drone. This has been made popular by a video made by Delft University of Technology, in the Netherlands. This a drone that carries an automated external defibrillator. In the video, it is flown to a patient who collapsed on the street and used to defibrillate his heart.

Now, a human heart does not fibrillate without reason and the reason in each instance is very bad. The major cause is an acute blockage of blood flow to the heart. The fibrillating heart fails to pump blood to the brain and so the patient passes out. Without chest compressions and fibrillation, death is rapid. However, even after shocking the heart out of that terrible rhythm, the patient has to placed in an ambulance by paramedics and transported to a hospital where a cardiologist can open up the blocked vessel or vessels with stents or a surgeon can bypass them.

So, though this AED drone may help shock the heart out of ventricular fibrillation, humans are needed to place the patient in an ambulance and drive him to a hospital for definite care. Very little can be done for these patients at the side of the road. Data shows survival is dramatically increased if patients are taken in for revascularization quickly.

Next, let us look at a condition often touted as being indirectly amenable to resolve with a drone’s use – the treatment of the anemic pregnant woman at a remote location with blood.

Now anemia in a pregnant woman is always serious. It can be chronic due to say, malaria, or it can be acute due to hemorrhage or bleeding. When such a patient reports to a clinic or a community-based health planning compound, a midwife or nurse can evaluate this patient and make the call for blood. If the anemia is chronic, she could easily transfuse the patient by getting a drone to drop off a unit or two. However, if the patient is actively hemorrhaging, she belongs in a hospital because active bleeding in a pregnant woman can end very badly for her and the fetus and is an emergency.

Let’s just say it is placental abruption, a condition where the placenta is detached from the uterus. She is going to nee surgical care and transfusing her blood is not going to fix the underlying problem.

Also, the bleeding and transfusion can set off a condition in the body called disseminated intravascular coagulation (DIC). As the body loses blood, it tries to form clots to reduce the bleeding. This depletes the body of clotting factors, thus worsening the bleeding. This a vicious cycle that needs to be taken care of in a hospital. It is another emergency.

The patient needs to be placed in an ambulance by paramedics and driven to a hospital where she can be cared for properly.

The third example is that of snake bites. Worldwide, there are about 5 million snake bites a year. 100,000 of these patients die. Due to underreporting in poor countries, the numbers could be much higher. In Ghana, vipers seem to be the most common snakes that bite, although there are also cobras. The snake injects the body of its victim with a venom. If this venom leads to generalized symptoms, the condition is called envenomization.

Getting envenomed by the venom of a viper leads to several symptoms the worst of which is the bleeding that often requires blood transfusions. The tissue at the site of the bite can also die and as the venom spreads, more tissue in that limb dies also. This often needs surgery to remove the dead tissue or in worst case scenarios, amputation of the limb. Failure to admit these patients, treat them with anti-venom plus other supportive measures can result in death.

Sure, a drone can deliver the anti-venom in a cool state and even blood and antibiotics but ultimately, the patients need to be transported by paramedics in an ambulance to a hospital.

In all three scenarios, we realize that even if a drone can arrive quickly with first-aid materials, the patient still needs definite care in a hospital and that demands paramedics and an ambulance. Drones cannot do that. At least, not yet.

In the healthcare system of every nation, one can tease out three main sectors: Preventative Care (Public Health), Emergent, Acute and Chronic Care (Hospitals and Clinics) and Rehabilitative Care.

In spite of all the strides made in preventative health, the bulk of healthcare delivery is seen in the emergency, acute and chronic space. This calls for community-based clinics that can be first in line to see the sick. Those that need more advanced care can then be transferred to district hospitals or even the bigger regional ones. This calls for an effective way to transport not only the acutely ill but also emergencies. This calls for ambulances.

For the transport of these sick patients, trained personnel are needed who can care for these patients during transport. Paramedics are needed.

Without a good and effective system to transport patients to the effective points-of-care, all the drones in the world flying all the blood and medications available will not save these patients. No politicizing will change that. It is that simple.

Thus, in a country with as few resources as Ghana has, maybe our eminent concern should be making sure the country has good ambulance coverage. It is reported that Ghana has 55 working ambulances. That is it.

What about the areas with bad roads or no roads? Well, if we are ready to invest in the newest technology, it shows a willingness to think out of the box. Maybe we need to get helicopters not drones to fly patients out of these areas. Maybe we can use hovercrafts in the areas under water.

So do we need drones at all? Yes, they can revolutionize the supply chain in the healthcare sector. That is a need that has to be met. However, as shown through the examples, the greatest supply chain in the world is useless if those who need care cannot be transported effectively and efficiently to the hospitals and are left to die far from the points-of-care at the back of pick-up trucks and in taxis.

I hope we can take care of our pressing needs first and not get carried away like those balloons filled with explosives the Austrians launched back in 1848.

What Is In A Culture?

The word “culture” has many definitions. It ranges from “customary beliefs and social forms…” to “cultivating living material in nutrient media…”

There is one definition that fits the present exercise I am embarking on and it is:

“the set of values, conventions or social practices associated with a particular field, activity or societal characteristic”.

Thus if one should examine the way we cook in Ghana, one could easily say we have a rather spicy culinary culture. Most meals are cooked with lots of pepper and other hot spices.

So let’s take the societal characteristic of infidelity in Ghana, a practice that seems to be more common among men than women and stands at the heart of the misery of a lot of married women. One can reach to our history of polygamy to understand why some men find the need to be with more than one woman. Another factor that plays into this practice is the lack of opportunities for women in business and the economy. Thus some women find the need to look for men who can “sponsor” a good lifestyle. All these factors play together to create a culture of infidelity.

Another societal finding is the sexual exploitation of children. Among a lot of men, sex with girls in their early teens or even pre-teens is not seen as abnormal. Looking at a history of child brides helps in getting to the bottom of this nefarious practice. Historically, girls were seen as ready for marriage and childbirth the minute they started menstruating. Thus it was not uncommon to see child brides. This terrible practice may make some men see sex with children as not being abnormal, thus creating a culture of sexual exploitation of children.

Then is the issue of sexual harassment of women. Anecdotally, this is a rather common occurrence in Ghana. It is seen in schools, workplaces, in bars, restaurants and even at places or worship. A 2013 study by Norman et al looked at sexual harassment at 4 Ghanaian medical schools. Of all the students interviewed, over 60% of the women reported some form of harassment versus 39% of the men.

Sexual harassment can often lead to sexual violence and that is yet another societal characteristic. The stats are damning. According to a 6-year collection of data by the Domestic Violence and Victim Support Unit (DOVVSU) of the Ghana Police Service, approximately six women are likely to be raped every week. Between 2011 – 2016, there were 30,408 cases of assault. If one adds the number of children assaulted, it more than worsens the picture. From 2011 – 2014, 5,752 children were defiled.

Though a lot of men and some women will not accept, certain societal norms allow these practices to flourish.

Probably the first of all these causes is the phenomenon of gender inequality. The fact that some see women as being less than men and only alive to cater to all the needs of men, even their sexual urges, is a problem. This inequality has been propagated through history and is often supported by religious beliefs. The results are sexist and misogynistic behaviors.

Secondly, the exploitation of the “weak” by the more powerful feeds into this. This is a phenomenon that is as old as humanity itself. So one sees girls getting assaulted by men or even boys by older women or men. Men wield most of the power in society and this power is used in lots of these instances of assault in a predatory fashion. So a woman seeking a job or even a promotion may have to give sexual favors to achieve her aim.

Thirdly is the rampant indiscipline. Sexual urges are common in all humans. However, one learns to control them and also learns to seek consent from a prospective partner before trying to engage him or her in any sexual activities. In a society that in undisciplined, it stands to reason that a large section of the men (and women) will have no personal discipline and a lack of the ability to control urges. If one adds the view that women are less than men and are there to cater to the needs of men, a toxic brew develops that propagates harassments and assaults.

Further, a lot of men in the society do not see rape or sexual assault as something that is wrong and criminal. Some even but joke about it or even minimize it. Some brag about sexually assaulting women or even children, seeing that erroneously as a feather in their cap.

To make matters worse, these predators are often not punished and can go on to assault again. In the villages, the elders take care of the case, often only reprimanding the perpetrator and telling the victims to live with it. In the urban areas, shame often keeps victims from reporting assaults.

Taking all these factors that perpetuate sexual violence against mostly women, can’t one say there is a certain culture that keeps these abhorrent practices alive? Now the presence of such a culture does not mean all men are predators but rather that certain norms persist that allow some men to act in a predatory fashion.

Which brings me to my question – what could one call such a culture?