Monday, November 25, 2013
Sunday, November 24, 2013
Saturday, November 23, 2013
S.W.O.T.
'This song was written by 4th year medical students from Queens University Belfast. Our society SWOT (Students Working Overseas Trust) is a charitable society run by the 4th year students that raises money every year, which we hand-deliver to 3rd world hospitals on our 4th year electives.
The song sums up what our society is about, and it's a new way for us to try and raise funds for those who need it most. We hope you enjoy it, its pure cheese, but its been great craic to make! Please give us a share on facebook or twitter to help us spread the word and get as many downloads as possible. It's available on iTunes, Amazon and Spotify, and many other online stores!
Watch this space, we are about to launch our new website too, so you'll be able to learn more about our society! We are always looking for donations and sponsors, feel free to contact us on swot@qub.ac.uk
The band:
Jonny McDowell - Lead guitar and vocals
Alana Spence - Vocals
Sean McNicholl - Rhythm guitar
Michael McKee - Drums and rap
Luke ward - Bass and vocals
Huge thank you to the following people
Audio recorded at - Einstein studios http://www.einsteinstudios.tv
Video filmed and produced by Four Creatives - http://www.fourcreatives.com
See our other awesome sponsors in the video.
Buy the song on iTunes, Amazon or Google play - https://itunes.apple.com/gb/album/thi..., http://www.amazon.co.uk/This-Is-Swot/..., https://play.google.com/store/music/a...
spotify:album:1EQv8eREwnWMKjm5hOVPFU'
http://www.youtube.com/watch?v=M7Cdnf2AbRg
I have no direct link with the above - found on Clare Gerada's twitter (immediate past president of Royal College of General Practitioners). Really good idea for charity distribution as medical students can often go to quite remote places for the electives.
Wednesday, November 13, 2013
doctor patient relationship
http://well.blogs.nytimes.com/2013/11/11/doctors-boundaries-with-patients/
Hard Cases 72 Comments
Alex Nabaum
It takes only a moment to step over the line, especially when no one knows exactly where the line is. In my case, it started with a visit from my old friend the activist.
The activist became my patient back in the mid-1990s, when H.I.V. was slowly morphing into a treatable disease. He was young then, with a mop of dark curls — excitable, suspicious and frantic about his health. He was convinced the new drugs were pure synthetic poison, a profiteering scam by the government and Big Pharma. He was also feeling sick enough that he thought he might just give them a try
He lurched back and forth between these two incompatible positions once or twice a month, dragging me and my prescription pad behind him in a flurry of abandoned amber plastic bottles. Eventually, though, good sense kicked in and he had to admit that on meds he felt a lot better than otherwise. He managed to retain his contempt for the system while regularly filling his prescriptions. I no longer winced at his name on my schedule.
And now it is suddenly decades later, his H.I.V. has long been perfectly controlled, and he is still fomenting revolution. He used to march and holler; now he works social media with a miserable old desktop computer that keeps breaking down.
As it happens, about a week before one of our infrequent appointments — he barely needs me any more — I had treated myself to a brand new laptop, sending an old perfectly good model into the back of the closet.
Of course I wiped its hard drive clean and gave it to him — for he is my old friend. But (also of course) we met furtively in a back corridor and I carefully concealed the contraband in a nest of old grocery bags — for he is my patient, and gifts to patients …well, we don’t usually do that.
Once again, apparently, we were dealing with two incompatible positions. Everyone knows that professional boundaries guide all medical activity in hospital, office and clinic. But aside from indisputable sexual and financial depredations, no one agrees exactly where these boundaries lie.
Kindness to friend and duty to patient: Are they one and the same? Or separated by a barbed-wire fence? Opinion is all over the map.
At one extreme is the position probably best articulated by one of medicine’s great clinician-scientists, Dr. Donald Seldin of the University of Texas. In a 1981 talk to an audience of physicians, Dr. Seldin deplored “a tendency to construe all sorts of human problems as medical problems” and thus within doctors’ duty and purview to fix. If it isn’t “relief of pain, prevention of disability and postponement of death,” Dr. Seldin said, why then, doctor, leave it alone! He got a standing ovation.
In the opposite corner stands Dr. Gordon Schiff of Harvard’s Brigham and Women’s Hospital, who was issued an official reprimand a few years ago for egregious boundary crossing.
The incident that it set it off: Dr. Schiff (now 63, an experienced senior clinician) had tangled with an insurer on the phone for two hours before he gave up and handed an impoverished patient $30 to pay for her pain pills. A resident observed the transaction and turned him in. But Dr. Schiff is a proud repeat offender, whose past infractions include helping patients get jobs, giving them jobs himself, offering them rides home, extending the occasional dinner invitation and, yes, once handing over a computer.
He was told physicians should stay away from “random acts of kindness” — an activity that may sound harmless but is quite distinct from the practice of medicine, and has its risks. Patients might get too familiar, expect too much.
Dr. Schiff published a long rumination about the incident a few months ago (which, he reported in an interview, has elicited the email equivalent of a standing ovation). In it he considers whom, exactly, the sanctions against befriending patients are designed to protect. The patient in some instances, he concludes, but the doctor in far more. “Let’s not pretend we are imposing limits for patients rather than our own best interests.”
Dr. Schiff draws medicine’s borders around a shared social agenda: doctors help the patient’s health by helping the whole patient. Dr. Seldin’s borders contain specific, technical tasks.
If you think too superficially about all of this, you may begin to hear Dr. Seldin screeching like Ebenezer Scrooge: Are there no charities? Are there no social workers?
But it’s not quite that simple. I too handed out the odd $20 bill at work without thinking much about it, until I didn’t see one patient for almost a full year afterward — and she was a sick person who really needed care. What had happened? “I couldn’t come back without your money,” she said.
So that was a random act of blindness on my part, good evidence of the perils of the terrain and the need to think before each step. I think — I hope — the activist and I understand each other a little better than that.
Hard Cases 72 Comments
When Healers Get Too Friendly
By ABIGAIL ZUGER, M.D.Alex NabaumHard Cases
Dr. Abigail Zuger on the everyday ethical issues doctors face.
The activist became my patient back in the mid-1990s, when H.I.V. was slowly morphing into a treatable disease. He was young then, with a mop of dark curls — excitable, suspicious and frantic about his health. He was convinced the new drugs were pure synthetic poison, a profiteering scam by the government and Big Pharma. He was also feeling sick enough that he thought he might just give them a try
He lurched back and forth between these two incompatible positions once or twice a month, dragging me and my prescription pad behind him in a flurry of abandoned amber plastic bottles. Eventually, though, good sense kicked in and he had to admit that on meds he felt a lot better than otherwise. He managed to retain his contempt for the system while regularly filling his prescriptions. I no longer winced at his name on my schedule.
And now it is suddenly decades later, his H.I.V. has long been perfectly controlled, and he is still fomenting revolution. He used to march and holler; now he works social media with a miserable old desktop computer that keeps breaking down.
As it happens, about a week before one of our infrequent appointments — he barely needs me any more — I had treated myself to a brand new laptop, sending an old perfectly good model into the back of the closet.
Of course I wiped its hard drive clean and gave it to him — for he is my old friend. But (also of course) we met furtively in a back corridor and I carefully concealed the contraband in a nest of old grocery bags — for he is my patient, and gifts to patients …well, we don’t usually do that.
Once again, apparently, we were dealing with two incompatible positions. Everyone knows that professional boundaries guide all medical activity in hospital, office and clinic. But aside from indisputable sexual and financial depredations, no one agrees exactly where these boundaries lie.
Kindness to friend and duty to patient: Are they one and the same? Or separated by a barbed-wire fence? Opinion is all over the map.
At one extreme is the position probably best articulated by one of medicine’s great clinician-scientists, Dr. Donald Seldin of the University of Texas. In a 1981 talk to an audience of physicians, Dr. Seldin deplored “a tendency to construe all sorts of human problems as medical problems” and thus within doctors’ duty and purview to fix. If it isn’t “relief of pain, prevention of disability and postponement of death,” Dr. Seldin said, why then, doctor, leave it alone! He got a standing ovation.
In the opposite corner stands Dr. Gordon Schiff of Harvard’s Brigham and Women’s Hospital, who was issued an official reprimand a few years ago for egregious boundary crossing.
The incident that it set it off: Dr. Schiff (now 63, an experienced senior clinician) had tangled with an insurer on the phone for two hours before he gave up and handed an impoverished patient $30 to pay for her pain pills. A resident observed the transaction and turned him in. But Dr. Schiff is a proud repeat offender, whose past infractions include helping patients get jobs, giving them jobs himself, offering them rides home, extending the occasional dinner invitation and, yes, once handing over a computer.
He was told physicians should stay away from “random acts of kindness” — an activity that may sound harmless but is quite distinct from the practice of medicine, and has its risks. Patients might get too familiar, expect too much.
Dr. Schiff published a long rumination about the incident a few months ago (which, he reported in an interview, has elicited the email equivalent of a standing ovation). In it he considers whom, exactly, the sanctions against befriending patients are designed to protect. The patient in some instances, he concludes, but the doctor in far more. “Let’s not pretend we are imposing limits for patients rather than our own best interests.”
Dr. Schiff draws medicine’s borders around a shared social agenda: doctors help the patient’s health by helping the whole patient. Dr. Seldin’s borders contain specific, technical tasks.
If you think too superficially about all of this, you may begin to hear Dr. Seldin screeching like Ebenezer Scrooge: Are there no charities? Are there no social workers?
But it’s not quite that simple. I too handed out the odd $20 bill at work without thinking much about it, until I didn’t see one patient for almost a full year afterward — and she was a sick person who really needed care. What had happened? “I couldn’t come back without your money,” she said.
So that was a random act of blindness on my part, good evidence of the perils of the terrain and the need to think before each step. I think — I hope — the activist and I understand each other a little better than that.
A version of this article appears in print on 11/12/2013, on page D6 of the NewYork edition with the headline: When Healers Get Too Friendly.
From the Editor's Desk
Malaysian politics
http://www.themalaysianinsider.com/opinion/ahmad-fuad-rahmat/article/factors-behind-the-anti-shia-attacks
Factors behind the anti-Shia attacks
August 17, 2013Latest Update: August 17, 2013 08:14 am
The current attacks against Shias in Malaysia are linked to four interacting factors
1. The Syrian Civil War
Any informed view of the current Syrian conflict will conclude that it is primarily caused by geopolitics. The interest of The United States and Israel is to dismantle Bashar Assad's regime, since it is a key strategic ally for Hezbollah and Iran.
Hezbollah and Iran are the only two remaining forces in the region that can pose a significant threat to the occupation of Palestine and America's wider interest in the Middle East, and they also happen to be Shia.
The claim that the Syrian conflict is essentially sectarian is therefore the projection and/or exploitation of suspicions against Shias to match the current political mood.
This has been brewing for some time. One case in point was the 2006 Israeli invasion of Southern Lebanon (Hezbollah's stronghold) where many Sunni Muslim figureheads called for the support of Israel while smearing Shias as the greater enemy for their supposedly deviant ways.
Hezbollah's victory, however, made it very popular in the Arab World, as it demonstrated certain courage and resolve against the Zionist occupation that was lacking among the majority of Arab governments, who often appear to be more willing to work with Israel's demands.
But the sympathies it garnered then are certainly waning. Eminent and influential cleric Yusuf Al Qardawi openly labelled Hezbollah as the Party of Satan while calling for Sunnis to join the fight for Assad's downfall.
Two widely-read newspapers, Ashraq al-Awsat and Al-Hayat, have condemned Hezbollah's support for Assad and their eventual participation into the civil war. In the meantime, tensions are compounded as Sunni-Shia skirmishes in Lebanon and Iraq are mutating into further confrontation and violence, heightening insecurities.
All of the above weave together to form a sectarian narrative of the Syrian conflict which is increasingly pervasive.
What does any of this have to do with Malaysia? Like much of the Islamic world, developments in the Middle East feature prominently in Muslim discourse. There is, for one, the inevitable historical references: the Arabian Peninsula was where Islam began, and Baghdad was where its Golden Age took shape. Egypt stands out not only for Al-Azhar University but also for where the Muslim Brotherhood - the pioneering political Islamic movement of the 20th century - began.
The recent outrage towards the ouster of Muhammad Morsi, so strongly declared by Muslim organisations aligned to both Barisan Nasional and Pakatan Rakyat, is just one example of how strongly sentiments from the Middle East can resonate here.
There is also a more direct connection. As of 2010, there are more than 10 thousand Malaysians studying in Jordan, Saudi Arabia, Yemen and Egypt, majoring in Islamic studies, medicine, engineering and business. This annual cycle of graduates returning from the Middle East has been in motion since the 1980s, and with it, the importation of the prevailing sentiments there.
Sensitivity towards the Syrian conflict is therefore not exempt from the view here. While there is, rightly, much outrage against Bashar Assad's tyrannical rule, this has largely been expressed in the Middle East and Malaysia alike in sectarian terms, thereby fueling further hostility towards Malay Malaysian Shias.
2. The influence of religious men
Many influential ustaz have gone on record to cast Shias in a negative light. It is not surprising to see the usual host of conservatives engaging in the vilification, although the Shia case is unique in that it evokes animosity even from across the partisan divide. Even ustaz who are otherwise apolitical are partaking.
The list is astonishingly long. It includes Muhammad Asri Zainul Abidin, Fathul Bari, Zahazan Mohamed, Zaharuddin Abdul Rahman, Aizam Mas'od, Fadlan Othman, Azwira Abdul Aziz, Abdul Basit Abdul Rahman,Abdullah Yasin and Abdullah Din among others (many of them, incidentally, are also graduates of Islamic higher education in Jordan).
Some of their premises evoke the current situation in Syria, although for the most part they underscore doctrinal differences.
There are of course ulama who have resisted the bandwagon. Hadi Awang's take on Syria, for example, is timely and accurate. But by and large negative sentiments are finding more appeal largely because the influence of religious personalities with access to mosques and the media.
3. Political convenience
The prevalence of such sentiments presents an opportunity for political exploitation: Put simply, Shias make good fictional villains to scare the Sunni Malay majority with. Christians make for convenient external bogeymen, but with Shias, fears of an "internal" threat can be stoked.
At any rate, what we are witnessing at the moment is only the beginning. This will continue to have distinct manifestations in different contexts. Kedah is interesting to note for its longstanding Shia population (descendants of the Shia community in Melaka from generations ago who fled to Southern Thailand after the Portuguese defeated the Sultanate).
Whole Shia villages exist today and while the occasional and minor bickering with Sunnis are not unheard of, the situation does not call for the kind of sweeping panic urged by religious authorities.
Is it also a plot to destabilize PAS? Mat Sabu himself has claimed that it is directed toward his ouster. But it is interesting to note that the daily vilifications from so many official and unofficial quarters have not resulted to anything more than the odd finger pointing and rumor mongering.
Moreover, it is not as if this is the first time that the Shia scare tactic is being used against the party. If much will change in the direction PAS takes after the Muktamar, it will be unlikely due to the current anti-Shia fever, which when viewed from a larger perspective is pale in comparison to the challenges the party had survived in the past.
The fact remains that arguments for a strong state, what more one with religious legitimacy, are always much easier to sell in a climate of fear. As it stands, it seems likely and tragically that the Malaysian Shia community will be collateral damage for the political interests of whichever career politician of the week looking to boost their religious credentials.
4. A conservative culture
The easy answer is to point to the authorities as the force behind all religious divisions and fear mongering in this country. While there is truth to this, it is the incomplete picture.
For one, a great deal, if not most, of the anti-Shia sentiments are stoked by Muslim preachers who are not aligned to any formal religious institutions (who one would also be accurate to identify as more PR leaning).
Furthermore, fear would not travel so far and wide if there isn't a mass to find it convincing in the first place. We shouldn't view society as comprised solely of malleable individuals with no sense of their own agency.
In an age of information, fear too is a choice, what more in a setting like Malaysia where power is viewed in terms of communal competition, in which the vilification of Shias is just one dimension. - August 17, 2013.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.
http://www.nytimes.com/2011/01/28/world/asia/28iht-malay28.html?pagewanted=all&_r=0
Such acceptance does not extend to Malaysia’s religious authorities.
The Constitution guarantees freedom of religion, but when it comes to Islam, the country’s official religion, only the Sunni sect is permitted. Other forms, including Shiite Islam, are considered deviant and are not allowed to be spread.
Mr. Mohammad was one of 130 Shiites detained by the religious authorities in December as they observed Ashura, the Shiite holy day commemorating the death of the Prophet Muhammad’s grandson Ali, in their prayer room in an outer suburb of Kuala Lumpur.
There are no official figures on the number of Shiites in Malaysia, but Shiite leaders estimate that there could be as many as 40,000, many of whom practice their faith secretly.
While sectarian divisions are associated more with countries such as Iraq and Pakistan, Islamic experts say Malaysia is a rare example of a Muslim-majority country where the Shiite sect is banned. They say the recent raid reflects the religious authorities’ reluctance to accept diversity within Islam, and was part of the authorities’ continuing efforts to impose a rigid interpretation of the religion.
Although there had been some earlier arrests of Shiites since the National Fatwa Council, the country’s top Islamic body, clarified that Sunni Islam was the official religion in 1996, the December raid on the prayer room occupied by the Lovers of the Prophet’s Household was the first in recent years, according to the Shiite group’s Iranian-trained leader, Kamil Zuhairi bin Abdul Aziz.
Mr. Kamil and the other Shiites who were detained in the raid have been summoned to appear before the Shariah court for hearings scheduled for March and April to answer charges that they insulted the religious authorities and that they denied, violated or disputed a fatwa. The offenses are punishable by a fine of up to 3,000 ringgit, about $981, imprisonment for up to two years, or both.
On a recent evening, a small group of men and a handful of women with toddlers in tow climbed the three flights of stairs to the prayer room where the raid had taken place.
A sign atop the building, which is sandwiched between a mechanic’s workshop and a small cafe on a quiet suburban street, reads “House of Knowledge.” A Koranic verse in Arabic marks the entrance.
Inside the prayer room, the flags of Malaysia and the state of Selangor flank a red and black banner bearing the name of Muhammad’s grandson.
As many as 100 Shiites attend prayers led by Mr. Kamil each week, although he said many Malaysian followers worship privately. “Most of the Shia are in hiding because of the oppression,” he said.
He said some fear they will be discriminated against when they apply for jobs if it is known that they are Shiites, while others are afraid of being detained by the religious authorities.
Some Sunni leaders have claimed that Shiites deviate from the true form of Islam and represent a “threat to national security,” according to Mr. Kamil. He said some Sunni leaders, alluding to violence in Iraq and Pakistan, have alleged that Shiite Islam permits the killing of Sunnis, an accusation he emphatically denied.
Since the raid, the group has installed a security grill in the stairwell leading to their prayer room, where a black curtain divides the men’s section from the women’s.
But Mr. Kamil and others attending the prayer session this evening insisted that they were not afraid to continue practicing their beliefs. “We are not in fear, but we live in difficulty,” he said.
Calling for dialogue with the Sunni majority, Mr. Kamil insisted that Malaysian Shiites, some of whom are married to Sunnis, want to live in harmony with all other religions.
A statement issued by a spokesman for the federal government said the Constitution guaranteed religious freedom to all Malaysians, and that the National Fatwa Council was responsible for guiding the practice of Islam in Malaysia.
“In 1996, the National Fatwa Council issued a ruling that Sunni Islam is the official faith of Muslims in Malaysia. Under this ruling, which is enforced by Islamic affairs departments in each Malaysian state, Shia Muslims are free to practice their faith, but are not permitted to proselytize,” the statement said.
“It would be inappropriate for the federal government to comment further on this state-based matter.”
The Selangor State Islamic Religious Department, which carried out the raid, did not respond to repeated requests for comment.
Harussani Zakaria, a member of the National Fatwa Council, said allowing different sects to practice in Malaysia could lead to disputes. “It already happens in some countries,” he said in a telephone interview. “We don’t want that to come here.”
Chandra Muzaffar, president of the International Movement for a Just World, a nongovernment organization based in Malaysia, said while there may be differences among the various sects, Shiites are part of the Muslim community. “It’s just wrong to describe Shia as deviants,” he said.
Greg Barton, acting director of the Center for Islam and the Modern World at Monash University in Melbourne, said that Malaysia’s religious authorities had adopted a more rigid approach to Islam in recent decades and that space for public discussion of religion had narrowed under the influence of “Saudi Salafism and Egyptian Brotherhood prejudice.”
“The group that speaks formally for Malaysian Islam is a very narrow group who have taken a very puritanical approach,” said Mr. Barton. “The religious bureaucracy has become a very meddling bureaucracy. It has a very pernicious impact on religious freedom, not just for non-Muslims but for Muslims as well.”
Mr. Barton said while there were no precise figures, there are probably tens of thousands of Shiites in Southeast Asia, most in Malaysia and Indonesia.
Mariyah Qibti, who teaches Shiite Islam to children at the prayer room on Sundays, has experienced firsthand the two countries’ differing approaches to Shiites. Born to a Shiite family in Indonesia, Ms. Mariyah went to Iran when she was 19 to pursue Islamic studies. Two years ago she married a Malaysian Shiite, and moved to Kuala Lumpur.
Feeding her 1-year-old son as she sat on a rug at the back of the prayer room, she said that, in contrast to Malaysia, in Indonesia Shiites could practice their faith freely.
Despite her looming court appearance in March, she says she is not afraid to continue practicing her beliefs.
“This is part of the risk of being followers of Shia,” she said.
Factors behind the anti-Shia attacks
August 17, 2013Latest Update: August 17, 2013 08:14 am
Ahmad Fuad Rahmat also writes for the ProjekDialog.com collective and is a member of the Islamic Renaisance Front. He works for the Centre for Independent Journalism and is a co-host for Night School on BFM Radio. He was trained in political philosophy.
1. The Syrian Civil War
Hezbollah and Iran are the only two remaining forces in the region that can pose a significant threat to the occupation of Palestine and America's wider interest in the Middle East, and they also happen to be Shia.
The claim that the Syrian conflict is essentially sectarian is therefore the projection and/or exploitation of suspicions against Shias to match the current political mood.
This has been brewing for some time. One case in point was the 2006 Israeli invasion of Southern Lebanon (Hezbollah's stronghold) where many Sunni Muslim figureheads called for the support of Israel while smearing Shias as the greater enemy for their supposedly deviant ways.
Hezbollah's victory, however, made it very popular in the Arab World, as it demonstrated certain courage and resolve against the Zionist occupation that was lacking among the majority of Arab governments, who often appear to be more willing to work with Israel's demands.
But the sympathies it garnered then are certainly waning. Eminent and influential cleric Yusuf Al Qardawi openly labelled Hezbollah as the Party of Satan while calling for Sunnis to join the fight for Assad's downfall.
Two widely-read newspapers, Ashraq al-Awsat and Al-Hayat, have condemned Hezbollah's support for Assad and their eventual participation into the civil war. In the meantime, tensions are compounded as Sunni-Shia skirmishes in Lebanon and Iraq are mutating into further confrontation and violence, heightening insecurities.
All of the above weave together to form a sectarian narrative of the Syrian conflict which is increasingly pervasive.
What does any of this have to do with Malaysia? Like much of the Islamic world, developments in the Middle East feature prominently in Muslim discourse. There is, for one, the inevitable historical references: the Arabian Peninsula was where Islam began, and Baghdad was where its Golden Age took shape. Egypt stands out not only for Al-Azhar University but also for where the Muslim Brotherhood - the pioneering political Islamic movement of the 20th century - began.
The recent outrage towards the ouster of Muhammad Morsi, so strongly declared by Muslim organisations aligned to both Barisan Nasional and Pakatan Rakyat, is just one example of how strongly sentiments from the Middle East can resonate here.
There is also a more direct connection. As of 2010, there are more than 10 thousand Malaysians studying in Jordan, Saudi Arabia, Yemen and Egypt, majoring in Islamic studies, medicine, engineering and business. This annual cycle of graduates returning from the Middle East has been in motion since the 1980s, and with it, the importation of the prevailing sentiments there.
Sensitivity towards the Syrian conflict is therefore not exempt from the view here. While there is, rightly, much outrage against Bashar Assad's tyrannical rule, this has largely been expressed in the Middle East and Malaysia alike in sectarian terms, thereby fueling further hostility towards Malay Malaysian Shias.
2. The influence of religious men
Many influential ustaz have gone on record to cast Shias in a negative light. It is not surprising to see the usual host of conservatives engaging in the vilification, although the Shia case is unique in that it evokes animosity even from across the partisan divide. Even ustaz who are otherwise apolitical are partaking.
The list is astonishingly long. It includes Muhammad Asri Zainul Abidin, Fathul Bari, Zahazan Mohamed, Zaharuddin Abdul Rahman, Aizam Mas'od, Fadlan Othman, Azwira Abdul Aziz, Abdul Basit Abdul Rahman,Abdullah Yasin and Abdullah Din among others (many of them, incidentally, are also graduates of Islamic higher education in Jordan).
Some of their premises evoke the current situation in Syria, although for the most part they underscore doctrinal differences.
There are of course ulama who have resisted the bandwagon. Hadi Awang's take on Syria, for example, is timely and accurate. But by and large negative sentiments are finding more appeal largely because the influence of religious personalities with access to mosques and the media.
3. Political convenience
The prevalence of such sentiments presents an opportunity for political exploitation: Put simply, Shias make good fictional villains to scare the Sunni Malay majority with. Christians make for convenient external bogeymen, but with Shias, fears of an "internal" threat can be stoked.
At any rate, what we are witnessing at the moment is only the beginning. This will continue to have distinct manifestations in different contexts. Kedah is interesting to note for its longstanding Shia population (descendants of the Shia community in Melaka from generations ago who fled to Southern Thailand after the Portuguese defeated the Sultanate).
Whole Shia villages exist today and while the occasional and minor bickering with Sunnis are not unheard of, the situation does not call for the kind of sweeping panic urged by religious authorities.
Is it also a plot to destabilize PAS? Mat Sabu himself has claimed that it is directed toward his ouster. But it is interesting to note that the daily vilifications from so many official and unofficial quarters have not resulted to anything more than the odd finger pointing and rumor mongering.
Moreover, it is not as if this is the first time that the Shia scare tactic is being used against the party. If much will change in the direction PAS takes after the Muktamar, it will be unlikely due to the current anti-Shia fever, which when viewed from a larger perspective is pale in comparison to the challenges the party had survived in the past.
The fact remains that arguments for a strong state, what more one with religious legitimacy, are always much easier to sell in a climate of fear. As it stands, it seems likely and tragically that the Malaysian Shia community will be collateral damage for the political interests of whichever career politician of the week looking to boost their religious credentials.
4. A conservative culture
The easy answer is to point to the authorities as the force behind all religious divisions and fear mongering in this country. While there is truth to this, it is the incomplete picture.
For one, a great deal, if not most, of the anti-Shia sentiments are stoked by Muslim preachers who are not aligned to any formal religious institutions (who one would also be accurate to identify as more PR leaning).
Furthermore, fear would not travel so far and wide if there isn't a mass to find it convincing in the first place. We shouldn't view society as comprised solely of malleable individuals with no sense of their own agency.
In an age of information, fear too is a choice, what more in a setting like Malaysia where power is viewed in terms of communal competition, in which the vilification of Shias is just one dimension. - August 17, 2013.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.
http://www.nytimes.com/2011/01/28/world/asia/28iht-malay28.html?pagewanted=all&_r=0
In a Muslim State, Fear Sends Some Worship Underground
By LIZ GOOCH
Published: January 27, 2011
KUALA LUMPUR — Like most Muslims in Malaysia, Mohammad Shah was raised according to the Sunni school of Islam. But when he was about 30, he said, he came to believe that Sunni teachings did not answer all of his questions about Islam. He began reading about the Shiite school of thought, the world’s second largest Islamic sect, and decided that “Sunni was not right for me.”
“I consider myself the new generation of Malaysian Shia,” said Mr. Mohammad, 33, using another term to describe Shiites. “My father is Sunni, my mother is Sunni. They are aware that I’m practicing a different school of thought. It’s no problem at all.” Such acceptance does not extend to Malaysia’s religious authorities.
The Constitution guarantees freedom of religion, but when it comes to Islam, the country’s official religion, only the Sunni sect is permitted. Other forms, including Shiite Islam, are considered deviant and are not allowed to be spread.
Mr. Mohammad was one of 130 Shiites detained by the religious authorities in December as they observed Ashura, the Shiite holy day commemorating the death of the Prophet Muhammad’s grandson Ali, in their prayer room in an outer suburb of Kuala Lumpur.
There are no official figures on the number of Shiites in Malaysia, but Shiite leaders estimate that there could be as many as 40,000, many of whom practice their faith secretly.
While sectarian divisions are associated more with countries such as Iraq and Pakistan, Islamic experts say Malaysia is a rare example of a Muslim-majority country where the Shiite sect is banned. They say the recent raid reflects the religious authorities’ reluctance to accept diversity within Islam, and was part of the authorities’ continuing efforts to impose a rigid interpretation of the religion.
Although there had been some earlier arrests of Shiites since the National Fatwa Council, the country’s top Islamic body, clarified that Sunni Islam was the official religion in 1996, the December raid on the prayer room occupied by the Lovers of the Prophet’s Household was the first in recent years, according to the Shiite group’s Iranian-trained leader, Kamil Zuhairi bin Abdul Aziz.
Mr. Kamil and the other Shiites who were detained in the raid have been summoned to appear before the Shariah court for hearings scheduled for March and April to answer charges that they insulted the religious authorities and that they denied, violated or disputed a fatwa. The offenses are punishable by a fine of up to 3,000 ringgit, about $981, imprisonment for up to two years, or both.
On a recent evening, a small group of men and a handful of women with toddlers in tow climbed the three flights of stairs to the prayer room where the raid had taken place.
A sign atop the building, which is sandwiched between a mechanic’s workshop and a small cafe on a quiet suburban street, reads “House of Knowledge.” A Koranic verse in Arabic marks the entrance.
Inside the prayer room, the flags of Malaysia and the state of Selangor flank a red and black banner bearing the name of Muhammad’s grandson.
As many as 100 Shiites attend prayers led by Mr. Kamil each week, although he said many Malaysian followers worship privately. “Most of the Shia are in hiding because of the oppression,” he said.
He said some fear they will be discriminated against when they apply for jobs if it is known that they are Shiites, while others are afraid of being detained by the religious authorities.
Some Sunni leaders have claimed that Shiites deviate from the true form of Islam and represent a “threat to national security,” according to Mr. Kamil. He said some Sunni leaders, alluding to violence in Iraq and Pakistan, have alleged that Shiite Islam permits the killing of Sunnis, an accusation he emphatically denied.
Since the raid, the group has installed a security grill in the stairwell leading to their prayer room, where a black curtain divides the men’s section from the women’s.
But Mr. Kamil and others attending the prayer session this evening insisted that they were not afraid to continue practicing their beliefs. “We are not in fear, but we live in difficulty,” he said.
Calling for dialogue with the Sunni majority, Mr. Kamil insisted that Malaysian Shiites, some of whom are married to Sunnis, want to live in harmony with all other religions.
A statement issued by a spokesman for the federal government said the Constitution guaranteed religious freedom to all Malaysians, and that the National Fatwa Council was responsible for guiding the practice of Islam in Malaysia.
“In 1996, the National Fatwa Council issued a ruling that Sunni Islam is the official faith of Muslims in Malaysia. Under this ruling, which is enforced by Islamic affairs departments in each Malaysian state, Shia Muslims are free to practice their faith, but are not permitted to proselytize,” the statement said.
“It would be inappropriate for the federal government to comment further on this state-based matter.”
The Selangor State Islamic Religious Department, which carried out the raid, did not respond to repeated requests for comment.
Harussani Zakaria, a member of the National Fatwa Council, said allowing different sects to practice in Malaysia could lead to disputes. “It already happens in some countries,” he said in a telephone interview. “We don’t want that to come here.”
Chandra Muzaffar, president of the International Movement for a Just World, a nongovernment organization based in Malaysia, said while there may be differences among the various sects, Shiites are part of the Muslim community. “It’s just wrong to describe Shia as deviants,” he said.
Greg Barton, acting director of the Center for Islam and the Modern World at Monash University in Melbourne, said that Malaysia’s religious authorities had adopted a more rigid approach to Islam in recent decades and that space for public discussion of religion had narrowed under the influence of “Saudi Salafism and Egyptian Brotherhood prejudice.”
“The group that speaks formally for Malaysian Islam is a very narrow group who have taken a very puritanical approach,” said Mr. Barton. “The religious bureaucracy has become a very meddling bureaucracy. It has a very pernicious impact on religious freedom, not just for non-Muslims but for Muslims as well.”
Mr. Barton said while there were no precise figures, there are probably tens of thousands of Shiites in Southeast Asia, most in Malaysia and Indonesia.
Mariyah Qibti, who teaches Shiite Islam to children at the prayer room on Sundays, has experienced firsthand the two countries’ differing approaches to Shiites. Born to a Shiite family in Indonesia, Ms. Mariyah went to Iran when she was 19 to pursue Islamic studies. Two years ago she married a Malaysian Shiite, and moved to Kuala Lumpur.
Feeding her 1-year-old son as she sat on a rug at the back of the prayer room, she said that, in contrast to Malaysia, in Indonesia Shiites could practice their faith freely.
Despite her looming court appearance in March, she says she is not afraid to continue practicing her beliefs.
“This is part of the risk of being followers of Shia,” she said.
Thursday, October 31, 2013
Poem - stopping by woods on a snowy evening
Stopping by Woods on a Snowy Evening
Whose woods these are I think I know.
His house is in the village, though;
He will not see me stopping here
To watch his woods fill up with snow.
My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.
He gives his harness bells a shake
To ask if there is some mistake.
The only other sound's the sweep
Of easy wind and downy flake.
The woods are lovely, dark, and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.
His house is in the village, though;
He will not see me stopping here
To watch his woods fill up with snow.
My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.
He gives his harness bells a shake
To ask if there is some mistake.
The only other sound's the sweep
Of easy wind and downy flake.
The woods are lovely, dark, and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.
Robert Frost
Saturday, October 26, 2013
an article on dissection
http://www.jsonline.com/news/health/The-Course-of-Their-Lives-Medical-College-of-Wisconsin-students-gross-anatomy-class-225058322.html#!/the-first-cut/
(Read the article on the weblink above - contains much more)
The noisy, first-day-of-school chatter subsides. A hush falls over 200 students in a lecture hall at the Medical College of Wisconsin.
Already, their thoughts are drifting up a flight of stairs to the sprawling dissection lab, where in two days they will meet and become intimate with something many have scarcely encountered: Death.
Khalid Sharif-Sidi, a 24-year-old from Galesburg, Ill., who has never seen a lifeless human body beyond a few seconds at a funeral, is nervous. He wonders if it will look real or fake, if the person will have tattoos or nail polish or piercings. He wants the body he dissects to look anything but real.
Andrew Kleist, a cardiologist's son from Pittsburgh, who shadowed his father often, and last May watched him unblock a heart attack patient's artery at 2 in the morning, feels excited but uncomfortable. The 23-year-old has been thinking about the body upstairs and what he must do to it — not just a body, a person.
Hillary McLaren, a 23-year-old from Neenah who hopes to become the fourth generation in her family to practice medicine, has been steeling herself for the sight of the cadaver. Her mantra: "Don't be that girl who passes out on the first day of anatomy."
Today they begin the defining course of their medical education.
A required rite of passage on the way to a doctor's white coat, gross anatomy offers first-year students a hands-on tour of an actual human body, the chance to cut into leathery skin and sinewy muscle, to see pale, stringy nerves that run through the legs like wires, to manipulate tendons in the arms and watch the corresponding fingers move.
To hold a human heart.
To feel the moist ridges of a brain.
Before the young students meet their cadavers, they focus up front, where a projector beams the videotaped image of a woman named Geraldine Fotsch.
Fotsch is just days from her 80th birthday. She prefers to be called "Nana," in homage to her 30 grandchildren. And she has made a decision these doctors-to-be will have to consider each time they wield a scalpel over the next five months.
Upon her death, she will not be cremated or buried — not right away. She has decided instead to allow medical students, young men and women like those watching her videotaped image, to dissect and learn from her body.
It won't be these students, of course. Nana was — and is still — very much alive. But her words will be the closest this class comes to understanding the anonymous human beings they are going to take apart.
In the video, she sits beside her interviewer, Todd Hoagland, associate professor for gross anatomy and a young man himself.
What would you like the students to know? he asks.
"I would want them to know it's OK to grow old. It's great to be old."
She shakes her head vigorously, aware she is contradicting a common image of aging.
"Grandchildren are the light of your life," she says. "I would not give up this time in my life for anything."
Do you have any fear of dying?
"I'm a little apprehensive," she says. "I figure I'm not sure if I've collected enough brownie points to go directly up."
She smiles and points toward the ceiling. The students laugh.
Has it been explained what will happen to your body?
"It has," she says, "and that's fine, because I'm not around. I'm someplace else.
"This is my gift to you. Do with it what you want."
While much in medicine has changed over the last century, no teaching tool has replaced the gift of a human body.
X-rays, MRIs and CT scans allow medical students to see inside flesh and bone to the sources of injury and disease. Special mannequins help future surgeons hone their incision techniques. Computer programs simulate what it is like to strip off skin.
Yet gross anatomy remains a throwback to 500 years ago, when Leonardo da Vinci dissected cadavers to learn the subject of his art.
Today's embalming techniques preserve the body better. Dissection is no longer a two-day sprint to outrun decay. In most other respects, however, technology has not changed or improved the basic process.
"I don't think there's any way you could reproduce the experience of actual dissection," says Christopher Ruff, professor and director of the Center for Functional Anatomy and Evolution at Johns Hopkins University School of Medicine.
No mannequin or computer can duplicate the force it takes to guide a scalpel through fat and fascia, the connective tissue.
A computer can't capture the diversity of human bodies, the way muscle appears pale yellow in some, the color of red clay in others.
Most of all, a computer cannot fully prepare students for the difference between the beautiful color illustrations in the textbooks and the actual bones, organs and arteries they will encounter in their patients. Textbooks show structures of the young and healthy. The patients in a doctor's office are usually older and sicker.
Hoagland remembers dissecting a cadaver in medical school, studying the networks that send blood and oxygen and brain impulses through the body.
"It was the first class I'd ever taken where the light bulbs kept going off," he says. "I had been a biology major, but I didn't have a sense of how it all fit together. This was like looking at a car as a whole system, instead of just getting all of the little pieces. It's seeing how the pieces all operate in a person. If you understand the big picture, all of the rest starts falling into place."
It is a fitting place to begin. Students start with the foundations they will use their entire careers — the map and the vocabulary necessary to communicate with anyone in medicine.
But gross anatomy also provides something less scientific. Students share an experience that will bond them long after they have graduated, entered practice and forgotten most of their time in medical school.
"This is an elucidation of death and dying," Hoagland says. "It's a way for students who have never experienced that to confront it."
That first class, on a Monday in August 2012, Hoagland tells the students what he expects.
Get to class early. Be scholarly and professional at all times.
No flip-flops in the lab. No shorts. No iPods.
Students will work in teams of six. There are 36 teams; 36 bodies.
Don't talk about the donors in the elevator.
Don't discuss them at Starbucks.
"Treat them well," Hoagland says. "Be good stewards of the gift. These are some of the most altruistic people around. They donate knowing what we are going to do to the body."
It was six years ago that Nana Fotsch and her husband, Bill "Pa" Fotsch, first considered becoming body donors. They had two grandchildren at medical school taking gross anatomy. Also, two of their children had been through the course on the way to medical degrees.
"There was a reverence they had for their cadavers," Nana Fotsch recalls, singling out her daughter in particular. "Colleen had a cadaver. He was a priest. She thought how wonderful it was that he dedicated himself in life to his faith and society and people. And he did the same thing in death."
The Fotsches did not embark on a lengthy discussion.
"It was just a no-brainer," Nana says. "It was almost like, 'Yeah, this is what you should do.'"
Pa signed up first, Nana followed.
They'd had long, happy lives. They felt lucky. Pa and Nana were high school sweethearts at Niles Township High School in Illinois. They'd dated, decided they couldn't stand each other, then got to college and changed their minds.
In 1954, they married at Our Lady of Perpetual Help, or as kids back then nicknamed it, Old Lady's Pickle House.
The Fotsches struggled at first. When their twins were born six weeks early, before their insurance had kicked in, the couple had to borrow $500 from Pa's father. After hospital expenses "we had nothing left," Nana recalls. "We had to borrow the money just to exist."
Pa spent two years in the Army, serving as a specialist first class, shuttling back and forth between the Frankford Arsenal in Philadelphia and Washington. By then they had three little children. They lived in a tiny apartment in Philadelphia.
After his Army stint, Pa designed special machines for Kearney & Trecker in Milwaukee, then was asked by his father and two partners to run a small tool and die company near South Bend, Ind. The Fotsches skimped on food and clothing, took no vacations and eventually saved enough money to buy out the partners. Later they bought another company called Baush Machine Tool, which made automotive machinery.
The couple moved from Indiana to Wisconsin in 1965. They bought a house in Elm Grove and raised their children; there were eight of them now, a daughter and seven sons.
The Fotsches were do-it-yourselfers, remodeling, pulling the kids into various projects. They bought a vacation place in northern Wisconsin, and that meant a whole new round of repairs and upgrades.
The boys built models and learned carpentry and electrical work. Colleen learned to sew. She was cooking meals and helping her mother with housework in first grade.
"We were a nuts and bolts family," Nana says.
Pa's reverence for fixing things, however, did not extend to the human body, not for some years.
"My husband, to get him to go to a doctor, well, they were all quacks," Nana recalls. "Gradually he changed his mind."
Pa might have been forced to revise his view of doctors had he met the three young men and three young women who gather at Table 1 on the first day of dissection.
They are part of a medical college class that scored in the 85th percentile on the MCAT exams and graduated with a 3.76 (A) grade point average from such schools as Yale, Stanford and the University of Wisconsin-Madison. They include 19-year-old prodigies, valedictorians and published poets. They speak Farsi, Russian, Chinese and Portuguese.
These facts are a source of pride — and anxiety. At their previous schools, the students of Table 1 were all at or near the top; now, wherever they look there's someone just as smart and just as driven.
On this Wednesday afternoon in mid-August, with directions given and dissection minutes away, they have little time for introductions.
Lori Wong is a 24-year-old from Los Angeles whose mother died from kidney and liver failure when Lori was a freshman at the University of Southern California. The experience left Lori a legacy of frustrations (the redundant tests, the doctors who lacked empathy) — and a firm belief that medicine can do better.
Joseph Zilisch is a 22-year-old from Kenosha, who carries this message tattooed on his back, "God will give me justice," and this one programmed on his cell phone screen: "I'm going to be a doctor." As a certified nursing assistant for several years while in college, he diapered and turned over the elderly and dealt with the naked human body until nothing about it bothered him.
Hillary McLaren, the young woman from a medical family, majored in biology and women's studies at the University of Michigan, and she talks of promoting equity in health care. Years ago an aunt learned Hillary was considering becoming a writer and offered this advice: You can always write when you're a doctor. But you can't always be a doctor when you're a writer.
Andrew Kleist, the cardiologist's son from Pittsburgh, is eager to begin dissection, to find out for himself why our bodies endure, or as he puts it, "why they don't just crap out like a Toyota after 15 or 20 years." He expects the experience to raise other questions, admitting, "I can't go to anatomy without thinking where the hell we came from."
Ashley Hinkamper is an outgoing 22-year-old from Quincy, Ill., who began volunteering at her local hospital in eighth grade. To cure herself of an aversion to needles and blood, she watched YouTube videos of blood draws. She cured herself so well that she was able to dissect a human cadaver while an undergraduate at Marquette University.
Khalid Sharif-Sidi, the son of Somali immigrants, saw his father's respect for doctors in that proud smile when Khalid gained admission into medical school. But the academic challenge Sharif-Sidi faces is never far from his thoughts: "I feel like failure is always around the corner," he says.
There is one more member of the group they have yet to meet, someone about whom each of the students has privately wondered and worried: the body.
Kleist believes he is about to disfigure a human being. He tells himself, "You signed up to be a physician, and this is part of it."
McLaren feels more at ease, especially after hearing from Nana Fotsch.
Zilisch keeps turning over in his mind what it would mean to give this gift.
"You're pretty useless lying in a casket," he says. "But I don't know if I'd want to see other people cutting up my grandfather."
The steel table before them is actually a long, raised metallic box, almost a casket. Students open two doors on top, revealing a sunken interior. They step on bars at each end of the table, lifting the interior.
Rising into view is a figure shrouded in white towels. A few pale toes jut out.
The air thickens. An odorous wave of embalming fluid washes over the room.
They unpack scalpels. They leave most of the towels draped over the cadaver, which lies face down. Only the back, where dissection begins, is uncovered. The skin is beige and wrinkly, more like a leather couch than someone's back.
The students look at each other, then at the steel table.
Who will make the first cut?
The tension reminds Sharif-Sidi of one of the last days before the start of medical school. Just a few weeks earlier, he and five friends drove to a remote cabin in the mountains of northern Tennessee.
One day they took a boat out on Norris Lake and decided to scale a steep rock and leap off it into the water. During the climb they all realized it was much higher than they'd thought. At the top, they could see the full expanse of the lake and the mountains beyond, and they waited, all of them.
Five minutes ticked by, maybe 10. Each wondered who would jump first.
That is how Sharif-Sidi feels looking down at the body. He is remembering that when the time came to jump, he waited and went second, and for one very deep breath, his feet were touching nothing at all until they slammed into the water.
So it is that Hinkamper, the only one who has previous experience dissecting a body, gently traces the first incision with her scalpel and begins.
Their professor is 43, but younger looking, tall with a beard and mustache, and a vivid memory of his own professor for gross anatomy.
It was the fall of 1997. Student Todd Hoagland sat in a lecture hall at Indiana University School of Medicine in South Bend listening to professor John O'Malley.
The man was an encyclopedia. He taught without a book, without even notes. Just a blackboard and chalk. A two-hour talk would flow seamlessly.
O'Malley took pains to reduce the distance between teacher and student, to make sure he was not placed on a pedestal. He addressed every student by name. He encouraged questions, praised accomplishments, challenged classes.
His face radiated an enjoyment of life.
"He had this gentle way and he knew everything," Hoagland says.
The human body was Hoagland's other teacher. He still remembers seeing the heart for the first time, how awed he was that this one muscle propels blood throughout the body.
He remembers admiring the elegance of the valves, massaging the coronary arteries with his fingers.
He remembers holding the brain, how densely packed it felt in his hands.
Until gross anatomy, so much of medicine had seemed theoretical. Picturing the work of cells and DNA requires imagination; muscles, nerves and arteries can be seen and felt.
Hoagland has taught gross anatomy for more than 10 years, the last two at the Medical College. Each time, the human body reveals something new. He has examined bodies with an extra cervical rib, an evolutionary holdover that can create a number of problems. He's come across bodies with six lumbar vertebrae instead of five.
He has noticed that different students approach anatomy in different ways. Some have been waiting years for this chance to get under the hood of the human body, to see how it's all wired. Others are nervous, uncertain of what it will feel like to see a preview of their own mortality.
And then there are the Type A students, who come to gross anatomy having led a largely goal-focused existence.
"They haven't had much time to think about their place in life. Where we go when we die," Hoagland says. "How can you not think what it is to be alive when you dissect a hand? How can you not think about who you are when you hold this brain in your hand?"
Hinkamper makes a gentle sawing motion with the scalpel. The skin separates. Fluid appears.
The students follow a manual of plain black-and-white drawings, which have all the aesthetic beauty of directions for putting together a crib. They also refer to Frank H. Netter's "Atlas of Human Anatomy," which has replaced "Gray's Anatomy" at many medical schools. If the manual makes the human body appear dull, Netter makes it appear impossibly beautiful, muscle the color of red wine, bones pure as ivory.
The students have one more source to guide them: Hinkamper, who has done dissection before. As she cuts, she points out fascia, pale connective tissue beneath the skin that wraps over muscles, vessels and nerves.
McLaren makes the next incision.
Sharif-Sidi pulls skin back to the right and left, laying open the inside of the back.
Using scissors, Kleist trims hair from the neck so that it won't impede the scalpel.
Zilisch squeezes skin around the waist, feeling how thick, how firm it is. Then he cuts horizontally across the lower back. Moisture — embalming fluid — seeps up and Hinkamper dabs at it with a paper towel.
Mark L. Harlow, one of five professors who pass from table to table overseeing dissection, shows the students how to let the scalpel follow the path of least resistance. The din of 36 groups of students fills the expansive room, so the members of Table 1 must lean in close to hear him.
As the professors move about demonstrating proper technique, a difference becomes clear. The students cut delicately, almost tentatively.
The professors cut briskly. They tug at skin. They dig their fingers beneath muscle or other tissue in order to reach the structures beneath.
"The idea is to find the things," explains associate professor, David Bolender, addressing the students at Table 1. "You don't need to make the dissection look like a picture in an atlas."
Gradually, the students apply more pressure as they cut. They are careful, knowing they are being graded on the quality of their dissection, knowing, too, that no tissue is to hit the floor.
Every piece must be placed inside a gray plastic tub to be cremated later with the rest of the remains.
After almost three hours when they have finished for the day, they wash the scalpels. They clean the table and reposition the flaps of skin that have been pulled back. They place the arms at the body's sides and draw the white towels over the top. Then, using the foot control, they lower the body back into the sunken portion of the table. All around them, bodies sink back into the other steel tables.
The room empties.
The students at Table 1 were so busy that they missed something. They do not know whether they are dissecting a man or a woman.
Only the next day do they notice the tag attached to their table. On it someone has drawn a little figure in red magic marker.
(Read the article on the weblink above - contains much more)
The First Cut
The Course of Their Lives
Chapter One
The First Cut
Already, their thoughts are drifting up a flight of stairs to the sprawling dissection lab, where in two days they will meet and become intimate with something many have scarcely encountered: Death.
Khalid Sharif-Sidi, a 24-year-old from Galesburg, Ill., who has never seen a lifeless human body beyond a few seconds at a funeral, is nervous. He wonders if it will look real or fake, if the person will have tattoos or nail polish or piercings. He wants the body he dissects to look anything but real.
Andrew Kleist, a cardiologist's son from Pittsburgh, who shadowed his father often, and last May watched him unblock a heart attack patient's artery at 2 in the morning, feels excited but uncomfortable. The 23-year-old has been thinking about the body upstairs and what he must do to it — not just a body, a person.
Hillary McLaren, a 23-year-old from Neenah who hopes to become the fourth generation in her family to practice medicine, has been steeling herself for the sight of the cadaver. Her mantra: "Don't be that girl who passes out on the first day of anatomy."
Today they begin the defining course of their medical education.
A required rite of passage on the way to a doctor's white coat, gross anatomy offers first-year students a hands-on tour of an actual human body, the chance to cut into leathery skin and sinewy muscle, to see pale, stringy nerves that run through the legs like wires, to manipulate tendons in the arms and watch the corresponding fingers move.
To hold a human heart.
To feel the moist ridges of a brain.
Before the young students meet their cadavers, they focus up front, where a projector beams the videotaped image of a woman named Geraldine Fotsch.
Rick Wood / Journal Sentinel
Geraldine 'Nana' Fotsch is the subject of a video shown to the students on their first day of gross anatomy class. Her late husband, Bill, agreed to allow medical students to dissect and learn from his body when he died. Nana has agreed to do the same. Watch the video
Upon her death, she will not be cremated or buried — not right away. She has decided instead to allow medical students, young men and women like those watching her videotaped image, to dissect and learn from her body.
It won't be these students, of course. Nana was — and is still — very much alive. But her words will be the closest this class comes to understanding the anonymous human beings they are going to take apart.
In the video, she sits beside her interviewer, Todd Hoagland, associate professor for gross anatomy and a young man himself.
What would you like the students to know? he asks.
"I would want them to know it's OK to grow old. It's great to be old."
She shakes her head vigorously, aware she is contradicting a common image of aging.
"Grandchildren are the light of your life," she says. "I would not give up this time in my life for anything."
Do you have any fear of dying?
"I'm a little apprehensive," she says. "I figure I'm not sure if I've collected enough brownie points to go directly up."
She smiles and points toward the ceiling. The students laugh.
Has it been explained what will happen to your body?
"It has," she says, "and that's fine, because I'm not around. I'm someplace else.
"This is my gift to you. Do with it what you want."
X-rays, MRIs and CT scans allow medical students to see inside flesh and bone to the sources of injury and disease. Special mannequins help future surgeons hone their incision techniques. Computer programs simulate what it is like to strip off skin.
Yet gross anatomy remains a throwback to 500 years ago, when Leonardo da Vinci dissected cadavers to learn the subject of his art.
The Evolution of Gross Anatomy
Modern anatomical studies began in the universities and academies of 16th-century Italy.
1500s: An early textbook was Andreas Vesalius' De Humani Corporis Fabrica, printed in 1543. Vesalius is considered the founder of modern human anatomy.
1770s: Scottish anatomist and physician William Hunter offered public demonstrations at the Royal Academy in London for sculptors, painters and paying members of the public.
1790: For years dissection laws were geared not toward the educational needs of doctors in training but toward punishing criminals. A 1790 U.S. law gave federal judges the right to add dissection to the death sentence for murder.
Early 1990s: By the beginning of the 20th century most cadavers used by medical schools were unclaimed bodies.
"I don't think there's any way you could reproduce the experience of actual dissection," says Christopher Ruff, professor and director of the Center for Functional Anatomy and Evolution at Johns Hopkins University School of Medicine.
No mannequin or computer can duplicate the force it takes to guide a scalpel through fat and fascia, the connective tissue.
A computer can't capture the diversity of human bodies, the way muscle appears pale yellow in some, the color of red clay in others.
Most of all, a computer cannot fully prepare students for the difference between the beautiful color illustrations in the textbooks and the actual bones, organs and arteries they will encounter in their patients. Textbooks show structures of the young and healthy. The patients in a doctor's office are usually older and sicker.
Hoagland remembers dissecting a cadaver in medical school, studying the networks that send blood and oxygen and brain impulses through the body.
"It was the first class I'd ever taken where the light bulbs kept going off," he says. "I had been a biology major, but I didn't have a sense of how it all fit together. This was like looking at a car as a whole system, instead of just getting all of the little pieces. It's seeing how the pieces all operate in a person. If you understand the big picture, all of the rest starts falling into place."
It is a fitting place to begin. Students start with the foundations they will use their entire careers — the map and the vocabulary necessary to communicate with anyone in medicine.
But gross anatomy also provides something less scientific. Students share an experience that will bond them long after they have graduated, entered practice and forgotten most of their time in medical school.
"This is an elucidation of death and dying," Hoagland says. "It's a way for students who have never experienced that to confront it."
That first class, on a Monday in August 2012, Hoagland tells the students what he expects.
Get to class early. Be scholarly and professional at all times.
No flip-flops in the lab. No shorts. No iPods.
Students will work in teams of six. There are 36 teams; 36 bodies.
Don't talk about the donors in the elevator.
Don't discuss them at Starbucks.
"Treat them well," Hoagland says. "Be good stewards of the gift. These are some of the most altruistic people around. They donate knowing what we are going to do to the body."
We view every gift as special and precious
— Todd Hoagland
"There was a reverence they had for their cadavers," Nana Fotsch recalls, singling out her daughter in particular. "Colleen had a cadaver. He was a priest. She thought how wonderful it was that he dedicated himself in life to his faith and society and people. And he did the same thing in death."
The Fotsches did not embark on a lengthy discussion.
"It was just a no-brainer," Nana says. "It was almost like, 'Yeah, this is what you should do.'"
Pa signed up first, Nana followed.
They'd had long, happy lives. They felt lucky. Pa and Nana were high school sweethearts at Niles Township High School in Illinois. They'd dated, decided they couldn't stand each other, then got to college and changed their minds.
View photos in a gallery
The Fotsches struggled at first. When their twins were born six weeks early, before their insurance had kicked in, the couple had to borrow $500 from Pa's father. After hospital expenses "we had nothing left," Nana recalls. "We had to borrow the money just to exist."
Pa spent two years in the Army, serving as a specialist first class, shuttling back and forth between the Frankford Arsenal in Philadelphia and Washington. By then they had three little children. They lived in a tiny apartment in Philadelphia.
After his Army stint, Pa designed special machines for Kearney & Trecker in Milwaukee, then was asked by his father and two partners to run a small tool and die company near South Bend, Ind. The Fotsches skimped on food and clothing, took no vacations and eventually saved enough money to buy out the partners. Later they bought another company called Baush Machine Tool, which made automotive machinery.
The couple moved from Indiana to Wisconsin in 1965. They bought a house in Elm Grove and raised their children; there were eight of them now, a daughter and seven sons.
The Fotsches were do-it-yourselfers, remodeling, pulling the kids into various projects. They bought a vacation place in northern Wisconsin, and that meant a whole new round of repairs and upgrades.
The boys built models and learned carpentry and electrical work. Colleen learned to sew. She was cooking meals and helping her mother with housework in first grade.
"We were a nuts and bolts family," Nana says.
Pa's reverence for fixing things, however, did not extend to the human body, not for some years.
"My husband, to get him to go to a doctor, well, they were all quacks," Nana recalls. "Gradually he changed his mind."
They are part of a medical college class that scored in the 85th percentile on the MCAT exams and graduated with a 3.76 (A) grade point average from such schools as Yale, Stanford and the University of Wisconsin-Madison. They include 19-year-old prodigies, valedictorians and published poets. They speak Farsi, Russian, Chinese and Portuguese.
These facts are a source of pride — and anxiety. At their previous schools, the students of Table 1 were all at or near the top; now, wherever they look there's someone just as smart and just as driven.
On this Wednesday afternoon in mid-August, with directions given and dissection minutes away, they have little time for introductions.
The Students
Select a student to hear why they want to become a doctor
There is one more member of the group they have yet to meet, someone about whom each of the students has privately wondered and worried: the body.
Kleist believes he is about to disfigure a human being. He tells himself, "You signed up to be a physician, and this is part of it."
McLaren feels more at ease, especially after hearing from Nana Fotsch.
Zilisch keeps turning over in his mind what it would mean to give this gift.
"You're pretty useless lying in a casket," he says. "But I don't know if I'd want to see other people cutting up my grandfather."
The steel table before them is actually a long, raised metallic box, almost a casket. Students open two doors on top, revealing a sunken interior. They step on bars at each end of the table, lifting the interior.
Rising into view is a figure shrouded in white towels. A few pale toes jut out.
The air thickens. An odorous wave of embalming fluid washes over the room.
Rick Wood / Journal Sentinel
Andrew Kleist (left) gets his first look at the body he and other team members will dissect.
The students look at each other, then at the steel table.
Who will make the first cut?
The tension reminds Sharif-Sidi of one of the last days before the start of medical school. Just a few weeks earlier, he and five friends drove to a remote cabin in the mountains of northern Tennessee.
I looked at it more as a body, as a learning tool.
— Ashley Hinkamper
Five minutes ticked by, maybe 10. Each wondered who would jump first.
That is how Sharif-Sidi feels looking down at the body. He is remembering that when the time came to jump, he waited and went second, and for one very deep breath, his feet were touching nothing at all until they slammed into the water.
So it is that Hinkamper, the only one who has previous experience dissecting a body, gently traces the first incision with her scalpel and begins.
I looked at it more as a body, as a learning tool.
— Ashley Hinkamper
It was the fall of 1997. Student Todd Hoagland sat in a lecture hall at Indiana University School of Medicine in South Bend listening to professor John O'Malley.
The man was an encyclopedia. He taught without a book, without even notes. Just a blackboard and chalk. A two-hour talk would flow seamlessly.
O'Malley took pains to reduce the distance between teacher and student, to make sure he was not placed on a pedestal. He addressed every student by name. He encouraged questions, praised accomplishments, challenged classes.
His face radiated an enjoyment of life.
"He had this gentle way and he knew everything," Hoagland says.
The human body was Hoagland's other teacher. He still remembers seeing the heart for the first time, how awed he was that this one muscle propels blood throughout the body.
He remembers admiring the elegance of the valves, massaging the coronary arteries with his fingers.
He remembers holding the brain, how densely packed it felt in his hands.
Until gross anatomy, so much of medicine had seemed theoretical. Picturing the work of cells and DNA requires imagination; muscles, nerves and arteries can be seen and felt.
Hoagland has taught gross anatomy for more than 10 years, the last two at the Medical College. Each time, the human body reveals something new. He has examined bodies with an extra cervical rib, an evolutionary holdover that can create a number of problems. He's come across bodies with six lumbar vertebrae instead of five.
The first day of med school you kind of want to prove yourself a little bit.
— Joseph Zilisch
And then there are the Type A students, who come to gross anatomy having led a largely goal-focused existence.
"They haven't had much time to think about their place in life. Where we go when we die," Hoagland says. "How can you not think what it is to be alive when you dissect a hand? How can you not think about who you are when you hold this brain in your hand?"
The students follow a manual of plain black-and-white drawings, which have all the aesthetic beauty of directions for putting together a crib. They also refer to Frank H. Netter's "Atlas of Human Anatomy," which has replaced "Gray's Anatomy" at many medical schools. If the manual makes the human body appear dull, Netter makes it appear impossibly beautiful, muscle the color of red wine, bones pure as ivory.
The students have one more source to guide them: Hinkamper, who has done dissection before. As she cuts, she points out fascia, pale connective tissue beneath the skin that wraps over muscles, vessels and nerves.
McLaren makes the next incision.
Sharif-Sidi pulls skin back to the right and left, laying open the inside of the back.
Using scissors, Kleist trims hair from the neck so that it won't impede the scalpel.
Zilisch squeezes skin around the waist, feeling how thick, how firm it is. Then he cuts horizontally across the lower back. Moisture — embalming fluid — seeps up and Hinkamper dabs at it with a paper towel.
Rick Wood / Journal Sentinel
For students (from left) Lori Wong, Khalid Sharif-Sidi, Joseph Zilisch and Andrew Kleist, the dissection process seen becomes part of a familiar routine.
More photos (Note: Some images show details of dissection.)
As the professors move about demonstrating proper technique, a difference becomes clear. The students cut delicately, almost tentatively.
The professors cut briskly. They tug at skin. They dig their fingers beneath muscle or other tissue in order to reach the structures beneath.
"The idea is to find the things," explains associate professor, David Bolender, addressing the students at Table 1. "You don't need to make the dissection look like a picture in an atlas."
Gradually, the students apply more pressure as they cut. They are careful, knowing they are being graded on the quality of their dissection, knowing, too, that no tissue is to hit the floor.
Every piece must be placed inside a gray plastic tub to be cremated later with the rest of the remains.
After almost three hours when they have finished for the day, they wash the scalpels. They clean the table and reposition the flaps of skin that have been pulled back. They place the arms at the body's sides and draw the white towels over the top. Then, using the foot control, they lower the body back into the sunken portion of the table. All around them, bodies sink back into the other steel tables.
The room empties.
The students at Table 1 were so busy that they missed something. They do not know whether they are dissecting a man or a woman.
Only the next day do they notice the tag attached to their table. On it someone has drawn a little figure in red magic marker.
Saturday, August 03, 2013
Poem - Just a breath of Freedom (4 Nelson Mandela)
by Tupac Shakur - from 'the rose that grows from concrete'
Just a breath of Freedom (4 Nelson Mandela)
Held captive 4 your politics
They wanted 2 break your soul
They ordered the extermination
of all minds they couldn't control
4 u the fate was far worse
than just a brutal homicide
They caged u like an animal
and watched u slowly die inside
As u Breath your first air of freedom
On the day you became a free man
Raise your Regal Brown in Pride
4 now you R in God's Hands
The life of many were given
So that day would one day come
That the devils in Power in Pretoria
would pay for the evil crimes they've done.
Just a breath of Freedom (4 Nelson Mandela)
Held captive 4 your politics
They wanted 2 break your soul
They ordered the extermination
of all minds they couldn't control
4 u the fate was far worse
than just a brutal homicide
They caged u like an animal
and watched u slowly die inside
As u Breath your first air of freedom
On the day you became a free man
Raise your Regal Brown in Pride
4 now you R in God's Hands
The life of many were given
So that day would one day come
That the devils in Power in Pretoria
would pay for the evil crimes they've done.
Poem: Sometimes I cry
by Tupac Shakur - from 'the rose that grows from concrete'
Sometimes I cry
Sometimes when I'm alone
I cry because I'm on my own
The tears I cry R bitter and warm
They flow with life but take no form
I cry because my heart is torn
and I find it difficult 2 carry on
If I had an ear 2 confide in
I would cry among my treasured friends
But who do u know that stops that long to help another carry on
The world moves fast and it would rather pass u by
Than 2 stop and C what makes you cry
It's painful and sad and sometimes I cry
and no one cares about why.
Sometimes I cry
Sometimes when I'm alone
I cry because I'm on my own
The tears I cry R bitter and warm
They flow with life but take no form
I cry because my heart is torn
and I find it difficult 2 carry on
If I had an ear 2 confide in
I would cry among my treasured friends
But who do u know that stops that long to help another carry on
The world moves fast and it would rather pass u by
Than 2 stop and C what makes you cry
It's painful and sad and sometimes I cry
and no one cares about why.
Tuesday, July 23, 2013
The government's silence over attacks on Muslims is worrying, and divisive
The police have performed well following the recent terrorist attacks on Muslims, but from the politicians … nothing
http://www.guardian.co.uk/commentisfree/2013/jul/22/government-silence-british-muslims-attacks
Last week, a nail bomb partially exploded at a mosque in the West Midlands – the fourth attack in two months on mosques in Britain during Friday prayers. A suspect in one of those attacks is also being questioned in connection with the killing of Mohammed Saleem, a Muslim pensioner in Birmingham, who was stabbed to death as he returned home from prayers. The police response to these attacks has been heartening, but the silence from government, and the establishment in general, has been deeply worrisome.
When Lee Rigby was murdered, politicians of every stripe scrambled to condemn and reassure. Cobra, the country's top emergency response mechanism, was convened under the home secretary, Theresa May. David Cameron reassured Britons that "we will never buckle in the face of terrorism". Compare this with near-silence that greeted the recent mosque attacks. Muslims have become accustomed, almost resigned, to media double standards – there is no example starker than the wildly different coverage of Rigby and Saleem's killings. But the failure to mobilise, condemn and reassure on the part of the political class is potentially far more dangerous.
It suggests not only that a Muslim life is less sacred than a non-Muslim one, but that Muslims do not have the same rights as others to be reassured. That attacks on them are attacks on a minority, and not on British citizens.
The significant (and some would say disproportionate) political and intelligence engagement in the wake of the Rigby murder wasn't entirely for practical purposes. Strong rhetoric combined with a show of force is a necessary response on behalf of a government in order to calm and instil a sense of safety in its citizens. The same sense of duty and urgency when British Muslims come under fire has not been in evidence.
The job of sorting out the backlash has been left to policing – of English Defence League rallies, mosques, and the investigation and following up of crime. It's as if Muslims were only a troublesome minority to be protected at the begrudging expense of the taxpayer. It has been local community leaders, and Muslim MPs, that have anchored the response, thanking the police and appealing for calm. This is not enough.
While policing may be practically effective, the failure of senior politicians, ministers, and No 10 to add to it the soft power of language, to denounce assaults and comfort Muslims as British citizens, is inimical to the cause of integration. It serves both to aid radicalisation of Muslim youths, a state brought about by a sense of otherness and marginalisation, and to instil the feeling that Muslims are Muslims first, and Britons second. This not only alienates Muslims, but entrenches the view that they are second-class citizens – effectively fair game.
The extent of Cameron's engagement as head of state reaching out to a concerned populace has been to comfort others vis-a-vis a Muslim threat, something for which he has been applauded.
Muslims are not members of a minority that should be grateful Cameron magnanimously declares it not a threat. They are British citizens who are increasingly under more urgent and immediate risk of terrorist attack than others.
These are not the everyday hate crimes that we have sadly become inured to, and which are faced by all religious minorities. Jews in the UK, for example, have for years experienced antisemitic attacks including desecration of holy sites and abuse of religious figures. In this most recent wave of targeting Muslims, however, we are not simply talking severed pig's heads and swastikas, but violent terrorist crime that aims to maim and claim lives. To some extent the disproportionality of the response can be attributed to the fact that Britain has suffered a scarring terrorist attack perpetrated by Muslims, and foiled others in the making. But the government is there to serve its citizens equally. Do we have to wait until it is too late, until scores of Muslims have died in a counter-attack, before the political class turns the juggernaut of complacency around?
The constant refrain is that Muslims are an insular minority that poses an integration challenge, existing on the fringes of British life. But when they are consistently treated by different standards in terms of their rights as citizens to security and succour, it only confirms that the fringe is where they belong.
Thursday, July 18, 2013
Saturday, July 13, 2013
Sunday, June 23, 2013
Friday, June 21, 2013
sauerkraut and stuff
http://www.thekitchn.com/recipe-stuffed-cucumber-kimchi-oi-sobaegi-kimchi-recipes-from-the-kitchn-191071
http://www.wildfermentation.com/making-sauerkraut-2/#comment-13842
http://www.wildfermentation.com/searching-for-koji-in-paraguay/
http://www.wildfermentation.com/bold-experiments-in-vegetable-fermentation/
http://waterandwool.blogspot.co.uk/
Monday, June 17, 2013
Walking wounded
A documentary well worth watching. Much respect to Giles Duley - and to Channel 4 for showing this.
http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline
http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline/episode-guide/series-1/episode-1
http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline/4od
http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline
http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline/episode-guide/series-1/episode-1
http://www.channel4.com/programmes/walking-wounded-return-to-the-frontline/4od
elderflower and fermented vegetables (pickles and brine)
http://www.telegraph.co.uk/gardening/plants/10117751/In-praise-of-the-elderflower.html
7:00AM BST 15 Jun 2013
'
However, the flavour that the flowers impart is universally loved,
brightening everything it comes into contact with. The flowers are at their best
on a sunny day, when their muscat aroma is at its headiest. Pinch or snip the
heads from the bush at the first joint. Use them immediately for the fullest
flavour or dry them by laying them, flowers down, out of the sun for a day. Once
dry, shaking releases the flowers from the stems.
They'll retain much of their early summer flavour and scent in an airtight
container. There are so many ways to get the best out of them. They are
spectacularly good tempura-battered, deep-fried and dipped in cinnamon sugar or,
as Stevie Parle suggested
in this paper last year, with salt, sugar and chilli. ...'
'
FLOWER RECIPES
Elderflower cordial recipe
About 25 elderflower heads
Pared zest of 4 unwaxed lemons, plus the juice
900g sugar
Shake the flowers to dislodge any insects but don't bother washing them.
Strip the flowers from the stems with a fork and place in a bowl together with the lemon zest. Pour 1.5 litres of water over, cover and leave overnight.
Strain through muslin into a saucepan. Add the sugar and lemon juice, warm and stir to dissolve the sugar, then simmer for a couple of minutes.
Pour into sterilised bottles and seal. Dilute to taste when drinking, and keep in the fridge once opened.
Gooseberry and elderflower fool recipe
500g gooseberries
4 tbsp caster sugar
2 strips of lemon zest
12 medium heads of elderflower
300ml double cream
Put the gooseberries into a pan with the sugar, lemon zest and a few splashes of water.
Fork the elderflowers from the stems into the pan. Heat gently until the gooseberries begin to break up, then simmer for 15 minutes or so, stirring occasionally.
Push the pulpy mush through a sieve and leave to cool completely.
Whisk the cream until soft peaks form, then fold it into the purée. It's good either left as a ripple or blended gently into a relatively homogenous whole.
Refrigerate for a couple of hours before serving.
Top with cooked crumble topping or toasted hazelnuts if you fancy.
BERRY RECIPES
The purple-black berries ripen at the end of summer, and, while high in vitamin C and a treat to behold, are not wildly adaptable in the kitchen. I know of only two really fine recipes, but both are special.
Elderberry juice
Cook 1kg of berries in a little water until they break down, pass through a sieve and add sugar until it reaches a sweetness you like.
It should taste akin to, but much better than, cranberry juice.
Pontack sauce
This is a centuries-old dark, pungent spicy sauce for game, slow-roasted pork and for adding depth to stews.
Warm 500g of berries stripped from their stalks with a fork, 150g of sugar and 500ml cider vinegar in a pan until the sugar dissolves.
Add 250g finely chopped shallots, four allspice berries, six cloves, a good grating of nutmeg, two blades of mace, 1in of finely chopped ginger, a pinch of salt and a tablespoon of black peppercorns and simmer until it reaches a glossy syrup.
Pass through a sieve and bottle. It will keep for years. '
http://www.telegraph.co.uk/gardening/9681309/How-to-ferment-autumn-vegetables.html
'
FLOWER RECIPES
Elderflower cordial recipe
About 25 elderflower heads
Pared zest of 4 unwaxed lemons, plus the juice
900g sugar
Shake the flowers to dislodge any insects but don't bother washing them.
Strip the flowers from the stems with a fork and place in a bowl together with the lemon zest. Pour 1.5 litres of water over, cover and leave overnight.
Strain through muslin into a saucepan. Add the sugar and lemon juice, warm and stir to dissolve the sugar, then simmer for a couple of minutes.
Pour into sterilised bottles and seal. Dilute to taste when drinking, and keep in the fridge once opened.
Gooseberry and elderflower fool recipe
500g gooseberries
4 tbsp caster sugar
2 strips of lemon zest
12 medium heads of elderflower
300ml double cream
Put the gooseberries into a pan with the sugar, lemon zest and a few splashes of water.
Fork the elderflowers from the stems into the pan. Heat gently until the gooseberries begin to break up, then simmer for 15 minutes or so, stirring occasionally.
Push the pulpy mush through a sieve and leave to cool completely.
Whisk the cream until soft peaks form, then fold it into the purée. It's good either left as a ripple or blended gently into a relatively homogenous whole.
Refrigerate for a couple of hours before serving.
Top with cooked crumble topping or toasted hazelnuts if you fancy.
BERRY RECIPES
The purple-black berries ripen at the end of summer, and, while high in vitamin C and a treat to behold, are not wildly adaptable in the kitchen. I know of only two really fine recipes, but both are special.
Elderberry juice
Cook 1kg of berries in a little water until they break down, pass through a sieve and add sugar until it reaches a sweetness you like.
It should taste akin to, but much better than, cranberry juice.
Pontack sauce
This is a centuries-old dark, pungent spicy sauce for game, slow-roasted pork and for adding depth to stews.
Warm 500g of berries stripped from their stalks with a fork, 150g of sugar and 500ml cider vinegar in a pan until the sugar dissolves.
Add 250g finely chopped shallots, four allspice berries, six cloves, a good grating of nutmeg, two blades of mace, 1in of finely chopped ginger, a pinch of salt and a tablespoon of black peppercorns and simmer until it reaches a glossy syrup.
Pass through a sieve and bottle. It will keep for years. '
http://www.telegraph.co.uk/gardening/9681309/How-to-ferment-autumn-vegetables.html
6:30AM GMT 16 Nov 2012
Sometimes it’s difficult to know what to do with certain vegetables at this
time of year. Not so much the cabbages, parsnip, kale and leeks – they’ll be
fine outside whatever the weather – but there are others that don’t last so well
in the frost and rain. Some of these are brilliantly suited to fermenting. This
is the process of preserving raw vegetables in brine, to eat through winter and
spring. You can use any brassica: cauliflower, brussels sprouts, broccoli or
cabbage. It also works brilliantly with apples, peppers and many of the roots:
carrots, onions, beetroot, turnips, jerusalem artichokes and celeriac. Many of
us have trugfuls of these which need using up.
We’re unusual among vegetable-growing cultures in that we don’t have a
tradition of fermenting our autumn veg. If you visit homes in France (where
fermented cabbage is called choucroute), all over Northern Europe – Germany,
Holland and Scandinavia, as well as Eastern Europe – Poland, Russia, Lithuania,
Hungary and Romania – many gardener/cooks will be busy setting up their
fermenting pots right now to make sauerkraut and fermented root veg. Farther
east, you’ll see the same tradition in warmer climates, with kimchi and brined
sour pickles all through Asia – China, Japan, Vietnam, Malaysia and, most of
all, Korea, where they eat kimchi with almost every meal. In fact, in Asia they
grow lots of winter radish, daikon or mooli, specially to ferment them, along
with burdock (or gobo). I’m now adding them to my sowing list for next year.
Nutrient rich
As well as a neat way to store veg, fermenting is nutritious too. You’re not
cooking but preserving the veg in their raw state, which maintains high levels
of vitamin C and breaks down many vitamins and other nutrients into more easily
digestible forms.
Captain Cook was recognised by the Royal Society for having conquered scurvy
among his crew by sailing with large quantities of citrus fruit and sauerkraut.
On his second circumnavigation in the 1770s, 60 barrels of sauerkraut lasted for
27 months and not a single crew-member developed scurvy, which had previously
killed huge numbers on long trips.
Make a good mix
David uses a mix of four types and colours of carrot, so they look as good as they taste. The yellow carrot is 'Solar Yellow’, the orange 'Nantes’, the purple 'Cosmic Purple’ and the white, an Australian variety with a very sweet flavour, 'Belgian White’ (from an Australian seed company called Diggers, diggers.com.au). The organic carrots (or cabbage, or a mix of both) are grated – no need to peel – and then two handfuls at a time are packed into the ceramic crocks. These are quite expensive to buy (see source below). A food-grade plastic bucket is fine as an alternative. Scatter a handful of unrefined, pure sea salt (with no added iodine as it would kill the all-important micro-organisms which cause the ferment) and a couple of good pinches of freshly grated ginger (or caraway and juniper berries with cabbage).
The first batch is tamped down with a large pestle, or you can use your fist, to help force out the water, before you repeat the next layer, and so on, until you get near the top. A 7.5kg (16.5lb) crock like David’s will easily fit the 5kg (11lb) organic carrots we have harvested for this batch, mixed with 125g (4.4oz) ginger and 200g (7oz) unrefined, pure sea salt.
If making sauerkraut, mix 2kg (4.4lb) sliced cabbage with three tablespoons of salt.
For an Oriental kimchi with a bit of chilli heat, leave the veg in chunks or slices for a textured, crunchy mix. Inter-layer the vegetables with a paste made from garlic, ginger, onions and deseeded chillies, with or without horseradish. Cover with brine made from about 1 litre of water to three tablespoons of salt. Don’t bother with the pestle.
Each crock is supplied with a pair of “stones”, ceramic discs which prevent everything from floating to the top as the water exudes from the vegetables. Exposure to the air would turn them mouldy, but the stones prevent this, slotted in to the top of the jar to weigh everything down. Boil the stones in soda crystals to sterilise them between each use. If you’re using a plastic bucket, a plate chosen to fit just inside the bucket and weighed down with a large glass bottle filled with water can replace the stones.
Finally, replace the ceramic crock top and fill the top gully with water to keep the inside sterile, or cover the whole thing with a cloth. Press down the weight whenever you walk past until the brine rises above the stone (or plate), usually within 24 hours. The whole fermentation process begins and you’ll start to see it bubble away. The pot can become quite warm within two to three days, so is best placed somewhere cool – in the cellar or a larder if you have one. Check the mix every day or two. Discard any bloom or mould on the top and taste the veg.
As time goes on, the flavour strengthens, but it generally takes a couple of weeks to be ready for the first tasting and will then store well for months if kept cool.
Spoon out a saucer at a time, packing the rest down carefully, re-weighting it and leaving it for a later day. I worried that the whole thing might go too far and rot and become poisonous, but the saltiness of the brine protects against putrefying micro-organisms in the early stages and favours the growth of the desired strains of bacteria – lactobacilli. Once underway, the acidic environment created by the fermentation is inhospitable to bacteria associated with food poisoning (such as salmonella and botulism), so it is safe.
I have one pot on the go now and I’m off into the garden this afternoon to gather the last of my beetroot to create another. So why not take another look at your unused vegetables, and enter the brave new world of fermenting. One bite, and you’ll pick up the habit for life.
http://www.sarahwilson.com.au/2012/04/how-to-ferment-vegetables/
Make a good mix
David uses a mix of four types and colours of carrot, so they look as good as they taste. The yellow carrot is 'Solar Yellow’, the orange 'Nantes’, the purple 'Cosmic Purple’ and the white, an Australian variety with a very sweet flavour, 'Belgian White’ (from an Australian seed company called Diggers, diggers.com.au). The organic carrots (or cabbage, or a mix of both) are grated – no need to peel – and then two handfuls at a time are packed into the ceramic crocks. These are quite expensive to buy (see source below). A food-grade plastic bucket is fine as an alternative. Scatter a handful of unrefined, pure sea salt (with no added iodine as it would kill the all-important micro-organisms which cause the ferment) and a couple of good pinches of freshly grated ginger (or caraway and juniper berries with cabbage).
The first batch is tamped down with a large pestle, or you can use your fist, to help force out the water, before you repeat the next layer, and so on, until you get near the top. A 7.5kg (16.5lb) crock like David’s will easily fit the 5kg (11lb) organic carrots we have harvested for this batch, mixed with 125g (4.4oz) ginger and 200g (7oz) unrefined, pure sea salt.
If making sauerkraut, mix 2kg (4.4lb) sliced cabbage with three tablespoons of salt.
For an Oriental kimchi with a bit of chilli heat, leave the veg in chunks or slices for a textured, crunchy mix. Inter-layer the vegetables with a paste made from garlic, ginger, onions and deseeded chillies, with or without horseradish. Cover with brine made from about 1 litre of water to three tablespoons of salt. Don’t bother with the pestle.
Each crock is supplied with a pair of “stones”, ceramic discs which prevent everything from floating to the top as the water exudes from the vegetables. Exposure to the air would turn them mouldy, but the stones prevent this, slotted in to the top of the jar to weigh everything down. Boil the stones in soda crystals to sterilise them between each use. If you’re using a plastic bucket, a plate chosen to fit just inside the bucket and weighed down with a large glass bottle filled with water can replace the stones.
Finally, replace the ceramic crock top and fill the top gully with water to keep the inside sterile, or cover the whole thing with a cloth. Press down the weight whenever you walk past until the brine rises above the stone (or plate), usually within 24 hours. The whole fermentation process begins and you’ll start to see it bubble away. The pot can become quite warm within two to three days, so is best placed somewhere cool – in the cellar or a larder if you have one. Check the mix every day or two. Discard any bloom or mould on the top and taste the veg.
As time goes on, the flavour strengthens, but it generally takes a couple of weeks to be ready for the first tasting and will then store well for months if kept cool.
Spoon out a saucer at a time, packing the rest down carefully, re-weighting it and leaving it for a later day. I worried that the whole thing might go too far and rot and become poisonous, but the saltiness of the brine protects against putrefying micro-organisms in the early stages and favours the growth of the desired strains of bacteria – lactobacilli. Once underway, the acidic environment created by the fermentation is inhospitable to bacteria associated with food poisoning (such as salmonella and botulism), so it is safe.
I have one pot on the go now and I’m off into the garden this afternoon to gather the last of my beetroot to create another. So why not take another look at your unused vegetables, and enter the brave new world of fermenting. One bite, and you’ll pick up the habit for life.
http://www.sarahwilson.com.au/2012/04/how-to-ferment-vegetables/
Saturday, June 15, 2013
Sobering...
'Growing up poor'. Short documentaries on the reality for some of our youth (UK).
http://www.bbc.co.uk/iplayer/episode/b01s4vw3/Growing_up_Poor_Learning_Zone_Wesleys_Story/
http://www.bbc.co.uk/iplayer/episode/b01s4vw1/Growing_up_Poor_Learning_Zone_Shelbys_Story/
http://www.bbc.co.uk/iplayer/episode/b01s4vvz/Growing_up_Poor_Learning_Zone_Frankies_Story/
http://www.bbc.co.uk/iplayer/episode/b01s4v16/Growing_up_Poor_Learning_Zone_Ambers_Story/
For any young people reading - your childhood and teenage years are such a short time, and then the realities of adulthood await you. It is tough, in more ways than you can imagine, but it can also be fulfilling, in more ways than you can imagine.
You may not believe me, but your time in school is a relatively protected existence. It will not always be this way. Use this time, don't lose it. People go on about how important education is, and doing the absolute best you can when education is without payment. But they go on about it because it is a key. A key that you don't really quite understand the value of until you are out of school, and out in the big, adult world. Work hard for that key. Achieve that key. Who knows what doors it could open for you. You'll still need to figure out your way to the door, and choose a door to enter, but the key is the first step to getting there.
Get that education, strive for it and be proud. You may or may not be in contact with your classmates in the several months after finishing school, but you certainly will be left with the marks of your studies for a lifetime.
Education is the first step to preparing you for the big, wide world.
http://www.bbc.co.uk/i/b01s4vw3/
http://www.bbc.co.uk/iplayer/episode/b01s4vw3/Growing_up_Poor_Learning_Zone_Wesleys_Story/
http://www.bbc.co.uk/iplayer/episode/b01s4vw1/Growing_up_Poor_Learning_Zone_Shelbys_Story/
http://www.bbc.co.uk/iplayer/episode/b01s4vvz/Growing_up_Poor_Learning_Zone_Frankies_Story/
http://www.bbc.co.uk/iplayer/episode/b01s4v16/Growing_up_Poor_Learning_Zone_Ambers_Story/
For any young people reading - your childhood and teenage years are such a short time, and then the realities of adulthood await you. It is tough, in more ways than you can imagine, but it can also be fulfilling, in more ways than you can imagine.
You may not believe me, but your time in school is a relatively protected existence. It will not always be this way. Use this time, don't lose it. People go on about how important education is, and doing the absolute best you can when education is without payment. But they go on about it because it is a key. A key that you don't really quite understand the value of until you are out of school, and out in the big, adult world. Work hard for that key. Achieve that key. Who knows what doors it could open for you. You'll still need to figure out your way to the door, and choose a door to enter, but the key is the first step to getting there.
Get that education, strive for it and be proud. You may or may not be in contact with your classmates in the several months after finishing school, but you certainly will be left with the marks of your studies for a lifetime.
Education is the first step to preparing you for the big, wide world.
http://www.bbc.co.uk/i/b01s4vw3/
Friday, June 14, 2013
Tuesday, June 11, 2013
The broader view...
http://www.guardian.co.uk/lifeandstyle/2012/dec/22/letter-to-husbands-physiotherapist?INTCMP=ILCNETTXT3487
Perhaps you are just doing your job. You're putting your many years of training and experience into practice and earning a good living. But your nine o'clock client happens to be my husband of 17 years. A man I've watched change from cocky, bronzed watersports instructor to someone who now has a blue badge for his car and needs two sticks to walk. My husband, who used to be so adventurous and spontaneous, who now wants to phone ahead, to check if there's a ramp, a handrail, a lift …
I know you haven't approached my husband as your run-of-the-mill tennis elbow or RSI case. You've taken him on as a bit of a project and a challenge for yourself. He's offering you a chance to see someone improve over a longer period of time than usual. You've read up on his condition and thought hard about how best to approach it and, as I've seen the improvements in him, I've been so grateful to you.
Over the years since my husband was diagnosed, the consultants have only seemed to him to be interested in the academic side of his condition. The painful quadriceps biopsy was meant to provide an accurate diagnosis by the identification of a specific gene. But it didn't. They were left with a puzzle – my husband had muscular dystrophy but which type? He became an interesting case for the doctors to report to their medical journals – someone to be poked and prodded, photographed, filmed and talked about.
It's been so good for my husband to have someone believe that his body's not totally beyond hope. There's been no one until he came to you that has shown him that some of his muscles can be improved. You've made him work hard on his core muscles and have given him much needed stability. As someone for whom falling over was a painful "occupational hazard" of everyday life this has made a huge difference. He hasn't fallen over now for more than six months. It's not just this newfound confidence that this gives him that I'm grateful for, you've given him back a little bit of the pride in his body that he used to have. For the first time in years, he's thinking of improvements not deterioration.
You've not offered him a miracle cure. Ramps, handrails and lifts are still the norm for us. But for the confidence and pride you've returned to him, I'm very thankful.
Keep up the good work.
A happier wife '
'A letter to … my husband's physiotherapist
The letter you always wanted to write
I know you haven't approached my husband as your run-of-the-mill tennis elbow or RSI case. You've taken him on as a bit of a project and a challenge for yourself. He's offering you a chance to see someone improve over a longer period of time than usual. You've read up on his condition and thought hard about how best to approach it and, as I've seen the improvements in him, I've been so grateful to you.
Over the years since my husband was diagnosed, the consultants have only seemed to him to be interested in the academic side of his condition. The painful quadriceps biopsy was meant to provide an accurate diagnosis by the identification of a specific gene. But it didn't. They were left with a puzzle – my husband had muscular dystrophy but which type? He became an interesting case for the doctors to report to their medical journals – someone to be poked and prodded, photographed, filmed and talked about.
It's been so good for my husband to have someone believe that his body's not totally beyond hope. There's been no one until he came to you that has shown him that some of his muscles can be improved. You've made him work hard on his core muscles and have given him much needed stability. As someone for whom falling over was a painful "occupational hazard" of everyday life this has made a huge difference. He hasn't fallen over now for more than six months. It's not just this newfound confidence that this gives him that I'm grateful for, you've given him back a little bit of the pride in his body that he used to have. For the first time in years, he's thinking of improvements not deterioration.
You've not offered him a miracle cure. Ramps, handrails and lifts are still the norm for us. But for the confidence and pride you've returned to him, I'm very thankful.
Keep up the good work.
A happier wife '
Sunday, May 12, 2013
Around the world in 80 diets
http://www.dailymail.co.uk/news/article-2319825/The-great-global-food-gap-Families-world-photographed-weekly-shopping-reveal-cost-ranges-3-20-320.html
http://www.telegraph.co.uk/foodanddrink/foodanddrinkpicturegalleries/8198839/What-I-Eat-Around-the-World-in-80-Diets-by-Peter-Menzel-and-Faith-DAluisio.html
http://www.time.com/time/photogallery/0,29307,2037749,00.html
http://www.npr.org/blogs/pictureshow/2010/08/10/129107806/whatieat
http://www.huffingtonpost.com/louise-mccready/what-i-eat-around-the-wor_b_706799.html
http://www.amazon.co.uk/What-Eat-Around-World-Diets/dp/0984074406
http://www.telegraph.co.uk/foodanddrink/foodanddrinkpicturegalleries/8198839/What-I-Eat-Around-the-World-in-80-Diets-by-Peter-Menzel-and-Faith-DAluisio.html
http://www.time.com/time/photogallery/0,29307,2037749,00.html
http://www.npr.org/blogs/pictureshow/2010/08/10/129107806/whatieat
http://www.huffingtonpost.com/louise-mccready/what-i-eat-around-the-wor_b_706799.html
http://www.amazon.co.uk/What-Eat-Around-World-Diets/dp/0984074406
Monday, May 06, 2013
Sunday, April 21, 2013
Wednesday, April 10, 2013
The new NHS...
David Lock: A new and very different type of NHS in England - short blog entry/article well worth reading.
http://blogs.bmj.com/bmj/2013/04/02/david-lock-a-new-and-very-different-type-of-nhs-in-england/?utm_medium=email&utm_campaign=7529&utm_content=BMJ%20-%20What%27s%20New%20Online&utm_term=David%20Lock%3A%20A%20new%20and%20very%20different%20type%20of%20NHS%20in%20England&utm_source=Adestra_BMJ
'There are a multitude of voices to explain why the marketisation of the NHS will be a disaster, and they are almost certainly right. But – I say with my tongue firmly in my cheek – there is a silver lining to every cloud. It will be a bonanza for lawyers. Every contract will be crawled over by lawyers, disputes will be far more common, and m’learned friends will be fully engaged and well rewarded. But all this comes at a cost. The NHS has traditionally spent about 6% of its annual spend on administrating the system. A market system, such as in the US, spends vastly more. A study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of US healthcare dollars went to healthcare administrative costs, nearly double the administrative overhead in Canada, on a percentage basis and vastly more than the NHS’s paltry 6%.'
http://blogs.bmj.com/bmj/2013/04/02/david-lock-a-new-and-very-different-type-of-nhs-in-england/?utm_medium=email&utm_campaign=7529&utm_content=BMJ%20-%20What%27s%20New%20Online&utm_term=David%20Lock%3A%20A%20new%20and%20very%20different%20type%20of%20NHS%20in%20England&utm_source=Adestra_BMJ
'There are a multitude of voices to explain why the marketisation of the NHS will be a disaster, and they are almost certainly right. But – I say with my tongue firmly in my cheek – there is a silver lining to every cloud. It will be a bonanza for lawyers. Every contract will be crawled over by lawyers, disputes will be far more common, and m’learned friends will be fully engaged and well rewarded. But all this comes at a cost. The NHS has traditionally spent about 6% of its annual spend on administrating the system. A market system, such as in the US, spends vastly more. A study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of US healthcare dollars went to healthcare administrative costs, nearly double the administrative overhead in Canada, on a percentage basis and vastly more than the NHS’s paltry 6%.'
Tuesday, April 09, 2013
Monday, February 18, 2013
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