Bagged, Tagged & Flagged

Moof has tagged me to give 7 songs I am listening to now. This is easy as I am motoring across Canada, visiting friends and relatives enroute, a 3000 kilometer trajectory that coincides with the honking Vs of Canadian geese overhead and every kind of duck you can think of in the ponds and shelter belts of the migratory pathways that sweep up across the Canadian prairies.

There is nothing better than CBC radio doing informed dialogue and when reception is poor, the CDs are croning.

And I wish I knew how to embed them for you as others do. This is the simple version of music titles and artists only.

• Jessie Winchester, Talk Memphis from The Best of Jesse Winchester
• Aaron Neville, You'll Find a Better Love from To Make Me Who I Am
• Charlie Parker, A Night in Tunisia from Ornithology
• Laura Smith, My Gate's Wide Open from It's a Personal Thing
• Leonard Cohen, A Thousand Kisses Deep from Ten New Songs
• Ian Tamblyn, Overhead South from Over My Head
• Ron Sexsmith, Former Glory from Cobblestone Runway

Without even trying, 5 out of 7 are Canadian! Not enuff women tho'

The Tag Rules are:
List seven songs you are into right now. No matter what the genre, whether they have words or even if they’re not any good, but they must be songs you’re really enjoying now. Post these instructions in your Live Journal/blog along with your seven songs. Then tag seven other people to see what they’re listening to.

I tag -

Miss M of Reflective Ponderings

Daniel Yiek of Sarikei Time Capsule

Kuching Connections of Kuching Connections

guruh roy of Halcyone

Tundra PA of Tundra Medicine Dreams- who needs something simple to do after hosting Medical Grand Rounds

Desmond Jerukan of Nadai Nama Nama

The Honey Farm

I pitch up at my friend Ernie's place in the South Okanagan in the middle of the fall honey extraction. There's no one in the main house so I head down to the Honey House on the ‘back forty’. The Honey House has been in construction for more than a year and now is finally fully operational. Although work remains to be done on the building, the equipment is all in place.

The floor of the Honey House looks clean but feels slightly sticky, probably from minor bits of wax or honey. Sam and Ernie are wearing rubber clogs in the extraction room so I don a pair as I enter.

Sam joins his dad after school and for a couple of hours the Honey House is a-hopping with activity. Supers, the square wooden boxes which hold the frames, are stacked up inside and outside the Honey House. Inside, first the top of the super is removed exposing the frames. Sam lifts out the frames, which sit vertically in the super, one by one to scrap the wax off. Once the wax has been removed, the frames are placed upright in a rotating stainless steel drum where the honey is whirled out of them. Liquid honey pours out transparent plastic tubing which Ernie directs it into massive metal drums as CBC FM plays in the background.

Besides his own crop, Ernie is extracting for his friends, neighbours and a number of other small operations in the South Okanagan valley so the supers and drums from each extraction need to be kept separate. It also means the phone is constantly ringing with people coming and going and advice offered and solicited.

Ernie’s crop is mostly clover, alfalfa and mountain fireweed, the latter a very popular item. There are small quantities of specialty honeys such as St. John’s Wort. I am surprised when I taste the honey and the propulis, the queen’s special food, that I can distinguish the various flavours. My only prior experience with flavoured honey has been those to which flavour was added. I can appreciate why these specialty versions are so greatly favoured.

Supers which are placed strategically near crops such as mountain fireweed seem to attract only bees feeding on that specific flower with often the colour of the propulis alone making it easy to identify which variety. And this separation seems to occur even if two sources of nectar are located close together.

For a while, when honey ale was popular, most of Ernie's honey went to breweries. Now some of the drums will go to a local granola manufacturer. A portion of the honey will also be sold during the summer at the local Farmer’s Market.

Ernie and his wife have been serious about the quality of their crop and have numerous 1st prize ribbons from the Provincial Fair. Their display of honey and bee paraphenalia is always a crowd pleaser as over the years they have collected stories, pictures, smokers, antique equipment, honey tins and beehive jars.

I leave Ernie and Sam to finish off in the Honey House and head back to the house. The computer desktop is full of articles about use of oxalic acid for mites, comparisons of various organic and non-organic approaches, notes about raising queens and marketing strategies. If I come back later in the year, I will find Ernie and his wife making and distributing their hand-dipped and molded beeswax candles. In the middle of the summer they are off early in the morning to the Market.

Later when his mom, dad and I are talking about a community development project with bee keeping as the income generating aspect, Sam hangs around on the edge of the discussion. On hearing someone mention restitution, he comments, "That's a great word, what does it mean?"

Later over dinner he tells us that his teacher asked them, because it is the start of the new school year, to list their favourite TV shows, celebrities and hobbies.

"What did you list," we inquire.

"I told him, I don't watch TV and celebrities are nut cases," Sam says. "I don't have time for them because bees are my hobby"

"Bees, like most agricultural pursuits, are a full time vocation, year round and totally encompassing", Ernie tells me later, "But I had never considered they might also help me raise my kids."

Photos: Road sign; flats in the super; flats in the extractor; cutting off the wax; liquid honey into the drums,bee paraphenalia & jars in stacks

Grand Rounds Vol. 2 No. 52

Grand Rounds is up at Tundra Medicine Dreams, the blog written by a Physician Assistant in Bethel, Alaska. Grand Rounds is the blogosphere’s weekly carnival of the best writing and thinking on topics related to health and healthcare. Click on Tundra Medicine Dreams to go to the site. You will also enjoy the lovely arctic pictures.

Beyond the Khyber Pass

In July, a group of us from the Society of Rural Physicians of Canada (SRPC) learned we had secured a two year grant from the Canadian Society of International Health for HIV/AIDS and gender training in Pakistan. We were bouncing-off-the-walls, cavorting-in-the-streets thrilled! Our Pakistani partners are a non governmental group (NGO), called Frontier Primary Health Care (FPHC), working in North West Frontier Province near the Khyber Pass.

Frontier Primary Health Care traces its roots back to an Austrian NGO which responded to the massive influx of more than 3 million Afghan refugees into Pakistan in 1981. Most of the refugees were Pustoo-speaking Pathans who shared their ethnic background with people living in North West Frontier Province and so were resettled there.

FPHC began, as most refugee groups do, with a focus on emergency and curative services in three smaller, rural camps sheltering 30,000 people. Gradually they were able to shift the emphasis to a public health model stressing maternal and child health, health promotion and disease control measures. They did such a great job that within ten years the health parameters in the camps were better than those of the Pakistanis who lived in the countryside surrounding the camps.

This was quite an accomplishment because infant mortality (deaths in children under one year of age) and maternal mortality (deaths of women in childbirth) were among the highest in the world, female literacy in the refugees was only 4% and rigorous purdah is still practiced.

FPHC succeeded by introducing immunization, providing nutrition education, training traditional midwives, establishing oral rehydration centers for treatment of diarrhea and bringing antenatal care and the other basics of the Primary Health Care approach to the families in the camp. Because the refugee camps are constructed of adjoined mud and wattle structures, it was also possible to introduce rudimentary sanitation and piped water to the camps fairly inexpensively.

Over time FPHC has extended their services to communities of Pakistanis in the areas surrounding the original camps. Currently they serve a population of approximately 200,000. They provide a full complement of Primary Health Care services, which while basic, are effective in reducing deaths and preventing disease. One important exception is water and sewage coverage. While 100% of refugees have access to clean water and sewage, less than 60% of the Pakistani population, who live more dispersed across the countryside, have ready access. Apart from vaccines and TB drugs, which are provided by donors, FPHC health services are provided at a cost of 90 Rupees or $1.50 USD per person per year.

With 200 employees, Frontier Primary Health Care now runs ten health units, three educational facilities providing literacy and skill training for young girls, an Essential Obstetric Unit and a Health Training Unit.

There are reasons for their remarkable success. Among them is the fact that they have an army of more than 500 active volunteers both male and female. Equally important, they focus on health education for community and religious leaders, youth and women as well as for health workers. Yet another, that they are lead by a skilled and devoted husband and wife medical team, Dr. Emel Khan and Dr. Wagma Reshteen.

Work on our project, called Strengthening STI / HIV Management in Pakistan, began in earnest in August this year, with preparation for a baseline survey. The working group at FPHC have decided to do three separate surveys: one for private practitioners, one for health facilities and one for community and religious leaders. Early drafts have been flying back and forth across the internet as the forms are finalized. (What did we do before we had the internet?) After translating and back-translating the surveys into Pushtoo, and training the interviewers they will begin gathering data.

I feel honoured to be working with these extraordinary partners, most especially at this unique time in world history. I will attempt to take you along with me as we proceed with our project.
Photos: Afghani mother and child; young boys by FPHC sign in Baghica camp; Trainer & water pump;Young girls at Ed center; women enter clinic; grandfather and grandson;& group of women in street.

Bearing Witness

Somehow the wrong URL went in to Grand Rounds this week and my post on air pollution appeared for a second time. Probably my mistake. I thought I was submitting the post on Mulu Caving and MCQs,which also fit with the theme of higher education. I was, in fact, hoping to keep a low profile about air quality in Sarawak.

The day after the original post, friends advised me that a couple of years ago someone working in the travel industry in Borneo who had mentioned that people might want to delay travel for a couple of days because of the haze at the time, came to work the next day and found he had been fired. There has been some easing up around the issue, but as I was a guest in the country, I certainly didn't want to upset anyone. My blog was more about how important numbers are in resolution of health issues and being grateful there were now numbers.

Then before I left Borneo, I got a call that my boss wanted to see me. Oh, I thought, he saw the blog.

My colleague, Aye, who has yet to view my blog, said, "Don't be silly, nobody is reading your blog."
I had to admit that she was, for all practical purposes right, after all, I am the one who checks the sitemeter.

But then a week or two later I discovered about links and was astounded to learn I had 44 of them. If you haven't noticed, I have only a few sites on my blogroll. It scares me to even think about going into my template to create links. This means I haven't really got into linking yet. So how had I managed to acquire so many links? When I checked to see who had linked to my blog, I noticed about thirty newspapers in Malaysia, India, Nepal, China, from all over South East Asia as well as airlines, banks, the military and automobile makers in Malaysia. And all these links dated to the time of my blog about air quality.

I used to think I had to debate, argue and convince people about health issues. I am more and more moving into a position of simply noticing and commenting, what the Quakers call, bearing witness. Blogs are good for this purpose. When everyone else is blissfully ignoring something, it can be useful just to state the fact. My blog about air quality acknowledges a situation and that for the time being is enough.

When I saw my boss, he wanted to thank me and ask me back next year and he was OK with the fact that my final report might be delayed. No mention was made about air quality.

Caving in Gunung Mulu National Park

We are going caving in Sarawak for the weekend. A package deal of 2 nights and 3 days will only cost $250 each. A direct flight takes us to Miri where a smaller plane drops us off in Mulu. Miri is a coastal city remote from the capital nestled up against Brunei. Once we reach Mulu, it dawns on me that the people in these more rural places will be more traditional. Indeed they are, with women on the streets and paths carrying traditional rattan baskets suspended by tump lines. Even people riding motorbikes are likely to carry a traditional baskets and wear a conical straw hat.

The fancy Royal Mulu Lodge is right in the Gunung Mulu National Park about ten minutes from the airport in Mulu. Gunung Mulu is a World Heritage Area which encompasses a series of accessible caves including Deer Cave, the largest in the world. In some of the caves in the region, people still harvest swiftlet nests high inside the caves for the tasty but expensive Bird’s Nest soup. Long lengths of bamboo ladders are positioned to extract the nests in a sustainable way. Bird’s nests have been a top foreign export of Sarawak for centuries. Unfortunately for us those caves are not open to tourists. We are greeted by our guide at the airport and taken by van to the Lodge. Waiting for us at the hotel which is laid out like a giant longhouse, are fresh chilled mango juice and a complimentary face wipe. This is the life!

At 2 pm the first day we head off to the first two caves. Dense vegetation clings to every surface on the two hour walk through the rain forest to Langs Cave and Deer Cave. We move on a wooden path a couple of feet off the ground. We are warned not to touch the side rails as there are many insects that sting. The guide is an young Kenyah woman with reasonable English. Travelling in the afternoon is not the best time to see animals or birds which are all sheltering from the heat but we find many fascinating insects and butterflies. A caterpillar that looks like it has a fur coat with the guard hairs still attached. A stick insect is so much like a stick that I truly do not see for the longest time although I am looking right at it. As we move closer to the caves, a round bug with red circular stripes appears more frequently on the sides of trees.

An ancient river bed scalloped the walls and floor of Deer Cave while ongoing work by the elements on the limestone creates stalagmites and stalagtites. Along the ceiling there are rippling folds of rock and round protuberances as well as the thin etched creations connecting the top and bottom of the cave throughout. In one section of the cave, guano lies several feet deep below the boardwalk. The smell of ammonia is so strong we cover our noses with handkerchiefs or hats as we pass over it. Thousands of bats live high in the roof of the caves.


The complex cave passages wind their way through the limestone mountains into chambers which are so large they astound. Stairs take us close to the top of one section in the largest natural rock chamber in the world where we can view the soft bodies of bats clinging to the walls. We come across a number of workers and researchers in the depths of the cave and spot snakes lurking in the formations at several spots. There is one rock formation that looks surprisingly like the profile of Abe Lincoln and others that resemble animals.

Langs Cave is just next to Deer Cave about 100 m. away. We stop for cold drinks at the Bat Observatory just outside the caves before we head back. At 5 pm most evening there is a spectacular bat migration. Today it starts to rain lightly at 4pm. Others in the group opt to wait to see if the rain stops so they can see the bat migration but we head back. I have tried to explain bat migration to friends, without success, how bats blanket the sky with a eerie chittering just a short interval before dusk and after dawn. It seems as if there is nothing else except them for a short period and then as if they were never there at all. It is one of the things you have to experience yourself. A Dutch group with us have come specially to see the bat migration so make arrangements to return the next day.

We are happy and muddy when we get back to the air conditioned comfort of our room. The next day we are taken by longboat up the river to Clearwater Cave and the Cave of Winds. We make a short stop at one of the only settlements of Penan. Longboats are tied up at the river edge. The community has set up stalls for handicrafts where we are able to purchase the beautiful black and tan rattan bags of exquisite design, patterned mats as well as jungle produce such as snake fruit and bamboo shoots. Older women with extended earlobe loops sell baskets. The homes are unpainted wood shacks, people are bathing in the river and lines of clothing are strung out in the sun to dry, a testament to the industry of the women. A satellite dish sticks out of the edge of one shack. A small naked girl idly watches me from her porch. Like many of such dislocations of normadic people, it doesn’t look like a very successful experiment.

We stop briefly at the National Park Center for our lunch. There are groups of pitcher plants and orchids of many varieties on display. We decide after a quick look at the water in Clearwater Cave not to swim in it. There are also arduous hikes in the area including the overnight hikes to the limestone Pinnacles and the Mulu Canopy Skywalk we don’t take.

At night we are treated to the best cultural display we have seen in Sarawak. It includes various cultural dances, blow pipe display, bamboo pole dancing and even someone twirling on a pole balanced on his stomach high above the crowd. The costumes are exquisite, the choreography excellent and the exuberance of the staff, who also serve us our dinner, is grand.

We have a couple of hours in Miri waiting for our plane connection so we hire a taxi to take us into the town. This proves to be an inspired decision as our driver goes out of his way to show us around his home town. A local park has reproduced a version of the canopy walk for which the region is famous and the handicraft stores are packed with local articles. We are tired but satisfied when we reach home.

As my time in Sarawak comes to a close, the multiple choice questions (MCQs) I have put off writing threaten to overwhelm. Sets of new MCQs are needed every year. In a country where English is a second, third or fourth language, MCQs are not the best way to measure competency or appreciation. Supposedly MCQs capture recognition, although I find I am doubting this too. MCQs are popular largely because they are easy to mark and for students, no composition or grammar are needed.

They aren’t easy to write. They rely in large part on language facility and tricks in wording. In best answer questions, several answers will be right but only one is the best possible answer. We have just completed the orals for the end of the community medicine rotation in fourth year. It has been an exercise about the crucial importance of simple phrasing and clear language without which the students don’t even understand the question. l am attempting to write simple, clear MCQs with varying results. I am getting more and more agitated as I try to match my original objectives up with questions that focus almost entirely on knowledge of facts. My colleagues, who have exactly the same kind of problem, make soothing gentle reassurances many of which end in lah. The lah is also extended to the English translation.

“It’s OK, lah. Don’t worry, lah.”

”Lah-ing” is a wonderful softening device if ever there was one, so Malaysian. Malaysians are a gentle, kind people. Even when you are annoyed with them, you are deflected by their innate kindness. Proverbs often extract the essence of cultures.

One can pay back the loan of gold but one is forever in debt to those who are kind.
Malay Proverb

Our MPH students come over for a Burmese Laksa lunch which is similar to but not the same as Penang Laksa. The Burmese require the thick shrimp and fish sauce to have exactly the right amount of lemon grass, so much tasting goes into getting it just right. The fish-shrimp sauce is ladled over different types of noodles with hard-boiled eggs, fried garlic, deep fried dahl paste, a dollop of hot pepper, chopped cucumbers and coriander on the side and lime juice squeezed on top.

It is also durian time so we are treated to Indonesian durian, not quite so good as Sarawak durian as I am told repeatedly. Three large spiked fruits are cracked open on the table and we help ourselves to the fleshy, succulent fruit. A treat someone’s father has brought back from his trip to locate enough durian to pickle.

The students present me with a Iban beaded top that circles my neck and extended over the whole upper body in cascades of bright triangles of design. I greatly admire the traditional Iban costumes seen mostly in dancers, which flow sedately from side to side emphasizing their hand and leg movements but until I put this beaded top on, was unaware of the kinesthetic experience of wearing one. The beads are heavier than they look and feel like a sustained hug that shimmers when you move. It makes you feel enclosed and protected as well as out there dazzling the world. What an amazing feeling and delightful surprise. This is of course the way with costumes of all sorts. You really do feel as well as look different in them, but the Iban have managed to distill an experience in this beaded dancing top.

One last task is to attend the student presentations of the community placement elective. They have worked hard and incorporated our previous comments. The written report is superb. They answer our questions well. Their analysis is detailed and their intervention was creative. The PowerPoint presentation is a tad lengthy with something like 125 slides. Afterwards they crowd around excitedly to show us their video of the placements. A group of them have, in addition to everything else, done a 10 minute movie of the whole placement from the community visits, setting up their rooms and bed nets, interviewing villagers, home visiting and the health education sessions. The video is professional and slick with fades, background music and stunning photography. It would make a good advertisement for the medical school’s community based programs. We tell them they should put it on You-Tube and show it to the dean. They are shy but pleased. The video better captures the richness of the community program and the connection students have established with the village than any exams will ever do. The Malaysians were right, one shouldn’t worry about MCQs.