A SAD BONFIRE OF STUPIDITIES

Honoring my profile, I'm lazy enough so I hardly publish one entry a month in this blog.
The following text is rather long for blogs but the intention is not just to publish it but to make sure stays online. Its is about a rather sorry affair I am not sure will end well. It is written in English because I follow the Miranda advise that anything I say may and will be used against me. So be it. But at least they will have to take the trouble of translating it into Spanish.

Keep on reading:

Child abuse mismanagement in a modern society

Modern societies are supposed to control and rationalize the miseries of everyday life. Child abuse is one of those miseries with a sad tendency to mismanagement. Over the years, the society has produced a vast array of laws, policies, regulations and norms, as well as it has created a number of agencies whose aim is to provide, foster and regulate child protection.

The different agents and administrations involved, however, often collide in their efforts and a child may end up a victim of “institutional abuse”: the wrong results of the combined actions taken by those responsible of caring for the wellbeing of a child.

Social services, child protection agencies, juvenile courts, medical pediatric services, foster homes, concerned parents, NGO’s saving children, foundations, school boards, charities groups, law enforcement agencies, police, district attorneys and many more, seem to include in their charters a special concern for the children and their mishaps. But all too often the firemen trample over each other water hoses and the end result is a one more disgrace overcoming an innocent child.

Such has been experienced recently in our country when a child, placed for adoption because inability of his biological mother to care for him, after three years was returned to this mother by a court order, just to become again a victim of abandonment and abuse by his mentally deranged mother. The legal battle that ensued occupied vast spaces in the news and the “bleeding hearts” television talk --or rather, bark-- shows for weeks. It was called “el niño del Rollo” case, for the name of the little hamlet of El Rollo, in central Spain, where it started.

About a year ago, in Catalonia, a 6 year old girl was diagnosed by the doctors at a large university children’s hospital of being the victim of child abuse. The report to Social services and the judges got sidetracked. The child, who was discharged from the hospital to her parents, was readmitted some weeks later, this time with severe head injuries that left her brain damaged and wheelchair ridden for life. When the situation hit the news it generated a tremendous turmoil in the media, and prompted an interagency revision of child abuse protocols. It was called “el caso Alba”, after the name of the poor child.

This past week another scandalous case loomed over, closer to me. On late April a 5 and a half month old baby was admitted by our Trauma unit with a spiral fracture of her mid femur. She had been sent by her family pediatrician with the suspicion of child abuse. No good explanation for the injury was provided by the family. The doctor sent a regular routine court notice of an injury. The X-Ray survey showed a periostal thickening in the tibia compatible with a previous fracture or injury. With that we reported the case to the judge, in Spain “juzgado de guardia”, judge-in-court on duty. Our report stated clearly that it was a case of child abuse and asked for a forensic evaluation. We also made sure the court had received the family physician initial report. The forensic doctor came over to see the child and we gave him a detailed summary of the medical proceedings that have been carried out (head ultrasound, skeletal X-ray and blood work), with the working diagnosis of child abuse, 995.5 in the International Code of Diseases (WHO-9^th ed., the one current in our midst).

It took (!) two days to contact Social Services, in Catalonia the “Direcció General d’Atenció a l’Infant i Adolescent (DGAIA)”, the General Directorate for Care of Childhood and Adolescence. To overcome delays, I sent a personal e-mail to the local DGAIA delegate, with whom I maintain occasional correspondence and a reasonable close contact: we meet once a month for a Child Protection Coordination Conference. She acknowledge the receipt of the report and informed she was starting actions.

The “juzgado de guardia”, the judge on duty shifted the case to another court, the nº 3 “Juzgado de instruccion”. The Spanish court system calls for an “instructor judge” to initiate court actions instead of the equivalent to district attorneys, the “fiscales”, who have no investigation responsibilities. Knowing this, we sent all the information by telefax to both courts and made a telephone call to confirm the reception. We also warned them that the child will be up for discharge from the hospital in a weeks’ time, as soon as the Orthopedic service was able to fix the fracture after few days of extension treatment with weights.

During these days supposedly Social Services contacted the court, the court interviewed the parents and, when we called the day before discharge to the court for instructions regarding the child’s custody, we were told to “do what we have to do”, so the child was sent home with her parents to be followed by the Orthopedic Out-patient clinic and the family physician.

I was going to regret that decision.

On June 10^th, the little girl, now almost 7 mo. old, was brought to the ER by paramedics because she had been taken by her father to an emergency clinic in her home town with what appeared to be a grand mal tonic-clonic generalized seizure. She had been administered one dose of diazepam and was in a post convulsive unresponsive state. She also had a bruise on her right malar (cheek bone) area. No explanation for this was given. A CT scan showed a midline subdural fresh hemorrhage, and a subdural effusion of liquid (not blood) content, compatible with a head injury or “shaken-baby” lesions.

Because of the hemorrhage we set the child for transportation to a hospital with Pediatric Neurosurgery facilities in Barcelona in case it might need drainage, which eventually did. And again we started the proceedings to notify the courts and the Social Services, sending over by fax the complete summary.

Later in the day, two officers of the Guardia Civil showed up in our floor asking about the child and the father. “La Guardia Civil” of some infamous fame during the Franco dictatorship in the 20^th century, now-a-days acts pretty much like the State troopers in the US: highway patrols and inter-county law enforcement. They stated that the mother, who apparently was absent from the home when the child had the seizure, did not know what had happened and had reported the disappearance of her husband and baby the since the night before. Further, in taking the baby to the emergency, the father had abandoned another 4 y/o little girl on her own in the home, that the mother found as she came home from work.

All this seems hard to believe now-a-days when just about everybody carries a cellular phone. During the (short) hospital stay in our service, the nursing personnel had been unsuccessfully trying to contact the mother. The father could not provide information of her whereabouts, nor was possible to contact her workplace, closed at those hours.

As the abandonment of the other sibling and the strange family relationships constituted more than suspicious of another case of child mistreatment, I sent the Guardia Civil officers to the court and called myself to report the incidence.

As I was talking to the court clerk, I mentioned that in this sorry affair we all will not be looking very good. At that moment, the judge in charge (a woman judge) picked up the phone and gave me an overly exaggerated rundown on keeping from criticizing court decisions or I would be charged in contempt (!!). I mumbled an excuse and ended the conversation, surprised of the overreaction which soon enough will regain its meaning.

That evening, with the child being transferred to another hospital, the intervention of the Guardia Civil and the rest, the incidence hit the news agencies. The next morning it was all over the front pages and radio news bulletins, and… the bonfire of vanities came to reality.

It was quite obvious that neither the court nor the Social Services had been diligent enough to make decisions to avoid a second incidence of severe case of child abuse.

It has been some time since I knew the difference between an event and the news related. The event was a perpetuation of child abuse while the victim was supposed to be under official watch. The news was the lack of coordination between agencies and the judicial system. Reminding the “Alba case” it hit the front pages with a vengeance.

I spent more than eight hours, under instructions of the hospital administration along with our PR unit, answering radio stations calls, giving interviews to newspaper journalist and being filmed by 6 or 7 different television stations and networks, telling what had happened.

The social services, the DGAIA refused to answer in the press directly but issued an statement claiming that when, one month before, they have asked the court for a ruling o, at least, information about the case and the family court statements, this had been denied by the judge in the ground that they had not appeared in the initial arraignment. Therefore they carried no further actions. Nothing, nada.

The police, acting under court orders had detained the father in Barcelona, while he was in a waiting room by the ICU at Sant Joan de Deu Hospital, the best children’s hospital in our area, were the child had been sent. The father appeared in court but the judge again released him without charges.

The next morning the media pressure was overwhelming and the different agencies administration officials became hysterical. The hospital Administration was relatively quiet because they though we have done all we could and, particularly, because I was taking all the burden of public appearances in a situation that nobody would look very pretty. But soon enough I was going to suffer the consequences of bureaucratic frantic attitudes.

I had been invited by a major television network to next morning’s talk show, a quite influential show anchored by Josep Cuni, a popular television newsman. I had appeared in that show a few times in the past, usually in matters related to child care, emergency medicine and the overcrowding of ERs in our country, bioethics and, also, child abuse. So it was just natural they invited me this time. They were going to send me a courtesy car to go to the TV station, just to minimize the inconveniences and shorten my time compromised.

That was not going to happen. The shit had really hit the fan and different government agencies were scurrying around and setting up CYA (“cover your ass”) actions and barriers and enlisting all the spin doctors they could get hold of.

The government officials got wind of the possibility of that TV appearance of mine and I was urgently summoned at the, for Spanish schedule standards, ungodly hour of 7.30 a.m. by the Regional representative of our Health Department, with the specific purpose of cajoling me into not appearing at the TV show. They even claimed they were under instructions of the Chief of Staff of the presidency of the Catalan Government, apparently worried sick for another case of governmental agencies malfunction. That really pissed me off. It was not just the obvious lack of confidence on me and on what I would say, but just the sheer censorship in a matter that, by then, was of public record. Along came the idea that our (current) government was not very happy with the TV anchorman, Josep Cuni, and his frequent criticism of the Administration. But to me were just bureaucratic hysterics and a clear form of information control I had thought had gone away with Franco thirty years ago. Bad deal.

Miserably altogether a fool’s errand: I called the TV station to decline my appearance. The station had enough footage from my interview the day before, so they just edited it in between interventions of the rest of the program guests. That way I ended up having a larger show time than what I could have been allotted had I been present. Not that I could care less. By then I was pretty fed up with the whole affair and very unhappy with the censorship.

The next morning the Sant Joan de Deu Hospital issued a statement on the child status and mentioned that, along with the injuries previously described, a more careful review of the images showed evidence of a parietal skull fracture. On those grounds the judge. Who obviously had been chastised by the press and, undoubtedly, her peers, ordered the immediate arrest of the father again.

I was then called to testify in court. The judge, after informing me of my rights in a rather, and probably hardly legal, perfunctory way, announced that she only wanted to take my statements in regard the second admission of the child. Then she went on asking about the skull fracture and “how in earth had we had missed that(!)”, which to her was of paramount importance as she had had to put a man in jail because of it. Knowing the judge demure from this and the previous contact, I contained myself as much as I could. I tried to illustrate Her Honor of the clinical significance of two serious intracranial lesions such as the subdural hematoma and the subdural effusions, versus a hardly clinically significant linear skull fracture which, in its own merits had not been accompanied by intracranial lesions, would have not required other treatment than watching. The same that the more than 60 cases of accidental asymptomatic linear fractures in small infants we may see in a year in our ER. But she was all excited by the skull fracture, I gathered because that had been diagnosed in a major hospital and all that. I cut myself short of asking if the tremendous femoral fracture of the first admission had any meaning to her.

All the agencies involved in the case: the Social services (DGAIA), the Overhead Committee of the Supreme Court that watches over judges, and the Department of Health (in behalf of the hospital) issued statements saying that, with the information available, all services had followed the protocols and that they did not contemplate any mishandling of the situation (sic!).

Probably out of surprise and concern, the Catalonia Ombudsman, Mr. Rafael Ribó, a former leader of the Catalan Communist Party, now retired from politics and a sensible man --not all communist had horns and devil’s tails—called for an interdepartmental conference on the case held this past Friday, but from what I heard in the news, the Ombudsman office will take a distant stance until specific responsibilities are cleared at the departmental levels.

It has been some time since I read Tom Wolfe’s “The Bonfire of Vanities” but the scenario came to me very vividly. I do remember, however, quite distinctly the scene in the movie of the same title where Morgan Freeman, acting as the presiding judge in one the final sequences, made a strong call for DECENCY to all present. That again is what I found missing in this sorry affair.

The child remains in the SJDD hospital pediatric ICU. They inserted a drainage in his head and are waiting for recovering.

The little sister, who was also a victim of abandonment, to my knowledge is in care of her mother who does not seem a very reliable person, something meriting revision.

Meantime the press is watchful of further developments and promising more exposés in the near future.

As for myself, I will stick to my guns and probably review the chapter on child abuse of the new edition of my book on Psychosocial Pediatrics. Probably I will recommend the readers that, in case of child abuse, if they want things done, report to not only social services and the courts, but to the press as well and all at once. It is possible that under the public eye the bureaucrats may be more diligent.

La “gola de mitjorn” y el cambio climático

Pues no es que vaya a comparar una observación puntual con el fárrago de estudios científicos de sesudos investigadores que ominosamente nos anuncian el fin del mundo tal y como lo conocemos. Es que ya estoy un poco harto de jeremias y casandras y de las quejas de “la caló”, cuando a mi me parece que hay poco nuevo bajo el sol que nos calienta y que el tiempo meteorológico siempre ha estado un poco loco y nunca llueve a gusto de todos.

El caso es que el 5 de mayo de este año del señor, la “gola de mitjorn”, la boca más meridional del río Ebro, no llega al mar. Una barra de arena de unos 40 centímetros de altura retiene las aguas del río y las blandas olas mediterráneas lamen la lengua de arena suavemente, algo tímidas por el poniente que sopla y que las mantiene quietas. Metí el dedo en las aguas de uno y otro lado para probarlas: una dulce y la otra salada. Por delante de mi nariz un oscuro cormorán vuela hacia tierra. A mi espalda, en una de las charcas de la isla de Buda, un bando de flamencos se despereza mientras una grulla cruza con paso solemne el camino de tierra que me ha traído hasta esta apartada orilla. Hace fresco aunque el sol haya roto los retazos de nubes que quedan de la última borrasca.

O sea, que el nivel del mar no ha subido, de momento. Y el delta se despierta algo más húmedo porque estamos ya en época de siembra del arroz.

Lo que los científicos vaticinan como consecuencia de las evidencias de aumento de la concentración de gases con efecto invernadero son cambios a medio plazo y que los humanos no vamos a percibir. O por lo menos no lo vamos a notar en la factura de la calefacción.

Los registros de temperatura que afirman que los últimos años han sido los más cálidos del siglo (pasado) no me dan ni frío ni calor. Lo de los glaciares y el casquete polar está dentro de lo que puede pasar por mil motivos. Mientras el polo norte disminuye su hielo hay evidencia de que en la Antártica el grosor total ha aumentado. Las emanaciones de CO₂ y metano de los automóviles, con ser notables, se equiparan a los pedos de las vacas, que son bastantes. Pero nadie ha contado los de las manadas de gñus africanos. Es cierto que están deforestando la Amazonia, pero en Catalunya la superficie forestal es ahora tres veces mayor que hace cincuenta años.

Este invierno ha nevado poco en el Pirineo. Pero también nevó poco hace unos años en Sierra Nevada cuando tuvieron que suspender el mundial de ski. Si se mira al pasado siempre los tiempos, atmosféricos y vitales fueron distintos. En el siglo XV François Villon, en su «Ballade des dames du temps jadis» se preguntaba que a donde habían ido a parar las nieves de antaño (“Mais où sont les neiges d’antan?”). En la misma época Jorge Manrique opinaba que “cualquiera tiempo pasado fue mejor” y algo más sobre las vidas y los ríos que van a morir al mar.

Pues el ramal sur del Ebro no “muere” en el mar. Ahí sigue, vivito y coleando, alimentando grullas y regando arrozales. Y cualquiera tiempo pasado fue simplemente igual y, en algunas cosas, bastante peor.

Lo que no cambia es el interés de los poderosos en meternos miedo a los humanos de a pie. No sea que vayamos a creernos que el mundo es nuestro y no suyo y se lo quitemos.

Decidle a Al Gore de mi parte que, cuando se vaya, no se olvide de apagar el televisor.

La desaparició dels metges de capçalera

La imatge del metge assentat al costat del llit de la malalta, prenent-li el pols, en la espera ominosa de que afebleixi, que va pintar Picasso fa més de cent anys, està en vies de desaparèixer definitivament.

Continuem fent servir el terme per a referir-nos als professionals d’atenció primària que, en un disseny de pràctica assistencial desenvolupat al segle passat, se’n fes càrrec de l’atenció immediata dels malalts i en proximitat.

La gradual desaparició de l’assistència domiciliària, sobre tot a l’àmbit de l’assistència pública, així dita “de la Seguretat Social”, no dona lloc a l’encontre dels professional i el malalt al voltant d’un llit.

Això sí, els nous equips d’assistència domiciliaria reprodueixen el model, però no el concepte. El mateix que la figura de “metge de família”, la qualitat del metge de capçalera s’ha atribuït al seu coneixement proper del malalt, quasi íntim. Aquest coneixement proper era generador de confiança. I aquesta confiança, de respecte al diagnòstic i compliment de tractaments i recomanacions per part del malalt.

Una bona part d’aquesta confiança raïa en la memòria del professional. El metge coneixia al malalt i els seus antecedents i història personal. Però això és un luxe que al segle XXI ja no es podem permetre. Ningú pot refiar-se de que un professional se’n recordi de tot el que li ha passat ni que ho faci amb fiabilitat.

L’historial clínic, en les seves versions en paper o en memòria cibernètica ha esdevingut un eina de treball massa important, i la complexitat de les dades recollides i la multiplicitat dels malalts no permeten deixar els registres només que a la memòria humana.

El treball en equip, o el treball dels equips, també acaben per substituir al professional únic en l’atenció. Els malalts han desplaçat la seva confiança del professional únic cap als professionals disponibles, i tal és l’efecte que això te en l’actual inaturable creixement de la demanda als serveis d’urgències: la gent s’estima més que l’atenguin quan els hi convé, per part d’un professional desconegut, que no pas pel seu metge que només està disponible unes hores concretes.

No seré jo qui jutgi les bondats o distorsions d’aquesta realitat. Em limito a constatar-la. Però si que recomano que els responsables de la distribució de l’assistència ho tinguin en compta i que s’adaptin a la realitat.

De diversidad cultural

Discretamente avergonzado por dejar este blog tan desatendido, voy y me lio a publicar una previa de un artículo sobre cultura y salud. Al fin y al cabo es otro trozo de mi, para quien le interese.

Ahí va:

Durante siglos el conocimiento en temas de salud se mantenía con un cierto paralelismo entre la gente y los doctos. Aunque los doctos adquirían saber con el estudio y con la experiencia, el ritmo de la adquisición, aunque gradual y progresivo, se mantenía en unos límites humanos, por no decir personales.

El traspaso del conocimiento a la población se hacía por el contacto, la consulta y la observación de los aconteceres. Aún así, a menudo los doctos intentaban ocultar el conocimiento y, a menudo, su ignorancia lata, con el uso del latín en su discurso y la caligrafía ininteligible en sus prescripciones. Así mantenían una cierta distancia de seguridad.

Entre la población, los depositarios del saber eran las familias, generalmente las mujeres, las madres, que los trasmitían a su descendencia de forma más o menos fiel. Y la siguiente generación lo incorporaba y lo elaboraba gradualmente.

Con el desarrollo de la medicina científica el progreso del conocimiento adquiere características exponenciales. Una muestra es la progresión del número de publicaciones que aparecen en el Medline. El conocimiento crece y los profesionales lo adquieren en proporción también creciente, pero cada vez resulta más difícil traducir esos nuevos conocimientos a la población por la también creciente complejidad del conocimiento.

Ahí se genera un distanciamiento cada vez mayor, hasta el extremo que profesionales y pacientes apenas comparten conocimientos o, ni siquiera, un mismo lenguaje.

En esa distancia, que es ya cultural, reside la percepción de la población de que la asistencia ha dejado de ser “humana”. Pertenece a otra dimensión. El reto es salvar esa distancia de forma eficaz y recuperar la confianza de la población.

La llegada de nuevos inmigrantes procedentes de otras culturas ha puesto de manifiesto una distancia cultural obvia. Pero cuando se pregunta a los inmigrantes cuáles son las dificultades que encuentran para relacionarse con los profesionales asistenciales, relatan los mismos problemas que la población autóctona: “no me atienden, no me entienden, me dedican poco tiempo, no comprendo lo que me dicen, son distantes, no me miran, sólo soy un número…“ etc. etc.

Los profesionales deben adquirir nuevas habilidades, nuevas competencias para conseguir salvar esa distancia. Deberán ser más humanos, es decir menos “sabios cibernéticos inalcanzables”, ¿menos extraterrestres, quizá? Así se “humaniza”, se reduce a la dimensión humana la asistencia.

Breaking and entering

That’s the title of a recent movie starred by my much admired Mrs. Penn, Sean’s wife, neé Robin Wright, as an autistic child’s mother.

And that’s our most recent adventure when last Monday, in the wee hours of the morning, an intruder broke into our home through one of the kitchen’s windows. On hearing a minor crack in the stairway, I woke up, grabbed a long walking stick I keep by my bedside and confronted the bastard, shouting my head off: “I’ll kill you, son-of-a-bitch…!” and few other niceties the Spanish language allows. He run away and lost himself in the nearby woodland.

The only thing missing was my wife's purse that was sitting in a bench by the stairway, which we later found in the garden with everything but the money, some 100 €.

The police came over in a few minutes but there was no trace of the intruder. In the morning, when the police came by to finish their work up, they informed us that there had been five more homes in the neighborhood assaulted that very night, but the others did not found out they have been assaulted until they woke up in the morning. “Silent robbers” are called the bastards.

After more than twenty years of peaceful living in our neighborhood, not caring much for building fences or locking doors, a recent wave of robberies is making our life a bit uneasy. We are not sure getting anti-burglar alarm systems will restore our peace. Nor upgrading my walking stick to a more deadly weapon either. Mind you the walking stick is more of a pole: a four foot long, one and a half inch thick ash wood rod, with a thick knob in one end and tapered in the other, ending with a metal tip. This is used commonly by the Pyrenees shepherds. I bought it some years back in the valley of Broto, where my father’s ancestors came from. It is pretty much the size and shape of the old “pilum”, the weapon favored by the Ibers of old to fight the Romans. That historic stupidity has given me some sense of security I wonder if I will ever regret. Will see.

Una tercera hora de castellano en las escuelas catalanas

Andamos otra vez a la greña por dirigir desde la política la educacions de los niños. Ahora toca (la verdad es que no se que es el que toc o lo que se toca...) añadir una tercera hora a la enseñanza del castellano (también llamado Español, por cierto) en las escuelas catalanas.

Qua la tercera hora haga falta o no va a tener menos importancia que si sirve para fomentar discrepancias políticas. Mientras, la ciencia aporta evidencias que nos deberían hacer reflexionar. La prestigiosa revista Neuropsicología, en su número de este mes de febrero publica un sugerente artículo que muestra que el bilingüismo parece ejercer un efecto protector sobre el comienzo de la demencia senil (“Bilingualism as a protection against the onset of symptoms of dementia”, Ellen Bialystok, Fergus I.M. Craik, and Morris Freedman. Neuropsychologia , Volume 45, num. 2 , 2007, Pags 459-464).

Ser bilingüe va más allá de aprender una lengua en una escuela de idiomas para trabajar de recepcionista en un hotel o navegar por Internet. Incluye pensar, sentir y emocionarse en más de una lengua. Y eso es una riqueza indudable. Los que la tenemos no debemos perderla. En ningún sentido.

No se si un periódico también puede llegar a tener demencia senil. Pero quizá que La Vanguardia también pudiese plantearse las realidades de nuestro país. Mientras, es posible que El Periódico está ya pensando en ese futuro. Buen ejemplo. Entre tanto, El Diari de Tarragona va bien manteniendo el bilingüismo.

War, peace, oil prices and whatever comes. A theory of conflict

Let's imagine that the American troops were received in Iraq as victors and liberators when they bashed through the Saddam Hussein defences back three years ago. It would reproduce the scenes of France 60 years ago: joyful French girls kissing wildly handsome G.I.'s, crowds cheering, champagne corks popping, flags weaving... The government restored set up the Forth Republic, the ungrateful patriots sent DeGaulle packing home and the Spanish Republicans who fought along with the Allies began dreaming of getting back to their homeland and, taking advantage of the war push, try to unsettle Franco.
A pretty picture that was not to be.

But it could have happened in Iraq. The Shiite imams could have helped out, the Kurds up North could have been ready to negotiate some autonomous settlement... The country pacified, up on its feet, the commerce working and the oil fields pumping happily millions of barrels of oil to fuel the First World energy craving, even the Third World needs to catch up a bit...

What? Oh, no! Who ever said we need a happy world?

Those millions of barrels of Iraqi oil would drag oil prices down so much as to make absolutely impossible for the oil producers of Texas, Oklahoma or even the Alaskan fields to compete. Cheap oil means increases in oil use and thus increases in air pollutants, and that is bad, isn't it? Cheap oil means fewer margins for speculation, for wheelings and dealings in the international markets, less returns for investors that put their money this past year on the fluctuations of Brent at 80 bucks the barrel. It would be the ruin for commodities brokers...

Nay, nay. What we need is a unstable market, moving confortably upwards but jolted between now and then by a nice little terrorist attack so the stock moves, the faint-hearted get scared and sell to a loss, and the bold reap a profit...

Does anyone believe that George W wants to finish up the Iraq mess? If he and his cronies are as smart as they claim to be, it is obvious that what they are doing is to extend the conflict because that's what they want. They are not failing in their purpose, are they?

No, I have not seen Michael Moore's movie. I even think he is missing the point. GW is not dumb: he is working for what he honestly believes: a better world... with enough stress to keep the things moving.

Entre acelgas y Massiel

Pues quizá era todavía el Pleistoceno inferior que tuve un encuentro fugaz con Massiel. En un pasillo. De un hospital.

De pie y en la entrada del servicio de Pediatría del hospital estaba una dama como vistosa o, digamos, llamativa, a quien no pude identificar, con cara de angustia, a la que presté escasa atención.

Hay que añadir que en aquel entonces y en aquel sitio no era infrecuente encontrar personajes más o menos pintorescos o, como ahora se entiende, famosos.

Al cabo de un rato dábamos de alta un niño que se había pillado un brazo en la puerta del ascensor y que habían atendido en el servicio de Traumatología. Me dirigí a su madre, la dama en cuestión, con cortesía elemental para asegurarle que las lesiones curarían sin secuelas y en poco tiempo y que acudiese a la consulta para revisión en unos días.

No fue hasta el día siguiente que en la prensa, y luego al cabo de pocos días en la prensa del colorín, apareció la noticia de que el hijo de Massiel había tenido un percance y había sido atendido en el hospital. Y supe entonces quien era la dama.

Las acelgas creces silvestres en un talud que bordea el depósito de aguas que hay cerca de donde vivo y sirven de alimento a la numerosa colonia de conejos que allí habita. Cuando hicieron el talud utilizaron como relleno tierras procedentes de una zona de huertas cerca del río y con ella llegaron las semillas. Sólo las he “cosechado” una vez y, frescas y hervidas, eran naturalmente comestibles.

No quisiera mostrar entusiasmo por las acelgas y otras verduras verdes, válganos la redundancia, como las espinacas, las borrajas y las coles. Que haya "verduras" que no sean verdes es una rara ocurrencia; se las llama hortalizas, que viene de huerta, como ojeriza de ojo y paliza de palo. Siempre he creído que detrás de la insistencia de madres y dietistas expertos en la conveniencia de ingerir verduras por lo de la fibra, el potasio y otras bondades, existe alguna maldad.

Me produce una cierta resistencia comer cosas cuyas bondades no están en su aspecto, gusto, aroma o consistencia, sino porque sirven para cagar y mear bien, mantener la tensión arterial controlada y prevenir el cáncer de colon.

Y que nadie se escandalice porque parezca que traiciono los sacrosantos principios de la profesión que ejerzo. Los médicos tratamos enfermos y enfermedades. Si puedo parafrasear a Clemenceau (¿o era Tayllerand?) cuando hablaba de guerras y guerreros, creo que la salud, la Salud con mayúscula, es una cosa demasiado seria como para dejarla en las pecadoras manos de los médicos.

Inocentes

El “modus operandi ” consiste en que los tres niños entrasen en la entidad bancaria exhibiendo periódicos gratuitos (MésTV, Metro, etc.) como si los repartiesen. Caminando deprisa se introducen por entre la gente que hace cola, llegan hasta los mostradores y se acercan pasando la mano por encima y, con la misma velocidad salen del banco. Afuera les espera un adulto que recoge la “recaudación” e, inmediatamente, se dirigen a otra entidad bancaria. En poco más de una hora se han recorrido todos los establecimientos de la Rambla.

Parece un guión extraído de “Oliver Twist”, solo que en vez de ser huérfanos londinenses de la época victoriana son inmigrantes rumanos, de etnia romaní.

A la tercera oportunidad que me los topé me dirigí al adulto que se acercó como curioso. Le informé que lo que hacía era un delito en este país: inducción al delito a un menor. Corrupción de menores. Masculló unas palabras y con un gesto de escepticismo o desprecio se dio la vuelta y se dirigió a otro banco.

Los niños son inocentes. Hoy 28 de diciembre es su fiesta ¿no?. Pero el adulto es un delincuente.

Llamé al 091 y me colgaron el teléfono después de informarme que tenía que hacer la denuncia por escrito y en comisaría. La Guardia Urbana se mostró más interesada y mandó un coche patrulla. Pero el oficial de guardia, extrañado, me llamó por teléfono para preguntarme porqué mostraba tanto interés por el caso (sic!). En la Fiscalía de Menores me dijeron que si los niños tenían menos de 14 años ellos no intervenían.

Pues alguien debería hacer algo antes de que, por el camino que van, un día decidan probarlo con el chalet de un joyero y un segurata les meta una bala en la cabeza.

Philip the Second’s mistake

One of many. Reading the history of Spain one can’t but deplore the shortsightedness of the rulers, particularly that of the most influential.

Just trying to understand today’s minor issues, for instance: the classical rivalry between Barcelona and Madrid soccer teams, I went back over some history books for enlightenment.

They have recently found some new remains of the original Iberian wall of the city of Barcino in the old part of town, “el Barrio Gótico”. Indeed, Barcelona was an original Iberian settlement, back in the 3rd century B.C., later colonized by the Carthaginians. The story goes that Barcelona got its name from Amilcar Barca, head of the Barca family and father of Hannibal. So Barcelona has been in existence for some 2200 years.

Madrid was just a Moorish castle erected sometime in the 11th century (“Madrid, castillo famoso/arde en fiestas su coso/ por ser el natal dichoso/de Alimenón de Toledo….”). It was just that until the XVI century, when Philip the Second of Spain decided to make it the capital of his realm. Tired of freezing his butt in the inhospitable winters of his native Valladolid, he moved south to the gentle hills of the Southern “meseta” past the Central Mountains of Guadarrama, following the advice of some geographical experts that told him that it was the “center” of his world.

That was the vision of a Castilian land-lubber, keener to “physical geography” than to political o social conditions.

By that time he was already the king of Portugal as well, right after the death of King Sebastian in Morocco. He had been married to a Portuguese princess and then became widower as she died of childbirth. (She had mothered the Crown Prince Carlos, the Don Carlos who was going to give so much trouble to his father later on). And he was the rightful heir to the Portuguese throne.

In a historical moment when the ruling of the seas was going to be the mainstay of power, he could have made Lisbon the capital of his vast empire. Lisbon was the “geographical” center of the world, the real new world; the hinge of the Old and the New worlds. That would have been a real “imperial” view, of a global empire.

Instead he got himself (and the country) into trouble for the sake of a religion I am sure he did not believe in, using the Inquisition as a controlling sectarian force and accusing the Catalans of heresy just because they did not want to pay so many taxes to cover the expenses of the war in Flanders.

… and then comes the FIFA and gives the 2006 Golden ball to a Real Madrid defense back Italian bastard instead of our fantastic Ronaldinho...!!! Damn!!!

Un cuento de Navidad

Embarazada de 31 semanas de gestación y con gemelos que se pone de parto en Ibiza y, como allí no pueden hacerse cargo de una situación potencialmente complicada, se procede a trasladarla. Pero no se encuentra un hospital disponible para acogerla ni en Mallorca, ni en Barcelona ni en Valencia, por lo que acaba siendo trasladada al aeropuerto de Reus-Tarragona y de allí al Hospital Universitario de Tarragona Juan XXIII, donde da a luz al cabo de una hora escasa (madrugada del 1 de diciembre). Tanto la madre como los recién nacidos, niño y niña, se encuentran bien. La madre ingresada en la planta de maternidad y los bebés ingresados en la Unidad de Cuidados Intensivos Neonatales del hospital, donde tendrán que permanecer varias semanas.

Buscar acogida para una mujer de parto recuerda la aventura de José de Nazaret y su señora, ahora hace 2006 años. Que el peregrinaje en búsqueda de acogida se haga en avión y que acabe en una UCI neonatal y no en un pesebre no es más que un signo de los tiempos.

THE SPY WHO CAME IN FROM THE HEAT

I am just surprised no one, thus far, has used this headline to refer to the Litvinenko affair. The poor guy has been buried in a special coffin to prevent radiation leakage. His is a very hot body.

This strange story takes you easily back to the Cold War years and all the cloak-and-dagger affairs the two superpowers carried on all over the world. With a little help from their friends, indeed, being those the Mossad, the Bulgarian secret services, the French Deuxieme Bureau, the Stasi, and a whole bunch of others more or less recognized shady operators.

The poisoning of Litvinenko has all the trappings of a KGB operation, now taken over by the FSB, as the intelligence services of the Russian Federation are now known. Old habits die hard.

Somehow, however, the British have decided this is just a crime, not a crime of state. Readier to admit the affair more as an embarrassment for the Putin government than his doing, they have obtained full cooperation from the Russian authorities.

The use of such a sophisticated killing method, poisoning with a rare radioactive isotope such as polonium-210 is, at least, convoluted in its development. Looks like the killers wanted a gradual progression towards death for some unknown reason. Killing anyone is a relatively easy matter: gunshot, knife, cyanide poisoning or just a gentle shove in a tube station platform just before the train enters the station… Quick and neat. Now is a mess and the polonium has left a trail all the way from the London hospital where Litvinenko died to several toilets in London restaiurants and hotels, at least 14 British Airlines planes, a Schleswig-Holstein home in Germany, and even Moscow.

Litvinenko had ample time to talk to the authorities and the press, getting all the publicity he could ever wanted. Is it a matter of clumsiness in the part of the killers or is just the intended effect? Indeed, a good script for a spy movie.
Reality often outsmarts fiction: John Le Carre, eat your heart out.

What calls my attention in this story is the radioactive part. Living within a 45 minutes car ride from three nuclear power plants (the fourth, “Vandellos I”, a Chernobyl era old chugging contraption that almost blew up some 15 years ago, is in a never-ending process of being dismantled) keeps me very sensible to nuclear energy and its effects on the human body.

It also seems almost forgotten the ominous fact that the nuclear arsenals of the superpowers (and Russia is still one) hold enough megatons to blow up the entire planet 100 times over. We seem to only shiver a little when somebody announces that so-called rogue states such us North Korea o Iran are about to build atomic bombs, as if the thousands of warheads already existing were not likely to blow up at the whim of one government or another.
Some time ago I was about to join the “Doctors Against Nuclear War” association, just when they got the Nobel Peace price. In an “ex post facto” sensation I felt it was not worth to join anymore. A sort of a “mission accomplished” feeling. Perhaps we need an association of “Doctors against Nuclear Peace”, or “Against Nuclear Energy Of Any Type”

Not that I do not recognized the many good uses of radioactivity, particularly the uses in Nuclear Medicine and radiotherapy, but I keep wondering if the world would not be a better place had the Curie espouses decided to get into cheese making or founded a winery in Alsace, instead of messing around with nuclear isotopes. And if Albert Einstein had used his marvelous relativistic mind to write poetry instead.

May be the next time around. If there is one.

The very best

- An American salary… and a Mexican job

- An Italian wife… and a French mistress

- A British home… and a Tuscany landscape

- A German car… and a Russian driver (body guard)

- A Swiss accountant… and a Swedish doctor

- A Catalan (perhaps a Chinese) cook, and a Spanish winery

- A Dutch secretary… and a Thai masseuse

- An Hindu servant… and an Argentinean stable boy

- A Japanese laptop… and a Finish cell phone

And the worst is just the opposite...?

Elections in Catalonia

The Catalans are back to the polls, almost one whole year before the end of the mandate period, as a consequence of the approval of the new Catalan constitution “L’estatut”. That, and the fact that the governing coalition of three parties , the “Tripartit”, was broken on differences over “L’estatut” and a few other major troubles that untied the flimsily woven accord of governance.

Granted that the three parties, identified as “leftists” had major differences to start with, being the Catalan Socialists Party (PSC) a rather benign social-democrat much in the line of British Labour Party, the Esquerra Republicana de Catalunya (ERC) a more radical Catalan nationalist republicans and the third member, Iniciativa per Catalunya-Verds (ICV), a melange of Euro-greens and what is left of the old Catalan Communist Party. Together they overcame the 23 year old governing coalition of rightist nationalists (CiU) while the representatives of the conservative party of Spain in Catalonia, the Partido Popular (PP) was just and excluded minority.

Now these five parties are again in the race and the perspectives are way up in the air.

The candidates are not precisely glamorous, rather lacklustre apparatchiks with long stories of wheelings and dealings in the convoluted Spanish political scene, but not very enticing for the common citizen elector.

The programs offer also very little. Catalonia is still very dependent of the Central Spanish Government. Although the new constitution, “L’estatut”, was meant to grant more autonomy, the final accord fell quite short of many Catalans expectations. The promise of getting more autonomy –and more money—from Madrid in developing the new “estatut” will not get much credibility, no matter who is promising. The socialists (PSC) because their Spanish counterparts, the PSOE, now in power in Madrid already cut the “Estatut” short, and the rest because they will have difficulties pulling off concessions from what are their political adversaries.

The Catalans are, however, a rather accommodating bunch. Prompted to compromises and used to find middle grounds in their way to conduct business, they come from a two millennium history of merchants and traders that once ruled the Mediterranean when outsmarted Venetians and Genovese and even the Popes during the Renaissance.

Today Catalonia is one of the leading countries (as a country it is, though not a state) in the economic development of Europe. What is being called “The Mediterranean Arch”, the coastland from the Italian Liguria all the way to Valencia, accepts Barcelona as its capital, over Marseille or Genoa. The commercial corridors from Milano to Toulouse are extended to Catalonia as the fastest developing region in Europe. Tourism is booming with almost ten million visitors this past year.

Catalans will not put any of this at risk by giving the majority to one single party. They had enough of that after 23 years with CiU, and the PSC, tto dependent of Madrid cannot pull out a majority either. My bet is that the share of the electoral pie will be pretty much the same it was in the last elections, with some minor changes that will be modulated in the post electoral accords between the parties, as the inevitable coalition government is constituted.

Long life to compromise.

El mal i el dolor

Fa dies que volia escriure a tall de les manifestacions d'autoritats religioses i civils sobre l’existència del mal i les dificultats dels homes per a entendre la seva existència en contraposició al be de Deu i la seva absència en moltes circumstancies terribles de l’actualitat.

Potser que arrenca de les manifestacions del Papa Ratzinger a la seva visita als restes dels camps de concentració nazis d’Alemanya. "On estava Deu?", es preguntava, igual que altres s’ho han fet en relació a la recent guerra del Líban.

Mirant la història, el passat sense massa ira, hi ha innumerables tragèdies, naturals o causades pels homes, que semblen reafirmar la presència del Mal i de rebot podrien negar la d’un Deu misericordiós de les víctimes: tempestes, erupcions volcàniques, inundacions, guerres, pestes, fams... els quatre o potser cinc genets de la Revelació galopant per tota la terra sense descans i sense pietat...

No tinc formació teològica (ni tampoc massa interès) per a argumentar sobre la presència de Deu i la del Mal, personificada aquesta com a diable o rei de l’infern. Les simplificacions maniqueistes no em semblen prou raonables. Ni tampoc tinc humor per a considerar les figures literàries del Mal, des de Mefistófeles fins als dimonis dels “Pastorets”. Ni m’agrada gens la tan estesa moda cinematogràfica nord-americana de les pel·lícules de terror demoníac.

Però per la meva dedicació professional, m’hi trobo sovint en situacions on el patiment, el dolor, l’angoixa pel sofriment ocupen un ample espai i temps. I, habitualment les víctimes son de les que, comunament, es reconeixen com a innocents, si és que totes les víctimes, pel sol fet de ser víctimes no son ja innocents; em refereixo als nens.

Quan aquestes víctimes o els que les acompanyen demanen explicacions: el com ha estat, com a pogut ser, que ho ha causat, el perquè, el perquè ell, el perquè ara... no resulta fàcil donar explicacions. El recurs més comú es la referència inconcreta a “La Biologia”, “la feblesa del cos humà”, la sort o la dissort, o el destí.

Hi ha un punt però que vull comentar. La proximitat sinònima que al català te el “mal” amb el “dolor” i la consideració que el dolor es pot evitar i que és innecessari, especialment el dolor inferit em porta a pensar en la necessitat de l’existència del “mal”.

El dolor, el dolor físic, concretament, hom entén que ha d’ésser evitat. S’ha de combatre. S’ha de alleujar i, en la mesura del possible, anul·lar-lo amb els recursos de que hi disposem: analgèsics i anestèsics. I essent doncs indesitjable, el dolor, no fora millor que no existís? No hauríem de trobar una “vacuna” contra tot dolor?.

Be, doncs no. Ja sabem que els individus que pateixen anestesia neurògena, absència de dolor, tenen una vida curta: com que res els hi fa mal, no saben defensar-se de cops, caigudes i accidents.

El dolor, que hi ha coses que fan “mal”, ajuda a aprendre a protegir-se un mateix. I des de ben petits. Quan un infant toca un objecte calent o punxant adquireix l’experiència del perill de l’indesitjable. El dolor d’una part del cos, d’un òrgan, una articulació o un queixal, et posar sobre avís d’un possible malfuncionament o patiment. Del dolor n’aprenem.

El dolor, el mal, existeix. Es indesitjable però no inútil.

El “Mal”, probablement també.

dissabte, 26 / agost / 2006

La piel de cabra

Los blogs deberían tener la disciplina de "Mi querido diario". El mío no. ¿Será "querido hebdomadario"? Me acusan, en privado, de escribir sólo los domingos y ni siquiera todos. Como los columnistas de los suplementos dominicales de los periódicos.
Aprovechando este agostado domingo miro hacia atrás y a mi, lo que me llama la atención de este blog es que casi me he olvidado de la idea del trilingüismo que anunciaba al principio y que hablo más de muerte que de vida...
A saber. Un crítico literario me decía hace tiempo que un libro de éxito, me imagino que una novela, debe contener una muerte en la primera página. Como un aviso. Así se atrae la atención del lector que seguirá leyendo a ver que fue lo que condujo a esa muerte. Y, en cambio, no hace falta que las novelas acaben con un muerto al final.
Me imagino que ese es el atractivo de las novelas de crímenes. Y quizá lo que llevó a Gabo García Márquez a mejorarlo anunciando la muerte en el mismísimo título cuando lo que en realidad se anunciaba era su imparable éxito literario.
Los domingos son para el ocio y el descanso, pero a mi frecuentemente me pillan trabajando. Aunque como mi tarea tiene una cierta intermitencia, igual hoy me permito aprovechar para ver una corrida de toros y un partido de fútbol en la televisión, epitome del ocio hispano.
Por ejemplo la última de la feria de San Sebastián: Victorinos para Juan José Padilla, Luis Miguel Encabo, dos veteranos consagrados y para Ivan Fendiño, un novel que es de Orduña, o sea de la tierra. Los "vitorinos" aparentemente siguen siendo lo que eran, ahora que casi nada es así. Enormes, bravos y con unos pitones monumentales.
Si alguien se cree que esto del toro va a menos que se lo pregunte a la familia Chopera que, junto con el ayuntamiento de Donosti han construido una plaza que parece un estadio deportivo americano. Ahí van todas las contradicciones e incongruencias de esta sociedad contenida en la piel de toro que y por ahora, se conoce como España, especialmente desde fuera de ella. A ver si se puede mezclar bien industria de transformación con gastronomía de postín, con nacionalismos leninistas violentos, festivales internacionales de cine, el suelo urbanizable más caro del sur de Europa, el "Eusko Gudari", los hierros de Chillida, las cooperativas de Mondragón y esa plaza de toros de Chopera en Irumbe. Y eso es en esa esquina. En el otro extremo están los cayucos abarrotados de guineanos desembarcando en la playa de Maspalomas en Gran Canaria para deleite de los turistas alemanes.
Como no hay quien lo entienda, me abstengo de interpretarlo. Me limito a constatarlo.
Por cierto, que creo que eso de que el mapa de la península es una piel de toro no es más que una figura literaria nacionalista rancia. En realidad es una piel de cabra. O ¿acaso alguien duda que la cabra, la puta de la cabra, la Capra hispánica, sea el animal español emblemático?
De toda la vida. El toro de lidia es una subespecie criada para la fiesta y con unas dimensiones manejables para los españolitos.
Los polacos se comieron el último uro, el Bos primigenius, el padre de todos los toros, en 1627. Y eso era una bestia de casi dos metros en la cruz y que pesaba dos toneladas. O sea, no apto para corridas.
Así que la piel de cabra. Un poco reducida a dimensiones cotidianas, quizá sea posible entender esto de la España. Lo que no va a haber quien entienda es a los españoles...

Counting the dead

These days I am getting quite a few e-mails on the Israeli-Hizbulah conflict. Or shall I say the new Lebanon war?.
One in particular, from a Canadian, called "coffin" something, counts the dead. In his page shows the numbers as little coffins. The current tally is of some 30 Israelis, 4 UN force men, and some 500 Lebanese. He gets the figures from the BBC reports.
It's a bad thing to count the dead. In Spain, 70 years after our Civil War we are still counting the dead from both sides. 500.000 is a commonly cited figure. Jose Gironella, a writer, entitled one of his novels about the Civil War "One million dead", pointing out in the prologue that there were 1/2 a million but another half million died in their souls.
Do not count the dead. One is just one too many.

ENRON, KEN LAY AND CAPITALISM

No doubt that the Enron scandal is the typical affair that gives capitalism its bad name. Just as I was browsing through the first pages of “Conspiracy of fools”, a book by Kurt Eichenwald, another NYTimes writer, on the Enron scandal my daughter Barbra gave me recently (and that I am saving for after I finish “Flu”), the news came about Ken Lay’s death, apparently from a heart attack.

I’ve read Ken Lay’s biography in the newspapers: the modest family young boy that made good. First in the Administration and later in Corporate America to lead one of the largest companies in the world of the energy business, to end up, through lies, financial engineering and utter mismanagement, starring a tremendous downfall that ruined hundreds of investors and brought down with it the Arthur Andersen accounting behemoth.

Now he is escaping justice by just dying off and it won’t be of any use for his creditors to dance a fandango over his gravestone.

Back some years ago while the whole scandal was breaking up someone (Was it one of “The Economist” headings?) asked “who is auditing the auditors?”. For audits and regulations are the tools of capitalism control… except when something gets to be big enough to scare everybody, including auditors and government regulators.

In Spain we have our share of high flying crooks as recently was discovered around the “Forum Filatelico” investments scam that just evaporated the savings of some three hundred thousand small investors, manly retired and modest And misters De La Rosa and Mario Conde are currently enjoying the hospitality of the Spanish jail system after their ambitious crookery back in the late nineties proved to be too much for our always inefficient judicial system.

Still all of this together is not enough to invite anyone to change the system. Capitalism is here to stay and one just has to be more keen in controlling thieves and robber barons dressed in Armani. Not that there is anything new under the sun. I have some idea that it was Croesus, in the old Roman times, that staged one of the first recorded delinquent bankruptcies under whatever name they gave it those days. The only difference could be that the Romans were a bit more expedient and simply beheaded the wrongdoers instead of wasting millions in lawyers and legal fees.

Indeed capitalism will survive. As for capitalists, who ever wanted to be the richest tenant in the graveyard?

Sic transit.

GENERAL TRAVEL RECOMMENDATIONS FOR ADOPTING PARENTS

With a wide range of differences depending of the country where the adoptee is coming from and even the time of the year, there is a set of recommendations for travelling parents common to most of all.

ATTITUDE. No matter how exciting the adventure of adopting a child from a foreign and usually exotic country is, the focus should be place in the fact that we are going to travel with a small child, an infant in most cases.
Babies like it simple. So do wise parents. The less contraptions and accessories, the better. Just watch what local mothers do in Third World countries.
Do not overload yourself with luggage. Think ahead when you travel in, because on the way back you’ll have to carry an extra 10 kilo piece of luggage: Your baby!!!Travel is always a hassle, so try to “unhurry” yourself. Plan ahead and take as much time as possible to get to places to avoid rushing and last minute runs to the airport gates.
On the other hand, try to stave off long waiting periods in uncomfortable airport lounges. If there are lines to keep, have just one of the members of the travelling party stand the line (that usually means the daddy) while mother and child sit around in a quiet corner.
A quiet mom keeps a quiet baby. However, babies tend to cry for little or no reason, so do not get upset if your baby gives you a hard time during the trip and waiting periods. No matter how little, he or she will be just as excited as you are from the new experience. Try to soothe him naturally once you have assured yourself that he does not need feeding o changing nappies. Cooing and rocking have always been the normal human way to quiet down a wailing little brat.

THE OTHER’S ATTITUDE. Not everybody likes children. Many adults feel annoyed by the presence of children in the usually close quarters of a travelling vehicle, bus, plane or whatever. It is your worry trying to avoid being a nuisance to others.
Also, in cases of obvious adoption, that is when the ethnic features show clearly that the parents are not biological, some brows may be raised in surprise or contempt. Adopting children from a poor country is not always seen with sympathy. So do not force your happiness on anyone nor expect any special treatment for carrying a baby.
Due to gender differences and behaviours in most Third World countries, women, mothers, keep to themselves and hardly ever make eye contact with others. You’ll be better off melting in with the crowd and try to behave like a local mom. You do not have to wear a “burka”: just pretend you do. A head scarf might help.
But just the same do not put up with stupidity or rudeness. Your baby is the most important thing in the world. Think on his/her and his/her outmost benefit and act consequently. Just as lionesses do…

TRAVEL KIT.

CLOTHING. When you get your child you may well change him to new (your) clothing. The simplest garments the better: a two pieces, shirt and pants, preferably cotton, washable and of light colours. Better oversized, he’ll fill them in eventually. Depending of the climate and temperature some other pieces may be added. Better fewer pieces or swaddles. Avoid the “onion baby” with four or five shirts, pullovers and jerseys. Keep in mind the temperature changes during the day and night and the air-conditioning in planes, as well as the sudden changes on boarding and unboarding.

For babies, one piece suits, bottom and back opened feet included, usually come handy. Make provisions for at least one change of everything because soiling is unexpectedly common.

Your provision of diapers should consider up to some six to seven changes in a 24 hour period. All the same, a little urine in a diaper never harmed anyone, so do not be over-compulsive in diaper changes.

FOOD AND NURSING. It will, of course, depend on the child’s age. For small children, babies and toddlers a set of two bottles, plastic washable, one for water and one for formulae, and a provision of nipples. Use only bottled water from unopened containers both to drink and to prepare formulae. Milk and baby-food in general do not need to be heated and may be given at room temperature[2]. If is too cold, just warmed it with your own body heat, keeping the bottle close to your own body for a few minutes.

To wash and clean bottle and nipples soap should suffice, as most children taken into adoption are of an age when they have already acquired a normal intestinal flora for the region where they live. Other than that and since boiling may not be feasible while travelling, the best disinfectant is plain regular lye, apt for human consumption. One tablespoon per litre of washing water will clear most common contaminants. Remember that the proportion for drinkable water is just 20 drops of lye per litre.

You may use whatever formula you bring with you from scratch. Changing formulae may upset the babies digestions, but that may happen just as well for changes in the water the formulae are prepared with. You may as well accept or purchase the formula the baby has been taking until then, as long as you get unopened and sealed containers. Discard any opened or used can since no guaranties of preservation can be taken for granted in most institutions.

Remember to prepare the formulae following strictly the manufacturers instructions. And do it yourself. Do not let hotel personnel, stewardesses or anybody else to prepare your child’s formula. You may not have previous childrearing experience, but you cannot trust what they have either. You’ll learn in the doing and your child will get used to your mistakes. That’s what mothering is.

In any case you’ll be better off with the lowest concentrations, that is: keeping the milk a bit clearer, with more water content. Your main concern should be around thirst, not so much about hunger. Specially if the baby, because of the changes, has more loose stools or frank diarrhoea. If the baby acts hungry just give him some more quantity, or feed him/her more often. The purpose is to keep the child happy and hydrated. You’ll have plenty of time at home to nourish and fatten your child, and that just if he/she needs so, because nutrition is a matter of quality, not quantity.

MEDICINES. You just cannot take with you the whole pharmaceutical production of industrialised countries. You will not need it either. Provisions just have to be made for minor ailments as for anyone travelling. Should you or your child or anyone else in your party get really sick you’ll just use the local medical resources. That should be better than trying to play doctors in the jungle.

Therefore the remedies to use are mostly those considered symptomatic: pain relievers, soothing creams, antacids, antibugs lotions, nose and eye drops and perhaps laxatives, although Moctezuma may prove otherwise. Prescription drugs should be kept for doctors, even in the Third World. They ought to know better, at least locally. Just the same it might be a good idea to carry along an antibiotic for general use in case of an obvious infectious problem while we get to proper medical care.

A list of medicines and doses is provided below.

TOYS AND ENTERTAINING. Toys, pacifiers and child entertainment devices are Western cultural constructions. Save yourself troubles and weight and forfeit toys and other useless things. Children can be distracted, entertained and otherwise amused with simple things like a piece of paper, clothing or just their own hands and feet. Save the teddy bears and overhead hanging mobile contraptions for grandparents or old aunts on due time. Still, the best, more universal of toys, is a ball[3] appropriate for the child’s size… that you can always model with a newspaper sheet.

Pacifiers may start a war instead of make peace. Specially when a child used to suck that dreadful invention looses it and starts crying in desperation. And be worth a king’s ransom when you come to grips with fixing your child’s denture before adolescence. Orthodontics are close to highway robbery in costs of money and to jail terms on time consumption. A con’s world.

In case of an emergency you may resort to a bottle nipple, or momma’s own, to cork up a screaming little fellow.

BATHING AND HYGIENE. One bath a day should suffice, other than what may be needed around diaper changes. The water just above body temperature in submersion baths. But, while travelling, a sponge bath may make do. Make sure you revise crevices and skin folds to avoid accumulation of grime and wash the hair at least every second day.

For skin care oils are better, as ancient Egyptians and Romans knew. But carrying bottles of oil may be difficult and if opened within a suitcase generate quiet a mess. So you may stick to baby lotions but do not overdo yourself. A baby with a healthy skin needs little protection. Just cleaning.

Sun screens are for Westerners. The best protection from the sunrays is a shade. In Spanish, and they (we) do know about sun, “sombra”, “sombrilla”, “sombrero” and “sombrajo”[4] are key words to keep cool.

Table 1. Medicines and remedies for travelling parents

PRODUCT	USES	DOSAGE
Acetaminophen	Fever, pain medicine	Children Drops: 10-15 mg /kg body weight Adults: 500 mg tablets
Ibuprofen	Fever, pain medicine	Children Drops or liquid: 5 mg/kg of bw 3-4 times daily Adults: 400 mg tablets
Saline solution: 0.9 % salt in water, sterile	Eye drops, cleansing	Ad lib
Ampicillin (Antibiotic)	Infections. General, diagnosed (ear infection, pneumonia, severe skin infection)	Children: oral solution, 50-100 mg/kg/day in 3-4 divided doses. Adults 0.5 gr, 3 times daily
Albuterol, Salbutamol, bronchodialator	Asthma, bronchitis and bronchiolitis	Inhaled. One “puff” as needed. Children use of a breathing chamber[5]
Antiparasitic lotion, anti lice lotion	Lice	Apply after hair washing, twice daily
Tiorfan. Anti-diarrhoea	Regular diarrhoea. Not for salmonella infections	Babies 10 mg/feeding Toddlers 20-30 mg/feeding Adults 60 mg 4-5 times daily
Antibiotic eye drops	Conjunctivitis	One drop in each eye every 2-4 hours for one day
Skin disinfectants: iodine, iodine derivates,	Erosions, little wounds	Apply as needed, generously

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WC Fields, a cynical an very funny North American clown and showman way back in the 1930’s used to say that “... a man who hates dogs and children can’t be all bad….”

[2] We drink the best of the wines “chambrèe”, don’t we?

[3] Think of the millions of people and dollars that go around a ball in football and basketball courts around the world.

[4] Shade, umbrella, hat, and thatch.

[5] You may make do with a water plastic bottle with the bottom cut off

Shakespeare, Mathausen, A farewell to arms

The Bard is due for another year celebration , come April 23rd. That’s “Book’s day” and Catalonia patron saint day, Saint George. TIME magazine’s last issue (March 27, 2006) brings Shakespeare once again to its cover. Shakespeare is indeed hot popular. Alas! an article by Gary Taylor, an editor, claims he is not the best English writer as compared with some other figures of English literature.

What made Shakespeare and Cervantes the most celebrated writers in English and Spanish languages probably has more to do with the advent/invent of printing and the diffusion their works got. It took 150 years for printing to develop fully and both writers enjoyed recognition in their days.

I’ve always compared the advent of the Internet with printing, as both represented a never-thought-before way of making knowledge available to the masses. It has been said that one year of the Internet as far as development and diffusion equals ten chronological years. So if it took 150 to produce major writers we should expect the most important developments in the web sometime around 2010 and 2011.

*****

Last week Mr J. Figueras was admitted to our hospital with a back pain, currently under observation while some image studies are carried out.
Mr. Figueras is one of the members of the Spanish Republican Army defeated in the Civil War that went to France in exile just to be detained and deported to the Mathausen concentration camp by the Nazis in 1940. He survived, was liberated by the American army, returned to France where he lived for more than a decade, finally returning to Spain in the sixties.

He has a lot to talk about and is a pleasure to hear his clear and strong voice as he rambles through his ninety years of full life.

I remember meeting a frail old man in 1969 at the Veterans Administration Hospital in Oklahoma City that was a veteran of the Spanish War, what in Spain is known “La Guerra de Cuba”, way back ¡n the last years of the XIX century. He confessed that he actually fought for the Spanish but nobody had asked him anything when he applied for the Veterans benefits…

Old soldiers never die… They fade away into the sunset.

*****

Other soldiers seem to have decided to put their fight to rest. Last week the Euskadi ta Askatasuna organization announced a permanent cease fire that may mean the beginning of a lasting peace in the Basque Country and for Spain too.
Pundits, politicians and just about everybody had filled the pages of news journals and radio talk-shows with comments, analysis and opinions, so much so that is not worth to dig on the situation any further. The wisest position is still that of “wait and see”. The Basque violent nationalists are probably getting tired and the extensive police work both sides of the (Spanish-French) border has bore them down quite a lot.

Also important has been the aftermath of the Islamist terrorist attacks of late (NYC and Washington DC, Madrid and London) that have given political violence a very bad name, if ever had a good one, making more difficult to defend political options using un-discriminated violence.

(Footnote: Using the word “terror” to mean violence-against-politically- established-power is not new. In one of the places of the city of Zamora there is a large bronze statue of Viriatus, a Lusitan (Western Spanish) warrior that fought for his country independence against the Roman Republic invading legions in the 2nd Century BC. At the base of the monument a sign also in large bronze letters reads: “Viriatus, Terror Romanorum”. Terror of the Romans. A bona fide, full blooded terrorist indeed.)

One thing the Spanish should keep in mind, particularly the reluctantly uncompromising members of the government opposition Popular Party is that when you start peace talks, you just have to talk to your enemies. And find a common ground to agree upon. That may be tough and difficult, but there is no any other than your enemies to make amends with if you really want peace.