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Monday, March 30, 2009

Physician Heel Thyself


Dr. Lester CN Simon

To arrive at the correct diagnosis, all doctors are taught to start by obtaining a proper medical history of the patient’s ailment. This should then be followed by a thorough physical examination and appropriate investigations. Let’s carry out this exercise to see if we can diagnose what is affecting the Antiguan and Barbudan doctors who were trained in Cuba and who are still unregistered and unemployed.

The first historical point we have to register is that as far back as 1988, the Cabinet of Antigua and Barbuda agreed that local doctors trained in Cuba will be eligible for registration on satisfactory completion of a one year of internship in Antigua and Barbuda. It should be noted that the local Medical Board was in agreement with that position. It should also be noted that this requirement for a local internship for one year was identical to what obtained in other English-speaking West Indian islands. Moreover, this requirement of a local one-year internship was adopted in many islands after consultation with the Dean of Medicine of the University of the West Indies.

The question you are dying to ask is why this requirement for registration was not communicated to all medical students going off to Cuba in 1988 and thereafter. I will answer that question by telling you that in 2007, almost twenty years after the Cabinet decision, I tried to find out how many of our medical students were in Cuba. I went to the Ministry of Education. No one knew the answer. It was suggested that I go to the Board of Education since that was the agency that gave scholarships. They asked me to give them a few hours to get the information. I gave them more hours than they wanted, and yet I was turned over to the Cuban charge d’affaire.

One crucial point we have to examine is what is meant by an internship. Let the definition from the online dictionary, Wikipedia, suffice: “A medical intern is a term used in the United States for a physician in training who has completed medical school. An intern has a medical degree, but does not have a full license to practice medicine unsupervised. In other countries medical education generally ends with a period of practical training similar to internship, but the way the overall program of academic and practical medical training is structured differs in each case, as does the terminology used.”

One key point to appreciate is that whilst academic medical training can be universalized, practical medical training is largely dependent on the way the local medical system is organized and the prevalence and morbidity of different types of diseases doctors are commonly exposed to.

Call it what you want because the name does not matter. Investigations by competent authorities including regional medical councils show that while the internship done in Cuba is perfect for Cuba, that same internship is grossly imperfect for Antigua and Barbuda and the rest of the English-speaking West Indian islands. This is the basis of the 1988 Cabinet decision. The fact that this perfect-for Cuba but imperfect-for-us internship in Cuba, is largely a reflection of the relatively good state of healthcare and the medical system in Cuba compared to the healthcare system in Antigua and Barbuda and the other islands, should not escape your attention. Cuba boasts an excellent, highly integrated medi9cal network system that is the envy of countries in the Caribbean, Latin America and the rest of the world.

The other key to hold on to is that the doctor doing an internship (the intern) does not have a full license to practice medicine unsupervised. Prior to the recent Medical Practitioners Act 2009, the laws of Antigua and Barbuda catered only for complete registration. This meant that any newly registered local doctor trained in Cuba, could practice initially unsupervised in a system for which he or she is not adequately prepared practically. And “practically” is the operative word. This is untenable. Ironically, after Cuba has done so much for us, we are being asked to do relatively next to nothing.

Those who suggest that older, local registered doctors are against local, Cuban-trained doctors are misguided. The medical pie is much larger than you think. The center of healthcare in the OECS in the future will be in the country that sees this Cuban-trained local doctor issue as an opportunity instead of a problem. This country should be Antigua and Barbuda.

Until such time when we can “cubanize” our healthcare delivery system, there is only one solution for all local doctors trained in Cuba, as noted as far back as 1988. Call it what you like: internship, externship, or whatever. My demonstrating colleagues must undergo the type of supervised practical training with the related registration in the proper place that is appropriate for the country in which they want to practice. And which country is that, my dear good doctor? Antigua and Barbuda, I presume.

Saturday, March 21, 2009

Teach Me To Love


Dr. Lester CN Simon

A man comes to my country and accuses me and many other Antiguans of xenophobia, on Observer Radio to boot, for the whole wide world (www that) to hear. I look up the word in the dictionary. It defines xenophobia as a fear or dislike of foreigners or of people significantly different from oneself. I now think that the man’s thoughts are fundamentally and significantly different from mine because until he called me xenophobic, I assumed we were similar. The man has just made me xenophobic.

To understand the potential battle we face with Jamaicans and Guyanese, a battle we must try our best to avoid, says Bruce Goodwin, we have to be honest and call a spade a spade by calling an Antiguan an Antiguan, a Jamaican a Jamaican and a Guyanese a Guyanese. There are many ways to define us but since we are trying to avoid a war, let us regard the very best defining qualities we can say about each other and see where the logic leads us.

Let as admit that Jamaicans are some of the most nationalistic people on this planet (and probably other planets too). Their patriotism will often override the class structure that separates many Jamaicans. Jamaican-ness is so encompassing, I was awestricken the first time I was in London and heard almost all West Indians, including myself (‘to rhatid”), but excluding Barbadians and Trinidadians, talk perfectly like Jamaicans.

When we regard the social and cultural national heroes of Jamaica, it is obvious that all of them, from Paul Bogle and George William Gordon to the female Nanny of the Maroons, Samuel Sharpe and Marcus Mosiah Garvey, are largely responsible for the strong nationalism that burns in the heart of all Jamaicans.

Jamaicans travel with their nationalism. Those who were oppressed by the class structure in Jamaica find themselves in a uniquely strange position in Antigua. With the shackle of Jamaican class structure removed, some Jamaicans in Antigua not only transfer some of their nationalism to Antigua, they are shocked (“to rhatid”) to discover that Antigua brings out more of their Jamaican-ness than Jamaica itself. “Kiss me neck”!

When we think of Guyanese, we see a people running from a very divisive country that potentially is the richest in the West Indies. Guyanese in Antigua discover the naked truth that their deep longing for a country to love, without all the divisiveness, is finally satisfied. So satisfied are they (and this refers more to nationalism than to economics), they bring most if not all of the members of their family to Antigua to discover the real Guyana in Antigua. Their migration on to the USA is just a further step in this burning quest for a country to love. Hugh Masekela says in a most memorable line in a song about colonialism, “Bring the ivory and bring geography”. Some say those days are gone. Others say colony is now colonizing colony.

In the while, Antiguans do not carry the spirit of King “Prince Klass” Court or Dame Georgiana Nellie Robinson. The former would be shocked at the social and political things we put up with and the latter would die twice if she were to discover how long we take to build a national library. Regarding our other three national heroes, the best that can be said about the politicians is that we must admit and learn from their faults as we cherish their nationalistic qualities. The remaining national hero is a work in progress.

The best we can say about Antiguans is that we welcome people with open arms. Indeed, it is difficult to define an Antiguan. Antigua was once the federal legislative capital of the Leeward Islands which included Anguilla, Antigua, Barbuda, Montserrat, The British Virgin Islands, Dominica (administratively), St. Kitts and Nevis. Our Antigua, the land of neighbours, was built by many people from many of our neighbouring islands. The longstanding cultural difficulty in defining Antiguan-ness is being experienced at a time when Jamaican-ness and Guyanese-ness are being defined as never before.

In the brilliant and original work by Bonnie Honig in her book, Democracy and the Foreigner, she takes a different look at the dilemma that underlies debates about immigration, citizenship and national identities. She does this by reversing the question and asks instead: “What problems might foreigners solve for us?”

It would be awfully, fatefully and fatally unbecoming, and un-West Indian if the long awaited fight for Antiguan-ness comes about at last because our nationalistic awakening by Jamaican-ness and Guyanese-ness leads to a war. Cuffy, the revolutionary leader of the Berbice Slave Rebellion, Marcus Mosiah Garvey and our King “Prince Klass” Court would die a thousand times over.

Meanwhile, back on the ranch of that man who comes to my country and becomes momentarily decerebrate and “lick-rish” and fast with his name calling, accusing us of xenophobia. Is there a word for what happens when someone else’s love for my country forces me to finally and demonstrably love what I have always taken for granted? Some might jester and say that this long awaited Antiguan-ness is actually “xenophilia”, the love of foreigners, because of the nationalistic lessons they are teaching us. But whatever that word is, my welcomed gentleman guest, it is not, cannot, and will not be xenophobia.

Sunday, March 15, 2009

When In Rome


Dr. Lester CN Simon

With all the talk about the influence of non-nationals in the recent general elections, I am forced to let out that before the general elections I wanted to form a political party. This party was to be called the Antigua National Front. To qualify for membership you must have born in Antigua on or before the day Antigua became independent, on November 1, 1981. The illogic of forming such a party would mean that my dear wife and children and many of my cherished Caribbean friends would not be members. So be it. I would vote for them.

The precise numbers are not yet in but it is clear that non-nationals had a profound effect on the outcome of the general elections. Be that as it may, the inescapable fact is that native born Antiguans accepted money for their votes and formed the basis of a bribery cake on top of which some non-nationals were simply the more vulnerable icing.

To understand the philosophy of bribery amongst nationals and non-nationals, we have to accept that we have lost the concept, if some of us ever had it, of what it means to be a citizen of Antiguan. We learn from Wikipedia, the free online encyclopedia, that citizenship involves rights and responsibilities by which we work to improve communities through economic participation, public service, volunteer work and other efforts, so as to improve life for all citizens.

It follows that in the absence of communities, citizenship has no meaning. There are many requirements for defining a group of people living together as a community. At its most basal level, the members of a community must share common interests. When these common interests are reduced to the singularity of money, we have a problem.

It is always instructive to hear someone justify what you regard as unjustifiable. They will tell you that it cannot be bribery. They do not, and will not ever, accept bribes. Rather, they are working, and working very hard too. They will ask you to look at Observer Radio. The owners went all the way to the Privy Council to win the inalienable right to electronic free speech and operate a radio station. Thank God (and the Privy Council) for Observer Radio. Many listeners say they do not know what they would do without it. Then they tell you that Observer Radio is playing advertisement for UPP and ALP; and getting paid. So when they put on a blue shirt today and a red shirt tomorrow, or tonight, they are working. They are advertising for both parties and getting paid, just like Observer Radio, your favourite radio station.

Students of economics will tell you that Adam Smith was the father of capitalism. They will mention his classic text, The Wealth of Nations, and extol his ideas about the pursuit of self-interest in the marketplace. They will tell you about Smith’s claim that individuals naturally look for economic activities that bring the greatest financial benefits. And, while you are thinking about the human, political advertisers during the recent general elections and whichever unprintable names you want to call them, they will tell you this: The father of capitalism was convinced that this natural economic self-interest would naturally lead to the maximum economic benefit of the entire society.

Only when these neophyte students mature and read the prequel to The Wealth of Nations will they really understand capitalism. In The Theory of Moral Sentiments, Adam Smith puts the entire concept of self-interest in proper perspective. Self-interest is “Only the first step towards the much higher goal of living a morally virtuous life”.

Stripped of a communal, morally virtuous life, naked capitalism, human political advertising, blind party surrogacy and political mercenary reduce us to the lowest common denominator of an inanimate set of vulgar factions.

Some argue that if some Antiguans are political mercenaries they are our mercenaries and general elections must be between us and our mercenaries exclusive of the more vulnerable non-national mercenaries. This is crooked thinking. The problem of political mercenaries, national or non-national, originates, resides and thrives in the well endowed, pecuniary bosoms of politicians, their advisers and financiers. It is the despicable politician that we must attack and exorcise.

Whilst some politicians will claim to be less guilty than others, they must all pay for the crime of being political pimps. The UPP has paid the price, and almost paid the ultimate price, of trying to woo non-nationals more than the ALP. My dear good leader, you cannot offer more juicy red apples than Lucifer. Beelzebub gave genesis to the insatiable appetite and tricked you into feeding the bottomless hunger. Ironically, the justice day UPP campaigned on, almost caused it to fall on its own petard. This is the sad, retributive justice the UPP is now facing.

There are more persons to be hoisted with their own petards, more expensive prices to be paid and more natural justice to be done and seen to be done. We must force public servants by hook to be accountable for their actions. All the members of the Electoral Commission, including the one with an overabundance of narcissistic arrogance, and all those in the office of the Supervisor of Elections, including the one with blind nostalgic allegiance, must resign immediately. Follow the bishop.

When the barbarian non-nationals do as the barbarian native Romans, so too must the erstwhile esteemed holders of high office who brought shame and disgrace on us walk behind the exiting good bishop. If they refuse to go voluntarily, we must march peacefully seven times a day, seven days a week, around the Jericho walls of their dishonored office. And, with seven crocus bags of bounteous offerings of pipe and crapo, we must demand that they demit to restore dignity to our high office.

Sunday, March 8, 2009

Goodnight Antigua and Barbuda


Dr. Lester CN Simon

According to a recent article in The New Yorker, the novelist, Ian McEwan, refers to a study in cognitive psychology in support of a character in one of his novels. He suggests that the best way to deceive someone is first to deceive yourself because you are more convincing when you are sincere.

Over the past few weeks, supporters of the two main political parties have been accusing each other of misrepresentation of facts and plain, outright, deliberate lies. People are being deceived; young and old. The older ones seem to be engaged in an abusive relationship in which they are lied to, neglected, psychologically beaten up and yet they hold on for dear life to their party. This is so because their party was the first party that made sense and life to them and made them feel like somebody. The party can do no wrong. Even if you usher them to the brink of truth and point out that they can do better, they remain steadfastly attached to their abusive party because all parties, they now excusably tell you, are the same. They already know from where and when the licks will come, so why change parties and subject themselves to having to learn a brand new set of licks, kicks and thumps, and black eyes?

How do we explain the objective evidence that a party is at fault in a particular matter and yet it enjoys the unwavering, volatile support of its diehard supporters? Remember those bad old days, which I hear still exist, when a child was sent home from school or the parent was called to school because the child had done something terribly wrong? In dazzling light of sparkling evidence, the parent resorts to a wanton and vulgar cursing of the teacher, the entire school and any and every living and non-living thing in sight. There may be two reasons for this clouded outburst. The parent may be unable to compute the situation and takes the only familiar way out. Worse, it could be that the parent is so desirous of the child doing well that the parent deceives himself or herself into believing that the child could not be at fault. Not my party. ‘A drunk yu drunk in yu libber?’

But how do we explain the magnetic hold the parties have on the young ones through the music? The common explanation is that the young people who attend the party meetings and political music shows are only interested in the music. It was Rudyard Kipling who said, “What do they know of England who only England know?” This inspired C.L.R. James to ask, “What do they know of cricket who only cricket know?” So now we must ask, “What do they know of music who only music know?”

Music tells stories. Music is the perfect deception tool. You can use music to sell ice cream, even without a cone or a container, in the hottest, bubbling corner in hell. Recently, some Jamaicans became blue vexed because of the public outcry against the lyrics and the daggering dance associated with dancehall music. They were so distraught to see their music singled out for the chopping block, they were forced to point out that Soca music was unadulterated sex incarnate and that this was in the lawful carnal knowledge of its practitioners. The music that bombards the ears and minds of the smallest of children these days is so explicitly sexual, it would make Mr. Benwood Dick lie down and send Jean and Dinah to Sunday school round the corner.

All children love stories and fantasies. The world that popular West Indian music has created for these poor, lost souls is so explicitly sexual, the children have to take on periodic or constant disguises of unreality to cope. And this is not just a male-action driven sexuality that the music is harvesting. It is a primal music sexuality that knows no bounds as it crushes your head into pap, shreds your waist into ribbons, removes the tendons from your knees and unbuckles the sinews around your ankles. This became frighteningly clearer to me when a Jamaican friend related how a teacher would cringe to enter a particular classroom of a top ranking girl school in Jamaica after recess because the classroom, even with the windows wide open, would reek with the pungent smell of raw, aerosolized sex.

The conjoining of music and political messages is not new. Unfortunately, there appears to be very little if any popular alternatives to sexual music for young people. Young people need young musicians that can take them to fantasy places where sex is not the sole driver, vehicle, conductor and passenger. The political parties understand the subversive and submissive power of music. Music and politics have become a very formidable, inseparable brand item. This brand has reached the contagious feverish pitch at which you can not only, “Talk as you like”, you can talk about what you later say you don’t like, what you don’t believe and what you have deceived yourself to believe so that you sound as sincere as the end of a letter.

We are now facing the wretched combination of the abuse and the deception of music and the same deadly elixir from some politicians, along with grand financial abuse and deception. Alarmingly and deceptively, some of us are pretending to be waking up to all these musical, political and financial abuses and deceptions for the first time. Did someone close the window?

How many more bedtime stories (another perfect deception tool) do we need to fall asleep? Maybe it doesn’t matter because when we wake up in a few days after the general elections, some of us will still clamour for the euphoria of public, explicit, musical sex, for the investment of deceptive finance from amour knights in shining armor and for our abusive, till-death-do-us-part political relationships. And we want this orgy of unreality, this repository of nonsense in our beloved, estranged native land of never ending make-belief where we can digitally ride off into the warm, glowing, software bed of a West Indian sunset and live happily ever after.