Stupidity is Surgically Treatable

One of my favorite medical posts this week is by South African surgeon, Bongi. Reading his post reminded me why I didn't go into general surgery as a career. These guys have to deal with the intestinal tract on a regular basis. Check out his post, There is No Pill for Stupidity.

Things Getting Worse in Iran

There is growing concern by the international community for the fate of the six Baha'i leaders arrested in Iran two weeks ago. Here is why.

Unleashing Potential

One of the most progressive aid organizations is Ashoka International, founded by Bill Drayton. It’s been around 25 years or so, and it’s certainly a contender for a Nobel Peace Prize. Bill figured that the best and fastest way to change the world was to identify people in countries who are getting started in socially innovative projects, and supporting them so that they can dedicate themselves to their cause. There is a worldwide “search” committee that consists of thousands of people in local communities who keep their eyes out for these sorts of people – the single-minded, almost fanatical idealist, who has a vision of something great. And every year, the foundation selects “Ashoka Fellows” who are given financial support so that they can pursue their dream, until the dream can get funding from other sources or become self-supporting. The financial support usually lasts about three years. As Bill says, “we’re investing in the person, not the project.” Over the years, they’ve supported 2,000 fellows.

I like the premise – find people who are change-makers, who know their communities and their problems, who are creative in coming up with solutions, and support them so they can make it happen. It’s a beautiful concept.

I do have a little bit of a different perspective, though. I think that more attention needs to be given to the average person, who doesn’t see himself or herself as a social entrepreneur. I think that the kind of change that the world needs will happen when every common citizen starts to recognize and unlock their own potential. My visit to Hopwood junior high still haunts me – all that potential, hidden even from the eyes of those who possess it. I wonder what are the keys to unlocking that potential. It has to be some combination of attitudes, insights and skills, both practical and spiritual.

Any ideas on unleashing this potential in the common citizen?

Marine Monument Dies

I'm going to predict that the proposed Marianas Trench Marine Monument in CNMI has effectively been killed. After reading the story in today's Saipan Tribune, I don't think President Bush will give much attention to the Marianas. A variety of local government officials here have voiced their opposition to the idea, while no one at the same level is voicing support. Meanwhile, other jurisdictions are clamoring to have a monument designated in their area. If I were the President (or one of his advisers), I'd recommend taking the path of least resistance. Why fight with the CNMI?

As far as I can tell, the resistance to the monument ultimately comes down to a certain psychological stance that is explained in Bornstein's How to Change the World (who is quoting from O'Toole's Leading Change).

Resistance occurs when a group perceives that a change in quesiton will challenge its "power, prestige, position, and satisfaction with who they are, what they believe, and what they cherish....The major factor in our resistance to change is the desire not to have the will of others forces on us."

Carl Talk and the Folly of Aid

I had a chance to sit down with my favorite French-Canadian general surgeon yesterday, and just chat. Carl is finishing up his stint at CHC, and his departure is a loss to the people of the CNMI. Last week Carl gave a presentation on his year in Ethiopia, his last post of service before arriving in Saipan.

Carl was there with an international aid organization. He was part of a three member team that consisted of a surgeon, an anesthesiologist, and an OR nurse. The project aimed to identify local people who would spend a year with them, get trained in how to be a surgeon, an anesthesiologist, and an OR nurse, and then head back into their provinces to provide service. The aid organization sent 21 of these teams throughout the country. Ideally, by the end of the year, there would be 21 local teams prepared to provide services to their people.

Carl had planned on spending his life doing humanitarian surgery. But his experience so disillusioned him, that he’s taken a break from pursuing that as a career.

He told me about how much difficulty he had when he was applying to various international agencies. He was offering his life to them, for free, and only one agency could accommodate him.

He told me that throughout Ethiopia, there were many international aid organizations, all in competition with one another, refusing to cooperate or pool their resources. The agencies were more concerned with making their annual reports look good and getting more funding than making sure their work actually made a difference.

He told me that the organization he worked for failed to take the local situation into account. They sent these fancy autoclaves to sterilize instruments – fancy because they had microprocessors with them to control the sterilization process. But the chips were set for sea-level, not for the elevation of Ethiopia, so they were useless. It would have been better to simply send pots and teach the people how to sterilize their instruments by boiling them, because that technology would always be available and repairable.

He told me that they used sutures at the central training hospital that would never be available in the provinces.

A year after his departure, of the 21 teams that were trained, only three were still functioning. That’s better than nothing, but it doesn’t make for a success story, especially considering the talent and dedication that poured in the way of the volunteer surgeons, anesthetists and nurses, who gave a year of their lives for this project.

It again points out the need for development projects to be decided locally, on the ground. For people to become empowered to identify their own problems and create their own solutions and seek the assistance they need. Development projects imposed from the outside are simply folly.

How to Change the World

Further to my post about being a selfish son-of-a-bitch, the books I ordered arrived, and I've been getting quite an education. I ordered four books. The first, The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good by William Easterly, helps us understand what kind of aid doesn't work, and presumably, what kind does work.

Easterly's perspective is balanced by The End of Poverty: Economic Possibilities for Our Time by Jeffrey Sachs. This book extols the power of aid, and is written by the architect of the UN's Millenial Plan to end poverty by 2025.

I knew these books were at opposite ends of the ideological spectrum, and thus thought they both deserved my attention. Both are by well-respected experts/economists, experienced in aid and poverty issues.

Not wanting to get bogged down by too may graphs (which both books have), and also not wanting to get overwhelmed by the massive scope of problems that these two books are sure to address, I also ordered a couple of very practical books.

Creating a World Without Poverty: Social Business and the Future of Capitalism is by Muhammad Yunus, who won the Nobel Peace Prize for his work in "micro-finance." He has shown that the world's poorest people are outstanding credit risks, and that loans as small as $10-20 can break the cycle of poverty by allowing poor families to start their own businesses.

The one I'm reading now, How to Change the World: Social Entrepreneurs and the Power of New Ideas, Updated Edition by David Bornstein, is a collection of accounts of social innovators who through their persistence and dedication to an idea, have changed the world. I'm finding it a fascinating read. I love learning about things I know nothing about. So far, that's included rural electrification in Brazil, child protection in India, and the development of the EPA's "bubble" policies in the 1970's upon which concepts like carbon exchanges have been built. The first few chapters explore the qualities of the people who bring about these sort of social changes. I'll write more about that later.

When the Body Lies

Sometimes the human body can be deceptive. That really scares me.

I saw a woman recently who had blurred vision that was getting worse over a few weeks. Looking inside the eye, it looked perfectly normal, but the vision was profoundly reduced. The vision in the other eye was normal. When the eye looks normal, and the vision is reduced, then there is something behind the eye causing the reduced vision. But where?

Well, the first step in finding the location of the lesion is to perform a visual field exam. The eye chart measures your straight ahead vision, but not your peripheral vision. You might be able to see 20/20, but you might be looking through a tiny tunnel of lost peripheral vision. A visual field test checks the peripheral vision. You look straight ahead while lights of various intensities pop up in different areas of the peripheral vision, and every time you see one of those lights, you press a button connected to a fancy computer. The computer maps out your visual field.

They eyes are wired in an interesting way. All the information from the retinae of each eye gathers into the optic nerve of each eye and takes off to the brain. But then, once just inside the brain, a funny thing happens. Some of the fibers from each eye cross over to join fibers from the other eye. They "decussate" in a place called the "optic chiasm." The result is that if there is a problem behind the optic chiasm -- after the fibers have crossed -- say, on the right side of the brain, both eyes (not just the right eye) will manifest a visual field defect since fibers from the left eye have crossed over to the right and are being affected by the lesion in the brain. The wiring is so specific that you can even tell how far back the lesion is by the type of visual field pattern loss in each eye. If the damage is in front of the chiasm, the fibers haven't yet crossed over, and the field defect will show up in only one eye.

I'm thinking this as I examine this woman, and I know that in order to find the location of the lesion, I need to know the visual fields of the unaffected eye. Because if the visual field is normal, the problem is in front of the chiasm in the optic nerve of the abnormal eye. If the visual field of the good eye has a defect, then the problem is in the brain. Got it?

I get the visual field. The bad eye is totally wiped out. The good eye is completely normal. That pretty much clinches the diagnosis. Her lesion is in the optic nerve, and in a woman her age, the likely cause is optic neuritis -- actually a specific variant called "retrobulbar" optic neuritis in which the inflammation is behind the eye, not in it, therefore when you look in the eye it looks normal. The maxim for retrobulbar neurtiits is "the patient sees nothing, and you see nothing."

So she has this variant of optic neuritis. What causes optic neuritis? The most likely cause for her is multiple sclerosis -- a lousy diagnosis, but one you want to know about. The next step is to get an MRI of the brain, because the brain in MS has characteristic plaques that light up on the MRI. The MRI won't change the outcome of the optic neuritis, but it helps the patient plan for their future if it is MS.

Problem: there is no MRI machine on Saipan. The closest one is on Guam. I could get a CT here, but it might not show anything, which might mean that the MS plaques may still be there, but CT couldn't see them. If the CT is positive, it helps, but if it's negative, you just spent $800 of her money unecessarily. She makes her way to Guam and gets the MRI.

And this is what can scare the snot out of you. The MRI results come in, and it doesn't show the characteristic MS plaques. It shows a tumor the size of a fist in her brain, back behind her optic chiasm where it should have shown an abnormality in the visual fields of both eyes. Everything that I thought was right, is just plain wrong. There is no way the visual field can be normal in her good eye with a tumor this size, but it is. It's likely that the tumor itself isn't actually causing any visual field problems. The MRI shows the tumor cells have infiltrated down one of her optic nerves and is choking it to death. Thus, only the vision and the visual field in one eye is abnormal. Her body isn't following the rules. But I am.

And the most scary part is that when everything pointed to optic neuritis, I was tempted to save her the trouble and expense of going to Guam for the MRI and just admit her to CHC and treat her according to the guidelines of the optic neuritis treatment trial. That's the sort of thing we often do on Saipan where resources are limited, and people can't afford to go off-island for further testing. If she hadn't been able to go to Guam, I would have done exactly that -- treated it as MS -- and thought nothing of it, confident in the information the human body was conveying to me. What a disaster that would have been.

Sometimes, you don't conquer disease. Sometimes you just accidentally trip over it and it dies. In the instant that you realize how close you were to making a deadly mistake, you find yourself totally humbled. The tumor was found, and she's going for neurosurgical treatment, but it was just dumb luck.

I keep replaying the events, the decisions, wondering what to do differently next time, and really, there isn't much, other than to realize that the body, sometimes will smile coolly at you and just lie with the deepest deception. And there's no way to know of its betrayal, other than with luck and the help of angels.

Green Power in Saipan

It's been a year or two since the "Green Power" law was passed. Basically, it allows for a concept called "net metering." There are two basic ways people use alternative (solar/wind) power. First, you can buy the power generating stuff -- solar panels, windmills -- and buy batteries that store the power generated, and use it when you need it. There are a couple of difficulties with this. First, the batteries are really expensive, so cost goes up. Second, you have to generate enough power to meet your demands. This is the method people use to live "off the grid." You generate and store their own power.

The other method is "net metering." You buy the solar panels or windmills, but your house is still connected to the utility. The power you generate is gets fed into the city power grid. If you don't generate enough to meet your needs, you get the extra you need from the utility. If you produce more than you need, you feed it into the grid for others to use, and the utility pays you for the power. The excess feeds through your meter and runs your meter backwards, thus the term "net metering". With this method, you use the grid as your "storage" so you save the cost of batteries. Of course, without storing the power yourself, when the CUC power goes out, yours does too.

The fact that we have this net metering law opens some huge possibilities for the consumer to bring down the power rates and also to contribute to power generation for other customers. The glitch for us has been that although the law has been passed, the regulations that define the practicalities of implementing the law have yet to be written.

I fired off an email to an undisclosed source close to the issue to find out about the status of the regulations. Here is a summary of the reply I received. It looks like we're getting close.

***

The net metering regs are being drafted right now. They are a blend of regs from a US green power NGO and 3 or 4 states. The adminstration is committed to making net metering happening, so that the private sector can help CUC meet its customers' needs cost-effectively and reliably. Oil will soon become unaffordable to small markets like the CNMI. We will need the sun, the wind, the ocean and geothermal resources to power our lives.

The consumers issues will be, of course, cost/revenue and reliability (both of your system and CUC). The regs should lock you into revenue of 1/2 the price of power at the time you install the solar. Solar is relatively expensive, but, when installed correctly and maintained (so the panels are clean and connections are protected from the salt air) should last for 10-20 years.

1. The kwh. As you may know, solar panels don't start working at 100% capacity the day you install them. The solar capacity increases to manufacturer's specs over a couple years, then slowly, slowly degrades over time. So, if you are figuring revenue, you will multiply an average output percentage times manufacturer's spec times "availability", or the number of hours per year expected of the "insolation".

2. The rate. You will want as much guarantee as possible that the rate you sign up for is the one you get. One argument from the statute is that your rate will vary as the CUC's rates vary. That means that if oil gets outrageously expensive (it's at $127/bbl now and on its way to $200/bbl by year end), our rates will increase past the 26 cents/kwh we now pay just for the oil, and you will like the variance. (Overheads, operations and maintenance and debt service typically cost about another 8-10 cents/kwh.) If we discover geothermal sources on Saipan, however, the bulk of our power will cost less than 10 cents/kwh total. You won't like that, because you will have paid for expensive solar and CUC won't be paying you very much back.

3. Rate stability. One way to make this all stable is through the regs. Another way is through a contract. The law will protect you better from the Legislature's rate orders for rate decreases if you have a contract. Ordinarily regs are a strong way to protect a customer, but a new statute trumps regs. Also, someone might argue that the CUC's interpretation of PL 15-87 to allow long term stability will stretch the statute's terms.

4. Another consideration for you is batteries. With solar, of course, you are unlikely to generate enough power during bad weather to run your house. And CUC may not be reliable during a supertyphoon. But batteries can easily double your investment. Many people use their utiltiy company as the "battery", relying on their own power when the sun shines.

If cost is not a big issue with you, you will want to buy a system that makes you energy independent -- oversize it, so you never peak in excess of your capacity, and use batteries. Of course you will also purchase very efficient mechanicals and appliances and superinsulate your home, and design a home that orients properly to the sun and the wind. These strategies provide you with much more value than buying the solar panels.

ONLY if there is an active group of potential green power producers examining the draft regs and contracts will you wind up with something satisfactory.

Retinal Physican Blurb: Our Man in Saipan

I'm not sure why I seem to be bursting upon the national scene at the moment. There was the recent interview by Ophthalmology Times, and now this piece that appears in Retinal Physician. There is also an upcoming story in Ophthalmology Management.

I'm trying to raise some money for a scholarship fund at Brilliant Star School, to allow low income children on Saipan to attend the school, so I'm hoping that the stories will lead to some benefactors. In any event, it seems to be my fifteen minutes of pseudo-fame. I can't say "fame," because, after all, these may be international magazines, but really, they're ophthalmology publications. In the Retinal Physician magazine, I'm wedged between stories titled "Antecortave Acetate Has New Target" and "OPKO Gets Key Patent for siRNA Drugs." The subtitle of the second piece is -- and I'm not making this up -- "But Controversy Erupts Over siRNA Concept." That context very nicely sums up the level of my fame.

I recently found out that the title of the story is a play on words from a 1970's sitcom called "Our Man in Rataan" about a journalist assigned to a god-forsaken post at the ends of the earth.

The best part of the story is where they refer to Marianas Eye Institute as "one of the best-equipped eyecare practices in the Asia-Pacific region." That's something Saipan can be proud of.

***

Our Man in Saipan
Dr. Khorram Finds His Tropical Island

David Khorram, MD, who received his retina training during residency at Northwestern University under Lee Jampol, MD, is the only ophthalmologist on the Pacific island of Saipan. Dr. Khorram passed up a retina fellowship because he wanted to practice in a part of the world that had a great need for an ophthalmologist. After doing some research, he chose the Pacific islands, and after a year practicing in American Samoa, he made his way to Saipan.

Over the course of the past 15 years, Dr. Khorram has built the Marianas Eye Institute into one of the best-equipped eyecare practices in the Asia-Pacific region, providing a wide range of both retina and general ophthalmology procedures.

He is also active in civic activities on the island, writing a weekly newspaper column and organizing a national soccer team [I think this is a reference to being a founding board member of NMIFA]. He recently published a collection of his columns in a book titled, "World Peace, a Blind Wife, and Gecko Tails" (available through Amazon.com). Dr. Khorram and his wife, Mara, have four children ages 3, 5, 7 and 9.

Dr. Khorram reports that he sees "a ton" of diabetes-related eyecare problems but almost no cases of macular degeneration, which he attributes to the island's relatively young population as well as genetic factors.

Saipan, which is located about 120 miles north of Guam, is the capital of the United States Commonwealth of the Northern Mariana Islands and has a population of approximately 60,000, many of whom are contract workers and not permanent residents.

The island was the site of fierce fighting in World War II as the United States established a base on Saipan for B-29 bombers that could reach the home islands of Japan.

Helping China's Earthquake Victims

I got an email yesterday with a bank account number, informing me I could "wire transfer" funds to the account to help the China earthquake victims. The email was from someone I know, but I'm always suspicious of an email that gives instructions on wire transfer of funds, even if the email doesn't begin with, "ATTN: Dearest One of God..."

I wrote to one of my buddies who is an executive with the American Red Cross, and here is his response, with guidance on how to donate.

Like you, I’m always a bit suspicious of anyone who tells me to “wire the funds” As you can see from news reports, the RCSC [Red Cross Society of China] has collected over a ½ billion USD’s thus far and fundraising hasn’t really started yet. American Red Cross had such a huge surge of donations for China that they’re not asking for, or establishing a campaign to raise money.

The complexities of these relief operations are staggering. Global interest peaks for about 3 weeks, and then the disaster is relegated to just another terrible tragedy. The readiness capability of each Red Cross Society often reveals itself when a huge event like this occurs. China is in relatively good shape with a strong Red Cross infrastructure and literally millions of volunteers. They consistently operate within Sphere, IFRC [International Federation of Red Cross and Red Crescent Societies] and WHO standards. The Burma Red Cross is less fortunate having to operate under military rule and limited access to outside resources.

Personally I would give to the IFRC directly. They can then push the funds to China in a manner that makes sense. One advantage of giving to the American Red Cross is that the donation would be tax deductible. I don’t think the IRS provides this benefit to a donation made directly to China or through the IFRC.

Human Potential as Development

As I've been delving into the area of sustainable development and poverty reduction over the past couple of weeks, a few themes have emerged.

1. Development projects work best when individuals at the grassroots set out to identify and solve their own problems, not when outside agencies and individuals come in to identify and solve their problems.

2. The most meaningful forms of development projects are those that unlock the capacity of the individual at the grassroots to do exactly that -- to believe in their own potential to address their own problems, and to develop the moral capacity to do so in a just and honest way.

3. Lack of money is usually not the biggest problem. There is lots of money and international aid available. The challenge is spending it in a meaningful way, and again, it goes back to having individuals within communities identify the meaningful ways to address their social and economic problems.

Purpose in life

Mara just shared with me this quotation from the Baha'i writings. I found it very thought provoking. I wondered how our island "nation" fares on the issue of knowledge. The individuals have a strong sense of community, and I feel manifest the idea of enhancing social good more than in most places in the world. Yet there is certainly a lot of untapped potential in this regard. It also got me thinking about the idea of "looking within" in a way to find one's own special talents and gifts and using them to the max.

"The happiness and pride of a nation consist in this, that it should shine out like the sun in the high heaven of knowledge... And the honor and distinction of the individual consist in this, that he among all the world's multitudes should become a source of social good. Is any larger bounty conceivable than this, that an individual, looking within himself, should find that by the confirming grace of God he has become the cause of peace and well-being, of happiness and advantage to his fellow men? No, by the one true God, there is no greater bliss, no more complete delight."

(Abdu'l-Baha, The Secret of Divine Civilization, p. 2)

Marine Monument Activities

Folks are in town to educate the community on the proposed Marine Monument. Here is the list of upcoming activities.

Tuesday, May 20^th, 11:45am – Hyatt Giovanni’s Restaurant

William Aila will speak to the Rotary Club of Saipan

Tuesday, May 20^th, 5pm-6:30pm – Hawaii Bar & Grill, Garapan

Meet & greet for Jay and William to meet project supporters

Tuesday, May 20^th, 7:15pm – American Memorial Park Auditorium

Presentation to Saipan Fisherman’s Association by Jay Nelson with special guest William Aila

Wednesday, May 21^st, 7:00pm – John Gonzales Show, KSPN Channel 2

General introductions and project information the first half-hour followed by a call-in Q&A in the second half hour

Thursday, May 22^nd, 7:00am – KZMI Radio Talk Show with Harry Blalock

General introductions and project information with Jay Nelson and special guest William Aila

Thursday, May 22^nd, 6:00pm - American Memorial Park Auditorium

Presentation to general public by Jay Nelson with special guest William Aila

Jay Nelson

Director - Global Ocean Legacy for Pew Environment Group. Ocean Legacy originated as an outgrowth of work done by Pew in 2005–2006 to support the creation of a fully protected marine reserve in the northwestern Hawaiian Islands. Partners supporting Ocean Legacy include Pew, the Sandler Family Supporting Foundation, the Oak Foundation, and the Robertson Foundation. Inspired by this success, the Pew-managed Ocean Legacy project is dedicated to establishing, globally, over the next decade, at least three to five large, world-class, no-take marine reserves. Ocean Legacy marine reserves will provide ocean-scale ecosystem benefits and help conserve our global marine heritage.

William Aila

William is a long time harbormaster on the Waianae coast of Oahu and commercial fisherman. He is well-known as an advocate for indigenous Hawaiian rights works closely with the group Na Imi Pono. In 2006 he ran for Governor of Hawai'i in the Democratic primary. William was intimately involved in advocating for the protection of the NW Hawaiian Islands for Native Hawaiian cultural and religious reasons from the late 1990's through today. He remains active in decisions about the management of the NW Hawaiian Islands today. William is very familiar with fisheries management in the Pacific through his more than ten year’s service on various Wespac advisory panels.

On the mend

My back is much better. It's still bad, but yesterday I didn't have any screaming episodes, and I seem to be able to move around a bit better.

We closed the clinic yesterday afternoon and took a staff outing to PIC for our first Marianas Eye Institute Olympics. I was tempted to participate, but Russ, or CEO on former PIC Clubmate, wouldn't even let me carry the clipboard. But I did get to wear one of the cool rhinestone studded caps, brought out especially for the occasion.

Last night, Mara and I went to a wedding. Our friend, Peter Loyola, who is one of the island's tennis coaches/stars, had recently become reacquainted with Dinna, the bride, while on home visit to the Philippines. Peter and Dinna were in school together from the second grade through high-school. Peter asked us to be "sponsors" of the wedding, which is a tradition in either the Filipino culture, or the Catholic church. I'm not sure which. I had to ask a few friends from both cultures about the significance and duties, and no one could really give a satisfying answer, but it seemed to be a combination of best man/maid of honor, groom's men/bride's maids, and godparents all rolled into one. There were about ten sponsors. The wedding and reception was held at Claret at Fiesta Resort. It's one of my favorite rooms on the island. It was an honor to be asked to participate in the ceremony.

Will this country never change?

Back in the 1980's, after the Islamic Revolution in Iran, several members of my family were imprisoned and executed because of their activities as members of the Baha'i Faith, whom the authorities regard as infidels. Back then the Baha'is were usually charged with things like "spying for Israel" or "promoting prostitution" (the latter because the Islamic government does not recognize Baha'i marriages). Things are starting to look alarming again.

The article below refers to the abduction and execution of the national-level governing council of the Baha'is back then. The Baha'is quickly reconstituted another nine-member governing body, which the Iranian government again abducted and executed. One of our former CHC doctors lost both of his parents to those executions. His father was a member of the first group, and his mother was elected onto the second group. He was a college student in the States at the time.

***

NEW YORK, 15 May 2008 (BWNS) -- Six Baha'i leaders in Iran were arrested and taken to the notorious Evin prison yesterday in a sweep that is ominously similar to episodes in the 1980s when scores of Iranian Baha'i leaders were summarily rounded up and killed.

The six men and women, all members of the national-level group that helped see to the minimum needs of Baha'is in Iran, were in their homes Wednesday morning when government intelligence agents entered and spent up to five hours searching each home, before taking them away.

The seventh member of the national coordinating group was arrested in early March in Mashhad after being summoned by the Ministry of Intelligence office there on an ostensibly trivial matter.

"We protest in the strongest terms the arrests of our fellow Baha'is in Iran," said Bani Dugal, the principal representative of the Baha'i International Community to the United Nations. "Their only crime is their practice of the Baha'i Faith."

"Especially disturbing is how this latest sweep recalls the wholesale arrest or abduction of the members of two national Iranian Baha'i governing councils in the early 1980s -- which led to the disappearance or execution of 17 individuals," she said.

"The early morning raids on the homes of these prominent Baha'is were well coordinated, and it is clear they represent a high-level effort to strike again at the Baha'is and to intimidate the Iranian Baha'i community at large," said Ms. Dugal.

Arrested yesterday were: Mrs. Fariba Kamalabadi, Mr. Jamaloddin Khanjani, Mr. Afif Naeimi, Mr. Saeid Rezaie, Mr.Behrouz Tavakkoli, and Mr. Vahid Tizfahm. All live in Tehran. Mrs. Kamalabadi, Mr. Khanjani, and Mr. Tavakkoi have been previously arrested and then released after periods ranging from five days to four months.

Arrested in Mashhad on 5 March 2008 was Mrs. Mahvash Sabet, who also resides in Tehran. Mrs. Sabet was summoned to Mashhad by the Ministry of Intelligence, ostensibly on the grounds that she was required to answer questions related to the burial of an individual in the Baha'i cemetery in that city.

On 21 August 1980, all nine members of the National Spiritual Assembly of the Baha'is of Iran were abducted and disappeared without a trace. It is certain that they were killed.

The National Spiritual Assembly of the Baha'is of Iran was reconstituted soon after that but was again ravaged by the execution of eight of its members on 27 December 1981.

A number of members of local Baha'i governing councils, known as local Spiritual Assemblies, were also arrested and executed in the early 1980s, before an international outcry forced the government to slow its execution of Baha'is. Since 1979, more than 200 Baha'is have been killed or executed in Iran, although none have been executed since 1998.

In 1983, the government outlawed all formal Baha'i administrative institutions and the Iranian Baha'i community responded by disbanding its National Spiritual Assembly, which is an elected governing council, along with some 400 local level elected governing councils. Baha'is throughout Iran also suspended nearly all of their regular organizational activity.

The informal national-level coordinating group, known as the Friends, was established with the knowledge of the government to help cope with the diverse needs of Iran's 300,000-member Baha'i community, which is the country's largest religious minority.

Wonder drug fails me

There is a saying in medicine: When a new drug comes out, make sure you use it while it still works.

The first two doses of the Baclofen worked great, eliminating the muscle spasms that feel like someone sticking a hot knife between my ribs. The spasms drop me to my knees, make me gasp and shriek simultaneously, and bring tears to my eyes. But the dose I took at 1 AM only lasted two hours. I didn't get much sleep after that. The next couple of doses only lasted two hours also, and the stuff makes me feel like I'm in a cloud.

So, now I'm just learning to move in such a way that the spasms don't occur. I'm getting better at it, but it's pretty delicate.

The X-ray showed some age appropriate degeneration (translation -- normal for a 45-year-old spine). There is probably some mild disk herniation there, which unless it starts causing neurological symptoms (numbness, weakness, tingling) is just treated conservatively.

Wonder Drugs

I never cease to be amazed by the power of drugs. This morning, I was screaming (literally screaming) with every time I tried to sit down because the the back pain. I crawled down to the orthopedic surgeon at CHC, Dr. Ruben Arafilis, who told me the pain was coming from a muscle spasm, and put me on Baclofen. Thirty minutes after taking the pill, the pain stopped. The spasm is happening either because of a herniated disk or a compressed disk -- neither of which is good. A compressed disk can be seen with a simple X-ray, so I got one today. If it's normal, then I may have to go to Guam for an MRI to evaluate for a herniated disk.

In the meantime, no soccer for me I've been waiting all year for the co-ed season to start again, and here I am sidelined, as the games get underway.

Netfilx works for Saipan

After the movie theater closed, and we started having more trouble getting movies at the video rental shops, we joined Netflix and have been getting our DVD rentals mailed to us.

I'm a big proponent supporting our local businesses, but when the service fails me, I go elsewhere. At our "one week rental" place, the videos are always out because someone else has them for the week. I'm not sure I understand the business model. And our mom and pop video store recently went nutty. The last time we returned a DVD, the clerk insisted that we had returned it in a different case. We returned it in the same case we got it in, complete with all the labels and bar codes, but for some reason she insisted we peeled these labels off of the original case and affixed them to the case we were now returning them in. "Why in the world would we do that?" "I don't know, but I know you did." "Listen, why don't I just pay you for a new case. It's like two bucks, right?" "I don't the money, I just want the truth." And the next couple of times we went in, she gave us the "tsk tsk" for having pulled some sort of a case switcheroo. Life is weird enough without gettin silently scolded every time you go to rent a DVD, so we looked to Netflix.

Netflix works great. You pay a monthly fee, they mail DVD's to you, and you mail them back whenever you're done watching them -- no due date. There are no shipping charges, and they include a mailer to send it back to them. You just open an account with them, create a list (or queue) of movies you want to receive, and as soon as they receive one back from you, they mail the next one out. They mail out of Honolulu, so the total turn-around time to Saipan is about 4-5 days.

The monthly fee varies depending on how many DVD's you want out at a particular time. If you get one at a time, it's around $5.99 per month.

I love it. We are watching some classics that the kids are really enjoying and that you just can't find here, like The Princess Bride, and Big. Any time I hear of a good movie, or see a preview that I like, I just add it to my queue. It's because of Netflix that I know I'll be watching Gandhi next week. You can browse by genre -- Drama, Comedy, Foreign, Documentary, etc. They also have nice collection of TV shows on DVD.

It's another option for cheap entertainment here on the rock.

On Poverty

I'm a selfish son-of-a-bitch.

On Wednesday, I watched the movie, Born into Brothels. If you haven't seen this movie, watch it. For those on Saipan, there is a copy available at the Public Library. A few years ago, it won the Academy Award, and a bunch of other major film festival awards, for best documentary. I usually hate documentaries, and rarely watch them. I can't say I really enjoyed the movie, but it really stayed with me, which is probably more important.

Born into Brothels is the story of the film-maker, who wanted to photograph women's issues in India, and ended up moving into a brothel in Calcutta in order to get to know the women and be trusted by them. In the process, she got to know the children whose mothers populated the red light district of Calcutta, and set out to teach them photography. It's a moving story of the children's experience of creativity, individuality, and for some, freedom from their surroundings and a chance for a better life. Watch the special features, which include the film-maker's visit to the children three years later, and a segment of them watching film and their reactions.

I had tears in my eyes during much of the movie. Man, these are children subjected to such horrible situations, and walking a predetermined path. And here, one woman changes the path for them, shows them that destiny has options.

Lately, I've been thinking about life. Some might characterize it as "mid-life crisis." For me, it's been mid-life evaluation. I've reached the pinnacle of accomplishments in my profession, and though it's satisfying, oddly enough, it's not automatically fulfilling. Sure, it's fulfilling looking back, but that doesn't necessarily carry me forward. There is a nagging feeling that there is more to be done. My friends tell me I'll go insane thinking like this, and that I should relax and just enjoy myself. I should. But movies like this get under my skin, because it's such a self-centered existence to think that once I've got everything I need, the rest is not my concern. We all spend so much of our lives thinking of our narrow self-interests -- our careers, our families, our children, our retirement, and we might even placate our hunger to feel good about our humanitarian souls by contributing to the worthy cause du jour. In the end, it's all pretty hollow.

All of this rumbling around in my head for the past few days has gotten me thinking about poverty, and the misery it brings. But also realizing that poverty doesn't come purely from lack of material goods, but from lack of morality. Aid gets pilfered or misappropriated (fancy words for "stolen") by people who line the trail from donor to recipient. And the aid often subjugates the recipient to a mentality of dependency. Aid is needed, but it has to be linked with education, transformation, a change of mind and heart for all parties. Long-term solutions require systemic changes.

I often think of the tragedy of many of the people who work here on Saipan. Because of the inequality of wealth among nations, our housekeeper left her boys in the Philippines when the children were under four-years old. She came to a place where the wages for a housekeeper were $350 a month, managed to live on this, and send enough home each month to put her boys through college. But she saw them once every five years. A mother removed from her sons, because of that nation's poverty and our wealth.

I'm trying to go beyond these words and figure out how to do something meaningful about all of this. I'm reflecting on something I read a few days ago also, that talks about "right living" and being "undeterred by fear."

We must be like the fountain or spring that is continually emptying itself of all that it has and is continually being refilled from an invisible source. To be continually giving out for the good of our fellows undeterred by the fear of poverty and reliant on the unfailing bounty of the Source of all wealth and all good -- this is the secret of right living.

I also know that without ongoing stimulation, I'll get distracted by the concerns of my own life. It's just so easy, because they are so readily accessible to my brain, like the blood that bathes it. So, I'm trying to give my mind some regular access to great issues, great ideas, just to stay engaged with the needs of my fellow human beings that for some stupid reason didn't have access to the things I did. The problems are big and complex. I don't pretend to have any clue of how to solve any of them, and I doubt I'll figure it out. But it is becoming clearer and more urgent for me to put my energy toward them, rather than toward my own little troubles.

So, the first step? I'm reflecting. I'm going to learn about some of the problems with being a savior. And I'm going to stay inspired -- I ordered the film, Gandhi, from Netflix and it should be here by the weekend. Yeah, it might seem like a pretty lame effort. Edmund Burke said, "All that is necessary for evil to triumph is for good men to do nothing." And although I don't want to be one of those good men doing nothing, I do want to be doing a meaningful something, which requires some thought, understanding and preparation.

It's also going to require me to stop being a selfish son-of-a-bitch, which is probably the biggest global impediment to ending poverty.

Lower Back Pain on Mother's Day

I've been flat on my back for about five days now. I'm not sure what I did, but my lower back has been killing me. I tried to ignore it for a while, but it's been pretty loud. For the past two days, I've been getting up minimally, like just to eat. The ice is helping, and I'm taking ibuprofen around the clock. I had a similar episode about two years ago, and managed to get long-term relief with some core strengthening exercises (Pilates). But, man, when a body gets to be 40 or so years old, it takes active work to maintain it.

I did get up yesterday and headed to the Hyatt for Mother's Day brunch. It's still the best Sunday brunch on the island, combining great food, beautiful atmosphere, and good company. But over the years, the price has gotten really high, and our family has gotten really big. So, we hadn't been for five years, or so. It was an opulent experience, and I even ate flesh from some formerly-living animals. (I don't want to say "dead" because that would be too graphic.) It was good. Savage, but good.

SurgeXperiences 121

The Surgery Blog Carnival is up at Sterile Eye, who is in Norway. The theme of the Carnival is "Tools of the Trade." I wrote the post just for the Carnival (and also used it for my weekly Saipan Tribune column). I like it when the carnival host picks a theme. It's like getting an assignment to write a story, and the theme stimulates my thinking. Here is the snippet about my submission.

As we’re about to move from physical to more metaphysical instruments we turn to eye surgeon David Khorram and his blog Marianas Eye. As a young student he found himself about to be seduced by a stethoscope. Fortunately he was saved from committing the cardinal sin of gadgetry. As the blood rushed back into his brain he realized the patients make appointments with doctors, not instruments.

The end of an era, the beginning of a new one...

President Bush signed the "Federalization" law. The Commonwealth of the Northern Mariana Islands will no longer control it's own immigration, and we will come fully under the US immigration system.

The repercussions are not yet fully known, but lots will change, for sure.

Various statements from members of Congress regarding the signing of the law can be found here.

Seduced by a Stethoscope

It was the first week of medical school and Littman, the world-famous medical equipment maker was on campus giving brand new stethoscopes to every entering student. The free “little gray Littman” was unadorned – the disc to place on the chest, the tube to carry the sound, the hollow ear buds. Littman also brought the sparkling models with them, all making the little gray Littman look okay, but not very sexy, like a homely dress in a room full of evening gowns. The sultry knockout of all stethoscopes was the Littman 501. She could be seen draped around the necks of all great cardiologists -- in their clinics, hospitals, and family photos.

Ahh, the Littman 501. Her sound capturing device was like a warm hand that would lie gently on any chest. Her double tube body with dedicated conveyance to separate ear canals ignored all voices but the one she was intent upon. Her soft ergonometric buds were like lips that would whisper sweet lub-dubs into your ears. She was dressed in elegant black with silver accessories. Walk with her through the wards, and hearts throb, beats skip, murmurs rise for you and your 501. Your unbuttoned white coat flutters, leaving those with lesser stethoscopes gazing admiringly, with a twinge of envy, then hurrying to keep pace. Stay with her long enough and she would curl up into a perfect halo, illuminating your way.

I held the little gray Littman in my hand, and saw the 501 gaze seductively at me from across the room, promising love, happiness and the ability to hear a paradoxically-split S2.

“What do you think?” I asked the cardiology attending who was there to browse. His Kentucky drawl thickened the air before his lips, the words slowly making their way through it. His statement stayed with me throughout my career. “It ain’t what’s in your ears that counts; it’s what’s between them.”

I love the high-tech tools of my trade – my slit lamp, the ocular coherence tomographer, my phaco machine, the laser -- but the most valuable tool I possess is me: my brain, followed closely by my eyes and my hands, all held together by my soul which helps me work compassionately.

The doctor-as-tool may seem obvious, but it isn’t. We often give better care to our equipment than to our selves, thus growing dull, sometimes even broken, from lack of maintenance. People come to see us, because of who we are. They’re happy when we have the best equipment, but they know that without the talent to use the technology, and the soul to stay off grumpiness, the doctor isn’t much use.

Last week the new patient looked stunned when I said that the treatment for her lingering red eye would be, well, brain surgery -- that without it, she would die. She had walked in, expecting more drops. But my eyes had seen the tortuosity of her conjunctival blood vessels. My brain had noticed them and drawn a conclusion. My hands opened the drawer, dusted off the stethoscope, and placed it, oddly enough, on her skull. I heard the faint swoosh swoosh swoosh – a leak from a vessel in her brain, squirting blood with every heartbeat. The leak was raising the pressure inside the cavernous sinus, slowing drainage of blood from her left eye. This was causing her chronic “conjunctivitis” which no drops seemed to cure. I put my little gray Littman back into the drawer, and smiled, knowing that technology can be seductive, but it’s not what matters most.

On the Other Side of the Diagnosis

After reading the post about my lectures at the University of Guam, a few people have asked me, "What did you read from your book that made the students and faculty cry?" Here is the piece. Truth be told I didn't read it. Someone asked me what was the most personal piece I'd written, and if I would read it. I can never read this piece out loud, so the professor asked one of the students to read it. It's hard to believe that this all happened only a year ago.

***

Thoughts of a Father

Have you ever wondered what it would be like to wait for a diagnosis of cancer? I now know. Here are my thoughts from the first day this began last week. I think he’ll be okay.

~

My son has a 6.5 centimeter lymph node on his neck. Ultrasound shows an 11.4 centimeter spleen – huge, upper limit of normal for an adult, much less for a six-year-old child. Blood work mostly normal, no clear diagnosis, mono test results two weeks away. Thus the recommendation to biopsy. Look for cancer – lymphoma, Hodgkin’s disease, childhood death.

I held him as he screamed yesterday, the needle entering his vein, and I thought, “I hope and pray this is not the beginning.” My sweet six-year-old child, so full of life and joy and determination and creativity and enthusiasm and lost in his plans to move up from kindergarten to the elementary classroom.

We’d take him to MD Anderson or Sloan-Kettering or wherever could give him the chance for cure. Should he be taken from us, such emptiness would be left all my days. For his sister, her life a dance with his, she just two years older, a gaping emptiness. And every day I would talk to his soul beyond, and ask for his intercession on behalf of his father, for strength and patience to make it without him.

I can imagine all this, but in my heart, it has to just be an exuberant immune response to mono, right? Please? How can my child have cancer? Diverse genetic mix, mostly vegetarian diet, clear island air, no carcinogens. It’s just not possible. I try to cut a deal with God: Save my son, let this all be a lump of nothing, make it all smaller, and I promise I will be good. In however many ways that I’m not, I’ll be good.

All my personal concerns, various worries, evaporate under the heat of this lump.

I saw my friend of long ago last year at the Hawaiian Eye Conference. “How many kids do you have,” I asked. “Two,” he responded, “a twelve-year-old and a ten-year-old.” “I thought you had twins.” “We did. One died two years ago. Lymphoma.” He talked of how this trip to the conference was the first he and his wife had been able to take. There was no time to mourn two years ago. “What can you do?” he said. “You’ve got these other kids that are alive and who need you. They need your love, your presence, your joy and enthusiasm for them. So you bury one child and try to keep moving forward.”

The universe and God I do not understand. Suffering and the suffering of the innocent, I do not understand. And at times like this, I don’t try to understand, fearing my explanation

or theory may just be false placation. It’s just the way it is, and there is nothing I can do about it. Will my magical thinking help? Will the universe still respond with “your wish is my command”? Is my son any more important, just because he is mine? Thousands of despondent parents bury their children every day – death by lymphoma, or leukemia, or tuberculosis, or starvation, or war, or murder. And the world just keeps going on. I just keep going on, thinking about me, my concerns, my pursuits, my hopes, oblivious of their pain and the fragments of their broken hearts. Why would I be so special as to receive my request from the universe, from God? I feel reticent even to ask.

Over the last few years when death would come up in conversations (your great-great grandmother died, Duke died, the cat died), Arman has so often said, “I’m scared to die, I don’t want to die alone, can you die with me, Dad?” We realized he thinks that the next world is in the ground, somehow related to the grave. “How will we be able to see each other if we get buried in different holes?”

For most of the day, I’m just doing something else. I look up from my work, and wonder what it was that was causing my anxiety? Briefly forgotten. And the knowledge rushes in, pushes the fragile calm out, my tears well up, and I sob.

(Published in World Peace, a Blind Wife, and Gecko Tails, by David Khorram, MD)

Movies, Power, Federalization and Pew

(My Saipan Tribune column for this week.)

Well, it’s been a newsworthy couple of weeks. The closing of Hollywood Theaters has definitely put a damper on spirits, even for those who never went to the movies. Its presence made us feel like a part of the “civilized” world. I was in Guam earlier this week, and when people asked me “How are things on Saipan,” the best way to sum it up was to say, “Our only movie theater just closed.” People immediately understood, and shook their heads in disbelief. Yes, things are bad, and “consumer confidence” is dwindling.

People would ask me what I think needed to be done to improve things, and really, I don’t think there is an easy solution. Certainly, we need a reliable utility. But we don’t control the price of oil, and it’s predicted to climb from its current level around $100 a barrel, up to $200 a barrel within the next year or two. Repairing the power plant can give us reliability, but it might not prevent the cost of power doubling. How can we cope with that? Alternative energy sources such as solar and wind power are simply not cost effective, however, they may become so as the price of oil rises.

Certainly another area that still needs improvement is government waste. We’d have more money available for various public services if waste wasn’t present. And honestly, much of that waste is related to power. Anytime I visit a government office, I take a jacket with me, because I know I’m going to be cold. It’s still beyond me why we don’t just adjust the thermostats around here.

A couple of years ago at the energy symposium that was sponsored by the Chamber of Commerce, one of the presenters told the story of a utility in California that was meeting increasing demand for power and was faced with building a new power plant. They analyzed the situation and realized that it would be more cost effective for them to hand out free energy saving light bulbs so that every home and business would convert to the compact fluorescent technology. It cost the utility money to give away the bulbs, but it saved them the expense of building a new plant. Just an idea that might help address a piece of our current problem. But honestly, there is no silver bullet.

Tourism is generally holding steady, but it’s clear that with rising travel costs, we cannot expect to see a significant rise in the coming months. There are no new industries, and we’re scratching our heads wondering how we can stimulate the economy, attract investors, create jobs. But we’re not alone. I take some consolation that at least the entire globe is flirting with recession.

And of course there is federalization. Whether you were for it or against it, it’s now a done deal, and though it’s certain that it’s going to happen, we don’t know what it’s impact will be. There will be things that some of us like about it, and things that we dislike. It will require the passage of time to sort it all out.

A ray of hope that was on the horizon was the proposed “Sanctuary at Sea”. Forget about all the arguments about more jobs, more tourists, and more federal money. Certainly those are beneficial outcomes. But for every good thing, someone else can give evidence of some possible bad outcome. Arguments at that level of “what can we get out of it” can go on forever. I felt that the monument was simply the opportunity, perhaps never to come our way again, for us to have the privilege of giving a gift to the world. The practicalities will work themselves out, if the desire is there. Let’s set our gaze outward, and into the future, and think of this as a gift worth giving to humanity. “Why should I? Maybe there are diamonds there for me! Maybe there are fish there for me!” Maybe. Yet, maybe, we can rise above these “me” centered concerns and think of leaving a legacy. Maybe centuries from now, we will be remembered in human history for our foresight and generosity in preserving a piece of the planet that increasing population pressures will threaten. The “Monument at Sea” is an opportunity for us to leave a positive mark, to create a positive image. And for people that care about being respected, that’s worth more than diamonds. It’s an opportunity for us to live up to our heritage as people of the land, people of the sea, people of the planet for whom we’ll serve as trustees. The monument is a small ray of hope that doesn’t solve all the problems we face, but it is something that lifts the spirit. And I have a feeling that with the myriad challenges sure to mount, it will be our spirits that guide the way.

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David Khorram, MD is a board certified ophthalmologist and director of Marianas Eye Institute and the author of the book, World Peace, a Blind Wife, and Gecko Tails. Comments and questions are welcome. Call 235-9090 or email him through www.MarianasEye.com, or leave comments at www.MarianasEye.blogspot.com. Copyright © 2008 David Khorram