Some thoughts on… Feeling Entitled

People in Greece are protesting the government for imposing austerity, people in the US are blaming Obama for not having passed a job program, and politicians across the US/ EU are blaming each other for the impasse. We seem to have devolved into a society that keeps asking the government or our leaders, what next they can do for us. Is it just Westerners who have this feeling of entitlement or do others as well? Instead of seeing what the Arts have to say about this, I’ll use our visit to Mali to inform the question.

On the spur of the moment, Klaus signed up 1½ weeks ago to carry out burn and facial surgeries in Bamako, Mali with an organization called ReSurge! The team of 15 surgeons, anesthesiologists, nurses and pediatricians, arrived on Saturday night for a 2 week assignment at Gabriel Toure hospital – one of two public care settings in this city of 1.2 million. Since I was in Europe anyway, I decided to join for the first few days.

Mali is amongst the 25 poorest countries in the world, and yet socially very rich. The streets are safe and people are welcoming. Like other cities, kids try to sell you phone cards or trinkets or water, but a gentle “non merci” and they don’t bother you further. There is respect for the elderly, a conscious requirement for politeness – one must say “bonjour” or give salaam before engaging in discussion, and a sense of public discipline. The oppressing heat and local culture may prevent the Northern go-getter environment, and music pervades the cultural aesthetic.

In advance of surgery over the next two week, the team on Sunday was devoted to setting-up the operating rooms and screening patients. The hospital is an open architecture African edifice with large verandas, a network of crumbling buildings, and patients waiting on hallways floors perhaps days on end to be seen. Their faces exude patience and trust rather than frenetic activity. They may be seen by a physician today, or they may not, at least they are here.

One stream of activity is the arbitrage of patients. Radio announcements to outlying villages and the city told people about the free service weeks in advance. On Sunday morning, the halls were filled with over 300 people including parents and children. The diversity of the afflictions varies from cleft palates to severe burns that have healed and left the children functionally compromised, i.e. can’t lift an arm or open their hand. The parents likely amongst the poorest in the country sometimes require two translators to get to English – there are 21 local languages and French is spoken widely. They have dressed themselves and the children in their finest clothes and shoes to see the physicians, some of them likely having waited weeks or traveled hundreds of kilometers.

The hospital is not equipped to conduct these types of operations, and so the group brought 37 boxes of anesthesia equipment, gauze, antibiotics, and other essential items. Much of the material will be left behind except the equipment which must be taken back for the next outing. At the outset, the operating room contains two beds, two trolleys and good air conditioning. By the end, the set-up is sufficient to conduct about 6-8 surgeries a day, leading to a total of perhaps 60 cases in the 2 week period.


Figure 1: Klaus and Giem (from Vietnam) having set-up operating rooms


Figure 2: Anne Marie (Netherlands) and Fran (San Francisco) with OR supplies


Figure 3: Improvising anesthesia exhaust

Although poor, this country is not Somalia. The kids are not malnourished, and the affection shown by the family to travel this far for a second chance is inspiring. The children are pure joy. They wait with open eyes and infinite patience likely not even understanding what the doctor will do.

Perhaps the most heart-rending decision is choosing who to treat given the seriousness of the condition and physical ability of the patient.
• A 3-month old with a cleft palate is turned away because she is too small – perhaps next year; sadness envelopes the parents’ face.
• A 4-year old with severe facial burns has a fever and screams for minutes at the touch of the nurses or instruments. He may be too frail to go through surgery, but the risk is taken otherwise he may lose his vision.
• A 6-year old named Aliya with a burn extending down her arm so that her wrist bone is showing, is so calm in the screening room, there is a thought she may not recover from anesthesia, the mother insists she is just very scared.

It would be impossible to treat everyone. As with any volunteer program, the point is to see and heal as many kids as possible with the limited resources of time and money.

In the US, the “Great Generation” went to war believing in the creation of a world which would be a better place for their children. Their offspring, the Baby Boomers and Gen X, twisted the challenge into believing that they deserved a better world, and needed to acquire it at any cost including leaving a worse world behind. This sense of entitlement is pervasive, to the point where there is a prospect that the next generation (those under 5 now) may be poorer than us and inherit a degraded environment.

In Mali, the children and parents in the hospital are not feeling entitled. They have endured a tough circumstance and are thankful for the assistance – they are in no way expecting or believing they deserve support. Perhaps it is privilege in the US that is driving this sense of entitlement. The next blog will be about the distinction between the two terms.


September 26, 2011

Some thoughts on… Brinkmanship

President Obama and Senator Boehner are locked in an epic struggle around the US budget and an increase in the debt ceiling. At stake is a potential government default resulting in stalled salary payments to government employees, a mar on the US’ debt rating and a further unraveling of the economy.

Held hostage to its Tea Party constituency, the Republicans have hijacked the conversation and are unwilling to accept any increase in taxes. The White House has acquiesced to the extent that many Democrats believe the President has given away too much. The current bill which has been broadly agreed to by both will be brought for a vote on Monday.

In these situations of brinkmanship, where the two sides are unmovable from their positions, how can a resolution be formed? Let’s see what the Arts have to say.

In Stephen Adly Guirgis’ play The Motherf*** with the Hat (MwtH), which ended on Broadway in mid July, the three main characters are caught in a love triangle. Bobby Canavale plays Jackie – broke, out of prison and can’t hold a job. His AA counselor played by Chris Rock is an upstanding citizen with a questionable moral standing. While Jackie’s fiancé, Veronica, is disappointed in his inability to be financially productive is still sexually attracted to him, and may or may not be having an affair.

The play is 90 minutes of strained yearning, dogmatic posturing and unrivaled cursing. The divide between Jackie and Veronica is heart wrenching. You know that the two should be together, but by the end of the play, they have moved to such resolute positions, that they are unable to come together. The emotions of the characters are open wires sparking at each other when near, but so twisted in polarity that they nullify each other on contact.

In the recent Harry Potter movie, Deathly Hallows Part II, the saga closes with the archetypal clash between Harry and Voldemort. The books and movies have become our modern day morality tales – teaching society about choices and consequences similar to Aeschylus and Euripedes. Good and evil are apparent in the main characters, but the spectrum between is filled by other characters who are more fascinating. These individuals, like Dumbledore, Professor Slughorn or Draco Malfoy, are gradations of good and evil, and bridge the distance between Harry and Voldemort to find a peaceful resolution.

J.K Rowling sets out from the beginning that there is not a common ground, and in order for one to live the other must die. Harry’s realization of this truth allows him to resign to death eventually coming back stronger to vanquish a weakened Voldemort. The eighth movie is the best since movie #3 (Prisoner of Azkaban). The dark tones and immediate pacing propel the story to the inevitable conflict, leaving the viewer exhausted and enthralled on the sideline. We saw the movie in IMAX 3D – definitely worth the $4 extra dollars.

In the on-going budget battle, there seems to be two resolutions. The first is for the President to relent to the demands of the Republicans. This seems to be the path he is taking. The hope is that by submission on the current battle, similar to Harry, he can eventually win the war. The second option is to hold to the positions, and let the country default. This will be a difficult outcome and like the characters in MwtH, we can wish for a different resolution. Perhaps US citizens and Tea Party members need to see the depths of an economic downturn in order to appreciate the consequences of brinkmanship.

July 31, 2011

Some thoughts on… Holding out for a Hero

The hero of the weekend is Governor Andrew M. Cuomo, who in the start of his first term has managed to pull off Marriage Equality in New York – a feat that has daunted leaders before him. The legislation makes sense because it draws a distinction between church and state. Religious organizations are exempted from conducting ceremonies if they wish, and cannot be sued by the state for doing so.

The celebrations in the City and around NY are a justified recognition that a commitment between same-sex individuals is as valid in the eyes of government as those between other people. But with all the euphoria, there is an underlying question of what exactly have we been waiting for?

Many same sex couples are already leading their lives – conducting commitment ceremonies, adopting children, serving the community, and creating their own legal contracts that simulate the benefits of marriage. The legislation will not make them more productive members of society and provides minor additional protection. So what have we really accomplished?

Let’s see what the Arts have to say. The summer blockbuster X-Men: First Class is a prequel to the series and presents the origins of how the super-beings were brought together. The X-Men are products of advanced DNA evolution giving them skills that differentiate and isolate them. Society fears their power and is biased against their mutant nature. Even though they continually save human society from destroying itself, they remain unappreciated and reviled.

In this installment, the director has introduced younger versions of two main characters James Macavoy (Professor X) and Michael Fassbender (Magneto). Both actors are thrilling. Their wry humor and intensity aspirate the deflating series back to its taut and punchy introduction. In the story, the leads take different approaches to dealing with a society that doesn’t appreciate their help. Magneto chooses to support mutant power by empowering them and divorcing from humans, while Professor X wishes to integrate and find common ground. They’re basic paradigms for the disenfranchised.

The meaning of Marriage Equality will differ for individuals. For some, it’s merely an indication of the separation of church and state – New York has no jurisdiction to discriminate relationships between individuals based on religious arguments. For others, it’s validation that same-gender commitment is equal in stature to different-gender relationships – opening the door for less prejudice. Overall, the measure is confirmation that GLBT individuals are not secondary citizens in the eyes of New York state law and that we can find common ground.

But, the rich and well-off individuals who supported and funded the measure are likely not the ones who will realize the true benefit. These folks already have enough legal documents in place to secure their financial and personal affairs. The true beneficiaries will be people that are not allowed to visit their loved ones in a hospital or are excluded from inheritance because they are not related and don’t have the finances or education to establish common law rights.

For everyone State measures are critical, but eventually the removal of the Defense of Marriage Act and Federal recognition of tax and benefits for same-sex relationships is essential for true integration and common ground. Here we may be tempted to hold off for another hero – President Obama – to change the law. But as we learned from X-Men and from ourselves we can’t wait for others to save us. Along with supporting Federal measures to change law, we need to find alternate ways to secure these benefits within the existing system.

June 26, 2011