mercredi 30 août 2017

SAD STATE OF DIABETES CARE IN THE UNITED STATES: DIABETES IS A SOCIAL ILLNESS

THE SAD STATE OF DIABETES CONTROL IN AMERICA
A study was recently published comparing patients with Type 2 Diabetes who are attending Endocrine Clinics in North America, for a study to compare usual care to that included Continuous Glucose Monitoring.
At the end of six months, the USUAL care, which I would imagine is the best care Endocrinologists and the Diabetes team was able to give in private practice, the HbA1c decreased by 0.5%, just half a point!
This is part of a study and we all know that when not under study conditions, the results tend to be half the published one, so in effect the Endocrine Care of these patients with obviously a Nutritionist, Diabetes Educator plus others made very little difference in the outcome.
Who were the patients?

158 adults who had had type 2 diabetes for a median of 17 years (interquartile range, 11 to 23 years). Participants were aged 35 to 79 years (mean, 60 years [SD, 10]), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5% to 9.9% (mean, 8.5%).

I decided to access the original article published in the Annals of Internal Medicine. Most of the practices studied were in the USA (3 in Canada) and in private practice clinics.
Patients who were receiving Usual care were predominantly white, 77 per cent whereas those they were being compared to (wearing a continuous glucose monitor device) were only about 50 per cent white and the rest being from the minorities. Half the patients had A1C between 7-8.5 and the other half between 8.5-10.

The academic institutions were Joslin in Boston, Washington University in St Louis, the Universities in Portland and Seattle: all heavy hitters in the field of Diabetes care and treatment.

Usual care was being compared to people wearing Continuous glucose monitoring device and the authors consider the difference in CGM wearers a success since a reduction of just 0.3% in HgbA1c is considered a “success”

Among the people I work with, the Native Americans of Nebraska, people walking round with an A1c of 9% is not at all uncommon, so for us a drop of 0.3% is not a success and I am sure this is the case among many poor and marginalized communities of Hispanic and Black Americans with Diabetes.

So for those of us working with Native Americans, we should be proud of our efforts, which is a Psychosocial Model emphasis on Education with intermittent consultation with a visiting Endocrinologist. The Omaha Model as it is called, has produced results much better than the ones published in this article. I liked the article and it is well done and well written but the irony is not seen: even with best MEDICAL attention, the A1c reduction was negligible. I am more than ever convinced that Type 2 Diabetes is a SOCIAL ILLNESS and the best results are when it is approached holistically with Diabetes Educators working in close cooperation with community operatives with intermittent consultations with an Endocrinologist.
In the Omaha Model, success is further guaranteed by the open minded Primary Care Providers who work in conjunction with the Diabetes Educator and Peer to Peer Educator.

ORIGINAL RESEARCH |22 AUGUST 2017
Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial
Roy W. Beck, MD, PhD; Tonya D. Riddlesworth, PhD; Katrina Ruedy, MSPH; Andrew Ahmann, MD; Stacie Haller, RD, LD, CDE; Davida Kruger, MSN, APN-BC; Janet B. McGill, MD; William Polonsky, PhD; David Price, MD; Stephen Aronoff, MD; Ronnie Aronson, MD; Elena Toschi, MD; Craig Kollman, PhD; Richard Bergenstal, MD; for the DIAMOND Study Group (*)
Ann Intern Med. 2017; doi: 10.7326/M16-2855


dimanche 27 août 2017

THE PEOPLE YOU MEET IN DOHA WILL CENTRE YOUR LIFE: THOUGHTS FROM THE PERSIAN GULF

HOW TO CENTRE YOURSELF WHEN YOU ARE TRAVELING OFTEN?  Thoughts from DOHA
As I entered the Al Mourjan Lounge at Doha International Airport, a young man clad in grey suit greeted me: Nice to see you again, Sir!
It made me think of what is real and what is fantasy, in this world we inhabit, where we temporarily interact with thousands of people: of course, in a case like Doha, the line between Fantasy and Reality is determined individually of course.
The power of relationships is what overwhelms me. Just on this day in Doha, three different Uber Drivers, all with the name Mohammed Plus something (Noushad, Rasheed) asked me:
Are you Pakistani?
Are you Sri Lankan?
Are you Bangladeshi?
At the check in at a fancy hotel in Doha, yet another Mohammed opens his eye in awe, as I begin to chat away in Spanish to his colleague. I dress to confuse the innocent onlookers, with cotton clothes from Cambodia or India, with a business card with a Kathakali mask featured on it.


With Sofia from Lisboa, I spoke a little bit of Portuguese, she marveled at my Brasilian accent, while I wondered how would it be to wander around the walking streets of Lisbon, the very same street that one hosted Fernando Pessoa, while chatting away in her sonorous language.
I am thinking of my dear friends in Havana (who are tattooed into your heart, said a cunning fake artist) and the Indigenous people I have become attached to.

Sofia briefly touched on the reality of the workers in Doha, many of them young women, far from their homes, toiling so that they can provide for their parents and siblings.
These workers may be exotic in our western eyes- Limbu speaking Nepalis with Bhutanese features, round faced Filipinas carrying deeply Spanish names, betraying their indigenous roots in their faces. 


I once asked a young Nepali woman where I could find good Nepali food in Doha, she answered: I do not eat out, sir; that unfolded the entire story of that delightful maiden from the shadows of the great mountains.
What is real for her? She is exotic in our eyes, as I dress to look exotic in the West. As Sofia exclaimed: They can teach us so much!
I have been molded by the many teachings of the Native American Indians, one learns to keep an innocent heart, cleanse your mind of judging others, and look at them as pure creations of human spirit, doing a noble task. For them the reality is not the opulence of Ritz Carlton, the exuberance of Marriott, the extravaganza of Al-Safwa First Class Lounge (repeated a hundred times in Kingdom of Saud Arabia, Kuwait, Dubai and Abu Dhabi and to a lesser extent in Oman, to certain degree in Malaysia and Singapore)
I salute you, young ladies of the Orient for allowing me to enter the world of your dreams.
Europeans who come to these shores are following a career or family members, usually a stepping stone to a diplomatic or corporate life. They know the best places to eat and drink in Doha or elsewhere in the Persian Gulf, in the company of other expatriates and create superficial rituals such as Brunch. The term expatriates are best used for them, as workers from India, Nepal or Bangladesh are not truly expatriates, as we know the term in the West. These Europeans will return home, as I do after each of my bi monthly visits to “exotic” Doha or Siem Reap or Kuala Lumpur or Cochin, carrying this image of the Levant, adding stars to their CVs, all well deserved. I admire their courage and far sightedness to come to Doha, to savour another life, even if that life lacks originality.
I salute all of you, shamelessly raising Billecart-Salmon Champagne from my seat 1K aboard this Qatar Airways flight bound for South East Asia.

Right now I wish I could recant these tales of love and ardour to the many who have touched my heart in passing. Without them knowing I loved them deeply.
Now they whisper the tales of my deep emotions, in Persian, that language of love and passion, in the shadows of the Karaj Mountains. Whatever happened to the lady who spoke Spanish with a Japanese accent, where did she take her passion away?
Find yourself a good woman and settle down, the cunning jealous ones would say.
I can only fall in love with the innocence, not with Doctors or Lawyers or Diplomats who cross my path with their thick agendas.


So to my Nepali, Sri Lankan and Filipina friends in Doha, it is I who is lost in this universe, this wandering Jew, sitting in this corner of Qatar Airways Flight, usually in seat 1K, attended by one of your Filipina or Korean sisters, savouring your innocence, the best gift you have given me and I wish you nothing but the best.

I love all of you.

jeudi 24 août 2017

MARRIOTT MARQUIS CITY CENTRE HOTEL IN DOHA QATAR: A STAY THAT BECAME A VACATION

A HOTEL STAY THAT TURNED ITSELF INTO A VACATION
And that mood followed me to Casablanca.

I love flying Qatar Airways; it means frequent transits through Doha. Before, I was not much interested in breaking my journey, despite very long flights such as my flight with QR: Houston to Doha to Jakarta, with a short break at the Doha airport. Also I was unduly influenced by the media depiction of Qatar in the Western Press and the heavily anti-Israeli tone of the Al Jazeera TV headquartered in Doha. I had caught flights on QR from Cochin, Colombo, Kuala Lumpur, Singapore, Jakarta; and then change planes at Doha and flown on to New York or Boston or Miami. It never occurred to me to have a stopover in Doha and visit the City.
Qatar Airways is the carrier of the brand Qatar, as my satisfaction grew with QR, I wanted to venture out and see Doha. QR and Qatar are synonymous as there are no other airlines based in Doha, unlike United Arab Emirates, home of Emirates, Etihad, Air Arabia, FlyDubai etc.
Qatar Airways and Tourism Qatar offer a promotion during the summer months (unbearably hot days) when passengers are encouraged to stop over for a day or two with no additional charges to the fare. I began to take advantage of this offer. I had a slew of 5 star hotels on the offer and on my last stopover, I chose Marriott Marquis City Centre Doha Hotel, right in the centre of the Commercial Business District of Doha.
Marriott is an American Brand but the comparison stops right there, there is nothing American about this hotel, everything reeks of Qatari Hospitality.
I had stayed there once before, and I was amazed that many of the staff, including the Manager of the Front Desk, Marcel, remembered me and offered a warm welcome. He instructed that I be given a nice room, as I remembered the high floor corner room of my previous stay. Similar room was offered and thus began a two day in which I barely ventured out of the hotel, made lots of new friends and enjoyed the offering, a diverse breakfast, chance of dipping in the pool, a spa. But what made my stay this comfortable was the Executive Lounge situated in the 8th Floor, which is open 24 hours a day but during certain hours of the day, there were food and wine offering.
After breakfast, I would retire to the room to do some writing and then drop by the Executive Lounge for a cup of tea. On the very first time I did that, the Executive Lounge usually is not occupied at that hour, I had the pleasure of a conversation with SK, a Zimbabwean from Cape Town, South Africa.  We talked and reminisced about Zimbabwe and South Africa and the beautiful city of Cape Town (along with Sydney, Rio, San Francisco, Vancouver), considered to be one of the more beautiful cities in the world.
I walked around the hotel, was greeted by the Guest Relations Officer, a petite lady from Nepal, who introduced me to a Hospitality Intern from Penang in Malaysia. Being a traveller, there is always room for some conversation or other; times were spent with pleasant conversations.
On my return to the Executive Lounge, that bundle of energy, Manisha, who is a perfect hostess, joyously greeted me. When they have so many guests, I am surprised that they remember someone who passed through the hotel for one night some months ago. Samjhana from Nepal reminisced about our last conversation when we talked about her place of origin, Lumbini, the place of birth of Buddha! They were both attentive whenever they were on duty.
Between the three of them, SK making Earl Grey tea and Manisha feeding at the Happy Hour time and filling up my glass with South African Sauvignon Blanc and Samjhana stopping by often to enquire whether I needed something more, I felt very content and had no complaints about time passing slowly. There were other people in the Lounge, Ragesh, Robinson and two very attentive young men and a lady who seemed to be in charge behind the scenes.
Hospitality industry now ranks among the first in the service industries and the character it takes to be successful in it, include pleasant mannerisms, a genuine interest in engaging the visitor and a desire and ability to establish a relationship.
I particularly liked to offer a welcome to the two students, one from Malaysia that I mentioned above as well as one from Aalborg, Denmark.
Two days went past quickly; I felt I was on vacation even though that was not the purpose when I landed at Marriott Marquis Hotel in Doha.
It was one of my most enjoyable hotel stays and I wish to thank SK, Manisha, Samjhana and others I have mentioned.
Few hours before I left the room, to go to the airport to catch a flight to Casablanca, there was a handwritten note left at the desk in the room, with a box of chocolates. I truly appreciated the gesture.
 BREAKFAST  EUROPEAN, GULF AND INDIAN TASTES 
 A wide variety of food was offered at the Executive Lounge during the Happy Hour from 5 30 to 7 30 pm.
 The indefatigable Manisha of the Executive Lounge

 Samjhana from Lumbini, Nepal 
A new friend  from South Africa .
 A hand written note of thanks, which was much appreciated.
a very content traveller, well relaxed at Marriott Marquis City Centre at Doha, Qatar.


QATAR AIRWAYS THE MAN IN SEAT 1 K

WITHOUT ANY DOUBT, in my opinion and those of many others, QATAR AIRWAYS is the best Airline in the world and I look forward to each and every flight with them. During this month, I would be on 8 of their flights and will give details later
Somehow or other I have become fond of their seat 1K and always request and is rewarded with that..
AirBus 350 as well as Dreamliner 787 have a nice private area of 1 K..
In the last five days, I have been thrice on seat 1K
New York to Doha, Doha to Casablanca and Casablanca to Doha ..
I am happy to be the 
Man in Seat 1 K 

lundi 21 août 2017

THINGS HAPPEN FOR A REASON: A MODERN DAY TECHNOLOGICAL ENCOUNTER AT 39 000 FEET

THINGS HAPPEN FOR A REASON: A MODERN DAY TECHNOLOGICAL ENCOUNTER AT 39 000 FEET.
The sleek Airbus 350 took off from New York JFK airport on time, now climbing over the clouds to a clear sky of a summer morning. Qatar Airways, the best Airline in the world, is renowned for its service and soon enough a flute of Billecart-Salmon champagne arrives, giving me a chance to practice Portugese with the flight attendant from Sao Paolo.
Soon, Wi-Fi on board comes on. The first few minutes of the Wi-Fi are offered Gratis; I do not wish to be connected on this 12-hour flight to Doha, a kind of disconnection from Internet as well as USA, metaphorically speaking.

Just check any messages and then shut off the computer, iPhone and concentrate on something else, away from things that remind me of my work with the Indians, my life in Cuba etc.
A message arrives. It is from Doha. It is one of my Sri Lankan friends who know I would be coming on this flight.
It said:
Doctor, could you please say hello to the person sitting in Seat 6 F. He is a well-known businessman in Sri Lanka and please give him my regards.
I am not very talkative on long flights. I went over to seat 6 F and introduced myself.
He was taken back, but said: yes I like the Sri Lankan community in Doha, but he was far more interested in talking about Cuba. His business takes him to Republica Dominicana as well as Haiti but he has great desires to visit Our Little Precious Island, Cuba!
It would be my pleasure to welcome you to Cuba. He seemed genuinely pleased.
I did not see him for the rest of the flight but towards the end of the flight, he came over to my seat and gave me his card and said:
Please let me know when you are in Colombo!

We had a pleasant chat and realized that we had many things in common.
I am sure, I will be stopping over in Colombo before the year ends!


Such an encounter would have been impossible a few years ago. Now most aircrafts have Wi-Fi and my friend was in Doha, 8 time zones away and he had sent me a message using whatsapp. I love this communicability using technology, while not too absorbed by it. Technology as a slave but not as a master.

PS I fondly thought of my Meskwakia teacher, "Dr" Pat Brown who said to me, Do not search for people, those you need to meet will come your way.