Sex, Drugs, and Public Health

May 30, 2020

The Dictator and the Parasite

Filed under: Uncategorized — cbmosher @ 5:05 pm

   From early May:

The Dictator came to power when I was ten years old. Like most dictators, he cheated. But his political skill and ruthlessness (including torture and murder) kept him in the office of president until I arrived in Paraguay in 1972, fresh from Internship, to be the Peace Corps doctor. He was a skillful politician, but his actions made it clear that he saw his fellow citizens, at least the farmers who lived outside the capital city, as stupid and lazy.

One of our Peace Corps Volunteers, assigned to work in a rural community, first met Skinny Maria at the Centro de Salud (Health Center). The girl’s mother was getting a routine pre-natal visit. But the Volunteer noticed that the barefoot girl’s skin color was unusual and that she was lethargic, almost falling asleep as she sat on the waiting bench. Her eyes caught him. Large and dark, like an owl’s, shining with an inquisitiveness that burned, but was slowly being extinguished.

He asked the doctor to look at the girl. Which he did – for about one second.

“She has hookworm,” he diagnosed.

“What’s that?”

“A parasite that gets inside you and sucks your blood. The girl is anemic. Look.” And the doctor pulled gently on Maria’s lower eyelid. Her conjunctiva – the mucosal surface of her lid – was white. “This should be bright red with blood supply. Her blood is pale; not enuf red blood cells.”

“What can we do for her?”

“Many of the poor children have it. Too many to treat them all. Besides, even if I treat her, she will just get infested with the parasites again.”

It only took the Volunteer a day of walking around his town to see that lots of kids had skin of pale chocolate instead of healthy brown. And several kids let him look at their conjunctiva.

He told me of his observations. If he was going to attack this problem, he’d need to understand the parasite’s behavior. I taught him what had been worked out by Medical Scientists over many years. Children in rural Paraguay, even five year olds like Skinny Maria, simply poop on the ground. The parasite’s eggs are in their feces and hatch in the warm, moist soil. Then, when a barefoot person steps on these worms, they burrow into the body. Eventually they arrive in the intestine, latch on to the lining of the gut, and chew until blood seeps out. They drink the blood, mate and lay up to a thousand eggs a day. For years.

“That’s why we want you to help folks build outhouses,” I explained. “If they stop pooping on the ground, the parasite will die out in the soil.”

The Volunteer convinced Maria’s mother to take the girl to the doctor for medicine to purge the parasite and for iron supplements to re-build her red cells. And helped the family build – and learn how to use – an outhouse.

He fitted a shoe on Maria’s dusty foot, Cinderella-like. “This is a gift for you,” he explained.

“Señor,” she looked down bashfully, “May I have two?”

The Peace Corps stint of two years seems like a long time to a recent college grad, but that time evaporated as he worked his way, family by family, thru his town, eradicating hookworm. Two years was, however, enuf time to see Skinny Maria’s eyes re-ignite, for her to regain her color, return to school, and completely reverse the pattern the dictator had seen as “stupid and lazy.”
Medical Science, combined with that 1970’s youthful zeal to change the world, began to defeat the parasite’s grip on the people of Paraguay. And that changed much more than just people’s health. The dictator eventually lost his grip, too. He was driven from power – and from the country. When I was last in Paraguay (2018) the rural people were almost as prosperous as the city folks had been in 1972. And shoes were everywhere.

What’s New:

Medical Science, applied to something new like Covid, begins with Observation, as it did for our Volunteer. Physicians with lots of Covid patients in epicenters around the world are beginning to report aspects of the disease other than the lung damage and pneumonia we saw at the beginning.

For instance, physicians in New York City have reported in a prestigious medical journal cases of stroke (brain damage from interrupted blood supply) in relatively young people (under 50). Observations of abnormal blood clotting reported from China may explain how such strokes could be triggered. And in France, they found neurological abnormalities in 40% of Covid patients admitted to hospital.
Centers in both China and the U S report seeing kidney damage, some requiring dialysis. And from New York City come reports of EKG abnormalities, heart attacks and abnormal function of heart muscles.
You’ve probably heard of the “Silent Hypoxia” phenomenon where patients have dangerously low blood oxygen readings but do not show “Air Hunger.”

While these reports “from the field” grab our attention (and make headlines in the lay press), the next step for Medical Science is to perform controlled studies to separate which of these problems are, in fact, related to Covid and which would have occurred anyway, without the virus infection.

In Med School and Internship, a disease like Covid would be called an “interesting case.” Almost always that’s not good for the patient.
It’s beginning to look like the virus may trigger a disease process rather than that the virus IS the disease. Also looks like it might be a variable syndrome, perhaps based on individual genetics. This picture will become clearer by the day.

Places with Success in Control:

New Zealand – used staged, logical, science-drive lock-down levels
– Continues with aggressive testing
– Now down to new daily cases in single digits
– 306 cases per million residents
– 0.06% of world population
– 0.05% of world cases

South Korea – protected Health Care Workers with adequate supplies
– Pay for all Covid related medical care
– Widespread face covering
– Widespread testing
– Aggressive contact tracing
– 210 cases per million
– 0.70% of world pop
– Only 0.34% of world cases

California – early lock-down
– Early personal distancing
– 1188 cases per million
– 12.0% of U S population
– Only 4.6% of U S cases

For comparison, U.S. data: – 3188 cases per million
– 4.3% of world pop
– 32% of world cases

The Big Picture:

As our Peace Corps Volunteer and Skinny Maria learned, When the health of a population is compromised, so are other aspects of society. Like school performance, productiveness, and life expectancy.
Appears that we’re all learning some revealing stuff during this slow-paced time. And thinking about what our society should look like after this home-isolation phase. Based on what I’ve heard from other folks, let me ask you what you think:

1. The pandemic has uncovered what doesn’t work well. It has un-masked – like the Emperor’s New Clothes – the fiction of our wealth. Individuals are struggling after just a month or two off the job while major corporations get bail-outs of taxpayer money. Also, our Health Care System is stressed with inadequate supplies of equipment (over 9000 Health Care Workers infected). 28 million Americans remain without health insurance, public hospitals are struggling while for-profit hospitals are financially fat.
Question: Do you think our society should prioritize protecting individuals or protecting corporations?

2. What we’ve learned that DOES work well: most citizens have been willing to inconvenience themselves to a degree in order to protect everyone (face coverings, home isolation etc).
Q: Will we continue to behave with everyone’s health in mind, or will we go back to “I should be allowed to do whatever I want?”

3. We’re learning the difference between NEED and WANT. And the value of connections with people (if only via computer or phone).
Q: What makes you happier – all your stuff, or time connecting with family and friends? Will we teach our children and grandchildren this lesson?

4. And will we do the preparation for our own deaths so the kids won’t have to do it? You know, Advance Directive for health care, the Will, get rid of the stuff no one needs (NEED vs WANT again). Or should we just leave a bulldozer to the kids so they can deal with our stuff?

April 7, 2020

The Eleven Phases of Coronavirus

Filed under: Uncategorized — cbmosher @ 6:21 pm

It’s been a month since I wrote the last article of Public Health Notes, but it feels like years have passed. I’m guessing a lot of you can relate to that. During that time, I find there are parts of my brain I can’t shut off. So I’ve been comparing Epidemic curves of various countries, calculating Prevalence rates and studying Coronavirus genetic mutation. Then I analyze what measures other countries took in an effort to control the virus, and the results they had. Figuring we should be able to learn from that and apply the measures that appear to work.
When I take a break here in Home Isolation, a different part of my brain elaborates, whether I like it or not, the eleven Phases of Coronavirus.

1. The PHASE OF FASCINATION : A new disease in a far away place. Yet again, a pathogen has jumped from a different species to us following in the footsteps (metaphorical; few disease have feet) of many other human infections. And such a pretty virus with its crown and all.

2. PHASE OF HOARDING: clearly a symptom of anxiety, causing abnormal behavior. Ironically, this behavior empties shelves which only increases anxiety among friends and neighbors. Therefore, hoarding is a communicable disease.

3. PHASE OF WEIRD FOOD: hoarding means getting food that won’t spoil over two to four weeks. Which means a change in what you eat. Like lentils. Those colorful little round things that have been on your shelf, untouched, for ten years. Hint form Dr. Mosher’s kitchen: they’re much less chewy when cooked. Also, you can never have too many tortillas.

4. PHASE OF BAD JOKES: see Facebook. Lots of toilet paper – themed comic relief. Parenthetically, my four year old granddaughter continues to insert the word “poop” into almost any sentence, followed by joyous laughter. Perhaps we never outgrow that. What do millennials from San Francisco call Covid-19 disease? “The Boomer Remover,” which I find personally insulting and, if it weren’t for the fact that I can’t leave the house, I would go to S F and straighten out.

5. PHASE OF DENIAL: wherein self-centered college kids congregate by the hundreds on Florida beaches and subversive elements hold “Coronavirus parties” and packed religious services, imperiling everyone.

6. PHASE OF SUPERSTITION: a hundred and fifty years ago, bearded men driving covered wagons roamed the west (anything beyond Pennsylvania), hawking magical cures and preventatives in brown bottles. The delivery system has changed, but human gullibility in the face of fear has not. Examples all over the Internet.

7. PHASE OF ALCOHOL: No. Not hand sanitizer. The same chemical but in different form. Beware this infamous Retirement Trap. Set a limit that you consider reasonable (I used to recommend no more than three drinks a week to patients on drugs that could effect the liver). On Home Isolation, alcohol is not the magical cure for boredom.

8. PHASE OF DUELING INFORMATION: anyone can come up with a theory. And anecdotal reports can be misleading, which is why we conduct clinical trials. Proving that a given therapy is safe is a major component of such trials, as is proving effectiveness. Depend on the advice of responsible physicians and your own good judgement. If you’re going to extract information from the Internet, be a good researcher and check several sources. Then you can put all that information together and, again, use your good judgement.

During this pandemic, against a virus for which we have no vaccine and no proven “magic bullet” treatment, our best chance is to slow the virus’ invasion into our community so that Health Care Workers can keep up. Follow the advice of the Public Health professionals, not politicians.

This is not “the economy” versus Public Health. Medical and Public Health professionals care about the economy like everyone else. It will come back. Always has. But people who die from the virus will not. Several economists have understood that our current economic slowdown is NOT AN ECONOMIC PROBLEM. It’s a Public Health problem. Control the pandemic and the economy will recover. First things first.

9. PHASE OF REJECTING THE JOHN WAYNE SYNDROME: hey, I loved cowboy movies when I was little. The Cisco Kid, Roy Rogers, Zorro. Maybe I was seduced by their clean clothes and perfectly shaven faces. Maybe the desire to be rescued is inherently human.

But I’ve learned in my travels, that our culture is unique in its worship of the lone hero: cowboy riding into the sunset; rebel cop single-handedly saving a city; fourteen year old with superpowers saving the planet.

But this is different. No hero will ride in on a white helicopter and save us. WE will save us. Working together as a community. Anyone of us messing around and ignoring the concept of Physical Distancing could sicken and kill many. But, together, we can all become Health Care Workers (see # 11).

10. PHASE OF “NOT OUR FIRST RODEO”: Public Health and medical people in most Counties have been through this before. We trained and drilled for pandemic responses to Influenza, Swine Flu (2009), West Nile Virus and Ebola (2012-14). Many of the folks who planned and drilled for these potential pandemics are still around. Moreover, Health Departments, hospitals, Ambulance services and first responders are getting ready again. But they need your help.

11. PHASE OF BECOMING A HEALTH CARE WORKER: if each of us follows the Public Health directions of Physical Distancing, home isolation, covering your cough, and calling your doctor if you get symptoms, that will transform our community into an army. It’s our best defense against the virus. It seems to be the action that worked in countries where the epidemic curve is low, giving hospitals, doctors, nurses, and other Health Care Workers time to fight.

The second action you can take in becoming a member of this army – becoming a H C W – is to send any N-95 masks you have to hospitals for use by the medical folks on the front lines. And if you have any surgical masks, send them also. The medical folks need the masks. Now.

If you have the skills, time, and motivation, you can also sew masks for the medical professionals.

Protect yourself and everyone else by behaving as if everyone you meet is infected. And meet as few as possible. It’s the safest way to win this war.

November 28, 2019

The Kids in Guatemala

Filed under: Uncategorized — cbmosher @ 6:43 am

 You have been very supportive financially and emotionally of this project.  Here’s an update:


Guatemala remains a spectacularly beautiful place in spite of chronic economic stagnation. And there are still two distinct populations: the European-dominated culture most obvious in the cities and lowlands, and the indigenous Maya groups of the highlands.

Distinct Maya groups are distinguished by location, different languages (Q’anjobal, Mam, K’iche and others) and their renown for unique skills. One group is known for its art, another is famous for their skill as merchants, another for their farming etc.

  Saw all three of our kids in Huehuetenango with their families.  Dani is bright and cheerful but has a bad case of scabies. (I’m waiting to see if I picked it up from his hugs). Also, his prosthesis no longer fits because his quadriceps muscle has grown!  Means he’s using the prosthesis, using his leg muscles.

Mario is a smiling, happy boy. His prosthesis is irritating his stump, a problem of sweating and not washing and drying its “sleeve” at night.  We bought him another polyurethane sleeve so he can alternate these and wash / dry after every wearing. Goal is to get him back on the soccer field.

2 year-old Maria screamed and cried as her dad walked her.  Clearly, she was not accustomed to wearing the prosthesis (i.e. the parents weren’t putting it on her).  Our prosthetist made some adjustments, and the girl walked with it a short distance, conniption-free.  He repeated to us that she needed Physical Therapy, regularly. She wasn’t available for this photo of the boys, their mothers, and our prosthetist.

We decided to go visit her family the next day. Scope out the situation.  A long drive over a dirt road, the last few miles by 4 W D pick-up.  Then we parked the pick-up in the road and climbed a very steep, rocky, rain-eroded path up to her house at 7000 feet. My Cardiologist would be proud, since, as far as I can tell, I survived.  Don’t shake my belief.

Pic of Maria Christina, Dad, Mom and us.  Their “house” is a small compound of three adobe huts – square, without door or windows. Dirt floors.  Cooking over an open fire with a single iron pot. Maria has 4 sibs, two parents, two sets of grandparents, and about four others of unknown relation. There was a newborn in an Abuela’s arms, neither of whom looked very healthy.  Their electricity had been cut off (a fight between the for-profit electric company and its 60,000 “customers,” including many who simply tapped into the wires and “stole” the juice). Shades of “Y La Llluvia Tambien.”

 So, it’s not just about prostheses – it’s gonna require a Social Worker, Physical Therapy, frequent visits to assess how well the apparatus fits, and other stuff.

      We charmed a local Pediatrician to oversee the kids and the project at this end.  We made little speeches to the local Rotary club which supports this project (in spirit – no money) and presented them a pretty little plaque of appreciation in hopes they won’t forget us and the kids the minute we leave. A Rotary club in the U.S. is interested to hear more about this.  A Rotary-to-Rotary connect may give the project life beyond Steve and mine. Important since the kids will require revision and / or replacement of prostheses as they grow. The woman in red is a dentist and Rotary president; the Pediatrician wears a jacket. 

We left Huehetenango for Guatemala City and visited a hospital for children. They had 30 cases of osteosarcoma last year, all but two requiring amputation.  There is a need there for prostheses, too.

September 14, 2018

In  “Guate”

Filed under: Uncategorized — cbmosher @ 10:16 am


         What the Guatemaltecos call their capital when they want to save syllables.

         Somewhere in the highlands, amid precipitous mountains and narrow valleys jigsawed by small plots of corn and squash, lives a seven-year-old boy with just one leg. Our hope is that we may be able to change his future.

         Dani has a congenitally absent lower leg on the left and a club-foot deformity on the right. Suspected cause: Amniotic Band Syndrome, a spontaneous development of scar-like bands in utero which physically stifle the normal stem-cell creation of extremities.

        U.S. surgeons From Operation Rainbow had operated on his right foot during a “medical mission” type trip a year ago. But they had no plan to help the boy post-op. Steve and Sandy, who volunteered with the fly-in surgeons as translators and logistics facilitators, arranged to get what Dani needed to function: a prosthesis on his left leg stump.

         This trip’s purpose was to check on Dani’s progress and assess whether more formal referral arrangements could be established for kids like him who lined up for help each time these surgery clinics came to the country.




         People park their wheelchairs on road medians all day to beg coins. A reminder of the likely fate of a physically impaired kid in a country as poor as Guatemala. And a reminder of what kind of life we want to help Dani avoid.

         He lives in a mountain town, a three to five hour drive over a very rough and dangerous road from the nearest city with resources. You appreciate the beauty carefully, lest you slide off the road and become yet another nameless cross.


         The folks who live in his town are primarily indigenous who speak Q’anjob’al, one of several Mayan dialects. Facility with Spanish is still limited here.

         What we found at Dani’s house was both disappointing and enlightening. He walked with crutches so smoothly, it was clear that he’d been using them, rather than the prosthesis, for a long time. Without crutches, he walked as clumsily as his handicapped chicken.


         Moreover, he held the prosthesis off the ground as he walked. We found that his stump had shrunken, was very loose in the socket of his prosthesis, and had already developed a couple of inflamed, sore spots. I was worried that the skin would soon break down, and probably get infected.

         Also, the brace which was meant to hold his surgically corrected foot in the normal position was ill-fitting and loose. Already his foot was twisting back to its abnormal position.


         He wore shoes with no laces – no support.

         The path to his house from the road was steep and slippery.


         The front patio of his house was of dirt (mud in the rainy season) and uneven. A poor surface to practice walking with a prosthesis.


         He has a supportive mother and family, but no father (he’s in “the North.” A place where, we learned by speaking to several townfolk, a large percentage of the men had gone. They work in the U.S. and send back money when they can).

         But Dani’s irresistible dimples show you how much he would love to run and jump and play soccer, like any other kid. His physical limitations show no signs of dousing his spark for life: he put on his prosthesis and followed us up the steep path between their corn fields as we left.




                                            The Plan

         We brainstormed Dani’s needs:

  1. Re-assessment by the prosthetist who built his device. Problem is, that professional’s office is eight hours drive from Dani’s town.

  1. A Physical Therapy professional to teach him and his mother how he should walk with the prosthesis and his club foot. Problem is, there are none in his town.

  1. A flat surface at his house to get proficient at walking.

  1. Some financial assistance to augment their expenses for travel, modification of orthotic equipment as he grows and wears them out with normal childhood activities, and school supplies (he has had very little schooling so far).

  1. A model to emulate.


                                         The Model


         We followed up on a lead to find this 11 year-old boy, Mario. He was at school in Dani’s town, running and playing soccer. His prosthesis is a cheaper version than Dani’s, but his optimism and energy are similar. His deformities are congenital, like Dani’s. Our hope is that the two of them will bond and re-inforce positive aspects of living with prostheses.



                               Hue-Hue  (Way – way)

         What the Guatemaltecos call Huehuetenango, the city closest to Dani’s town when they want to save syllables.

         In this city, where the U.S. surgeons with Operation Rainbow conduct annual surgeries, we found:

  • A professional out-patient Rehab facility which will work with Dani for $3 a visit;

  • A local Rotary Club which, after we spoke of this case and our plan, has adopted the “Dani Project” under the direction of a physician who is a Rotarian; and

  • An energetic community supporter, Manolo, who will bird-dog Dani’s needs.


                                         Xela (Chela)

         What the Guatemaltecos call Quetzaltenango when they want to save syllables.

         We travelled two and a half hours from Hue-Hue to this city, looking for the prosthetist who made Dani’s device. We found him. Showed him our videos and pictures, asked his advice. He had solid ideas of what will be needed in terms of prosthesis and braces. He offered us all the options but suggested the less expensive. We liked that having Gringosin his office didn’t result in his recommendation for the most expensive options.  Additionally, he will travel to Hue-Hue twice a month to see patients, including Dani. His taller (workshop) can manufacture whatever is needed.


         We felt comfortable with his honesty and knowledge. We grabbed cups of coffee next door to his office where the dueñhad hung this poster:


         Translation: “Thousands of plants die each year because of Vegetarians. Save a plant! Eat tacos!”

         Food here was “basic” and, to decrease risk of diarrhea, we ate what had been cooked to high temperatures: beef (or was it leather?) and slow chickens (those tenderized beneath the tires of passing trucks).




                                         The Wedding

         Found a restaurant in an old Spanish-style building constructed as a large square with a central patio. The patio had originally been open – a garden – but now was roofed. We were the only customers other than a large wedding party. Sat in the second-floor balcony and watched the bride in Mayan dress and the groom dance on the patio below. When the DJ followed up a traditional song with Elvis (Jailhouse Rock), the groom discarded his jacket and the fun level increased.



         Due to the Mayan-Spanish-English language disconnect, the irony of the song was no doubt lost on the heterosexual bride, groom and guests. But Elvis still sang ‘Number 47 said to Number Three; you’re the cutest jailbird I ever did see – – – ’ as they danced their pre-honeymoon frenzy.

                                     The Waitress’  Story

         She was round-faced, with a smile of glittering teeth. As a wedding played out on the patio below, the topic of marriage somehow came up. She said she was 30. Two kids.

And a widow.

Husband was killed in what sounded like a brutal attack about which we didn’t request details.

         Financially strapped, she made a trip north, looking for work. Arrived at the Rio Grande across from Texas. She told us she had to pay $500 to be boated across or else face significant physical and sexual abuse.

         Once across, she walked north thru the scrubland until, dehydrated and on the verge of unconsciousness, she stumbled into a hospital E.R. in McAllen. “They were wonderful,” she said of the E.R. staff. They resuscitated her.

         But she was soon captured by I.C.E. and deported.

         Even for city-dwellers, life is not easy in Guatemala.




         ‘Twas a surprise to learn that Guatemala is the world’s leading producer of this spice.

         High in a rain forest, where we bumped over a pass between the lowlands (Zacapa) and the valley area surrounding HueHue, we met an eccentric guy who raises bonsai and orchids while he manufactures machines to separate the seeds.


         This ten-foot high plant has very small white flowers at its base. The seeds develop there. For commercial use, the sprouted seeds need to be separated from those still intact. This drum, laden with wire spokes, achieves that as it tumbles the seeds.



         Try baking it into your bread. Or put a little in your coffee.





         My skin puckered. I shivered. Déjà vu of medieval rituals from childhood.

         Although Fundamentalist Protestantism has made deep inroads into Latin America, many folks, including indigenous groups like the Maya, have transformed their traditional beliefs into Catholicism. The lady in the turquoise jacket was shuffling her way to the altar. On her knees.

         (Ah-h-h, yes, I recall: the more it hurts, the greater the ecstasy awaiting you. Someday. Maybe.)

         Down in the more sophisticated (and more European) city of Xela, this apparition issued forth one evening.



                                       Back to  Guate

         A U.S. and Guatemala based organization which provides prostheses and long-term support, Range of Motion Project (ROMP), looks to be a good resource for patients who live closer to the capital and the lowland town of Zacapa. They re-purpose expensive components from the U.S., manufacture prostheses in country and have made prosthetic hands with a 3-D printer. We arranged a referral pattern for future patients from Rainbow’s surgical clinics in Guatemala City and in nearby Honduras.





         This foundation, based in Sacramento, has supported children with burns who need surgery, and is now also willing to provide some financial support to amputees we identify via Operation Rainbow. With this crucial link, we believe there’s a referral system in place. Not an easy or perfect system – nothing looks to be easy or perfect in Guatemala, especially transportation. But support is there for Dani, and there is the potential for expansion of the system to other kids who will need it.





April 2, 2018

Número Cinco

Filed under: Uncategorized — cbmosher @ 7:58 am

Final Thoughts on Cuba



The Revolutionaries are dying out. Tourism has eclipsed agriculture as a major revenue source. The life blood of Cuba – music – got a transfusion from the Rolling Stones. Even amid the recent anti-NRA backlash, Cuba was a powerful undercurrent. And the island’s birth rate and child mortality rate made me simultaneously flash back to Bolivia in 1970 and flash forward to the world I won’t live to see.


I. Politics –        Raul, Fidel’s brother, has said he will retire from the presidency in April. Three of the most famous (still living) stalwarts of the Revolution are going with him. They’re all over 85.

            Who will succeed him? Anti-Cuba fanatics here in the U.S. continue to label the government a “repressive dictatorship.” While everyone we spoke to in Cuba scoffed at this catch phrase, there’s no doubt that leadership since 1959 has been a one-man show. Nothing unusual about that in Latin America. A sharp Paraguayan lady named Beatriz one lamented “why is it that we Latin Americans always tolerate strong men for presidents?”



            But Cubans have not embraced the Castro family un-critically. What the Cubans told us about the brothers: they are effusive in their love and admiration of Fidel; derogatory about Raul. He has not connected emotionally with the Cuban people and has simultaneously rankled hardliners by saying that Cuba needs younger leadership and by his détente with Obama and the U.S.

            How it works:

The president is elected by a Council of State.

That Council is formed by the National Assembly.

The Assembly is composed of one member for every 20,000 Cubans, elected by local (municipal) and regional (provincial) voting.

At the municipal level, membership in the Communist Party is not required to be nominated.

“Assemble to nominate delegate (date & place)” Sign on neighborhood building

Interesting to note that Raul’s son is not eligible to become president because he did not get elected to the National assembly.

Also interestingly, Raul’s daughter, Mariela, a well-known LGBT activist, could be eligible. But she says she’s not interested. “Who do I want for the future of the country? I have no idea. In all those I look at, I see virtues and defects – including my dad.”



II. Cigars –        It was a family-owned tobacco farm. After 1959, the government took it over. The brothers got wages, usual benefits (health care, education, literacy) and can keep about ten percent of the crop for their private (although clandestine) sale. Tourists stream thru their farm and populate the surrounding agricultural zone of Viñales.

This brother hand-made cigars from broad, cured leaves. He discarded the central “vein” of each leaf. “Too much nicotine in there,” he explained. They recycle that part as an organic insecticide. Cubans exuded pride about their organic farming initiatives. We saw organic farms in several areas, including the city. But this one – the Finca Agri-ecológica– in Viñales, was large.



III.  Beaches –              On the southern coast, the sea is blue, sandy, warm. A stark contrast to the brown, foaming waves that battered the Malecón.


All beaches are public. Cubans and tourists shared. Tourism booming.

But the Sonic Attacks!!

We explored the exterior of the US embassy (still cleaning up post-hurricane). We experienced no symptoms. Saw no anxiety from embassy employees.

There have been reports that the Russians had used sonic attacks in the past. Required investigation. So we went to their embassy.

Symptoms experienced there were of questionable veracity. A few more Cuba Libres may help.

But more professional investigators came up with a plausible explanation. Computer scientists from Univ. Michigan found that similar high-frequency signals like those recorded in the US embassy can be elicited from security systems which use ultrasound. Signals from such motion detectors can become audible if another near-by U-S device induces interference. The inaudible 32 kHz signal then becomes an annoying high-frequency “tinny” sound of 7 kHz which matches the Cuba recording.

“Cuba is the Safest Country for Tourism.”This pronouncement by the International Tourism Fair in Spain, January 2018.

Is it safe in Cuba for the same reason it was in Paraguay during the 1970’s? A populace terrified to break the law in a Police State with torture chambers and the inclination to drop dissidents from airplanes? Where you can’t go a block without seeing police, as in Argentina, Uruguay, Northern Ireland?

Actually, the only cops I remember seeing in Cuba were directing traffic around an accident and occasionally pulling over speeders on the divided highway. Saw less police presence in Cuba than in downtown Seattle.


IV. Cars –        On his explorations, Steve found some of those who maintain Cuba’s iconic but aging fleet. Some had garages:

Others worked in the streets:

My vote for funkiest:

And, after a Tropical Depression sucked some of the heat and humidity from the air, our favorite convertible:

V.  Music –      We heard it everywhere. Jazz, Rumba, Son, Salsa, Rock. Felt as though music might be more important than food to Cubans.

In 2016, the Rolling Stones scheduled a concert in Havana. There were beaucracratic barriers, but as Keith Richards said, “the Rolling Stones can do things governments can’t.”

The Obama – Castro détente resulted in the first visit by a U.S. President to Cuba since the Revolution. It was scheduled on a day that conflicted with the Stones’ planned concert. So Mick and Company moved their performance date.

Keith again: “Basically, Obama was our opening act.”

Crowd estimate: a half million.

Explains the Sticky Fingers decals on many cars.

Our host, Abel, played for us the “Havana Moon” video. Then he returned to his Hollywood westerns with Spanish dubbing. “Isn’t that stuff prohibited?” we probed. “How do you get news, sports, movies from the U S on government-controlled TV?”

His smile sparkled. He pulled out a small electronic device. “El Paquete,” he introduced us to the plug-in that he (and much of Havana) gets delivered every week by street entrepreneurs.

No Iron Curtain here.




VI. Art –       In addition to music, art is ubiquitous in Cuba. As with all art, some of it was good. They sell it on the streets and in studios. The most fascinating venue was the Fábrica de Arte, a re-purposed factory where we had an espléndido dinner (Happy B’day to one of us), then explored the internal labyrinth. The place throbbed with some primal Latin music. Young Cubans, dressed chic, exuding cool, strolled around us, drinks in hand.





VII.  The Yummy Revolution-

                                           What we expected: rice, beans, water

                                           What we got:  lobster, wine, crème brûlée

The wave of free-enterprise enthusiasm sweeping the island spawned paladares– restaurants catering mostly to tourists. As mentioned in Número Dos, our friends had given a favorable review to one of these near our B & B. And the restaurant nestled into the Fábrica de Arte had served food as tasty as you’d mouth-dissolve in any upscale U.S. place. With prices to match.

But these were somehow – – – disappointing.  I was looking for something different. Something – – – Cuban.

On a night of warm Havana drizzle, we were led by a Bouncer-bodied maître d’  into a room of pristine white walls hung with sensuous paintings by local artists. Beneath the sultry gazes of painted girls with naked breasts and ebony-muscled musicians, we settled into a table. White cotton tablecloth, gleaming stainless cutlery, a candle.

A young waiter with slick black hair, wearing a starched white shirt and black slacks, trembled a little while striking a match to light the candle. Then, careful to approach us from the left, he handed us, one-by-one, large, professionally printed menus.

A half-dozen Appetizers; entrees of beef, chicken, seafood; even a couple of vegetarian options; a wine list. Most dishes were what you’d find in Europe or the U.S., translated into Spanish. The lone traditional dish: Ropa Vieja (more tasty sounding if not translated). “Old clothes” is shredded beef.

“Sorry, Señores,” sheepishly. “Only the pasta you can not have. Everything else.”

We had to ask.

“There is very little gas today,” his dark eyes moistened like a schoolboy awaiting discipline. “Enough to cook the seafood but not enough to boil the pasta.”

No importa,” we tried to reassure him. And ordered Chilean wine. He bowed awkwardly as if it were his first time and backed out of the room.

“Love it. Not enough gas for pasta.”

“Clearly it’s not that they can’t afford it. The paint in this place, based on prices we saw in the government store, is worth a small fortune.”

Our waiter re-appeared and cradled the bottle in his French-cuffed arms for Steve’s approval.

Then there was a struggle.

Corkscrew, foil wrap, bottle, cork, all too confounding. Our poor waiter, his lips pressed together so tightly I thought they’d bleed, flailed to maintain dignity as the process frustrated him.

“Have you ever opened wine before?” Steve disarmed his question with a laugh.

The Cuban kid imprisoned within starched cotton and a façade someone had taught him, relaxed enough to laugh in reply. Steve pulled the cork – slowly so the kid could watch – then handed the bottle back to him so he would be our waiter again.

In the gleaming dining room – mimicking the cold sterility of some upscale Miami place – the food tasted like in the States. But beneath the vibrant eyes of the paintings that watched us, attended to by a waiter who was now a friend, the experience had become, at last, Cuban.

As we rose to leave, a waitress brought us each a paper flower. White, of course, but obviouosly, thankfully, hand-made.

On an afternoon of glaring sun, enroute to the Oriente, our guide told us we’d stop at what he promised would be a “wonderful restaurant.” The road meandered thru thick green hills, where the cows and horses outnumbered cars, houses were sparse, crude and unpainted, and the roadside vegetation grew taller than our vehicle.

The restaurant was someone’s farmhouse, unpainted, chickens running free. Raw wood tables on the packed-earth in front of the house, a thatched roof above for shade. The kitchen was a wood-fired grill outdoors. The bathroom was a latrine. Family members, aged between ten and seventy, attended us wearing simple dresses, faded, threadbare.

We requested beer to quench (and to avoid potential dysentery from water). The menus were hand-written, mis-spelled and food-stained pieces of paper. There were, as I recall maybe four choices.

Those who had the lobster, served in this most primitive of settings, burst with uncontrollable praise about its flavor for days thereafter.

As I observe the enthusiastic efforts of these budding entrepreneurs, I can’t help but see the same spirit in what Cubans created during the pre-Revolution days and have reproduced since in Miami. Then I compare this behavior to that of to other Latin Americans: Paraguayans, Haitians, Bolivians. There appears to be a strong gene for Capitalism in the Cuban chromosomes.

“The future of Cuba must include some private enterprise without ever abandoning the accomplishments of the Revolution.”

                                                                        This young museum docent



VIII.  Racism –                        Fidel addressed the legacy of slavery head-on. He saw overt racism as a direct conflict with his goals. He passed policies to desegregate beaches, parks, work sites and social clubs and outlawed all forms of legal and overt discrimination, including discrimination in employment and education. Political representation by Afro-Cubans doubled. We met black-skinned physicians and other university graduates. However, toward the end of his time, Fidel admitted that full social integration was elusive:

“We discovered that marginality and racial discrimination with it are not something that one gets rid of with a law or even with ten laws, and we have not managed to eliminate them completely in 40 years.”

The poorest sections of Havana were, disappointingly, the Blackest. BTW, researching the demographics of Cuba is frustrating. The percentages are all over the place. Folks whom we would call African-American might fall into the “White” or “Mulatto” categories in Cuba.

But I never sensed the alienation and anger there from dark-skinned folks as we do daily (even if subconsciously) here in the U.S.

Center: the Orthopedic Surgeon we interviewed



IX. Sexism –        we met women who were veterinarians, physicians, entrepreneurs. Cubans were proud to point to their record on equal access. The recent election resulted in over 48% of the National Assembly being women.



X.  Z P G –        “I worry about our future,” Alex told us. He is an Ob-Gyn doc who drove us to eastern and southern parts of the island. “Our birth rate is falling dangerously close to our death rate.”

Cuba death rate:  7.29 per 1000

          birth rate:   11.02 per 1000

          Pop Growth Rate:  0.14

Birth rates generally far exceed death rates in “Developing” countries and Growth Rates exceed 1.0 . I observed one of the major factors for this phenomenon in Bolivia in 1970 where the Public Health physician in charge had been unsuccessful at getting women to accept birth control. They had multiple pregnancies with the associated serious medical complications.

However, the child death rate was 50% by age 5. Adult children care for their parents in old age (no Social Security, Medicare or pensions in Bolivia), so women were having five or six kids hoping three would survive to adulthood.

He approached this issue from a Public Health perspective. Vaccination of children resulted in lower child death rates and, soon, more little mouths to feed. At which point women knocked on the hospital door, seeking birth control.

I suspect similar mechanisms (in addition to social / religious pressures) drive birth rates in other “Developing” countries where a projected 900 million more will be born over the coming ten years. While in “Developed” countries, where pensions, social safety nets and health care are much more accessible, only an additional 56 million are projected.

Zero Population Growth, which Cuba is rapidly approaching, is primarily a characteristic of “Developed” countries like Iceland, Finland, Germany, Denmark, Sweden, Japan and others.

The U.S., on the other hand, looks like this:

            Death rate – 8.38 per 1000

            Birth rate – 13.83 per 1000

            Pop Growth Rate:  0.75

Which would be Okay, I suppose, if we would feed and care for that population. But an estimated one in eight U.S. residents do not have enuf food. This in a country with a whopping 40% of food waste.



XI. More Revolutions –        Fascinating to note the roles of two Florida-based characters in the recent March For Our Lives. Emma Gonzales wore a jacket plastered with slogans when she spoke in D.C. Prominent on her right sleeve was the flag of Cuba. And Marco Rubio took to the microphones to tell the kids that he didn’t support their efforts. Is the Cuban expatriate population finally abandoning it stance of vitriolic hatred toward their ancestral island? If so, the Cuban Revolution, which has continued to be fought in the U.S. for the past 59 years (long after the shooting stopped), is coming to its conclusion just as the last Revolutionaries fade from the scene.


“History will absolve me.”

                                                Fidel   Oct 1953




XII. Punchline –          Ironically, Cuba now looks more like a “Developed” country in spite of its crippled economy (thank you, Embargo):

  • full-scope social safety net for heath care, education, food, shelter

  • literacy rate of 99.7%

  • approaching Z P G

  • burgeoning small-scale entrepreneurship available to the population

  • societally addressing Racism

  • societally addressing Sexism (48.8% of National Assembly is women)

  • gun-death rates comparable to the Netherlands and Britain

While, also ironically, the Trump-led U.S. is decaying from its previous “Developed” status:

  • deteriorating social safety nets of health care, pensions, public education

  • literacy rate of only 90.4 %

  • Capitalism that has degenerated into all-consuming Greed and the shrinking of the Middle Class

  • Racism rampant and denied (see Obama Presidency)

  • Sexism continues in many sectors including Tech and Politics (only 19.6 % of congress is women)

  • Out-of-control gun violence

  • Food waste in the face of hungry citizens

Looks to me like the 242 year-old Idea that has been the U.S. peaked in the decades between WWII and the end of Vietnam and is deteriorating into two populations: a small ruling class of the wealthy with no loyalty to the U.S. (either in paying taxes or in locating its manufacturing), and a poorly educated (and increasingly poor) populace – – –

while Cuba’s 59 year-old Idea, resilient in the face of economic bullying, shows the world a Socio-Economic model for the Future.

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