Showing 1 - 10 of 407 annotations tagged with the keyword "Cross-Cultural Issues"

Annotated by:
Clark, Mark

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The title of this memoir derives from the Native American custom of bending a tree’s growth in order to indicate a direction of safe passage.  The custom represents a reverent cooperation with nature through which a compassionate communication is accomplished: a message to other journeying souls as to how they might find a way to their flourishing.  The title is exquisitely apt for this memoir, which echoes the gesture of the arrow tree, testifying to a safe passage through the wilderness of COVID.  The author, a first-rate, published Victorian scholar, contracted COVID-19 in March 2020 upon her return from a sabbatical at the University of Cambridge, which was cut short as a result of the pandemic. 

Weliver has suffered from symptoms ever since: hers is the experience of living with long COVID.  The condition warrants her taking a leave from her university, and she returns to her childhood home of Interlochen, in northern Michigan.  Her living in and engaging with the natural world there encourages her to undertake meditations about that world and her place in it as she lives with her illness.  The writing—the foundational means of her healing—inclines her, crucially, to think with the stories of the Odawa (Ottawa) and the Ojibwe (Chippewa), Anishinaabek ("Original Man") of the region, which she researches as a means of deepening her understanding of her home, her origins, and the nature of her identity.  Her quest for understanding turns not only to these stories, but to an integration of them with the wisdom of other guides in her life: authors of the Romantic and Victorian periods, poets and thinkers of Taoism and other ancient Eastern philosophies, mentors in her rich journey of studying both literature and music (she attended Interlochen Center for the Arts, Oberlin, where she double-degreed in English Literature and Voice (Music), Cambridge, and the University of Sussex), and her own family, particularly her mother.  Her prose is accessible and welcoming, not at all the erudite sort one might anticipate from a reputable scholar: it invites curiosity and encourages insight that is, at times, breathtaking and joyous.  This “arrow tree” memoir points its readers in the direction of a safe passage to the home of our natural world, where, in finding union with that world, we may experience healing not only from COVID but from habits of the heart that have left us more broken than we know.

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Annotated by:
Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Fevers, Feuds, and Diamonds is Paul Farmer’s latest work exploring the connection between health and the social and historical structures that surround it.  Focusing on how and why Ebola spread in West Africa in 2014, the book is difficult to categorize — it is not only temporally expansive, ranging from the late 15th century to the present day, but it also combines elements of a memoir, an anthropological treatise, and an abbreviated historical text with powerful calls to action in over 500 pages.   

Stemming partially from a desire to fulfill a “personal penance for inaction” during the early days of the outbreak, Farmer chooses to learn about Ebola from “the personal histories of the Ebola dead, of survivors, and of their caregivers.”  Harking back to his days as a college anthropology major, many of the book’s themes, embodied in its title, are introduced via these in-depth interviews.  His two main subjects, Ibrahim and Yabom, are Ebola survivors who, after initially recovering from their illness, make it their work to support other Ebola survivors.  Through their words and narratives, we witness some of what it was like to experience the civil strife that predated the outbreak, see how Ebola expanded from isolated cases to clusters and communities, how family members sick with the disease were cared for, what it meant to survive Ebola, and now what it means to live with its sequelae.  Translation for Farmer was provided by Dr. Bailor Barrie, one of his former students, whose story as a medical student in Sierra Leone during its civil war soon becomes part of the narrative, as well.  Through the words of these three people, pieced together over many extensive conversations, a narrative is developed, allowing those most impacted by Ebola to tell its story. 

Farmer interweaves his first-person perspective with their stories, emphasizing his role in 2014 and how Partners in Health became involved in assisting in the outbreak.  While working in West Africa during the Ebola epidemic, late one night, Farmer mixes up Liberia and Sierra Leone.  Realizing how different their histories are, he vows to “make amends for my ignorance” and transitions from storytelling on the personal level to history-telling on the country level.  To ensure that he, and we, never mix them up again, Farmer traces the histories of Sierra Leone, Liberia, and Guinea in four chapters.  During this section, he refers back to the book’s title, taking on the effects of the rise of imperialism, colonization, the use of sanitation/Pasteurian principles, the impact of resource extraction, and much more on each of these nation’s stories and relationships with Ebola.  As he describes it, “if you want to understand the magnitude and dynamics of this Ebola epidemic, in other words, think in terms of fevers, feuds, and diamonds.” 

Fevers, Feuds, and Diamonds is bookended with reflections on COVID-19 in the introduction and epilogue.  In the introduction, he reflects on the book’s “obvious implications for our response to COVID-19” and how COVID-19, though different in many ways, shares certain similarities with Ebola — among them, the speculative nature of its origins and the fact that it is a zoonosis.  Most importantly, according to Farmer, treating and managing it will require understanding many of the same “cultural complexities and... challenges” that treating Ebola required.  After taking us on a journey through West Africa and up to 2014, Farmer writes an epilogue reflecting on how the central crisis of Ebola was the prioritization of “containment over care” whereas COVID-19 has become a crisis of containment.  To him, writing this on April 10th, 2020, and to the reader reading it a year later, COVID-19 is seen as partially a disease of healthcare workers’ exposure, and partially a disease of social inequity, but completely a disease whose management, treatment, and eventual control will be defined by the “staff and stuff and spaces and systems” in place and who has access to them.  Even with this pandemic at the forefront of our minds, Farmer reminds us that Ebola should not be off our radar just because a new disease is on it— there continue to be outbreaks of Ebola in the Congo.  Ultimately, Farmer’s words leave you thinking — about this pandemic, about the past, and about the connections between them.  If only to prompt more thought, one of Farmer’s last comments is also his most powerful: “If there’s indeed a lesson to be learned from Ebola, it may be this one:  for everything we do, or say, in pandemic time, let’s keep asking the same question.  Might this help?







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Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

This engaging and informative book describes the latest scientific understanding of the brain, primarily in humans, but also in other animals. The author, a leading brain researcher, writes clearly and often with humor. 

As Barrett explores the deep history of brains, she emphasizes that as much as some humans may prize thinking, the brain’s central task is not thinking but monitoring and guiding—day and night—the many systems of the body. Brains of all creatures manage a “budget” for various factors such as water, salt, glucose, blood gases, etc., to create an on-going fitness against any future threats.

Our brains and bodies are interlinked, interactive, and unified, not the “triune” brain Carl Sagan popularized in 1977. All animal brains have similar neurons, and all mammals share a “single manufacturing plan” for brain development after birth. Babies’ brains develop according to their genes and in response to their environment, especially to their caregivers. Human brains have flexible networks much like the global air-travel system and can vary from person to person and, individually, over time because of brain plasticity.           

Our individual brains influence—even create—our perceptions and relate to brains of other people through family, language, gesture, culture, and more. Barrett concludes, “Social reality is a superpower that emerges from an ensemble of human brains. It gives us the possibility to chart our own destiny and even influence the evolution of our species” (p. 123). 

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Annotated by:
Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

House on Fire:  The Fight to Eradicate Smallpox is a memoir written by William H. Foege, the physician best known for developing the strategy of ring-vaccination in the eradication of smallpox.  Concisely put by New Scientist, his book is “a mixture of memoir, dry public health guide, and riveting tale of an all-consuming mission.”   

Though a brief read, House on Fire is comprehensive on each of these fronts.  Foege walks us through his life, starting first with his upbringing in Washington state and ending with his role in India as part of the smallpox eradication team there.  Notably, the book’s narrative ends before Foege’s tenure as CDC Director in the late 1970s and early 1980s, focusing explicitly on his involvement in combating smallpox.  Using his career in public health as a framework, he details how he became involved in global health and how each deployment around the world, whether for the CDC, WHO, or Peace Corps, added to his understanding of contagious disease and of how to better approach smallpox containment.  Ever the epidemiologist, Foege does not shy away from including graphs and charts to emphasize his points, especially as they relate to public health data collection.  He takes the reader behind the scenes of conferences, regular meetings, and everyday discussions to show the collaboration necessary for global health work, the planning needed, and the good-natured humor and guile it often requires.  At times, his interactions seem like a who’s who of American public health:  throughout his career, he works with D.A. Henderson, Alexander Langmuir, David Sencer (who also writes the book’s foreword), and Don Francis.  

Outside of his own history, Foege acknowledges that in order to understand smallpox and to understand the mission of eradication it is necessary to understand the disease’s complex history.  He begins the book with the history of smallpox and details the development of the vaccine from its crude precursor, variolation, to Edward Jenner’s early version derived from cowpox.  As he progresses through his story, he notes important historical moments in the battle against smallpox:  the development of the jet injector and bifurcated needle as ways to better administer the vaccine, the elimination of the virus first from countries and then whole continents, and, most poignantly, the final cases of smallpox ever recorded.  

Though the book necessitates some level of public health knowledge, or at least a comfort with viral disease and baseline public health interventions, it consolidates its role as a basic public health guide at the appendix.  In the last pages, Foege reflects on what to do if there were ever a bioterror attack with smallpox, complete with a diagram on how to administer the smallpox vaccine.  

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The City We Became

Jemisin, N.K.

Last Updated: Dec-07-2020
Annotated by:
McClelland, Spencer

Primary Category: Literature / Fiction

Genre: Novel

Summary:

This is the first in an intended trilogy of speculative fiction (read: what we used to struggle to label as sci-fi or fantasy). by author N.K. Jemisin.  It tells the story of a world where cities can come alive, not in the corporeal sense, and not in this universe, but in a way that intersects nonetheless with our reality.  The trouble is, not all cities distinguish themselves enough to be born, and those that do often are interrupted in the process and suffer a stillbirth.  We are plopped down in New York City at the moment of its intended birth, in a struggle between the city, its six human avatars (one for each borough, and one for the city as a whole) and the otherworldly force that is trying to destroy it.  

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The Beauty in Breaking

Harper, Michele

Last Updated: Sep-18-2020
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Beauty in Breaking is the memoir of an African American physician who, in her own words, has “been broken many times” (p. xiii).  

Despite maintaining a veneer of affluence, the author, her mother and siblings live in constant fear of being battered by her father. Following one particularly vicious attack, she accompanies her injured brother to the local emergency room. That day she serendipitously discovers her calling: “As my brother and I left the ER, I marveled at the place, one of bright lights and dark hallways, a place so quiet and yet so throbbing with life. I marveled at how a little girl could be carried in cut and crying and then skip out laughing” (p. 18).  

Much later, the author (Michele Harper) undergoes a shattering breakup and divorce. She endures disappointments at work, some of which, regrettably, can only be explained by the color of her skin.    

As she picks herself up time and time again, Harper discovers her inner resilience: “The previously broken object is considered more beautiful for its imperfections” (p. xiii). She learns from the experience of her own suffering to develop compassion in her clinical work. The bulk of the Beauty in Breaking is devoted to case studies of the author’s clinical encounters with patients in the emergency room.

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The Bridge in the Jungle

Traven, B.

Last Updated: May-15-2020
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The Bridge in the Jungle is a novel about the tragic death of Carlos, an 8 or 9 year old (no age is given) hyperactive Mexican boy, and the aftermath of his mother's overwhelming grief for him, sometime in the early 20th Century in a very poor village deep in the jungle. (The lack of specific details are intentional, as I shall discuss below.) The narrator is an American man staying in the village while looking for alligator skins and bird feathers to sell in the U.S.. He observes the little boy's brother, who works in the oil industry in Texas and has just returned for the weekend, give his little brother brand new shoes. Carlos is overjoyed to wear them since all the villagers but the pump master's wife wear threadbare rags for clothes. This is the little boy's first pair of shoes, much less shiny new American ones. While sitting outside in the village with his host, both waiting for an outdoor party, the narrator hears an ominous splash that is Carlos falling to his death off the treacherous bridge, a bridge that has no railings. The remainder of the novel depicts the grief of the young mother - a grief that reaches the suffocating proportions of Greek tragedy - and her villagers' genuine support.

Described in minute detail by the narrator, the villagers - who have turned over every stone in the woods, dived many times in the river, and ridden to nearby villages to find Carlos - turn to an old man who requests a perfectly flat piece of wood and a stout candle. He then meticulously fastens the candle to the wood and carefully launches this raft of mystical exploration and recovery on the river. Every villager watches this ceremony with rapt attention. It is truly a riveting passage, for the raft travels under its own power from the river bank against the current, meandering slowly towards the bridge where it finally stops, despite the current, under the bridge, the only place no diver has yet looked:
"The board in the meanwhile has wandered farther under the bridge, but always in a right angle to the fifth post. Now it is under the middle of the bridge. From here it sails towards the fourth post, though only for about a foot. And here it stops as if it were nailed to the water. It does not mind the current nor the light breeze that sweeps softly across the surface of the river. The manner in which the board has halted is entirely different from that in which it stopped before. Now and then it trembles slightly, as if something were breathing against it from below. But it no longer whirls. ... The board begins softly to dance as if impatient. It seems that it wants to be relieved of its torture. It wriggles, swings about itself, though it does not move as much as two inches. One might think it is trying to go down to the bottom."
(page 110-1)
A villager dives and retrieves Carlos and hands his body to his mother:
"With an indescribable nobility and solemnity, and in his eyes that pitiful sad look which only animals and primitive people possess, he steps slowly forward. And Perez, the man whose daily task it is to fell the hard trees of the jungle and convert them into charcoal, lays that little water-soaked body in the outstretched arms of the mother with a tenderness that makes one think of glass so thin and fragile that a single soft breath could break it."
(page 113)
The villagers, in a procession that is tragicomic, take Carlos' body to the graveyard where a well respected teacher, now drunk from all the mescal others have offered him, gives an eulogy that suggests Christ's Sermon on the Mount. However, with inverted symbolism, this sermon is for, not by, Jesus and is delivered by a drunken priest-figure who is so drunk he falls into the open grave. To Traven's credit he introduces this farcical moment to emphasize how none of the villagers, much less the author, and, consequently, the reader, laughs at a decent man trying his best to honor Carlos. It is truly a most moving finale to a most moving book.



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Elizabeth Siegel Watkins reports on the use of estrogen alone and in combination with progestin for women during menopause and after menopause from the 1890s until the book was published in 2007. She concentrates on the sixty years between 1942 and 2002. The event Watkins uses to mark 1942 as an important moment is the U.S. Food and Drug Administration (FDA) approval for the estrogen product Premarin as hormone replacement therapy (HRT) in women with menopause symptoms. The event she uses to mark 2002 is the release Women’s Health Initiative (WHI) findings that showed estrogen is not the “elixir of life” that many thought it was then.  

Watkins builds her story off the trajectory of estrogen use during this sixty-year period, which spanned two peaks followed by two crashes. The estrogens for HRT first crested in the early 1970s before its use dropped dramatically in 1975 on uterine cancer fears. Estrogen use began to rise in the early 1980s on regained confidence from combined use with progestin to reduce uterine cancer risk and from hopes that bone loss could be prevented and even reversed. This resurrection continued through the 1990s as estrogen use during and after menopause became “associated with reduced risk of colon cancer, prevention of tooth loss, lower incidence of osteoarthritis, increase in bone mass, reduced risk of Alzheimer’s disease, and lower rates of death from all causes” (p. 241). 
 

Based on surveys of prescribers and prescription data during this time, Watkins concludes that “physicians who saw menopausal women as patients were…enthusiastic prescribers of HRT” (p. 244). They remained enthusiastic, making Premarin the most prescribed pharmaceutical product through much of the 1990s and until 2002 when the WHI trial was stopped three years early because it showed that HRT failed to produce the expected benefits, and even worse.
Women who took the estrogen–progestin pills, as compared with those in the control group who took placebo pills, increased their risk of breast cancer by 26 percent (relative risk of 1.26), coronary heart disease by 29 percent (1.29), stroke by 41 percent (1.41), and pulmonary embolism (blood clot) by 213 percent (2.13). (p. 271)
The investigators advised clinicians based on these results, that HRT “should not be initiated or continued for the primary prevention of coronary heart disease” (p. 271). Watkins quotes an editorial from the Journal of the American Medical Association that went further in saying that the trial “provides an important health answer for generations of health postmenopausal women to come—do not use estrogen / progestin to prevent chronic disease” (p. 273). HRT prescriptions plummeted.  

These clinical inputs into the trajectory of estrogen are just the bare bones of estrogen history. Watkins fills in the story: 
The story of estrogen is woven from several strands: blind faith in the ability of science and technology to solve a broad range of health and social problems, social and cultural stigmatization of aging, shifting meanings and interpretations of femininity and female identity, and the pitfalls of medical hubris in the twentieth century. (p. 1)
Watkins weaves these strands into the story of estrogen, which she tells in a chronological fashion, often as the subjects of individual chapters. Some include: the implications of rising feminism; pharmaceutical company promotional activities; the roles of patient advocacy organizations; FDA requirements for patient information about prescription drugs; generational differences in views of menopause; evolving research methods and evidence standards; and cultural shifts and mainstream media influences. 

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State of Wonder

Patchett, Ann

Last Updated: Nov-21-2019
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Dr. Marina Singh, a pharmacologist and former obstetrician, is sent to a research site in the Amazonian jungle somewhere in Brazil that is operated by the company she works for, Vogel Pharmaceutical. The company chief executive officer, Mr. Fox, dispatches her there to check on the progress of the research and to get details on the reported death of her colleague, Dr. Anders Eckman, while he was there on a previous research trip. Eckman’s wife, uncertain that he was dead, asks Marina to find out what had happened to her husband. The plot centers on Marina’s dual missions at the Amazon jungle site. 

Marina’s trip reunites her with the legendary and imperious Dr. Annick Swenson, who is an obstetrician and the lead researcher at the site. Thirteen years before, Swenson was Marina’s supervisor during her obstetrics residency. A mistake Marina makes while she’s delivering a baby after disregarding Swenson’s advice drove her out of obstetrics and into pharmacology, and then eventually to Vogel. The company is supporting Swenson’s research hoping it will produce a blockbuster product. Mr. Fox is growing impatient having received only brief and vague communications from Swenson over the past five years. 
 

Decades earlier Swenson had followed her mentor to the jungle location where the Lakashi tribe lives, and after frequent visits over this time, resided there permanently to work on the research Vogel was funding. The research was based on observations Swenson and her mentor made about Lakashi women; they never go through menopause and they are fertile into their old age. Swenson’s project is to find out why, and provide the information to Vogel in order to develop a product that could give women the option to avoid menopause and to have babies much later in life. 

Swenson finds it is the bark of the (fictional) Martin trees when combined with excretions of the (fictional) Purple Martinet moth deposited in the bark Lakashi women ingest that extends their fertility after menopause. Trying it herself, Swenson becomes pregnant at age seventy–three. She also finds that the same bark protects the Lakashi women against malaria. Swenson eventually concludes that her research should not proceed to product development for fertility, but instead for prevention of malaria. Certain that no American pharmaceutical company would “foot the bill for Third World do-gooding,” Swenson decides to reallocate the fertility research funding to her malaria vaccine work without permission from the company (p. 289). A cat and mouse game ensues around the research funding, Swenson’s pregnancy ends, and the mystery of what happened to Anders Eckman is solved. Marina Singh’s life is changed, probably forever.

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Responding to a shortage of doctors in rural areas in 2013, Dr. Virji, a Muslim, moved from the urban East coast to a small town in Minnesota.  Welcomed at first, he and his family began, after Trump's election in 2016, to experience withdrawal, suspicion, and outright racism in his own and neighboring towns, despite having established solid, trusting relationships with patients.  His children were being ostracized in school.  Discouraged, he took steps to accept a job in Dubai, but changed his mind after a local pastor invited him to speak in her church to correct common misconceptions about Muslims and to engage his neighbors in deeper dialogue about their differences and commonalities.  The lecture was so successful, he took it further into other towns and parts of the country.  He has stayed in Minnesota and witnessed change because of this invitation and his candid, open-hearted response. 

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