Summary:

Ian Young spent the summer of 1970 as a medical student working at a hospital in the province of Kabylia in Algeria. He was assigned to the Maternity department, where he worked primarily with two Bulgarian doctors. Most foreign medical personnel in Algeria at the time came from Eastern bloc countries, as "Islamic Socialism" was the official political system in the newly independent (1962) North African country. According to Young, obstetrical care for the mostly Berber women of the area was brutal, disorganized, antiquated, and dangerous.

Dr. Vasilev, the head of the department, is a passive and indecisive man, who spends most of his day reading the newspaper. Once roused from his lethargy, which doesn't happen very often, he demonstrates competence and concern for his patients. His colleague, Dr. Kostov, is an aggressively brutal man who introduces himself to pregnant patients by shoving his fist into their vaginas.

Both doctors excuse their behavior by saying, "We just can't do it here they way we do it in Bulgaria." For the most part, they do not use sterile technique, and although anesthetics are available, neither Kostov nor Vasilev typically use them. The Algerian nursing staff provides at least a modicum of organization and care in this dreadful environment.

At first Young approaches the situation with disbelief and anger. He then attempts to improve the quality of care, first by introducing a flow sheet for obstetrical care, and later by submitting a report on the poor conditions to the hospital director.

Mild-mannered Dr. Vasilev supports him, but no one uses the new flow sheets, and the Director considers the report a personal (and political) affront. Meanwhile, Ian Young presents the reader with a seemingly endless series of fascinating patient cases and interesting stories about hospital personnel, as well as about his excursions to various parts of Kabylia.

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This is a collection of poems that ranges widely through both the geographical and spiritual worlds. Susan Rich began her career as a human rights activist and Peace Corps volunteer in Niger. She has also worked in South Africa, Bosnia, Gaza, and as a program coordinator for Amnesty, International. Her poems are lyrics of empathy, discontent, and hope, unified by her "Cartographer's Tongue."

From an international medical and health perspective, some of the best of these poems are "Haiti," "The Woman with a Hole in the Middle of Her Face," "In the Language of Maps," "The Toughest Job," "The Beggars," "Sarajevo," "La Verbena Cemetery," "Whatever Happened to the Bodies," and "The Scent of Gasoline."

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In this collection, Judith Arcana brings together her long-standing feminist activism, especially for reproductive health and abortion rights, and her gifts as a poet. Although Arcana's activism dates back to the early seventies, most of the poems in the book were written between 1998 and 2004. They draw from "the lives of women and girls I know or have simply encountered" (xi).

The collection is divided into four sections: "Separating argument from fact," "Information rarely offered," "Don't tell me you didn't know this," and "Here, in the heart of the country." Spoken in first, second, or third person, these poems evoke the myriad individual situations in which women of childbearing age become pregnant, and the trajectories their lives may take as a result.

The title of the collection derives from one of its poems ("What if your mother") and the related, immediately preceding poem, "My father tells me something, 1973" (6-7). Arguing back to those who confront her with, "What if your mother had an abortion? . . . they mean me," the speaker/poet answers, "then I say she did . . . . "What if, what if. / What's the point of asking this phony question?"

From the preceding poem, the reader has learned, along with the speaker listening to her father in 1973, that the poet's mother had an abortion in the Depression era, early in marriage. With this juxtaposition of poems we are introduced early in the book to the complexity of the issues surrounding pregnancy, parenthood, and abortion and to the timeline of a continuing national and personal debate. This complexity is the subject of the collection.

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This is the journal that Oliver Sacks kept during a "fern foray" in Oaxaca, Mexico. Sacks is a fern lover, even though he admits to an even greater passion for club mosses and horsetails. In 1993 John Mickel of the New York Botanical Gardens introduced Sacks to the New York chapter of the American Fern Society (AFS). Consisting mostly of amateur naturalists, AFS meetings were both congenial and passionate, unlike the cold competitiveness of professional meetings in neurology and neuroscience. The New York AFS folks arrange periodic trips to hot spots in the fern world to indulge their passion. In 1999 Oliver Sacks accompanied them on a trip to Oaxaca, which is a veritable paradise of ferns.

Though the trip is only 10 days long, Sacks packs a month’s worth of sights and sounds and meditations into his journal. We learn a lot about the hundreds of species of ferns that range from southern Mexico’s rain forests to the nooks and crannies of its arid central plateau. But the author’s curiosity roams freely and absorbs his new environment. We learn about the origin of chocolate, the history of tobacco, and the archeology of Monte Alban. We learn about the process of distilling mescal in one’s backyard. Most of all, we are introduced to nearly a dozen vivid characters, united in their enthusiasm for fieldwork and ferns.

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In a rural town in Louisiana in the late 1940's a poorly educated young black man, Jefferson, is in the wrong place at the wrong time: he is in a liquor store with two friends when they murder the white storekeeper. Jefferson is unfairly convicted of murder and sentenced to the electric chair by a white judge and jury.

His defense lawyer, in trying to stave off the death sentence, labels him a "hog"--and it is this label that Jefferson's godmother wants disproved. She enlists the help of the narrator of the novel, Grant Wiggins, the plantation schoolteacher.

Wiggins agrees to talk with Jefferson only out of a sense of duty--he is an unhappy, angry man who dreamt of escape from his impoverished youth yet returned to his hometown after a university education to teach in the same one-room parish school he attended. Despite humiliation at the hands of the white sheriff, Jefferson's lack of cooperation, and his own sense of futility and uncertain faith, Wiggins forges a bond with Jefferson that leads to wisdom and courage.

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This fine collection of writings by women involved in health care stems largely from a writing group cosponsored by the Nebraska Humanities Council and the Creighton University Center for Health Policy and Ethics. However, other writings also appear in this volume: in all there are 40 pieces by 16 authors. Writing genres include essay, short story, and poetry. The works are divided into three sections: Power and Powerlessness, Vulnerability and Voice, Connection and Disconnection. As noted in the introduction, these are "major themes in feminist perspectives in ethics" and the works are offered as reflections on modern ethical dilemmas in health care.

Some of the most powerful pieces are stories about being the newcomer--the student or junior trainee. For instance, "Washing Cora's Hair" by co-editor Amy Haddad is a poignant look at the struggle of two young nursing students to wash the long braids of a bed-bound elderly woman in her cramped home, and "The Story of David" by Ruth Purtilo, written as a memoir looking back to when she was a newly graduated physical therapist, concerns her interactions with a young, angry, depressed quadriplegic patient and with her superiors.

Another memorable piece is "The Things You Do" by Kelly Jennings Olsen. This story about being a new volunteer emergency medical technician masterfully controls the tensions of emergency medical care, the anguish of the father whose little girl slipped under his tractor, and the nuances of living in a small town. Several poems also deal with issues of the newcomer and witness to suffering (e.g., "As Ordered" by Ruth Ann Vogel--a poem about shaving the head of a neurosurgical patient on the pediatric ward)

As noted by the multiple keywords listed above, these pieces touch on many topics. Power relations play a key role, both between professionals and between patient and the health care team. For instance, in the polished story, "Procedures" the author Kim Dayton writes from the perspective of a young single mother with a critically ill neonate. This mother is repeatedly prevented from visiting her child because of "important" events like rounds and procedures, and she ironically only gets to hold her baby after the baby dies.

Throughout the collection the patients are described with honesty and vividness. Their suffering can haunt the health care worker ("Maggie Jones" by Veneta Masson) as well as teach ("Back to Square One" by Barbara Jessing). Many of the pieces remind us of our good fortune and the privilege we have in our lives and in providing health care services (e.g., "Spring Semester" by Amy Haddad). Ultimately in this volume our common humanity is emphasized--the connections between people and the remarkable grace that can be exhibited in the face of suffering.

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When shooting a music video in Cuba, director Carlos Macovich chooses a young Havana jintera to dance opposite the model Fabiola Quiroz. Several years later, he returns to find out what happened to the pretty, feisty girl they picked off the street to dance in their video. The documentary explores Yuliet's and Fabiola's relationships with the families, their fathers, and each other.

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This haunting memoir by a South African surgeon who has witnessed tremendous suffering across the globe is best read as his story, and not a war chronicle as the subtitle would suggest, since large chunks of the book are not about war in the dressing station sense of the term. That said, however, the war that rages inside the author continues throughout the book and gives the reader glimpses of wisdom gained during Kaplan's remarkable journey of life amidst death. The book is culled from journals of writing and sketches that he kept throughout his travels.

Kaplan's first crisis occurs when he joins fellow medical students in an anti-apartheid demonstration in Cape Town and, following the lead of a more senior student, Stefan, tends to the wounded and frightened after riot police attacked the demonstrators. Kaplan then gets the call of not only medicine as service, but surgery as service, when, as a neophyte doctor, he saves the life of a youth shot in the liver by the police.

This feat should not be underestimated, though the author writes with humility. Indeed, in recounting later incidents in which patients die, the odds tremendously stacked against the patients surviving anyway (a woman with disseminated intravascular coagulopathy and multiple organ failure, or the Kurdish boy in a refugee camp with a great hemorrhaging, septic wound), the author's self-chastisement is a painful reminder of how the physician suffers with each loss.

After a beautifully written prologue which begins, "I am a surgeon, some of the time" (p. 1), the book proceeds chronologically, each chapter named for the location of the action. Kaplan leaves South Africa to avoid military service and the fate that befell Stefan, who becomes an opioid addict after euthanizing a torture victim in a horrible scene of police brutality and violence. Kaplan's post-graduate training in England and BTA (Been to America) research stint heighten his sense of cynicism about hierarchy in English society and capitalistic forces in American medical research.

Ever the outsider, Kaplan first returns to Africa (treating victims of poverty, deprivation and violence), then sets off to war zones in Kurdistan, Mozambique, Burma (Myanmar), and Eritrea. In between, he works not only as a surgeon, but also a documentary filmmaker and a cruise ship and flight doctor. He avoids the more established medical humanitarian relief efforts, such as Médecins Sans Frontières, and instead prefers to work where no other ex-pat physician will go--enemy territory, front lines, and poorly equipped dressing stations.

Along the way he decides the number of people he has helped as a surgeon, particularly in Kurdistan, has been small compared to the potential to intervene in broader public health measures (he meets a Swiss water treatment engineer) and occupational health exposés to help abused victims (e.g., of mercury poisoning in South Africa and Brazil). The book ends with Kaplan studying to become an expert in occupational medicine, though, incongruously, in the heart of London's financial district where he treats stress-related illness.

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Edgar Drake, a forty-one-year-old English piano tuner, accepts a commission from the 1886 British War Office to tune an Erard grand piano located in a colonial military outpost in Mae Lwin commanded by Surgeon-Major Anthony Carroll. Edgar leaves the squalor, fog and drizzle of London, as well as his middle class life and his wife Katherine, childless for eighteen years, for a journey by boat, train, carriage and horse to the exotic, intoxicating beauty of Burma.

En route, Edgar is surrounded by stories--a tale by the deaf Man With One Story, rumors about the legendary, eccentric Carroll's peace-making with the local Shan via music and cultural exchange, and socio-historical treatises about the Burmese, internecine wars, and British imperialism. The journey becomes a search for the meaning of home and purpose in Edgar's life. It is an adventure far beyond his prior imaginings and dreams.

The clash of cultures, British and Burmese, civilian and military, wealthy and poor, rule-bound and individualistic, is explored throughout the text. For example, a tiger hunt led by several British officials ends in disaster. Edgar meets Burmese culture on both grand and personal scales: street theatre; appealing, poverty-stricken children; the garb and cosmetics of various tribes; and, ultimately, the allure of Khin Myo, an educated Burmese woman who guides him to Mae Lwin and Carroll.

Carroll, a renaissance physician with a Victorian fervor for botanical and medicinal classifications and investigations, asks Edgar to assist him in his clinic. Common infectious diseases are diagnosed and treated by this forward-thinking physician, and he also performs finger amputations on the mangled hand of a boy without benefit of anesthetic. Other maladies are treated with local remedies and prayer. Meanwhile the delirium of malarial fever descends on Edgar.

Edgar does finally meet and treat the ailing, badly out-of-tune Erard piano. Edgar's expertise is required--his aural excellence and perfect pitch, his delicate yet callused hands, and his willingness to be innovative in the repair of a bullet hole. But what Edgar cannot be prepared for--intrigue and deceptions, fascination with the lush beauty of Burma, and his own shifting priorities and secret longings--is ultimately what sets his fate.

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A severe synopsis of Foucault's first major work might show how Foucault charts the journey of the mad from liberty and discourse to confinement and silence and how this is signposted by the exercise of power. He starts in the epoch when madness was an "undifferentiated experience" (ix), a time when the mad roamed the countryside in "an easy wandering existence" (8); Foucault shows the historical and cultural developments that lead to "that other form of madness, by which men, in an act of sovereign reason, confine their neighbors" (ix), challenging the optimism of William Tuke and Phillipe Pinel's "liberation" of the mad and problematizing the genesis of psychiatry, a "monologue of reason about madness" (xi).

Central to this is the notion of confinement as a meaningful exercise. Foucault's history explains how the mad came first to be confined; how they became identified as confined due to moral and economic factors that determined those who ought to be confined; how they became perceived as dangerous through their confinement, partly by way of atavistic identification with the lepers whose place they had come to occupy; how they were "liberated" by Pinel and Tuke, but in their liberation remained confined, both physically in asylums and in the designation of being mad; and how this confinement subsequently became enacted in the figure of the psychiatrist, whose practice is "a certain moral tactic contemporary with the end of the eighteenth century, preserved in the rites of the asylum life, and overlaid by the myths of positivism." Science and medicine, notably, come in at the later stages, as practices "elaborated once this division" between the mad and the sane has been made (ix).

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