Archive for the ‘Medicine’ Category

Its been more than 40 years

May 25th, 2014 No comments

Reflections happen every once in a while. Sometimes deliberately and other times triggered off by a simple event, object or gesture. So it was for me this morning while sitting in the Star Alliance Lounge at Heathrow T1. I have been here before.  In fact, I distinctly remember being here for hours while waiting for a flight. Plugged into power and catching up for hours. I can’t find a post about it (searched Heathrow, Lufthansa and Riesling for the lovely wine that captured my attention six hours into the wait – after 1700 as well) but I can even remember where I was sitting.

However, it wasn’t any of that which caught my attention. Rather it was hunting down the women’s restroom.  There are two restrooms clearly marked in the Lounge; one men’s and one women’s. But I can remember when this simply wasn’t the case. This is allegedly a business class lounge which used to mean business travelers since no one who didn’t have a company paying the high tariff for the seat would travel in business. Especially not if you are from Minnesota – it wouldn’t seem like a sensible use of funds. Except for one time during my college/professional school/residency years on the rare times I flew – it was cattle car. Once, for whatever reason having to do with exhaustion, a kind check-in agent and a strike of fate, I wound up with a free upgrade. It also might have had to do with being well dressed and traveling alone. In any case, I was directed toward the lounge. There were no women’s restrooms; business travelers are men, right?

Seemed to be just the way of the world in the early 1970s. I can remember being on a surgical rotation at one of the U of MN affiliated hospitals. The surgeon I was with sent me off to change so I could scrub in on his cases that day. There were three changing rooms: Doctors, Nurses, Orderlies. Female med students, who it turned out were a rarity at this hospital for excellent reasons, don’t fall into any of those categories. When I failed to show up in the expected five minutes, one of the orderlies came to find me. Why wasn’t I changed? Where? The nurses had already told me that their changing room was for nurses (note the lack of male nurses in that time frame. And the fact that nurses are assumed to be female. It is 2014, and most of the time we still caveat nurse with “male” for the 20-35% of the professional who aren’t female. The assumption is not quite so obvious that doctors are male only due to the overwhelming numbers of young women entering med school in the last 10 years).  Said orderly thought the whole thing was funny, explained that the place had a reputation which is why they almost never had women rotating through there on surgical clerkships and found me “the closet.”

That is right – a closet. Not the nurses changing room with lockers, not the orderlies with one of the guys standing guard at the door. And certainly not the doctor’s changing room where the male med students were more than welcome to change. Today? I would have just let the chips fall where they may and used the doctor’s lounge but I was not at all willing to rock the boat back then.

When asked why I was late I explained about the changing rooms. The surgeon was astonished. Obviously this was not something that had occurred to him as an issue. I suggested that if he could not get this resolved that I could change preceptorships so as to go to other hospitals. How would I do that? Talk to Mamma Pearl (Assistant Dean of Students) about this hospital not being “ready” to have female med students……

Fast forward to 2014. There are men’s and women’s changing rooms, restrooms, locker rooms (unless of course you are a Dutch military deployed camp. Then it is uni-sex with locks on all doors, stalls and showers. Everyone is an adult, everyone gets privacy).

In most shopping centers there are family restrooms. There are set-ups to change diapers which didn’t exist when mine were young. Some of the airport lounges even have a “child room” which I think is de facto recognition that whether or not you want small children in the executive lounges adults are going to keep brining them. The goal then is to keep them separate enough from the rest of the travelers that no one gets hurt…

Drifting around from topic to topic I guess. But I have managed to get caught up on all of my audiobook downloads, two novels I hadn’t gotten around to finishing and some nice munchies courtesy of Star Alliance.  Their timetable download turns out to be a PC app but booking a round the world flight is easy and relatively cheap compared to a couple of round trip FRA-SFO round trips.

Who knew?

Wonder if finding clean bathrooms and changing rooms is going to continue to improve?


Categories: Medicine, Travel Tags:


August 12th, 2013 Comments off

To many, Marseilles is that French city which is the gateway to Provence; just a stop on the way to more interesting places. Of course there is a somewhat famous cathedral, winding streets, little outdoor cafes and the obligate castle.

To me it is that place in 2011 where we disembarked from the MSC Lirica in a commercial area a complicated and deadlocked highway system from downtown. If it hadn’t been for the Eldest and her hauling out her French, smiling at a taxi driver we might not have made our departure. Note that Maus and College Guy were along, both of whom speak a more than adequate French but didn’t want to play. Mine is fine for reading, but I don’t speak taxi.

It is also home to several colleagues at the Institute of Tropical Medicine, the National Arbovirus Reference Center and the Army Health Service. Marseilles, as I am now reminding you – is a port. France like many of the other European powers was want go to sea, Plundering Africa was fairly high on their list which explains all those French speaking locations that don’t belong to the Belgium King.

So it was interesting to explain to fellow travellers that not only is it the second largest city in France but it remains very immersed in maritime culture.

We docked in the commercial harbor; the old being strictly pleasure craft and the small tour boats. Learning from past experiences, I took the ships water shuttle.

Along both sides of the inner harbor is an interesting mix of eateries, tourist shops, bars, cafes, marine supply & chandlery, sea going agencies, and more than one antique store dedicated to ships artefacts.

Oh yes, museums.

What turned out to be the hardest again was finding stamps, especially since the country in which I live is aka Germany ( soft g) as English has crept in even in this bastion of national superiority and purity.

Pictures soon – they seem to make the phone server nuts.

Categories: Medicine, military, Travel Tags:

Enough sense to

May 21st, 2013 2 comments

You would think after all the time I have lived in Europe I would have better sense. I even told you that I had managed to uncover, while cleaning up the bedroom and packing, the two lovely umbrellas purchased in Naples.

So explain to me why, in spite of the fact that it rained yesterday, I didn’t think to take one along today? Perhaps it was because it rained yesterday while I was inside the MECC and so missed the entire experience of rain in Maastricht. Seeing is believing. Since yesterday I neither saw nor experienced the rain I didn’t think of it this morning. All of this is the long explanation for why I wound up dashing the 1.5 km back to the hotel from the Convention Center.

The lectures today were interesting – topics ranging from malaria through immunization programs to pulmonary embolus risk after flights – all of which took second place in my concern compared to getting my new red leather jacket (from Istanbul) wet.

So may I just leave you with

An. atroporavus is perfectly happy indoors

An. atroporavus is perfectly happy indoors

Categories: Medicine, Travel Tags:

History of

May 20th, 2013 Comments off

One of the things that has delighted me over the years is the history of medicine lectures that start each morning at ISTM conferences. Usually presented by a fairly well know but local academic these have been relevant, entertaining and educational.

This conference is no different. Today’s topic, presented by Professor Hillen from the Netherlands is From House of God to Academic Hospital – a History of Medicine in Maastricht.

the original hospice - for taking care of the poor

the original hospice – for taking care of the poor

I think most of us forget that “organized” delivery of care was since earliest times in western Europe, the right, responsibility and mission of religion and religious orders. Not being any different than other cities – Maastricht, with the original city being founded in Roman times saw early the establishment of hospices to care for the poor under the religious umbrella.

From there it is not much of either a physical or intellectual jump to see how care evolved through the centuries with areas being set outside the city walls both for leprosy and later for plague.

special clothing, not just scare, but to keep out the smells of the plague

special clothing, not just scare, but to keep out the smells of the plague

From these humble beginnings developed one of the first guilds of barber surgeons, later medical schools in the region till today as a academic center. I have more pictures, but these were the ones that delighted me the most.

Tomorrow we will hear from Dr Marc Coosemans, a Belgian entomologist about the history of malaria in the region and we will finish on Wednesday morning with the History of the Dutch East India Company.

Much of the rest of today was taken up with more discussions on malaria, vaccines and fast and furious section on trauma and injury in travel.

Categories: Medicine Tags:

Pre-Conference Courses

May 19th, 2013 3 comments

When I registered for this conference it seemed to me I had two choices: travel on Saturday and use Sunday for look around and education or travel on Sunday and be rushed. Since this turned out to be the two week holiday for most of southern Germany, being smart about travel seemed wisest.


really shaggy sheep grazing

really shaggy sheep grazing

So here I am, registered, educated and fed. Not a bad deal.

The session I attended turned out to be extremely interesting. Titled Responsible Tourism the three speakers covered a fairly wide range of topics. The first discussed the economic impact of tourism for good and bad on the developing world ( with a strong aside about who actually makes money and how/why/what travel health professionals can accomplish. The idea of the human zoo comes to mind…. Visit a local tribe and see….

The second speaker, more than a little disorganised covered the two way street of disease impact on both travellers and local populations ( hint – the new world only furnished syphilis. The old world provided measles, mumps, chicken pox, smallpox, …..)

The final speaker was the most interesting and organised. She discussed the whole emerging money making field of volunteer tourism aka voluntourism . Specifically she discussed Gap years, short term feel good projects and the more than real negative impact that many of these program’s have. As a group we had a rousing discussion of the different segments of this population.

Even more fun was the opening ceremony complete with The Night Watch


The living Night Watch

The living Night Watch



And an excellent speaker who discussed what was really portrayed in many of the Old Dut h Master’s Paintings.

The lighter side of old Dutch Masters

The lighter side of old Dutch Masters

I forgot to take pictures of the exquisite food preparation. You will just have to use your imagination.

Categories: Medicine, Travel Tags:

Getting to Maastricht

May 18th, 2013 Comments off

It was just short of 2000 last night when I had a blinding flash of the obvious. I didn’t have to pack liquids in my suitcase. I was taking the train. Yes, I know that it should have been in my mind early on but you have to remember that I normally take the train to the airport so train in my mind is normally an intermediate form of transportation, not the definitive one. In this case it meant that I could toss my toothpaste, sunblock and hand lotion in my backpack without fear of loss at the first security point. What security point? I am taking the train. Or rather – trains.

Today I am headed to Maastricht in the Netherlands for the ISTM Conference on Travel Medicine (19-23 May).

Just in case you cared – by road it is 343 km which means Google maps estimates driving time around 3:10 ( I will spare you the 23 steps of the driving distance). By public transportation (now also there complete with numbers of changes) the estimate is around 5:19 from Google.

Heidelberg Hbf
Train IC
Train IC 2216 towards Stralsund Hbf
8:25am – 11:15am (2 hours 50 mins, 5 stops)
Köln Hbf
High speed train ICE
High speed train ICE 16 towards Bruxelles-Midi
11:43am – 12:16pm (33 mins, 1 stop)
Aachen Hbf
Train RB
Train RB 11912 towards Heerlen
12:32pm – 12:59pm (27 mins, 6 stops)
Walk to Landgraaf
About 1 min (7 mins to make transfer)
Landgraaf (Platform 1)
Train Stoptrein
Train towards Maastricht Randwyck
1:06pm – 1:44pm (38 mins, 10 stops)


The Netherlands

This is what the Bahn had to say:

Heidelberg Hbf Sa, 18.05.13 ab 08:25 5 IC 2216 Intercity
Köln Hbf Sa, 18.05.13 an 11:15 5
Umsteigezeit anpassen
Köln Hbf Sa, 18.05.13 ab 11:43 6 ICE 16 Intercity-Express
Aachen Hbf Sa, 18.05.13 an 12:16 9
Umsteigezeit anpassen
Aachen Hbf Sa, 18.05.13 ab 12:32 1 RB 11912
RB 11962
Fahrradmitnahme begrenzt möglich
Heerlen Sa, 18.05.13 an 13:06
Umsteigezeit anpassen
Heerlen Sa, 18.05.13 ab 13:16 4 32044 Regionalzug
Fahrradmitnahme begrenzt möglich

In actuality, it is going to take me slightly more than 6 hours because  I have to take an alternate method from Koln on since all the seats are sold out on ICE 16 and I need to take a regional instead.

obviously, I am over the border into Holland

obviously, I am over the border into Holland

It doesn’t bother me – I save money and enjoy the the Bummelbahns. Besides, it leaves me more time to knit.

Speaking of same – I finished the simple cotton scarf to go with one of the hats knit in March.

Allegedly the hotel has WiFi.

1600 Update

Yes the hotel has wifi – no charge! I am ensconced in a most comfortable room after having trucked across the city (ok, only 1,4 km) to get here. I am about to go out and wander around including finding some supper, but first wanted to finish up this note.  Now I have to just decide what is next on the project list for those between lecture times….

Categories: Knitting, Medicine, Travel Tags:


May 15th, 2013 Comments off

The middle day of these conferences always seems never ending.  To top it off, the weather is cold and there is supposed to be a BBQ tonight. I am sure that you can just imagine how excited I am. Not.

In fact, it seems pretty much a given that I am skipping most of the social events. Since I am no longer in the situation that attending these kind of things constitutes mandatory fun – I see no reason why I should pay to attend something where there will be little to nothing I am willing to eat. Oh, yes, and beer – not particularly interested in that either.  Originally I was going to go and meet friends for dinner, but that has been postponed which leaves me an evening to myself.

I can’t say that I am disappointed after having spent the day first listening to a succession of gloom and doom scenarios for which various assorted detection, diagnosis, triage and treatment  ideas and protocols were put forward. I will admit to a certain bit of cynicism after working in the field for so many decades. Plus, I find a basic fallacy in everything that is proposed.

Please tell me how many of the terrorist attacks (Afghanistan, Boston, Twin Towers, you name it) have been single point events and how many have involved more than one nasty item.

Exactly. Unlike the bio-defense people who know that the most likely thing to happen is going to be more than point source, not instantly detected and a rapidly spreading problem – these lovely people are still happily in the “one oops” one time pinpoint release/explosion/meltdown/whatever mindset. I suspect that there is most likely much more intelligent planning going on somewhere behind classified doors to which, thank goodness, I am no longer privy.

So – with an evening to knit (grin)

the hat needed a matching scarf

the hat needed a matching scarf

Categories: Knitting, Medicine, military Tags:

One Health

February 17th, 2013 3 comments

Even though it is a major initiative well past first blush of implementation, I would be willing to bet that almost none of you have heard of  One Health.  The idea – establishing close links between human and veterinary medicine make absolute sense. People affect the environment (wildlife as well as climate in their roles as anything from pet owners to farmers, developers, explorers and tourists) while animal health is key to both the food supply as well as infectious disease.

I have borrowed the following map to give you an idea of some of the newly emerging problems. Some diseases are shared between animals and peoples with one or the other serving as host. Others are a simple, inadvertent spill over into the other population.


It is a concept whose time is probably long over due. Established in ~ 2007-2008 it has spread well beyond the founding at University of Iowa (yes Virginia, there is actually life and good works in the middle of the corn belt) and has seen buy in at governmental, NGO, grass roots and private foundations.  The CDC has jumped on the band wagon, using the concept to further progress in Med-Vet interface as well as flu surveillance while the EU has to a large extent gone in the direction of biosecurity.

In any case, the idea is that professionals from a wide spectrum of backgrounds work together on common interests and grounds with the idea that the interface should provide some synergy and accelerate progress on some of the more complicated challenges.

If the whole thing leaves you thinking “blinding flash of the obvious” please remember that we make progress to a large extent through research. Academicians make their name by becoming expert in a very specialized field. That tend toward highly specialized interest starts before graduate school, is further guided through PhD research and encouraged by the whole publication process. Multi-disciplinary is not a familiar concept to most.

In practical application it means that slaughtering off large numbers of poultry infected with H5N1 (HPAI) is not really done for the benefit of the farmer (who loses the flock prior to being able to slaughter and sell the birds) but it prevents spread to others and  humans. At the same time, the impact of the loss of protein to the population will have implications for human health well beyond the small risk of infection spread.

It means that surveillance of West Nile Virus needs to include entomology (the mosquitos), local bird flocks (wild life management), horses (vet services) and human case reporting (encephalitis). Any single one of these will neither give the whole picture nor the extent of the disease impact from either infectious load or economic cost.

See! I do listen as well as knit….

Categories: Medicine Tags: