ProseKnitic – of Words und Wolle

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

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

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

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.

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

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

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

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

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

Heidelberg Hbf

IC Train IC 2216 towards Stralsund Hbf

8:25am - 11:15am (2 hours 50 mins, 5 stops)

Köln Hbf

ICE High speed train ICE 16 towards Bruxelles-Midi

11:43am - 12:16pm (33 mins, 1 stop)

Aachen Hbf

RB Train RB 11912 towards Heerlen

12:32pm - 12:59pm (27 mins, 6 stops)

Landgraaf

Walk to Landgraaf

About 1 min (7 mins to make transfer)

Landgraaf (Platform 1)

Stoptrein Train towards Maastricht Randwyck

1:06pm - 1:44pm (38 mins, 10 stops)

Maastricht

Maastricht The Netherlands

This is what the Bahn had to say:

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

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….

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

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….