Voyage through Germany

The traveller left the reunion of dormitory mates, who had shared a “corridor” at the Egmont Kollegium in Copenhagen nearly 40 years before, a little early. The venue was the house of one of the mates and his wife, near Haderslev, in southern Jutland. A lot had been achieved during Saturday: A superb lunch in the garden, an excursion to Christiansfeld with a guided tour through the small town replete with the Herrnhuter Protestant Fraternal Community, and a picnic in the small forest; then the mildly ritualistic dinner, this time with exquisite game and matching wines. Songs, speeches, chatting, good spirits. The outlandish collection of hunting trophies including several dangerous bears, which had been expertly shot and skilfully stuffed, could not be forgotten.
The host and hunter understood the traveller’s desire to leave early and drove him to the railway station. The conversation was gentle, about pensions, getting on with life, places to live, arrangements to make.
The traveller had a little more than an hour to kill, while waiting for a connecting train in Hamburg. Posters told him that an exhibition by the painter Rothko was on in the city. Having often heard the name of this modern painter, but not really knowing his work, he decided that the exhibition would be the best place to spend the time. After first going in the wrong direction and getting too close to people who looked like drug addicts, homeless East Europeans or both, the traveller found the exhibition and saw Rothko’s paintings. Some paintings with large monochrome rectangles or bands, which were not quite monochrome, because the colour in each rectangle was variegated and often much darker, kind of burnt, towards the edges, made a strong impression. They were good, artistic, strong. Yet, the traveller got mildly irritated by two things: There were too many of these good paintings of rectangles: At some point Mark Rothko had started copying himself, living off a formula that worked? The other irritation was more sinister, as the traveller recognized at once. He did not like the fact that Mark Rothko was Jewish: two many of the people who had made it in New York were Jewish. Could others not get a chance?
Back in the railway station, the traveller just managed to get about one kg of German Sunday newspaper and a magazine to enjoy on the onward journey. He was headed for Basel in Switzerland, where he worked, but had made arrangements for stopping over in Bad Arolsen. While he was deeply immersed in an article in die Welt about the decay of musical culture in Germany or some such subject, another traveller came to his reserved seat, insisting it was his. ‘Sorry, I have a reservation for this seat until Kassel, you can see for yourself, but, we have just left Fulda, the train passed Kassel long ago, oh I see, dammit, you are right. With a weary and haughty look, our traveller got up, found an empty seat, descended at the next station, took a train back to Kassel, explained himself to a member of the Zug team, thus avoided paying, and hence arrived in Bad Arolsen at nearly 11 at night. A taxi took him to the reserved hotel, where, surprisingly he was able to have a lonely dinner in a garden restaurant, sitting close to a very civilized wine drinking party.
The following day, he easily found the International Tracing Service for holocaust victims. The young lady with whom he had an appointment was well dressed in a blue jeans suit and a white linen shirt. At first, she gave the traveller printouts that she had already prepared. They were copies of personal registration cards, which referred to train transports for the two persons, who were travelling in 1942 from Prague to “unknown destination” according to some Czech text on the cards, which were otherwise in German. The sympathetic lady explained that the numeric code on the cards meant that the train was headed for the Lublin-Maidanek camp in eastern Poland. ‘But in my family, we have always assumed that they had been taken to Auschwitz, yes, in fact, the Red Cross Centre also assumed that until some years ago, but newer research has sorted out the destination of all the trains (or maybe most of them) deporting people to concentration or extermination camps. The two persons whose fate so interested the traveller were an elderly couple in 1942, though not very elderly. He, whose first name was Simon Majer, was 61 years old and she, Janka, was 53. The German lady and the traveller agreed that in Maidanek they would both have been selected for getting killed as rapidly as possible. Probably by gas, but shooting could not be excluded.
The journey from Prague to Maidanek probably took something like 20-24 hours. It is much longer than Prague – Oswiecim (Auschwitz). The traveller thought that the travel time could be further investigated, but under all circumstances, it would have been a torture. As the journey took place mainly standing in wagons normally used for livestock and no food or drink was likely to be available, it was possible that one or both of the persons mentioned would have died before arriving in Maidanek. According to a post-card (the last) sent by Simon Majer one month before the deportation in 1942 to his son, who then lived in Denmark, where he later begat the traveller, Janka had been in poor health then. The postcard had been shown to the traveller by his mother around 1960 in Copenhagen.
The traveller tried obtaining information on a number of other people, close relatives of Janka and Simon Majer, while in Bad Arolsen, but despite the patient assistance of the staff of the Tracing Service and its well designed search machines, it was not possible to find anything to match those other persons.
Having said good-bye to the helpful people and the quaint little town, the traveller continued his journey to Kassel and on to Basel with a sense of mission accomplished - although, in reality nothing had been accomplished, but nothing more could be done, he felt.
On arrival in Basle, the traveller scanned the two printouts and sent them to others, who were as interested in the information, as he was. A few weeks later, he discussed with one of them, whether such efforts were worthwhile. ‘We must look to the future, yes, but we must also know the past, I think that we as survivors have an obligation to bear witness to what exactly is the truth and not allow it to be abused by those who deny it or by those who abuse it for political agendas, which are not justified. Yes, but one should not become obsessed, there are so many people suffering now and needing help, yes, that is true, but still’.
Some months later, the traveller wrote the above and decided to acknowledge the great writer, José Saramago, whose style he is humbly imitating. Since it is so easy, he then looked up Saramago on Wikipedia and discovered that the Nobel Prize winner had written in 2002 in the respected Spanish newspaper, El Pais:

“ Intoxicated mentally by the messianic dream of a Greater Israel which will finally achieve the expansionist dreams of the most radical Zionism; contaminated by the monstrous and rooted 'certitude' that in this catastrophic and absurd world there exists a people chosen by God and that, consequently, all the actions of an obsessive, psychological and pathologically exclusivist racism are justified; educated and trained in the idea that any suffering that has been inflicted, or is being inflicted, or will be inflicted on everyone else, especially the Palestinians, will always be inferior to that which they themselves suffered in the Holocaust, the Jews endlessly scratch their own wound to keep it bleeding, to make it incurable, and they show it to the world as if it were a banner. Israel seizes hold of the terrible words of God in Deuteronomy: 'Vengeance is mine, and I will be repaid.' Israel wants all of us to feel guilty, directly or indirectly, for the horrors of the Holocaust; Israel wants us to renounce the most elemental critical judgment and for us to transform ourselves into a docile echo of its will.”

Well, there we are now, guilty and hated, thought the traveller, before we were only hated.

Basel, November 2008

Allan Schapira

PS: Comments are welcome

Ka’ du li’ røget sild vs. champorado? 0n a strange intersection of Danish and Philippine cultures

Danes of my and possibly other generations should remember this song, which was part of the repertoire for group spirit fostering and boredom reduction in summer camps in the 1960s:

Ka’ du li’ røget sild?
Ka’ du li’ røget sild?
Ka’ du li’ røget sild med chokoladesovs?
Det smager vœldig godt - det’ godt
Det smager vœldig godt -det’ godt
Det smager vœldig godt med chokoladesovs

Briefly translated:
Do you like smoked herring?
Do you like smoked herring with chocolate-sauce?
It tastes really good
It tastes really good with chocolate-sauce

The point of this silly poetry was of course the repulsiveness and un-thinkability of the combination.

The limitations of my mother country’s culinary instincts were brought home to me, when visiting the home-land of Rafael, my Filipino partner in February 2007. While getting introduced to cacao and pili-nut trees and so many local products from these two species, I became acquainted with the champorado, a rice-porridge flavoured with unsweetened cocoa powder. In the Bicol Region, coconut milk is of course also an essential ingredient. A good breakfast champorado is served with dried anchovy or smoked fish, tinapá, on top. The provocative contrast between the gentle porridge and the tangy fish is brilliant, almost addictive.

Try it! In addition to the anti-oxidants it probably has excellent day-after properties.

Malaria 2007: Turning back the clock to march forwards with closed eyes

As much as I would like to point to progress in 2007 comparable to last year’s advances, I feel compelled to point out that in international health, a development is taking place that may lead to wastage of resources, disillusionment, and ultimately loss of human life. A number of global leaders have now turned their eyes to elimination and eradication of malaria,[1] and malaria control is once again becoming a dirty word as it was in the 1950s, when malaria experts had convinced themselves and political leaders that the only right choice was to use insecticide spraying to ensure the eradication of malaria from Earth within 5 to 10 years. Candau, Pampana, Soper, Macdonald, Russell and others leading the global eradication initiative in the 1950s knew that they made the world take a risk, and they had calculated that it was worth taking on the basis of models, which were scientifically defensible at that time. By the late 1970s the epidemiological and biological evidence had shown that mankind did not possess the tools that would be required for global malaria eradication. Despite some good technical developments, such tools are still not available, and an analysis of the potential of new tools that could be developed also does not suggest that we are likely to get rid of malaria parasites.

To be positive about all this, I should recognize that the aim for eradication may stimulate more investment in improving health systems, where this is most needed, as much as investment can buy such progress at all, and research for new and better tools to combat malaria. Surely, the powerful people, who have decided to take the international community in this direction, have been led by their good hearts. They are not the kind, who would abide by cardinal de Retz’ maxim, L’ambition dont on n’a pas les moyens est un crime. Leadership manifests itself by deviating from such wisdom. But it also does not distinguish itself by disregarding the combination of past experience and current scientific knowledge.

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[1] http://www.gatesfoundation.org/nr/downloads/globalhealth/

MalariaForumReport.pdf

Allan's duck

This delicious posting had been inadvertently removed during much of 2007. My abject apologies - it shall not happen again

WARNING: THE PROBLEM WITH BLOGS IS THAT THE LATEST POSTING APPEARS ON TOP. YOU ARE NOT SUPPOSED TO ENJOY THIS FANTASTIC RECIPE, BEFORE YOU HAVE CAREFULLY READ THE TWO POSTINGS BELOW! LET YOUR CONSCIENCE DECIDE.

AND MERRY CHRISTMAS BY THE WAY!

Allan’s canard à l’orange (Geneva, 24 December 2005)

Take a fresh 1.5 kg duck, ideally a cannette, with slightly dark meat, but not a wild duck. Clean it.

Make stuffing:

Slice three shallots, fry to golden in olive oil.

Add 15 small green olives without stones.

Add 200 grammes of clams (Italian vongole). Can be from small can.

Add 1 tsp salt, 1 tsp black pepper ½ tsp thyme, ½ tsp rosmary, ½ tsp basilic 2 tsp sage,.

Crumble 5 cream crackers or a sheet ot matzoh into the mixture (as alternative, consider spaetzli, noodles or couscous).

Reduce over low heat. Adjust taste.

Put aside ¼ of this stew for sauce.

To the remainder add segments of 1 orange.

Stuff this into duck, then bind it.

To the ¼ left, add finely sliced zest of ½ orange. Cook gently for ½ hour.

Pass through sieve, keep the liquid for sauce, throw away solid.

Add the liver of the duck after mashing it with a fork (if you don’t have it (the duck’s liver, use 2 tablespoons of foie gras de canard (if your conscience forbids you the use of foie gras, use chicken liver or imagine what it would be like)).

Rub the duck with olive oil with salt and pepper

Heat the oven to 250⁰C, turn on grill. Place the duck on grid, and grill it on top and bottom (only the time needed for it to brown). Lower temperature to 150. Roast for 30 mins with back up, 60 mins with breast up. Add water regularly to the pan under the grid.

Turn off oven, leave duck inside, remove pan, pour drippings into bowl. Skim the fat off and discard. Add the jus to the sauce. Reduce, adjust taste. You may add a little orange liqueur.

Take duck out, shovel stuffing into warm bowl, carve and serve on a warm dish for example with small potatoes and haricots verts à l’ail.

Acknowledgements: Thanks are due to the Thanksgiving Turkey, the Poulet Marengo and Larousse gastronomique.

Andrew Spielman in memoriam

Professor Andrew ('Andy') Spielman, Harvard School of Public Health passed away on 20 December 2006. Together with Dr Jackie Cattani and Professor Michael Reich, Andy was my mentor during my year at Harvard in 1987-8. Very quickly I came to like and respect his intellectual curiosity, his strong principles and his warmth and humour.
His perspective on disease control was that of a biologist , a system thinker, concerned with balancing the need to help people and the need to avoid unnecessary damage to biological systems. It was possible, sometimes even necessary, to disagree with him, but his biological perspective remains essential. As much as we can be grateful for the fact that he was able to remain highly active up to 2006, when he was 76, his death is a terrible loss to the world of vector control scientists.

2006 - The year of circumcisions

For sure, the two greatest advances of humankind this year, as far as can be judged on this day of winter solstice, were on the genital front, although in opposite directions for the two genders involved.

The international public health establishment, still dominated by men, paid most attention to male circumcision. In fact, the publication of data indicating a clear protective effect of around 50% of this operation in relation to the risk of HIV/AIDS is wonderful news. Very good that WHO in its press statement[1] also draws attention to the downside which could perhaps be oversimplified as: DON’T go and get circumcised in order to double your sexual contacts afterwards. For more general information about male circumcision, its origins, consequences, risks, benefits and how to do it, I recommend the Wikipedia article.[2]

As expected, the general press (at least the pathetic Swiss tabloid I subscribe to) was more interested in the female side, but it really was heartening to see the headline news on the condemnation of female genital mutilation (FGM) by a meeting of leading Muslim clerics in Cairo on 22-23 November 2006. Der Spiegel published a good article online in English.[3] Female genital mutilation encompasses clitorodotomy (removal or splitting of the clitoral hood), clitoridectomy (removal of the clitoris), and infibulation (removal of the vulva) also known as pharaonic circumcision. The practice seems to have had its origin in ancient Egypt and is nowadays widespread in a number of African countries. It also occurs in some countries in Asia, but much less frequently. It has been estimated that 2 million girls and women are subjected to it every year, although it is possible that a decline has started. The severe effects of FGM on the health of the girls and women subjected to it as well as their offspring have been well documented in a multi-country study.[4] The Muslim scholars made it clear at the meeting in Cairo that not only is this practice not supported by Islam; it “contravenes the highest values of Islam and is therefore a punishable crime.”

The purpose of FGM is in general to prevent sexual desire in girls thereby improving marital fidelity. I would consider it one example of the cruelty systematically inflicted by men on women in so many cultural settings. It is akin to burning of witches in Europe, honour killings, burning of widows in India and, most strikingly, binding of feet in China. Most of these practices have been abandoned, but only after inflicting suffering beyond imagination on millions of victims.

The meeting in Cairo was instigated by a German non-governmental organization, Target.[5] . Although I find this NGO to be driven too much by one person, zum Überfluss a man, I find the intentions and results so laudable, that I have sent them a donation. Now I hope stronger local movements and networks will emerge, and that they can muster the right persons with the necessary willpower and understanding of local cultural and economic contexts to set and achieve targets for FGM elimination.

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[1] http://www.who.int/mediacentre/news/statements/2006/s18/en/index.html

[2] http://en.wikipedia.org/wiki/Circumcision

[3] http://www.spiegel.de/international/spiegel/0,1518,452790,00.html

[4] WHO Study Group on female genital mutilation and obstetric outcome (2006). Female genital mutilation and obstetric outcome: WHO collaborative study in six African countries. The Lancet 367, 1835-41

[5] http://www.target-human-rights.de/index.php

Article on malaria control published by The Lancet

The below text was published online by The Lancet on 7 December 2006, and in the printed journal on 16 December (The Lancet 2006; 368:2111-2113). As copyright has been assigned to The Lancet, the text may not be reproduced without written permission from The Lancet or me.

Subscribers to The Lancet can find the published article at http://www.thelancet.com/journals/lancet/article/PIIS0140673606698127/fulltext?isEOP=true

Comment

DDT: a polluted debate in malaria control

Allan Schapira,
Geneva, Switzerland.
a.schapira@bluewin.ch

A recent press statement from WHO about dichlorodiphenyltrichloroethane (DDT) and indoor residual spraying for malaria control¹ caused a considerable stir, despite the fact that, in terms of policy, it merely re-iterated WHO’s endorsement of DDT as a useful insecticide for malaria control, albeit in a highly promotional way. In this recurring debate, arguments for and against DDT, as before, have been heated and mainly based on considerations far removed from the realities of malaria control.

One group that criticised the WHO statement has inferred that my resignation from WHO’s Global Malaria Programme in September, 2006, was related to my opposition to its promotion of DDT.² This assumption is erroneous. For many years, WHO’s malaria-control professionals have fought hard against pressure from various sides to ensure access in malaria-endemic countries to DDT.³ Hopefully, the statement now issued by the Global Malaria Programme¹ will put an end to this debate, so that all countries that need DDT for malaria control will have unfettered access to use it in accordance with WHO guidelines and with the Stockholm Convention on Persistent Organic Pollutants, if they are signatories to the latter.

Meanwhile, remarks from the opposite camp have not lacked passion, conveying the impression that large-scale use of DDT for malaria control, so long held hostage to misguided concerns for the environment, will now save the lives of millions of people from malaria.⁴ This idea is not so simple. As pointed out in WHO’s new position statement, indoor residual spraying is an effective intervention, provided a programme infrastructure can be set up and maintained to include trained sprayers, supervisors, managers, stocks, equipment, and vehicles, that roads allow access to every village at the right time at least once a year, and that insecticides are not diverted to agriculture. The need to prevent diversion has been highlighted for DDT, but for malaria control it is equally important for other insecticides. Furthermore, especially in areas with intense and perennial transmission, it is essential to maintain the population’s long-term acceptance of spraying once or several times a year.⁵

In view of the difficulties encountered in maintaining indoor residual spraying, WHO has invested substantially in exploring other methods, especially insecticide-treated bednets. These nets have been effective in many rigorous trials,⁶ especially to reduce childhood mortality in Africa. Few trials have compared insecticide-treated nets and indoor residual spraying, but results so far suggest that the methods are more or less equal in efficacy.⁷ As pointed out by WHO,⁸ the two methods are similar in the way they work, although unlike indoor residual spraying, insecticide-treated nets can protect individual users or households. Few data exist for the use and cost-effectiveness of combining these two methods. In view of the substantial costs of prevention for the huge populations at risk, national programmes will generally need to choose one of these two methods for a specific geographical area.

The choice of insecticide is secondary. Since only pyrethroids can be used for insecticide-treated nets, and pyrethroid resistance is emerging as a constraint on their effectiveness,⁹ the fact that four classes of insecticides can be used for indoor residual spraying should be one of the main reasons justifying renewed interest in this method.

In the choice between indoor residual spraying and insecticide-treated nets, a WHO study group convened in 2004 noted that the decision should, in most cases, be based on operational factors.⁸ Because long-lasting insecticidal nets can be managed easily with minimum risk of diversion of insecticide, for most high-burden countries that have not developed an infrastructure for indoor residual spraying, the priority will be to ensure coverage of at-risk populations with such long-lasting nets. The renewed interest in indoor residual spraying could lead to interminable debates in countries about the pros and cons of DDT. Such discussions pit sectors against politicians when, in fact, a non-partisan commitment is needed desperately to protect individuals at risk of malaria with one of the two proven methods.

1 WHO. WHO gives indoor use of DDT a clean bill of health for controlling malaria. WHO promotes indoor residual spraying with insecticides as one of three main interventions to fi ght malaria. Sept 15, 2006: http://www. who.int/mediacentre/news/releases/2006/pr50/en/print.html (accessed Nov 15, 2006).

2 Pesticide Action Network North America. Global coalition of health and toxic experts demand that WHO stop irresponsible promotion of DDT. Sept 26, 2006: http://www.panna.org/resources/newsroom/stopWhoPromotionDdt20060926.dv.html (accessed Nov 15, 2006).

3 Schapira A. DDT still has a role in the fi ght against malaria. Nature 2004; 432: 439.

4 Stossel J. Hooray for DD T’s life-saving come-back. Oct 4, 2006: http://www.townhall.com/columnists/JohnStossel/2006/10/04/hooray_for_ddts_life-saving_comeback (accessed Nov 15, 2006).

5 Global Malaria Programme. Indoor residual spraying: use of indoor residual spraying for scaling up global malaria control and elimination. 2006: http://malaria.who.int/docs/IRS-position.pdf (accessed Nov 9, 2006).

6 Lengeler C. Insecticide-treated bednets and curtains for preventing malaria. Cochrane Database Syst Rev 2004; 2: CD000363.

7 Lengeler C, Sharp B. Indoor residual spraying and insecticide-treated nets. In: Murphy C, Ringheim K, Woldehanna S, Volmink J. eds. Reducing malaria’s burden: evidence of effectiveness for decision makers. Washington, DC: Global Health Council, 2003: 17–24.

8 Report of a WHO study group. Malaria vector control and personal protection. 2006: http://www.who.int/malaria/docs/WHO-TRS-936s.pdf (accessed Nov 9, 2006).

9 Etang J, Chandre F, Guillet P, Manga L. Reduced bio-efficacy of permethrin EC impregnated bednets against an Anopheles gambiae strain with oxidasebased pyrethroid tolerance. Malar J 2004; 3: 46.