Tag Archives: culture

by

Whether ’tis Nobler in the Mind

I may have inadvertently stumbled upon something important. I may have found a boundary marker that potentially distinguishes New Age from Old Age. Of course, definitionally I could be way out of my league –New Age being construed as anything that happened after I left university- but considered as a panoply, I think it works, if only conceptually.

I happened upon an article in the CBC news app while scrolling through my phone, that struck me as interesting: http://www.cbc.ca/1.4302866 -perhaps because I had never thought about technology in those terms, and perhaps because I felt embarrassed that I had been caught doing just that.

The premise was that we seem to turn to various apps on our devices for problem solving of many sorts. Everything from comparing shopping prices to trends in fashion to the latest news. And, as we are increasingly discovering, these digital peregrinations revisit us in the form of directed advertisements hoping to cash in on our whimsical journeys. Nothing is thrown away in the digital world –even our whims are stored, categorized, and pragmatically redistributed. And if notions, then it seems a small step to include moods. Emotions –positive, or otherwise- should be equally trackable.

In fact, I learned that ‘Google announced it now offers mental-health screenings when users in the U.S. search for “depression” or “clinical depression” on their smartphones. Depending on what you type, the search engine will actually offer you a test. […] And Facebook is working on an artificial intelligence that could help detect people who are posting or talking about suicide or self-harm.’

Perhaps this is where I feel the shadow of a boundary issue. There seems little question that mood disorders transcend age and gender; what is more problematic, however, is whether there may be a generational divide in confiding those emotions digitally, or even believing that solace could lie therein. The problem is not so much in putting these issues in writing –diaries, and correspondence, after all, have long been a rich retrospective source for biographers. The difference, it seems to me though, is the intent of the disclosure –diaries have traditionally been personal, and usually, not meant as a way of communication, but rather a way of sorting out thoughts. Private thoughts. Letters, as well, were directed to particular individuals –often trusted confidants- and not meant for publication outside that circle. Have the older generation –Generation R, for example (Retirement, to attach a label)- been sufficiently swept up in the digital river, to feel comfortable in clinging to its flotsam like their children?

I’m certainly not gainsaying the efforts of the internet giants to expand into the mental health realm –it seems a natural progression, so perhaps this is a start… and yet it’s one thing to key in on various words like ‘depression’ and have the algorithm kick in with a screening test, but another to sift through the context to determine the appropriateness of offering the test. I suppose random screening like that may be helpful for some, but as Dr. John Torous, the co-director of the digital psychiatry program at Harvard Medical School and chair of the American Psychiatric Association’s workgroup on smartphone apps, observes, ‘”One of the trickiest things is that language is complex … and there’s a lot of different ways that people can phrase that they’re in distress or need help.”’ Amen to that.

Quite apart from translational difficulties and the more abstract and culturally-fraught issues with their changing metaphors and societal expectations, there are other language problems –even in the dominant language of whatever country: changing vocabularies, local argot, and misspellings, to name only a few.

To state that human culture is complex, is a trope, and to believe that artificial intelligence will be able to keep up with its multifaceted, ever-changing face, anytime soon is probably naïve. And, as the article points out, privacy –no matter the promises of the internet provider, or the app-producer- is another weak link in the chain. Quite apart from malicious hacking, or innocent and trusting confidence in the potential for help, ‘Our phones already collect a tremendous amount of personal data. They know where we are and who we’re speaking and texting with, as well as our voice, passwords, and internet browsing activities. “If on top of that, we’re using mental-health services through the phone, we may actually be giving up a lot more data than people realize,” Torous says. He also cautions that many of the mental-health services currently available in app stores aren’t protected under federal privacy laws [at least in the United States], so you’re not afforded the same privacy protections as when you talk to a doctor.’

In a very real –if mainly age-related- sense, I am relieved I did not grow up in the digital age. I am fortunate that Orwell’s prescient ‘1984’ was available, not as a quaint attempt at predicting the future, but as a warning about a creeping surveillance that seemed so malevolently unrealistic when it was written –it was first published in 1949, remember. And when I read it, the date was still sufficiently far in the future that it seemed more science fiction than predictive. Yet, as the years wore on, and society changed in unexpected ways, the horrors of the theme, for me at least, became more and more uncomfortable. More and more possible, despite the reassuring smoke blown in our eyes by those eager for progress, and mesmerized by the possibilities.

I mention this, not to suggest that I was unique in this discomfort –I was obviously not- nor to imply that what we are now experiencing is evil, or even threatening, but merely to explain the hesitation of many of those my age in accepting, unreservedly, the digitally-wrapped gifts so readily proffered. It is not a venue to which I would likely turn for health issues, or emotional sustenance.

For me, there is something more reassuring about an eye-to-eye encounter with another member of the same species, able to understand the vagaries of language, and compare the nuanced phrasing of my words with the expression on my face. Perhaps, I’ll change -perhaps I’ll have to- and yet… and yet I’d still feel better dealing with an entity –a person– able to experience the heart-ache and the thousand natural shocks that flesh is heir to. And yes, someone who has read and understood what Shakespeare meant.

Advertisements
by

Let No One Put Asunder

At my age, I suppose I should have learned to expect the unexpected, to revel in the entrepreneurism of a new and alien generation, and to wonder at its ability to see opportunity in the predicaments of others. But then again, why not? Isn’t that what lawyers are all about? And doctors…? Where would we be without predicaments?

Alright, I accept that the approach may seem cheeky, or even downright calculating, but I have to say I sometimes admire the attempt –a Swedish hotel chain is ‘offering a refund to couples who get divorced within a year of staying at one of its places.’ http://www.bbc.com/news/blogs-news-from-elsewhere-39382059 The idea being, apparently, ‘to encourage spouses to spend time together and work on their relationship’. And so, ‘It’s offering a “relationship guarantee” on mini-breaks at its hotels, so if things subsequently don’t work out and the marriage ends within a year, then the chain says it will reimburse the cost of a two-night stay’.

Of course, they’re not fools; nobody wants to be taken to the cleaners -they’re out to make a profit and, perhaps naively, figure that those who decide to vacation together for a while might not be that close to the brink. And, naturally, ‘There is some fine print: couples must be already married, stay in the same room and reference the relationship guarantee when booking. If they subsequently divorce and want to claim a refund, they have to submit court documents as evidence’.

I don’t know… At first glance, it might seem that they’re either very naïve, or really convinced they have an effective therapy -I mean, the divorce to marriage ratio in Sweden (2010, at least) was 47%. On second glance, however, the marriage rate in Sweden according to Eurostat Demographic Statistics –OECD Family Database (2014)- was only around 6 per 1000. So who, exactly, is sufficiently wide-eyed not to notice they may be on to something? I’m reminded of most private insurance agencies who offer great deals as long as you are low risk and have no major ongoing disabilities.

But it speaks to something larger, I think: the institute of marriage itself. Marriage is something which is incredibly difficult to define. In its simplest form, it is an officially sanctioned union between two people that affords legitimacy to any offspring and entails certain rights and responsibilities -and these vary from one society to another. In Western cultures it has been the religious –or secular (usually governmental)- authorities that are required to sanction and guarantee those issues. But in other societies, families, traditions, and deeply held beliefs often prescribe the boundaries, duties, and also the rights of each person in the relationship. Hence the cross-cultural misunderstandings and misgivings. We tend to ascribe the most legitimacy to that of the society in which we were raised.

Guilt, is not imposed, by and large, it is acquired -usually at a very early age- by deviating from the expectations of those we love and trust: our family, and immediate friends, bonds that link intimately with cultural and, often, religious beliefs. Sexual mores and intimacy are no exception -in fact, they are often the incentives offered by matrimony.

But marriage is becoming more popular recently, even in Sweden, with the ongoing influx of migrants from other cultures who were raised with different familial and religious obligations to which they feel they must adhere -obligations which may not be as easily dissolved, or as readily ignored as in the host country. After all, ‘Marriage is a matter of more worth than to be dealt in by attorneyship’ according to Shakespeare.

So is the hotel chain actually reading those trends, too? And are there other conditions –loopholes- that are not immediately apparent in their advertisements? Fine print? Exceptions? I don’t know, but I certainly wish them well. It’s a gamble on their part, to be sure… But I think I’d put my money in real estate, frankly.

Perhaps I’m just being far too cynical, though. Far too… divorced –there, I said it- but I’m willing to bet that they haven’t read the famous definition of how realistic are the expectations of marriage by none other than George Bernard Shaw in his preface to ‘Getting Married,’ 1908: ‘[W]hen two people are under the influence of the most violent, most insane, most delusive, and most transient of passions, they are required to swear that they will remain in that excited, abnormal, and exhausting condition until death do them part’.

Pick your side on divorce and marriage, but they do seem to follow each other around and around like a tail the dog. I have to say, part of me is tempted to quote Samuel Johnston’s sarcasm (out of context) on the hotel chain’s promise -that it’s ‘The triumph of hope over experience’. And yet, when I stop to think of it, why not credit them with the courage of their conviction? Why not Alexander Pope’s ‘Hope springs eternal in the human breast’…?  After all, that’s what they’re trying to accomplish in those couples who stay with them… And that’s what we all hope for, isn’t it?

 

 

by

Acknowledging the Mind’s Eye

Sometimes, in the midst of a problem –in the midst of an era- the resolution derives not so much from the answer as from the acknowledgement that there is an issue to begin with. I find it interesting that Nature has given us an ability to adapt more efficiently -to ignore, I suppose- that which arises gradually than that which falls upon us as an event –interesting, because that allows us to discount something until it results in complications. Difficulties. It is the Janus view of evolution, I suppose.

An article in the BBC news alerted me to one novel approach to encourage acknowledgment of an issue that has plagued some societies for what seems to be millennia: sex selection –or perhaps, more honestly,  destruction:  www.bbc.com/news/world-asia-india-37034444

It got me thinking… We tend to cherish and preserve what we value; we neglect, or abandon that which we don’t. Denigrate it, even. Perhaps an occasional nudge in the ribs may cause us to look around and see where we have wandered –realize that there is really no need to stand so close to the edge.

But it does give one pause for thought –how do some of these things become imbedded in a culture? Surely they don’t start out as intentionally malevolent. Or is that being revisionist and unduly naïve? I’d like to think that some of the customs, however egregious we find them now, were products of a different time when other priorities required precedence. Confusing times, perhaps, when we barely knew who we were in our overarching need to identify and fend off them. Troubling times beneath the roiling waters in which we are just beginning to be able, however slowly, to surface for air.

And the problem, as always for those of us less afflicted, is acknowledgement –recognition that there is more to do. There is always more to do…

Despite being a gynaecologist for more years than I can remember, I suppose I have always lived in a man’s world. It’s hard not to wear the clothes you were assigned. And yet, every so often, that usually-locked door is knocked ajar briefly, and the light from within is blinding. Unintentionally heuristic.

I was sitting in a busy coffee shop recently and managed to find a tiny unoccupied table against a windowless and shadowed wall in the corner. Perhaps it camouflaged me -made my presence less noticeable, my gender less obtrusive- but as I sat there staring silently at the busy room, fragments of conversation from the next table floated past like dust motes in the feeble light. Two women were catching up on their lives. I didn’t mean to listen, but sometimes words are beacons: currents, vacuuming up the air between –meant to be heard, meant to inform. It’s hard to ignore words when you sit in shadows.

“And so how is Janice doing now?” a grey-haired woman in pigtails wearing black track pants and a yellow sweat shirt asked between gulps of coffee and grabs for the oversized chocolate cookies she had balanced precariously on her plate. She clearly had little need of more calories, but the presence of her more sizeable friend likely justified the debauch in her mind. It works for all of us, I think.

Her friend just shrugged amicably. “You know what it’s like, Dory,” she said, and launched into her bagel as if she were packing a box. “Kids are kids…”

Dory munched softly on a cookie and considered the issue. “She’s hardly a kid, now, Alice. She’s, what, seventeen?”

Alice nodded her head equally thoughtfully and her long dark hair slid back and forth over her shoulders like a wash cloth. Although considerable larger than her friend, she carried her weight gracefully, and with the gravitas that suggested a person of authority. Dressed in what seemed in the dim light to be an expensive white silk blouse I could make out little ruffs on each wrist. I don’t normally notice such things, but with each movement of her arms, they risked coating themselves with cream cheese from an impertinent bagel, now lying in fragments in front of her. “Eighteen…” She took a delicate sip from her coffee and sat back on her chair as if the subject required a little more thought.

“Still, she should know where she’s headed by now…” Dory left the question of direction open, but her eyes betrayed her opinion. “I mean, who she is…” she added, italics begging for attention.

Alice sighed and leaned forward again to pack another item into her waiting mouth. “I think she’s always known.”

“And how about you?”

Alice smiled and nodded. “Some things a mother just knows, Dory.”

Dory was obviously trying to understand, but her confusion was apparent, even to accidental eyes watching from the shade. She shook her head, disapproval hovering over her like a cloud. “Did you ever to speak to her about it, Alice?”

Alice’s eyebrows both rose at the same time. “Whatever for, Dory?” she said, genuinely puzzled at the remark.

It caused Dory to sigh rather more loudly than necessary. “Well, I would have thought…”

Alice refurbished the smile she’d sacrificed to the bagel and leaned an elbow on the table. “Thought what?”

Dory straightened her back like a boxer ready to receive a blow. “Well… that…”

“That my daughter would think the same way as her mother? She learned the Theory of Mind when she was five, Dory.” Her friend visibly winced at that. “The world is different for each of us, Dor,” she said, reaching out and grasping Dory’s hand. “And the question should not be why, but rather, how can I best negotiate it…?”

Dory tried to smile, but even from the shadows I could see her lips twitching with the effort. “Do you think if…” But she was clearly too embarrassed to finish her thought –and anyway, I could see Alice shaking her head and squeezing her hand affectionately.

“Somethings just are, Dory. And my main duty as a mother is to help her to accept them.” She let go of Dory’s hand and picked up her coffee for a sip. “And to help others to accept her…”

“But…” There was a hint of helplessness in that one word.

“But what’s not to love, eh?” she said, glancing towards the door and standing up to wave at a smiling teenager gliding towards them like a boat about to dock. And then Janice waved back, just like anybody else…

by

The itsy bitsy teenie weenie?

I am no longer simply bemused at the secular paranoia that seems to be growing like Topsy in the Western world; I am becoming irritated; I am becoming annoyed that it is now even conflating fashion with politics and spreading like blight in a deliberately monocultured crop. Pick your battles, folks –this is a demeaning one. https://www.theguardian.com/world/2016/aug/16/burkini-ban-defended-as-french-mayors-urged-to-cool-local-tensions?CMP=Share_iOSApp_Other

Or is it just silly: burkini -coined merely to suggest the word ‘burka’ and also contrast it with its other ‘ini’ cousin the bikini? An attempt to denigrate opposites? Have we grown so accustomed to less being more on the beach, that more is now less? Have we already forgotten how shocking the bikini was when it first appeared in the middle of the last century? How it was banned from many beaches then, and declared sinful by no less an authority than the Vatican?

Admittedly, the bikini reveals considerably more of the female anatomy and no doubt arouses different sorts of… well, passions, shall we say, than the iteration I’m discussing. But some of the burkini styles and colours are quite beautiful and, at least from my prairie -and admittedly male perspective- far more attractive than the burka parent. It is, for all intents and purposes, a tempest in a teapot.

Terrorist events in France have undoubtedly kindled a controversy over an issue that would otherwise have been merely a dispute over aesthetics –“Why would anybody want to wear something like that, on a beach? It must be so hot…” And that would have been that. Except for the resistance of some governments to clothing with even a hint of religious affiliation, the burkini would have quietly slipped into normalcy – become as obvious as nose-rings or purple hair. A barely noticeable mise-en-scène.

Of course there was that skirmish on a Corsican beach in August between some villagers and three Muslim families: https://www.theguardian.com/world/2016/aug/15/corsica-mayor-bans-burkini-violence-beach-protests-sisco-france  But, interestingly, it was not at all certain whether any of the women were wearing burkinis at the time… The mayor decided to ban them anyway.

I can understand the reason… sort of. The idea, presumably, was to defuse tensions -not draw attention to cultural or religious differences in a time of us and them. Even when, in fact, they are actually us. The problem, I suspect, is that we are living in an inter regnum –a time when differences, no matter how picayune or superficial, may assume larger than life proportions –a significance that, when viewed years hence, might seem recondite –if not puerile. But it’s all very confusing, not to mention counterproductive, even now.

Surely inclusivity engenders familiarity and acceptance –on both sides. Banning something often breeds resistance and anger. And banning an innocent article of clothing is both capricious and inflammatory. If there were ever anything that could engender feelings of separation and non-acceptance, it is the belittling of the honest attempts of a culture to adapt to something that so enamours the population in which it is enmeshed -something that allows Muslims to visit beaches while letting them adjust their customs to what may never have been envisioned as a desirable or even feasible activity by their ancestors.

I remember a patient of mine that had a different take on the issue. Fatima was a devout Muslim woman who had nonetheless adopted many of the dress codes, so familiar on our streets. I was seeing her and her husband for antenatal care in their first pregnancy and once they both realized that I was nothing to be feared, we were able to talk openly about many things other than her pregnancy.

At the beginning, for example, she would always arrive wearing the more inclusive covering of a niqab –albeit a colorfully patterned one. Then she began wearing a hijab to our visits. I asked her why.

I remember she looked at me and her eyes twinkled as her mouth wrinkled into a shy smile. I noticed her husband was smiling, too.

She immediately shrugged, as if it was an unimportant observation on my part. “I wanted you to know when I was smiling,” she said mischievously. Then, her eyes suddenly became the interrogators –gentle inquisitors- and hovered about my face for a moment. “And quit looking at him,” she giggled. “He’s terrible at choosing clothes anyway…” It was a good-natured rebuke; Fatima evidently disliked our western stereotypes.

Although it was her husband that was the reason for her presence in Canada –he was doing some post-doctoral research in oceanography- Fatima was also fluent in English and more observant about our own vagaries than I was.

It was a hot summer that year, and conversation naturally turned to Vancouver’s love of its beaches.

“I really don’t understand Vancouverites,” she said with a laugh. “They flock to the beach and strip down so they can lie on the hot sand like wieners on a barbecue…” We all laughed. “I think it’s just a fad, though,” she added, her face turning serious for a second.

I nodded. “Maybe someday, someone will design beach clothing that is comfortable and cool, but still protects them from the sun…” I said it without thinking, I have to admit.

“We already have,” she said and winked.

How parochial we can be in this country, despite the vaunted cultural mosaic of which we are so demonstrably proud.

Cultures change –but more slowly than fashions. Maybe the rest of us will someday find ourselves covering up more of our skin on beaches to prevent UV damage; mothers are already dressing up their toddlers as they muck about in the sand… Beaches themselves are a fashion, after all. There was a time not so long ago when people feared the sea and –at least in Britain- only aristocrats seeking the putative benefits of both spa and beach for reasons of health were able to afford the areas where this was offered. In time, of course, the rabble followed and now we merely view beaches as de rigueur. But given the fickleness of contemporary life, perhaps this too shall pass, as the adage has it.

Fortunately, however, France’s highest court has allowed us to breathe deeply again, and step back a few paces for now -it has decided to suspend the ban on burkinis: http://www.bbc.com/news/world-europe-37198479 Sadly, the issue has not yet been put to bed; there is still considerable resistance among politicians and elements of the population who fear an upheaval of the status quo, and a slide into the morass of sectarianism. Several mayors have even threatened to ignore the ruling.

French law notwithstanding, it seems to me that the noticeability of an article of clothing like the burkini should not merit more than a transient raising of an eyebrow –if that- and certainly not a clash of Civilizations. Its proscription will not discourage terrorism, but perhaps its approval might. Who knows what a welcome might do to a culture so long viewed as other: strangers in a strange land…?

 

by

An Unfamiliar Worry (for some)

I don’t know how the world used to manage with just men at the helm. There are so many things –obvious things- that simply pass by us uncharted. I don’t think its intentional; it’s more likely that those things just do not affect us in the same way. They have different consequences; we assign them different priorities –if we assign them at all…

There are, of course, some issues at which men seem relatively proficient at first glance- such as dealing with the needs of refugees arriving in Europe or wherever, from war torn areas of the world. When they arrive, attempts are made to provide for their health and safety while they are being processed. Because of the large numbers arriving, this often means settling them temporarily in camps where the basic needs of shelter, food, and medical care can be provided.

But those are relatively easy things to plan for -easy things to discuss at any  rate. Add in education for the children, maybe phone service so they can communicate with their families back home, and perhaps even, as icing on their cakes, leisure activities, and… Well, apart from a chance of permanent resettlement or, of course, improving the chaos in their home countries so they could return, what else could refugees possibly need? Or want?

Full disclosure: I am a man, and despite my forty-plus years as a gynaecologist, I’m afraid my brain is still sometimes stuck in Y mode. One would have thought that if anyone could transcend gender –wear other shoes- a gynaecologist might be in the running. But I missed this one: ‘About one in four of Zaatari’s [Jordan’s largest refugee camp] residents need sanitary pads. The UN does distribute them now and again to women aged 14 to 45, but there are never enough to go round.’ Sanitary products, even if they are available, can be expensive; the temptation is probably to use whatever personal money is available for other, more survival-oriented necessities. I learned this from an insightful article in BBC News: http://www.bbc.com/news/magazine-34925238  A British woman named Amy Peake not only discovered the need, but found a simple machine in India that would allow women  to make sanitary pads cheaply and on site. ‘On top of that, Peake discovered, there is a desperate need for incontinence pads for the many wounded, elderly and disabled people – and traumatised children. “The children are really suffering,” says Peake. “The problem is that the mothers have been trying to cope for so long that basically they’ve given up. Night after night of urine and they can’t keep them clean.’

There are so many things in everyday life that most of us take for granted until they are not available –things like a clean and timely change of clothes, the ability to maintain personal cleanliness in a culturally sensitive manner, and in private if desired. Although necessary, it is simply not sufficient to provide only the obvious -food, shelter, and so on- and then assume normalcy will ensue; we are all products of societies laden with traditions and expectations –this is what it is to be human. To strip these away is not only cruel, and disrespectful, it is also degrading. Inhuman. After all, they were living lives much like us until forced by war and unspeakable danger to flee from their homes for the sake of their families. For the sake of their futures… They are not merely bodies in need of sustenance, they are mothers and fathers… children… and so are we. So the question we must continue to ask ourselves is whether we would be comfortable treating our own families in the same way as these refugees. Would we feel that we have been sensitive to their needs?

Admittedly, in times of crisis and overwhelming numbers, some things must be prioritized, while others, perhaps less important to survival, need to be relegated to the background. But not neglected. Not forgotten. The refugees, already traumatized and exhausted by the hardships of their journeys and often bewildered by the contrasts with their previous lives, are ill equipped to complain. They are initially powerless, and confused, but very soon understand that once the basics have been provided, once the threat to life and limb has receded, there is another thing they desperately require: dignity. If they are ever to be assimilated into another country, another culture, another life, they must regain their self-esteem. Their pride.

We must not forget that different societies may view the world in different ways. Things to which we in the West have long since been accustomed are sometimes still problems elsewhere. Attitudes about the management of menstruation is one such problem. In many traditions, it is not only a secretive event that must be concealed from others for fear of ridicule, but also dealt with by whatever is at hand. The stigma around menstrual periods is complicated and culturally sensitive as I have already discussed in several other blogs:

https://musingsonwomenshealth.wordpress.com/2014/11/26/menstrual-taboos/, https://musingsonwomenshealth.wordpress.com/2015/04/01/menstruation-and-sports/, and even: https://musingsonwomenshealth.wordpress.com/2015/03/13/the-tampon-tax/

So I’m not sure why this article came as such a revelation. Maybe it was a reminder that we all see the world from our own perspectives: two people crossing one bridge is really two people crossing two bridges… And yet, to a third who is watching from the edge, it’s still the same bridge.

I should have known!  ‘But every little difference may become a big one if it is insisted on.’ as Lenin said.’ so I suppose I’ll have to accept that Time is a series of tests, and you only get marked at the end… I hope.

I can only offer the words of Iago in Shakespeare’s Othello:

‘I will wear my heart upon my sleeve
For daws to peck at…’

 

 

 

by

The Dark Night of the Canadian Soul

I hesitate to refer to the 16th century mystic Spanish poet St. John of the Cross’ dark night of the soul, but I am troubled by the political process in which I feel engulfed. Swallowed… And yes, powerless. And it’s not so much that I disagree with the ideology expressed or dislike the personalities of the leaders and their approach to solving what they feel are the problems confronting the country (according to their polls) –that is politics and universal. If it were only that, it would then become merely a matter of taste or confirmation bias that determined my vote. I might feel disappointed if I didn’t get my choice of government, but not angry.

But I feel angry now –already. Or is it helpless? I find myself powerless to change what appears to be happening around me. Mutating around me as I watch. Party after party seems to be willing to debase itself for votes, pandering to the fearful in one population and the ignorant in another. It is not a principled approach and it does not provide equality for all –or even most.

It seems to me that in a democracy –especially one that espouses multiculturalism as does Canada- it is the rule of law that must be equitable: laws that apply to all -and equally, no matter whether it is a small minority whose ethnic or geographic culture pulls it in an awkward direction, or an elsewhere-maligned religious group who chooses to dress differently from our current norm. Democracy –at least as I imagine it- is not simply the rule of the majority; intrinsic to it is an obligation to protect the minorities within it because it is the right thing to do. And because the law applies to everyone –even minorities.

The rights of all should not be subject to arbitrary or capricious revision without exhaustive and careful consultation from all those who might be affected. It should not be so much a majority decision, as an examined and consensus-driven decision. One side should not be pitted against another. As in international relations, the ideal would be for all sides to talk to each other. Communicate. And while a decision need not be unanimous, it should at least meet with the general approval of every side. Polling –no matter how cleverly conceived- canvasses only those who are polled…

But you wonder why I am angered and not simply disappointed at the political process? I seems as if I can no longer vote for the principles I hold important. Perhaps I have retrospective falsification of my memory, but I can’t remember as much divisiveness in federal politics before -as much negative advertising, as much pretended obsequiousness and crawling for power. As much casting aside of principles in a desperate grab for control. I am appalled that we, as a nation, must tolerate this fawning pretense of servility. Appealing to the lowest common denominator may seem fair to some, but it is certainly not the way to run a country for all.

I blame the current government for acceding to those who would divide the country to satisfy their agenda. I blame the political system for allowing those who stumble first past the post (FPTP) to be elected even if they have not earned the majority of votes. And I blame us all –you and me- for not demanding a more representative way of electing the government. As much as I dislike using quotes from Wikipedia, one of their summaries does seem to illustrate my frustration with FPTP: Wasted votes are votes cast for losing candidates or votes cast for winning candidates in excess of the number required for victory. For example, in the UK general election of 2005, 52% of votes were cast for losing candidates and 18% were excess votes – a total of 70% wasted votes. This is perhaps the most fundamental criticism of FPTP, that a large majority of votes may play no part in determining the outcome. This “winner-takes-all” system may be one of the reasons why “voter participation tends to be lower in countries with FPTP than elsewhere.”

In other words, in Canada, I have no option but to attempt to vote strategically -and for someone with whom I do not necessarily agree- simply to make sure that the one I disagree with even more, does not get elected. If I vote on principle, or electoral platform, my vote may be wasted.

So why do I vote? Perhaps because the devil I know may well be worse than the devil I don’t… Help me St. John of the Cross, because I find it truly dark out there.

 

by

The Mistaken Identity

Communication is a fascinating thing. It enables descriptions of the world in different sounds, different gestures, different expressions. A shrug of indifference in one culture is a greeting in another. A nod can convey a myriad of intentions -context is everything. Only the smile seems a common currency. As a gynaecologist, I am ruled by boundaries, beyond which I dare not venture without, at the very least, the permission of a smile.  It is a sign hung upon the face that needs no words -the Rosetta Stone that unlocks the mysteries of culture and walks the unfamiliar language like a bridge.

My office is a tiny United Nations, with a rainbow range of clothes on display, and skins to match. The waiting room is impossible to ignore, but equally difficult to understand. Words are encrypted by language, and intent masked by the panoply of expressions encoded in millennia of habitual use. It is a place of pleasant noise. Expectant. Pregnant, if I may say, with expectations both imminent and anticipated. Now is just a passing fancy; it is the future they await: a baby, a diagnosis, or just the reassurance that they are in not imminent need of help. It is a place of smiles, both nervous and shy -signals that they understand their different reasons for sitting side by side.

But it is sometimes a more confusing world once they have entered my consulting room. Words matter there. Meanings are crucial, explanations need context, symptoms require a modicum of description. Except for the more flagrant and visible aberrations of bodily integrity, diagnoses require detail. Language. And patients who are adept at simple conversations in English often struggle with words they would not encounter in the home. What is hidden from sight, is usually hidden from discussion: there is seldom a need to talk about an ovary nor, for that matter, a vagina -even in their own language. It is more often passed over with a blush, or an anxious smile.

I tell the referring doctors to ask their patients to bring a translator with them if they think it may be a problem, but too often it is a family member with similar language skills who accompanies them -a daughter who is too embarrassed to say the words, or a husband in front of whom she is ashamed to admit the problem. Everyone smiles, but often with incomprehension or discomfort.  I love the challenge.

Sometimes the challenge is of a different sort, however; sometimes it is me who is embarrassed.

There were just two of them in the waiting room -sisters, likely, and not too far apart in age. As I walked into the room to greet them, they were huddled together whispering loudly about something and didn’t notice me until I was standing right beside them.

“Wei?” I said in a rather tentative voice, reading the name off the referral letter that was written on a piece of paper, but not certain I had pronounced it  correctly.

I was immediately greeted by a smile -two smiles- and they both stood up. Neither made eye contact, but they followed me down the corridor to my office -normally a good sign. I felt confident that one of them was Wei.

“Wei, you sit in this chair by the desk,” I said, addressing the space between them, and hoping for clarification in the assigned seat. But instead, they seemed confused and I could almost feel the mental flipping of coins as to who sat where. I addressed the Wei seat first. “Wei?” I said, to cement the relationship.

They both smiled -nervously, I thought. The Wei seat answered for them both. “Wai,” she said -by way of correction I assumed. Even though I’d taken conversational Cantonese many years before, I never mastered even the rudiments of the many variations of pronunciation, let alone meanings of words that seemed otherwise identical. But I was happy at the confirmation of identity and smiled my acknowledgement.

“So why are you here today, Wai?” I said, careful of my pronunciation. And careful to differentiate her from her sister. Apart from the name, the referral letter was illegible.

They exchanged glances, apparently trying to decide who should answer. Obviously one of them was better at English, and they wanted to make sure I understood. It was Wai in the assigned patient chair who answered. She seemed pleased that she was able to speak, but she, too, seemed to need to clarify the situation before proceeding any further. “She my sister,” she said pointing at the other chair.

I smiled and nodded at the information. “How do you do?” I said to each of them. Clearly there was a series of preliminary introductions and small talk that were deemed necessary. Polite. I decided not to rush things, but after conferring briefly with her sister, she got right to the point.

“Me?” she said, pointing to herself. I nodded in assent. She smiled broadly and looked at her sister. Proudly, I thought. I could see her struggling to find the correct words. “Baby,” she said, and her smile almost split her face in two. “First baby!”

I could tell this was going to be a difficult. Her sister stayed quiet, merely nodding whenever Wai said anything. “Do you speak English?” I said, politely turning to the sister. Hope springs eternal. But she shook her head smiled. “Only little,” she added after a moment and an inquisitive glance at Wai.

It was Wai’s turn. “I the good English,” she said confidently and not without an ill-disguised condescending glance at her sister.

I wasn’t really sure how to proceed. Taking an adequate history was impossible -even finding out if there were problems with the pregnancy so far seemed remote. But Wai appeared so enthusiastic and happy, I thought I’d try for a few basics. “So, when is the baby due?” I immediately regretted the word ‘due’ because her face fell. I decided to try a more basic form: “When baby come?” I felt embarrassed to say it like that -it too, seemed condescending- but Wai understood and smiled again.

“Seven,” she said, holding up seven fingers.

Encouraged, I considered pressing on with more detail. I thought I’d try for the date of her last period -that would  help me plan what to do next in terms of ultrasounds, blood tests, and so forth. “When did your last period start?” I said as slowly as I could without sounding silly. But I quickly realized I’d framed it poorly. “When last bleeding?” I tried, blushing at the clumsy attempt.

Again the smile. “June one,” she said, this time holding up one finger confidently.

Great, I was getting somewhere at last.  But when I then tried to ask her if she’d had an ultrasound yet, it became immediately apparent that I had reached the bottom of the well. I shrugged and put on my best smile. “I’m going to need more information…” I sighed to show I knew how difficult it must be for her. “You’re going to need to bring an interpreter next time, Wai…” She looked disappointed, so I think she understood. She turned unexpectedly to her sister and quickly said something to her that sounded like she was confused. They both looked at me for a moment, and then huddled together in quiet conversation, occasionally risking a puzzled stare and then submerged themselves in words again.

“So, you not talk to Wei?” she said, pronouncing the name as I had in the waiting room and pointing to her sister.

“Are you not Wai?” I said, confused at the pronunciations, then glancing at my watch.

She nodded vigorously and smiled. “I Wai; my sister Wei,” she said, touching her sister gently on the arm. Then they both began to laugh. “You make mistake..?” said Wai -I think it was Wai; I was becoming quite confused. But I have to admit I blushed all the same.

I managed to chuckle along with them; they seemed quite amused by the whole encounter.

“Not problem,” said Wai, glancing at her watch. “We come back.”

And so began another day at the regional section of my own United Nations Gynaecology division… Do you see why I love what I do?