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:  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:,, and even:

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…




The Gyne Phone

The iconoclasts were people who destroyed religious icons for various reasons. It’s a practice that began thousands of years ago. And somebody’s messing with the icons again -but this time, it’s the  iconoplasts

The icon has ancient roots and the word derives from the Greek word eikon meaning ‘likeness’ or ‘image’. Originally, it was usually a religious depiction of a god, or saint, but destruction of icons (iconoclasm –clasm deriving from the Greek word Klan, meaning to break) gradually morphed into destructive acts against the status quo. However, given the ubiquity of the computer, icons today usually refer to representative symbols on the screen of different options or programs.

Before written traditions gained a foothold, the dissemination of information or tribal history depended on oral transmission –i.e. on memory. But this presented some problems in terms of the sheer volume and accuracy of what needed to be passed along. Addressing this issue, Wikipedia (sorry!) notes: “Without the use of writing systems to transmit information through time, oral cultures employ various strategies that serve similar purposes to writing. For example, heavily rhythmic speech filled with mnemonic devices enhances memory and recall. A few useful mnemonic devices include alliteration, repetition, assonance, and proverbial sayings. These strategies help facilitate transmission of information from individual to individual without a written intermediate…”

Then, with the advent of written transmission of information, one can imagine a gradually increasing dependence on this and perhaps a decline in the need for the enhanced memory techniques so necessary before:  At the time, I suspect this phase would have been fraught with objections from those traditionalists concerned about the atrophication of memory itself. Change is worrisome; it can have unintended consequences…

Well, the Phoenix has once again been aroused:  It seems that since most of us carry instantly –and ubiquitously- available information around with us in the form of smart phones or tablets, there is little need to memorize phone numbers or even addresses. And even less incentive, since we might remember them incorrectly. Egad!

I’ve noticed the transition over the years in my practice. At first, the patients would come in with lists –questions written on usually irretrievable little pieces of paper stuffed into their purses. Of course if they couldn’t find the lists, some of them then made desultory attempts to remember what they had written, but often to no avail. I became quite skilled at offering clues as to what they might want to ask, but alas, that too atrophied as time and computing advanced. It’s a two-way street, I guess. Use it or lose it.

But my younger patients (of course) appear to have taken it to extremes –or at least, so it seems to me… Judin was the most recent example, I think. She was a twenty-something woman of Persian extraction and she had come to me because of abnormal pap smears. Otherwise healthy, she sat proud and unmoving like a marble goddess in the chair opposite my desk. Her eyes tiptoed to my face and sat there like curious birds. She was dressed casually in a pale blue sweat shirt and white jeans, and as she moved her head from time to time, her earrings tinkled like little bells hiding inside her long, dark gleaming hair. Her phone lay dormant on her lab, but I could see her right hand clutching it like another equally precious jewel.

I commented on how beautiful and unusual I found her name and she smiled serenely, tossing her hair nonchalantly back and over her shoulders. “It’s the name of a village in Iran where my cousin was from. She came to live with my parents but died before I was born.”

“A village near Tehran?” I have to admit I was approaching the limits of my knowledge about Iran –my knowledge of its geography, at any rate.

She shook her head and the tinkling started again. “No, it’s in a very dry and poor region of the Sistan and Baluchistan province in the south east corner of my country -by the Gulf of Oman and the Arabian Sea,” she added helpfully, but she could read the confusion on my face. “Tehran is quite far north near the Caspian Sea.” She stopped for a moment to smile. “Judin is in the middle of nowhere.” Her eyes twinkled this time instead of her earrings. “Honestly!”

Judin –the woman- was obviously well versed in geography and family history, and I would have loved to pursue it further, but I realized, as did Robert Frost, that ‘I have miles to go before I sleep’… I had to press on with the consultation.

Some of the questions were background issues –housekeeping data that I needed to acquire to ensure I would not miss any other information that might be relevant to her abnormal pap smears. “When did your last period start?” I asked, assuming this would be a good place to start.

She smiled, and called her eyes back to roost while she lifted her phone from her lap like a religious icon. She tapped at it for a moment. “Just a minute,” she said sweetly enough. “Gotta find the app…” I could see her scrolling through the screen, her face intense, her body rigid. “Oh, here it is,” she said and glanced at me. “What was the question?”

“When did it start?” I prompted, fascinated by the effort she was making in her search.

I lost her eyes for a moment as they disappeared behind her lashes and then her lashes behind her hair as it fell forward when she lowered her head. “Well…” I could tell she was into it now: her voice seemed strained and I could see she was really concentrating. “…I’m having it now, and they only last 3 or 4 days since I started on the birth control pill…” Suddenly her face surfaced before she could restart a smile. “I don’t actually know… I guess I forgot to enter it.” She blushed and her smile disappeared. “Sorry,” she said, and looked at her phone again. “I’m going to say ‘yesterday’…” She thought about it for a moment. “No, it must have been the day before, or I probably would have remembered it.” She assumed the goddess pose again. “Yes,” she said, but more firmly now –more assertively. “Yes, it was two days ago!” She looked at me with an almost smug expression on her face that seemed to say “Isn’t technology wonderful?”

I nodded and entered the date in my computer –my substitute for her smart phone, I suppose. “And were your periods regular when you were not on the pill?” She looked at me strangely. “You know, once a month…?” I added.

She hoisted the phone once more and scrolled through it looking for the app again. It seemed to be taking a long time, so I pretended to bang my mouse against my coffee cup accidentally. “Yes,” she said hesitantly and without looking up. “But, you know I wish all months had the same number of days. Eyeballing the calendar to see if it’s the same would be so much easier.” She glanced at me, and then submerged her face in the phone again. “It’s easier to count the days I bleed than the ones I don’t.” Another glance to see if I was following her. “Fewer squares to count,” she added to make sure I understood.

“Maybe you should suggest that to the app-people,” I said, wondering if I’d used the correct word.

“You mean the IT people? The software engineers?” She smiled at me like a mother might to correct her young child. “What a great idea!” she said, when the idea struck home.

But I’d been skipping about in taking her history, and I thought I’d make sure I’d obtained the entire historical data before moving on to more pertinent issues. The age of menarche -or first period- can sometimes be helpful gynaecological information. “Do you remember how old you were when you first began to menstruate?” I could see a puzzled expression taking control of her face. I thought maybe English might be her second language and ‘menstruate’ might not be a word she would hear around the house. “When did you start your periods?”

The puzzled look disappeared, and a different one –an almost irritable one- replaced it. “Two days ago…” She cocked her head as if I hadn’t heard her the first time. But she was willing to forgive it, I could tell.

“No…” I paused for a moment, in order to figure out how to phrase it more clearly for her. “I mean you probably started to have your periods when you were quite young… Do you remember what grade you were in, or where you were living when you had that very first one?”

She nodded her head and stared at something on the wall behind me as if she was thinking about it. “I was young alright, but…”

I waited, for a moment or two and was just about to tell her to forget about it so we could move on when she suddenly fixed me with another puzzled stare. I could feel the weight of her eyes sitting on my glasses like two passenger pigeons that had already delivered their message.

“I can’t answer that question, doctor,” she said and sat back in her chair. My eyebrows must have moved because I could see her sigh in disbelief at my ignorance. “I didn’t have a phone then…” she said and shrugged. It was so obvious!