George Haycock, MB, BChir, FRCP, FRCPCH, DCH

• Emeritus Professor of Paediatrics, Guy?, King?, and
• Sr. Thomas?Hospitals School of Medicine, King? College,
• University of London
• Emeritus Consultant Paediatrician and Paediatric
• Nephrologist, Guy? and Sr. Thomas?NHS Foundation Trust,
• London, United Kingdom

The connection between the content of spontaneous temporal lobe hallucinations and the alien abduction paradigm is consistent with such a hypothesis spasms near belly button quality baclofen 10mg. They are ordered to assassi nate a political leader or a folk hero muscle relaxant pain reliever purchase generic baclofen online, or defeat the British invaders spasms quadriplegia order 10mg baclofen mastercard, or harm themselves quad spasms after squats generic 25mg baclofen mastercard, because it is the wish of God, or Jesus, or the Devil, or demons, or angels, or lately aliens. Think of the power of repetitive imagery in advertising, especially to suggestible viewers and readers. Somehow small hairless beings with big heads (and eyes) have been our staple aliens for a long time. Wells argued that humans evolved from smaller-brained but hairier primates with an athleti cism far exceeding that of Victorian academics; extrapolating this trend into the far future, he suggested that our descendants should be nearly hairless, with immense heads, although barely able to walk around on their own. It looks to me eerily like a foetus in roughly the twelfth week of pregnancy, or a starving child. Not a single being presented in all these accounts is as astonishing as a cockatoo would be if you had never before beheld a bird. Samuel Butler, Characters (1667-9) or just an instant in the darkened room I sense an apparition Fcould it be a ghost? In astonishment, I seem to be smelling the salt air of the Coney Island summer seashore of my childhood. In an obsessively rigid, practically ori ented society, perhaps I would be cautious about admitting to such experiences. Courts have banned its use as evidence or even as a tool of criminal investiga tion. The American Medical Association calls memories surfacing 130 On the Distinction between True and False Visions under hypnosis less reliable than those recalled without it. True, Lawson had cued his subjects briefly and directly; but in many cases the therapists who routinely deal with alien abductions cue their subjects, some in great detail, others more subtly and indirectly. The psychiatrist George Ganaway (as related by Lawrence Wright) once proposed to a highly suggestible patient under hypnosis that five hours were missing from her memory of a certain day. There are many other examples, some a spurious memory of being lost as a child in a shopping mall, for instance of greater emotional impact. False memories can be implanted even in minds that do not consider themselves vulnerable and uncritical. The child who, when first asked, cor rectly denies having caught his hand in a mousetrap later remem bers the event in vivid, self-generated detail. Is there any reason to think that adults are wholly immune to the fallibilities exhibited by children? On many occasions in his Presidential campaigns, Mr Reagan told an epic story of World War Two courage and sacrifice, an inspiration for all of us. Only it never happened; it was the plot of the movie A Wing and a Prayer that made quite an impression on me, too, when I saw it at age 9. It is not hard to imagine serious public dangers emerging out of instances in which political, military, scientific On the Distinction between True and False Visions or religious leaders are unable to distinguish fact from vivid fiction. Or it may no longer correspond, even in its major features, to what really happened. If we sew cleverly enough, we have made ourselves a memorable story easy to recall. The situation is rather like the method of science itself where many isolated data points can be remem bered, summarized and explained in the framework of a theory. In science the theories are always being reassessed and con fronted with new facts; if the facts are seriously discordant beyond the error bars the theory may have to be revised. But in everyday life it is very rare that we are confronted with new facts about events of long ago. More than gods and demons, the best-attested apparitions are those of saints, especially the Virgin Mary in Western Europe from late medieval to modern times. Christian Jr in his book Apparitions in Late Medieval and Renaissance Spain (1981). Alternatively, in plague-infested times, Mary promises to cure the disease but only if her request is satisfied. But when she informs her father or husband or priest, she is ordered to repeat the story to no one; it is mere female foolishness or frivolity or demonic halluci nation. Days later she is confronted again by Mary, a little put out that her request has not been honoured. In one case the testimony of a delirious eight-year old boy, taken two days before his death from plague, was soberly accepted. Thus anyone seeing a vision disturbing to those in power was ipso facto an unreliable witness, and saints and virgins could be made to say whatever the authorities wanted to hear. The fervour of pilgrims in such shrines was impressive; it was not uncommon for rock scrapings or dirt from the shrine to be mixed with water and drunk as medicine. Almost all the urgent requests by Mary were remarkable for their prosaicness for example, in this 1483 apparition from Catalonia: I charge you by your soul to charge the souls of the men of the parishes of El Torn, Milleras, El Salent, and Sant Miquel de Campmaior to charge the souls of the priests to ask the people to pay up the tithes and all the duties of the church and restore other things that they hold covertly or openly which are not theirs to their rightful owners within thirty days, for it will be necessary, and observe well the holy Sunday. The matter was addressed in the Siete Partidas, the codex of canon and civil law compiled under the direction of Alfonso the Wise, king of Castile, around 1248. In it we can read the following: Some men fraudulently discover or build altars in fields or in towns, saying that there are relics of certain saints in those places and pretending that they perform miracles, and, for this reason, people from many places are induced to go there as on a pilgrimage, in order to take something away from them; and there are others who influenced by dreams or empty phantoms which appear to them, erect altars and pretend to discover them in the above named localities. In listing the reasons for erroneous beliefs, Alfonso lays out a continuum from sect, opinion, fantasy and dream to hallucination. Clearly, the secular and ecclesiastical authorities, even in times of extreme credulity, were alert to the possibilities of hoax and delusion. From which could follow the seduction of peoples, the inception of new sects, and many other impieties that subvert the Church and Catholics. For poor peasants whose visions had no political content, the punishments fell short of the ultimate severity. But in deference to certain just reasons that move us to mitigate the rigour of the sentences we decree as a punish ment to Francisca la Brava and an example to others not to attempt similar things that we condemn her to be put on an ass and given one hundred lashes in public through the accustomed streets of Belmonte naked from the waist up, and the same number in the town of El Quintanar in the same manner. And that from now on she not say or affirm in public or secretly by word or insinuation the things she said in her confessions or else she will be prosecuted as an impenitent and one who does not believe in or agree with what is in our holy Catholic faith. Despite the penalties, it is striking how often the witness stuck to her guns and, ignoring the encouragements offered her to confess 138 On the Distinction between True and False Visions that she was lying or dreaming or confused, insisted that she really and truly had seen the vision. In a time when nearly everyone was illiterate, before news papers, radio and television, how could the religious and icono graphic detail of these apparitions have been so similar? William Christian believes there is a ready answer in cathedral dramaturgy (especially Christmas plays), in itinerant preachers and pilgrims, and in church sermons. People sometimes came from a hundred miles or more so that, say, their sick child could be cured by a pebble that had been trodden on by the Mother of God. In a time haunted by drought, plague and war, with no social or medical services available to the average person, with public literacy and the scientific method unheard of, sceptical thinking was rare. The content of the communication is, despite its purported celestial origin, mundane. The witnesses, often females, are troubled about speaking out, especially after encountering ridicule from males in positions of authority. In I Am With You Always: True Stories of Encounters with Jesus (Bantam, 1995), first-hand accounts, some moving, some banal, of such encounters are laid out. If you dreamed it, if it felt good, if it elicited wonder, why then it really happened. Note there are no therapists touting the reality of needles in cans and urging their patients, subtly or directly, to go public with the news. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts. Why do they believe these witnesses but not those who reported, with comparable conviction, encounters with gods, demons, saints, angels and fairies? Moreover, such experiences were likely to be generated and interpreted as real events rather than imagin ings when they were associated with restricted sensory envi ronments. What a more critical mind might recognize as a hallucination or a dream, a more credulous mind interprets as a glimpse of an elusive but profound external reality. Therapists who take the alien abduction stories at face value deny this, saying they would know if their patients were sexually abused. Some estimates from opinion surveys range as high as one in four American women and one in six American men have been sexually abused in childhood (although these estimates are prob ably too high).

Leaves are boiled muscle relaxant g 2011 cheap baclofen 25 mg, and the water used as a treatment for chicken pox muscle relaxant 500 mg discount 25 mg baclofen, by the Guyana Patamona zma muscle relaxant order baclofen line. Macerated leaves are boiled and used for washing the skin as a treatment for measles muscle relaxant commercial generic 10mg baclofen with visa, by the Guyana Patamona. Latex: Latex is used for treating venereal diseases, especially syphilis, by the Guyana Patamona. In preparations for diarrhoea, dysentery, diabetes, low blood pressure, fractures; seedling is a mild purgative. In French Guiana, an infusion is drunk three times daily as an hypotensive; decoction with sodium sulphate is drunk to remedy cutaneous eruptions. Surinam Tirio women wash with a cold water infusion of the bark to "fall out of love". Juice from macerated leaves is applied to cuts and wounds to stop bleeding, by the Guyana Patamona. Leaf and Stem: Macerated leaves and stem are boiled and used as an antiseptic for wounds and sores, by the Guyana Patamona. Juice from macerated leaves and stem is applied onto persistent sores for healing, by the Guyana Patamona. Leaf: Leaves are warmed and used as an analgesic for hard boils, by the Guyana Patamona. Macerated leaves are warmed and applied onto sores for healing, by the Guyana Patamona. Leaf: Crushed leaves are applied externally to treat snakebite, thrush, ulcers, and to hasten the opening of boils. Fruit contains vochysine, an unusual pyrrolidinoflavan composed of an alkaloid and a flavan (135A). In Guyana, the inner bark is powdered in a decoction to cleanse ulcers and relieve sore eyes. Leaf: In French Guiana, leaves are soaked in vinegar, then crushed and used to remedy impetigo. Surinam Creole: nengrekondre-pepre, nengre kondre pepre, ningre kondre pepre, ningre-kondre-pepre. Macerated with Justicia secunda in a decoction used as a laxative and a general medicine. Seeds, usually preserved in brandy, are chewed to treat grippe and slight abdominal pains. Pulverised seeds used in an enema for constipation pains, and mixed with mustard oil in an ointment for arthritis pains. Pulverised with seeds of Piper nigrum and coconut oil for an ointment used to treat general swelling and pains. Crushed in citron juice and employed for 289 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) glandular problems. Leaf: Decoction used as a fever-bath for pulmonary conditions and typhoid, and to wash hair to remove dandruff. Leaves are used in an infusion to treat dysentery, and in a herbal bath for strengthening the nerves. Root: Decoction used as an emetic to bring up phlegm from throat, and to alleviate consumption. Root is boiled with water and drunk as a cure for malarial infection, by the Guyana Patamona. Fruit: Fruits are used as an anti-fungal agent for curing ringworms and “lata”, by the Guyana Patamona. Fruit is crushed, and used as an anti-fungal or as an anti-pruritic, by the Guyana Patamona. Fruit is crushed, mixed with water, and used to treat dermatosis, by the Guyana Patamona. Fruits are crushed, and the juice used to treat genital herpes or to treat sores, by the Guyana Patamona. Liquid squeezed out of boiled leaves is inhaled by the Surinam Tirio to treat colds. Stem and Leaf: Decoction is used in a bath or wash to alleviate fatigue, as a febrifuge, and as a disinfectant for itches, sores, and the ulcers of leishmaniasis. Leaf: For a rarely employed oral abortifacient, the French Guiana Wayapi mix the leaves with leaves of Citrus aurantiifolia and Ocimum micranthum in a concentrated decoction. Inflorescence: Mixed with the inflorescence of Lantana camara in a tea-like decoction to counteract flatulence. Macerated and mixed with rum or vermouth, and the resulting beverage is drunk to alleviate rheumatic pain. Boiled with leaves of Cymbopogon citratus and Bambusa vulgaris and the liquid consumed to treat fever and ague. Boiled in a decoction with the fruit of Justicia secunda and Piper nigrum for a remedy to menstrual pains. A preparation containing ginger, known as "fiery-jack ointment", is made in Guyana. Rhizome: French Guiana Palikur use it in a plaster to relieve headaches; digestive; rubbed on rheumatic areas; sudorific. In Surinam, the rhizome is mixed with other spices for asthma, cramps and stomachache. Rhizome is used for making beverages or for flavoring food, by the Guyana Patamona. Rhizome is grated, mixed with water, and dropped in the nostrils for treating colds or dropped into the eyes for curing migraine headaches, by the Guyana Patamona. Rhizome and Leaf: In a decoction with parched seeds and leaves of Jatropha curcas for use in treating menstrual pains. A multidisciplinary overview of intoxicating snuff rituals in the Western Hemisphere. Ethnobotany and Conservation of the Tropical Forest with Special Reference to the Indians of Southern Suriname. New Plant Sources for Drugs and Foods from the New York Botanical Garden Herbarium. Isolation and structural elucidation of allamandine, an antileukemic iridoid lactone from Allamanda cathartica. Steroids and triterpenes from Alangium lamarckii, Allamanda cathartica, Abrus precatorius and Holoptelea integrifolia. The ethnobotany of the Paumari 296 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) Indians. Five plants of the family Cucurbitaceae with flavonoid patterns of pollens different from those of corresponding stigmas. Effect of Momordica charantia on the glucose tolerance in maturity onset diabetics. Occurrence of flavonol 5-methyl ethers in higher plants and their systematic significance. A note on the isolation and identification of two pharmacologically active constituents of Euphorbia pilulifera. Screening of medicinal plants of Rwanda (Central Africa) for antimicrobial activity. Ocimum sanctum: an experimental study evaluating its anti-inflammatory, analgesic and antipyretic activity in animals. Ocimum sanctum: a preliminary study evaluating its immunoregulatory profile in albino rats. Isolation and structure of longistylines A,B,C and D, new prenylated stilbenes from Lonchocarpus violaceus. Effect of neem seed oil on blood glucose concentration of normal and alloxan diabetic rats. Preliminary pharmacological evaluation of extracts of takini: Helicostylis tomentosa and Helicostylis pedunculata. Evolution of the identification of the myristicaceous hallucinogens of South America.

Deficiency: Uncomplicated deficiency is characterised by symptoms such as sore tongue muscle relaxant modiek order baclofen now, weakness muscle relaxer ketorolac baclofen 10mg fast delivery, loss of weight muscle relaxant in pregnancy order genuine baclofen online, tingling of extremities back spasms 34 weeks pregnant generic baclofen 25mg on-line, apathy, mental and other nervous abnormalities. When there is a lack of intrinsic factor, essential for the absorption for the vitamin, pernicious anaemia results, in which there is degeneration of the spinal cord. Ascorbic Acid (Vitamin C) Ascorbic acid (vitamin C) was isolated and its chemical structure elucidated in 1932 by C. In olden days, sailors to whom fresh fruits and vegetables were not available for many days during long voyages at sea developed this disease. It is reported that 100 out of the 180 men who sailed with Vasco da Gama, died of scurvy before they reached India in 1498. It is comparatively stable in an acid medium but is destroyed by the action of heat, oxygen and catalysts such as copper. Thus it plays an important role to build and maintain strong tissues in general, especially connective tissues (bone, cartilage, dentin, collagen, etc). High concentrations of vitamin C are found in metabolically active tissues in the body, indicating its importance in their function. Being a strong reducing agent, it helps to tie up free radicals and thus protects the body from their deleterious effects. Sources: Amla (nellikai, also called Indian gooseberry) is one of the richest sources of ascorbic acid, which contains 600 mg/100 g of the fruit. Citrus fruits such as oranges, sweet lime, grape-fruit and pomelo are also excellent sources of ascorbic acid. Leafy vegetables such as drumstick leaves, amaranth, cabbage, which are more frequently available, are excellent sources of vitamin C (Figs. Sprouted pulses such as Bengal gram and green gram are good sources and have proved to be of value during drought and famine conditions when other sources of ascorbic acid, such as fresh fruits and vegetables are not available. It is not stable in alkaline pH, so soda should not be added in food preparation to prevent loss. C Fruits mg/100g mg/100 g Amla 600 Drumstick leaves 220 Guava 210–310 Capsicum 137 Cashew fruit 180–210 Drumstick 120 Orange juice 64 Bitter gourd 88 Limes 63 Knol-khol 85 Papaya 57 Radish leaves 81 Mausambi 50 Cabbage 55 Lemon, sweet 45 Methi leaves 52 Pineapple 39 Cluster beans 49 Plantain 20 Tomato, ripe 27 Mango 16 Potato 17 Bananas, Sapota 7 Other beans 25 Apples, Grapes 1 Water-soluble Vitamins 111111111111111 Figure 9. The recommended daily allowance increases with age from 20 to 40 mg for children and is 40 mg per day for adult. The amount recommended is liberal, as ascorbic acid is a very labile nutrient (Table 9. Tiny breaks occur in the walls of very small blood vessels and haemorrhages result. Spongy gums and haemorrhages in body tissues are other symptoms of scurvy; these can be reversed by including ascorbic acid rich foods in the diet. List the requirements of the following nutrients: (i) Thiamin (ii) Riboflavin (iii) Niacin. The increase in the number of fractures in the elderly as also the incidence of high blood pressure are also pointers that focus one’s attention on minerals, calcium and sodium. A liberal inake of calcium, with increased mobility and exposure to sunlight is known to improve the strength of bones and thus reduce their fragility. A reduction in sodium intake can be one of the helpful factors in reducing hypertension. Though advertisements for dietary supplements may lead you to believe that these may be the answer to the problem, it is not so. Nature and Composition As you may know from your elementary chemistry course, minerals are inorganic substances. So far we have studied nutrients, (carbohydrates, fats, proteins and vitamins), which are organic compounds. In bones and teeth the minerals calcium and phosphorus are deposited in protein material. The mineral elements found in the body form only 4 to 6 per cent of the weight of our adult body. Of this 90 per cent is accounted for by seven minerals (calcium, phosphorus, potassium, sulphur, sodium, chloride and magnesium). The other minerals are known as trace elements, as these add together to about 10 per cent of the total mineral content of the body. Minerals are also found in soft tissues such as nerves and muscles and in blood and other body fluids. Major and Trace Minerals 117117117117117 General Functions of Minerals Some minerals play an important role in the regulation of body functions. Minerals do not act singly in their function and regulation of body processes, but work with the help of other minerals and organic compounds. A certain concentration of each element must be present for efficient functioning of the body. Some of the important tissue formations and processes in which mineral elements function in unison are discussed below. This will be followed by a discussion of each important mineral element and its specific functions. Bones and teeth are formed of tough protein material into which minerals are deposited. Most of the bone formation (ossification) in the foetus occurs in the eighth and ninth months of pregnancy. Throughout the growth phases (childhood, adolescence and early adulthood) the bones become long, thick and increase in hardness. Thus the blood levels of these minerals are maintained by withdrawal of these elements from the bone. The minerals provided in the diet replace those withdrawn and thus help to maintain the bone structure. Thus even in bones, there is a continuous process of maintenance and repair of the tissue. Soon after birth up to about third birthday, the permanent teeth are formed, while wisdom teeth are formed between the eighth and tenth year. Tooth enamel and dentine contain an appreciable quantities of calcium and phosphorus. As these parts do not contain blood vessels, a decayed tooth cannot repair itself. Hence the only way to ensure the health of teeth is to take care of the teeth and prevent decay. Structural Components of Soft Tissues: Many mineral elements are found in the structural components of soft tissues. As Components and Co-factors of Vitamins, Hormones and Enzymes: Various regulatory compounds contain very small amounts of mineral elements as constituents. For example, sulphur is part of many important compounds such as thiamin (a B vitamin) and coenzyme A. Vitamin B12 contains cobalt; the enzyme carbonic anhydrase contains zinc and the hormone thyroxine contains iodine. Incorporation of iron into haemoglobin needs copper, while the synthesis of insulin in the pancreas needs zinc. Muscle Contraction and Response of Nerves are regulated by the mineral elements (sodium, potassium, calcium and magnesium), present in body fluids in definite amounts. Normal response of nerves to physiological stimuli are also regulated by these mineral elements. Control of Water Balance: Sodium and potassium are responsible for the control of water balance between the inside and outside of cells. Potassium is mainly found in the fluid inside the cell, while sodium is chiefly found in the fluid outside the cell. Maintenance of Acid-Base Balance: It is very important to maintain a constant pH in the body fluids at all times to ensure normal function of our body. This function of mineral elements in maintaining acid-base balance is discussed in detail in Chapter 11. Dynamic Equilibrium As in the case of other nutrients, there is a continuous turnover of minerals in body tissues; they take up minerals, synthesise new compounds and discharge waste matter.

When optimally linked to lifestyles muscle relaxant 303 discount generic baclofen canada, moving back and forth from larger cities the clinic–based team muscle relaxant tl 177 buy discount baclofen 10mg online, they can be the eyes spasms near kidney baclofen 25 mg without a prescription, ears and to the reservation due to interrelated factors such arms of the provider spasms of the larynx buy discount baclofen 10 mg on-line, helping patients follow their as employment, substance use, medical illness and providers’ treatment plans, including adherence to family support. Not surprisingly, achieving good medications, appointments, and healthy lifestyles. Monthly team speak their native language, and are familiar with meetings allow efficient case discussion and devel traditional customs. A pharmacist may be able to to an elder—patiently sitting with someone who confirm missed refills, while case managers aide has little opportunity to be heard in a rushed clinic in coordinating substance abuse treatment and a visit—allows opportunities for true communication. This team–based lizing community outreach workers was instituted approach ensures that there is comprehensive Delivering Health Care in Severely Resource–Constrained Settings 89 care and consistent communication to the patients inspire others to help us pursue life–long careers in among different team members. The task is daunting; it is also a privilege migrate from service unit to service unit, there is with infinite rewards. Early United States as a formal collaboration between Brigham and Government Interest in Native American Health. Moral Responsibility in a Context With increasing awareness and sensitivity of Scarcity: the Journey of a toward issues of global health, disparities within the Haitian Physician United States are often overlooked. It is our job, as physicians who believe in health equity for Native Paul Pierre Americans, to advocate for this long–neglected minority group. We must support ongoing local efforts to build communities in addition to treat lmost all Haitian physicians have been ing our patients in the office. We must also raise involved in some sort of “social move broader awareness about the hardships facing our A ment” at one point in their professional patients and lobby for change. In a country characterized by a natural incli with academic institutions and educate our physi nation to question authority, fighting the status cians–in–training about the work that we do, and quo of the ineffective, corrupt and disorganized 90 Narrative Inquiry in Bioethics. Fall 2012 Haitian health system often appears to be the right temporary actors performing in the cynical play of thing to do. In 2002, I played an active role in a large protest the social movement that we started ended up movement for better working conditions at the hurting the very same people that we were trying largest health facility in Port–au–Prince: the Gen to help. Port–au–Prince is the capital Extending access to heath care to poor people and economic center of Haiti. It is home to close seemed to me at that time to be too complicated and to a third of Haiti’s ten million people. Drug and medical supply resources are so limited in “resource–limited” coun stock–outs were routine. Unsu options we were provided were not real ones—since pervised physicians in training (like me) were the all of them would end in more suffering. Attending physicians of providing health care to poor people needed to were busy running their own private clinics, and be approached differently. I am the physicians–in–training, we had the responsibility of third of four children, and the first male child in my caring for the poor, but we had no means. My father made me understand very clearly frustrated and angry witnessing our powerless that my first responsibility was for my siblings. On many occasions, I had the parents of my that I had no authority over any of them. I ended patients buy the gloves that I would use to examine up with a lot of responsibility but with very little their sick relatives. The few of us who completed school, the inheritance of medications left by others who entered university, studied abroad and “emerged” had just passed away. There was no way for this were considered, to some extent, responsible for the hospital to fulfill its mission, and no way for its staff others—the ones who couldn’t go to school, uni to deliver anything other than mediocre care. All the luck, in our medical development, and so we refused to intelligence and education of Haiti was invested continue to work. We are community assets and are pletely paralyzed the delivery of care at the hospital expected to deliver. I was in rural tation of the agreement was permanently delayed Haiti performing a required one–year medical by other competing “state emergencies” including residency program called the “social service. We were would choose first and often would try to stay as Delivering Health Care in Severely Resource–Constrained Settings 91 close to Port–au–Prince as possible. Poor Hinche, a dead–end town, located six hours from people living in an underserved place like Cange Port–au–Prince in the dry season and an unpre were likely to remain poor because they have little dictable amount of time during the rainy season. Only the State had the legitimacy to my grades, which while not among the highest address sustainably and equitably all these issues. However, I was away the day when we in resource–limited countries should have as its had to choose, and was left to pick among what core strategy to be supportive of the public sector. Since, I’ve been working to help poor communities Hinche was my first rural experience as a physi realize their socio and economic rights by providing cian. I was working in a 100 bed district hospital in direct primary care and supporting advocacy efforts a state of ruin. There was no electricity in the city that promote the sharing on the basis of needs, of but the hospital had a generator and a German aid resources, and technologies that humanity have organization donated fuel for daily operations. In practice, erful earthquake struck Port–au–Prince, killing the backup system was only used to power the 316,000 and injuring as many more. One night, I became so the earthquake, I was working as a primary care frustrated trying to do surgical procedures on a physician and community organizer in rural Africa. When I hit the door, it collapsed, along team in charge of organizing health care services with the wall around it. We to my patient to finish the job, reinvigorated by decided to focus our efforts on trying to deliver the precious technology. He was terrified that all the equipment kept marginalization, extreme poverty, and violence are there would be stolen and he would lose his job. We were interested in helping I barely fought when the director of the hospital to break the causality fundamentally entrenched and the administrator decided to hold my monthly in this association. The “reputed danger in the right war, but I was definitely fighting the ous” people that we found were extremely poor wrong battle. They lacked everything I was provided with the option of working but civility and gratitude. We quickly established peacefully at a clean health facility in the small systems that allowed us to hire more than 500 town located 35 km south of Hinche in September staff members, including more than 40 physician 2003. We began to its local partner organization, Zanmi Lasante, the offer comprehensive primary health care services Bon Sauveur Clinic offered comprehensive and that included psychosocial accompaniment, basic dignified primary care services to vulnerable people laboratory services, and drugs. Everything environmental conditions—especially for children was running at full capacity by February 15th. In and elderly people, in a desert area where summer 2010, these four clinics ended up serving more than temperatures easily reach 131°F. I am honored to be part of the global In addition to this dramatic exodus, a real war health movement that is trying to make the world followed between Polisario Front army (the political better by working relentlessly to overcome social representative of Saharawi people) and Moroccan injustice through human solidarity. This lasted until 1991, when a cease–fire armistice was signed, in view of a subsequent ref erendum for auto determination (never celebrated). Consequences of these complex events were terrible: victims of the war, victims of the exodus, displacement of Saharawi society and families (the Delivering Health Care in Saharawi majority of Saharawis still live in their homeland Refugee Camps Near Tindouf (Algeria) under a rigid occupation by Moroccan army and Vincenzo Pezzino suffer violation of fundamental human rights), precarious life in refugee camps (mostly tents and sand–made huts), poverty, food deprivation, unsafe Introduction drinking water from wells, lack of essential services, In the years 1991–2002 I visited the Saharawi and so on. The objective (including vaccinations) were gradually organized of these visits was to provide medical assistance with some success. However, health care services in various areas of health care and organize more remain far below the standards of western coun effective health care services. Essential drugs, diagnostic tools and instru 8–12 days in this territory, either alone or as part ments, and specialists are largely needed. These Solidarity for the Saharawis’ terrible life condi medical missions, were organized by “Al Awda,” tions prompted me and other colleagues to offer our an association of solidarity for Saharawi people, medical expertise to help providing better health located in Catania, Italy. I have always been concerned by the disparity services were provided during each of these trips. My efforts could be only a drop of water in the Context ocean, but the ocean is made of drops. My contact About 170,000 Saharawi people have been living with the Saharawi population, their welcome, and in this region since 1976, when they escaped from my life in these refugee camps—all this experience Moroccan occupation of Western Sahara (formerly markedly increased my commitment to providing Spanish Sahara), a large territory (266,000 sq. Since then, Saharawi people have been To my eyes the Saharawi people appeared as a camped in Algerian territory, under prohibitive proud and dignified population, who were firmly Delivering Health Care in Severely Resource–Constrained Settings 93 seeking for a peaceful and legal solution of their presence and the types of consultation I could offer struggle. Their objective is to be recognized by the as an endocrinologist—diabetes, thyroid diseases, international community as an independent popu and infertility. As a matter of fact, these areas cover lation, with the right of self–determination and to the vast majority of endocrine disorders all over the return to their homeland, where they would like world. People that needed to be examined came and to build up a new country inspired by democracy sat down on the floor, either inside or outside the and freedom. The Saharawis’ dramatic vicissitude building, waiting their turn for consultation.

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