Prevention: So Many Mosquitoes, Only So Many Nets

Simple as they are, even mosquito nets generate complicated numbers games.
Only one answer is easy: more are needed.

Last Friday, as part of the first official World Malaria Day, United Nations Secretary General Ban Ki-moon called for “universal coverage” by 2010.

For simplicity’s sake, most experts go along with an estimate — that the world needs about 250 million nets at about $10 each.

That is for the current United Nations goal of having 80 percent of all pregnant women and children under age 5 who live in malarial areas under nets.

The goal is somewhat arbitrary, since the ideal would be nets for all, but that would more than double the cost.

The age 5 cutoff is used because older children usually develop some resistance through repeated infection. But some experts fear a surge in deaths of children 6 and up once they “outgrow” nets. About a million people, mostly children, die of malaria each year.

The 80 percent goal contains a safety margin: research suggests that when more than 60 percent of a village’s homes use insecticide-filled nets, mosquitoes die off instead of just biting unprotected neighbors.

Nick Cave Digs Himself a Singular Niche

Nick Cave, from "Down Under", has a new CD out!
He is a gifted song writer in the style of Lou Reed..


One of my favorite songs of his is "As I Sat Sadly By Her Side"
Melodramatic melodic structure accompany lyrics such as:

"But watch the one falling in the street
See him gesture to his neighbours
See him trampled beneath their feet
All outward motion connects to nothing
For each is concerned with their immediate need
Witness the man reaching up from the gutter
See the other one stumbling on who can not see"

With trembling hand I turned toward her
And pushed the hair out of her eyes
The kitten jumped back to her lap
As I sat sadly by her side"

Here is a Youtube link:

Mr. Mugabe's Violence

THE EVIDENCE is now overwhelming that the Zimbabwean regime of Robert Mugabe is engaged in a massive, orchestrated and brutal campaign to punish and terrorize its opponents.
(..)
n some areas, torture camps have been established where victims are taken and beaten while their homes are looted and burned.
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. While the bureaucrats drag their feet, Mr. Mugabe's campaign of terror continues in the countryside -- and virtually ensures that if a presidential runoff is held it will not be free or fair. "What we are witnessing constitutes a form of rigging," said the chairman of the human rights association.
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In few places in the world could such a brazen operation proceed without triggering intervention by neighbors or the United Nations. Sadly, Zimbabwe remains one of those places, largely because the president of its most powerful neighbor, Thabo Mbeki of South Africa, has chosen to shield Mr. Mugabe from pressure. Though the U.N. Security Council finally met to consider the Zimbabwean situation yesterday, it did so in private and issued no statement -- because its current chairman happens to be from South Africa. The Southern African Development Community has been similarly stymied, even though its chairman, Zambia's Levy Mwanawasa, has courageously stood up against Mr. Mugabe.

Beautiful website

This site beautifully showcases a very talented wedding photographer...

Nothing But Nets

This website was mentioned in the comment section of the post on World Malaria Day.
This is a neat website that deserves its own entry.
Play a game and help someone get an insecticide treated bed net--great concept!
(I love the interconnection of our time through the internet!)

We’ve got another way for you to get in the game and help prevent malaria! All you have to do to help save a life is play Deliver the Net, a cool new game created by the UN Foundation to commemorate World Malaria Day, April 25th. The challenge: race the sun and hand out as many insecticide-treated bed nets as you can to African families. The more nets you deliver – before the mosquitoes come out – the more lives you save. Once you’re done playing the game, sign up, confirm your email, and a life-saving bed net will be sent on your behalf!*

FDA takes closer look at complaints from Lasik customers

This should provide additional quality information about the procedure for patients as well as the ophthalmologists who perform this procedure (I don't).
Most studies I have read have demonstrated >95% satisfaction with the procedure by patients who have had it done. I am curious what prompted the FDA to get involved--what were the issues behind the scene that led the FDA to look into this particular procedure of all the surgical procedures that are performed across the board.
I personally don't at all mind wearing glasses and thus have never considered having the procedure.

WASHINGTON - A decade after Lasik eye surgery hit the market, patients left with fuzzy instead of clear vision are airing their grievances before federal health officials.


Make no mistake: Most Lasik recipients do walk away with crisper vision, some better than 20/20.

But not everyone's a good candidate, and an unlucky few do suffer life-changing side effects: poor vision, painful dry eyes, glare or problems seeing at night.

How big are the risks? The Food and Drug Administration thinks about 5 percent of patients are dissatisfied with Lasik. How many struggle daily with side effects? How many are just unhappy that they couldn't completely ditch their glasses? The range of effects on patients' quality of life is a big unknown.
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But doctors advise against Lasik for one in four people who seek the surgery. Their pupils may be too large or corneas too thin or they may have some other condition that can increase the risk of a poor outcome.

Solomon estimates that fewer than 1 percent of patients have severe complications that leave poor vision. Other side effects, however, are harder to pin down. Dry eye, for instance, can range from an annoyance to so severe that people suffer intense pain and need surgery to retain what little moisture their eyes form. That's the kind of question the FDA's new study is being designed to answer.

United Airlines, FedEx donate plane for new Flying Eye Hospital

ORBIS, a non-profit development organisation dedicated to saving sight worldwide, announced yesterday it would replace its current DC-10 Flying Eye Hospital with a DC-10 Series 30 freighter, with United Airlines and FedEx donating the aeroplane.
The $US 2 million donation is based on the plane’s estimated value and being funded equally by United and FedEx.

Pay Attention! Brain Scanners Detect Slip-Ups Before You Do

A mindless mistake on a monotonous task may feel like a momentary glitch, but its mental roots run deep.

In a study published today in the Proceedings of the National Academy of Sciences, researchers used fMRI machines to record neurological patterns preceding careless errors.

The recordings revealed a cascade of shifting activity in the parts of the brain associated with focusing attention and maintaining routines. Researchers observed test subjects' minds going on autopilot up to half a minute before the subjects actually made mistakes, even though the subjects weren't aware of their own lapses of attention.

From Boston to Burma, with vision

Dr. Bill Ragan, a wonderful anesthesiologist, gives his perspective on the Orbis trip to Burma in this article published in The Boston Globe. He writes well, capturing the feeling of the country as well as the reward of treating the patients...

Across Globe, Empty Bellies Bring Rising Anger

In Cairo, the military is being put to work baking bread as rising food prices threaten to become the spark that ignites wider anger at a repressive government. In Burkina Faso and other parts of sub-Saharan Africa, food riots are breaking out as never before. In reasonably prosperous Malaysia, the ruling coalition was nearly ousted by voters who cited food and fuel price increases as their main concerns.

“It’s the worst crisis of its kind in more than 30 years,” said Jeffrey D. Sachs, the economist and special adviser to the United Nations secretary general, Ban Ki-moon. “It’s a big deal and it’s obviously threatening a lot of governments. There are a number of governments on the ropes, and I think there’s more political fallout to come.”

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Leaders who ignore the rage do so at their own risk. President René Préval of Haiti appeared to taunt the populace as the chorus of complaints about la vie chère — the expensive life — grew. He said if Haitians could afford cellphones, which many do carry, they should be able to feed their families. “If there is a protest against the rising prices,” he said, “come get me at the palace and I will demonstrate with you.”

When they came, filled with rage and by the thousands, he huddled inside and his presidential guards, with United Nations peacekeeping troops, rebuffed them. Within days, opposition lawmakers had voted out Mr. Préval’s prime minister, Jacques-Édouard Alexis, forcing him to reconstitute his government. Fragile in even the best of times, Haiti’s population and politics are now both simmering.
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The Poor Eat Mud:
In Haiti, where three-quarters of the population earns less than $2 a day and one in five children is chronically malnourished, the one business booming amid all the gloom is the selling of patties made of mud, oil and sugar, typically consumed only by the most destitute.

“It’s salty and it has butter and you don’t know you’re eating dirt,” said Olwich Louis Jeune, 24, who has taken to eating them more often in recent months. “It makes your stomach quiet down.”

Discussion Panel on Human Rights at KSU

Wow--I find this very cool!

Discussion Panel on Human Rights at KSU

World Malaria Day April 25

As per Dr. Jeffrey Sachs at the UniteforSight conference at Yale, there may be some major malaria eradication programs announced around the time of World Malaria Day.

If you want to help, consider contributing to World Vision...

Death doesn't knock, it buzzes.

Your gift will multiply 8 times it's value and help provide life-saving medicines and supplies to to fight malaria and other child killers.

Deadly malaria is spread through the unfelt bite of a mosquito, and it claims more than one million innocent lives each year. What's especially tragic is that malaria is both preventable and treatable, but many parents lack the basic tools and medicines to keep their children safe and healthy.

Jackie Greene

For local Reno denizens, a great young talent, Jackie Greene, is coming to Bartley Ranch--a great outdoor venue.
I was initially turned onto Jackie Greene, by my good friend Albert Vitale, who several months ago flew in with his wife from Salt Lake City to join us for a Jackie Greene show at the Crystal Blue Club in Lake Tahoe. It was a great show--with great energy and musicianship.

Jackie combines the troubador style of Johny Cash, the lyrical wit of Bob Dylan, and the energy of Bruce Springsteen to create a very unique style.

Check him out!

A Worsening Food Crisis

THE WORLD'S most dangerous conflicts stem from religion and ideology -- tragic proof that man does not live by bread alone. But when bread is hard to get, that, too, causes unrest. And lately, it has been very expensive indeed: The World Bank estimates that global food prices have risen 83 percent in the last three years. Hence, food riots in Haiti, Egypt and Ethiopia and the use of troops in Pakistan and Thailand to protect crops and storage centers. Many countries are banning or limiting food exports. World Bank President Robert B. Zoellick says that 33 countries are at risk of food-related upheaval. Famine may revisit North Korea, parts of Africa or, disastrously for U.S. foreign policy, Afghanistan.
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To many, the villain is biofuels. U.S. and European ethanol programs, intended as an antidote to climate change and an alternative to OPEC oil, stand accused of snatching food from the world's hungry.
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But ethanol's impact should not be overstated. The International Food Policy Research Institute, which is critical of ethanol, pins about 25 to 33 percent of the recent price rise on biofuels; the U.N. Food and Agriculture Organization guesses about 10 to 15 percent. Most of the crisis is rooted in three other factors: drought in grain-exporting Australia; the surging price of crude oil, which raises food prices through the costs of shipping and petrochemical fertilizer; and booming demand for food in China, India and other newly prosperous areas of the developing world. These areas consume not only more staples such as rice and wheat but also more meat from animals fed on grain. This trend is here to stay -- and, unlike Australian drought or oil inflation, no one should want it to go away. Lifting hundreds of millions of Asians out of poverty is a historic achievement.
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To cope with the current situation, the United States must contribute its share to help the U.N. World Food Program fill a $500 million gap in its budget. Congress should change U.S. law to let U.S. aid buy food in developing countries themselves, which could boost local producers. Looking further ahead, the U.S. and multilateral institutions must also support greater investment in farming in the developing world, including funding for research into improved crop yields, which has been in steady decline over the last 25 years.

Today's crisis could be tomorrow's opportunity. If the era of cheap food is over, higher prices might stimulate local agricultural production in Africa and other places that now depend on imports. This will be likelier if the United States and Europe finally dismantle the wasteful crop subsidies and trade barriers that fatten their farmers' bank accounts -- but distort international markets at the expense of the poor.

When an Upset Stomach Roils Your Trip

Up to 60 percent of travelers to developing countries suffer bouts of diarrhea, often from unsanitary food and water.

Studies have failed to show that better meal hygiene prevents stomach problems.

An antibiotic called Xifaxan has been approved to treat traveler’s diarrhea; many doctors prescribe it for prevention as well.

Orphan boy lives in garbage dump

CNN)--He doesn't know how old he is, but he thinks he's 7. His name is Khin Zaw Lin. He's lived in a garbage dump virtually his entire life.
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Lin is one of about 300 refugees in the dump who survive on other people's trash. Many are children. Some are women with babies.

Their daily routine follows the same pattern: They mill about the dump, waiting for the next truck to arrive, hoping for enough discarded food to get them through the day.

Lin pokes through the rubbish with a machete. He says he collects bottles and plastic for three cents a sack. He shows me his feet, which were filthy and ribbed with cuts.

He tells me through an interpreter that he can't afford shoes. He walks barefoot through the treacherous landscape.
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Lin is one of about 300 refugees in the dump who survive on other people's trash. Many are children. Some are women with babies.

Their daily routine follows the same pattern: They mill about the dump, waiting for the next truck to arrive, hoping for enough discarded food to get them through the day.

Lin pokes through the rubbish with a machete. He says he collects bottles and plastic for three cents a sack. He shows me his feet, which were filthy and ribbed with cuts.

He tells me through an interpreter that he can't afford shoes. He walks barefoot through the treacherous landscape.
(..)
Lin gives the money to his adopted mother. She tells me that Lin's biological mother gave him to her in Myanmar when he was a baby because she couldn't cope with the responsibility.

Life under the military junta in Myanmar can be brutal. The country's economy is collapsing, and torture and rape under the country's military regime is commonplace. Lin's new mother decided to flee to Thailand in search of a better life. She found a garbage dump instead.

Still, she says scavenging for food in the dump is actually an improvement on her previous life.

As I listen to Lin's story, a question keeps going through my mind: How can a 7-year-old spend his entire childhood in this squalor? Video Watch as Lin and others root through the dump »

Perhaps it's because Lin is invisible -- he doesn't have a passport or papers. He is part of special group of refugees from Myanmar that don't officially exist.
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Near the end of my meeting with Lin, I ask his adopted mother if she, and Lin, would ever escape the rubbish dump.
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Her answer is as hard as the world she and Lin inhabit.

"Never."

Global Warming Rage Lets Global Hunger Grow

A demonstrator eats grass in front of a U.N. peacekeeping soldier during a protest against the high cost of living in Port-au-Prince


We drive, they starve. The mass diversion of the North American grain harvest into ethanol plants for fuel is reaching its political and moral limits.

The reality is that people are dying already," said Jacques Diouf, of the UN's Food and Agriculture Organization (FAO). "Naturally people won't be sitting dying of starvation, they will react," he said.

The UN says it takes 232kg of corn to fill a 50-litre car tank with ethanol. That is enough to feed a child for a year. Last week, the UN predicted "massacres" unless the biofuel policy is halted.

We are all part of this drama whether we fill up with petrol or ethanol. The substitution effect across global markets makes the two morally identical.

The Health Insurance Mafia

Get rid of health insurance? This article in the WSJ from Dr. Kellerman, clinical professor of pediatrics and psychology at USC's Keck School of Medicine suggests we do so.


The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of "protection." But even the Mafia doesn't stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional "cost of doing business" increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service.

Insurance is all about betting against negative consequences and the insurance business model is unique in that profits depend upon goods and services not being provided. Using actuarial tables, insurers place their bets. Sometimes even the canniest MIT grads can't help: Property and casualty insurers have collapsed in the wake of natural disasters.

Health insurers have taken steps to avoid that level of surprise: Once they affix themselves to the host – in this case dual hosts, both doctor and patient – they systematically suck the lifeblood out of the supply chain with obstructive strategies. For that reason, the consequences of any insurance-based health-care model, be it privately run, or a government entitlement, are painfully easily to predict. There will be progressively draconian rationing using denial of authorization and steadily rising co-payments on the patient end; massive paperwork and other bureaucratic hurdles, and steadily diminishing fee-recovery on the doctor end.

Fuel Choices, Food Crises and Finger-Pointing

To quote from Jeffrey Sachs talk at the UniteforSight meeting this weekend:
"Rich countries can put food in gas tanks while the poor can't afford to feed themselves."

The idea of turning farms into fuel plants seemed, for a time, like one of the answers to high global oil prices and supply worries. That strategy seemed to reach a high point last year when Congress mandated a fivefold increase in the use of biofuels.

But now a reaction is building against policies in the United States and Europe to promote ethanol and similar fuels, with political leaders from poor countries contending that these fuels are driving up food prices and starving poor people. Biofuels are fast becoming a new flash point in global diplomacy, putting pressure on Western politicians to reconsider their policies, even as they argue that biofuels are only one factor in the seemingly inexorable rise in food prices.

In some countries, the higher prices are leading to riots, political instability and growing worries about feeding the poorest people. Food riots contributed to the dismissal of Haiti’s prime minister last week, and leaders in some other countries are nervously trying to calm anxious consumers.

(..)

According to the World Bank, global food prices have increased by 83 percent in the last three years. Rice, a staple food for nearly half the world’s population, has been a particular focus of concern in recent weeks, with spiraling prices prompting several countries to impose drastic limits on exports as they try to protect domestic consumers.

Extended Forecast: Bloodshed

The interrelation of climate change and global poverty was a recurring theme in a most amazing speech I heard this weekend at Yale by Jeffrey Sachs, author of "The End of Poverty," and more recently,
Common Wealth: Economics for a Crowded Planet.



Here’s a forecast for a particularly bizarre consequence of climate change: more executions of witches.

As we pump out greenhouse gases, most of the discussion focuses on direct consequences like rising seas or aggravated hurricanes. But the indirect social and political impact in poor countries may be even more far-reaching, including upheavals and civil wars — and even more witches hacked to death with machetes.

In rural Tanzania, murders of elderly women accused of witchcraft are a very common form of homicide. And when Tanzania suffers unusual rainfall — either drought or flooding — witch-killings double, according to research by Edward Miguel, an economist at the University of California, Berkeley.
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There is evidence that European witch-burnings in past centuries may also have resulted from climate variations and the resulting crop failures, economic distress and search for scapegoats. Emily Oster, a University of Chicago economist, tracked witchcraft trials and weather in Western Europe between 1520 and 1770 and found a close correlation: colder weather led to more crackdowns on witches.

(..)

The point is that climate change will have consequences that will be difficult to foresee but will go far beyond weather or economics. There is abundant evidence that economic stress and crop failures — as climate scientists anticipate in poor countries — can lead to violence and upheavals.

In the United States, for example, some historians have found correlations between recessions or declines in farm values and increased lynchings of blacks.

Paul Collier, an Oxford University expert on global poverty, found that economic stagnation in poor countries leads to a rising risk of civil war. Professor Collier warns that climate change is likely to reduce rainfall in southern Africa enough that corn will no longer be a viable crop there. Since corn is a major form of sustenance in that region, the result may be catastrophic food shortages — and civil conflict.

The area that may be hardest hit of all — aside from islands that disappear beneath the waves — is the fragile Sahel region south of the Sahara Desert in West Africa. The Sahel is already impoverished and torn by religious and ethnic tensions, and reduced rainfall could push the region into warfare.

“The poorest people on Earth are in the Sahel, barely eking out an existence, and climate change pushes them over the edge,” Professor Miguel said. “It’s totally unfair.”

His research suggests that a drought one year increases by 50 percent the risk that an African country will slip into civil war the next year.
(..)

The greenhouse gases that imperil Africa’s future are spewing from the United States, China and Europe. The people in Bangladesh and Africa emit almost no carbon, yet they are the ones who will bear the greatest risks of climate change. Some experts believe that the damage that the West does to poor countries from carbon emissions exceeds the benefit from aid programs.

Co-Payments for Expensive Drugs Soar

In ophthalmology, this exact scenario is faced by patients who have to pay 400$ co-pays for Lucentis for Macular Degneration. Fortunately, we have an excellent alternative in Avastin--the total cost of which is less than 50.00 total (vs Lucentis at >2000.00$).


Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.

With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.
(..)
But the result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes.

The World Food Crisis

Most Americans take food for granted. Even the poorest fifth of households in the United States spend only 16 percent of their budget on food. In many other countries, it is less of a given. Nigerian families spend 73 percent of their budgets to eat, Vietnamese 65 percent, Indonesians half. They are in trouble.

Last year, the food import bill of developing countries rose by 25 percent as food prices rose to levels not seen in a generation. Corn doubled in price over the last two years. Wheat reached its highest price in 28 years. The increases are already sparking unrest from Haiti to Egypt. Many countries have imposed price controls on food or taxes on agricultural exports.

Trying to Figure Out the Cataclysmic Chasm in Healthcare

From "A Doctor in Manhattan:"

I mean, here we are, just plowing ahead curing everything right and left, leaving many of us to live longer and longer while women and children are dying at young ages from thing like malaria, measles and infant diarrhea. Diseases we in the developed world left behind in the history books years ago.

Really, really think about that. While we sit here worrying about which statin to take because we won't get off our fat ass to exercise, kids are dying all over Africa from malaria and measles.

That's because there's no master plan. There's no prioritizing where the money is going on a worldwide basis.

Now I know those laisse faire capitalists out there are saying "Leave it alone. Let it evolve. It's working, just not at the pace everyone wants it to. And not equally everywhere, but give it time. We're figuring it out..."

But are we figuring it out? Or are we just figuring out best how to make money doing it?

ORBIS publicity in Reno

What do you get when you meet with a fascinating reporter (that I would love to interview myself) and a photographer with a passion for international reporting and philanthropy? This: Local Publicity for Orbis!!!

The Rice Raiser

Today was a great day in that my wife and I celebrated the birthday of a friend of mine and his family at a brunch event today. Nothing like a Sunday Brunch on a sunny, Spring day at a quaint cafe, "Voila" with good friends...

During brunch, I also had the great fortune of meeting Ms. Lorri Sawatsky--visiting from Canada.
Lorrie is as example of an individual living life with courage, purpose, and vision. ( I love meeting people like this--the entire Orbis team fits into this category as well).

Lorri visited Cambodia several years ago and was appalled by the conditions of poverty she witnessed, including children using headlights to pick through garbage dumps for food...

Moved by her experiences, she has establised "The Rice Raiser" charity.
She is also working on getting non-profit status in the U.S.
Please check out her website: RiceRaiser.org

HCMC eye hospital to receive $500,000 donation

This is another example of why Orbis is the best ophthalmology NGO in existence:

Unlike many other programs, which are great in providing short-term solutions to eye care,
Orbis is totally focused, in a very comprehensive way, on sustainable eye care in the developing world, encompassing training as well as infrastructure.


Orbis International, a US non-profit organization devoted to blindness prevention in developing countries, will donate nearly US$500,000 to Ho Chi Minh City’s Eye Hospital to upgrade its pediatric department.

(..)

The project was recently approved by the municipal administration with Orbis funding US$490,000 and the hospital contributing an additional $60,000.

The plan is to equip the hospital with modern facilities, develop infrastructure and help train pediatric ophthalmologists from 22 southern provinces and cities.

The upgrades, scheduled for completion at the end of 2010, will help prevent blindness and improve the vision of children aged 15 and under in the region.

Myanmar Photos

Here are some links to photos from Myanmar on my son's Flickr sites:

Kyle's photos: http://flickr.com/photos/8758395@N04/

Ryans's photos: http://flickr.com/photos/ryandhindsa/

Which comes first (why stories matter)

From the always excellent Seth Godin blog:


Most of the time we do the work. The work is our initiative and our reactions and our responses and our output. The work is the decisions we make and the people we hire.

The work is what people talk about, because it's what we experience. In other words, the work tells a story.

But what if you haven't figured out a story yet?

Then the work is random. Then the story is confused or bland or indifferent and it doesn't spread.

On the other hand, if you decide what the story is, you can do work that matches the story. Your decisions will match the story. The story will become true because you're living it.

Leehom Helps The Blind With Online Auction

Leehom Wang (王力宏) yesterday unveiled a set of autographed t-shirts and baseball cap that he is putting up for auction to raise money for ORBIS, a charity that works to prevent and treat blindness in developing countries.

Leehom is fronting a contact lens commercial for Bausch & Lomb after becoming the company's first male face in Asia.

Bidding takes place on http://www.bausch.com.hk until 10 April. A set will be sold to the five highest bidders.

Getting to Mandalay for Orbis

Dolores, the incredibly busy Orbis travel agent, and I traded many emails to crystallize the flight to Mandalay for me and my family.

Itinerary: Reno--San Fran--Tokyo--Bangkok--Yangon--Mandalay.

Unfortunately the trip started off with a delay out of Reno.
By the time we arrived in San Francisco, our flight to Bangkok had taken off.

In San Francisco, we met with a United airline representative to re-book our flights to Mandalay.
This somewhat intellectual, actually nerdy, looking chap, confidently proclaimed that not only could he rebook our flights but that instead of having us recheck our baggage in Bangkok, he could have it checked all the way to Mandalay. The key to the success of this seemingly improbable goal was the use of some sort of “radio ID tag.” Taken in by his confidence, I stated to my wife, Shilpa, that he must be some sort of “savant” in the alternate reality of the air travel universe. Overhearing this comment and perhaps pleased that his greatness has been recognized, he glanced up from the counter with a broad smile, shook my hand vigorously and presented us with food vouchers for six hungry Dhindsa’s. Happily surprised by this gift, I took the occasion to lecture my children about the virtues of showing appreciation to strangers.

Many hours later after passing through Los Angeles, Tokyo, and Bangkok we arrived in Yangon, Myanmar! (Our suitcases, perhaps not surprisingly, did not arrive.)


When we arrived in Yangon, we saw Dr. Charlene Hsu and Dr. Jin Kim, two other members of the Orbis Volunteer Faculty team. They were having their picture taken in the airport by a tall, Middle Eastern man. For a moment, I thought that Ahmad Gomaa, the excellent and cherubic Egyptian ophthalmologist, who had been in charge of the Orbis program in Enugu, Nigeria had undergone a total makeover.

Breaking my sleep-deprived random associations, this possible male model then asked us to take his snapshot with the plane in the background… Then another set of photos—this time with the Dhindsa clan and Drs. Hsu and Kim. (At this point, I am thinking we did not get this paparazzi type treatment on our last Orbis trip in Enugu from Ahmed and Amelia). After the extended photo shoot, I asked the middle Eastern gentleman what the plan was now—pass through customs, baggage collection, get on connecting flight to Mandalay etc. ?
(I am also getting a bit nervous about all this photography in a government building—in... Myanmar.) He looks at me quizzically. I respond with my own look of confusion. Breaking the silence and dead-locked gazes, Dr. Hsu explains that this gentleman is not from Orbis , but simply a random passenger/tourist who wanted to have his photo taken, and that she and Dr. Kim then wanted their photo take with the plane in the background etc…”Okaaaay….”


Once we get through customs, we set about trying to deal with our lost luggage. Not being very facile in Burmese, we search about for an English-speaking airport official.
After a number of attempts we find someone who in halting English tells us to go wait at the “Lost Luggage” podium. Dutifully we do so. However, nobody comes to the podium for what seems to be an eternity. We try to engage airport officials passing by. They all smile politely and keep moving.

Meanwhile, my wife and I strategize:
Priority 1—Get to Mandalay by tomorrow am, as this is the official start of the program (screening day).
Priority 2—Get our luggage.

Shilpa suggests that she and the 4 kids could stay in Yangon, and hopefully catch a flight the next day to Mandalay, when the luggage arrives. I am thinking: There seems to be a dearth of English speakers (at least in the airport) and while Shilpa is fluent in Gujrati, and the kids in Latin, our Burmese vocabulary is limited to “Mingalarpar”--—“Hi.”

We will have no telephonic means of communication.-- in an unfamiliar country. As we mull together all these points, an angel appears—actually an English-speaking representative from Bangkok Air. After a bit of negotiation, she assures us that she will get our luggage to us in Mandalay. Still weighing the likelihood of this, Dr. Charlene Hsu suddenly appears with an expeditor hired by Orbis. The expeditor urgently informs us that the domestic flight to Mandalay is leaving imminently. Taking her at her word (forgetting about our luggage issues), all six of us break out into a run behind this middle aged lady expeditor, out of the international terminal, into the sweltering heat, and in to the domestic terminal, several blocks away.

In the departure lounge, we seat ourselves next to our new found friends: Drs. Hsu and Kim.

For the next 5 minutes we fan ourselves furiously prior to boarding the rather small “Mandalay Air” plane. I focus on the fact that we are now only an hour and a half away from Mandalay. Unexpectedly, about 30 minutes later the plane begins to descend. The Captain states that we are stopping in the new capital of Myanmar: "Naypyidaw." “Okaaay” …After about a 5 minute pause, the captain continues that we will let a few passengers off and take off again and head off to Mandalay."--alleviating my fear that we had boarded the wrong plane. I settle back in my seat as my mind now wanders back to the lost luggage. However, the plane remains on the tarmac for about 30 minutes, at which point the captain explains that we should be taking off in about 5 minutes-- after “technical difficulties” are solved. This "tehnical difficulty" phrase gets repeated every 5 minutes... for the next 30 minutes. It is then decided, without explanation, that the plane will be evacuated.

All the passengers are then shepherded to the terminal of the airport via a rather modern appearing (at least relative to the airplane) bus.

We are deposited in a glass encased waiting room in the terminal. We take this opportunity to get to know Dr. Hsu and Dr. Kim and some other passengers, including an American who does psychological counseling of former child soldiers in Liberia, and who is vacationing here. I am thinking her skills might come in handy any time—here as not only the kids, but the adults all seem a bit anxious. (Another example of the really unique people one meets in travel to exotic destinations). She keeps my 7 year old daughter entertained and happy by sharing roasted pumpkin seeds with her.(As I gaze at Isabelle's happy face—I ponder why we can’t all find stress relief in the ingestion of such simple morsels. Maybe that is why I am not a counselor of former child soldiers).

After about an hour, the airline officials kindly announce that we can leave our room of confinement and head off to the airport café, where they will be serving “refreshments.” The official casually notes that they are unable to repair the technical difficulties with the airplane but hopefully at some point another plane will come from Yangon to pick us up and take us to Mandalay. My wife and two little ones head through the narrow doorway toward the café’ with the child psychologist. I try to engage in conversation and even a bit of levity with Dr. Kim. But he just keeps shaking his head, muttering, “This is not good.”

Suddenly an airport shuttle bus comes up to the waiting room and starts loading up the passengers from our room. An airline spokesman, notes that the technical difficulties have been fixed. Feeling simultaneously confused and somewhat anxious in that I have no idea where my wife and little ones are, I try to exit through the door to get them. Another smiling airport official blocks my exit, gesturing me to go through the other doors to get on the bus. Unable to speak enough Burmese to explain my goals, I resort to hemi-ballistic, wild gesticulations. Out of the corner of my eye, I note that Dr. Kim and the rest of the gang are now headed off to the airplane as the shuttle pulls away.

A surge of desperation nearly propels me through the “human barrier” when my wife and kids show up at the doorway. Wipe brow. Breathe sigh of relief. Another shuttle bus comes to take us to the plane.

As we board the plane, we pass Dr. Kim, who looks up at me from his seat, shakes his head, and mutters, “This is not good.”

Fortunately, our trip to Mandalay is uneventful.

As we headed off the airplane, all six members of the Dhindsa family almost simultaneously utter one word: “Wow!”as we spotted the Orbis DC 10 flying eye hospital. It looks beautiful in its pristine white with the bold, blue logo and slogan emblazoned near the front of the aircraft: “Orbis
Saving Sight Worldwide.”

We are greeted at the airport by my old “kaibigan” (“friend” in Tagalog), Leo. Originally from the Phillipines, Leo is a scrub nurse with whom I had done thousands of cases together at the King Khaled Eye Specialist Hospital (KKESH). I had left KKESH and moved to Reno five years ago. Leo had left to work for KKESH 12 years ago to work for Orbis (which I belief is a career record for Orbis Flying Hospital staff. The intensity of the flying hospital usually can only be handled in one or two year increments). Leo was an amazingly good scrub tech back in the day in Saudi. We had a great time on the long bus ride back to the hotel catching up on our mutual acquaintances and reminiscing about the good old days at KKESH.

Once, we made it to the hotel we were greeted by Dr. Ekta Aggarwal, a most charming ophthalmologist from Chennai, and Orbis Medical Director, Dr. Hunter Cherwek. The always thinking Hunter, presciently anticipating that our luggage would be lost, bestowed upon us an extensive array of clotheing-- for all the Dhindsa’s, (his entire wardrobe?) including his famous, as I was later to learn, elastic-waisted pants). My 14 year old boy, Ryan spied a “Tiger Beer” T shirt in Hunter's wardrobe and quickly claimed it for himself.

We also had the pleasure of handing off the corneas we had brought all the way from Reno-- on ice. (Daneille had fedexed us these from the New York Orbis office the day before we left.) The kids, as Danielle had predicted, really got a kick out of our responsibility for "bringing the eyes" to Myanmar! (We were relieved to hear from the cornea specialist on the trip, Dr. Robert Pineda, that the corneas all appeared viable upon transplantation surgery).

Happy that we would not be condemned to wearing our rather “ripe” clothing much longer (Though our family is close-knit, any further sharing of body odor could lead to a rather spectacular unraveling of such ties, or so I was afraid), we relaxed in the well-appointed lobby with a hotel-provided refreshing, actually almost glowing, green lemonade drink--spiked with cayenne pepper. Savoring this unusual concoction and feeling quite content having finally hooked up with the Orbis crew, I allowed my adrenalin levels to come down-- to the strains of old Beatles standards wafting by from the local, live lobby band. Another unexpected pleasure in our first hour in Mandalay...




LEO--gets down!