Thursday, November 29, 2007


I watched another movie about Bolivia today, the third in a triad of depressing films about the country (The Devil’s Miner, Our Brand is Crisis and Bolivia). This is an Argentine film about an illegal Bolivian immigrant who comes to Buenos Aires in 2001, at the height of the Argentinean economic crisis. He has left his family and three daughters in La Paz, unable to work there after the “Yankees” burned the fields where he used to work on a combine. The fields grew coca, among other crops.

He’s a hard-working and polite man, doing his best for his family. But the majority of the clients in the lower-middle income restaurant he works at are also unemployed or facing serious financial difficulties as a result of the crisis. Not very accepting of other races to begin with, tensions mount when foreigners are given work and locals remain unemployed.
It’s a stark, simple movie, filmed in black and white, never for more than 3 days at a time due to budget constraints. But it’s effective, not only in portraying the situation in Argentina and the case of the common Bolivian migrant, but of highlighting the tensions of immigration in many countries, of the dichotomy between what is better for the individual and what is better for the national society.

Wednesday, November 28, 2007

Bolivian Strife

Today I spoke to a former colleague in Bolivia who told me the office and the country are shut down again due to protests. The topic is still the relocation of the government from La Paz to Sucre, the same issue that was causing commotion in August. It’s sad and difficult to see to see such continued strife in a country that needs unity and economic growth.

Yesterday I watched a fascinating movie about Bolivia called Our Brand is Crisis. It’s about the 2002 Bolivian presidential elections. One of the candidates, Goni, who had previously served one term as President, hired a U.S. political consulting firm, GCS Consulting, to advise him on his presidential campaign.

I’d heard of Goni while I was in Bolivia, heard how he was raised in the U.S., became the President of Bolivia, then fled to the U.S. after protests that drove him out of office. I’d seen leftover signs of support for him, especially in the rural Cochabamba region, where his name was still spraypainted onto walls and bus stands. But I hadn’t much sense of what type of a person or a President he was, nor did I have any idea that a group of Americans was so involved in the election. It seems from the movie that Goni definitely could not have won without the assistance provided by this consulting firm. The nagging question remains – would it have been better for the country had he not won?

The methodology used by the firm was quite impressive – endless focus groups and careful statistical studies to read the mood of the people, to understand what they wanted, and to instruct Goni how to deliver. At the same time, they also worked to discredit Goni’s two main rivals – Evo Morales (currently the President of Bolivia) and Manfred. Through carefully constructed messages, they were able to help Goni win by just a hairline. The final results were Goni 22.5% of the vote, Evo Morales 20.9% and Manfred 20.8%. No one candidate received more than about a fifth of the vote, an indication of divisiveness even more powerful than that in America.

Evo’s campaign was unexpectedly helped by the U.S. ambassador at the time, Manuel Rocha, a man James Carville (one of the consultants) called an idiot. Rocha made the following speech shortly before the election, linking Evo Morales to Osama Bin Laden:

“It’s unbelievable but true. A few weeks ago Evo Morales claimed the US embassy threatened to kill him. This vile accusation is totally false, an absolute lie. The U.S. has threatened to kill one man: Osama bin Laden. Perhaps Evo Morales, with his tremendous lie..wanted to show his solidarity with that assassin and terrorist. Evo Morales also said in a speech…that if he is elected…he’ll stop the US anti-coca program..I want to remind Bolivians California will only buy your natural gas if Bolivia is not involved in cocaine. Citizens of Bolivia. Open your eyes. The future of your children and families is in your hands.”

Goni joked that perhaps Rocha was actually Evo’s campaign manager, since after that speech, Evo’s support increased. “It’ll make me happy if he keeps talking,” Evo said. In focus groups, people responded that the ambassador’s speech made them more likely to vote for Evo. “It brings out the rebellious part in us,” said one man. “So now because we’ve been attacked and because I feel rebellious, I’m going to vote for Evo Morales.”

I try to imagine an ambassador of any other nation making a speech to the American people before an election and telling them to open their eyes. I don’t think such a condescending tone would go over very well with the electorate.

So Goni won by a hairline, but his victory didn’t last long. His reputation for arrogance continued and people continued to feel he didn’t understand or represent them. I was surprised to hear that his Spanish was about as heavily accented as mine, which seems to make it difficult to integrate among one’s followers. He didn’t seem to really understand or care about the poor and was extremely reluctant to communicate directly with or move among the poor. Under pressure from the consulting company, he sent someone else out into the communities to listen to the people, but didn’t do it himself.

Within seven months, the government was in crisis. Goni wanted to sell natural gas via Chile, but the people were against it. They considered Chile an enemy since losing their coastline to Chile in the 1879 war. And Goni raised taxes on all salaries above 880 bolivianos a month (about $100 a month). The consultants thought the tax should have been raised only on salaries about 5,000 bolivianos a month (about $500 a month), which would have avoided making the very poor even more poor. And finally, the people didn’t see progress on the creation of jobs, which was the number one issue during the election.

These problems led to street blockages and protests, led by Evo Morales. Goni used troops to clear the streets, resulting in the death of about 100 people. Forced to leave office, his vice-president took over for 20 months, but didn’t have much more success.

In December 2005, Evo Morales was elected with 54% of the vote, a landslide not seen since Bolivia’s 1982 return to democracy.

Now of course, two years later, there is a lot of criticism of Evo’s policies (especially in Santa Cruz, where I was). It’s true there are real downsides to having a poorly educated national leader, for pandering to sentiments of the majority rather than promoting technically strong plans that will have actual impact. But I learned from the movie that the large, poor, indigenous Bolivian majority is not going to understand or support economic plans unless they are explained and sold to them. That any candidate who wants to hope for success in Bolivia needs to take these people seriously.

One Week Until Due Date

Our due date is one week from today. For at least a week now, we’ve been living in the very unique and interesting situation of complete uncertainty. We took refuge in the statistics that 85% of first-time deliveries are late. Surely, we’d be in that 85%. So we mentally oriented towards December 5th or later as the arrival date of our new infant.

However, a scare last week, during which we thought it was coming, juggled the psychological bits. Now we know it could be any day. It could be today or it could be almost three weeks from today.

This means that if there is something we want to accomplish – we must do it now because we don’t know if there will be any time tomorrow. It’s pushing Jim to work hard at work to get his major deadlines out of the way ahead of time. And while I have less responsibility at the moment, I’m also trying to make progress on some of my larger goals. I try to make sure that nobody is waiting for anything major from me because at any moment I could become incommunicado.

It means that all social arrangements are made on an as-available basis. Sure, I’d be glad to have lunch next week, but only if something unexpected doesn’t happen first. Let’s be sure to confirm the day before.

While I still get out for a daily stroll, and still make it to the gym for a light workout almost daily, I’m getting to the point where I don’t want to venture much more than an hour from home. I had thought about meeting a friend in New York City this weekend, but am now rethinking it. Do I really want to face a three-hour trip back should the moment unexpectedly arrive?

As someone who usually plans ahead, this helps me to live more in the moment, to be more accepting of my inability to control things, which I suppose is just the beginning of parenthood. But this situation also helps me to understand people who choose elective c-sections. Many of the books I’ve been reading criticize this birth by convenience. I tend to think that nature will usually make sure the baby comes when it’s ready. But it actually is quite difficult for a woman and a partner to essentially put their lives on hold for up to month. I’m lucky in that I’m able to work from home. Others, especially those with physical jobs or long commutes, probably need to take leaves. But with the stingy leave policies available in the U.S., 3-4 weeks leave before a birth (while this is standard in many parts of the world) means an even shorter period of time is available after the birth. I can see how people would rather set the birth date and conserve all of their leave time to spend with the baby.

Of course, choosing elective surgery because our leave policies force such choices is not a good sign of the priority placed on women’s health. I would hope that, like in Germany and in many other countries, 4-6 weeks before the birth and 8-10 weeks after the birth would be a normal and standard leave. I would hope that the opportunity to work at home before the birth would be made available to more women. But until then, I can see how people are tempted to end the expectation and the uncertainty and just get it over with.

Friday, November 23, 2007

A Tourist in Medical America

Yesterday, Thanksgiving, was unseasonably warm. I took my favorite stroll and soon put my jacket into my backpack, comfortable in just a t-shirt. I saw people jogging in t-shirts and pants, and others strolling in light, open jackets. The leaves are now a darker shade of magenta and mustard-yellow, with more brown branches mixed in. It’s still beautiful and brilliant, but a different hue. It’s like gazing at a different, but marvelous, painting every week.

Today we had our 38/39 week prenatal appointment. We’re getting to the final countdown. As someone who has never spent a night in a hospital, I find the frequent medical visits and the upcoming hospital stay to be a form of cultural tourism, especially given the troubled state the U.S. medical system is currently in. We’ve chosen a strong hospital and some of the best doctors available locally. But still, some of the overall problems of the system – the following of norms that haven’t been proven as effective and the emphasis on cost over quality of care - are still easily apparent.

Everyone who gets an epidural at the local hospital has to be hooked up to a fetal heart rate monitor. I’d read that when these monitors say everything is OK, it is OK. But when it says there’s a problem, it’s often mistaken. I asked the doctor whether there was any means of verifying a problematic signal from the fetal heart rate monitor.

He said no, that various methods had been tried, but none were reliable. He said he wasn’t sure why the U.S. had signed on to this technology and these procedures, but it had.

“So what do you do if it indicates a problem?”

“We do a cesarean, but 9 times out of 10 it proves to have been unnecessary.”

I then asked about the period we could stay in the hospital. It’s generally two days for a standard delivery, 3-4 for cesarean. But the timing is based on the time one gives birth. If you give birth at 11:59 p.m., you have to leave at 10 a.m. two days later, for a stay of about 36 hours. If you give birth 10 minutes later, you get an extra 24 hours.

I’d heard that a doctor could write a note saying that the patient needed a longer stay and then they could at least stay the full day, rather than having to leave by 10. I asked him about this and he said it depended on the hospital need for beds. If they need the bed, you can’t stay longer.

“So it’s not up to the doctor?” I asked.


“Nor does it matter whether the patient needs the additional time?”

“In the past, people generally stayed in the hospital 24 hours and most of them seemed to do just fine.”

That was the first indication I’d heard that the current standard of two days is somehow generous. The mouth of a Chinese friend fell open when we told her the standard stay is two days. She worked as a pediatric nurse for 26 years in China and never heard of such a thing. There, as in many parts of the world, ten days is more the norm.

Not to say that I want to stay ten days. But it’s unfortunate to think that people are pushed out before they are ready, before their milk has come in and they’ve learned how to breastfeed, before they feel ready to take care of both themselves and the new, needy being. I wonder if more support and care early on would affect the rates of post-partum depression.

Tuesday, November 20, 2007

GIfts and More Gifts

This afternoon I turned on the TV for background noise and ended up on Oprah. It was an episode called My Favorite Things, during which Oprah shows all of her favorite goods for the holidays. It was basically a one hour advertising session.

The episode was filmed in Macon, Georgia, where 40% of the population is watching Oprah on any given day. Makes me wonder how the people of Macon have so much free time that almost half of the population has time to watch daytime TV.

Oprah gave all the products she reviewed on the show to the audience members. Of course, it was nice for them to receive all kinds of free things. But to see them (mostly middle-aged women) jumping up and down, fanning themselves, kissing each other, and looking like they were going to faint at the sight of a free refrigerator, or worse, a couple of free cupcakes or bars of soap, was pretty depressing.

The holiday season is already well underway and it will only intensify later this week. The big day of shopping begins on Friday, on the day after Thanksgiving. After people give thanks for what they have, they run out to get more. The local drug store began to stock Christmas candy on the same day they removed the Halloween candy.

I’m glad that during my first holiday season in the U.S. in years, Mark and I won’t be celebrating Christmas. While we will buy gifts for relatives who celebrate the holiday, for us, we’re going to replace Christmas with New Year’s as our big celebration. We’ll spend Christmas as a quiet weekend at home – no pomp and no stress.

Monday, November 19, 2007

The First Snow and I Become a Cord Blood Donor Reject

Today the first snow fell. It seems early to me for New Jersey. But it was so startlingly beautiful that it captured my attention and even led me outside to photograph it. When I looked outside my office window, I saw thick, fluffy white flakes drifting down in front of the brilliant red, orange and green leaf collage that composes my view. It didn’t stick to the ground but just fluttered through the sky – a magical white blanket – then disappeared. It now feels like winter.

Today I received the disappointing news that my application to donate our baby’s cord blood to a public cord blood bank was rejected. After doing quite a bit of research on the options – saving it in a private bank, donating it to a public bank, or throwing it out – Mark and I had decided to donate it. It was a decision I felt good about. It doesn’t hurt, it could help someone else, and if by chance no one else needed it, it might still be around if someone in our family developed a need.

I stopped donating blood after I was told by a blood collector I had the surface veins of a 90-year-old. So I was happy to have found something I could donate. I filled out the veritable mountain of paperwork required of donors and sent it back. Out of the many, many variables, the only question I marked a yes to was having spent time overseas. I have lived overseas for much of the past three years. But I didn’t expect that to be a problem. I’m in very good health, as the many boxes checked no indicated.

Guess I was wrong. They rejected me because I was in Bolivia and there is malaria in the Santa Cruz region. I told them I was in the city, not the rural areas and that I never heard of a malaria case among the people I came in contact with over five months. While I have taken anti-malarial medications in other countries due to the risk, in Bolivia it was so close to non-existent that I didn’t take anything, nor did the other foreigners I came into contact with. Even if, by chance, malaria came to the city, I was there during the winter, when mosquitoes just weren’t around. And if I had acquired malaria, wouldn’t I notice it by now?

Most importantly, malaria can be easily tested for. Why throw out a donation when they could just do a test and verify that I don’t have malaria. Last week, the medical director agreed with me. He said they would warn the doctor of a potential recipient of the risk and that doctor could order a malaria test. But apparently he consulted with his supervisors and they didn’t agree. Because today he called and said they couldn’t take the risk.

I wonder if it has to do with the recent case of the HIV-tainted organs donated by someone who acquired the disease shortly before dying. Similarly, they think I could have acquired malaria recently and not realize it yet. But in this sad, but single HIV case, the only one in more than a decade, everyone except the patients knew the donor was high-risk. The opportunity was there to order an HIV test before doing the transplants. It was just a failure of communication. It’s too bad that there is so little confidence in the communication structure of the donor system that it’s considered wiser to discard a potentially life-saving donation than to ensure that the appropriate information, documented in the reams of paperwork, is passed on to the people who need it.

Sunday, November 18, 2007

Indian Women - Young and Old

This afternoon we went to visit a photo exhibit by Fazal Sheikh called Beloved Daughters: Photographs. The exhibit was composed of two parts – one highlighting widows, who lived in a community where they devoted their lives to Krishna. The other was about young girls kidnapped or tricked into prostitution or women who were burned or otherwise abused in marriage.

The stories were so sad. A few of the widows had supportive families and voluntarily chose a life of abnegation and devotion to God. But others were cast out by their families, devoid of any protections once they no longer had a husband. One was married at the age of 5 to a boy who was 12. While the marriage was never consummated, when she lost her “husband” she was never able to marry again and had to live in this commune of widows. Another was thrown out by her husband after a neighbor raped her while she was home alone. Others were cast out for producing only female heirs. Another had problems when she couldn’t conceive, so her husband took a second wife. Just then, she became pregnant. The second wife was jealous. When the husband died, the second wife set the bed on fire, killing the child and burning the woman over half her body.

The second part of the exhibit focused on the younger women – the children and teenagers abused and roped into prostitution, the young wives killed or burned because of abusive husbands or insatisfactory dowries. The saddest photos were those of the very young girls, well under ten, rescued from brothels. They had greasy hair, wide eyes, glittering shoes, and traces of makeup. The exhibit also reflected the valiant work done by some NGOs, such as one founded by two women, both of whom had daughters burned to death, to offer protection and safety to the victims of these crimes.

Sheikh, the recipient of a MacArthur genius award, focuses his work on displaced peoples around the world. He reminds us, as India moves ahead into the global economy, that ancient prejudices deny rights to many and that only through awareness and activism can such injustices be halted.

Thursday, November 15, 2007

Neverending Fall

Fall here is neverending and so beautiful. Now the trees that have turned color glimmer solid shades of red, orange, auburn or yellow – giant firecrackers lining the road. It’s like driving through a pointillism painting, with each leaf an individual dot.

From the window of my home office, I look out at boughs of deep red, over orange over green. I find it deeply soothing and am grateful for all the trees here. It adds enjoyment to any drive, walk or even afternoon daydream.

Today was a rainy, windy day. In the morning, I parked under a tree. When I went to retrieve the car in the afternoon, leaves had fallen onto the car and the water made them stick. All over the car – on the hood, the roof, the windows and the doors, beautiful yellow leaves clung, like an elaborate decoration. I found it disappointing to see many of them blow off with the wind as I began driving.

As we made the long descent from fall into winter, Mark and I are also preparing for a new season in our lives. There are less than three weeks to go until our due date and today, we saw signs that the process of labor is beginning. Just as the leaves explode, then fall off the leaves, our baby is now fully developing and is preparing for its descent. Whether we are ready or not, a new season is approaching in our lives.

Friday, November 09, 2007

Blue Man Group

Tonight we attended a performance of The Blue Man Group. It’s been around a while and has gained quite a bit of notoriety, but I never knew exactly what they did. The concert, How to be a Megastar, was put on at a local stadium and drew quite a crowd of people willing to pay the $65-100 ticket price.

It was a multimedia show led by three men with blue, bald heads and blue hands. It involved a variety of instruments made from unique materials, artistic lighting and jokes. I didn’t bring my camera, thinking I might not be allowed in with it. But so many people had cameras and phones that one of the Blue Men indicated that people wave their lighted cell phone screens, rather than cigarette lighters. That created the odd image of many lighted consoles gleaming across the stadium, swaying back and forth.

Now into my ninth month, I’m getting to the point where I might need to soon replace my long nature walks with treadmill strolls at the gym, with a toilet nearby. While my walk today was physically difficult, the scenery is quite amazing. Many leaves have now fallen, leaving more trunks. This adds more brown to the otherwise red, yellow, orange and green landscape. Leaves float on the still water, making a carpet alongside the dirt path. People come out to photograph the geese or stop their cars to take pictures of the beautiful scenery. It’s really magnificent.

Saturday, November 03, 2007

Extended Autumn

Fall in New Jersey is a beautiful season. Having grown up in the Midwest, where trees changed color rapidly and winter quickly moved in, here I appreciate how the fall comes gently. I can watch the subtle daily changes in the colors and the gradual fluttering of the leaves. And we benefit from the moderate, cool temperatures for an extended period of time, as Indian summer transitions into frost, we set up our heating system, pull out the blankets, and take the air conditioners out of the windows.

Yesterday I took a walk at sunset and saw a scene so beautiful it caused a woman to stop her car and come out to take a picture. I walked across a bridge over a lake. On one side, the cloudless sky was a deep blue, the trees lining the blue water a patchwork of yellow, green, orange and red. On the other side of the bridge, a soft cottony carpet of clouds covered the sky. The clouds were a deep pink and violet and they reflected this color onto the water. Combined with the colorful trees, it made for a vision so vibrant it was magical. I could look back and forth from the calm blues and autumn tones on one side of the bridge to the wild pinks and purples and shadows on the other.

We took out our air conditioners today. That gives us more window space and more light. It also seals away the outside air better. With the heat from our recently repaired oil furnace wafting upwards through the iron grates, we feel warm and cozy. I think of all the people, all the families, who have inhabited this house over the past century or more.

We had a lead inspection the other day. The inspector found lead, but told us it was under 10 layers of paint and probably at least a layer of paper. I imagine all the history hidden behind the walls. What kind of walls did different families look at? What kind of life experiences did they have here? What kind of memories did they create?

There is one small reminder of a former resident on the stairs leading down to the basement. A single brown, tie-up shoe that once fit a toddler, caught on a ledge in the stairway, covered with a thick layer of dust. That person whose little feet once ran across these same floors could well be an adult by now. No one seems to have had the heart to remove the evidence of his former presence. Soon a new person will begin its life in this house that has been a home to so many others. While we will probably move away before the baby forms any memories of this place, it will remain in the pictures, in its history, as the place it first called home.