Sunday, September 5, 2021

Culture Clashes

In a recent news article about the aftermath of the US pullout from Afghanistan, a Taliban spokesperson was addressing the issue of women’s rights. He made the following statements:

“[T]here will be no issue about women’s rights.”

He opposes Western views that “women should have an education without [a] hijab.”

“That is a change of culture. Our culture … they can receive education with hijab. They can work with hijab.”

“There will be no issue about the women’s right. No problem about their education, their work. But we should not be after changing each other’s culture as we are not intending to change your culture, you should not be changing our culture.”

I recognize that there are many who have reason to doubt these statements, given the history of the often brutal way in which the Taliban has dealt with its citizens. But I’d like to focus on the last sentence regarding culture. So let me give a little of my own cross-cultural experience and then I’ll come back to Afghanistan at the end.

 

Some of My Cultural Experiences

I have had the opportunity not only to travel to other countries on work-related activities, but to get involved in investigating the culture of other countries and writing about it. You can read about some of that here. Over the years we produced a series of host family handbooks for these countries.

Culture can be illustrated as being like an iceberg in that most of it is “below the water line” and is not observable.

[Cultural Iceberg]

 


When two cultures clash, the clash most often is between the various components that are unseen. So, while we can easily see things like dress, food, etc. we are not aware of things like personal space, the importance of time (or lack thereof), etc. But these unseen aspects can be even more important than the ones that are unseen.

[Culture clash]

 


One can also think of culture as being the color of our glasses. When a person is wearing yellow-tinted glasses and sees something that is blue, it appears to them as green. But another person who might be wearing red-tinted glasses would see that same object as violet. Taking off your own glasses and putting on someone else’s (i.e., looking at the world through their lenses) is not easy.

[Culture lens]



Aspects of Culture

Here are some of the aspects of culture that we explored in these various handbooks. Not every topic is important in every culture, but this gives you an idea of the range of things we need to consider.

  • ·        Greetings
  • ·        Direct/indirect communication style
  • ·        Showing negative emotions
  • ·        Volume and tone of voice
  • ·        Eye contact
  • ·        Disagreements
  • ·        Conflict resolution
  • ·        Independence/dependence
  • ·        Religion and beliefs
  • ·        Life cycle customs (birthdays, weddings, deaths, etc.)
  • ·        Friendships
  • ·        Social values
  • ·        Personal hygiene
  • ·        Modesty/nudity/sexuality
  • ·        Diversity/prejudice/disability
  • ·        Personal space

 

Thailand Example: Greetings

During my first full day on my first trip, Noon [a former exchange student who had lived with us for a year] had told me that I should expect to be visited by a number of her relatives. After all, it’s not every day that one’s “American father” comes to visit. I was seated with her in their living room and could hear voices outside. She told me, that’s my uncle. He came in the room and walked toward me. I stood and was preparing to greet him with the traditional Thai wai (bow) – hands together, etc. Instead, I was surprised that he stuck out his hand to shake mine, to which I thought, “he’s going to greet me in the US tradition instead,” so I shook his hand. But the next words out of his mouth were, “How old are you?” I was a bit taken aback, as this is not the typical first question that anyone in the US asks, but I also quickly went through the reading on culture that I had done and realized why he was asking. Relative age is very important in Thailand and the younger person must honor the older person, including by bowing more deeply so that your head is below the other person’s. Since we were both older gentlemen with balding, white/grey hair, he did not know if I was older or younger and needed to know so that he knew how to address me. All this thinking went through my head in a fraction of a second, so I then answered him, to which he replied, “Ah, young man, young man.” (He was about a year older than I was.)

I’ve used this story many times to illustrate how culture plays a part in our lives. On the visit with the AFS-USA team a few years later I had told this story to the team at the beginning of our time there. The following day, we were visiting a school and the teacher asked the class if they had any questions for us. One of them finally got up the nerve to talk and asked, “How old are you?” which turned into a great teaching moment.

But I’d like to relate one other “greeting” incident where I did NOT do the right thing. Most of the Thai members of our AFS-USA-Thailand group were female, since most AFS volunteers in Thailand are teachers. They would address me with the Thai greeting, “Suwadee Kha”. So, I decided that I would greet them back by saying “Suwadee Kha” to them. But this only generated a lot of giggling on their part. It turns out that “Suwadee” mean not simply “Hello,” but something more like “Hello from,” and the “Kha” part is feminine. So “Suwadee Bangkok” on a t-shirt means “Hello from Bangkok” and “Suwadee Kha” means “hello from a female!” Thus, when I say hello, I need to use the male ending and say, “Suwadee Khrap.” They quickly corrected me and I added to my knowledge of cultural mistakes!

 

Germany Example: Nudity

In 2007, I was part of a group who travelled to Germany to confer with our German counterparts in writing the first of a series of handbooks that addressed culture specific issues for host families of students from that country. One of the volunteers had acquired two magazines designed for young teens. One was in German and was for a German audience, the other was published by a US subsidiary of the same company and was designed for a US audience. They were both for the same month in the summer of that year.

The US version had its lead article devoted to Selena Gomez, a young actress who was about 15 and who had recently begun working on shows on the Disney Channel. Like most such magazines, there was a picture of her on the cover. The article inside had several more pictures with captions, but not a lot of text to go with it. All were in keeping with the wholesome image that one would expect of Disney.

The German version also had a picture of Selena on the cover, but there was more text in the article as well as additional pictures. However, the pictures were designed for a German audience which has different cultural norms – so there were pictures in various phases of undress and one where she was nude from the waist up.

I was startled enough by that, but turning over a few pages my cultural norms received a further shock.

There was an article, which apparently was a regular feature, with the title being something like “All About Me” (but in German of course). Taking a full page was a full-frontal nude picture of a teenage girl, about 15 or so. Around the edge were facts about her – age, hobbies and interests, etc. She was evidently a reader of the magazine and had submitted it for publication. In the US that kind of thing would be labeled as child porn, but since nudity in Germany is fairly common (coed saunas, changing on the beach in full view of others, etc.) it was not out of the ordinary. Flipping over the page, one encountered another such picture, but this time a full-frontal nude male about the same age and similarly marked.

 

Applicability to Afghanistan

Now, let’s look back at the last sentence in the quote from the Afghani spokesperson:

“But we should not be after changing each other’s culture as we are not intending to change your culture, you should not be changing our culture.”

Afghanistan has a long and storied history. There is evidence of human activity dating back 52,000 years and of urbanization dating back 4000-5000 years ago. Although landlocked, its position at the crossroads of central and south Asia made it the target of conquest by many different empires over the centuries. Thus, at various times, the dominant religion (Hindu, Buddhist, Islam) was a product of whomever controlled the area at the time. But these times of occupation each lasted hundreds of years, the time required for introducing a change of culture.

Those of us in the West make a great number of mistakes in our relationships with places like Afghanistan. These include at least the following:

o   Our view of the world is overly influenced by the modern-day boundaries of countries. But in the case of Afghanistan, those boundaries were only established in the late 1800s by agreement between the British and Russians. Thus, the current country includes areas which have had different tribes over the centuries and these differences in historic control mean that there is still much internal conflict.

o   Afghanistan has been a Muslim country for a millennium and a half. Change takes a long time.

o   The Afghani people rightfully have a negative view of outsiders. Much of their history has been one of being overrun by others – whether those from Iran to the west, India to the east, Russia to the north, or the British during their empire-building time.

o   All past changes in culture were imposed by conquering armies who then occupied the land (or at least part of it) for centuries afterwards.

Against this background, we see the recently-ended US occupation – a scant 20 years. And we see the typical US philosophy – not of wanting to conquer and control, but to enter in order to find and root out those who dared to attack us on 9/11/2001 and then leave once we had accomplished our purpose.

And then we have the expectation that simply because we were there for 20 years that they will change their culture in areas such as women’s rights, religion, etc. and simply ignore the prior centuries! No! Their culture includes warring tribes within an externally imposed border, reliance on Islam, disdain for “outsiders” and only changing if those changes are imposed upon them for several centuries. And we have the audacity to think that our being there for 20 years will cause change! It doesn’t work that way.

I’ve written many times in the past that when we ignore the events of the past and are not students of history, that we are setting ourselves up for failure. In this case, as much as I may disagree with some things that the Afghani spokesperson represents, his statement on culture change is correct. The influence of the 20 years of US occupation will be but an insignificant footnote in the history of this part of the world.

Wednesday, September 1, 2021

Medical Checkup

Recently I had my annual Medicare “Wellness Checkup”. As I was mentally reviewing how things were going with me recently and what I should share with my primary care physician (PCP), I prepared a mental outline of just four words – Head, Heart, Blood, Foot. This gave me enough of a reminder that I would not forget what I should share with her. But I thought this might be a good outline to summarize my medical situation for this blog as well.

 

Head – Alzheimer’s Studies

I’ve shared recently about my involvement in a number of Alzheimer’s studies, so I won’t repeat that here. If you want to read details and you have not done so, here is a link. But I’d like to spend a little more time on the most recent study that I’m about to embark upon – the AHEAD study. Unlike all the other Alzheimer’s related studies, this one is a phase 3 Clinical Research Study (see below for what this means). But since it may actually have an impact on any progression of the disease, it will also mean that I will be dropped from both the ABC and APT Webstudy as those are looking at changes over time in individuals who are not receiving treatment.

The fact that they consider me eligible for the AHEAD study means that I have met their criteria, including (1) no current diagnosis, and (2) has an elevated or intermediate level of amyloid in my brain. While the latter will be confirmed by an initial PET scan (see participation requirements) , the spinal tap I had in 2019 would have shown the presence of the proteins that are produced by the amyloids.

While all the other tests that I take periodically continue to show unimpaired mental abilities, I have begun to notice that I have had a few instances the past few months where I was trying to come up with either a word of a name and totally drew a blank – very unlike me. Is this an early indication of Alzheimer’s in me? I don’t know, but I will continue to monitor myself for additional instances of these memory failures.

Clinical Research Studies

Just a little education on drug studies. Once a drug has gone through laboratory testing and possible testing in animals, it enters a series of clinical research studies. These studies are divided into several phases as follows:

Phase 1 – Is it safe?

In this phase, a small dosage of the drug is administered to a few people, perhaps a dozen, of healthy subjects to ensure that there are no major side effects. If there are none, then the dosage may be increased and administered to another group. This process continues until the doctors find a dosage that is most likely to work while having an acceptable level of side effects.

Phase 2 – Does it work?

In this phase a group of 25-100 patients who have the disease that the drug is designed for are given a dose to see if the drug works as intended. Sometimes the patients are divided into groups and they receive different dosage amounts, or it is administered in a different way (say orally v. via an IV).

Phase 3 – Is it better than an alternative?

In this phase the drug (or a placebo) is administered to a large number of people, perhaps a thousand or more, for a long period of time, perhaps 2-4 years. Some (picked at random) may receive a placebo instead. These patients, and often the doctors administering the drug, do not know if they have received the actual drug or the placebo. This is to ensure that the impact of the drug is what is creating the difference and not that just the patient’s attitude is having an impact. Patients are selected from many different geographies, economic levels, racial groups, etc. to see if there may be other things at work.

 

Heart – Cardiology Status

I also posted about my recent nuclear stress test, so I’ll not repeat myself on that here. You can follow this link if you are interested. I relayed this to my PCP as well that I have no concerns about my heart health.

 

Blood – Bloodwork and Diabetes Status

Back in mid-July, upon the recommendation of my PCP I had my first appointment with a pharmacologist, an individual who examined all my current medications as well as my most recent bloodwork. She was looking for any potential drug interactions (when you take as many pills as I do each day, that is always a possibility), as well as she made recommendations on future treatment or dosage changes that might be of benefit.

She saw no potential interactions, but noted that I was at the maximum dosage of a couple of the medications I take to manage my blood sugar levels. But of concern was that my sugar level has started going back up. My A1c levels were always somewhat marginal, i.e., pre-diabetic, and with medication were being kept from getting out of hand, but even so had slowly crept up into the diabetic range, i.e., over 7. I’d managed to keep it not much more than that, but then it started back up again and my most recent bloodwork showed me at 8.0 – too high!

Thus, her recommendation was that since I was already at the maximum dosage of the primary medications I take for it, that it was time to begin taking insulin. She passed that onto my PCP who ordered an initial supply for me. Time for a daily needle stick – in addition to the finger stick I take to check my levels each morning!

As I write this, it’s now been about 6 weeks since I started a daily injection. The rules are (1) start at a dosage of 10 units, (2) every three days take an average of my morning (fasting) blood sugars and if the average is not yet in range, increase dosage by 2 units, and (3) when consistently below a reading of 130, then maintain that dosage.

My average before starting was about 195 (per her instructions I brought my meter with me that showed a history of the readings). After the first two weeks, my average was down to 179. After another three weeks my average was down to 163 (very stubborn and keeps plateauing!) But then I finally started seeing some real progress. Only a week later my average for the past week is 145, including my first reading ever below the target 130!

I’m hoping that I will reach my target by about mid-month. Since my next scheduled A1c test is in January and it measures average sugar levels for the prior 90 days, I’m pretty certain to be below 7 – and my personal target is to see it in the low 6’s. I will celebrate (with non-sugary foods of course) if I can reach that!

 

Foot – Slow Healing Process

I’ve noted in the past about the fact that I have a distortion at the ball of my big right toe due to arthritis and the pressure that walking puts on that area of my foot. This builds up a callus which eventually breaks loose and leaves me with a sizable hole on the bottom of my foot. This first happened in the spring of 2017 and in May of that year I developed sepsis which put me in the ICU for several days. In January of 2018, after several months of weekly tissue grafts, I developed an infection under the graft and had a second bout of sepsis. After more healing, staying off my foot for an extended period and treatment at a wound care center, I finally got it healed up.

But then this spring, after nearly 3 years, the callus once again broke off. This time I went to a podiatrist and was fortunate enough to get one that had previously worked in the wound care center. For the past several months I’ve been meeting with him about every three weeks for evaluation. In between I’ve been trying to offload my foot as much as possible (not walking on it, using a cane so I can put less pressure on it, etc.) Once the hole started getting smaller, he referred me to a pedorthist (a person who specializes in custom shoes). It took several weeks for a new pair to be delivered (the COVID pandemic has affected all kinds of supply chains). With these new shoes I can put aside the cane, but I’m still trying to avoid as much walking as possible.

I’ve managed to avoid any more episodes of sepsis (since a bad case can kill you), but the slowness of the healing process is quite frustrating. In the meantime, I do a lot of sitting (which causes sores in other places that I won’t go into here), and I faithfully change the dressing on my foot per the podiatrist’s instructions.

 

Summary

Head – OK, but being aware of any potential changes while I “give back” through participation in studies.

Heart – Great, no issues at all since my original heart attack in 2005

Blood – New regimen, making progress

Foot – Going slowly which is frustrating

 

Appendix – How Long Will I Live?

Back in 2015, when I was starting this blog, I addressed this question (see link). With this medical update, I thought it appropriate to look at this again. Since I have good genealogical records, I have listed below all my ancestors back to my great-great-great-grandparents (58 people as there are two who are more recent immigrants and I don’t know their parents back in Europe).

At age 73, I am now older than 28 of these 58 ancestors. So, I’m pretty much in the middle of all these individuals. But in just two years I will be as old or older than another 6 of them. Thus, while there are certainly days where I feel “old”, and with my sparse white hair, slow walk, etc. I would certainly not be mistaken for being “young”, I am hopeful of having about another decade on this earth. Then at age 83, I would have become older than all but 8 of these 58 direct ancestors.

But I’m really not in charge of my destiny. Sure, I try to do the right things in taking care of my health. But God is the one who has the final say, and whenever “my time is up”, then I will happily join with Him in glory!

 

Ancestors of Alan Russell:

·        Vernon Russell – 85

o   Erskine Russell – 75

§  Louis Russell – 74

·        Walter Russell – 43

o   Silas Russell – 83

o   Hester [Disbrow] Russell – 90

·        Lois [Cook] Russell – 38

o   Levi Cook – 81

o   Sally [Barton] Cook – 87

§  Anna [Merchant] Russell – 32

·        Francis Merchant – 74

o   unknown

·        Nancy [Soan] Merchant – 60

o   unknown

o   Vera [Levy] [Russell] Rogers – 68

§  Maurice Levy – 42

·        Alexander Levy – 78

o   Lewis Levy – 64

o   Caroline [Lee] Levy – 81

·        Phoebe [Isaacs] Levy – 66

o   Phillip Isaacs – 76

o   Anna [Marks] Isaacs – 85

§  Caroline [Northrop] Levy – 63

·        Lawrence Northrop – 83

o   Joel Northrop – 74

o   Catherine [Canfield] Northrop – 76

·        Mary Lois [Rogers] Northrop – 82

o   Benjamin Rogers – 61

o   Lois [Chaffee] Rogers – 38

·        Sylvia [Pierpont] Russell – 88

o   Harold Pierpont – 71

§  Wilson Pierpont – 66

·        Charles Pierpont – 59

o   Austin Pierpont – 57

o   Sally [Beecher] Pierpont – 52

·        Mary Ann [Warner] Pierpont – 82

o   Jared Warner – 67

o   Mary [Bronson] Warner – 90

§  Annie [Merrill] Pierpont – 39

·        Nathan Merrill – 85

o   Elijah Merrill – 64

o   Anna [Perkins] Merrill – 89

·        Eunice Hoadley – 72

o   Artemus Hoadley – 39

o   Alma [Frisbie] Hoadley – 82

o   Sara [Blackman] Pierpont – 81

§  Clarence Blackman – 59

·        Isaac Blackman – 79

o   Joel Blackman – 57

o   Nancy [Crofutt] Blackman – 62

·        Harriett [Johnson] Blackman – 71

o   Cyrus Johnson – 49

o   Frances [Lockwood] Johnson – 79

§  Alice [Talmadge] Blackman – 58

·        Stephen Talmadge – 80

o   William Talmadge – 64

o   Anna [Sperry] Talmadge – 82

·        Sarah [Few] Talmadge – 81

o   John Few – 74

o   Rebecca [Fisher] Few – 75

Age at death:

·        31-40: 5       (32, 38, 38, 39, 39)

·        41-50: 3       (42, 43, 49)

·        51-60: 7       (52, 57, 57, 58, 59, 59, 60)

·        61-70: 10     (60, 61, 62, 63, 64, 64, 64, 66, 67, 68)

·        71-75: 9       (71, 71, 72, 74, 74, 74, 74, 75, 75)

·        76-80: 6       (76, 76, 78, 79, 79, 80)

·        81-85: 13     (81, 81, 81, 81, 82, 82, 82, 82, 83, 83, 85, 85, 85)

·        86+: 5           (87, 88, 89, 90, 90)