April 2010


‘To live is to suffer, to survive is to find meaning in the suffering. If there is any purpose in life at all, there must be a purpose in suffering and in dying.  But no man can tell another what this purpose is.  Each must find out for himself, and must accept the answer that his solution prescribes. If he succeeds, he will continue to grow despite all the indignities.’   

So writes one time Harvard Professor of Psychology, Gordon Allport in his preface to Viktor Frankl’s abiding monument,  ‘Man’s Search for Meaning’.   He claims it as the central theme of existentialism.  We might, however question whether it is always necessary to suffer in order to grow.  There is something Calvinist in that notion.  But what Frankl shows us through his narrative is how it is possible to withstand the most dreadful pain, torture and privation by finding and retaining an essential meaning in life. 

Viktor Frankl was a jewish psychiatrist, living in Vienna in 1939.  He could have escaped to America; he had a visa, but he could not bring himself to abandon his parents to their fate.   He was arrested by the Nazis and taken to Auschwitz, but he survived.  He wasn’t a Capo, a privileged collaborator; he found the meaning in his suffering to survive.    

‘Man’s Search for Meaning’  focuses on everyday indignities and privations, the cruelty, the lack of food, sleep and adequate clothing, the lice, dysentery, work, and endurance.      

After the initial shock of becoming a number instead of a human being, a prisoner enters into phase of apathy and indifference.  He tries not to be noticed, merges in with the crowd, gives an impression of smartness and fitness for work; does  anything that would stop him being singled out and sent to the gas chambers.  Many gave up, refused to work and accepted their fate, but those who survived discovered and nurtured an essential purpose in life that was worth clinging on to. 

 Frankl describes how the memory and love for his wife kept him alive.  In the midst of the most dreadful degradation, he focussed on thoughts that uplifted the soul;  an image of mountains, the coming of spring, music, snatches of poetry, the book he wanted to write.      

There is nobility in suffering,  Frankl claims, opportunities to find a moral compass and retain human dignity.  Suffering can bring out the best in a person if he sees meaning in it.

Fyodor Dostoevsky said that the only thing he dreaded was not to be worthy of his sufferings.    Those who let their inner hold on their own dignity and meaning, eventually fell victim to the camp’s degrading influence.   They gave way to introspection and retrospection, lost purpose and hope, and just lay on their bed of stinking straw and were taken away to die.     

Frankl described a strange timelessness in the camp.  Hours or days of degradation and pain, passed slowly, but months and years passed quickly, punctuated by suffering.  Survivors saw it as a provisional existence, something to be endured for as long as it took; they retained the hope  they would be free. 

Prisoners were supported by  the companionship of mutual privation.  They tried to help each other.  They kept each other warm at night, they remove the lice from their hair, they shared their food, they told grim jokes. They were a kind of community; they trusted each other.  Religion was a potent bonding force; prisoners often gained solace by praying together every night.

Unfortunately, their suffering did not always end when the guards left and the camp gates were opened .   Release was all too often associated with bitterness and disillusion.  Life had moved on.  Their family had died.  There was no work and they had lost the companionship of shared suffering.  Others could not understand   

For Frankl, his experience in Auschwitz became the mainspring of his life.  From it he developed a philosophy of hope and a psychotherapy for those in despair, based on the discovery of the meaning  of their suffering.   It was Niezsche who said, ‘He who has a why (a purpose) to live can bear almost any how.’   Frankl explains that the ‘why’ of existence is was not so much what we expect from life, more what life expected from us in terms of work and family.   Life ultimately means taking responsibility.   Sometimes action is needed, sometimes contemplation, sometimes it’s just necessary to accept fate.  When a man realises that suffering is his destiny, he will accept it as a challenge.  Such thoughts can keep a prisoner from despair.   Again, Nietzsche,  ‘That which does not kill me, makes me stronger.’

Few of us in the west have ever been tested in the way Frankl was.   But meaning can be threatened in other ways,  such as the  death of a spouse, the devastation of divorce, the collapse of love, the loss of purpose in retirement or unemployment, the estrangement from one’s children, the disillusion with a cause or faith.   When people lose meaning and purpose, then they succumb to an inner emptiness, an existential vacuum,  the boredom and loneliness, which lies at the base of much of the unhappiness of modern life. 

Empty people try to fill their lives with thrills and diversions;  the sexual libido becomes rampant in existential vacuum, so does the pursuit of power, the addiction to shopping, alcohol, drugs, the accumulation of money.  It is pure escapism into immediate gratification, a frantic search for meaning in sensation.  ‘We had such a wicked time, I got smashed, the sex was fantastic!’ 

Such diversions rarely lead to meaning.  Quite the reverse;  often the will, the hope, the purpose and the self respect dies a little more.  Frankl states that people can transcend the thrill-seeking self and discover a meaning in their lives by creating a work or a deed, by experiencing something or encountering someone (such as falling in love), and most of all, by the attitude we take towards unavoidable suffering. 

He claims that we can be ennobled by taking on the suffering another would have to bear, like giving up a relationship that would devastate them, an ambition that would cause them pain. This might give suffering a meaning, but it is avoidable.  And is martyrdom and self sacrifice ever a valid route to redemption and happiness?   Only if the sacrifice has a deeper meaning to the integrity of the ‘soul’,  outside of the act itself.   

 Survival of identity and meaning  (what I tend to regard as the soul) is more important than mere corporeal integrity.   The anorexic starves their body so that their basic identity and meaning can thrive.  And for many other sick people,  illness endures the meaning of what has happened, until a person can bear to bring it to mind.   If the meaning and purpose are devastated by life’s vicissitudes, then the body will easily become vulnerable to disease.  Mind, body and soul (meaning) are a continuum, which contains health and happiness.   

‘Man’s search for meaning’ was first published in 1946 in German under the title of ‘Ein psycholog erlebt das konzentrationslager’.  Frankl developed the existential concept of logotherapy from his experience.  Unlike psychoanalysis, logotherapy  does not dwell on the past, but focuses on the  development of a meaning in a person’s suffering that can break the cycle of loneliness and unhappiness.   

It’s the finest, most delicate thread in the world and can be dyed and woven into smooth yet light clothes fit for an emperor let alone a modern man of distinction or a lady of style and discernment.  This cloth is the bee’s knees, the cat’s pyjamas or, to more explicit, the beautiful lament of the doomed moth.  Yet for thousands of years its existence was a closely guarded secret, hidden behind a thousand mile wall in the fastnesses of Northern China.  Anybody who tried to take the secret out  was instantly put to death. 

According to legend, the Empress was sitting under a mulberry tree when a white egg-shaped cocoon fell into her tea and she observed a thread uncoiling from it. She picked up the end and started to wind it round her finger.  It didn’t break and just kept on coming and coming.   

Eventually, having leant how to dye, weave and fashion clothes from this precious thread,  the Chinese traded it to the rest of the world via the Silk Road, an overland trade route though the legendary Samarkand and the deserts Central Asia to the emporia of Europe.  The Venetian, Marco Polo followed the same route in the opposite direction to bring back knowledge of China to the west.

 The Silkworm (Bombyx mori) is the caterpillar of a pallid moth native to Northern China.  Over the centuries, it has been inbred to the point where it can no longer survive in the wild. It has a fat body and small wings and cannot eat or fly.  It just reproduces and dies within five days, just enough time for  the female to lay, on the underside of a  mulberry leaf,  200 to 500 lemon-yellow eggs that eventually turn black and hatch into tiny caterpillars.  The emerging silkworms are fussy eaters, dining only on mulberry leaves ( Morus alba)  for 4 to 6 weeks until they are nearly 3 inches long, having moulted several times.  When the silkworm has had its full of mulberry leaf, it spins a cocoon from a single strand of silk made of protein secreted from two salivary glands in the caterpillar’s head. This process takes 3 or more days.  The silk covers a hard brown-shelled pupa, from which the adult moth emerges.

In Northern Laos they let the caterpillars grow, feed them on fresh mulberry leaves until they form cocoons and pupate. Some of pupae are allowed to hatch into a silk moths and produce a new crop of silkworms, but the rest are first steamed to kill the pupae (which  would break the silk if they emerged as moths).  Next the cocoon is dunked in hot water, (rather than tea), to dissolve the sticky coating that binds the silk.  Then they wind the half mile strand of silk that makes up each cocoon on a small wheel, spin the threads from several cocoons together,  dye them and weave them on a small loom to make the cloth.  The Loatians do all of this in the space under their houses on stilts, the silkworms protected from predators in small mesh cages. 

I wonder if the cocoon altered the taste of the Empresses tea.

You see people like Michael Baird all the time at scientific conferences; pudgy, balding, slightly unkempt,  full of their own self importance.  But Baird, like many academics, was a lazy man; a one discovery wonder.  As an Oxford post-doc, he revised  one of Einstein’s theories, an achievement of brilliance that won him the nomination for a Nobel Prize some 20 years later.  Since that time, he had relaxed and reaped the rewards of his eminence, delivering lectures, giving out prizes, opening  research institutes, and offering his support to worthy causes and his name to organisations.   Maybe his prize had given him a sense of entitlement; maybe he had always had it.  But Baird believed he deserved the trappings of eminence.  And, if he wanted something, he was quite entitled to go out and get it?  Sex, food, devotion, recognition, it was all the same to him.  They were his just deserts. 

There was something decadent about Michael Baird.  He didn’t look after himself.  He lived amid his own rubbish in a run-down apartment in Paddington.  He was overweight; he ate all the wrong food.  He ignored his doctor’s warnings.  He just didn’t seem to care. He had been married 5 times; each marriage only lasted a few years and was childless.  He didn’t work at a relationship; he took from it and then destroyed each of his marriages by other affairs, often with quite unsuitable people. 

It was as if he didn’t value himself very much or could only be valued in the eyes of somebody else. Yet, why was he so attractive to some women?  Is it that they saw somebody worthy of rescue?  Does his fame, his celebrity, the semblance of power, have something to do with that? 

Michael was a chubby baby and at the age of six months, he won the local bouncing baby competition.  He was all dimples and smiles, he couldn’t fail.  He never looked back.  His mother, trapped in a loveless marriage devoted all her attention on him, fed him the most tasty dishes, and  even when he was older and at university, she went on a cordon bleu cookery course so that she could cook him food he would enjoy. His father, meanwhile, fostered Michael’s interest in electronics, mechanics; the ways things worked. Michael was a special little boy.  He was clever and got a place to Oxford.

As Michael grew up, his mother needed more excitement.  She 17 love affairs in 11 years and exhausted, died of breast cancer when Michael was about 23.  Michael never talked to his father about this and forgave his the tragic lack of meaning of her life.  He had, after all, inherited it, but in a different way.  Despite the nobel prize, Michael’s life always threatened to gravitate to meaninglessness.   He inhabited an existential vacuum, sustained by food, sex and the admiration of others.     

The scene was set.  The accident had to happen.  Michael was appointed the nominal head of a climate research institute near Reading.  He wasn’t really interested in the job, but it had a certain amount of kudos and a reasonable government salary.  Besides, he didn’t have to do very much.   Tom Aldous was a young clever post-doc who had read all of Michael’s work and realised that the Baird Einstein conflation held the secret for not only artificial photosynthesis but also the utilisation of the suns energy to split water, releasing oxygen and also hydrogen which could be used as a fuel.  Michael wasn’t really interested, he just wanted a quiet life with plenty of food and plenty of sex.  Aldous’ enthusiasm was an embarrassing irritant. 

Patrice, Michael’s fifth wife had discovered Michael’s latest affair and with it a string of other extramarital liaisons, so she embarked on a relationship with their builder Rodney Tarpin just to show him, but Tarpin became violent.

While Michael was away on a somewhat bizarre polar conference on a boat in a field in Spitzbergan, Patrice also took Aldous as a lover.  Michael came home early and discovered Aldous in the sitting room in his dressing gown.  Aldous, fearful that he would lose his job, ran towards Baird but slipped on the polar bear rug, banged his head on the corner of the glass table and died instantly. 

Michael assessed the situation instantly.  Nobody would believe he hadn’t killed Aldous. He found Tarpin’s box of tools in the cupboard and smeared the hammer with Aldous’ blood, wiped Tarpin’s hairs from a comb on Aldous’ hand and then left.  He got away with it.  Tarpin was convicted and went to prison, but Baird lost his position in Reading. 

Things started to unravel when he used Aldous’ work to set up a company to investigate artificial photosynthesis with an American collaborator.   His old institute accused him of plagiarism, his collaborator started to pull out and his current girlfriend Melissa, who had had their child, came to Texas only to discover that Michael was having a torrid sexual liaison with Darlene, a local waitress.  Tarpin was out of prison and in America looking for him.

It was as if Baird had carried a dark shadow with him all his life.  No matter what good happened, his work, his fame, his marriages, it would always destroy them and eventually it would eventually destroy him. But why?   Was he brought up with few scruples and the conviction he could get away with anything?  Could he not bear the burden of a greatness he felt he didn’t really deserve?  Was he just so frightened of exposure that he would lie, cheat, steal, deceive; do anything to avoid it?   Life held no meaning for Baird; things had come too easy.  Apart from rare bursts of enthusiasm, he never worked very hard, so nothing had any value.  He just existed, took the easy path and came to despise the man he had become.  In a way, one feels, he welcomed the whirlwind about to envelope him.  It would either kill him or give him a reason to survive.    

 

Solar is Ian McEwan’s latest novel, published last month.  He has taken  on the difficult modern phenomenon  of narcissism entitlement and ennui and has created an unlikeable character and a disturbing novel, in which moments of farce merely serve to emphasise the essential darkness.    

What role does an artist have in the debate about the environment?   Surely it all depends on scientific data and predictions.  The solution must be based on interpretation of evidence and engineering solutions, mustn’t it?   But it is not as easy as all that.   There are so many factors to consider.  Take the coastline for example.  Up until now,  the initiatives have all been about  defence; holding the line, building sea walls, putting in flood gates.  It’s a siege mentality.    But now it’s different.  Rising sea levels is something we cannot oppose.   It was King Canute, who reputedly  demonstrated the limits of human potential with regard to time and tide.   A thousand years later, it seems we are discovering it all over again. 

Sea levels are going to rise, coastal erosion is going to take place all along East Anglia,  land is going to be lost.  You cannot stop it.  All you can do is try to accommodate it and limit the damage so it does not affect certain resources that just have to be sustained, like Sizewell B Nuclear Power Station, like Southwold, Lowestoft, Felixstowe and Woodbridge.   But to do this, other things may have to go.  Farmland may have to left to revert to salt marsh,  but protected by baffles and breakwaters  so that the run-off from high tidal shifts does not encourage further erosion.  Lighthouses and other coastal structures like Martello towers may have to go.  Land below sea level may have to be allowed to flood.   A controlled breach may have to be made in the elbow of the River Alde where fifty yards or so of shingle just separate from the sea,  but this would silt up Orford so that after 1000 years it would be landlocked like Winchelsea.   

But there are so many factors to consider in trying to think what might happen,  the height of the tides, the extent of coastal drift, the topography and geology of the land,  the bathygraphy,  and of course human activity.  Mr Peter Boggis, local engineer and landowner,  had taken matters into his own hands and dumped thousands of lorry loads of hard core onto the foreshore above Southwold to prevent the erosion of the soft sandy bedrock of his land, but the sea has just continued to undermine his efforts, eroding the underlying soft sand so that the hard core subsides and is also  washed away and the erosion continues.   In other placed they have tried to protect the Martello Towers and other coastal amenities, like Felixstowe Golf Course, by depositing a band of large blocks of Norwegian granite  (rock armour) along the shoreline, but rock armour is only as firm as the ground it is dumped on or leans against.  In any case, eddies are set up where the granite ends causing accelerated erosion down the coast.  There are always knock on effects.  

So where does the artist come in.  Well, as Simon expressed it,  the informed artist is an observer,  he applies a prepared mind to explore contingencies and consequences.   He has no vested interest and can therefore afford to have an  unbiased perspective and promote a conversation among other stakeholders;  environmentalists, engineers, landowners and politicians.  The perspective of the artist differs from that of the scientist because it is by necessity, exploratory and speculative and gives free rein to the imagination.  The informed artist has no idea what will happen, but, lacking vested interests, is in a good position to work out what might.  The scientist is programmed by Popperian philosophy to set up a hypothesis and try to disprove it.  He has already decided what will happen.  This scientific approach is much more rigid and focussed;  its methodology and statistics offer a ‘semblance’ of proof, but only under the rigid conditions of the ‘experiment’.  They tend to  foreclose discussion. 

In reality, we need both approaches.  The artist and scientist should work more together. The exploratory models, based on the intuition and imagination of the informed artist can help to focus and structure the scientific investigation so that it takes into account all contingencies and creates a much tighter null hypothesis that will lead to less ambiguous conclusions and more effective strategies.   

We are talking here about chaos and meaning.   Natural phenomena, like the patterns of flow that create the weather, the rivers and sea, growth and even human emotion and illness, appear chaotic and can all to readily escape the arbitrary rules we try to impose on them.   We need to make fully informed responses to them in the sure knowledge that while we cannot hope to control, we can understand and contain.  Philosophy requires the integration of imagination and reason, intuition and fact, information and speculation to achieve a more meaningful and effective response.  

 But philosophy requires freedom of thought and matters such as coastal management are highly political; people stand to lose or gain enormous sums of money.   The conversation can all too easily be railroaded by the political manipulations of landowners, farmers, entrepreneurs, developers,  powerful stakeholders with sufficient resources to employ lawyers to find loopholes.  The project could so easily be stalled and then abandoned by an incoming government, the ability to plan productively will be lost, and when the disaster occurs, the losses will be catastrophic. 

And all the while, the  unexpected can  happen.   This week there has been a massive volcanic eruption in Iceland, pumping ash high into the atmosphere and grounding all aircraft coming in and out of the UK.   Simon informed me that the last time this happened, it caused widespread famine in France and initiated the French Revolution. 

On April 15th, Simon Read, my brother,  talked about his latest exhibition of drawings to an audience at The New Cut Arts Centre in Halesworth, Suffolk.  He explained how he had abandoned the creation of works of art for their own sake many years ago, developing  his artistic intuition and skill to explore phenomena; light, movement, growth, the flow and turbulence and water; the essential meaning of things.  He has utilised the insights this has given him in the service of the debate on coastal management.                          

Easter passed me by this year.  It’s not because I’m an atheist.  I think beliefs, faiths, meanings are essential to our well being, but very personal and for me not to be culturally regulated.   I believe in love, metaphysics, forgiveness, wild places and regular exercise.  No, it was because I spent Easter in the Intensive Care Unit of the Oulu University Hospital,  fighting off Malaria.  I’ve already described the circumstances in my previous blog (But they don’t get Malaria in Finland,  10th April).  What I want to think about in this piece is the why I can hardly remember anything about it, just odd glimpses of green, a male nurst who was a professional strong man, and somewhere in there the thought that I may not get through this.  I was never unconscious (except for the brief periods when I was asleep) but I was terribly tired.     

Maybe it was the tiredness.  Maybe my body was physiologically in a state of conservation and repair.  I’d stopped fighting or thinking.  I was just existing.   With the first few bouts of fever, the sensitivity of my scalp, the persistent headache, the shivering, induced a state of despair.  I was  delirious and repeating, ‘ Oh my God, Oh my God, Oh my God’, worryingly reminiscent of my mother’s  anxiety dementia.  But then I seemed to give up and accept whatever would happen. 

 Such states of body and mind correspond to Hans Selye’s  General Adaptation Syndrome (1936),  in which he documented a stereotypical responses to stressors of all kinds, physiological, medical and psychological.   They all, he concluded, tap into the same mechanism. 

The first response to a stressor is to fight it with the sympathetic nervous system; hence the anxiety, the pain, the shivering  but this gives way to a state of sweating and sleep; a state of conservation  dominated by the parasympathetic nervous system.  You see the same response in animals, whose ultimate response to overwhelming stress is to curl up in the corner of their cage and ‘play possum’.   But both people and animals vary according to whether or how quickly they exhibit which response.     

Post Traumatic Amnesia is a kind of dissociation.  It is a response to overwhelming trauma and could be thought of as a mechanism that protects the individual from the knowledge that would destroy their sense of self, like risk of death, abuse, or the collapse of a key relationship.   It is often associated with other aspects of the post-traumatic stress reaction, such as nightmares, bodily weakness, and a variety of somatic symptoms.   If you cannot remember or deal with what has happened, then nightmares and somatic symptoms often remain to express the trauma in coded form. 

But what is the mechanism?   The stress response not only involves the autonomic nervous system (sympathetic and parasympathetic), it also includes the hypothalamo-pituitary adrenal (HPA) system, which releases a cascade of transmitters and hormones (CRF, ACTH, cortisol, aldosterone) as a compensatory mechanism to offset the damaging effects of excessive and sustained  sympathetic arousal on the body.  The HPA system maintains the function of the organism in the face of overwhelming stress, maintaining energy supplies, damping down the immune system, suppressing inflammation and pain and blocking memory.  

So can it all be explained by activation of the HPA axis?   If so, why are Chronic Fatigue Syndrome and Alexithymia (the disconnection of the emotional and rational expression), which may both coexist as part of the post traumatic reaction, associated with diminished cortisol responses.   Does this represent a state of exhaustion or switching off?  There is never an easy answer to anything. 

With a days of the Malaria being treated, the tiredness disappeared is.    I became frustrated with  being in hospital and although still weak began, to devise strategies for discharge.  The will to live had reasserted itself.  What would have been the point of remembering what it was like?

You cannot go to Cambodia and not see Angkor Wat, Suzanne responded, wide eyed and incredulous that I could even think about it.  But I wasn’t so sure.  Maybe it was the tourist thing.  I don’t like being shown around by a guide, the same inane chatter, the same non- information, the same  inability to answer any question with any depth, the air conditioned car, the inevitable tourist traps; the souvenir sellers -the same whiny pleading tone, just one dollar mister, look 10 post card – one dollar, the feelings of guilt – the amputees,  the exploitation of it all.  

Don’t get me wrong.  Angkor Wat is part of a truly magnificent and beautiful complex of temples that was hidden away in the jungle for many years until rediscovered by the French archaeologist, Henri  Mouhot in 1859.   It is a candidate for the 10th wonder of the modern world, the advertising posters proclaimed.   Some of the temples, particularly the Roulos group and Bateus Reay are so lovely especially when viewed in the evening when most of the tourists have gone, the sun is low in the sky and birds are singing – mellow russet stones amid the dense green foliage.   And then there’s the Jungle Temple, its walls and columns completely overwhelmed by the giant muscular roots of  strangler figs, a mysterious and eerie setting for the film Tomb Raider starring Angelina Jolie. 

Angkor Wat is not so much a church but a house for the Gods.  There are no big spaces.  People just walk round and visit, maybe talk to the monks.   The carved friezes on the outer wall depict scenes from the Ramayana as well as beautiful illustrations of everyday life ten centuries ago. 

I always marvel at the sheer complexity and sophistication of life so long ago.  It reminds me of the triumphant columns of ancient Rome,  the reliefs on the Temple in the Valley of the Kings in Egypt or the magnificent Assyrian reliefs in the British Museum, but you need time to reflect on such things away from the press of tourists and the self congratulatory chatter of Nak, our increasingly irritating guide. ‘I am very fit, I love fast cars, I go cycling.  I cycle back to Siem Riep in 20 minutes.’  Oh really, that’s very good, I reply for the umpteenth time, hoping he might just pick up the note of sarcasm in my voice and desist.  But he’s completely oblivious.  ‘I very strong and handsome.  I love beautiful women.’  ‘You rascal, you.’   

And then there are  the terraces of the Leper King (so named because his image has been overgrown with moss and bits of toes and earlobes are missing) and of the Elephants in Angkor Thom.  These are situated at the edge of a massive arena, larger even than the Circus Maximus in Rome and dominated by massive carvings of Garuda (which until now I thought was just the name of the Indonesian airline). 

What is interesting is not the differences of the Angkor Wat complex, but the connections, the similarities with other cultures; ancient Rome, classical Greece, the Egypt of the pharaohs, the Tigris- Euphrates valley, and of course numerous sites in India.  It’s like convergent evolution; the same patterning is built into human culture but may come to fruition at different times without any obvious link between them.  But could the Khmer kingdom have been aware of classical western civilisations?  Might there have been a link through India; Alexander the Great?   It makes you think, but you have to have time to think.  You need the mental space to discover things for yourself, to pause and reflect.  Another group of flag waving, chattering Korean tourists completely negates that.  But Nak was getting the message.

So I now know what the Nagas are and appreciate that the churning of the sea of milk by the Gods pulling on opposing nagas around Mount Meru threw up all kinds of mythical creatures including the beautiful half Goddess Apsara dancers.  I understand how each ritualised step of the Apsara dance carries a particular emotional significance.  I know about conflicts of Vishnu in his incarnation as a monkey general against the demons.  But I struggle to find any deeper significance in these myths.  So they’re relegated to the back burner.  I know about the life of Buddha, his birth into privilege, his marriage to a princess, the great renunciation, the long years of meditation under the Boddihava Tree until he attained the beatific state of Nirvana.   I find out that Angkor Wat was a garrison for the Khmer Rouge and another temple a field hospital.  I understand how the temple complex was built between the 8th and 12th centuries by workers in exchange for their food and lodging and that there were only 4 classes of people at the time; soldiers, farmers, workers and monks – a bit like in mediaeval England.  Facts at the periphery of awareness become fleshed out awaiting  further enlightenment.      

But I guess that’s what travel is about, opening the mind to possibilities, doing some work to try and understand the context, associations and meanings; a  voyage of self discovery.   I’m afraid a guided tour can prevent that.  It’s a bit like eating fast food; it disempowers and is not very nourishing, but if time is short, it can at least provide an awareness for further  study .  So despite Nak, twenty thousand Koreans and Japanese, the whining post card sellers, the guilt at being a rich tourist bastard,  I guess this was a positive experience.  Next time I shall do it free lance and on a bike.

The most serious emergency we had to deal with at Villa Maria was the lady who was brought in on the back of a bicycle, having ruptured her uterus during childbirth. We could feel the baby’s legs clearly under the abdominal wall. She needed an emergency laparotomy.  More usual procedures included lancing of breast abscesses, setting fractures, tooth extractions and treatment of gonococcal strictures.  The male ward was full of gonococcal strictures. When Dr Ivanovich, exiled from Yugoslavia for some dark reasons, marched into the ward, he would announce in his stentorian voice,  ‘Oomkoomkoomala  Booroongi?’ (Do you pass urine well?) whereupon all the patients would raise their sticks or whatever and call out, ‘Booroongi!’  The last thing they wanted was the hockey stick, a particularly nasty curved stainless steel bougie that was inserted into the urethra and forced into the bladder rupturing the strictures on the way!  What they really desired was a ‘Murphy’, a magic injection of coloured fluid that would make everything well.   

This was Uganda in 1967.  Medicine was a two tier system.  The shaman or local witch doctor looked after most illness with a combination of herbs, spells and hope.  The western doctor dealt with the rest; mainly surgical conditions. 

But much the same situation exists in Cambodia in 2010.  In Phnom Penh,  traditional medicine exists alongside conventional medicine. So when Trevor, an Australian ex-pat working for an NGO,  had a bad back he was given Clysters or cupping, where you heat the cups up, put them on the back so that the skin is sucked into the cups.  Clysters were abandoned in England by the middle of the nineteenth century.  Chinese herbs are used quite frequently. Acupuncture is used as well. But when a child fell down and started talking gibberish he was said to be suffering with the forest spirits and taken to an animist or shaman for healing.  Others would seek help from the pharmacy, some would might even go to a health clinic.     

Too many doctors in Phnom Penh  rely on tests and shiny equipment than on good clinical practice.  But equipment often breaks down, you cannot get the reagents or the parts, disposables are expensive.  Local substitutes and simple sterilisation techniques tend not to be used.  It’s  like being in a deep pit with a broken ladder, with no money to repair the ladder.

And then there are deeply entrenched prejudices to overcome.  Often a woman will not allow herself to be examined by a male doctor and will refuse Western treatment.  There is a terror of surgery.  Still too many people die because they refuse modern treatments or they can’t afford it. 

If the patient is admitted to hospital, nursing is done by the relatives who supply food, bring in the drugs, test the urine, administer  the bedpans and generally looked after the patients.  The nurses, as they are today, are  more like technicians.  This was what it was like in Villa Maria Hospital in 1967.  In Cambodia they felt that they weren’t being treated properly unless they got an intravenous infusion. 

It’s different  in the country.  Most people go to herbalists.  It’s much cheaper.  Herbalists understand the relationship between the illness, the person, the circumstance and the illness and select appropriate herbs and advice to treat them. 

In  rural Laos, patients prefer to keep their troubles to themselves, but if they fall sick, first the village elders are consulted, then the local healer or shaman.  Great faith is placed in the remedies handed down through generations.  And faith is a great healer!  Only if the disease does not respond to the shaman and time, might they think of contacting a doctor or nurse, but that takes money and a long journey into town.

There is just one doctor for every 9000 patients in rural Laos and most  want to be like western style specialists.  But there is at least one healer in every village and most women have a home spun knowledge or herbs, potions and illness.  Surely some kind of practical educational programme that recognises the best of both systems would be very valuable.  After all, the healers understand the patient and can put in the illness into a context where a combination of herb, home remedy and placebo may prove all that the patient needs, but if they also understood when the illness is not  just the result of circumstance but an infection, a cancer, a chronic inflammation that needs western medicine, then the skills of the western trained doctor can be focussed where they are most needed.             

When it comes down to it, a lot could be achieved by the application of good clinical medicine and simple bench testing,  combined with a working collaboration with local healers.

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