Oct 262017
 

WHO (World Health Organization) chose this date, approximately 2 years after the last known case of naturally occurring smallpox, to announce that the disease has been completely eradicated from the world – a rare and stunning event. Smallpox is a special human disease in that it is one of the few that cannot migrate to other species. It can infect humans only, so the WHO set the goal of eliminating smallpox from human hosts because once there were no infected humans, the disease would be effectively extinct. There’s the extinction of one endangered species that no one laments. Smallpox exists now only in carefully guarded lab specimens (available for ongoing testing), which once in a while are mishandled and cause someone to be infected. But for all intents and purposes smallpox has been wiped out.

Not so very long ago, smallpox was a worldwide scourge with infants (and adults) dying regularly on all continents. Then Edward Jenner came along and vaccination was born. http://www.bookofdaystales.com/edward-jenner-and-smallpox/ Vaccination was very effective in Europe, but the rest of the world lagged behind – especially Africa. A concerted effort by the WHO got the job done, though, in the end. Into my teens (1960s) I was required to prove I was vaccinated against smallpox when traveling abroad, but by my twenties it all came to an end. Hooray.

Smallpox is caused by two strains of virus, Variola major and V. minor. V. minor is the rarer of the two strains, and causes a much less severe disease (sometimes called alastrim), with a fatality rate of around 1%. No treatment is available, and the only protection is vaccination. The virus is usually transmitted by prolonged face-to-face contact with a person showing symptoms. The incubation period averages 12–14 days. Smallpox was still causing an estimated 2 million deaths every year as late as 1967.

The global effort to eradicate smallpox from endemic areas, particularly in Africa, began in 1959 with a mass vaccination campaign. This approach met with little success, and a more-effective targeted approach was developed in the late 1960s. This involved active surveillance by case hunting, combined with rapid containment, by intensive vaccination, of infection in areas reporting outbreaks. The majority of African countries were free from smallpox by 1972. By the end of 1975, the virus had been eradicated worldwide except in Ethiopia, Somalia, and Kenya. The nomadic people of the Ogaden Desert retained endemic smallpox with an unusually mild form of the disease, which facilitated persistence in the population. From 1975, WHO efforts were concentrated on this region. Ethiopia saw its last case in August 1976 and Kenya in February 1977.

Somalia proved particularly challenging because much of its population of 3.5 million was nomadic. A mass vaccination campaign in the country in 1969 had failed because many nomadic people in the region had cultural objections to vaccination, and either refused or avoided it. Elimination efforts relied on an intensive reporting system. A severe drought in 1975 exacerbated the difficulties by increasing movement across the border with Ethiopia, and frequent outbreaks continued. In March 1977, surveillance efforts found over 3000 cases in the south of the country.The Somali government declared a state of emergency and successfully appealed to the United Nations for assistance. By June of that year, when the outbreak peaked, 3000 Somali health workers supervised by 23 international advisers were involved in the eradication efforts. Eradication work was hampered in July when the Ogaden War broke out, limiting access to the desert.

The last known natural occurring case of smallpox (V. minor) was contracted by Ali Maow Maalin around this date in 1977. Maalin worked as a cook at the hospital in the port-town of Merca in southern Somalia, as well as an occasional vaccinator for a WHO smallpox eradication team. He had not been successfully vaccinated, even though smallpox vaccination was obligatory for hospital employees. According to CDC epidemiologist Jason Weisfeld, one of the people who led the later containment effort in Merca, Maalin had received the smallpox vaccine but it had failed to take, and he had not been protected. Other sources, however, state that he had not been vaccinated. In an interview in 2007, Maalin said that he had not been vaccinated, explaining: “I was scared of being vaccinated then. It looked like the shot hurt.” Some ironies are staggering. The guy was helping eradicate the disease by encouraging vaccination, but didn’t get vaccinated himself and caught smallpox.

In August 1977, an outbreak developed in a Somalian nomadic group of twenty families; eight children developed symptoms in August to October. On 12 October 1977, two children with smallpox symptoms were discovered at an encampment near the small inland settlement of Kurtunawarey, around 90 km from Merca. Local officials drove the children to Merca, where there was a nearby isolation camp. Maalin, then aged 23, served as a guide to the party taking them in a closed Land Cruiser from the hospital where he worked either in the home of a surveillance supervisor or directly at the isolation camp. He is believed to have been infected during the journey, which lasted no more than 5–15 minutes. One of the children, a six-year-old girl named Habiba Nur Ali, died two days later. She was the last person to die from naturally acquired smallpox. The outbreak among the nomadic group was successfully contained by WHO workers by 18 October, but – critically – investigators failed to identify Maalin as a contact.

On 22 October, Maalin fell ill with fever and headache, and received malaria treatment in hospital. After four days a rash appeared. Perhaps working on the assumption that he had been successfully vaccinated against smallpox, Maalin was then believed to have chickenpox and was discharged from hospital. Over the next few days, his symptoms developed to indicate smallpox as the cause. Not wishing to be put into isolation, Maalin failed to report himself. On 30 October, a male nurse colleague reported him, possibly for the reward of 200 Somali shillings (around $35), and Maalin was transferred to the isolation camp. He was diagnosed with an infection of the Variola minor strain of smallpox, based on his symptoms and later confirmed by laboratory tests. The date of diagnosis is sometimes stated as 26 October 1977. Maalin did not experience complications, and subsequently recovered fully and was discharged in late November.

Donald Henderson, who directed the WHO eradication program from 1967 until 1976, describes Maalin’s case as “a classic one in depicting omissions and mistakes in program operations.” Maalin, described by Henderson as “a popular man,” had been visited by many relations and friends during his illness before he entered isolation. While hospitalized with fever, he had walked freely around the hospital, interacting with multiple patients.

Multiple measures were used to contain the potential outbreak in the town of Merca. The response was coordinated by Weisfeld and Karl Markvart. Maalin’s contacts were all traced by the WHO eradication team. A total of 161 contacts were identified, 41 of whom had not been vaccinated. There were 91 people who had been in face-to-face contact with Maalin, 12 of whom were unvaccinated. Some of his contacts lived up to 120 km outside the town. All contacts were kept under surveillance for six weeks. His face-to-face contacts and their families were vaccinated, but none showed any sign of having been infected. Merca Hospital was closed to new patients, all its medical staff were vaccinated and existing patients were quarantined in situ. The residents of the fifty houses neighboring Maalin’s lodgings were vaccinated, and vaccinations were later extended to the ward of the town in which Maalin lived. House-to-house searches throughout the entire town looked for cases. Police checkpoints on all exits to the town, including footpaths, were established to vaccinate anyone passing who had not been recently immunized. A total of 54,777 people were vaccinated in the two weeks following Maalin’s isolation. The response later broadened, with monthly house-to-house searches across the region widening to a search throughout Somalia, completed in December 1977.

The containment efforts proved effective and, on 17 April 1978, WHO’s Nairobi office sent a telegram stating: “Search complete. No cases discovered. Ali Maow Maalin is the world’s last known smallpox case.” Although there have been subsequent cases of smallpox from laboratory contamination, Maalin remains the last case of naturally acquired smallpox in the world. On 26 October 1979, two years after the day when Maalin’s rash appeared, WHO declared that smallpox had been eradicated globally.

Unfortunately the story does not end so well for Maalin. Maalin remained in the Merca area, where he was employed in a range of roles. In the mid-1990s, he was selling medicines in a nearby small town. Maalin was among the 10,000 volunteers who participated in the effort to eradicate poliomyelitis from Somalia, which succeeded in 2008. He explained his motivation for volunteering: “Somalia was the last country with smallpox. I wanted to help ensure that we would not be the last place with polio too.” Maalin worked for WHO as a local coordinator with responsibility for social mobilisation, and spent several years travelling across Somalia, vaccinating children and educating communities. The Boston Globe described him as one of the “most valuable” local coordinators for WHO. He encouraged people to be vaccinated by sharing his experiences with smallpox: “Now when I meet parents who refuse to give their children the polio vaccine, I tell them my story. I tell them how important these vaccines are. I tell them not to do something foolish like me.” He continued to work as a regional coordinator for the vaccination drive, and was hailed as one of the “true heroes” of the campaign. After the 2013 reintroduction of poliovirus into Somalia, Maalin was again carrying out vaccinations in the Merca district when he developed a fever, and died days later, on 22 July 2013, of malaria. He was survived by his wife and three children.

I’ve not been to Somalia nor the general region of the Horn of Africa, so I’m flying blind here when it comes to recipes. Until Somalia settles down politically I’m not going there either. But the cuisine looks familiar enough. There are different regional Somali culinary traditions of course, with some East African, Arab, Ethiopian, Yemeni, Turkish, Indian, and Italian influences. It is the product of Somalia’s tradition of trade and commerce. Some notable Somali delicacies include sabayad, lahoh/injera, halva, sambuusa, basbousa, and ful medames. Play with the names and you’ll understand. For example, sambuusa is a variant of the Indian samosa.  Here’s a video for you:

Oct 012016
 

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Today is the UN International Day of Older Persons.  This from the WHO website:

The International Day of Older Persons is an opportunity to highlight the important contributions that older people make to society and raise awareness of the issues and challenges of ageing in today’s world. The theme for 2016, Take a Stand Against Ageism, challenges everyone to consider ageism – the negative attitudes and discrimination based on age – and the detrimental impact it has on older people.

The bit about “important contributions” is a tad condescending, and the “issues and challenges” bit is a little broad. But I’ll go with it. Let’s start with what an “older person” is. The WHO tactfully does not give an age but this does:

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So apparently I am an “older person” at 65. Who knew? I thought 60 was the new 40. Here’s this “older person” at 63.

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The beard wasn’t doing me any favors in that regard, so I lost it. My sister thinks I should lose the chops now also. Not a chance. The good thing about getting older is being able to be a curmudgeon. When I was younger I was simply a pain in the arse. Now it’s cute. If you don’t like it you can f**k off. And you know where you can stick this sign.

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I have various thoughts about aging and, since this year’s theme is ageism I’ll get to that eventually. Other thoughts first. The need for a special day for older persons is in large part due to the modern cult of youth which has been creeping up steadily since at least the 1950s. When I was a boy in the 1950s I thought that people my age were ancient. That’s partly a function of my own youth at the time, and partly a function of different standards. Medicine was quite different then, and also people slowed down more quickly. My paternal grandparents were dead by their 50s and my mother wore a full set of dentures in her 30s. These were normal facts of life back then. On the other hand, a raft of my maternal great aunts and uncles lived well into their 90s and one made it past 100. I also had a great aunt by marriage who was going strong into her 100s – living alone, cooking for herself etc. until she dropped. But these were notable exceptions.

Nowadays, especially in the United States, older people have become a nuisance for many families whereas once they were valued. They get stuck in retirement homes and visited on Sunday afternoons. That practice is a gigantic failure of society. Younger relatives are too “busy” to look after people as they grow older so they get pushed aside. That doesn’t cut it with me, nor with many other cultures. In rural Italy nonna lives at home with one of her children and her grandchildren, and when she gets feeble she sits outside during the day and greets local villagers as they pass by. Someone brings her lunch where she is sitting, and in the evening she goes inside for dinner. She doesn’t need a nursing “home” – just someone to show some basic compassion.  Here’s a picture I took in 1963 in Australia of my neighbors (and my sister with them). No thought of bunging “gran” in a nursing home. She was a valued family member even though she needed a wheelchair.

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There was a time, especially before the Industrial Revolution, when local “worthies” (old folk) were specially prized members of society because of their knowledge. Let’s say there’s an unusually heavy frost in the fields followed by a devastating flood. What do you do about ploughing this year? This just doesn’t happen. Well – you seek out the oldsters who tell you, “I remember my father saying that this happened when he was a boy. What he did was . . .” There are also well-documented cases of land-usage disputes in the 18th century that were settled by the courts by calling on the testimony of the oldest members of the village who gave evidence based on what their grandfathers had told them, and this testimony was legally binding. All gone.

The simple fact is that in a world where technology and fashions change so rapidly, the expertise of the elderly isn’t valued any more, although I like this tale:

An ocean liner was disabled because its main engine had failed. Expert engineers were called in but no one could fix it. Finally a 70 year old man who had worked on ship’s engines like it for 40 years was called in. He examined the engine for many hours, then took out a mallet and tapped in a certain spot twice. The engine sprang to life. The man asked for $10,000 for “services rendered.” The owners were flummoxed at the cost and asked for an itemized bill. This is what they got:

Tapping on the engine . . .  $2

Knowing where to tap . . . $9,998

I’m pretty good at keeping up with the latest developments in computers, smartphones, and whatnot, but it can be a struggle. I have complete sympathy with older people who are tired of constantly learning new things. I stopped updating Windows for my laptop at version 7. Enough is enough. Besides, later versions are crap. Newness for the sake of it is a disease of modern capitalism, and we don’t fight back enough. Word processing software is an infinite improvement over typewriters, but I don’t need the latest update every five minutes. Yet software companies want to push the new versions for the sake of revenue, not because they are really any better. I’ll take my current version of MS WORD, (which I am writing on now and which is about 5 years old), over the DOS version of WordStar I used on my first PC in 1983. I don’t need the latest bells and whistles even though I am sure they are just wonderful. I’m a simple hack who needs to get words on paper (or screens, or whatever).

This year’s theme, ageism, is, indeed, a big problem that continues to spread. Sexism and racism are, alas, still with us in spades, but they do, at least, have vocal opponents. Ageism is the forgotten prejudice. Luckily in Europe I can still find work at my age. I’m retired, so that’s not  a major issue. But I want to travel and live in different countries; teaching helps me out. Besides, teaching gets me embedded in new cultures easily. However . . . many countries in the Middle East and Far East have strict age limits on hiring. In China the cutoff is 60 although “foreign experts” such as myself can push the ceiling up a bit. In parts of the Middle East (notably Dubai and Saudi Arabia) and Indonesia the cutoff is 55. I’ll grant they have issues over health. These countries don’t want foreign workers being off sick a lot and a burden on the healthcare system. So demand a full physical !! It ain’t rocket science. In China I had to go for a full workup that took several hours – 11 clinics involving blood tests, an EKG, ultrasound, eye tests, chest X-ray . . . you name it. That works to weed out the feeble.

The other problem has to do with countries that have massive unemployment coupled with population pressure. If older people stay on in jobs into their 70s and beyond, they cripple opportunities for younger people entering the workforce. That’s a huge problem in the US right now where age discrimination is illegal. People are living longer and often want to keep working in a market where personnel needs are diminishing anyway – partly because of corporate greed, and partly because of improvements in technology that increasingly replace humans with machines. Asian countries “solve” the problem with mandatory retirement ages. This “solution” goes some of the way to help with youth unemployment, but it does not address the fact that by sending out sexagenarians to pasture, you are losing your knowledge base. I am a much better teacher than a 20-something fresh out of college because my 40 years of experience on the job are worth something. Admittedly I’m also more expensive. Cost versus quality? Tough choice. Usually I lose (or accept a pay cut).

What about old git cooking? Hard to say really. I did discover a few years ago in Argentina that I could cut vegetables just as well sitting at the table as standing at the kitchen counter and straining my back in the process.  I still don’t like doing it though, and have given up the practice. My back is stronger now for some inexplicable reason. So are my knees. It could be that I have strengthened them by walking more since I gave up driving. It’s also true that older people can do daft things such as leaving the oven on all night. But fair’s fair. I destroyed my fair share of kettles and blackened countless pots by leaving them on the stove and going back to writing when I was in my 30s. But forgetfulness and loss of motor control do creep up on you.

On the other hand, my landlady in coastal North Carolina was knocking 70 and cooked for a large-ish family every single day. Everyone went off to work and in the evening came home to a fully cooked meal, made from scratch. She started preparation around 10 am and worked on dinner for 8 hours. It was not solid work, of course, but many dishes took long, long hours. Greasy greens are a great example. First here’s a great oldster, Peg Leg Sam (1911-1977), blues singer and huckster from North Carolina who came to prominence in the early 1970s courtesy of a friend of mine in the Folklore program at UNC-Chapel Hill.

What about them greasy greens? Well, you just need to be an old-timey southern cook to get them right. Collards are the greens of choice. In Britain – called colewort – they are picked very young and go into what we used to call “spring greens.” In the US they are left to grow old and leathery (like the old cooks), and need to be boiled for long hours to tenderize them. Start with a “mess” of greens – i.e. enough to fill a large pot. Wash them well and cut out the hard parts of the stalks. Shred them loosely with your hands and stuff them into a pot. Pack them down well because they will cook down. Fill the pot with cold water and add a good slab of salt pork. Then cook and cook and cook on a low simmer. 8 hours or longer was normal in my household.

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In the last hour or so my landlady added cornmeal dumplings. These are made by mixing cornmeal with a little flour then binding with lard and water. I never liked them so have not bothered to learn the recipe. This site looks good: http://www.ansonmills.com/recipes/462  They are way too heavy for my tastes. I make my dumplings with flour and baking powder.

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To serve greasy greens my landlady put them in a big bowl with the dumplings and salt pork on top and a raw onion and vinegar on the side. The younger members of the family didn’t care for the onion and vinegar, but Elsie piled on chopped onion and a splash of vinegar every time with a little bit of fat added “for flavor.” Not heart food.  Elsie was not a slender woman, but she did live to a ripe old age – bless her.

 

Apr 072015
 

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World Health Day is a global health awareness day celebrated every year on 7 April, under the sponsorship of the World Health Organization (WHO). In 1948, the WHO held the First World Health Assembly. The Assembly decided to celebrate 7 April of each year, with effect from 1950, as the World Health Day. World Health Day is held to mark WHO’s founding, and is seen as an opportunity by the organization to draw worldwide attention to a subject of major importance to global health each year. The WHO organizes international, regional and local events on the Day related to a particular theme. Resources provided continue beyond 7 April. World Health Day is acknowledged by various governments and non-governmental organizations with interests in public health issues, who also organize activities and highlight their support in media reports, such as through press releases issued in recent years by US Secretary of State Hillary Clinton and the Global Health Council. World Health Day is one of eight official global public health campaigns marked by WHO, along with World Tuberculosis Day, World Immunization Week, World Malaria Day, World No Tobacco Day, World Blood Donor Day, World Hepatitis Day, and World AIDS Day.

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The WHO is promoting improvement of food safety as part of the 2015 World Health Day campaign. Unsafe food — food containing harmful bacteria, viruses, parasites or chemical substances — is responsible for more than 200 diseases, and is linked to the deaths of 2 million people annually, mostly children. Changes in food production, distribution and consumption; changes to the environment; new and emerging pathogens; and antimicrobial resistance all pose challenges to food safety systems.

The WHO is working with countries and partners to strengthen efforts to prevent, detect and respond to foodborne disease outbreaks in line with the Codex Alimentarius. The organization believes food safety is a shared responsibility — from farmers and manufacturers to vendors and consumers — and is raising awareness about the importance of the part everyone can play in ensuring that the food on our plates is safe to eat. Such awareness includes a number of routines that should be followed to avoid potentially severe health hazards. The tracks within this line of thought are safety between industry and the market and then between the market and the consumer. In considering industry to market practices, food safety considerations involve the origins of food –including practices relating to food labeling, food hygiene, food additives and pesticide residues, as well as policies on biotechnology and food and guidelines for the management of governmental import and export inspection and certification systems for foods. In considering market to consumer practice the general thought is that food ought to be safe in the market, of course, and care should be taken to maintain high standards for delivery or preparation for the consumer.

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Food can transmit disease from person to person as well as serve as a growth medium for bacteria that can cause food poisoning. In developed countries there are intricate standards for food preparation, whereas in lesser developed countries the main issue is simply the availability of adequate safe water, which is usually a critical concern. In theory, food poisoning is 100% preventable. The five key principles of food hygiene, according to WHO, are:

Prevent contaminating food with pathogens spreading from people, pets, and pests.

Separate raw and cooked foods to prevent contaminating the cooked foods.

Cook foods for the appropriate length of time and at the appropriate temperature to kill pathogens.

Store food at the proper temperature.

Use safe water and raw materials.

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A 2003 World Health Organization report concluded that about 30% of reported food poisoning outbreaks in the WHO European Region occur in private homes. According to the WHO and CDC, in the USA alone, annually, there are 76 million cases of foodborne illness leading to 325,000 hospitalizations and 5,000 deaths. Also in 2003, the WHO and FAO published the Codex Alimentarius which serves as a guideline to food safety. However, according to Unit 04 – Communication of Health & Consumers Directorate-General of the European Commission (SANCO): “The Codex, while being recommendations for voluntary application by members, Codex standards serve in many cases as a basis for national legislation. The reference made to Codex food safety standards in the World Trade Organizations’ Agreement on Sanitary and Phytosanitary measures (SPS Agreement) means that Codex has far reaching implications for resolving trade disputes. WTO members that wish to apply stricter food safety measures than those set by Codex may be required to justify these measures scientifically.” There remain many conflicts between the food industry, concerned with keeping production costs low, and food inspectors trying to ensure that food in the market is safe to eat.

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As a global traveler I am always concerned about food safety, and making sure I have a safe water supply. I do the obvious things such as washing all market fruits and vegetables, keeping my hands clean when preparing food, eating organic foods, and using a clean water supply. But it is not as simple as it sounds. Organic foods are not usually labeled globally, and the standards vary enormously. Certain practices, such as using bottled water, are effective in the short run but not sustainable in the long run.

I’m in the habit of eating salads when I can, building in lots of variety and creativity. Here’s a set from a dinner I had with my adopted brother, Rodrigo. This was in Buenos Aires, all the salads made from local ingredients in season (which is the norm).

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First five. Help yourself.

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Endive, chicory, and roquette with extra virgin olive oil.

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Halibut, squid, and sea legs with lemon and ginger.

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Cabbage and capers in vinegar.

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Pasta with tomato, green pepper, and oregano with olive oil.

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Eggs, potatoes, and ham in mayonnaise.

 

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A full plate.

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Sixth for dessert — strawberries and peaches on a bed of whipped cream and mashed bananas.