Archive for April, 2007

Hospital – 27 April 2007

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Today is day 1 of cycle 2A – a cyclophosphamide and vincristine with dexamethasone cycle, plus a few other drugs I don’t remember. I actually came into hospital yesterday. I had a new PICC inserted into my right arm in the morning (9.30am), then, because there wasn’t a bed free until 4.30pm, had to wander around and generally entertain myself. I finally got into bed, did all the usual things, was prehydrated for four hours, and then premedicated. I eventually got the cyclophosphamide at 10pm, and the dexamethasone. All things considered, I didn’t have too rough of a night. The dexamethasone generally makes you sleepless, especially when given so late, but I did sleep a fair amount, until about 5.30am when the morning blood and observation round happened. All seems, otherwise, to be going well.

I can’t think of much else that has happened so far. I will probably go for a trip down to the apheresis facility this morning, to see what will happen. And, all things running to plan, I’ll be out of hospital on Sunday. I find myself growing a bit tired of the hospital experience. It is dull, and the being woken in the middle of the night – multiple times – is frustrating. However, it is for a limited time. I keep reminding myself of that.

I said morning prayer early this morning. The New Testament reading for this morning was from John 10:19-30. The Jewish leaders are trying to clarify who Jesus is, or at least who he claims to be. Jesus, typically, doesn’t answer directly, but does answer clearly, by saying:

“I did tell you [who I am] but you do not believe. The miracles I do in my Father’s name speak for me, but you do not believe because you are not my sheep. My sheep listen to my voice; I know them, and they follow me, I give them eternal life, and they shall never perish; no one can snatch them out of my hand. My father, who has given them to me is greater than all; no one can snatch them out of my Father’s hand. I and the Father are one.” (John 10:19-30, NIV)

This passage is interesting, and possible challenging. One of the first challenging things is “…you do not believe because you are not my sheep.” Jesus is speaking to the Jewish leaders, at a moment in time and for a particular reason – to address their question about who he is. It is because the questioners (and I don’t think we should extend it beyond them to a whole class or group of people, it seems to me the text doesn’t support that) don’t belong to Jesus that they don’t believe, perhaps can’t believe.

The next part describes how Jesus’s sheep – those who belong to him – behave, and what Jesus does for them by virtue of their belonging to him. “My sheep listen to my voice; I know them, and they follow me, I give them eternal life, and they shall never perish; no one can snatch them out of my hand.” This part does apply to those of us who are Christians, who are adopted as Jesus’s brothers and sisters through baptism and faith. This is a list of what we do (listen and follow), partly out of obedience, partly out of love, partly out of gratitude (and no doubt for other good reasons, too). But it is important to remember, it seems to me, that the listening and following is enabled because of God’s love, and the grace he gives to all of us who believe and trust in him. The list is contains what Jesus does – knows us, gives us eternal life so that we shall never perish, protects us from being taken away from him. In Greek the last two statements about eternal life and protecting us from being stolen from him are very strong – we are placed into that condition by Jesus’s actions and it is impossible for us to be in another condition unless we cease to belong to Jesus (which is always possible if we choose to make it so).

“My father, who has given them [Jesus’s sheep] to me is greater than all; no one can snatch them out of my Father’s hand. I and the Father are one.” This last part is perhaps the greatest challenge for the Jewish leaders. The mission, action, and continuing protection of Jesus is based on his relationship with the Father, and the sealing of the Father on his mission and continuing presence in the lives of all of his sisters and brothers. Nothing can take us from Jesus, because the Father, who is greater than all – all of the forces of the world, all of the forces within us, all of the things that fight against the light of God in the world. “I and the Father are one.” This was obviously, judging by the reaction of the Jewish leaders to the statement, profoundly affronting – and looking at the radically monotheistic background of Judaism, one can well understand how it would be so, and how natural it was for the Jewish leaders – protectors of the history, doctrines, dogmas and practices of a Judaism under threat – to react in the way the did. In fact – how could they react otherwise, because “… you do not believe because you are not my sheep.”

In Greek the statement “I and the Father are one” is not asserting that Jesus and the Father are the one person, but of the one essence – a distinction that becomes important in the development of the revealed doctrine of the Trinity. In fact, this whole passage speaks to the internal relationship of the Trinity, and how that becomes important in our lives and being.

Coming back to listening and following. Remember, we are enabled to listen and follow by the grace of God. Our own energies and enthusiasms will help, but they help us to co-operate with God’s action in our lives. Our listening and following can’t be ad hoc, either – they need to be built into our lives. That is one of the ways in which we co-operate with God, by giving the relationship we have with God the importance and centrality it deserves. In the way of contemplative prayer, which the way of Christian Meditation seeks to support, we allow internal and external silence to be present in our lives as a sign of our commitment to God’s work within us, and as a way of creating the space in our otherwise hectic and God excluding lives to allow the still small voice of God to work, change, refine and form us into who we are meant to be, in God’s love.

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Male Circumcision (first go)

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The medical and cultural practice of male circumcision has long interested me. I think this partly comes from being an uncircumcised boy, youth and man in a peer-group that was otherwise mostly circumcised. It also comes from an interest in how this practice became so widespread in non-religious Western culture, what encouraged it, how it became embedded as a cultural norm, how has been sustained, what has caused, in some parts of the world at least, a reduction in prevalence of the practice, and what causes people to polarise in their opinions when discussing the practice. As a health care professional I am interested in what circumcision does – whether there is evidence to support the assertions of advocates who say it provides health benefits, and I am also interested to understand what harms there are arising from the practice.

At the beginning of what will be a series of articles, a number of things bear stating. I am strongly opposed to infant male circumcision, as I feel that the health benefits ascribed to circumcision, used to justify the practice of infant male circumcision, are tenuous at best, and considered against the risks and the harms arising from infant male circumcision fade into insignificance. If individuals wish to be circumcised when they are old enough to provide informed consent, understanding potential risks and benefits, then so be it. Research suggests that this group will overwhelmingly chose circumcision for social or cultural reasons, as the vast majority of (rare) issues arising from pathologies of the foreskin are easily treated medically rather than surgically.

My feelings about religious imperatives towards circumcision (such as in some Australian indigenous groups, Judaism and Islam) is that this is a cultural practice, which if it continues should be practiced as humanely as possible, and with as little harm to the one circumcised. It is striking, for example, that circumcision has become much more radical in Judaism over time – more of the foreskin is amputated now than in the past. In Islam the imperative to circumcise arises out of culture appended to religious practice, rather than a religious command in holy text. Similarly, circumcision as an initiatory rite (as in some Australian indigenous groups) is a cultural imperative, which I believe should be rethought, and alternatives developed.

To continue this lengthy preamble, I’m aware of recent research arising out of Sub-Saharan Africa suggesting that circumcision exerts a protective effect against the transmission of HIV. I’m also aware of many critiques of the research, not the least of which is the observation that because circumcision affects sexual behaviours, and many sexual behaviours are strongly culturally influenced, it is impossible to make broad generalisations about the effect that circumcision would have in other cultures. Certainly, it bears stating that one of the cultures that circumcised the vast majority of their infants experienced the highest rates of HIV transmission – the United States.

In future blogs I’ll plan to deal with:
• Social influences on circumcision
• Why circumcision became prevalent
• Health costs and health benefits of circumcision
• Construction of discourses about circumcision
• Sexual aspects of circumcision, including how circumcision affects sensitivity of the penis

A final statement – I don’t intend any of this to apply to the mutilatory practices known euphemistically as ‘female genital mutilation’. There is a great deal of information on the internet about this issue, which I’d encourage you to read if you’re interested (and everyone should be).

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Paper on torture and language for a symposium

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Below is the text of a paper for presentation at a symposium on torture. It discusses the nexus between the practice of torture in recent times and the uses of language.

“No physical or mental torture, nor any other form of coercion, may be inflicted on prisoners of war to secure from them information of any kind whatever. Prisoners of war who refuse to answer may not be threatened, insulted, or exposed to any unpleasant or disadvantageous treatment of any kind.”
(Article 17, Third Geneva Convention)

Torture is the action or practice of inflicting severe pain on someone as a punishment or to force them to do or say something, or for the pleasure of the person inflicting the pain. To coerce is to persuade an unwilling person to do something by using force or threats. Synonyms for coercion include force, compulsion, constraint, duress, oppression, enforcement, harassment, intimidation, threats, arm-twisting, and pressure.

International and U.S. law prohibits torture and other ill-treatment of any person in custody in all circumstances. The prohibition applies to the United States during times of peace, armed conflict, or a state of emergency. Any person, whether a U.S. national or a non-citizen, is protected. It is irrelevant whether the detainee is determined to be a prisoner-of-war, a protected person, or a so-called “security detainee” or “unlawful combatant.” And the prohibition is in effect within the territory of the United States or any place anywhere U.S. authorities have control over a person. In short, the prohibition against torture and ill-treatment is absolute.

Each day brings more information about the appalling abuses inflicted upon men and women held by the United States in Iraq, Afghanistan, and elsewhere around the world. U.S. forces have used interrogation techniques including hooding, stripping detainees naked, subjecting them to extremes of heat, cold, noise and light, and depriving them of sleep—in violation of the Geneva Conventions and the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. This apparently routine infliction of pain, discomfort, and humiliation has expanded in all too many cases into vicious beatings, sexual degradation, sodomy, near drowning, and near asphyxiation. Detainees have died under questionable circumstances while incarcerated.

As George Orwell pointed out most effectively, governments control language as well as people. Since the Abu Ghraib prison scandal broke, the US government (and our own), from the highest officials in Washington to Army prison guards in Baghdad, have used every euphemism they can think of to avoid the word that clearly characterizes what some of soldiers and civilian contractors have been doing: torture.

“What has been charged so far is abuse, which I believe technically is different from torture,” said former Secretary of Defense Donald Rumsfeld. “I’m not going to address the `torture’ word.” And nobody else seems to want to address it either. Rather, we are told, military police officers at Abu Ghraib were encouraged to treat the prisoners so as to create “favourable conditions” for interrogations. In any bureaucracy, orders or clearance to do something beyond the law always comes in code. For those in senior positions, deniability is vital.

The legitimisation of the use of torture, couched in the more palatable language of ‘coercion’ begins with a definition of those to be subjected to such treatment. Shortly after the opening of Camp X-Ray at Guantanamo Bay, Rumsfeld described the detainees as ‘hardened criminals willing to kill … for their cause’.

The US government’s declared global War on Terror has provided it with a rhetorical framework to argue that ‘special needs create special circumstances’. George W Bush has been quoted as saying to his advisors, following the September 11 attacks ‘I don’t care what the international lawyers say, we are going to kick some ass.’ And the history of his administration’s actions since then demonstrate that resolve, and the consequences flowing from it, dressed in the language of the possible. In these special circumstances it is asserted that those accused of terrorism, or, as in the case of David Hicks, supporting terrorism, may be defined as enemy combatants. A relatively unused provision in international law allows for the categorisation of persons involved in ‘international armed conflict’ as enemy combatants, a group of people not explicitly protected by the Geneva Conventions, as quoted previously. The US federal administration categorised a large number of those detained at Guantanamo Bay as ‘enemy combatants’ to justify treatment – euphemistically called ‘management techniques’ – beyond, and in contravention of, the Geneva Conventions, international and domestic US law. An American organisation, Human Rights Watch, expressed concern regarding this development, describing it as dangerous loop-hole, threatening the basic guarantees of justice and fairness.

The time following the devastating September 11 attacks saw the development by the US administration of three legal doctrines to legitimise the President’s otherwise unlawful sanctioning of torture as policy. The first was to argue that in a time of war the President, as commander-in-chief, could override the treaties and laws otherwise binding the US. The second innovation was a redefinition of torture, and the action of torturers. It was argued that if the intention of the torturer was to extract necessary information, then the torturer was not culpable, and further that if the torture did not extend to the point of causing organ failure (that is, death), then it was not torture per se, but rather coercion or the aforementioned creation of favourable conditions for the recovery of information. The final legal ‘discovery’ was the argument that the US naval base at Guantanamo Bay was not on US territory, and therefore beyond the jurisdiction of US courts.

Parallel to the development of legal doctrine was the creation of an apparatus to facilitate torture (now labelled as coercion). The CIA was given powers, by executive order, to allow for the creation of a system of facilities outside the US, and therefore beyond US law, for the detention and ‘extraordinary rendition’, or ‘extreme interrogation’ of enemy combatants. In some cases this consisted of making arrangements for the temporary transfer of detainees to nation-states notorious for the use of torture in interrogation. One of the facilities created by the CIA is known as Camp Echo – the facility in which David Hicks is housed at Guantanamo Bay. Concurrent with these developments were alterations made to armed forces operating procedures to allow for inhumane interrogation techniques. These included the approval by Donald Rumsfeld of sixteen interrogation techniques that used methods not compliant with the Geneva Conventions, and were beyond the existing Army standard interrogation manual.

The effect of this legal and administrative change of status, a change effectively based on arguments about language and the meaning of words, has been to create the conditions for an extraordinary horror.

It is, in many ways, language and the use of language that has made these abuses possible. Words allow redefinition. Redefinition of status allows a change in treatment to a redefined method of interrogation. Most US, and Australian citizens would baulk, rightly, at the use of torture for any purpose. But when the word ‘torture’ is banned, or used only by groups defined by governments as ‘extreme’ or ‘irrelevant’ (such as Amnesty International or the International Red Cross) discourse becomes limited, and atrocities tolerated. The use of language creates discourse, and discourse makes thought and discussion possible.

It is no doubt true that the torture of prisoners under Saddam Hussein was incomparably more widespread than that perpetrated by US forces, and often ended in death. The same is true in dozens of other regimes around the world. But torture is torture. It permanently scars the victim even when there are no visible marks on the body, and it leaves other scars on the lives of those who perform it and on the life of the nation that allowed and encouraged it. Those scars will be with us for a long time.

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“More guns could have prevented US uni massacre: advocates.”

Check out the ABC’s reporting of comments from US gun rights advocates.

Utter, utter madness and lunacy. Watch Bowling for Columbine and tell me that the US needs more people with guns wandering around.

I’m glad I live in Australia!

Here’s a website with useful thoughts on violence and gun control in the US.

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Doctor Who – Smith and Jones (episode 1, season 3)

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I watched the first two episodes of the new (third) season of Doctor Who before I went into hospital.

Episode 1, Smith and Jones, has the task of introducing Martha Jones, the new companion. Like all “introduction” episodes, it has a lot of work to do, and a great deal of the narrative is spent establishing who Martha is, what her background is, what motivates her, and suggesting how she is going to relate to the Doctor (as well as differentiating her from Rose Tyler). The plot is simple, accordingly (I won’t go into it here – you can read a synopsis at Outpost Gallifrey).

Both David Tennant and Freema Agyeman perform well – a little Tennant eating of the carpet (though much less than last season) and a gratuitous kiss, but otherwise the leads work well together, and have a good dynamic, boding well for the future, I think. The supporting players, especially Anne Reid as Florence Finnegan, and Roy Marsden as Mr Stoker, the consultant, are also impressive, especially Reid, who manages to simultaneously convey menace and vulnerability. We don’t see as much of Marsden, as he is despatched reasonably early in the episode. Ben Righton’s medical student Oliver Morgentern is also well played.

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The episode opens with the title sequence, in contrast to the usual format of a pre-sequence trailer. In a manner similar to Rose, we’re introduced to Martha Jones, who it is established early on is at the centre of a complex family, with some broken or at least strained relationships. She is intelligent, resourceful, more mature than Rose Tyler, and inquisitive. Her training to be a doctor equips her with a degree of intellectual sophistication which makes her dialogue with the Doctor more meaty. Early on in the episode, when the hospital is transported to the moon, Martha is depicted as being one of the few calm people in the building (in fact, the only calm ones are Martha, the Doctor, Mr Stoker and Mrs Finnegan). She also has an insight into what has been going on on the Earth for the last few years – unlike so many characters in the series who ‘buy’ the official line about mass psychosis or hypnotism, Martha is aware of the attempted invasions of Earth by the family Slitheen, the Sycorax, the Cybermen and Daleks, and the Racnoss. During the episode the Doctor almost appears to be auditioning Martha for the role as his companion. His reactions to her response to the situation, and her behaviour, almost seems like testing, at the very least scrutinising. It seems, perhaps, that he has taken Donna’s advice (given in The Runaway Bride) seriously – he needs a companion, and he’s seeking a new and appropriate one, despite his protestation at the end of the episode that he’d “rather be on his own”.

The Doctor is more restrained and at ease with himself – in a way more subdued and internal, though still capable of eccentricity. The Doctor’s alienness is underlined, and his willingness to put aside social convention or at least manners displayed – he dismisses Martha’s friend Julia with a series of rude asides in a manner similar to Christopher Eccleston’s Doctor. The Doctor’s knowledge of the situation he finds himself in is limited, though he knows more is going on than he expected to find. His physical vulnerability is underlined, and also his willingness to perform acts of self-sacrifice if needed. I found myself shocked at first at the Doctor’s easy capacity to kill one of Mrs Finnegan’s henchmen, until it was revealed that the henchmen, Slabs, are not actually alive. His readiness to arrange for Mrs Finnegan’s death (for he must surely have understood that was what would happen) is striking, though perhaps consistent with recent behaviour.

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We’re introduced to two new alien races – the obviously alien Judoon, a police force with heads like rhinos and an unyielding ethical policy, and the humanoid Plasmavore Finnegan. The Judoon are realised very well. For a few moments, as they stride across the surface of the moon, I thought (even though I knew it was not to be!), that perhaps these were Sontarans, as the costuming was similar. The nice touch of portraying the Judoon as simply doing a job – not bad, and not the baddies of the story, and unveiling the real baddie as Mrs Finnegan, was something I appreciated. Anne Reid, a versatile and under-rated actor, plays Mrs Finnegan with a relish and an almost Hannibal Lecter-esque quality (the scenes with the straw stand out).

The continuing references to Mr Saxon (posters, and in this episode a mention) are present. They presumably represent hints at a story arc (a la ‘bad wolf’ from season 1).

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Visual effects are well used here, and judiciously. There are some obvious ‘set pieces’, such as the hospital on the moon and the landing of the Judoon space ships, but on the whole this is about character, dialogue and plot rather than special effects. The score, by the reliable Murray Gold, supports rather than overwhelming the story. It seems to me there is a difference in tone in the incidental music in this episode, but maybe that’s just due to the new theme for Martha.

I enjoyed this episode, and I think it has a lot going for it. As far as introductions to seasons, it stands out above Rose, which probably had a lot more work to do (reintroducing the series and a new Doctor, as well as a new companion). I’m not as against New Earth as others – I thought it was a decent story that stood on its own reasonably well.

All in all – a creditable, enjoyable and worthy start to the season!

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