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Elspeth Brown on digital collaboration in LGBTQ oral history

This week on the Oral History Review blog, we’re continuing our recognition of LGBTQ Pride month with a special podcast featuring Elspeth Brown. In the podcast, Brown discusses the LGBTQ Oral History Digital Collaboratory, as well as her work as a member of the community and a historian. Check out the links below for more information, and send us your proposals if you’d like to share your work with the OHR blog.

The LGBTQ Oral History Digital Collaboratory is a five-year digital history and oral history research collaboration that connects archives across Canada and the United States to produce a collaborative digital history hub for the research and study of gay, lesbian, queer, and trans* oral histories.  The Collaboratory is the largest LGBTQ oral history project in North American history, connecting over 200 life stories with new methodologies in digital history, collaborative research, and archival practice. The Collaboratory is supported by a research grant from the Social Science & Humanities Research Council of Canada.

The project explores the histories of trans* people, queer women, gay men, and lesbians in the United States and Canada through the creation of a virtual research meeting place, the completion of four distinct oral history projects, a digital LGBTQ “oral history hub,” and a digital trans archival collections pathfinder.

The TransPartners Project is devoted to exploring (and historicizing) the experience of partners for trans* men. More specifically, it focuses on partners who were with their partner before and during at least six months of the transition, however defined (the couple does not have to be together now). The project also functions as a site to gather resources that might be of interest to partners of trans men, since there is currently so little information available for partners.

The Canadian Lesbian and Gay Archives is the largest independent LGBTQ+ archives in the world. With a focus on Canadian content, the CLGA acquires, preserves and provides public access to information and archival materials in any medium. By collecting and caring for important historical records, personal papers, unpublished documents, publications, audio-visual material, works of art, photographs, posters, and other artifacts, the CLGA is a trusted guardian of LGBTQ+ histories now and for generations to come.

Image Credit: “Gay Pride Paris 2013″ by Guitguit. CC BY NC-SA 2.0 via Flickr.

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Does everyone love the National Health Service? Uncovering history’s critics

The National Health Service (NHS) has never just been about the state’s provision of universal healthcare. Since 1948, it has been invested with a spectrum of ‘British values’, including decency, fairness, and respect. Featured in the Opening Ceremony of the London 2012 Olympic Games, and hailed in polls as the thing that makes people most proud of being British, the NHS enjoys widespread affection. These sentiments reached fever pitch during the recent 2015 General Election. Voters ranked the future of the service top among their concerns, ‘Save Our NHS Day’ witnessed thousands of volunteers petitioning across the country, and the comedian Russell Brand proclaimed ‘there’s no one in Britain that don’t love the NHS’.

After numerous institutional studies, historians’ attention is only now turning towards the ‘culture’ of the NHS, examining manifestations of ‘popular’ attachment to the institution contained within personal testimony, novels, film, television, and other mediums. As this shift takes place, it is crucial not to lose sight of the fact that organised networks of critics opposed nationalised medicine from the beginning and possessed their own cultural expressions of dissent. ‘The Good Doctor – A Fairy Story’, a satire printed in 1949 by an organisation called the Fellowship for Freedom in Medicine (FFM), told of a GP living in ‘the land of Myopia’ who ‘knew all the rules and regulations off by heart’. When asked by his son what happened to ‘all the naughty doctors’ who did not similarly worship state medicine, the fictional doctor replies, ‘Oh! They were mostly sent to a place called Parliament where a great big giant called Bureaucracy guillotined them!’

The Fellowship made a social life out of NHS opposition. Members proudly wore ‘F.M.M.’ badges and formed friendships through the group. At regional gatherings across the country, once committee business ended, FFM doctors toasted each other’s birthdays and professional accomplishments. Dances, where invited Tory MPs and foreign supporters of the organisation participated, followed lavish dinners on the occasion of Annual General Meetings at Caxton Hall, London.

The FFM, a conservative organisation of doctors and interested supporters, led efforts to end state healthcare in the 1950s and 1960s. At an inaugural meeting of seven hundred doctors on 9 November 1948, the Fellowship’s founder, Lord Thomas Horder – celebrity physician to Prime Ministers and royalty – proclaimed the organisation’s ambition to restore the ‘freedom’ of medicine from ‘the dead machinery of the bureau’. Beyond satire and forming personal relationships around a shared distaste for the NHS, fighting government monopoly required advocating private health insurance. Helping manufacture the perception of an NHS ‘spending crisis’, the Fellowship worked with insurance providers, such as the British United Provident Association (BUPA), and hospitals founded outside the NHS, like the Kingston New Victoria Hospital, to lobby a Conservative Party open to hearing alternative ways of financing medical supply. Through novel contribution-based health schemes, they presented their ideas as more suited to a time when large segments of the population enjoyed rising incomes and the need for universal state welfare came under increasing scrutiny.

Looking beyond high-level policy-making reveals the diverse associations of NHS opponents who sought to undermine the ‘Sacred Cow’ of the British welfare state. These coalitions of interests operated on the basis of more than just economic and medical critiques. Recognising that ideas, representations, and meanings of the new service weighed increasingly heavy on technical debates regarding healthcare, the FFM presented a rival vision of the institution. Members portrayed nationalised medicine as ‘dictatorial’ and a bureaucratic nightmare. State monopoly pervaded consulting rooms throughout Britain, undermining the sacred ‘doctor-patient relationship’ in a sinister fashion. Drawing on Cold War fears regarding the impact of government ‘planning’, the Fellowship referred to ‘the Iron Curtain of state medicine’ and compared doctors who resigned in protest to the NHS as ‘outcasts from the Bolshevik regime’. Such intense rhetoric enticed allies on the libertarian right, including the Society for Individual Freedom and the Institute for Economic Affairs.

Though Britain’s healthcare arrangements are typically discussed in a domestic vacuum – stemming from a prevalent sense of self-congratulatory exceptionalism – NHS critics won overseas admirers, demonstrating the significance of international context in writing histories of the service. The American Medical Association, fighting in the 1950s and 1960s to prevent the passage of universal healthcare bills, reproduced the FFM’s data and invited members abroad to recount the horrors of British ‘socialised medicine’. Contact existed with the French Défense de Médecine Libre, the Dutch ‘De Vrije Artstentribune’, and the Italian Comitato Nazionale per la Difesa della Professione Medica, part of a broader European reaction against government influence in medical affairs.

The story of how ‘the people’s NHS’ triumphed over ‘Mr. Bevan’s dictatorship’ must be explained. These representations speak to changes in British national identity after 1945 and offer comparison with international thinking on the service as a model to be emulated, or avoided at all costs. If the NHS embodies the ‘closest thing the English have to a religion’, as Nigel Lawson observed, then it is imperative to consider the apostates as well as the faithful.

Headline image credit: Project 365 #219: 070809 Badge Of Honour by Pete. CC-BY-2.0 via Flickr

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Hope, women, the police panchayat, and the Mumbai slums

The Mumbai slums have recently achieved a weird kind of celebrity status. Whatever the considerable merits of the film Slumdog Millionaire and the best-selling book by Katherine Boo, Behind the Beautiful Forevers (now also a play and a film), these works have contributed to the making of a contemporary horror myth. So too have the bus tours of the slums that are now a regular fixture on the schedule of foreign tourists to Mumbai.

But not everything that happens in the slums of Mumbai is tragic. There is hope as well as despair in the slums, there are people building community, tolerance, and a different future in this physically challenging environment. Many of these people are women, almost always poorly educated and some even totally illiterate.

One of the more unlikely ventures of the Mumbai slums is the police panchayat. This institution was the brainchild of a former Chief Commissioner of Police, A.N. Roy, who knew that the police provided practically nothing of value to the teeming slums of Pune and Mumbai. Roy came up with the idea of establishing a body to resolve small disputes and maintain order in the slums. The body was to be composed of, and run by, people (mainly women) from the community, with a single policeman attached to the body. Roy called the body a panchayat in order to associate it in the public mind with the community body by that name that is said to have dispensed justice in the ‘traditional’ Indian village.

Roy believed that the police panchayat could help the community to help themselves, while simultaneously improving relations between police and slum dwellers. On the first count, at least, he has been proven right. Whether there has been any major change in relations between the police and those at the bottom of the Mumbai heap is more problematic. But there is no doubt that in Roy’s time as Chief Commissioner of Police in Mumbai, he did provide a great deal of symbolic support to the organization.

Roy’s real stroke of genius was to recruit Jockin Arputham, a singular activist of the slums, as his leader of community involvement. It is the women, led by Jockin, who have built the police panchayat.

I first came across this organization in 2004, shortly after it was established in Mumbai, and I have recently been looking more closely at what it is doing. I was drawn to it out of a long interest in the sociology of Indian law – the social by-ways of community dispute settlement, as well as the behaviour of the legal institutions of the state.

There are now a couple of hundred police panchayats dotted throughout Mumbai and a few other cities, too. Many of them have been operating effectively under the stewardship of some extraordinarily committed women, who sometimes meet daily to handle the volume of work. That work is not what was originally envisaged. It is not ‘petty disputes’ about water, bad behaviour of children, and other neighbourhood disputes that have preoccupied the police panchayats.

Surprisingly, these bodies have evolved into a conciliation and mediation body for families in crisis. They are helping fill a great need for families whose relationship problems are beyond their own capacity to resolve. There are only a tiny number of family law courts in Mumbai (and, of course, everywhere else in India), with an even slighter complement of mediators attached to them. And, in any case, the courts are not always the right place to address these sorts of issues.

Image: March 8 rally in Dhaka, organized by Jatiyo Nari Shramik Trade Union Kendra (National Women Workers Trade Union Centre), an organization to the Bangladesh Trade Union Kendra. Photo by Soman. CC-BY-2.5 via Wikimedia Commons.

These family cases are often complex and can take up a number of meetings over a period of weeks, as well as follow-up work outside the hearings. Sometimes the panchayats conclude that relations between the parties have broken down to an extent that the marriage cannot be put together again. But often the women of the panchayat manage to bridge divisions and restore harmony sufficient for the marriage to continue. The members of the panchayat have a clear bias towards preservation of marriage, wherever this is reasonably possible.

Many of the cases arise from the clearly changing outlook of young women in India, as elsewhere. Young women now tend to demand, if not complete, equality with their male partner, at least much more equality than was characteristic of the past. And they are not always so attuned to fitting into a household frequently dominated by their mother- in-law. The result of such attitudes can be serious conflict. But there are also a whole range of other family disputes of diverse origin.

The conflicts are not confined to any particular community, and there is a large, perhaps even disproportionate, number of Muslims who approach these institutions for help. No doubt this is facilitated by a membership that is drawn from different religious and caste communities, and is predominantly female.

Despite the successes, it is not clear that the institution represents a model to be generally replicated throughout India. One of the problems is that the fit between police and community seems somewhat forced and may even be broken down over time. On a day to day basis, the police are no longer involved in the operations of the institutions. Despite this, Jockin says there are moves to attach a panchayat to every police station in the country. This seems to some policy makers a cheap way of getting the community to do the work of the state. For Jockin, it would spell the end of the community basis of the panchayats; it would strip them of their dedicated and selfless commitment to service, and convert them into lifeless and bureaucratic organs of the state.

Whatever the difficulties of the police panchayats, their successes are worthy of celebration. Not only have they done significant work in the critical area of family mediation and conciliation, but they have also provided a vehicle for the tremendous empowerment of poor women with little or negligible formal education. They represent a compelling testament to what can be done in the slums.

The police panchayat is not an example of ‘law’ at work, but it is an institution dispensing genuine and practical justice to people who have missed out on just about every benefit distributed to more affluent people. It is something of a hybrid institution – an essentially community body, with some useful, if problematical, ties to an organ of the state (the police). It represents an intriguing development for someone interested in the intersection between institutions of the state and instruments of community authority.

Featured image: Mumbai India slum June 2005 by Sthitaprajna Jena. CC BY-SA 2.0 via Wikimedia Commons.

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Are you a sugar scholar?

How much do you know about all things sweet? Are you an obsessive “Top-tier Sugar Scholar”? Or are you a dabbling “Sugar Novice”? No matter your level of scholarship, if sweetness and obscure facts are your game, we have just the perfect quiz for you. Prove what you know (and, perhaps, don’t know) about sweetness and mark whether you think the statements are true or false. And no cheating! Your sugary scholarly integrity is at stake here. All facts were pulled from The Oxford Companion to Sugar and Sweets, edited by Darra Goldstein.

Headline image credit: Toasted pound cake with strawberries. Photo by Shari’s Berries. CC BY 2.0 via Flickr. (Quiz background CC0 via Pixabay)

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Look away now: The prophecies of Nostradamus

If you like your prophecies pin sharp and “on the ball” then look away now. The 16th century celebrity seer Nostradamus excelled at the exact opposite, couching his predictions in terms so vague as to be largely meaningless or so open as to invite almost any interpretation. This has not, however, prevented his soothsayings attracting enormous and unending interest, and his book – Les Propheties – has rarely been out of print since it was first published 460 years ago. Uniquely, for a renaissance augur, the writings of Nostradamus are perhaps as popular today as they were four and a half centuries ago, and rarely a month goes by without one or other of his portents of doom attracting the attention of the tabloid press. While Nostradamus made all sorts of predictions in his treatises and annual almanacs, some trivial, others relating to major world events, those that continue to excite are the ones that appear to prophecy global catastrophe and the end of days. Embraced by the swivel-eyed conspiracists, and others of that ilk and eschewed by the rational and scientifically literate, there is one thing that we can all be sure of. As these spoutings almost invariably have no date attached, one or other of them is bound to come true, given enough time. Certainly, our planet and our civilisation is constantly under threat, on the one hand from nuclear calamity, and on the other by any one of a small portfolio of what I call Global Geophysical Events (GGEs), or “gee-gees.”

The latest anniversary of Les Propheties seems, therefore, like a good time to revisit the big geophysical threats that face our world and our society, especially as it coincides with the bicentennial of perhaps the greatest volcanic eruption since the ice retreated 10,000 years ago. A couple of months before the Battle of Waterloo – yet another key event commemorated this year – the previously innocuous Indonesia volcano, Tambora, blew itself apart in a cataclysmic explosion that took around 70,000 lives on Sumbawa and neighbouring islands in the Java Sea. As far as I am aware, this is an event that seems to have escaped Nostradamus’ future scanning, which – given the huge impact it had on western civilisation – is one in the eye for those who, today, still pore over his every word.

As the estimated 60 million tonnes of sulphur gas, pumped out by the eruption infiltrated the stratosphere to form a veil of tiny aerosol particles that blocked out much of the Sun’s heat, so the global climate took a turn for the worse. As a consequence, 1816 is earmarked in the historical record as the Year Without a Summer; plunging temperatures bringing killing summer frosts and a devastated harvest across Europe and eastern North America. While Tambora’s brilliant volcanic sunsets have been charged by some with inspiring the flamboyant skies of some of J. M. W Turner’s later works, the appalling weather of 1816 supposedly set the tone for Mary Shelley’s Frankenstein.

“Sunset after a tornado in Oklahoma”, by tpsdave. Public domain via Pixabay.

The impact of the eruption on the average European citizen, however, was far less frivolous. In what economic historian, John Post, has called ‘the last great subsistence crisis in the western world’, tens of thousands succumbed to famine and disease, as bread riots and civil stife stalked the European continent. In Ireland alone, typhus and other ailments are estimated to have claimed more than 40,000 lives.

Fortunately, eruptions on the scale of Tambora are rare, but not so rare that we can safely dismiss them in terms of offering a significant future threat. One estimate is that there is a 1 in 10 chance of a Tambora-scale event in the next 50 years, but the Earth does not operate to a timetable so the next Tambora could blow at any time. Certainly there are a few candidates around that are currently focusing the minds of volcanologists. Of particular note is Chile’s Laguna Del Maule volcano, which is swelling at the astonishing rate of 25cm a year, above a massive body of magma lying just 6km beneath the surface. Not too far away, in neighbouring Bolivia, the restless Uturunca volcano is also causing some concern. Here a 70km-wide bulge that has been growing since the early 1990s could culminate in a gigantic eruption.

It would be easy to dismiss any major impact of such threats on today’s society, arguing that modern farming methods, distribution systems and globalisation, would make it much easier to handle widespread harvest failures than in 1816. This would also, however, be a dangerously complacent attitude, and an equally valid case could be made for the very interconnectedness of world markets making things worse; the collapse of food production across Europe, parts of North America and perhaps elsewhere, resulting in global shortages that drive massive hikes in the cost of food commodities. At the same time, the intense worldwide competition for food supplies slashed as a consequence of the harvest failures could drastically reduce the range of products available, interfere with supply and distribution, and bring about a collapse of the ultra-sensitive, time-critical, stock control systems operated by supermarkets, leaving their shelves increasingly depleted. While the less well off could be priced out of purchasing even staple foodstuffs, panic buying by those who can afford it could quickly empty the stores.

“Tornado on the horizon”, by skeeze. Public domain via Pixabay.

Another Tambora would undoubtedly, then, not be good news, but there are far worse threats waiting in the wings. Wearing my Nostradamus hat, therefore, let me conclude with my top five “gee-gees”. All are extremely unlikely to happen in any single year, but in the longer term all are 100 percent certain. Be afraid, be very (all right, just a little bit) afraid!

Volcanic super-eruption. Could it be Yellowstone, one of the currently restless South American volcanoes, or an innocuous volcano we are not watching? Super-eruptions happen, on average, every 50 millennia or so, giving human lifetime odds of around 700 to 1.
A potentially global-economy shattering earthquake striking one of the world’s three (London, New York, Tokyo) financial command and control centres. You know who you are Tokyo! Probability of occurrence in a human lifetime (three score years and ten): virtually.
Climate change. It’s here; it’s happening now. We are currently on course for a 4°C+ global average temperature rise by the century’s end, which translates to double figure rises at high latitudes, where most of the world’s ice resides. Whatever we do, we are already committed to a 5m+ rise in sea level; sufficient to swamp all the world’s coastal cities.
An ocean-wide megatsunami. The next giant landslide at one of the Hawaiian or Canary Island volcanoes could swamp the coastlines of – respectively – the Pacific or Atlantic oceans. Human lifetime odds are 150 to 1.
While we have spotted 872 of the 1km+ diameter Near Earth Asteroids that present a potential threat to our civilisation, there are still at least a few hundred out there that could strike with little or no warning. The human lifetime odds of an impact by an object large enough to cause global mayhem show how unlikely this is, at around 8,500 to 1.

Featured image credit: “Lightening storm”, by osgoodcs0. Public domain via Pixabay.

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Foods and festivals of Ramadan around the world

On 17 June, the new moon signaled the start of Ramadan (or Ramzan as it’s called throughout South Asia), the ninth month of the Islamic lunar calendar in which observant Muslims abstain from eating, drinking, smoking, and sex during daylight hours. Increased religious devotion sets the tone for the month as Muslims gather for special prayers, acts of charity, and Qur’anic recitations in gratitude and devotion to God. Long hours of fasting are difficult, but Ramadan is a joyous celebration, and the foods and festivities that follow the fast are as diverse as the global Muslim population.

Muslims awake before dawn for sahur, an early morning meal. The sounds of musaharati beating a drum in the streets of Lebanon or canons firing in Mecca awaken Muslims to eat. Tuning in to Ramadan TV, many listen to Qur’anic recitations to focus on the spiritual reasons of fasting. More popular shows are also available, including slapstick comedy programs in Indonesia and a live question-and-answer show in Turkey. These varied traditions rouse Muslims from sleep and prepare them for a day of resilience and austerity.

Fasting cultivates virtues of self-control, compassion, and gratitude. It fosters empathy, reminding people of those who suffer from hunger and poverty on a daily basis. Seeking to show compassion, Muslims give zakat (or zakah), donate food for tables of mercy and volunteer to serve the community. In gratitude and service to God, Muslims show others the generosity that God has shown them.

Traditionally, Muslims break their fast around dusk by eating dates and drinking a few sips of water, a tradition dating back to the Prophet Muhammad. After performing evening prayers, families and friends join together for iftar, the breaking of the fast. Soups and stews are common fare, from India, where Muslims dine on Hyderabadi haleem, a meat, lentil, and cracked wheat stew, to China, where Muslims enjoy pao mo, a lamb/mutton and bread soup from the Shaanxi province, to Ethiopia, where Muslims dine on doro wett, a chicken stew. Other specialty iftar dishes include beguni, batter-fried eggplant popular in Bangladesh; moi-moi, a steamed bean pudding favored in Nigeria;, a split pea and meat patty served in Iran; and bolani, flat bread fried and stuffed with vegetables eaten in Afghanistan.

“Kuih Lapis in green and white layers” by Nithyasrm. CC BY-SA 4.0 via Wikimedia Commons.

No iftar is complete without desserts. In addition to fruits, favorite delights include the Palestinian treat konafa (also known as knafe), shredded philo dough layered with raisins, nuts, cheese, or cream and sweetened with syrup served throughout the Middle East; kahk, a cookie stuffed with dates, nuts or Turkish candy and topped with powdered sugar popular in Egypt; kolak pisang ubi, a sweet potato banana compote savored in Indonesia; and kuih lapis, a layered cake enjoyed in Malaysia. Sweet drinks are also popular, like qamar al-deen, a thick apricot juice; jellab, a grape, raisin, rose water, and sugar concoction topped with pine nuts; and lassi, a yogurt-based refreshment sweetened with rosewater and fruit.

Festivities accompany food. In Egypt, children carry colorful fanus and sing songs in the streets. In areas of Indonesia, Muslims bathe in holy wells and springs to welcome Ramadan with physical and spiritual purity. Ramadan tents offering buffets and live entertainment pop up throughout the UAE. Laylat al-Qadr, the “Night of Power,” is a particularly celebratory night, as Muslims perform extra prayers, ask God for forgiveness, and recite the Qur’an in commemoration of the first revelations received by the Prophet. Muslims in Morocco supplement these festivities with a special celebration to notice children who begin fasting.

No Ramadan festival is more important than Eid al-Fitr. A family holiday, many Muslims travel long hours to celebrate Eid with loved ones. In mosques and homes, prayers of thanksgiving are uttered as people express gratitude to God for the strength to fast and rejoice over the blessings bestowed upon them. Those who can afford it purchase new clothing, send Eid cards, donate to charities, and gift money to children.

Although each region has diverse foods and local traditions to celebrate, Muslims around the world understand Ramadan as a sacred time set aside in obedience to God. Distinct foods and festivities serve to bind the community together, reminding Muslims of their dependence upon God and each other.

Image Credit: “Shami Kabab.” Public Domain via Wikimedia Commons.

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Music mentorship and the learning process

At age 23 I had finished my second degree in vocal performance from a distinguished music program, but so what? I felt that I was too young and inexperienced in the professional world to embark on a solo career. As luck (and connections) would have it, a well-known recording group in the Midwest, The Roger Wagner Chorale, eventually offered me that on-the-road experience and performance confidence that would also allow me to meet one of the greatest singing actors of the 20th century.

After returning to Los Angeles from one of our tours, I saw a primitive handbill in a bank in LA. It announced that the singer Giorgio Tozzi would be speaking one night in Santa Monica at a school I had never heard of. I could not believe it. Giorgio Tozzi was my hero growing up. He was a star singer at the Metropolitan Opera for many years, and I had all of his recordings. He was one of the world’s greatest opera singers to act onstage. I went to the address listed on the handbill. It was hard to find-a walkup to a multi-purpose room — not a place where you would think you would find a man like Tozzi. I will never forget it when he walked into that room. He had an aura about him, a way of speaking and moving that was purposeful in action and so very clear and resonant in every sense of that word.

I realized soon that the audience in Santa Monica that evening did not even know who Tozzi was, the greatness of that powerful voice and stage presence. A talent that was so immense that the American composer Samuel Barber, when readying the musical score for the world premiere of his new opera, Vanessa, would write an extra aria just for Tozzi when he was cast as the Doctor in the world premiere of the opera, enlarging the role.

The group of folks gathered there in Santa Monica didn’t know who Tozzi was because they were not opera goers. In fact, most were not even remotely interested in classical music. However, his words that night spoke directly to all of us. He was what you would call a Mensch. He had a quality of warmth and joy and intelligence, and the way he spoke, his delivery-was forceful and gentle at the same time. He knew how to communicate, which was the main point that he conveyed that evening: all of the arts are primarily communication.

I could not wait to speak with the man in person, feeling that it must be fate that we were drawn together, and it was clear that he had to be my mentor and teacher. However, my excitement turned to disappointment when Mr. Tozzi told me that he was now living in Southern California to follow his new acting career in film and TV. He would be busy and on the road, and although he had taught while singing at the MET a few choice singers at Juilliard, he clearly was now moving in a different direction. While I had to respect the man’s decision, of course, it didn’t take long for me to pick up the phone the next day and call him (his number was listed in the phone book!). After much hyper-ventilated pleading, Mr. Tozzi finally agreed to hear me sing in his Malibu home. He could easily see how eager and excited I was to work with him. The generous man stopped working with me after more than two hours, and invited me to come back the following week! When I offered to pay him, he declined. Instead, he offered me the official “Tozzi scholarship.” That involved me housesitting at his Malibu house overlooking the Pacific Ocean when he and the family were out of town on location.

This began a beautiful and life-changing experience of mentorship by the great man, not only learning about opera and singing, but also giving me the opportunity to see how important a broad knowledge of arts and humanities is to a performer when pursuing a life in the arts. Tozzi’s curiosity and interests covered philosophy and languages and history and literature and all of the fine arts. The discussions that he led after our lessons in his house-having drinks and sharing dinner were stimulating sessions that I lived for during those five years before I was to move to Germany.

Although I had just left the university after earning two degrees in music, Giorgio taught me what learning was at its core. Everything I had learned in my years at college did help me with skills and developing “the craft,” but I realized just how narrow my pursuits were within the music school curriculum. You see, skills and craft became tools in Giorgio’s view. Music and all of the arts were about communication, whether it was on the opera stage or on Broadway or acting in films or in TV. Giorgio did it all, never limiting himself or cared about what anyone else thought. To him it was a learning process. And that is what he would always say as he began his master classes later in his life. He said, “I expect that today I will learn more than you will.”

Featured image: Santa Monica. CC0 via Pixabay.

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African health leaders claiming the future

Improving health in Africa is a team effort, involving many people from different backgrounds. The considerable gains made in recent years would not have been possible without the contribution of the people themselves, national and global political will, and the support of development partners. All too often, however, the role played by Africans themselves has been overlooked or downplayed in international policy making as well as in publications. It is time to redress the balance and celebrate their achievements.

Health leaders in sub Saharan African countries face some of the most demanding challenges anywhere in the world. Disease, poverty, the legacy of colonialism and, all too often, conflict, corruption, and political instability combined, make improving health extraordinarily difficult. Looking back we can see many great African health leaders who have played their part as the following few examples show.

In 1976 a young Kenyan doctor, Miriam Were – to the consternation of her professors in Nairobi – started her PhD on patient participation in rural Kenya. She went on to become one of the early exponents of community health workers in Africa and developed an approach through which local people worked with their neighbours to promote healthy behaviour and tackle diseases. As she puts it: ‘Through this approach, health-promoting and disease-preventing norms develop in the community’ and ‘If it doesn’t happen in the community, it doesn’t happen in the nation’. The impact of those early developments is enormous and can be seen throughout Africa.

“when you focus on the poorest first, you take the rest with you, When you focus on where the greatest gaps are, you make the biggest gains.”

In the same year Dr Pascoal Mocumbi became Health Minister in war-torn Mozambique and was charged with delivering health care at a time when most doctors had left the country. He had trained as both a nurse and a doctor, and recognised that some nurses could undertake surgical procedures, provided that they had the right training and supervision. He set up a programme to train the Tecnicos de cirurgia to perform obstetric surgery to cover the rural areas. Peer reviewed research over 20 years shows that the Tecnicos have the same success rate as doctors and at less than half the cost. The programme continues to save lives in rural Mozambique today.

Twenty years later, Dr Uche Amazigo became the Head of the African Campaign for Onchocerciasis (river blindness) Control and was faced with the daunting task of how to deliver prophylactic drugs to millions of Africans in remote villages. With colleagues, she set up a volunteer network of thousands of local people as community distributors who ensured that everyone in their home villages received the right dosage every year to control the diseases. By 2011 more than 600 million treatments had been given, and an estimated 7 million years of blindness prevented. Plans are being made to eliminate – not just control – the disease (L. E. Coffeng et al). This is one of the greatest mobilisations of a population as part of a public health campaign anywhere in the world.

These stories of leadership need, however, to be seen alongside the relationship of dependency that has grown over the years between Sub Saharan Africa and its development partners. As Francis Omaswa has written: ‘Africans went to the Bretton Woods institutions and other institutions and countries begging for advice and for money and we got both but in exchange for certain core values’.

Development partners have played an enormous role in bringing new resources and skills to the continent and provided benefits to millions of people. However, the very best of intentions by passionate donors has often created duplication of programmes, whilst lack of coordination has led to inefficiencies. Local expertise has frequently been ignored with the result that programmes are ineffective and parallel systems of health care have been created, thereby weakening rather than strengthening local health systems. Worse still, there has sometimes been fierce competition between foreign organisations as they manoeuvre commercial-like businesses to outflank their competitors for funding and prestige. This competition has sometimes been overlaid and complicated by different political and moral ideologies and agendas being fought out by foreigners in African countries.

International agreements from the Rome and Paris Declarations onwards have set out frameworks for effective development. There have undoubtedly been improvements – but not everywhere. The reality of ‘country ownership’ with partner support has yet to be realised in most of Africa. The idea of ‘mutual accountability’ between partners and countries is not yet working in practice. Now it is time to for Africans to reclaim leadership in their own countries and to re-balance this relationship.

Nairobi Skyline by afromusing. CC-BY-2.0 via Flickr.

Rwanda has been re-building itself over the 20 years since the genocide and now has a social insurance health system that reaches 98% of the population and effective local health services in almost all parts of the country. It has been hailed as an example of country leadership and partner support with strong and mature relationships being developed between the country and its principal partners. This has allowed the development of a distinctively Rwandan approach to health improvement suited to its own social, economic, and physical environment.

The Rwandan system has been built on the principles of equity and human rights, a holistic approach to health and its determinants – neither vertical nor horizontal in its application – the use of information, the spread of knowledge, and the engagement of the whole population. Private enterprise and incentives are deployed in the service of the public good and citizens are expected to take a measure of responsibility for themselves. At its heart is the idea that ‘when you focus on the poorest first, you take the rest with you. When you focus on where the greatest gaps are, you make the biggest gains‘ (P.E. Farmer). Whilst Rwanda still faces many challenges, it offers an example of how country leadership, supported by partners, can create a successful national system, and incidentally, pioneer innovations of relevance to other African countries and beyond. Everyone can learn from each other (Crisp).

Looking forward, and writing as parliamentarians in our respective countries, we recognise that it will take political will and sustained leadership to change attitudes and develop a new relationship between Africa and the rest of the world. We envisage the ultimate goal should be to establish something more like the post-war Marshall Plan through which America and the world banking system invested in Europe as its people built new institutions and economies rather than simply continuing the gift of charity from generous people to their poor neighbour. The world needs a strong Africa today just as it needed a strong Europe 70 years ago.

In the meantime, and while we press for this change, we believe it is important to recognise and celebrate African health leaders and the millions of people – paid and unpaid, professional and untrained – from African and partner countries who strive daily to improve health across the continent.

Featured image credit: Kigali, Rwanda by Dylan Walters. CC-BY-2.0 via Flickr.

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Can schizophrenia really be treated by “talk therapy” alone?

A recent study published by psychologist Anthony Morrison and colleagues in the British medical journal, The Lancet, is stirring up a long-standing debate about the treatment of schizophrenia. The article describes a randomized controlled trial with people diagnosed with schizophrenia who refused to take psychiatric medications called “antipsychotics.” The researchers tested whether these patients could be treated with a form of talk therapy called cognitive-behavioral therapy (CBT) in lieu of medications. In the study, patients received one-on-one counseling sessions in which the therapist normalized their experiences and taught them psychological coping strategies to reduce stress and manage their illness. After 18 months of treatment, 41% of patients receiving CBT achieved a “good clinical response” compared to only 18% receiving standard care.

Some people are understandably skeptical of the results of the study. One reason is that schizophrenia is seen as a chronic, debilitating disorder in which the sufferer experiences hallucinations (hearing voices or seeing things that aren’t there), delusions (false beliefs that the person is convinced are true), and other thinking disturbances that can severely interfere with normal functioning. Although schizophrenia only affects about 1% of the general population, it is estimated that 5% of the public experience psychotic symptoms, such as hallucinations or delusions, at least to some degree. Antipsychotic medications are thought to work by affecting neurotransmitters such as dopamine in the brain, thereby reducing the severity of hallucinations and delusions.

Despite their ability to help many people, the limitations of antipsychotic medications have become increasingly clear over the years. These medications aren’t effective for everyone and often produce problematic side effects that range from excessive drowsiness to potentially life-threatening complications, requiring careful clinical monitoring for safety. Not surprisingly, about 50% of patients don’t adhere to their antipsychotic medication regimens. Research shows that antipsychotics can negatively affect a person’s health over time, leading to shrinkage of brain tissue and other cognitive impairments. Current treatment guidelines recommend that antipsychotics be continued even after the psychotic episode has remitted to prevent future relapse. Given emerging concerns over the long-term effects of antipsychotics on the brain, some have suggested that these medications are better used as short-term treatment and that alternatives be considered in the longer-term.

© Mark Bowden via iStock.

Another recent study appears to affirm the wisdom of reducing unnecessary long-term antipsychotic usage when clinically possible. Wunderink and his colleagues randomized 128 patients in a first episode of psychosis to either continue their antipsychotic medication or to withdraw the medication under a doctor’s supervision following remission of their symptoms. At two-year follow-up, those who discontinued the medications showed no differences in the severity of their symptoms compared to patients who stayed on antipsychotics. Even more surprisingly, those who were taken off the antipsychotic once initially stabilized had over twice the rates of recovery from schizophrenia compared with those whose antipsychotic treatment was continued (40% vs 18%). It appeared that patients who safely discontinued the medications were less functionally impaired over time compared to those who remained on antipsychotics, resulting in higher recovery rates. Many are surprised to learn that recovery from schizophrenia is even possible. But prominent cases like that of the late John Nash, a Nobel-prize winning mathematician and subject of the book and film entitled A Beautiful Mind, provide public examples of this process.

So if can offer diminishing returns over time for many patients, what else can be done? There are now a large number of studies conducted with thousands of patients in different countries showing that adding psychotherapy, such as CBT, to a person’s treatment produces better clinical outcomes compared with medications alone. Therapy for psychosis continues to evolve. In recent years, researchers have begun incorporating mindfulness techniques into the treatment to provide further benefits. Put simply, mindfulness means bringing nonjudgmental awareness and acceptance to our moment-to-moment experiences, including thoughts and feelings. Being more mindful has been shown to produce many benefits to a person’s psychological and even physical health. Today’s CBT treatments for psychosis are increasingly combining mindfulness, acceptance, and self-compassion to help patients manage psychotic symptoms and to promote social and occupational functioning.

It is important for service users and their family members to know that current guidelines recommend combining ognitive-behavioral therapy with antipsychotic medication to achieve the best results when treating psychosis. But the Lancet study, showing that CBT can be beneficial even when patients are not taking antipsychotics, is challenging this conventional wisdom. Although potentially exciting, we must tread cautiously here. Further studies are needed to confirm the appropriateness of CBT for psychosis in the absence of ongoing antipsychotic treatment. Even if CBT alone can be shown to be useful for at least a subgroup of patients with schizophrenia, it is not likely to be an option for everyone. But recent research reminds us that we have a lot more to learn about how to help people cope with their psychosis. In the end, we must carefully weigh the benefits as well as costs of medications or psychotherapy for psychosis to better understand how they should be used, either alone or in combination, to promote optimal recovery from a very debilitating illness like schizophrenia.

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Lesbian existence and marginalization in India

India’s first ‘lesbian ad’ went viral at the start of June this year. The advert featuring a young lesbian couple awaiting the arrival of one set of parents to their joint home is uncompromisingly ‘out’ even as it sets this exceptional moment in the everyday intimacy and domesticity that most relationships share. The ad is actually part of a new digital campaign launched by the brand Myntra for its range of ‘contemporary ethnic apparel’ called Anouk. The campaign titled ‘Bold Is Beautiful’ comprises of two other ads on single women and single mothers respectively. The three beautifully shot, styled, and smartly narrativised ads on the predicaments of ‘modern Indian women’ are equally provocative even as it is the ‘lesbian’ ad that has garnered most attention. All three scripts focus on women who lie outside of, and thus fundamentally threaten, the hetero-patriarchal foundation of any – not just Indian – society. This comes out most poignantly, I think, in the advert featuring a single mother and her child who deeply disrupts patriarchal power by responding to one of the many prying neighbours by asserting that her daughter has her and does not need a ‘papa’. A society which does not need men – in the family, in romance and sex, or for consumption – heralds the end of patriarchy as we know it.

The ‘lesbian ad’ received overwhelmingly positive responses on social media and the blogsphere, suggesting how far India had traveled from the days when cinema halls were burnt for screening a film on female lovers. Others found evidence for this popular acceptance of homosexuality – at least amongst middle class Indians – in the fact that this was not even the first advert of its kind. Local brands of watches and jewelry like Fastrack and Tanishq had already used progressive slogans and images around homosexuality to sell their products. And this in the context of the Supreme Court’s decision in 2013 to uphold the criminalisation of homosexuality in section 377 of the Indian Penal Code.

But we should be wary of assuming that the ‘mainstreaming’ of such progressive ideas around same-sex relationships is a product of the media and the market. On the contrary, I would argue – drawing on my ongoing research into queer especially lesbian politics in India today – that the changed context and common sensibility that we are currently witnessing is a product, if anything, of the sustained mobilisation and activism of groups, organisations and campaigns for sexual rights since the 1990s.

Deepa Mehta’s film, Fire, is generally recognized as transforming the public debate on sexuality in India by pushing lesbian issues on the agenda for the first time in the late nineties. Declaring that they were part of the nation-state in their responses to right-wing attempts to censor and ban the film, lesbians asserted their existence and disrupted dominant sexual and cultural norms that relied on rendering them invisible. While the controversy around the film saw lesbian centered public protest for the first time, lesbian groups were in operation in metropolises like Delhi from the mid-eighties. Likewise, campaigns for legal rights by gays and lesbians (to overturn section 377) open up an unprecedented space, not merely for rendering such marginalized subjects visible but for questioning the existing heteronormative order.

Image: “A group of Hijra in Bangladesh” by USAID. Public domain via Wikimedia Commons.

A prominent Kolkata-based lesbian organization and the only one of its kind in eastern India, Sappho was started by six middle-class Bengali women on 20 June 1999 as an ‘emotional support group’ for sexual minority women. While Sappho continues to provide a ‘safe space’ for lesbian, bisexual, and transgender women, Sappho for Equality or SFE was started in 2003 as a registered NGO that functions as a locus of the organization’s activism and outreach. SFE fulfills the founder members’ belief in the need for the support of the wider (heterosexual) community in its struggle for sexual citizenship, and represents a shift from service provision to issue-based activism. It is the public face of the organization, and through its public awareness-raising programmes, such as running a queer film festival and being a part of one of Kolkata’s most prominent cultural activities, the annual Book Fair, it has become part of the weave of the cultural-political life of the city.

Members of Sappho are automatically members of SFE, but not the other way round. Sappho embodies, in this way, two common strands of the queer movement in India—one that links sexuality to identity (the support group) and one that attempts to break this very association (the activist platform). Yet the fluidity of identities persists in the everyday life of queer activism, observable in the manner in which some members of SFE later become members of Sappho. This ‘flow’ from one organizational form to another based on identity and belonging complicates common ways of thinking about sexual identity and sexuality itself as something fixed by birth, nature, or God.

Sappho members are best described as middle or lower middle class; many come from surrounding suburban areas, and the majority are more comfortable speaking Bengali than English. They inhabit an economically liberalized India, and owe their visibility and activism to the political configurations that this made possible, whether through the international funding ‘boom’ or the globalizing of the media. Important generational differences are already on display even though the organization has a recent history. The first post-Fire generation of activists often distinguish their struggles – in the face of violence, above all, from the family, and internalized homophobia – from the generation of young women who are today entering the organization, well informed of their sexual orientation and who seek pleasure and friendship.

In being compromised of largely educated and middle class women (features that characterize lesbian activism in India as such), does such a form of organizing marginalize non-urban and working-class lesbians? We know that a wider context of socio-economic disparities renders economically marginalized and socially stigmatized sexual minorities (such as kothis, dhuranis, and hijras) more vulnerable to institutionalized forms of violence and abuse than class and caste privileged groups. While it is important to pay attention to such internal differences within sexual minorities, it is also important not to pit categories of marginalization or vulnerability against one another (such as class and sexuality). In other words, we need a conceptual framework that enables us to understand that a woman can be working class and lesbian.

We also need to appreciate that whether elite, middle class, or non-elite, lesbian existence in India is marked not just by marginalization but also by invisibility. To go back to the ‘lesbian advert’ I began with, to dismiss the ad for showcasing only privileged ‘modern’ women with high consumer potentials, as some were suggesting in conversations it prompted, is politically counterproductive and analytically facile. Identities are not products of one ‘thing’ but several complex and shifting components. It is by recognizing these kinds of complexities born out of neoliberalism and the intersectionality of class, caste, religion, and gender that we move towards a genuinely relational and expansive understanding of identity in relation to and mobilizations around sexuality.

Featured image credit: “Bangalore Gay Pride Parade”, by Nick Johnson. CC-BY-2.0 via Wikimedia Commons.

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